PT and Pregnancy

Question 1

Normal Pregnancy

Answer 1

• Last 40 weeks (280 days)
• Range is 38-42 weeks
• Broken up by trimesters

***Used to permit induction at 38 weeks but have found fewer complications if born at 40 weeks

Question 2

Gestational age:

Answer 2

• •age of the pregnancy as measured by time from the mother’s last menstrual cycle

Question 3

Fetal age:

Answer 3

• actual age of the fetus

Question 4

1st Trimester: Weeks 1-5

Answer 4

• 6-12 days after conception blastocyst imbeds in uterus marking the beginning of the embryonic stage
• By week 4 (speck of glitter)
  
  • Vessel that will become heart starts contracting
    
    • ‘heart’ is only a single large fused vessel
    • Some conduction cells (SA/AV nodes) have formed causing contraction
• By week 5
  
  • Neural tube closed
  • Limb buds visible

Question 5

1st Trimester; Week 6-9

Answer 5

• By week 6
  
  • Lung buds have formed
• By week 7
  
  • Brain has divided into ventricles and lobes
  • Heart now has 4 rudimentary chambers
• By week 9 (jelly doughnut)
  
  • Fetal heart tone can be picked up by doppler
  • Spontaneous limb movements can be seen on ultrasound

Question 6

1st Trimester; Weeks 10-13

Answer 6

• Week 10 (size of a cocktail weenie)
  
  • marks transition to fetal stage
  • Called fetus instead of embryo
• By week 12
  
  • Heart beat can be heard on ultrasound
• By week 13
  
  • Active limb motion occurs

Question 7

2nd Trimester: (week 13-28ish)

Answer 7

• By week 16 (pint of ice cream)
  
  • Fetus is ~6 inches long
• By week 21
  
  • Generally can start to feel fetus move
  • (movement may be felt as early as week 16 but rare)
• By week 24
  
  • Gas exchange could be possible in lungs
  • Lungs are still developing

Question 8

3rd Trimester: (28 weeks)

Answer 8

• By week 31
  
  • Fetus is 15-17 inches long
• By week 35
  
  • Finger nails reach the end of fingers
• By week 36
  
  • Fetus has a high chance of survival with medical intervention if born now

Question 9

Hair and Nails

Answer 9

• Estrogen
  
  • Hair grows thicker and fuller due to increased estrogen
  • Hair may also grow thicker over entire body
  • Nails also grow thicker
• After delivery
  
  • Mother may lose hair
  • Nails return to normal

Question 10

Skin

Answer 10

• Stretch marks
  
  • Rapid weight gain
  • Large fetus
  • Obesity before/during pregnancy
  • Prevention
    
    • Not a surefire way
    • Vitamin E oil and/or cocoa butter
• Mask of pregnancy
  
  • Increased melanin release by skin
  • Results in darkened patches on upper lip, other areas of face

Question 11

Breasts

Answer 11

• Enlarge
• Painful/tender
  
  • During 3rd Trimester breasts often become tender to toucH
  • Many women sleep with maternity bra for support/protection

Question 12

Joints

Answer 12

• Ligaments
  
  • Relaxin released to assist in loosening joints of pelvis
  • Impacts entire body
  • Increased risk of strain/sprain/ tear at this time

Question 13

Feet

Answer 13

• Swelling
  
  • Pressure on vena cava from fetus
  • Increased fluid retention
• Arches
  
  • May flatten permanently due to relaxin
  • Especially if mother does not wear supportive shoes

Question 14

Braxton-Hicks

Answer 14

• Practice contractions
• Start as early as 28 weeks
  
  • Occasionally end of 2nd Tri
• Uterus contracts for 30-60s
  
  • Thought to be a way to tone the uterus
  • Increase blood flow to placenta
  • Soften cervix

Question 15

Weight Gain

Answer 15

• Normal weight mother-25-35 lbs
• Obese mother-10-20 lbs
• Underweight mother-28-45 lbs
• General rule
  
  • 2-4 lbs in 1st Trimester
  • 1 lbs per week after

***Some women lose weight during the 1st Tri, that is ok as long as their appetite picks up later

Question 16

Delivery

Answer 16

• First Stage: Dilation and Effacement of Cervix
  
  • early phase
  • active phase
  • transition phase
• Second Stage: Pushing and Birth
• Third Stage: Delivery of the Placenta

Question 17

1st Stage (hours given for 1st time mom)

Answer 17

• Early-6-10 hours
  
  • Water may break
    
    • Membranes rupture
  • Cervix dilates 3-4cm
• Active-4-6 hours
  
  • Cervix dilates 4-7cm
  • Labor truly begins
  • Epidural given now
• Transition-2 hours
  
  • Cervix dilates 7-10 cm
  • Contractions 1-3 min apart
  • DON’T PUSH

Question 18

2nd Stage

Answer 18

• ~2 hours for first time mothers
• Cervix is fully dilated
• Pushing begins
• Contractions are often farther apart but much stronger
• Episiotomy occurs at this point (if permitted)

Question 19

3rd Stage

Answer 19

• Delivery of placenta
• Few smaller contractions
• Physician/Midwife
  
  • May massage abdomen to assist in separation of placenta
• Many women don’t even notice as they are focused on baby

Question 20

Pregnancy Problems

Answer 20

• Gestational diabetes
• Preeclampsia
• Placenta Previa
• Placental Abruption
• Diastasis Recti

Question 21

Gestational Diabetes

Answer 21

• What
  
  • High glucose levels during pregnancy
• Risk factors
  
  • Obesity
  • Hispanic or Native American race
  • Rapid weight gain
  • Poor diet
• Complications
  • Preeclampsia
  • Poor liver function in fetus
  • Large fetus
  • Fetus with poor glucose control
• Management
  
  • Most can be with diet/exercise
  • Some women require insulin

Question 22

Preeclampsia

Answer 22

• Occurrence
  
  • 20 wks or more
  • HTN with kidney involvement
  • Other organs can be involved
• S&S
  
  • High BP
  • Swelling hands/face
  • Proteinuria
  • Headache
  • Abdominal/back pain
  • Vomitting
  • Headache/blurred vision/dizziness
• Management
  • Delivery is only cure
  • If infant near term (36wks +) infant will be delivered
  • If too early mother will be on bed rest
  • May stay in hospital or sent home if symptoms do not worsen
  • May require medications to prevent seizures

***If you question if a mother has preeclampsia, send to the ER

Question 23

Placenta Previa

Answer 23

• What
  
  • Placenta covers part or all of cervix opening
• S&S
  
  • Painless vaginal bleeding
  • Occurs in 2nd or 3rd Tri
  • Some may not have any symptoms
• Management
  • If DX after wk 20, mother must cut back on activity level
  • May be placed on bed rest
  • If bleeding heavily, mother may be admitted
  • C section deliver is generally recommended

Question 24

Placental Abruption

Answer 24

• What
  
  • Placenta separates from uterine wall, limits O2 to fetus
• S&S
  
  • Vaginal bleeding
  • Cramping
  • Abdominal pain
  • Uterine tenderness
• Management
  
  • If separation is small bed rest until bleeding stops
  • If moderate complete bed rest recommended
  • If severe (1/2 or more separated) emergency delivery commences

Question 25

Diastasis Recti

Answer 25

* **What** * Separation of the linea alba * **S&S** * Palpable separation of rec abdom * ‘pooching’ out of abdomen after delivery * **Risk Factors** * Obesity * Rapid weight gain * **Managemen**t * Surgery * Exercise * PT

Question 26

Exercise and Pregnancy

Answer 26

* Safe to exercise throughout a normal pregnancy * If woman has a high level of activity before, can maintain a higher level during as long as: * Weight is safely gained * Fetus is healthy * NO complications arise * Woman understands intensity will need to decrease as pregnancy goes on

Question 27

Benefits of exercise

Answer 27

* **Evidence suggests:** * Baby can be smarter * Labor and delivery are faster and easier * Can relieve aches and pains of pregnancy * Can decrease risk of gestational diabetes

Question 28

Exercise Guidelines

Answer 28

* Avoid heavy repetitive weight training during 1st Tri * May be associated with increased miscarriage * If a workout leaves a woman feeling truly exhausted * Time to decrease intensity * No evidence of higher activity levels and any birth complications * An increase in intensity during pregnancy should be avoided * The potential for direct trauma should be considered

Question 29

PT and Pregnancy- Most common things we see…

Answer 29

* Back pain * SI pain * Diastasis Recti

Question 30

Back Pain

Answer 30

* Associated with postural changes and relaxin * Intervention * Traditional exercise interventions OK as long as position is safe * Postural training key * Body mechanics key * Mobilization * Caution with positioning and force * Modalities * Deep heat, traction, e-stim contraindicated

Question 31

SI Pain

Answer 31

* Pain in SIJs from weight of fetus, postural change, and relaxin * Interventions * Stabilization exercises * Pregnancy or SI belt use * Avoid activities that aggravate pain

Question 32

Diastasis Recti

Answer 32

* Interventions * Specific DRA exercise * Only tx for abdomen until separation is 2cm or less * Use of girdle * After delivery