Physiotherapy In Pregnant Population - Changes and Red Flags Flashcards

1
Q

Hormonal Changes (6)

A
  • ↑ Oestrogen: ↓ ligament and tendon stiffness, ↑ water retention.
  • ↑ Progesterone: smoot muscle relaxation, ↓ vascular tone.
  • Relaxin: ↑ ligament laxity + softens cartilage of SIJ and pubic symphysis.
  • Cortisol: may have inhibitory affect on immune system.
  • Oxytocin: uterine contractions.
  • Prolactin (milk secretion) & melatonin: uterine contractions.
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2
Q

Cardiovascular Changes - Arterial System (4)

A
  • ↑ cardiac output due to ↑ stroke volume and HR.
  • 50% ↑ in blood volume around 6 months.
  • ↓ BP due to vasodilation and ↓ vascular resistance (progesterone).
  • Anemia die to ↓ blood volume -> dilution.
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3
Q

Cardiovascular Changes - Venous System (3)

A
  • ↑ diameter of veins in LL due to hypotonia (progesterone)
  • Compression of venous system in pelvis and LL by uterus & weight gain -> varicosities.
  • Supine Hypotension Syndrome: uterus compresses Inf. vena cava -> fainting, BP drop. No exercise in supine after 20 weeks.
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4
Q

Respiratory Changes (4)

A
  • ↑ RR to 18/min, ↑ O2 consumption to 20%.
  • Ribs flare out and up.
  • Diaphragm elevates 4 cm and chest wall widens by 2 cm -> leaning back (bell rung up).
  • Lung capacity remains the same.
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5
Q

Cognitive Changes (2)

A
  • Baby brain: brain fog, ↓ concentration, absentmindness.
  • ↓ brain volume by 4%, returns to normal post partum.
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6
Q

Urinary Changes (2)

A
  • Uterus compresses bladder + ↑ renal blood flow -> ↑ urinary frequency.
  • ↓ antidiuretic hormone - ↑ urination at night.
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7
Q

GI Tract Changes (2)

A
  • ↓ peristalsis -> constipation (due to progesterone) -> ↑ UI postpartum by 50%, ↑ pelvic organ prolapse.
  • Never ignore a bowel call, do PA, water + fibers.
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8
Q

Bone Density Changes (3)

A
  • ↑ need for calcium by fetus -> mobilization of calcium from maternal skeleton.
  • Bone mineral density ↓.
  • ↑ Risk of fracture during pregnancy and post (lactating).
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9
Q

Postural Adjustments (9)

A
  • Foot pronation
  • Knee hyperextension
  • Anterior pelvic tilt
  • Lx lordosis
  • Tx kyphosis
  • Cx lordosis
  • Forward head movement
  • Scapula prtraction
  • ↑ Tx perimeter, ↑ subcostal angle
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10
Q

Balance and Gait Changes (3)

A
  • Displacement of center of gravity.
  • Compensatory gait: ↓ step length, speed, ↑ double support time, step width, BoS.
  • ↑ Risk of falls (PA and support belts can ↑ postural stability and ↓ risk of falls).
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11
Q

Medical Complications (5)

A
  • Hyperemesis Gravidarum: severe vomiting.
  • Gestational diabetes.
  • Placental abruption (will end pregnancy)
  • Cervical insufficiency
  • Pre-eclampsia (BP >140/90, very high risk for baby).
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12
Q

Red Flags - Medical Referral - Onset of Labor (4)

A
  • Vaginal spotting or bleeding.
  • Leaking amniotic fluid.
  • Regular progressive uterine contractions.
  • Back or abdominal pain, rhythmic, radiating.
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13
Q

Red Flags - Medical Referral - Neurological (5)

A

Vision changes
Mental confusion
Slurred speech
Cauda equina symptoms
Severe, persistent headache

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14
Q

Red Flags - Medical Referral - Cardiovascular (5)

A

BP > 140/90
Sudden, severe chest pain
Tachycardia
Dyspnea
Signs of DVT

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15
Q

Red Flags - Medical Referral - Visceral (5)

A

Acute abd. pain
Flank/suprapubic pain + fever
Shoulder + abd pain
Dysuria and hematuria
Infection symptoms

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16
Q

Red Flags - Medical Referral - MSK (5)

A

Recent fall or trauma
Findings inconsistent with MSK
Pain not changed by position
Cullen sign (bruising on navel)
Gray Turner sign (bruising on flank).

17
Q
A