Pregnancy Pelvic Floor

Are the contractions regular?

Time your contractions from the beginning of one to the beginning of the next. Look for a regular pattern of contractions that get progressively stronger and closer together. False labor contractions will remain irregular.

With C-seciton might have pain at c-seciton __. __ incontinence, posture, ___, and post-partum __ concerns.

scar, flatus/urinary, diastasic recti, musculoskeletal

when their MMT is >3, position in __ and gradually progress to ___. Add ___ contraction to functional activities and exercise. Add advanced PFM exercises like: hold followed by several ___, __ or more level elevators, and anything you can think of. At MMT > 4/5 we can add ____ for resistance training.

sitting and standing, PFM, quick squeezes, 3, vaginal weights

T/F: Evidence does not tell us whether strenuous training leads to preterm labor, but the advice is that those with a history of or at risk of preterm labor should be advised to reduce her activity in the second and third trimesters.

true

T/F: Premature labor may present with the same signs and symptoms as labor.

true

T/F: Strong evidence for pelvic floor muscle training as treatment for SUI, mixed UI, late pregnancy, postpartum, post-sx incontinence.

true

T/F: Studies have shown that women who exercise regularly during their pregnancy return to their pre-pregnancy weight, strength, and flexibility faster than their sedentary counterparts.

true

contains 2 arteries and 1 vein. Arteries carry deoxygenated blood from fetus, and vein carries oxygenated blood to fetus.

umbilicus

what if they still can't get it?

refer to specialist

grade scale for the internal exam

0: absent contraction 1: flicker 2: weak squeeze, no lift 3: moderate squeeze, lift present 4: good squeeze held against resistance 5: strong squeeze, against strong resistance 6: very strong squeeze, gripping finger tightly

muscle scale for pelvic exam?

0: absent contraction 1: flicker 2: weak squeeze, no lift 3: moderate squeeze, lift present 4: good squeeze, held against resistance 5: held against strong resistance

what are some possible types of pt interventions?

1. Behavioral Management/Education 2. Manual Therapy to decrease muscle spasms, connective tissue restrictions, and scar restrictions 3. Manual Therapy to address skeletal dysfunctions (alignment adjustments/joint mobilization) 4. Core and Postural Training 5. Self Management Tools 6. Pelvic Floor Muscle Training

what are the 4 causes of underactive pelvic floor muscles?

1. Childbirth: overstretch muscle injury, pudendal nerve traction or compression injury, loss of PFM integrity from trauma/episiotomy/tearing. 2.Chronic Increased Intra-abdominal Pressure: obesity, chronic cough/asthma, repetitive lifting, chronic constipation, high impact exercise. 3. Surgery: loss of integrity of supportive ligaments and muscles. 4.Aging: disuse atrophy, decreased estrogen, loss of smooth muscle fibers, altered central/peripheral neurotransmission, decreased size of urethral striated muscle.

what are the 3 stages of delivery

1. Dilation: The time it takes for the cervix to dilate from zero to 10 centimeters. 2. Propulsion: The time between full dilation of the cervix to the actual delivery of the baby. 3. Placental: The period of time between the birth of the baby and the delivery of the placenta, or afterbirth.

Fetus changes position to allow for passage through the pelvis. What are the 7 ways it changes position?

1. Engagement: Head passes through the pelvic inlet. 2. Descent: Continued downward progression. 3. Flexion: Chin tucks as descending head meets resistance from the walls and floor of the pelvis. 4. Internal Rotation: Fetus turns back of its head toward symphysis pubis to clear ischial spines. 5. Extension: Head crowns and extends beneath the symphysis pubis as it is delivered. 6. External rotation: Fetus rotates again to allow shoulders to be delivered. 7. Expulsion: Anterior shoulder passes under the symphysis pubis and the rest of the body follows.

what are 4 contraindications for internal pelvic exam?

1. Pelvic, genital, or urinary infection 2. Pregnancy 3. Prior to 6 weeks post-partum, unless cleared by physician 4. Prior to 6 weeks post pelvic surgery, unless cleared by physician

home exercise program

1. Stretches to improve LE/abdominal/LB flexibility 2. Core and postural strengthening exercises 3. Diaphragmatic breathing to decrease pain and promote relaxation 4. Teach self scar mobilization 5. Teach self trigger point release or massage techniques to patient or family 6. Dilator stretching to improve PFM flexibility 7. PFM (kegel) exercises

what are the 3 categories of pelvic floor muscle dysfunction?

1. Underactive PFM 2. Overactive PFM 3. Non-functioning PFM

what are 6 signs of labor?

1. Uterine contractions which happen every ten minutes or more often. 2. Menstrual-like cramps in lower abdomen. May come and go or be constant. 3. Dull backache felt below waistline. May come and go or be constant. 4. Pelvic Pressure which feels as though the baby is pushing down. Pressure comes and goes. 5. Abdominal cramping, with or without diarrhea. 6. Vaginal discharge may suddenly increase in amount, or become mucousy, watery, or lightly bloody.

what muscle substitutions should you watch for (4)?

1. Valsalva, bearing down 2. Abdominals 3. Adductors 4. Gluteals

what is overactive pelvic floor signs/impairments?

Absent or partial voluntary PFM relaxation.

what day do we ovulate during out cycle

14

Placenta formation has occurred at ___ days. Blood vessels begin to develop beneath the chorionic layer. Gradually the embryo and mother's bloodstream becomes closely connected, separated only by a thin ___ barrier. The placenta allows for ___ and ___ to cross from the mother to the fetus.

21, placental, oxygen and nutrition

Postpartum treatment involves: Gradually resume previous exercise in __ weeks Abdominal exercises- modified for diastasic recti __strengthening Postural__ re-educaiton and strengthening Manual therapy to address musculoskeletal impairments __ for pain management __and US for scar restrictions

4-6, PFM, postural, TENS, Scar mobilization

pregnancy lasts __ weeks with __ considered full terms. It is divided into __ trimesters 1: 2: 3:

40, 38-42, 3 0-12 13-26 27-40

Minute ventilation increases ___% even though rate and total lung capacity unchanged. Tidal volume (quiet breath) ___. __ and decrease. Baseline O2 consumption increases ___%. CO2 output ____. More sensitive to CO2 in the blood. Natural state of ____exists to meet O2 demands of pregnancy and CO2 disposal needs of fetus.

40-50%, increases, ERV and RV, 10-20, increases, hyperventilation

Data suggest that hyperthermia in excess of 39 deg C (102.2) during the first ___days of gestation may also be teratogenic in humans; however there have been no reports that hyperthermia associated with exercise is teratogenic in humans.

45-60

Uterus increases __x original size ___ muscles, especially the rectus, are stretched to their elastic limit. Force of contraction decreases. Pelvic floor muscles drop as much as an __. ___ cause an overall ligamentous laxity, leading to increased laxity in pelvic joints. Center of gravity changes leading to ___ (usually increased lumbar lordosis). Recommended weight gain is ___ lbs.

5, Abdominal, inch, Hormones, postural changes, 25-27

Neural adaptation of muscles improve the first___ weeks of training More prolonged training results in ____. Both improved __ and ___ may improve the ability of the pelvic floor muscles to assist with closure of the urethra.

6-10, muscle hypertrophy, neural control and hypertrophy

The expected rates of cure for pelvic floor muscle training is up to ___%. Expected rate of improvement up to ___%.

73%, 97%

T/F: Do not perform abdominal crunches or sit ups until closure of diastasis!

true

Manual Therapy involves palpating and examining flexibility of the muscle groups adjacent to the pelvic floor for tightness, muscle spam, and fascial restriction including...

Abdominal Muscles Diaphragm Hip flexors Lumbosacral musculature Gluts/Piriformis Adductors Hamstrings

what are the 3 parts to the Pelvic Organ Prolapse POP testing?

Anterior (cystocele): Using 2 fingers apply posterior vaginal pressure. Ask client to bear down and watch for descent from anterior position. Posterior (rectocele): Using 2 fingers apply anterior vaginal pressure (light). Ask client to bear down and watch for descent from posterior position Uterine: Using 1 or 2 fingers palpate vaginally central and deep. Ask client to bear down and feel for descent of cervix (firm) from center of vagina.

symptoms of non-funcitonaing pelvic floor muscles?

Any PFM symptom may be present

what are some types of relaxation exercises?

Diaphragmatic Breathing Body Scanning Visualization Guided meditation/imagery

Behavioral Management/Education

Bladder Diary/Bladder Retraining Bladder Irritants Urge Control Strategies Sleeping Longer Strategies Avoiding increased intra-abdominal pressure Toileting Training Underwear and clothing changes Lifestyle changes, postural changes

mom perspective of symptoms?

Body aches Breast changes Constipation Dizziness Leg cramps Varicose veins Hemorrhoids Itching Swelling Morning sickness Nasal problems Numb or tingling hands Stretch marks, skin changes Urinary frequency and leaking Heartburn and indigestion Fatigue, sleep problems

___ levels are elevated throughout pregnancy. Appears to be responsible for ___ (striae). High levels of cortisol inhibit the ___.

Cortisol, stretch marks, immune system

what if they can't get it?

Cue to "stop the flow of urine" or "prevent the release of gas" Change position. Try co-contraction with transverse abdominis, gluts, adductors, abductors Coordinate with breathing. Sphincters wired together. Suggest sitting on their hand. Suggest they use a mirror at home to observe their perineum. Suggest they stop urine at home (infrequently, as a test). Suggest they insert a finger into the vagina and feel the muscles squeeze and lift. Cue males to lift their scrotum.

what are some condition that could make a mom a high risk pregnancy?

Cardiac Disease Severe Anemia Diabetes Chronic HTN Renal Disease Hemoglobinopathies Premature rupture of membranes Premature onset of labor Incompetent cervix Placenta Previa 3rd trimester bleeding Multiple gestation 2 previous premature infants

procedure for using dilators?

Client in a comfortable, reclined position Practice inserting smallest sized dilator while relaxing PFM and breathing Leave inside for up to 10-15 minutes Stretch at different points around pelvic clock (posterior portion only) Gradually progress to larger sized dilators as tolerated There should be minimal to no pain!

indications for abdominal ultrasound?

Confirm fetal health Check fetal anatomy Estimate gestational age or growth Assess amniotic fluid volume Guide needle placement Determine fetal presentation Check position of placenta and cord

T/F: Endocrine changes required to support pregnancy affect most systems in the pregnant woman.

true

what are some tools to assist with training?

EMG Biofeedback Electrical Stimulation Perineometer (pressure) Vaginal Cones/Weights

3 things that occur days to weeks prior to delivery?

Effacement - shortening or thinning of the cervix from a thickness of 5 cm to the thickness of a piece of paper. Often expressed in %. Dilation - opening of the cervix from the diameter of a finger tip to approximately 10 cm. Oxytocin-receptors increase in number

___ leads to increased vascularity in tissues: increases uterus size & helps maintain lining. Levels up to __ times higher than pre-pregnancy. Increase __ size. Contributes to relaxation effect on __ of pelvis and peripheral joints.

Estrogen, 30, breast, ligaments

how should we examine skeletal dysfunction?

Examine alignment using appropriate bony landmarks Special tests to determine SI dysfunction, hip impingement, etc. Observe posture: Scoliosis, forward head, increased thoracic kyphosis, increased/decreased lumbar lordosis Examine A/PROM and joint mobility for stiffness or hypermobility Examine for leg length discrepancy Examine feet/ankles for hyperpronation, stiffness, hypermobility Examine Myotomes/reflexes

High Risk Pregnancy Treatment

Follow bed rest restrictions and all pregnancy guidelines for exercise and positioning Bed exercises to maintain strength, ROM, posture If not having pre-term contractions: gentle TA and PFM engagement Breathing exercises Exercises to manage swelling and risk for DVT Education on post partum rehab

___ that occur before a woman becomes pregnant or during pregnancy can increase the likelihood for a high-risk pregnancy. A mother with __ and ___ would be considered a high risk pregnancy Premature labor or multiples (twins, triplets, etc) can create high-risk situation as well.

Health conditions, heart disease or diabetes,

during pregnancy: __ size increases & the heart is elevated because of the change in position of the diaphragm. Blood volume increases __% (approx 1.5-2 liters) HR increases ___ bpm Stroke volume: ___% Cardiac output: ___% Systemic vascular resistance __. Blood pressure ____ in the first trimester. Plasma volume___ Red blood cell mass ____. Relative proportion is not the same and during pregnancy women can get an anemia of pregnancy.

Heart, 35-50,10-20, 10-20, 30-50, decreases, decreases, increases, increases.

how do you grade speed?

How many 1 second contract/relax contractions can they perform up to 10 at same MMT.

how is endurance graded?

How many seconds can they maintain hold at the same MMT, up to 10 seconds.

how are repetitions graded?

How many times can they repeat endurance contraction for the same amount of seconds at same MMT.

___: Lining of the uterus has thickened and cervix is sealed with a mucus plug. Once zygote reaches the uterus it is termed a ______ . Blastocyst cells differentiate into embryoblast and trophoblast. ____ cells are appendage organs that penetrate the endometrial tissue of the uterus for implantation (___ days). These cells become the chorion which will make up the placenta. A single layer of cells from the uterine lining surround the blastocyst forming the __. At this time a hormone is released by the tissues called ___ (hCG) that helps to maintain the pregnancy. This is what is detected in the mother's blood to confirm pregnancy.

Implantation, blastocyst, Trophoblast, 7-10, embryo, human chorionic gonadotropin

what is overactive pelvic floor muscles symptoms/diagnoses?

Incomplete bladder or bowel emptying, dyspareunia, pelvic pain, prostatitis, painful bladder syndrome, vaginismus, vulvodynia.

what are some causes of overactive pelvic floor muscles?

Joint misalignment Habitual postural dysfunctions Childbirth trauma/episiotomy/tears/adhesions Surgical trauma/adhesions Sexual abuse Pelvic inflammation/infection/disease Hemorrhoids/fistulas/fissures Bowel and bladder disorders

what are some techniques to treat skeletal dysfunction?

Joint mobilization Rotational PA/AP Muscle energy techniques Manipulations (if trained) PROM Mobilization/Release to surrounding ligaments and muscles If leg length discrepancy or foot abnormalities consider heel lift and/or orthotics

Common Musculoskeletal Disorders During Pregnancy

LBP Piriformis syndrome SI Joint pain Coccydynia Calf Cramps Costal Margin Pain Carpel Tunnel Syndrome Diastasis Recti

how is power graded?

MMT Graded 0-5 based on PFM squeeze around finger.

what are some GI symptoms?

Morning Sickness Decreased smooth muscle activity Heart burn Decreased motility Constipation

what are some techniques in manual therapy that can be used to release the muscle, fascial, and scar restrictions?

Myofascial release Soft tissue mobilization Connective tissue release Cross friction massage Strain counter-strain (Positional Release) Active release Trigger point release Visceral mobilization Craniosacral Stretching Nerve Gliding

describe non-functioning pelvic floor muscles?

No PFM action palpable

what things should we examine for posture and core strength?

Observe scoliosis, forward head, increased thoracic kyphosis, increased/decreased lumbar lordosis, knee valgus/varus Observe diaphragmatic breathing vs. chest breathing Ability to isolate and volitionally contract transverse abdominis and multifidi MMT for abdominals Active straight leg raise test Examine for diastasis recti (see lab handout)

what is underactive pelvic floor muscles?

PFM are unable to contract when needed or weakened

what is overactive pelvic floor muscles?

PFM unable to relax and may contract during functions such as defecation or micturition at inappropriate times.

External exam includes: Observation for erythema, irritation, atrophy, scars. Palpation of __ at each "clock" location for pain, sensation, and tone. ___ of perineum by observing PFM contraction, valsalva, and cough Reflexes like __ and __.

PFM, AROM, anal wink, Bulbocavernosus

Internal exam includes: Palpation of ___ for pain, sensation and tone. ____ (PERFECT) - Power, Endurance, Repetitions, Fast Contractions. _____ (POP) testing.

PFM, Strength testing, Pelvic Organ Prolapse

The purpose of dilators is to stretch ___, assist in ___, and gradually improve tolerance to ___.

PFM, desensitization, vaginal penetration

subjective exam?

PMH/HPI (History of Present Illness) Bladder/bowel/sexual history Medication Pain rating and qualifiers Recreational Activities/Exercise Home/Work Environment

Vaginal Delivery:

Pain from episiotomy or tearing Pain with intercourse Pelvic organ prolapse Flatus/Urinary incontinence Body mechanics/Posture Diastasis recti Post partum musculoskeletal concerns

examine for skeletal dysfunction to what areas?

Pelvis/Sacrum/Coccyx Lumbar spine Hips Also consider cervical spine, thoracic spine, ribs, knees, feet/ankles.

how should you position a mom?

Positioning: Limit supine lying to 5 minutes after 1st trimester due to vena cava compression. Reclined supine lying as long as no symptoms. (*) Position patient tilted to her left or on her left side. Avoid motionless standing.

___ promotes health of placenta and uterine lining. Causes ___, including uterus and GI tract. May lead to indigestion, constipation, UI. Elevations shown to increase ligament ____. With ___and obstruction of the iliac veins by uterus, increased risk of varicose veins, hemorrhoids.

Progesterone, smooth muscle relaxation, laxity, venous dilation

___ promotes lactation (progesterone is also required.) Stimulates__ and __.

Prolactin, appetite and feeding

Recommendations from American Congress of Obstetrics and Gynecologists: Use the ____. Mild to moderate exercise ___x/wk vs. intermittent. Avoid ___after the first trimester. Decrease motionless __. Modify intensity based on symptoms. Stop if fatigued, not to exhaustion.

RPE, 3, supine, standing,

____ has effects throughout multiple body systems. Serves to inhibit uterine contraction and soften the ___. Like ___ and __, appears to relax ligaments of pelvis and other joints.

Relaxin, Relaxin, estrogen and progesterone

objective exam?

Screen LB, hips, LE including ROM, strength, flexibility, palpation, nerve fxn, neural tension and special tests

Relative contraindications to aerobic exercise during pregnancy

Severe anemia Unevaluated cardiac arrhythmia Chronic bronchitis Poorly controlled type 1 diabetes Extreme morbid obesity Extreme underweight History of extremely sedentary lifestyle Intrauterine growth restriction in current pregnancy Poorly controlled hypertension/preeclampsia Orthopedic limitations Poorly controlled seizure disorder or thyroid disease Heavy smoker

Absolute contraindications to aerobic exercise during pregnancy

Significant heart disease Restrictive lung disease Incompetent cervix /cerclage Multiple gestation at risk for premature labor Persistent second or third trimester bleeding

Functional activity training include "____". Perform a functional ___ (co-contraction of pelvic floor and transverse abdominis muscles when making a transitional movement or lifting). Incorporate PFM contraction with steps, squatting, marching, etc. Incorporate PFM exercises into their regular exercise routine.

Squeeze before you sneeze, brace,

can you stop the contractions?

True contractions continue regardless of your activity level or position. In fact, they often grow stronger with increased activity, such as walking. With false labor, you might be able to stop the contractions by changing your activity or position, lying down or taking a walk.

how long do contractions last?

True contractions last more than 30 seconds at first and get progressively longer — up to 90 seconds. The contractions of false labor vary in length.

what should we do if diastasic recti is present?

Tupler Technique Head lifts and pelvic tilts All core strengthening exercises must include splinting Taping for support and to assist with closure Release muscle spasms, fascial restrictions, and scar restrictions in abdomen Educate on decreasing intra-abdominal pressure using TA and PFM contractions during transfers, lifting, sneeze/cough

Type II vs. Type I exercise prescription

Type II: Brief rapid contract/relax exercises of 1-2 secs Type I: Prolonged holds, work towards 10-15 secs Hold/ Relax ratio 1:2 to begin

____is what connects the fetus to the placenta in order to exchange gas and nutrients with mother's blood stream. Also pictured here is the amniotic sac. ___ is water combined with protein/carbohydrates/lipids/urea all of which are important for the development of the fetus. The fetus breathes in and swallows the fluid and contributes to __ and ___ tract development. Also provided a protective cushion from blows to the mother's abdomen.

Umbilical cord, Amniotic fluid, lung and GI

what are some UG symptoms?

Urinary frequency and urgency increases Bladder capacity increases (smooth mm changes)

what are the symptoms of underactive pelvic floor muscles?

Urinary incontinence, fecal incontinence, pelvic organ prolapse

Warning signs to terminate exercise while pregnant

Vaginal bleeding Dyspnea before exertion Dizziness Headache Chest pain Muscle weakness Calf pain or swelling (need to rule out thrombophlebitis Preterm Labor Decreased fetal movement Amniotic fluid leakage

Avoid ___ and holding breath. Screen for posture, fitness, and diastasis recti. Limit __activities. Most___ are contraindicated during pregnancy. Superficial heat or ice may be beneficial.

Valsalva, SLS , modalities

Avoid exercises with potential for __ (contact sports, risk of falling). Ensure adequate nutrition (300kcal/day required to meet metabolic needs of pregnancy). Augment __ by increasing hydration, appropriate clothing, and optimal environment.

abdominal trauma, heat loss

signs and impairments of underactive pelvic floor muscles?

absent or weak voluntary and involuntary PFM contraction

supports and protects fetus.

amniotic fluid

Avoid jarring ___ exercises that could cause joint injury. No ___ raises. Use caution with __ and __ stretches. Modify ___ if diastasis present. Avoid difficult ___ positions. Wear good athletic shoes. Wear strong, supportive ___. Discontinue exercises that cause pain. Avoid valsalva maneuver during exertion. Beware of __, steam rooms and hot tubs due to affects on both mother and fetus.

ballistic, double leg, hamstring and adductor, abdominals, balancing, bra, hot saunas

Regular exercisers have better regulation of ___levels which decreases their risk of gestational diabetes.

blood glucose

as the baby is delivered it passes through a __ birth canal and ___ birth canal.

bony, soft tissue

After implantation inner cell mass differentiates into different tissues. 1. ___: surrounds embryo and forms placenta. 2. ___: creates amniotic fluid and sac. 3. ___: no use in humans and degenerates as the fetus develops. 4. ___: contributes to umbilical cord development.

chorion, Amnion, yolk sac, allantois

It is normal for: PFM able to __ and __on demand. PFM responds to increased ___ appropriately. Normal __, __, and __ function. Strong/normal ___ and ___ muscle contraction with complete relaxation

contract and relax, intra-abdominal pressure, urinary, bowel, and sexual, voluntary and involuntary

The basics of teaching pelvic floor strengthening are the same, no matter the setting. The pelvic floor is part of the "__" and good strength and proper timing of activation is part of core strengthening.

core

The purpose of EMG Biofeedback Training: 1. Increases awareness of ___. contraction 2. Improves ___ to perform exercise 3. Establishes ___ objective data 4. Monitors ___ of exercise program. Either external surface pads applied to perineum or internal sensor inserted vaginally/rectally.

correct PFM , motivation, baseline, progress

separation of the rectus abdominis muscles due to excessive intra abdominal pressure

diastasis recti

pregnancy is one in which some condition puts the mother or her fetus at a higher than normal risk of complications during or after birth.

high-risk pregnancy

During the first trimester, there is ___ of fertilized ovum, __ changes, small ___ gain, and fetus __ oz, __cm, kicks, turns head, swallows.

implantation, hormonal, weight, 2, 6-7

Basal metabolic rate and heat production __. An additional ___ calories/day needed to meet basic metabolic needs of pregnancy.

increase, 300

Subcostal angle ___ ; ribs flare up and out. AP & transverse diameters increase by ~__ in. Hormonally mediated; occurs prior to uterine enlarging. Diaphragm is elevated __ in., caused by change in rib position. Hormones cause ___ and___of the upper respiratory tract. Both __ and __ performance are decreased.

increases, 1 in., 1.5, edema and tissue congestion, subjective workload and maximum exercise

layer 1: layer 2: layer 3:

layer 1: 3-9 o'clock (Finger inserted to DIP joint) layer 2: 3-9 o'clock, and 11-1 o'clock (to PIP joint) layer 3: 3-9 o'clock, 10 and 2 o'clock (to MCP joint)

Many ____ are unsafe during pregnancy or while breast feeding; can cause harm to fetus or infant. Risks of any given medication depends on ___. All medications need approval by physician. Increased __ and ___alter transport of medications. Even ____ and ___ can cause problems during third trimester.

medications, trimester, kidney and cardiac output, aspirin or ibuprofen

signs/impairments of non-functioning pelvic floor muscles?

non-contracting, non-relaxing PFM

Because of the increased resting oxygen requirements and the increased work of breathing caused by the pressure of the enlarged uterus on the diaphragm, there is decreased ___ available for the performance of aerobic exercise during pregnancy. The work of breathing increases during pregnancy; dyspnea is present with mild exercise as early __ weeks.

oxygen, 20

allows for nutrient uptake, waste elimination and gas exchange via the mother's blood supply.

placenta

Educate patient about the role of the pelvic floor in __ and ___. Teach patient to identify ____ contraction. Teach appropriate exercise based on current __ and __. Provide duration, reps, frequency.

postural support and continence, pelvic floor muscle, ability and diagnosis,

At ovulation ovum develops into corpus luteum which releases____to thicken uterus. Ovum stays in fallopian tube for about ___ hours after ovulation waiting for a single sperm to fertilize it. _____ is a protective covering on ovum to ensure only 1 sperm can fertilize the egg. After fertilization ovum completes 2nd meiotic division, and then sperm and ova DNA can combine. Now fertilized egg is called a ___ and divides rapidly as it moves through fallopian tube for ___ days until it reaches uterus.

progesterone, 24-48, Zona pellucida, zygote , 3-4

If implantation occurs the corpus luteum does not degenerate and continues to release high amounts of ___ and low amounts of ___during 1st trimester. hCG is responsible for preventing the corpus luteum from degenerating. Once placenta develops levels of estrogen and progesterone continue to __for the duration of pregnancy.

progesterone, estrodiol, rise

grade scale for pelvic organ prolapse (POP)?

stage 0: no prolapse stage 1: most vital point is > 1 cm. above the hymen stage 2: most distal pt. is < 1cm above or below hymen Stage 3: most distal point is >1cm below hymen Stage 4: most distal pt. is >2cm below hymen. visible upon perineal observation

Exercise Guidelines for High Risk Pregnancies: Prolonged __ positioning is a concern. Some exercises, especially __may stimulate uterine contractions. Do not allow ___. Certain body mechanics and postural instruction will stimulate abdominal contractions. Keep exercises simple; perform slowly, smoothly, and with min exertion.

static, abdominal ex , Valsalva,

when their MMT is 0-1, position in ___ or with buttock ___, utilize ____ techniques such as tapping, quick stretch, and use of accessory muscles to improve recruitment, may benefit from ___.

supine, elevated, facilitation, internal electrical stimulation

when their MMT is 2-3, position in ___ or __ position, teach to isolate form __ and to breathe. Train __ and ___ contractions. Do elevator exercises for ___. Duration of holds, relaxation, and amount of reps is based on their ___ during exam.

supine, hook lying, accessory, quick and endurance, coordination, ability

the purpose of relaxation exercises includes controlling the ___ due to stress, anxiety, and pain. Promotes __ of tens muscles, including PFM.

sympathetic nervous system, relaxation

when it comes to core and postural training: Train isolation and gradual progression of __ and ____ contractions in different positions. Strengthen ____ muscles : anterior cervical muscles, trapezius, rhomboids, latissimus dorsi, etc. Teach home and work station ___. Train ___and educate on the relationship to PFM relaxation.

transverse abdominis and multifidi, postural muscles, ergonomics, diaphragmatic breathing

characteristics of an ideal pelvic floor muscle contraction: Pelvic floor contracts __ and __. Anus pulls __ and __. Contraction is of ____ to nearly maximum level of intensity. __ or ___ is absent. __ and __ muscle contractions are absent.

upward and inward, inward and lifts upward, moderate, Bearing-down or straining, Thigh and gluteal

Third trimester, ___ very large with reg contractions, common c/o related to __ changes. Senate, ___in, about _ lbs.

uterus, musculoskeletal, 16-19, 7

during the second trimester, pregnancy becomes ____, __ an d__ subside relative to comfort, fetus __lbs, __ in.

visible, nausea and fatigue, 1-2lbs., 14