Pregnancy Flashcards
Contraindication to exercise
Cardio issue
* Hemodynamically significant heart disease
* Preeclampsia/pregnancy induced hypertension
Pulmonary issue
* Restrictive lung disease
Pregnant related:
* Incompetent cervix
* Multiple gestation with risk of preterm labor
* Persistent 2nd or 3rd trimester bleeding
* Placenta previa after 26 weeks of gestation
* Ruptured membranes
Precaution
Cardio issue
* Severe anemia
* Unevaluated maternal cardiac dysrhythmia
* Poorly controlled hypertension
Pulmonary issue
* Chronic bronchitis
* Heavy smoker
Systemic issue
* Poorly controlled type 1 diabetes mellitus
* Extreme morbid obesity
* Extreme underweight
* Orthopedic limitation
* Poorly controlled seizure disorder
* Poorly controlled hyperthyroidism
* History of extremely sedentary lifestyle
Pregnant related issue:
* Intrauterine growth restriction in current pregnancy
* History of precipitous labor
Exercise guideline
Frequency: varies
Intensity:
HR<140 bpm/60-70% HRmax
measure at the peak of activity
Time: based on RPE
Type:
**Avoid end range exercise of joints (ligament laxity)
**Avoid planks/crunch/sit up–>avoid increase pressure to diastasis
Change of body during Pregnancy
Physical & Postural changes
- Normal weight gain = 20-30 lbs
- Inc.Cx & Lx lordosis, Tx kyphosis
- Scapular protraction, rounded shoulder
- C.G. shift upward & forward
- Weight shift to heel
- Genu recurvatum
- Inc. foot pronation
- Ligament Laxity–>due to relaxin
Cardiovascular changes
- HR: inc 10-20 BPM by full term
- CO: inc 30-60% in pregnancy
Positioning
Best:
Left side lying+ pillow between knees+pillow underbelly
(can change to right)
**no supine: weight of fetus–>press on vena cava
**no prone
Supine: high fowler
Cesarean Section Precaution and ambulation
Precaution:
o No lifting or pushing (e.g. lifting car seat or pushing stroller) > 10-15lbs for 6 weeks
o Limit stairs as much as possible
o No core exercises (except PF/TA) for 6 weeks
o Log roll into and out of bed – no crunching for 6 weeks
Ambulation:
0-2 week: <20 min walk, indoor+relative rest
2-4 week: 20-30 min walk
>4 week: 45 min walk if symptom free, can add small inclines & increase as tolerated
Cesarean Section Consideration
-Deep diaphragmatic breathing
-Kegel and reverse kegel
Posture:
**avoid slouching
**upright standing/walking, laying straight
**bring baby to breast (avoid flexion)
Early scare care:
TENS–>incision pain
Watch out for signs of infection
Splinting for movement:
- Light pressure to scar during transfer
- Splint scar when bowel movement, coughing/sneezing
Diastasis Recti Abdominis (DRA)
Etiology, Presentation
Etiology:
-normal during pregnancy and early postpartum
-should resolve in 2-6 months
Presentation:
- Can result in back pain.
- May see abdominal bulge/doming
Diastasis Recti Abdominis (DRA) Exercise Consideration & Recommendation
-Core exercises: TRA, multifidus
-Kegel and reverse kegel
-Deep breathing exercises to strengthen diaphragm
**Do not perform sit-ups, straight leg raise or any core activity
**exhale on exertion to avoid valsalva
Recommendation:
- External support: KT/Abdominal binder
- Correct movement pattern e.g. supine to sit
Diastasis Recti Abdominis Testing
With 1-2 fingers beside each other, place your finger(s) perpendicular to spine at 3 different locations along the midline of the rectus abdominus:
- ½ way between umbilicus and xiphoid process
- Level of umbilicus
- ½ way between umbilicus and pubic symphysis
Ask the patient to bring their head and shoulders up off the bed/plinth
–> Assess the spacing at each of the above levels
Palpate for a separation of rectus abdominis/widening of linea alba
>2.5cm or 2 fingers width is significant
Kegel
- Exhale–>diaphragm move up
- Gentle contraction and lift of the pelvic floor
E.g. Close flower/jellyfish and lift
**lengthen after each contraction
–>avoid overtightening
Reverse Kegel
- Inhale–>diaphragm move down
- lengthen/ relax of the pelvic floor
E.g.blossom flower/open jellyfish
Placenta Previa
- Placenta is in a position below the fetus
- Continue: Pelvic floor & breathing exercise
Stop abdominal exercise
Preeclampsia
- Acute hypertension after 24wks gestation:
S/S:
- hypertension
- edema
- headache, visual disturbance
- hyperreflexia.
