PMC High-Risk Pregnancy Considerations 3 — Questions and Answers
Question 1: A client with a twin pregnancy at 30 weeks asks about massage positioning. The safest primary position is:
- Prone with a pregnancy pillow
- Supine with a wedge under the right hip
- Semi-reclined left lateral or full left lateral (Correct answer)
- Seated upright in a massage chair
Correct answer: Semi-reclined left lateral or full left lateral
Left lateral positioning relieves aortocaval compression, which is more pronounced in multiple pregnancies due to the larger uterine mass.
Question 2: Which blood pressure reading at rest would classify a pregnant client as having chronic hypertension (not gestational)?
- 120/80 mmHg at 36 weeks
- 140/90 mmHg first recorded at 32 weeks
- 135/85 mmHg after a stressful day at 38 weeks
- 140/90 mmHg documented before 20 weeks gestation (Correct answer)
Correct answer: 140/90 mmHg documented before 20 weeks gestation
Hypertension documented before 20 weeks gestation (or pre-existing before pregnancy) is classified as chronic hypertension, not a pregnancy-induced disorder.
Question 3: Massage therapy may benefit a client with hyperemesis gravidarum (HG) primarily by:
- Stimulating the digestive system to improve nutrient absorption
- Reducing anxiety and sympathetic nervous system activity that can worsen nausea (Correct answer)
- Applying deep pressure to the abdomen to relieve cramping
- Providing acupressure on forbidden pregnancy points to stop vomiting
Correct answer: Reducing anxiety and sympathetic nervous system activity that can worsen nausea
Reducing stress and sympathetic tone through gentle massage can indirectly lessen nausea severity, as anxiety significantly worsens HG symptoms.
Question 4: A prenatal client discloses a history of preterm labor in her previous pregnancy. The therapist should:
- Decline to treat her until after 37 weeks
- Obtain physician clearance and avoid techniques known to stimulate contractions (Correct answer)
- Limit sessions to 20 minutes to minimize stimulation
- Focus only on upper body work regardless of her current symptoms
Correct answer: Obtain physician clearance and avoid techniques known to stimulate contractions
A history of preterm labor is a significant risk factor; physician clearance ensures the care plan is appropriate and avoids contraindicated techniques.
Question 5: Which acupressure point is considered most contraindicated during high-risk pregnancy due to its potential to stimulate uterine contractions?
- LI 4 (Hegu) — webbing between thumb and index finger
- GB 21 (Jianjing) — shoulder well point
- SP 6 (Sanyinjiao) — above the medial malleolus (Correct answer)
- ST 36 (Zusanli) — below the knee on the tibia
Correct answer: SP 6 (Sanyinjiao) — above the medial malleolus
SP 6 (Spleen 6) is strongly contraindicated in pregnancy as it has traditional associations with stimulating uterine contractions and cervical dilation.
Question 6: Symphysis pubis dysfunction (SPD) in pregnancy is best addressed by the massage therapist through:
- Deep adductor stretching to realign the pelvis
- Avoiding all hip and pelvic work and referring to physical therapy
- Gentle myofascial work on hip muscles and avoiding techniques that separate the knees widely (Correct answer)
- Applying joint mobilization to the pubic symphysis
Correct answer: Gentle myofascial work on hip muscles and avoiding techniques that separate the knees widely
Gentle soft-tissue work around the hips and pelvis can reduce SPD discomfort, but techniques that separate or stress the symphysis joint must be avoided.
Question 7: A client at 34 weeks with IUGR (intrauterine growth restriction) asks if massage is safe. The most accurate response is:
- Massage is contraindicated because it may reduce blood flow to the fetus
- With physician clearance, gentle massage focusing on relaxation is generally appropriate (Correct answer)
- Only deep tissue techniques are beneficial as they improve placental perfusion
- Massage is completely safe and no modifications are needed for IUGR
Correct answer: With physician clearance, gentle massage focusing on relaxation is generally appropriate
With obstetric provider clearance, gentle relaxation-focused massage is appropriate for IUGR clients, as stress reduction may support maternal well-being without harming fetal circulation.
PMC High-Risk Pregnancy Considerations 3
A client with a twin pregnancy at 30 weeks asks about massage positioning.
The safest primary position is: