PMC Contraindications & Risk Factors 3 — Questions and Answers
Question 1: During which trimester is the supine hypotensive syndrome (aortocaval compression) most likely to occur and why?
- First trimester, because hormonal changes dilate blood vessels maximally
- Second trimester, because the placenta reaches peak size
- Third trimester, because the enlarged uterus compresses the vena cava when supine (Correct answer)
- Equally likely in all trimesters due to progesterone effects
Correct answer: Third trimester, because the enlarged uterus compresses the vena cava when supine
By the third trimester the uterus is large enough to compress the inferior vena cava in the supine position, reducing venous return and causing hypotension.
Question 2: A client in her second trimester reports that she had a pulmonary embolism two years ago. This information indicates:
- No special precautions are needed since the event was pre-pregnancy
- A history of thromboembolism is a high-risk factor requiring medical clearance before massage (Correct answer)
- Only the legs should be avoided; the rest of the body can be massaged normally
- Massage is absolutely contraindicated for the remainder of the pregnancy
Correct answer: A history of thromboembolism is a high-risk factor requiring medical clearance before massage
A personal history of pulmonary embolism signals an elevated risk of clotting; medical clearance is mandatory before initiating prenatal massage.
Question 3: Which site is considered a local contraindication on ALL prenatal clients regardless of trimester?
- The gluteal region
- SP6 (Spleen 6) acupressure point on the inner ankle (Correct answer)
- The upper trapezius muscle belly
- The lateral aspect of the forearm
Correct answer: SP6 (Spleen 6) acupressure point on the inner ankle
SP6, located four finger-widths above the medial malleolus, is traditionally avoided in pregnancy because sustained pressure may stimulate uterine contractions.
Question 4: A client at 32 weeks reports sudden onset of bright red, painless vaginal bleeding this morning. She says she feels fine now. The therapist should:
- Proceed with the massage since she feels fine and the bleeding has stopped
- Advise her to call her OB immediately and not perform massage until cleared (Correct answer)
- Perform only light craniosacral work avoiding the lower body
- Reschedule for next week and monitor if bleeding recurs
Correct answer: Advise her to call her OB immediately and not perform massage until cleared
Painless bright red bleeding in the third trimester is a classic presentation of placenta previa; immediate medical evaluation is required regardless of current symptom relief.
Question 5: Severe symphysis pubis dysfunction (SPD) in a prenatal client primarily requires the therapist to:
- Avoid all leg and hip work entirely for the duration of pregnancy
- Use caution with hip abduction, adduction, and any technique that stresses the pubic joint (Correct answer)
- Massage the adductors deeply to relieve the pain
- Apply strong traction to both legs simultaneously to decompress the joint
Correct answer: Use caution with hip abduction, adduction, and any technique that stresses the pubic joint
SPD involves instability of the pubic symphysis; movements that force the joint apart or together can worsen pain and inflammation.
Question 6: Which condition would be classified as a relative contraindication, allowing massage after medical clearance?
- Active preterm labor with cervical dilation
- Placental abruption confirmed by ultrasound
- Well-controlled gestational hypertension with physician approval (Correct answer)
- Ruptured membranes with suspected infection
Correct answer: Well-controlled gestational hypertension with physician approval
Well-controlled gestational hypertension with documented physician approval is a relative contraindication where modified massage may proceed safely under medical guidance.
Question 7: A pregnant client at 24 weeks reports her doctor diagnosed her with polyhydramnios. How does this affect massage planning?
- Polyhydramnios has no impact on massage positioning or pressure
- The therapist should use only prone positioning to reduce uterine pressure
- Massage requires medical clearance and extra care with positioning due to the enlarged uterine size and associated risks (Correct answer)
- Deep abdominal work is encouraged to help redistribute amniotic fluid
Correct answer: Massage requires medical clearance and extra care with positioning due to the enlarged uterine size and associated risks
Polyhydramnios (excess amniotic fluid) enlarges the uterus more than typical and is associated with fetal and maternal complications, warranting medical clearance and careful positioning.
PMC Contraindications & Risk Factors 3
During which trimester is the supine hypotensive syndrome (aortocaval compression) most likely to occur and why?