PregnancyPregnancy

Advanced Sports Advanced Sports Medicine 4134Medicine 4134

Dr. Paulo SanzoDr. Paulo Sanzo

November 30, November 30, 20122012

Jeff PloenJeff Ploen Jessica FrenchJessica French Jen WrightJen Wright Ben MacKayBen MacKay

PregnancyPregnancy

First, First,

Then,Then,

And THEN And THEN

General Overview of Nine General Overview of Nine Months of PregnancyMonths of Pregnancy

From Conception to BirthFrom Conception to Birth

The First TrimesterThe First Trimester

Lasts from conception to the twelfth week of Lasts from conception to the twelfth week of pregnancypregnancy

3 periods during the first trimester:3 periods during the first trimester: The Germinal PeriodThe Germinal Period

Fertilized egg travels and implants in wall of uterusFertilized egg travels and implants in wall of uterus Implantation occurs 10-14 days after conceptionImplantation occurs 10-14 days after conception

The Period of the EmbryoThe Period of the Embryo Lasts from third through eighth week of pregnancyLasts from third through eighth week of pregnancy Major organs and anatomical structures begin to formMajor organs and anatomical structures begin to form

The Period of the FetusThe Period of the Fetus Lasts from ninth week of pregnancy until birth Lasts from ninth week of pregnancy until birth All major organs continue rapid growth and become All major organs continue rapid growth and become

interconnectedinterconnected

The Second TrimesterThe Second Trimester

Fetus assumes distinct human Fetus assumes distinct human appearanceappearance

The nails harden and skin thickens, The nails harden and skin thickens, as well as the eye lashes, eye brows, as well as the eye lashes, eye brows, and scalp hair appear during fifth and scalp hair appear during fifth and sixth monthsand sixth months

FetusFetus’’s visual and auditory senses s visual and auditory senses are functional are functional

The Third TrimesterThe Third Trimester

All organ systems mature rapidlyAll organ systems mature rapidly Fetus prepares for birthFetus prepares for birth Fetus reaches ‘age of viability’, the point at Fetus reaches ‘age of viability’, the point at

which the fetus can survive outside of the which the fetus can survive outside of the uterusuterus

Fetus shows better-organized gross motor Fetus shows better-organized gross motor activity, and sleepiness/ waking activityactivity, and sleepiness/ waking activity

Towards end of ninth month, fetus is positioned Towards end of ninth month, fetus is positioned head-down with limbs curled up in ‘fetal head-down with limbs curled up in ‘fetal position’position’

TeratogensTeratogens

External agents such as viruses, drugs, External agents such as viruses, drugs, chemicals and radiation that can harm a chemicals and radiation that can harm a developing embryo or fetus.developing embryo or fetus.

Time when organ system or body part is at Time when organ system or body part is at highest risk of effects from teratogens is highest risk of effects from teratogens is known as ‘sensitive period’.known as ‘sensitive period’.

Effects of teratogens on a body part or organ Effects of teratogens on a body part or organ system are worst during the period when that system are worst during the period when that structure is forming and growing most structure is forming and growing most rapidly.rapidly.

TeratogensTeratogens

The same defect can be caused by The same defect can be caused by different teratogens.different teratogens.

A variety of defects can be caused by a A variety of defects can be caused by a single teratogen.single teratogen.

The longer the exposure or the higher the The longer the exposure or the higher the ‘dose’ of the teratogen, the more likely it ‘dose’ of the teratogen, the more likely it is that serious harm will be done.is that serious harm will be done.

The long-term effects of a teratogen often The long-term effects of a teratogen often depend on the quality of the postnatal depend on the quality of the postnatal environment.environment.

Subjective AssessmentSubjective Assessment

When pregnant female comes to you, the When pregnant female comes to you, the kinesiologist, you should ask:kinesiologist, you should ask: NameName AgeAge Medical historyMedical history Genetic historyGenetic history Previous surgeriesPrevious surgeries Current/past medicationsCurrent/past medications If they have ever or are using “street drugs” or smokingIf they have ever or are using “street drugs” or smoking Alcohol/caffeine useAlcohol/caffeine use Occupation and current working statusOccupation and current working status Marital status and childrenMarital status and children

Objective AssessmentObjective Assessment

When observing the client, evaluate:When observing the client, evaluate: HeightHeight WeightWeight BMIBMI Blood PressureBlood Pressure General alignmentGeneral alignment Range painful movementRange painful movement

Conditions During Conditions During PregnancyPregnancy

ConstipationConstipation Affects half of pregnant womenAffects half of pregnant women Causes: Causes:

increase in progesterone increase in progesterone the colon absorbing more water the colon absorbing more water worse in first 13-14 weeksworse in first 13-14 weeks

Treatment: Treatment: Drink plenty of fluidsDrink plenty of fluids Eat high fiber foodsEat high fiber foods Take fiber supplements – psylium husks, Metamucil, Take fiber supplements – psylium husks, Metamucil,

Ex-LaxEx-Lax EXERCISE! EXERCISE!

Conditions During Conditions During PregnancyPregnancy

FatigueFatigue Almost all women report increased fatigue in the 1st Almost all women report increased fatigue in the 1st

trimester.trimester. Causes: Causes:

Body is working harderBody is working harder More levels of progesterone,More levels of progesterone,

Treatment: Treatment: Take napsTake naps Drink plenty of fluids, but avoid fluids 2-3hr before bed. Drink plenty of fluids, but avoid fluids 2-3hr before bed.

LacLac ExerciseExercise Gentle stretches before bedtime can help prevent Gentle stretches before bedtime can help prevent

nighttime crampingnighttime cramping Eat foods rich in proteinEat foods rich in protein

Conditions During Conditions During PregnancyPregnancy Back Ache Back Ache

Many women experience back aches during 2nd and 3rd Many women experience back aches during 2nd and 3rd trimesterstrimesters Causes:Causes:

Poor posture Poor posture Extra weightExtra weight Change in centre of gravityChange in centre of gravity HormonesHormones

Treatment:Treatment: Pay attention to posturePay attention to posture Exercise Exercise

Swimming Swimming Pillow support in bed Pillow support in bed Ask for assistance when lifting heavy objectsAsk for assistance when lifting heavy objects Heat/coldHeat/cold MassageMassage Support beltSupport belt Wear supportive low heel shoesWear supportive low heel shoes

Benefits of Exercise During Benefits of Exercise During PregnancyPregnancy

Maintenance/improvement of maternal fitnessMaintenance/improvement of maternal fitness Control of excess weight gainControl of excess weight gain Improved posture and appearanceImproved posture and appearance Increased energyIncreased energy Improved sleepImproved sleep Decreased incidence of back painDecreased incidence of back pain Improved self-esteemImproved self-esteem Decreased incidence of varicose veinsDecreased incidence of varicose veins Decreased water retentionDecreased water retention Decreased level of tensionDecreased level of tension Possible decrease in complications during labourPossible decrease in complications during labour Shortened labourShortened labour More rapid postpartum recoveryMore rapid postpartum recovery

Disadvantages of Not Disadvantages of Not ExercisingExercising

Studies have shown that women who Studies have shown that women who exercise do not experience an exercise do not experience an increase in:increase in: Premature Rupture of Membranes Premature Rupture of Membranes

(PROM)(PROM) When the membranes that hold the amniotic When the membranes that hold the amniotic

fluid break too early.fluid break too early. Congenital AbnormalitiesCongenital Abnormalities

Risk ReductionRisk Reduction

Pre-Eclampsia (Toxemia)Pre-Eclampsia (Toxemia) Occurs only during pregnancy and the postpartum periodOccurs only during pregnancy and the postpartum period Affects 5-8% of all pregnanciesAffects 5-8% of all pregnancies Causes blood vessels to constrict resulting in high blood Causes blood vessels to constrict resulting in high blood

pressure and a decrease in blood flow to organs and pressure and a decrease in blood flow to organs and uterus.uterus.

Having high blood pressure before pregnancy puts you at Having high blood pressure before pregnancy puts you at risk, also having a BMI of 30 or morerisk, also having a BMI of 30 or more

Characterized by high blood pressure and presence of Characterized by high blood pressure and presence of protein in the urineprotein in the urine

Symptoms: excess swelling of hands and feet, headaches, Symptoms: excess swelling of hands and feet, headaches, changes in visions, vomiting blood, ringing in the earschanges in visions, vomiting blood, ringing in the ears

Occurs in the 2nd or 3rd trimestersOccurs in the 2nd or 3rd trimesters

Kinesiologist’s RoleKinesiologist’s Role

Exercises During PregnancyExercises During Pregnancy

Low impact aerobicsLow impact aerobics Water aerobicsWater aerobics WalkingWalking Kegels Kegels PilatesPilates YogaYoga CyclingCycling SwimmingSwimming

Kegels Kegels

Help prepare body for labour Help prepare body for labour Kegel exercises are easy to do - can Kegel exercises are easy to do - can

be done anywherebe done anywhere Kegels help strengthen the pelvic Kegels help strengthen the pelvic

floor musclesfloor muscles Many women do kegel exercises to Many women do kegel exercises to

prevent incontinenceprevent incontinence

Yoga (prenatal) Yoga (prenatal)

Help with breathing and relaxationHelp with breathing and relaxation Promote feelings of well-beingPromote feelings of well-being EnergizingEnergizing Stress reliefStress relief Improve posture Improve posture Meet others who are facing the same Meet others who are facing the same

challengeschallenges Note: Avoid positions lying on the back Note: Avoid positions lying on the back

WalkingWalking

Vary the intensity Vary the intensity Less impact on the knees and anklesLess impact on the knees and ankles Easy way to start exercisingEasy way to start exercising Supportive shoesSupportive shoes Water bottleWater bottle Spray bottleSpray bottle Maintain good postureMaintain good posture

SwimmingSwimming

Uses large muscle groups of the legs Uses large muscle groups of the legs and armsand arms

No strain on ligaments No strain on ligaments Feeling of weightlessnessFeeling of weightlessness Improved circulationImproved circulation Water Temp 18-25 °CWater Temp 18-25 °C

Exercises to Avoid During Exercises to Avoid During PregnancyPregnancy

Ball sportsBall sports Contact sports: ultimate fighting, wrestling, footballContact sports: ultimate fighting, wrestling, football Sports that involve bouncing, leaping, a sudden Sports that involve bouncing, leaping, a sudden

change of direction (increased joint laxity from change of direction (increased joint laxity from hormones make joints susceptible to sprains)hormones make joints susceptible to sprains)

Exercises that put you at risk for falls: Exercises that put you at risk for falls: rollerblading, horseback ridding, skiingrollerblading, horseback ridding, skiing

After 1st trimester avoid exercise in the supine After 1st trimester avoid exercise in the supine position position

Lying in the prone positionLying in the prone position Lifting heavy free weights Lifting heavy free weights

Contraindications to Contraindications to ExerciseExercise

Pregnancy induced hypertensionPregnancy induced hypertension Premature rupture of membranesPremature rupture of membranes Preterm labor during the prior or current pregnancyPreterm labor during the prior or current pregnancy Persistent 2nd or 3rd trimester bleedingPersistent 2nd or 3rd trimester bleeding There should be an evaluation to determine whether an exercise There should be an evaluation to determine whether an exercise

program is appropriate if the woman has conditions such as: program is appropriate if the woman has conditions such as: Cardiac disease, constrictive lung diseaseCardiac disease, constrictive lung disease Chronic hypertensionChronic hypertension Severe anemia Severe anemia Chronic bronchitisChronic bronchitis Extreme obesityExtreme obesity Extreme underweightExtreme underweight History of an extremely sedentary lifestyleHistory of an extremely sedentary lifestyle Orthopedic limitationsOrthopedic limitations Heavy smokerHeavy smoker

CONTRAINDICATION/PRECAUTION

 Pregnancy (around foetus)

Pregnancy (anywhe

re)

NON THERMAL    

ULTRASOUND (NON THERMAL) CI  

PULSED SHORTWAVE CI CI

LASER    

     

TENS CI  

INTERFERENTIAL CI  

LOW FREQUENCY CI  

CI  

   CONTRAINDICATION/PRECAUTION Pregnancy (around feotus)

Pregnancy(anywhere)  

HEAT    

INFRARED    

WAX    

SHORTWAVE (CONT/PULSED) CI CI

MICROWAVE CI CI

HOT PACK    

     

OTHER    

BIOFEEDBACK (NO STIMULATION)    

COLD THERAPY P  

ULTRA VIOLET RADIATION Psee modality

details

Recommendations for Recommendations for ExerciseExercise

Beginners Beginners non weight bearing activities pose the least risk of injurynon weight bearing activities pose the least risk of injury 20 – 30 minutes of activity a day at a comfortable pace20 – 30 minutes of activity a day at a comfortable pace

Previously active women Previously active women participation in aerobic activities are generally safeparticipation in aerobic activities are generally safe Exercise in high altitudes is not recommended Exercise in high altitudes is not recommended

Running Running can be continued late into pregnancy to maintain fitness, less than 45 can be continued late into pregnancy to maintain fitness, less than 45

minmin Weight training Weight training

light weights and moderate reps will maintain flexibility and muscle light weights and moderate reps will maintain flexibility and muscle tone and reduce the risk of joint/ligament injurytone and reduce the risk of joint/ligament injury

Should be able to converse while exercising – vigorous exercise Should be able to converse while exercising – vigorous exercise offers no benefits during pregnancy, only more complicationsoffers no benefits during pregnancy, only more complications

Listen to your body – stop if you feel breathless, nausea, dizzy, Listen to your body – stop if you feel breathless, nausea, dizzy, tiredtired

Pulse should NEVER exceed 140 beats per minute!Pulse should NEVER exceed 140 beats per minute!

Recommendations for Recommendations for ExerciseExercise

Positions/Posture:Positions/Posture: Avoid lying on your back after 12th week of pregnancy Avoid lying on your back after 12th week of pregnancy Abdominal exercises Abdominal exercises Avoid standing for long periods Avoid standing for long periods Avoid back swaying (lordosis) – cat back stretch, Avoid back swaying (lordosis) – cat back stretch,

strengthen abdominalsstrengthen abdominals Rounded upper back (kyphosis) – chest stretches, upper Rounded upper back (kyphosis) – chest stretches, upper

back strengtheningback strengthening Avoid valsalva maneuver – increase blood and intra-Avoid valsalva maneuver – increase blood and intra-

abdominal pressure abdominal pressure Avoid lying in the prone position after the 1st trimesterAvoid lying in the prone position after the 1st trimester

Pelvic TiltsPelvic Tilts

Side Leg LiftsSide Leg Lifts

Alternating Arm/Leg RaiseAlternating Arm/Leg Raise

Precautions for ExercisePrecautions for Exercise

Dehydration and hyperthermia: Dehydration and hyperthermia: Avoid exercise in hot humid environmentsAvoid exercise in hot humid environments Drink plenty of liquids – prior, during, afterDrink plenty of liquids – prior, during, after Appropriate clothing may help dissipate heatAppropriate clothing may help dissipate heat Hot tubs/saunasHot tubs/saunas

Poor Balance:Poor Balance: Centre of gravity shifts as pregnancy progresses Centre of gravity shifts as pregnancy progresses Exercise cautiouslyExercise cautiously Pay attention to changes to terrainPay attention to changes to terrain

Muscle cramps and soreness:Muscle cramps and soreness: Stretch muscles and warm-up before exercisingStretch muscles and warm-up before exercising Wear supportive well cushioned shoesWear supportive well cushioned shoes

Don’t over do it!Don’t over do it!

Watch for dizziness, blurred vision, Watch for dizziness, blurred vision, nausea, shortness of breathnausea, shortness of breath

Stop or slow downStop or slow down Heart rate should not exceed 140-Heart rate should not exceed 140-

145 beats per minute145 beats per minute Contact doctor the following occur: Contact doctor the following occur:

vaginal bleeding, uterine vaginal bleeding, uterine contractions, leaking amniotic fluid contractions, leaking amniotic fluid

And Finally…And Finally…

Exam Question 1Exam Question 1

Of the following, which are Of the following, which are contraindications to exercise during contraindications to exercise during pregnancy?pregnancy? A) Pregnancy induced hypertensionA) Pregnancy induced hypertension B) Premature rupture of membranesB) Premature rupture of membranes C) Persistent 2nd or 3rd trimester bleedingC) Persistent 2nd or 3rd trimester bleeding D) Preterm labor during the prior or current D) Preterm labor during the prior or current

pregnancypregnancy E) All of the aboveE) All of the above

Exam Question 2Exam Question 2

What is the hormone responsible for What is the hormone responsible for excessive joint laxity found in excessive joint laxity found in pregnant women.pregnant women. A) relaxinA) relaxin B) progesteroneB) progesterone C) testosteroneC) testosterone D) estrogenD) estrogen E) gonadotropinE) gonadotropin

Exam Question 3Exam Question 3

What are some good exercises for a What are some good exercises for a pregnant woman?pregnant woman? A) SwimmingA) Swimming B) KegalsB) Kegals C) Ultimate FightingC) Ultimate Fighting D) A and CD) A and C E) A and BE) A and B