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*Complex Patient - Physiotherapy > Week 6- Women’s Health Physiotherapy > Flashcards

Week 6- Women’s Health Physiotherapy Flashcards

1
Q

What does gravida mean

A

Number times a person has been pregnant

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2
Q

What does parity mean

A

Number of births

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3
Q

What does nulligravida mean

A

Never been pregnant

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4
Q

What does primigravida mean

A

Pregnant for first time/one time

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5
Q

What does multigravida mean

A

Pregnant more than once

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6
Q

What is full term and the associated trimester

A

40 weeks, divided into three trimesters
1st trimester= week 1 to 12 (month 1-3)
2nd trimester= week 13 to 28 (month 4-6)
3rd trimester= week 29 to 40 (month 7-9)

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7
Q

Explain what’s expected in in the first trimester

A
  • Baby Growth 0.1mm–7cm
  • Placenta develops Wk 5
  • Extreme fatigue
  • Urinary frequency
  • Constipation
  • ↑ Blood Volume
  • Weight gain or loss
  • Heartburn & Headache
  • Nausea & vomiting, cravings/distaste
  • Emotional & hormonal changes
  • Breast tenderness, ↑ size, nipple changes
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8
Q

What is expected in the second trimester

A
  • Baby Growth 7cm to 35cm
  • Foetal movements 5th month
  • Continued breast changes, heartburn, constipation
  • Shortness of breath, ↑ RR, tidal volume
  • Bleeding gums, nosebleeds, nasal stuffiness
  • Dizziness & fainting
  • Skin changes
  • Body aches, round ligament pain, sciatica
  • Increase in joint laxity (relaxin)
  • Swelling of ankles/hands/face, leg cramps
  • Varicose veins
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9
Q

What is expected in the third trimester

A
  • Baby Growth 36-50cm
  • 28wk=1kg, term=2.5-3.8kg
  • Colostrum production, ongoing breast changes
  • Cervix thinning
  • Braxton-Hicks contractions
  • Painful joints, dragging feeling in pelvis
  • ↑ shortness of breath, then lightening
  • Urinary frequency/incontinence, constipation
  • Swelling, fatigue, trouble sleeping, varicose veins
  • Heartburn, haemorrhoids, stretch marks, skin changes
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10
Q

What is the typical weight gain in a typical pregnancy

A

10-16kg

Increased blood volume= 1.2-1.8kg 
Breasts= 0.5-0.9kg 
Uterus= 0.9kg 
Amniotic fluid= 0.6-0.9kg 
Placenta= 0.6kg 
Baby= 2.5-4kg 
Fat= 1.8-4.0kg 
Water retention= 1.5-2.5kg 
Increased blood and fluid= 1.0-1.8kg
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11
Q

What is the weight gain for twins or triplets

A 
Twins= 16-21kg 
Triplets= 21+kg
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12
Q

What is low weight gain associated with

A

Premature birth

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13
Q

What is overweight/ high weight gain

A
  • High BP
  • Gestational diabetes
  • Large baby
  • C-section
  • Difficulty losing weight post natal
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14
Q

What are advised total weight gain

A
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15
Q

What are the specific MSK changes in pregnancy

A
  • Force across some joints ↑ x2
  • Change in COG & joint mobility
  • Spine: ↑ Lx lordosis, Cx protraction, downward mvmt of shoulders, stretch of spinal ligs, ↑ breast size
  • Abdominals: stretching, weakness, separation
  • Pelvis: Widening of SIJ and PS, ↑ pelvic anterior tilt=↑ use hip extensors/abductors and ankle PF
  • Widened stance to maintain trunk movement
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16
Q

Prevalence of pregnancy-related pelvic girdle pain

A

up to 72% prevalence of lumbopelvic pain in pregnancy

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17
Q

Where May pregnancy related pelvic girdle pain present

A

Pain of musculoskeletal origin that is experienced in the lumbar and/or sacroiliac area during pregnancy and/or immediate post partum period. Pain may occur in conjunction with or separately in the symphysis pubis.

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18
Q

Lumbar pain in pregnant people

A

• 2/3 pregnant women (Pennick, 2013)
• 2nd half of pregnancy
• Consider BPS model: biomechanics (e.g. posture, muscle weakness, Z-jt irritation), hormonal (e.g. fluid retention, joint
flexibility, neural sensitivity), psychosocial
• Activity-aggravated, local pain or radiation down thigh, often
worse at night

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19
Q

What are risk factors for lumbar pain in pregnancy

A
  • pre existing LBP, Hx LBP
  • previous pelvic trauma
  • ? Occupation, multiparity, hypermobility, obesity (less evidence)
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20
Q

What is the management of LBP/PGP

A
  • Multimodal approach (PT, joint mob, brace, exs) better than usual care
  • Multimodal approach more beneficial
  • Aerobic + PFM + stabilisation exs = sig. effect on LPP prevention
  • Positioning, exercise, support belts, acupuncture
  • Hydrotherapy some benefit
  • Heat, ice, massage
  • Exercise that is enjoyed and individually-tailored/supervised

Moderate evidence:
• Acupuncture or exercise decreases LPP/PGP more than usual care
• Women who exercise cope better with LPP

Low quality evidence:
• Exercise significantly decreases pain/disability LBP
• Hydrotherapy sig. reduced LBP-related sick leave

Note: even if low evidence, if they enjoy that activity it will be beneficial for them

21
Q

Pelvic girdle/ SIJ pain in pregnancy aggs and prevalence

A
  • Pain worse on WB, prolonged sitting, SLS, shear
  • SIJ provocation tests +ve
  • 20-45% of pregnant women
  • 80-90% recover 6/12 post delivery
22
Q

Pelvic girdle/ SIJ pain in pregnancy risk factors

A

multigravida, Hx LBP, stress, obesity, young age, occupational/strenuous work, SE status, C-Section

23
Q

Pelvic girdle/ SIJ pain in pregnancy management

A
  • support brace
  • acupuncture (+exercise)
  • stabilisation exercises (hip add/abd, glutes, TAB)
24
Q

Symphysis pubis pain in pregnancy

A
  • increase mobility; insidious or traumatic
  • normal wiring in pregnancy 9-10mm
  • joint May click or crunch (with or without pain)
  • local anterior pain, pain on weight bearing, leg separation, SLS
  • usually resolves 4-12/52 PP
25
Q

How to manage symphysis pubis pain

A

Rest, advice/education, walking aids (crutches/walking frame), pelvic support braces, stabilising exercises

26
Q

What is advice you can give around PSG/PGP/LPP

A 
Try:
• Pillows between legs when sleeping
• Sit to put on shoes/socks/underwear
• Legs together to get in/out of bed/car
• Less stress/more sleep
Limit:
• Uneven weight distribution
• Bending/lifting/carrying weights
• Wide leg separation
• Crossing legs
27
Q

What are benefits of exercise in pregnancy

A
  • Increased bone strength / lean muscle mass
  • Improved maternal physical fitness / PFM function
  • Fewer delivery complications / reduced rate C/S
  • Decreased risk of elevated BP / pre-eclampsia
  • Reduced risk gestational diabetes
  • Improved physical / mental wellbeing
  • Decrease back / pelvic pain
  • Maternal weight control
  • Childcare prep
28
Q

What are potential risk factors of exercising in pregnancy

A
  • Hyperthermia -> avoid hot weather/dehydration
  • Falls risk -> due to COG/weight changes
  • Risk abdominal injury -> ?low risk
  • ↑ joint laxity -> ?injury risk
  • ↑ extracellular fluid load -> wrist pain/CTS
  • Effect on birth weight (ACOG, 2003) -> Birth weight not affected by exercise in women with sufficient caloric intake
29
Q

What are high risk exercise activities

A
  • High altitude training
  • Pressure changes (e.g. diving)
  • Abdominal trauma/pressure (e.g. weightlifting)
  • Contact/collision sport (e.g. MMA, soccer)
  • Risk of falling (e.g. horse riding, judo, skiing)
  • Hard equipment used (e.g. cricket ball, hockey stick)
  • Extreme balance/coordination/agility (e.g. waterskiing)
  • ?Exercise in supine after 28/40 (due to pressure on major vessels)
30
Q

What are exercise guidelines during pregnancy

A

Aerobic Exercise (SMA guidelines):
• Healthy women can begin/maintain moderate intensity aerobic exercise
• No study has found negative effect on foetus/pregnancy
• Swimming, running, aerobics, cycling = safe
• Safe upper limit uncertain
• Avoid excess stretching / ballistic movements
• No effect on course or outcome of labour
• Associated with fewer birth interventions

Resistance Exercise (SMA guidelines):
• Recommended 2 sessions/wk, submax intensity
• Light-moderate training with free weights, machines, bands, body weight or combo
• Recommendation: light to moderate weights, avoid heavy max isometric contractions
• Avoid Valsalva, supervise safe technique
• Minimise supine position 2nd and 3rd trimester
• No obvious effects on weight gain, complications, course of labour, birth weight

31
Q

How often should pregnant women be exercising

A
  • Exercise program of average 43min, 3x/wk, max HR 144bpm leads to no adverse effects
  • Sedentary women can commence a light to moderate exercise program during pregnancy (SMA guidelines)
  • Healthy women can continue preconception regular aerobic exercise program (SMA guidelines)
  • Elite athletes – continue/adapt and monitor exercise
32
Q

When to stop exercising

A
  • Abdominal pain
  • Amniotic fluid leakage
  • Uterine contractions/labour, PV bleeding
  • Calf pain or swelling (DVT)
  • Chest pain/tightness/palpitations
  • Decreased foetal movements
  • Dizziness or presyncope
  • Dyspnoea pre-exertion, excessive SOB
  • Excessive fatigue, muscle weakness/poor balance
  • Headache (unfamiliar, sudden onset)
33
Q

What are contraindications and precautions to exercise

A
34
Q

What are post partum changes

A

• Separation of linea alba (rectus diastasis) = NORMAL during pregnancy/early PP

-Birth injuries common:
• Large birth weight >4kg —> PFM injury
• Forceps>ventouse —> diastasis pubis, PFM injury
• Prolonged labour (active pushing )—> diastasis pubis, PFM injury
• Pressure on coccyx —> LBP/coccydynia
• Bleeding into SIJ —> sacroiliitis

-Pelvic floor dysfunction common:
• Prolapse
• Incontinence
• Pelvic pain

35
Q

What are the 4 grades of perineal tears

A

Note grade 3/4: High risk of future faecal +/- flatus incontinence

36
Q

What education do you give inpatient c-section

A
  • Post-op advice, scar and wound cares
  • Mobilise & progress walking as pain allows
  • Remember: MAJOR SURGERY
    • No lifting heavier than baby - 6 weeks
    • No heavy housework - 6 weeks
    • No driving - 6 weeks
    • No sit-ups/crunches – log roll
    • Pelvic floor exercises post-op
    • Static TAB contractions/pelvic rocking
    • Ease into gentle aerobic exercise as pain allows (aim 30min walk by 6weeks)
37
Q

What is the post partum return to activity guidelines

A
  • Aim for 30min/day walking/low impact exercise by 6/52
  • Can begin gentle walking/PFMX/TAB after birth
  • Practice “good”3/12 post birth
38
Q

What is pelvic floor muscle function

A

Sphincteric Function

  • conscious control over bladder & bowel
  • Contract = pelvic organs lift, sphincters tighten
  • Relax = allow you to wee and poo (and fart!)

Supportive Function

  • Support pelvic organs
  • Workswithin“corecylinder”tosupport/stabilize
  • PFM+Diaphragm+TAB+MF

Sexual Function

  • proprioceptive sensation
  • erectile function and ejaculation/orgasm
39
Q

What are they 3 layers of the pelvic floor called

A

1- urogenital triangle/ superficial perineal
2- deep urogenital diaphragm
3- pelvic diaphragm

40
Q

What are the muscles in the 1st layer of the pelvic floor, urogenital triangle/ superficial perineal

A
  • Bulbospongiosis
  • Ischiocavernosis
  • Superficial transverse perineal
  • External anal sphincter
41
Q

What are the muscles in the second layer, deep urogenital diaphragm

A
  • External urethral sphincter

* Deep transverse perineal

42
Q

What are the muscles in the 3rd layer, pelvic diaphragm

A
  • Levator Ani: pubococcygeus, puborectalis, iliococcygeus
  • Coccygeus (aka ischiococcygeus)
  • Piriformis
  • Obturator internus
43
Q

What is urinary incontinence

A

“Accidental or involuntary loss of urine from the bladder”
• Leakage with ↑ abdo pressure
• Constant or urgent need to urinate
• “Stress Incontinence” = SUI = activity-related leak
• “Urge Incontinence” = UUI = sudden + strong urge leak
• “Mixed Incontinence” = SUI + UUI
• Frequency/urgency
• “overactive bladder” = OAB (wet/dry) +/- nocturia
• ?detrusor instability / ?behavioural
• ?hypertonic PFM / ?UTI

44
Q

How many Australians experience incontinence

A

-4.8 million Australians (>50% are >50yr old)
• 4.2 million with Urinary
• 1.3 million with Faecal
-By 2030: 5.6 million urinary, 1.8 million faecal

  • 77% Nursing Home Residents are incontinent
  • 40-60% of residents will wet the bed tonight
  • In 2010, total financial cost $66.7 billion (~$14,014 pp)
  • projected rise of > $450 million by 2020
45
Q

Prevalence of urinary incontinence

A
  • 80% are Women
  • 65% women and 30% men sitting in GP room report incontinence, only 31% seek help
  • 70% with urinary leakage do not seek advice or treatment
46
Q

Faecal incontinence prevalence

A
  • 20% men, 12.9% women

* 1 of 3 major causes of admittance to Rest Home in Elderly

47
Q

What are risk factors for PFM dysfunction

A
  • Pregnancy & childbirth
  • Constipation / straining
  • Chronic coughing
  • Heavy lifting / high impact exercise
  • Age
  • Obesity
  • ↓oestrogen levels (menopause)
  • Co-morbidities: MS, Parkinsons
  • Hx of poor bladder habits
  • Prostate issues
48
Q

What is management of incontinence

A
  • Pelvic Floor Muscle Exercises (PFMX)
  • 84% of women with stress incontinence are cured with PFM training after 5 physiotherapy sessions
  • General lower limb muscle strengthening
  • Reduce strain on PFM, support pelvis/sacrum
  • Lifestyle modifications
  • Medications
  • Surgical Interventions

*Complex Patient - Physiotherapy (13 decks)

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