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
