Class 2 - Treatment Considerations in Pregnancy

Question 1

Contraindications for _________ massage include:
- First trimester of pregnancy
- High risk pregnancies
- Problems with cervix & placenta
- Pre-term labour/threat of pre-term labour
- Vaginal/uterine bleeding
- Health of fetus is in question

Answer 1

Abdominal Massage

Question 2

T/F - Light abdominal techniques would never cause a miscarriage or still birth, however we want to eliminate the association and ease the mind of the RMT.

Answer 2

True

Question 3

Abdominal massage is _________ and greatly beneficial for connection with baby, tissue and fascial stretch in the ______ and _____ trimesters to enhance birth parent’s connection with baby and increase tissue stretch.

Answer 3

Indicated
Second & Third

Question 4

T/F - Always massage the abdomen in a medial to lateral direction so you are not increasing the possibility or severity of diastasis recti.

Answer 4

True

Question 5

Some contraindications for ______ massage include:
- High risk pregnancies
- Mastitis
- Breast cancer/undiagnosed lump
- Post-surgical infection
- Current active infection
- Abscess

Answer 5

Breast Massage

Question 6

T/F - Since we are never touching the areola or nipple in our breast massage, there is no way nipple stimulation can induce contractions.

Answer 6

False - ALTHOUGH we are never touching the areola or nipple in our breast massage, there is A POSSIBILITY THAT nipple stimulation can induce contractions.

Question 7

Onsite work and direct pressure to the breasts is _______________ as mastitis is a bacterial _________.

Answer 7

Contraindicated
Infection

Question 8

T/F - Manual techniques to a breast with mastitis cannot cause damage to blood vessels, thrombophlebitis and increase abscess size.

Answer 8

False - Manual techniques to a breast with mastitis CAN cause damage to blood vessels, thrombophlebitis and increase abscess size.

Question 9

Milk that remains in the breast after a feeding can back up into a ____, inflaming the surrounding tissue and causing a blockage. This is a common cause of ________.

Answer 9

Duct
Mastitis

Question 10

T/F - A small, hard lump that’s sore to the touch, or a very tender spot in the breast indicates there may be a clogged duct.

Answer 10

True

Question 11

Applying ____ compresses/packs between feedings may ease the pain of mastitis. Applying a ____ compress just before breastfeeding may help with milk flow.

Answer 11

Cold
Warm

Question 12

Always wrap a clean cloth/towel to prevent skin damage when applying compresses, especially with mastitis because it can affect the skin’s ability to gauge ___________.

Answer 12

Temperature

Question 13

Indications for ______ massage during pregnancy include:
- High level of change in breast tissue
- Pain
- Congestion
- Structural imbalances due to pregnancy posture, TrPs and increased MRT in pectorals
- TOS due to pregnancy posture

Answer 13

Breast Massage

Question 14

Indications for ______ massage during breastfeeding include:
- Pain
- Congestion
- Structural imbalances due to breastfeeding positions
- TOS due to breastfeeding positions

Answer 14

Breast Massage

Question 15

T/F - Varicosities don’t usually appear for the first time in pregnancy.

Answer 15

False - Varicosities MAY appear for the first time in pregnancy.

Question 16

With severe ____________, there may be clots in deeper veins.

Answer 16

Varicosities

Question 17

Some symptoms of _____ _____ include:
- Sudden/severe pain, swelling, heat & redness
- Decreased circulation to affected limb
- Pain upon palpation

Answer 17

Blood Clots

Question 18

T/F - 80-90% of blood clots occur in the right leg or iliofemoral vein.

Answer 18

False - 80-90% of blood clots occur in the LEFT leg or iliofemoral vein.

Question 19

T/F - Blood clots can be asymptomatic.

Answer 19

True

Question 20

Some risk factors for _____ _____ include:
- Cesarean section or other recent hip, pelvic and/or knee surgery
- Bedrest & immobility
- Leg injury
- History of previous DVT
- Smoking
- Age greater than 40 years
- Obesity
- Family history

Answer 20

Blood Clots

Question 21

DVT’s are __ times more likely to occur in pregnant patient’s.

Answer 21

6 times

Question 22

DVT’s are 5 times more likely to occur in the __________ time period and the patient has a ___ times greater risk for developing a pulmonary emboli in comparison to pregnancy.

Answer 22

Postpartum
15 times

Question 23

_________________ for varicosities/DVT include:
- No massage over varicosities, known blood clots or phlebitis
- No deep pressure to the adductors or inguinal region
- No massage to legs if there are known clots

Answer 23

Contraindications

Question 24

Some early warning signs and symptoms of ____ ____ __________ include:
- Pain
- Swelling
- Warmth
- Redness
- Leg cramps, often starting in the calf
- Leg pain that worsens when dorsiflexing the foot
- Blue/white skin discolouration

Answer 24

Deep Vein Thrombosis (DVT)

Question 25

T/F - The level of blood-clotting proteins decreases during pregnancy, while anti-clotting protein levels increase.

Answer 25

False - The level of blood-clotting proteins INCREASES during pregnancy, while anti-clotting protein levels DECREASE.

Question 26

T/F - Possibility of too much bleeding at childbirth tends to increase the blood's clotting ability around birth, occasionally too much.

Answer 26

True

Question 27

An enlarged ______ increases pressure on the veins that return blood to the heart from the lower body, leading to potential blood clots.

Answer 27

Uterus

Question 28

_______ increase as pregnancy progresses, as it is needed for labour and delivery.

Answer 28

Relaxin

Question 29

T/F - Stability is usually more of an issue than mobility in pregnant patients, and should play a large role in your treatment plan.

Answer 29

True

Question 30

Relaxin and ____________ soften connective tissue in the body and this commences from ___ weeks gestation onwards and continues until __ months postpartum.

Answer 30

Progesterone 10 weeks 6 months

Question 31

What are the 2 structures most affected by relaxin and progesterone?

Answer 31

1) Pelvis 2) Lumbar Spine

Question 32

T/F - Relaxin and progesterone affect some ligaments and joints, as well as tendons and fascia.

Answer 32

False - Relaxin and progesterone affect ALL ligaments and joints, as well as tendons and fascia.

Question 33

T/F - Muscles will increase in MRT to support unstable structures during pregnancy, and this places a great deal of strain on them, especially weight bearing structures.

Answer 33

True

Question 34

It is not uncommon to see dysfunction of the _____ symphysis, low back pain and SI joints, and joints may even feel "______".

Answer 34

Pubic "Wobbly"

Question 35

Some ________ related to ligament laxity include: - Joint mobilizations (use low grade application) - Rhythmic mobilizations - Passive stretching (no overpressure) - Prior dislocations

Answer 35

Cautions

Question 36

Pelvic or ______ joint mobilizations are completely contraindicated as they may induce pre-term ______.

Answer 36

Sacral Labour

Question 37

For pregnant patients, we want to use ___-_____, gentle stretches and for self-care, we should instruct them to perform stretching ______ using their breath.

Answer 37

Mid-Range Slowly

Question 38

Contraindications for __________ include: - High risk pregnancies (potential to destabilize pelvis & induce pre-term labour) - Pubic symphysis dysfunction (avoid psoas and other hip flexors)

Answer 38

Stretching

Question 39

Contraindications for ______ work include: - No deep prolonged/pointed pressure work - No joint mobilizations to this area

Answer 39

Sacral

Question 40

T/F - Any sacral work is completely contraindicated for high risk pregnancies.

Answer 40

True

Question 41

T/F - We can use general broader massage techniques to the sacrum in a healthy pregnancy.

Answer 41

True

Question 42

Many pregnant individuals have heard your ______, back and ____ should not be massaged because it's possible to cause uterine contractions and pre-term labour. It is ________ we can actually do this.

Answer 42

Ankles Feet Unlikely

Question 43

___________ encompasses focused, intent based, deep sustained pressure.

Answer 43

Acupressure

Question 44

The following ___________ points should be avoided: - Large intestine 4 - Spleen 6 - Kidney 3 - Urinary bladder 60 & 67 - Liver 3 - Gallbladder 21 - Bladder 31-34

Answer 44

Acupressure