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Mincer Final Exam- 4 > Pregnancy and Exercise > Flashcards

Pregnancy and Exercise Flashcards

1
Q

Define High Risk Pregnancy

A

Any fetal or maternal condition that can adversely affect the successful outcome of the pregnancy often resulting in premature infants

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2
Q

Name a few conditions that would increase the risk of pregnancy

A

Preexisting maternal conditions such as;

  • Lung and heart disease
  • Diabetes
  • Chronic illness, and
  • Disability can be identified and managed in the first trimester to decrease the risk.
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3
Q

name some high risk conditions

A

preeclampsia, premature labor, or multiple gestation

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4
Q

When is bed rest recommended and what do PT need to be aware of in this condition?

A

Bed rest may be prescribed for;

  • Preterm labor
  • Premature rupture of membranes
  • Amniotic fluid volume disorder
  • Placental abnormalities
  • Pregnancy induced hypertension
  • Pulmonary edema
  • Hyperemesis gravidarum
  • Cardiomyopathy, and
  • Multi-fetal pregnancy.

PT assessment should observe position restrictions, home set-up and support available. Bed rest results in a shift of body fluids toward the head and reduced WB-ing rapidly induces changes in every physiologic system. These changes also result from isolation, reduced kinesthetic and sensory stimuli.

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5
Q

Relative Contraindications or Limitations to Exercise during Pregnancy

M3B - COP3E TH2UD2S2

A
  • Diabetes, Anemia or other blood disorder
  • Thyroid disease
  • Dilated cervix
  • History of preterm labor during previous pregnancy
  • Uterine contractions that last several hours after exercise
  • Sedentary lifestyle
  • Extreme obesity or underweight (including eating disorders, poor nutrition, and inadequate weight gain)
  • Overheating - high maternal core temperature may be associated with abnormal fetal development (teratogenesis) in the first trimester
  • Breech presentation during the third trimester
  • Multiple gestations
  • Pulmonary disease (eg exercise-induced asthma, COPD)
  • Peripheral vascular disease
  • Hypoglycemia
  • Cardiac arrhythmias or palpitations
  • Pain of any kind with exercise
  • MSK conditions (eg, diastasis recti, pubic symphysis separation, sacroiliac dysfunction)
  • Medication that alters maternal metabolism or cardiopulmonary capacity
  • Smoking, alcohol, recreational drug, and caffeine consumption
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6
Q

Give some example as far as safe environmental temperature during exercise

A
  • Swimming pool temperatures should not exceed 85* F to 90* F (29.4* C to 32.2* C)
  • Avoid Jacuzzi temperatures above 101* F (38.5* C)
  • Avoid exercising in hot, humid weather or with fever
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7
Q

Define Diastasis Recti

A

Diastasis recti (also known as abdominal separation) is commonly defined as a gap of roughly 2.7 cm or greater between the two sides of the rectus abdominis muscle

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8
Q

What are the general guidelines for safe levels of exercise during a low risk pregnancy? (4 soft rules)

A
  • Exercise regularly, at least 3X per week
  • Include warm-ups and cool-downs
  • Frequent change of positions may be required to avoid SHS but Be careful of sudden changes in posture to reduce possible orthostatic hypotension
  • Modify the intensity of exercise according to symptoms and stage of pregnancy
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9
Q

What are the general guidelines for safe levels of exercise during a low risk pregnancy? (Things that should be avoided - 7)

A
  • Avoid ballistic movement, rapid changes in direction, and exercises that require extremes of joint motion
  • Avoid an anaerobic (breathless) pace Strenuous activity should not exceed 30 minutes; 15- to 20-minute intervals are recommended to decrease the risk of hyperthermia.
  • Ketosis and hypoglycemia are more likely to occur with prolonged strenuous exercise
  • Discourage vigorous exercise or exertion in high heat and humidity, with high pollution levels, and during febrile illness
  • Avoid prolonged periods of standing, especially in the third trimester
  • Avoid gastrointestinal discomfort by eating at least 1.5 hours before an exercise workout Low=resistance and high=repetition exercise is recommended.
  • Avoid Valsalva maneuvers and encourage proper breathing during exercise
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10
Q

Exercise and rest:

A

Low=resistance and high=repetition exercise is recommended. Avoid Valsalva maneuvers and encourage proper breathing during exercise

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11
Q

What are the requirements for maintaining metabolic homeostasis (diet and exercise)

A

Maintain metabolic homeostasis by adequate caloric intake. Increase it to 300 kcal per day for pregnancy alone, 500 kcal per day more for exercising during pregnancy, and 500 kcal per day more for lactation (may vary based on prepregnancy weight)

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12
Q

Other general guidelines for safe levels of exercise during a low risk pregnancy (5)

A
  • Fluids should be taken before, after, and possibly during exercise to avoid dehydration
  • “No pain, no gain” does not apply to exercise during pregnancy
  • Maternal adaptations favor non-weight-bearing exercise instead of weight-bearing exercise
  • Postpartum progression into prepregnancy exercise routines should be gradual
  • Stop exercise or activity if unusual symptoms occur
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13
Q

What is supine hypotension syndrome?

A

Hypotensive state brought on by compression of the inferior vena cava and sometimes the aorta by the gravid (pregnant) uterus, resulting in decreased venous return, decreased cardiac output and a drop in blood pressure when the woman assumes a supine position or during prolonged standing or semi recumbent sitting.

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14
Q

what are the signs for recognizing SHS?

A
  1. Pallor or cyanosis
  2. Muscle Twitching
  3. Shortness of breath
  4. Hyperpnea
  5. Yawning
  6. Diaphoresis
  7. Cold, clammy skin
  8. A wild expression
  9. Syncope
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15
Q

what are the symptoms for Supine Hypotension Syndrome?

A
  1. Faintness
  2. Dizziness
  3. Restlessness
  4. Nausea and Vomiting
  5. Chest and abdominal discomfort or pain
  6. Visual disturbances
  7. Numbness or paresthesias in the limbs
  8. Headache
  9. Cold legs
  10. Weakness
  11. Tinnitus
  12. Fatigue
  13. Desire to flex hips and knees
  14. Anguish
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16
Q

What are the signs of severe Supine Hypotensive Syndrome?

A
  1. Unconsciousness
  2. Incontinence
  3. Impalpable pulses
  4. A lifeless appearance
  5. Convulsions
  6. Cheyne-Stokes respirations**
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17
Q

How should SHS be prevented?

A

avoid spending long time in the contraindicated positions Women in the second trimester of pregnancy and beyond follow the recommendation to avoid exercise in the supine position.

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18
Q

How should SHS be addressed if present?

A
  • Consensus opinion considers right or left side lying or turning 30 degrees to the left from supine to relieve caval occlusion. (Boissonault).
  • If SHS is present the patient’s LE should be placed above the head (using the wedge, with head below the heart, similar with the Trendelenburg position that we learn for clearing the lungs in cardio-pulmonary ) to return blood to the heart and brain. SHS can also be easily avoided by left lateral tilt positioning.
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19
Q

Define **Cheyne–Stokes respiration

A

is an abnormal pattern of breathing characterized by progressively deeper and sometimes faster breathing, followed by a gradual decrease that results in a temporary stop in breathing called an apnea. The pattern repeats, with each cycle usually taking 30 seconds to 2 minutes (wikipedia)

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20
Q

Signs and Symptoms that Signal the Patient to Stop Exercise and Contact Her Physician (Hall and Brody ) - 14

A
  • Pain of any kind
  • Vaginal bleeding
  • Uterine contractions that persist at 15-minute intervals or more frequently and are not affected by rest or change of position
  • Persistent dizziness, numbness, tingling
  • Visual disturbance
  • Faintness
  • Shortness of breath (SOB, dyspnea)
  • Heart palpitations or tachycardia
  • Persistent nausea and vomiting
  • Leaking amniotic fluid
  • Decreased fetal activity
  • Generalized edema (rule out preeclampsia)
  • Headache (rule out hypertension)
  • Calf pain or swelling (rule out thrombophlebitis)
21
Q

Signs and Symptoms that Signal the Patient to Stop Exercise and Contact Her Physician (ACOG website) 10

A
  • Vaginal bleeding
  • Dizziness or feeling faint
  • Increased shortness of breath
  • Chest pain
  • Headache
  • Muscle weakness
  • Calf pain or swelling
  • Uterine contractions
  • Decreased fetal movement
  • Fluid leaking from the vagina
22
Q

What are the guidelines for beneficial and safe exercise in the postpartum period?

A
  • Gradually return to exercise but exercise regularly (three times per week).
  • Correct anemia before engaging in moderately strenuous activities.
  • Stop exercising if vaginal bleeding increases or bright red blood appears.
  • Avoid moderately strenuous activities if excessive vaginal bleeding occurs or soreness of an episiotomy persists
  • Avoid exercises that raise the hips and pelvis above the chest, such as bridging, knee-chest positions, and inverted postures, until postpartum bleeding has stopped completely.
  • Avoid extreme stretching, and heavy weight lifting for 12 weeks or longer if joint laxity persists
  • Use the same precautions as in pregnancy to prevent musculoskeletal injury, for approximately 12 weeks.
  • Provide good support to the breasts during exercise, especially if nursing.
  • Target heart rates and limits should be established in consultation with a physician and may be based on the fitness level during and before pregnancy.
23
Q

Why should you introduce exercise in your routine gradually postpartum

A

The process of reversal to the prepregnant state is thought to take 6-8 weeks (although the anatomic effects of relaxin may persist as long as 12 weeks).

24
Q

Why should inverted positions be avoided?

A

These positions put the body at risk for a rare but fatal air embolism through the vaginia.

25
Q

What should nursing moms do before exercise?

A

Feed the infant before exercising to avoid discomfort

26
Q

Why does Low Back Pain commonly arise during pregnancy?

A
  • Significant Postural changes in pregnant women, including need for quick adaptation to these changes
  • Cervical, thoracic, and lumbar spinal curves increase; inclination of sacrum increases.
  • Change in spinal curvature correlated more closely to LBP than the center of gravity moving anteriorly
  • Prevalence of LBP is high.
27
Q

Is annulus the culprit for LBP in pregnancy?

A

The annulus is considered a ligamentous structure and therefore susceptible to the laxity that occurs in pregnancy. However, no evidence demonstrates a higher incidence of herniated discs in pregnant women vs. non-pregnant.

28
Q

What are the typical S&S for LBP in pregnancy

A
  • Mechanical LBP more common than HNP or DDD. \ Can be assessed in pregnant pt. In the same way you would assess a non-pregnant pt.
  • PTs should always consider kidney infection as a possible source of LBP. Due to high risk of kidney infection, PTs should always screen for this when pt complains of thoracolumbar or posterior rib pain.
29
Q

What are the typical approaches to treatment for the pregnant?

A

a Woman in 1st trimester may have more trunk AROM than non-pregnant pt.

Later in pregnancy the active spinal movements decrease due to bulk of fetus and stretch on dorsolumbar fascia

May occasionally develop flattened lumbar spine or lateral shift

There may be increased mobility to posteroanterior pressures on spine, but this hypermobility is normal when generalized to the whole spine.

30
Q

Why does SIJ Dysfunction commonly arise during pregnancy?

A
  • Prevalence rate 20%
  • Generally thought that increased mobility due to Relaxin is a cause of SIJ pain
  • Unilateral or BIL symptoms of SIJ or pubic symphysis pain are more likely to have their pain resolve within 6 months.
  • Women with pain in all 3 joints (SIJ, PS, and, sacrococcygeal?? or SIJ Bilaterally????) took much longer to recover and had higher disability
31
Q

What are the typical signs and symptoms for SIJ in pregnancy?

A
  • SIJ pain aggravated during weight-shifting activities: sit to stand, rolling in bed, donning socks and shoes, gait, stair climbing.
  • Sharp pain in and around sacrum and buttocks with referral to entire pelvic region. May refer down leg to knee, more rarely to the foot. This makes differentiation between radiculopathy and SIJ pain difficult at times.
32
Q

Typical approaches to SIJ treatment for the pregnant

A
  • PT should engage in joint and soft tissue mobility as well as examining intrinsic support around pelvis.
  • PT should examine body mechanics, posture, environmental factors such as chairs and bed cushioning, job and family demands
  • May use soft tissue or joint mobilization
  • If unusual presentation is noted, refer back to OB/GYN or PCP
  • Need to watch for sacroilitis- inflammation and bone erosion at margins of SIJ caused by infection
  • Need to also watch for transient osteoporosis of the hip or spine can also mimic SIJ pain
33
Q

Why does Pubic Symphysis Dysfunction commonly arise during pregnancy?

A
  • Groin/pubic pain that may refer to thighs is a relatively common MSK symptom during the childbearing year
  • Pubic symphysis dysfunction in pregnancy and postpartum due to joint mobility around pelvis
  • Significant force at joint during parturition
34
Q

What are the typical signs and symptoms PSD?

A

3 types of dysfunction:

  • Pubic symphysis separation,
  • Osteitis pubis, and
  • General dysfunction (shifting at joint)-

Similar S/S

  • Pain with gait and weight shifting activities, especially bed mobility (may be unable to get out of bed)
  • Abduction of LE
  • Pain on palpation
  • Shifting of pubic tubercles
  • May have occasional bladder dysfunction
35
Q

What are the typical approaches to treatment pf PSD for the pregnant?

A
  • Can use radiographs or ultrasound to confirm diagnosis
  • May use a trochanteric belt for external support
  • Education with body mechanics and bed mobility techniques
  • Limit weight bearing
  • Joint mobilization Stabilization exercises
36
Q

Why does Thoracic and Rib Dysfunction commonly arise during pregnancy?

A
  • Rib cage undergoes significant changes during pregnancy thus dysfunction
  • Never returns to non-pregnant state once childbirth occurs
  • 3rd trimester fundus of uterus is basically all up in the xiphoid process’s business :)
  • Elevated diaphragm
37
Q

What are the typical signs and symptoms for Thoracic and Rib Dysfunction

A
  • Dysfunction at sternocostal, costotransverse, and costovertebral joints
  • Pain, and/or Pressure in vicinity of mechanical pain
  • May have Referred pain
  • Possible Soft tissue restriction and Trigger points
38
Q

What are the typical approaches to treatment of Thoracic and Rib Dysfunction for the pregnant?

A
  • Due to potential for referred pain to T-spine from kidney infection means it is important to screen for this if preggo :) pt. Presents with rib/T-spine pain
  • Due to pt. experiencing discomfort with sitting activities, she may prefer a recumbent position without disabling pain or discomfort
39
Q

Why does HA and C-spine Dysfunction commonly arise during pregnancy?

A
  • May be the result of endocrine system-mediated effects on the neurotransmitters or on the vascular system of the brain
  • May occur d/t pregnancy induced hypertension and preeclampsia
  • Changes in spinal curvature resulting in added stress to facets or adaptive shortening of suboccipitals
  • Postpartum headache can occur d/t dural puncture from epidural
  • Women with Hx of HA may have migraines at the beginning of pregnancy
40
Q

What are the Symptoms of Tension -Type HA in pregnancy?

A
  • BIL, dull, steady pain that worsens throughout the day
  • Pressure that feels like a tight rubber band around the head
  • Lasts 4-24 hours; areas of tenderness on head and neck
  • Onset gradual and sometimes slight
  • Anxiety, nausea, or dizziness present
41
Q

What is the treatment for Tension -Type HA in pregnancy?

A
  • Identify stress- and tension-producing situations •develop new ways of coping
  • Rest, ice packs, biofeedback, relaxation techniques, PT
  • Analgesics, sedatives, other meds that have no or few effects on the fetus
42
Q

What are the S&S for migraines in pregnancy?

A
  • Severe, throbbing, unilateral (one-sided) pain
  • Lasts 4-72 hours
  • May be accompanied by nausea, vomiting, dizziness, tremors, increased sensitivity to sound and light (photo/phonophobia)
  • Classic migraine (with aura) - warning symptoms include visual disturbance, numbness in extremities, strange olfactory sensations, possible hallucinations
43
Q

Why does Coccydynia- (pain on or around the region of the coccyx) commonly arise during pregnancy?

A

Result of parturition-related trauma such as:

  • Sacral-coccygeal subluxation or fx
  • Stretch injury to the sacral-coccygeal ligaments or intercoccygeal discs
44
Q

What are the typical signs and symptoms coccydynia?

A
  • Pain in the region of the coccyx or perineum, with sitting as the most common agg factor
  • In addition to the localized trauma to the joint and bone itself, there may be assoc soft tissue dysfunction particularly in the coccyx and levator ani musculature that makes up part of the pelvic floor
45
Q

What are the typical approaches to treatment of coccydynia for the pregnant?

A
  • Provide pt with seating adaptations to lessen weight on the coccyx, and to support the lumbar spine to maintain lordosis and disallow lumbar flex with posterior pelvic tilt will aid in healing of tissue and should provide some pain relief
  • If the pt is still symptomatic after following (a), for a few weeks postpartum, than manual therapy to any joint subluxation or concomitant soft tissue dysfunction should be initiated.
  • Some PTs have advocated the use of Iontophoresis with dexamethasone esp if there is sig pain provoked on the dorsal surface of the sacrococcygeal surface.
  • Other PTs have advocated high-volt galvanic stimulation to the area by a rectal probe or internal soft tissue mobilization.
  • Wrey at al- combined joint manipulation under general anesthesia and injection around the coccyx provided the best results.
46
Q

Why does extremity dysfunction commonly arise in pregnancy?

A

Not as common as back or pelvic ring pain but more common than in the general population

  • Caused by nerve entrapment and neuropathies of peripheral and cranial nerves
  • Ligamentous laxity, load on the knees and fluid retention cause chondromalacia patella
47
Q

Typical signs and symptoms of Extremity dysfunction

A

Pain at the patella during prolonged or end-range flexion of the joint and patellar tracking problems

48
Q

What are the typical approaches to treatment of extremity dysfunctions for the pregnant?

A

Should be similar to general population, but because the condition is transient avoid investing in expensive orthotics

  • off -the-shelf temporary orthotics that support the arch and provide some cushioning are preferred
  • PT should be cognizant of the ligamentous changes in the foot (laxity) and by addressing those could positively infuence the problems up the chain

Mincer Final Exam- 4 (10 decks)

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