Myopathic gait (or waddling gait) is a form of gait abnormality.The "waddling" is due to the weakness of the proximal muscles of the pelvic girdle.The patient uses circumduction to compensate for gluteal weakness.
Haemostatic changes in pregnancyhttp://www.sciencedirect.com/science/article/pii/S0049384804004475
Pregnancy-Associated Changes in the Thyroid-Stimulating Antibody of Graves’ Disease and the Relationship to Neonatal Hyperthyroidism*http://jcem.endojournals.org/content/57/5/1036.short
Anatomical changes in Pregnancy
Anatomical changes in
Hazrat Bilal Malakandi
semester, DPT, IPM&R KMU
• Pregnancy is the fertilization and development
of one or more offspring, known as an embryo
or fetus, in a woman's uterus.
• Pregnancy results in many anatomical changes
• Few of them are discussed shortly in next slides
Changes in Reproductive organs
– The uterus expands from a strictly pelvic organ
before 12 weeks to become an abdominal
organ for the remainder of gestation.
– the uterus increases in weight from 60 to
1000g (20 times its original weight).
– In size, it changes from 6.5 to 32 cm.
• Its shape changes from elongated to oval by
the second month, to round by midgestation,
then back through oval to elongated at term
(the end of a normal nine-month pregnancy).
• Uterine expansion is caused by the growing
fetus and an increase in connective tissue and
in the size and number of blood vessels
supplying the uterus
• The portion of the uterus connecting the body
of the uterus and the vagina.
• During pregnancy, the cervix is closed. A
mucus plug forms over the cervix ,providing a
protective barrier between the vagina and the
• During labour and delivery, the cervix shortens
and widens (or dilates).
• A 10 cm opening is left between the uterus
and the vagina to allow for passage of the
fetus into the birth canal.
• If the cervix begins dilating prematurely, it is
sometimes stitched together during the
second trimester, until the fetus in mature.
This procedure is known as a cerclage.
Changes in Musculo-skeletal system
• Placental production of the hormone relaxin causes
pelvic ligaments and the pubic symphysis to relax,
widen, and become more flexible.
• This increased motility eases birth passage, but it
may also result in a waddling gait during pregnancy.
• Changes in joint laxity occurring during pregnancy.
By M Calguneri, H A Bird, V Wright
• The expanding uterus causes an
progressive lumbar lordosis.
• Lumbar lordosis leads to low back pain in 40 to
50 percent of all pregnant women.
Carlson HL, Carlson NL, Pasternak BA, Balderston KD. Understanding and managing the
back pain of pregnancy. Curr Womens Health Rep 2003; 3:65.
• Pregnancy and Back Pain . . . . By Kristen Schott, PT, MPT
Increased lordosis in pregnancy due to
increased anterior load.
Center of Gravity
• The increasing bulkiness of the abdomen changes
the woman's center of gravity forward. This shift
increases the stress on your joints and causes your
back to curve forward.
• The change of the center of gravity location in late
pregnancy is temporary and two months after
delivery the center of gravity is located as it was at
the beginning of pregnancy.
• Journal of Huan Kinetics. Volume 26, Issue -1, Pages 5–11, ISSN (Online) 18997562, ISSN (Print) 1640-5544, DOI: 10.2478/v10078-010-0042-1, January 2011
Changes in Respiratory system
• The diaphragm is progressively elevated and
compressed. Possibly because of expansion
and elevation of the rib cage.
• The lungs are compressed due to growing
uterus in later pregnancy making it more
difficult to breathe deeply.
During pregnancy, postural changes occurred.
• These changes include
• forward head,
• rounded shoulders,
• increased lumbar lordosis,
• Center of gravity shift,
• hyperextended knees, and
• pronated feet.
• Muscular changes are also typical. often
noted alterations include shortened hip
flexors, lower back musculature, and
• Abdominal muscles, neck, and upper back
muscle groups elongate.
• Functional Changes in Back Muscle Activity Correlate
With Pain Intensity and Prediction of Low Back Pain
Changes in cutaneous system
• They are usually more marked below the
umbilicus, on the breasts and may appear on the
buttocks and thighs.
• In some women they are not marked or even
don't appear during pregnancy.
• Falling of hairs and brittleness of nails may occur
It is due to suprarenal changes, it usually begins to
appear after the 4th month. The pigmentation
may appear anywhere but the commonest sites
1. Linea nigra: which is a line of pigmentation
between the umbilicus and the symphysis pubis.
2. Cloasma gravidarum or mask face of pregnancy
which is butterfly pigmentation of the forehead,
nose, upper lip and the adjoining parts of the
Changes in weight
• In normal pregnancy the average gain is
– 0.3 Kg/week up to 18 weeks,
– 0.45 Kg/week from 18-28 weeks and
– a slight reduction with a rate of 0.36- 0.41 Kg/week
• Slight weight loss may occur in the last 2 weeks.
The average weight gain for primigravidae is
12.5 Kg. and is probably about 0.9 Kg. less for
Weight gain is produced by:
– Fetus ----------- ------3.63-3.88 Kg
– Placenta -------------- 0.48-0.72 Kg
– Amniotic fluid ------- 0.72-0.97 Kg
– Uterus and breasts - 2.42-2.66 Kg
– Blood and fluid ------ 1.94-3.99 Kg
– Muscle and fat ------ 0.48-2.91 kg