Musculoskeletal Conditions Flashcards
(29 cards)
Physiologically why do musculoskeletal conditions develop in pregnancy
Increasing levels of progesterone and relaxin cause joint laxity
Growing weight of uterus changes centre of gravity and posture
Increased body mass increases mechanical strain on spine
Fluid retention leads to compression of soft tissues
Describe carpal tunnel syndrome
Compression of the median nerve in carpal tunnel the incidence increases by15 times in pregnancy
What are the symptoms of carpal tunnel syndrome
Tingling, numbness and pain
What is the cause of of carpal tunnel syndrome in pregnancy
High levels of progesterone cause oedema and oedema compresses the nerve
How can you manage carpal tunnel syndrome
Drink lots, sleep with raised hands, compression wrist band
Describe pelvic girdle pain (PGP)
Pain that affects the pelvis as well as the hips or thighs
What causes PGP
High levels of relaxin and change in pelvic and abdominal muscle activation cause uneven movement
Also linked to activation in pain receptors as protective mechanism in pregnancy
What is the incidence of PGP
Affects 1:5 (RCOG,2015)
What are the symptoms of PGP
Pain in pubic region, lower back, hips, groin, thighs and knees, clicking or grinding in the pelvic area, pain made worse by movement e,g, walking on uneven ground or moving legs apart
How to self manage PGP
Maintain good posture
Rest
Changing positions regularly
Warm baths
Avoid heavy lifting
Where should midwives refer to for PGP
Physiotherapist
Treatment for PGP
Physio exercises
Manual therapy
Heat or ice packs
Acupuncture
Support belt
Crutches
Pain relief see GP if paracetamol not adequate
Considerations for birth with PGP
Accessible positions, avoid Lithotomy
Incidence for PGP postnatal
1:10 continues with analgesia and see GP
describe spinal cord injuries (SCI)
an insult to the spinal cord resulting in a change, either temporary or permanent to its motor, sensory or autonomic function
what are risks of having a SCI
pressure ulcers, UTIs, respiratory infections, anemia, VTE, spasms
describe pre-conception care for SCI
specialist clinic appt
plan to conceive ideally once physical and emotional rehabilitation has taken
signpost to groups for parents with SCI or disabilities
antenatal care for SCI
early care planning
consultant led care
aim for NVD unless SCI sustained in childhood or has pelvic trauma
referred clinical pelvimetry
if cephalo pelvic disproportion is suspected book for ELCS for 39/40
careful management of skin: waterlow scoring and pressure relieving mattress
risk assess for VTE
consider perception of fetal movements and contractions
BP and pulse recorded every AN visit
intrapartum care for SCI
personalised bladder and bowel care
indwelling catheter may be required or already in situ
look out for autonomic dysreflexia (AD) sudden onset of very high BP can be fatal. continuous monitoring of BP
early epidural may reduce risk of AD
consider admitting to hospital once 37/40 for regular CTGs, as sensations of contractions and perineal stretching will vary
care by MW and SCI nurse, involve obstetric and specialist team
continous electronic fetal monitoring
analgesia required as routine even if there is no perception of pain as episiotomy and suturing without it can trigger spasms or AD
postnatal care for SCI
can BF if SCI is above T4
may require nasal oxytocin spray or additional stimulation as the neuronal pathway from breast to brain is affected
additional help
contraception: avoid oestrogen based products as risk of VTE
describe rheumatoid arthritis
auto-immune condition where immune system attacks lining of joints resulting in inflammation and thickening of joint capsule
symptoms of rheumatoid arthritis
warm, painful swollen joints which may reduce mobility
preconception care for ppl with rheumatoid arthritis
use contraception to avoid pregnancy and discontinue use if pregnancy is planned
medications e.g. methtrexate and leflunomide are teratogenic and should not be used in pregnancy
low doses are safe
describe lupus
auto-immune condition where the immune system produces auto-nuclear antibodies which attack healthy cells
