pregnancy part 1 Flashcards
common changes with pregnancy
weight
gain 25 to 35 lbs
postural changes
➤ Kyphosis with scapular protraction and shoulder internal rotation
➤ Increased cervical spine and lumbar lordosis, forward head posture
COG
➤ Center of gravity (COG) shifts forward and upward because of enlargement of the
uterus and breasts
➤ Wider base of support (BOS) during advanced pregnancy with external rotation
at the hip joint; difficulty with walking and stair climbing
ligamentous instability
➤ Sacroiliac (SI) joint hypermobility and pain
➤ Leads to increased predisposition for injury to weight-bearing joints: low back,
lower extremities, pelvis
Recommend non-weight-bearing (NWB) or less stressful activities (swimming,
walking, stationary bike)
muscle weakness
➤ Abdominal muscles are stretched and weak, pelvic floor weakness
➤ Back pain → excessive lifting, bending, and walking can produce pain
urinary changes
➤ Pressure on the bladder causes frequent urination and increased incidence of
reflux and UTIs
➤ Stress incontinence (80% of the time) due to weakness of the pelvic floor muscle
respiratory changes
➤ Depth of respiration increases
➤ Tidal volume and minute ventilation increase, whereas total lung capacity is
unchanged or decreases slightly
➤ Natural state of hyperventilation exists during pregnancy to meet the increased
oxygen demands during pregnancy
➤ Diaphragm is elevated and thoracic cage widens → hyperventilation, with mild
exercise
cardiac changes
➤ Blood volume increases throughout pregnancy and returns to normal 6 to 8 weeks
postpartum
➤ Venous pressure increases in the lower extremities, especially during standing;
due to increased venous distensibility and increased uterine size
Changes due to venous distensibility: ↑ HR, ↑ cardiac output (CO), ↓ BP
BP is often low in the early 1st trimester and may increase in last trimester
⚬ Slight decrease in SBP with greater decrease in DBP
cardiac changes 2
HR increases by 10 to 20 beats per minute by full term; returns to normal 6
weeks postpartum
CO increases by 30% to 60%
⚬ Increases significantly during left side-lying, as there is less pressure on
the aorta by the uterus
⚬ Note: Left side-lying is preferred throughout pregnancy > avoids supine hypoten-
sive syndrome
metabolic changes
➤ Increased basal metabolic rate and heat production
➤ Lower fasting blood glucose levels
➤ Body requires an additional 300 kcal per day to maintain homeostasis
➤ Stroke volume (SV) and CO increase with exercise
relaxation treatment
Jacobson progressive relaxation, mental imagery, yoga
breathing management
slow, deep, diaphragmatic breathing; Lamaze techniques
➤ Avoid Valsalva maneuver
FITT
➤ Frequency: 3 to 4 days per week
➤ For prepregnancy BMI < 25 kg/m2, moderate-intensity exercises are recommended
➤ For prepregnancy BMI ≥ 25 kg/m2, low-intensity exercises recommended
➤ Start with 15 minutes and progress to 30 minutes, for a total of 150 minutes per
week at recommended intensity
Include 10– to 15–minute warm-up and 10– to 15–minute cooldown
➤ Dynamic, rhythmic large-muscle exercises: walking,
exercises
➤ Postural education and exercises
Stretch and strengthen appropriate muscles
➤ Pelvic stabilization exercises
➤ Pelvic floor muscle exercises
➤ Focus on strengthening trunk flexors, hip extensors, and pelvic floor muscle
➤ Ankle pumps for late-stage pregnancy; elevate legs to assist in venous return
➤ Progress from gravity-assisted to standing positions as strength and awareness
increase
Why is left side lying beneficial
Decreases IVC compression, maximizes CO, improves circulation, decreases
GERD as internal organs are relaxed, and improves maternal and fetal
circulation
contraindicated
● No supine lying during 3rd trimester
➤ Supine hypotensive syndrome → compression of IVC due to uterus
In supine position, add a pillow or wedge under the right hip to improve CO
Avoid > 5 minutes in supine position after first trimester
contraindicated modalities
➤ Therapeutic ultrasound (US) and traction: low back, pelvis, and abdomen are
contraindicated
➤ Electrical stimulation is contraindicated as well: low back, pelvis, abdomen
Iontophoresis is also contraindicated: low back, pelvis, abdomen
➤ Can use superficial heat and ice during pregnancy
However, use superficial heat with caution during pregnancy
exrecises contraindicated
➤ Bilateral straight leg raising (SLR): stress on abdominal muscle
➤ Fire hydrant exercise: SI joint and lumbar spine can be stressed
➤ Quadruped hip extension: beyond anatomical range
➤ Unilateral weight-bearing, excessive hip abduction, or hyperextension: SI joint
irritation
prolonged periods of motionless standing can cause
Compresses IVC
absolute contraindication
● Preeclampsia, severe anemia, restrictive lung disease, type 1 diabetes
Precautions for pregnancy
● Vaginal bleeding
● Persistent pain: chest, pelvic girdle, low back
● Leakage of amniotic fluid
● Painful contractions that persist beyond exercise session
● Shortness of breath
● Tachycardia
● Headache, dizziness
● Swelling and/or pain in calf
post cesarean complication
● Cesarean section: surgical delivery of the fetus by an incision through the abdominal
wall and uterus
● General, spinal, or epidural anesthesia may be used
● 1 to 3 days post: breathing exercises, coughing or huffing to loosen phlegm, and pelvic `floor exercises
● Later: gentle partial sit-ups and head lifts, low-intensity aerobic exercises, pelvic tilts
in quadruped position
post cesarean complication part 2
➤ Risk of pulmonary, GI, and/or vascular complications
➤ Postsurgical pain and discomfort
➤ Incision site: adhesion development, scar tissue formation
➤ Faulty posture
➤ Pelvic floor dysfunction
Abdominal muscle weakness
pelvic floor dysfunction
Urinary or fecal incontinence
Organ prolapse
Overactivity
Poor proprioceptive awareness and disuse atrophy
Pain throughout the pelvic girdle and trunk
