Physiotherapy In Pregnant Population - Changes and Red Flags

Question 1

Hormonal Changes (6)

Answer 1

• ↑ 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.

Question 2

Cardiovascular Changes - Arterial System (4)

Answer 2

• ↑ 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.

Question 3

Cardiovascular Changes - Venous System (3)

Answer 3

• ↑ 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.

Question 4

Respiratory Changes (4)

Answer 4

• ↑ 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.

Question 5

Cognitive Changes (2)

Answer 5

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

Question 6

Urinary Changes (2)

Answer 6

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

Question 7

GI Tract Changes (2)

Answer 7

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

Question 8

Bone Density Changes (3)

Answer 8

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

Question 9

Postural Adjustments (9)

Answer 9

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

Question 10

Balance and Gait Changes (3)

Answer 10

• 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).

Question 11

Medical Complications (5)

Answer 11

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

Question 12

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

Answer 12

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

Question 13

Red Flags - Medical Referral - Neurological (5)

Answer 13

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

Question 14

Red Flags - Medical Referral - Cardiovascular (5)

Answer 14

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

Question 15

Red Flags - Medical Referral - Visceral (5)

Answer 15

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

Question 16

Red Flags - Medical Referral - MSK (5)

Answer 16

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