Pregnancy and Pelvic Floor: An Overview

1. Women’s Health: Obstetrics and Pelvic Floor Chapter 24

2. Overview of pregnancy and related conditions

3. Characteristics of Pregnancy • First Trimester Changes • Second Trimester Changes • Third Trimester Changes

4. Anatomical and Physiological Changes of Pregnancy • Weight Gain During Pregnancy • Changes in Organ Systems • Uterus and related connective tissue • Urinary system • Kidneys • Ureters

5. 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

6. 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

7. Anatomical and Physiological Changes of Pregnancy (cont'd) • Changes in Posture and Balance • Center of gravity • Balance

8. Pelvic Floor Musculature • Female Pelvic Floor • Innervation • Function

9. Effect of Childbirth on the Pelvic Floor • Neurological Compromise • Muscular Impairment • Episiotomy

10. Pelvic Floor Dysfunction • Classification of Pelvic Floor Dysfunction • Prolapse • Urinary or fecal incontinence • Pain and hypertonus • Risk Factors for Dysfunction • Childbirth • Other causes

11. 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

12. Diastasis Recti • Incidence • Significance • Functional limitations • Decreased fetal protection • Potential for herniation • Examination for diastasis recti • Intervention for diastasis recti

13. Postural Back Pain • Incidence • Characteristics • Interventions

14. Sacroiliac/Pelvic Girdle Pain • Characteristics • Interventions • Activity modifications • Exercise modifications • External stabilization

15. Varicose Veins • Characteristics • Interventions • Exercise modifications • External support

16. Joint Laxity • Significance • Interventions • Exercise modifications • Aerobic exercise

17. Nerve Compression Syndromes • Causes • Interventions

18. Exercise Interventions for pregnancy, Labor, and related conditions

19. Maternal Response to Aerobic Exercise • Blood Flow • Respiratory Rate • Hematocrit Level • Inferior Vena Cava Compression • Energy Needs • Core Temperature • Uterine Contractions • Healthy Woman Response

20. Fetal Response to Maternal Aerobic Exercise • Blood Flow • Fetal Heart Rate (FHR) • Heat Dissipation • Newborn Status

21. 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

22. 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

23. 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

24. Critical Areas of Emphasis and Selected Exercise Techniques (cont'd) • Perineum and Adductor Flexibility • Self-stretching

25. Pelvic Floor Awareness, Training, and Strengthening • Contract-Relax • Quick Contractions • “Elevator” Exercise • Pelvic Floor Relaxation

26. Relaxation and Breathing Exercises for Use During Labor • Visual Imagery • Muscle Setting • Selective Tension • Breathing • Relaxation and Breathing During Labor

27. Unsafe Postures and Exercises During Pregnancy • Bilateral Straight-Leg Raising • “Fire Hydrant” Exercise • All-Fours (Quadruped) Hip Extension • Unilateral Weight-Bearing Activities

28. Exercise Critical to the Postpartum Period • Pelvic Floor Strengthening • Diastasis Recti Correction • Aerobic and Strengthening Exercises

29. Cesarean Childbirth • Significance to Physical Therapists • Surgical risks • Interventions • Pelvic floor rehabilitation • Postsurgical rehabilitation • Emotional support

30. 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

31. 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

32. 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