1. Copyright © 2013. F.A. Davis Company Part V: Special Areas of Therapeutic Exercise Chapter 24 Women’s Health: Obstetrics and Pelvic Floor

2. Copyright © 2013. F.A. Davis Company OVERVIEW OF PREGNANCY AND RELATED CONDITIONS

3. Copyright © 2013. F.A. Davis Company  First Trimester Changes  Second Trimester Changes  Third Trimester Changes Characteristics of Pregnancy

4. Copyright © 2013. F.A. Davis Company  Weight Gain During Pregnancy  Changes in Organ Systems – Uterus and related connective tissue – Urinary system Kidneys Ureters Anatomical and Physiological Changes of Pregnancy

5. Copyright © 2013. F.A. Davis Company  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)

6. Copyright © 2013. F.A. Davis Company  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)

7. Copyright © 2013. F.A. Davis Company  Changes in Posture and Balance – Center of gravity – Balance Anatomical and Physiological Changes of Pregnancy (cont'd)

8. Copyright © 2013. F.A. Davis Company  Female Pelvic Floor  Innervation  Function Pelvic Floor Musculature

9. Copyright © 2013. F.A. Davis Company  Neurological Compromise  Muscular Impairment  Episiotomy Effect of Childbirth on the Pelvic Floor

10. Copyright © 2013. F.A. Davis Company  Classification of Pelvic Floor Dysfunction – Prolapse – Urinary or fecal incontinence – Pain and hypertonus  Risk Factors for Dysfunction – Childbirth – Other causes Pelvic Floor Dysfunction

11. Copyright © 2013. F.A. Davis Company  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 Interventions for Pelvic Floor Impairments

12. Copyright © 2013. F.A. Davis Company Diastasis Recti  Incidence  Significance – Functional limitations – Decreased fetal protection – Potential for herniation  Examination for diastasis recti  Intervention for diastasis recti

13. Copyright © 2013. F.A. Davis Company  Incidence  Characteristics  Interventions Postural Back Pain

14. Copyright © 2013. F.A. Davis Company  Characteristics  Interventions – Activity modifications – Exercise modifications – External stabilization Sacroiliac/Pelvic Girdle Pain

15. Copyright © 2013. F.A. Davis Company  Characteristics  Interventions – Exercise modifications – External support Varicose Veins

16. Copyright © 2013. F.A. Davis Company  Significance  Interventions – Exercise modifications – Aerobic exercise Joint Laxity

17. Copyright © 2013. F.A. Davis Company  Causes  Interventions Nerve Compression Syndromes

18. Copyright © 2013. F.A. Davis Company EXERCISE INTERVENTIONS FOR PREGNANCY, LABOR, AND RELATED CONDITIONS

19. Copyright © 2013. F.A. Davis Company  Blood Flow  Respiratory Rate  Hematocrit Level  Inferior Vena Cava Compression  Energy Needs  Core Temperature  Uterine Contractions  Healthy Woman Response Maternal Response to Aerobic Exercise

20. Copyright © 2013. F.A. Davis Company  Blood Flow  Fetal Heart Rate (FHR)  Heat Dissipation  Newborn Status Fetal Response to Maternal Aerobic Exercise

21. Copyright © 2013. F.A. Davis Company  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 Exercise for the Uncomplicated Pregnancy and Postpartum

22. Copyright © 2013. F.A. Davis Company  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

23. Copyright © 2013. F.A. Davis Company  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

24. Copyright © 2013. F.A. Davis Company  Perineum and Adductor Flexibility – Self-stretching Critical Areas of Emphasis and Selected Exercise Techniques (cont'd)

25. Copyright © 2013. F.A. Davis Company  Contract-Relax  Quick Contractions  “Elevator” Exercise  Pelvic Floor Relaxation Pelvic Floor Awareness, Training, and Strengthening

26. Copyright © 2013. F.A. Davis Company  Visual Imagery  Muscle Setting  Selective Tension  Breathing  Relaxation and Breathing During Labor Relaxation and Breathing Exercises for Use During Labor

27. Copyright © 2013. F.A. Davis Company  Bilateral Straight-Leg Raising  “Fire Hydrant” Exercise  All-Fours (Quadruped) Hip Extension  Unilateral Weight-Bearing Activities Unsafe Postures and Exercises During Pregnancy

28. Copyright © 2013. F.A. Davis Company  Pelvic Floor Strengthening  Diastasis Recti Correction  Aerobic and Strengthening Exercises Exercise Critical to the Postpartum Period

29. Copyright © 2013. F.A. Davis Company  Significance to Physical Therapists – Surgical risks – Interventions Pelvic floor rehabilitation Postsurgical rehabilitation Emotional support Cesarean Childbirth

30. Copyright © 2013. F.A. Davis Company  Exercises  Coughing or Huffing  Interventions to Relieve Intestinal Gas Pains – Abdominal massage or kneading – Pelvic tilting and/or bridging – Bridge and twist  Scar Mobilization Suggested Activities for the Patient Following a Cesarean Section

31. Copyright © 2013. F.A. Davis Company  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

32. Copyright © 2013. F.A. Davis Company  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 High-Risk Pregnancy (cont'd)