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Women’s Health: Obstetrics and Pelvic Floor. Chapter 24. Overview of pregnancy and related conditions. Characteristics of Pregnancy. First Trimester Changes Second Trimester Changes Third Trimester Changes. Anatomical and Physiological Changes of Pregnancy. Weight Gain During Pregnancy
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Women’s Health: Obstetrics and Pelvic Floor Chapter 24
Characteristics of Pregnancy • First Trimester Changes • Second Trimester Changes • Third Trimester Changes
Anatomical and Physiological Changes of Pregnancy • Weight Gain During Pregnancy • Changes in Organ Systems • Uterus and related connective tissue • Urinary system • Kidneys • Ureters
Anatomical and Physiological Changes of Pregnancy (cont'd) • Changes in Organ Systems (cont’d) • Pulmonary system • Hormonal influences • Respiration • Cardiovascular system • Blood pressure and volume • Heart
Anatomical and Physiological Changes of Pregnancy (cont'd) • Changes in Organ Systems (cont’d) • Musculoskeletal system • Abdominal muscles • Pelvic floor muscles • Connective tissue and joints • Thermoregulatory system • Metabolic rate
Anatomical and Physiological Changes of Pregnancy (cont'd) • Changes in Posture and Balance • Center of gravity • Balance
Pelvic Floor Musculature • Female Pelvic Floor • Innervation • Function
Effect of Childbirth on the Pelvic Floor • Neurological Compromise • Muscular Impairment • Episiotomy
Pelvic Floor Dysfunction • Classification of Pelvic Floor Dysfunction • Prolapse • Urinary or fecal incontinence • Pain and hypertonus • Risk Factors for Dysfunction • Childbirth • Other causes
Interventions for Pelvic Floor Impairments • Patient Education • Teach the patient about pelvic floor anatomy and function • Provide individual instruction in exercise performance • Neuromuscular Re-Education • Facilitate pelvic floor muscular activation • Exercise and Biofeedback • Use biofeedback with instrumentation • Combined biofeedback with exercise • Manual Treatment and Modalities
Diastasis Recti • Incidence • Significance • Functional limitations • Decreased fetal protection • Potential for herniation • Examination for diastasis recti • Intervention for diastasis recti
Postural Back Pain • Incidence • Characteristics • Interventions
Sacroiliac/Pelvic Girdle Pain • Characteristics • Interventions • Activity modifications • Exercise modifications • External stabilization
Varicose Veins • Characteristics • Interventions • Exercise modifications • External support
Joint Laxity • Significance • Interventions • Exercise modifications • Aerobic exercise
Nerve Compression Syndromes • Causes • Interventions
Exercise Interventions for pregnancy, Labor, and related conditions
Maternal Response to Aerobic Exercise • Blood Flow • Respiratory Rate • Hematocrit Level • Inferior Vena Cava Compression • Energy Needs • Core Temperature • Uterine Contractions • Healthy Woman Response
Fetal Response to Maternal Aerobic Exercise • Blood Flow • Fetal Heart Rate (FHR) • Heat Dissipation • Newborn Status
Exercise for the Uncomplicated Pregnancy and Postpartum • Guidelines for Managing the Pregnant Woman • Examination • Education • Stretching/flexibility • Muscle performance and aerobic fitness • Precautions • Recommendations for Fitness Exercise • Precautions and Contraindications to Exercise • Absolute contraindications • Precautions to exercise
Critical Areas of Emphasis and Selected Exercise Techniques • Posture Exercises • Corrective Exercises for Diastasis Recti • Abdominal Muscle Exercises • Head lift • Head lift with pelvic tilt • Stabilization Exercises • Dynamic Trunk Exercises • Pelvic motion training • Trunk curls
Critical Areas of Emphasis and Selected Exercise Techniques • Modified Upper and Lower Extremity Strengthening • Standing push up • Supine bridging • Quadruped leg raising • Modified squatting • Scapular retraction
Critical Areas of Emphasis and Selected Exercise Techniques (cont'd) • Perineum and Adductor Flexibility • Self-stretching
Pelvic Floor Awareness, Training, and Strengthening • Contract-Relax • Quick Contractions • “Elevator” Exercise • Pelvic Floor Relaxation
Relaxation and Breathing Exercises for Use During Labor • Visual Imagery • Muscle Setting • Selective Tension • Breathing • Relaxation and Breathing During Labor
Unsafe Postures and Exercises During Pregnancy • Bilateral Straight-Leg Raising • “Fire Hydrant” Exercise • All-Fours (Quadruped) Hip Extension • Unilateral Weight-Bearing Activities
Exercise Critical to the Postpartum Period • Pelvic Floor Strengthening • Diastasis Recti Correction • Aerobic and Strengthening Exercises
Cesarean Childbirth • Significance to Physical Therapists • Surgical risks • Interventions • Pelvic floor rehabilitation • Postsurgical rehabilitation • Emotional support
Suggested Activities for the Patient Following a Cesarean Section • Exercises • Coughing or Huffing • Interventions to Relieve Intestinal Gas Pains • Abdominal massage or kneading • Pelvic tilting and/or bridging • Bridge and twist • Scar Mobilization
High-Risk Pregnancy • High-Risk Conditions • Premature onset of labor • Preterm rupture of membranes • Incompetent cervix • Placenta previa • Pregnancy-related hypertension or pre-eclampsia • Multiple gestation • Diabetes
High-Risk Pregnancy (cont'd) • Management Guidelines and Precautions • Exercise suggestions with high-risk pregnancies • Positioning • Range of motion (ROM) • Ambulation/standing • Relaxation techniques, bed mobility, and transfer activities • Preparation for labor • Postpartum exercise instruction