PT and Pregnancy

Question 1

What postural changes occur during pregnancy?

Answer 1

• Forward Head
• Kyphosis
• Increased Lumbar Lordosis
• Anterior Pelvic Tilt

(changes occur even after pregnancy due to carrying baby)

Question 2

How does blood pressure change depending on trimester of pregnancy?

Answer 2

Blood Pressure Decreases: 1st and 2nd Trimester
Blood Pressure Increases: 3rd Trimester of Pregnancy

Question 3

Why is Supine Lying not indicated in pregnancy?

Answer 3

Causes compression of the Inferior Vena Cava (IVC).

• Declines CO
• Can cause supine hypotensive syndrome

Question 4

When is Supine lying contraindicated in pregnancy?

Answer 4

No supine lying after 1st trimester.

Question 5

What is the best position to lay in during pregnancy and why?

Answer 5

Left Side-Lying:

• Decreases IVC compression
• Maximizes CO
• Decreases GERD
• Improvement to Maternal and Fetal Circulation

Question 6

How is Resting HR affected during pregnancy?

Answer 6

Increases by 10-20 bpm

Question 7

How is HR affected during exercise?

Answer 7

Does not proportionally increase with increased intensity during exercise

Question 8

How do hormones during pregnancy affect ligaments?

Answer 8

• Decreases ligament tensile strength
• Hypermobility as result of ligament laxity
• Increases risk of injury to the back, pelvis and LE

Question 9

What is Preeclampsia? When does it occur?

Answer 9

Pregnancy induced acute hypertension, after 20th week of gestation.

Question 10

What signs and symptoms occur during preeclampsia?

Answer 10

• Increased protein in urine
• edema; sudden weight gain
• headache

Question 11

How are reflexes altered during preeclampsia?

Answer 11

Causes Hyperreflexia

• increasing BP leads to hyperreflexia

Question 12

How is a diagnosis of preeclampsia made, what blood pressure reading is indicative of preeclampsia?

Answer 12

Blood pressure > 140/90 mmHg.

Diagnosis made by second reading 4 hours after first to confirm diagnosis

Question 13

In an event of confirmed preeclampsia, what action should be done?

Answer 13

This is an emergency, call 911 or get the bitch to the hospital

Question 14

What is gestational diabetes?

Answer 14

Diabetes that occurs during pregnancy, returns to normal after childbirth.

Question 15

What is Eclampsia?

Answer 15

Occurs after pregnancy, leading to

• headache
• visual disturbances
• development of seizures!

Question 16

If lying in supine where should a wedge or towel be placed?

Answer 16

Small wedge under the R hip, to promote turning to the left.

Question 17

Are breath-holding activities or Valsalva maneuver recommended for pregnant patients?

Answer 17

No, it increases intraabdominal pressure and should be avoided

Question 18

What is Placenta Previa? Can we exercise?

Answer 18

Lower displacement of the placenta, which may cause it to detach before the baby is delivered.

• Exercise is Contraindicated!

Question 19

In relation to BP when should exercise be contraindicated?

Answer 19

• Preeclampsia
• Pregnancy induced hypertension

Question 20

What trimesters is exercise contraindicated in the event of vaginal bleeding?

Answer 20

Second and Third Trimesters

Question 21

Cardiopulmonary Contraindications to Exercise?

Answer 21

• Hemodynamically significant heart disease
• Restrictive Lung Disease
• Severe Anemia

Question 22

For patients with Gestational DM when is exercise contraindicated?

Answer 22

During uncontrolled maternal type 1 diabetes as there could be ketoacidosis

Question 23

How to check for diastasis recti?

Answer 23

Have patient in hooklying

Ask patient to perform curl up (lift shoulders off mat)

Palpate for separation of the linea alba

Question 24

What degree of separation is significant for Diastasis Recti?

Answer 24

> 2 cm separation

Question 25

What patients with pregnancy should Diastasis Recti be checked? When can we perform this (how many days post-partum)

Answer 25

Check on all women after delivery, (does not matter if it was vaginal or C-section birth)

• Done 3rd day postpartum

Question 26

For patients with> 2cm Diastasis Recti what maneuver must be performed during exercise?

Answer 26

Abdominal Bracing

Question 27

For a patient with 3-4 cm Diastasis Recti, what exercise may be appropriate and how can we progress this?

Answer 27

Exercise with only lifting the head + bracing

• Progress to posterior pelvic tilt + head lift + bracing

Question 28

Exercise appropriate for a patient with >4 cm diastasis recti?

Answer 28

Abdominal Bracing + Breathing Exercises

Question 29

When is surgery for Diastasis Recti generally indicated?

Answer 29

> 6cm

Question 30

How does a finger width correlate with measurements?

Answer 30

1 finger width = 1 cm

Question 31

With all abdominal contractions/exercise when should exhalation occur?

Answer 31

Perform all abdominal exercise with exaltation

(exhale when contracting to reduce intra-abdominal pressure)

We do not want valsalva

Question 32

Why should we limit single-leg weight bearing activities?

Answer 32

• Can promote sacroiliac or pupic symphisis discomfort
• Aggravate Sacroiliac dysfunction

Question 33

When stretching what muscle groups do we want to avoid overstretching and why?

Answer 33

Hamstring and Adductor Muscles

• Can increase pelvic instability or hypermobility

(especially in patients with existing instability)

Question 34

How is COG altered in pregnancy?

Answer 34

COG shifts forward and upward as the fetus develops

Question 35

Which hormone causes ligament laxity?

Answer 35

Relaxin

Question 36

What is Cystocele?

Answer 36

The herniation of the bladder into the vagina

Question 37

What is Rectocele?

Answer 37

The herniation of the rectum into the vagina

Question 38

What is Uterine Prolapse?

Answer 38

Bulging of the Uterus into the Vagina

Question 39

For a patient who has undergone C-Section, what modality can be utilized to reduce incisional pain?

Answer 39

Postopertative TENS; placed parallel to the incision