Pregnancy

1. Advanced Sports Medicine 4134 Dr. Paulo Sanzo November 30, 2012 Jeff Ploen Jessica French Jen Wright Ben MacKay Pregnancy

2. Pregnancy

3. First,

4. Then,

5. And THEN

6. General Overview of Nine Months of Pregnancy From Conception to Birth

7. The First Trimester Lasts from conception to the twelfth week of pregnancy • 3 periods during the first trimester: • The Germinal Period • Fertilized egg travels and implants in wall of uterus • Implantation occurs 10-14 days after conception • The Period of the Embryo • Lasts from third through eighth week of pregnancy • Major organs and anatomical structures begin to form • The Period of the Fetus • Lasts from ninth week of pregnancy until birth • All major organs continue rapid growth and become interconnected

8. The Second Trimester Fetus assumes distinct human appearance • The nails harden and skin thickens, as well as the eye lashes, eye brows, and scalp hair appear during fifth and sixth months • Fetus’s visual and auditory senses are functional

9. The Third Trimester All organ systems mature rapidly • Fetus prepares for birth • Fetus reaches ‘age of viability’, the point at which the fetus can survive outside of the uterus • Fetus shows better-organized gross motor activity, and sleepiness/ waking activity • Towards end of ninth month, fetus is positioned head-down with limbs curled up in ‘fetal position’

11. Teratogens • External agents such as viruses, drugs, chemicals and radiation that can harm a developing embryo or fetus. • Time when organ system or body part is at highest risk of effects from teratogens is known as ‘sensitive period’. • Effects of teratogens on a body part or organ system are worst during the period when that structure is forming and growing most rapidly.

12. Teratogens • The same defect can be caused by different teratogens. • A variety of defects can be caused by a single teratogen. • The longer the exposure or the higher the ‘dose’ of the teratogen, the more likely it is that serious harm will be done. • The long-term effects of a teratogen often depend on the quality of the postnatal environment.

14. Subjective Assessment • When pregnant female comes to you, the kinesiologist, you should ask: • Name • Age • Medical history • Genetic history • Previous surgeries • Current/past medications • If they have ever or are using “street drugs” or smoking • Alcohol/caffeine use • Occupation and current working status • Marital status and children

15. Objective Assessment • When observing the client, evaluate: • Height • Weight • BMI • Blood Pressure • General alignment • Range painful movement

16. Conditions During Pregnancy • Constipation • Affects half of pregnant women • Causes: • increase in progesterone • the colon absorbing more water • worse in first 13-14 weeks • Treatment: • Drink plenty of fluids • Eat high fiber foods • Take fiber supplements – psylium husks, Metamucil, Ex-Lax • EXERCISE!

17. Conditions During Pregnancy • Fatigue • Almost all women report increased fatigue in the 1st trimester. • Causes: • Body is working harder • More levels of progesterone, • Treatment: • Take naps • Drink plenty of fluids, but avoid fluids 2-3hr before bed. Lac • Exercise • Gentle stretches before bedtime can help prevent nighttime cramping • Eat foods rich in protein

18. Conditions During Pregnancy • Back Ache • Many women experience back aches during 2nd and 3rd trimesters • Causes: • Poor posture • Extra weight • Change in centre of gravity • Hormones • Treatment: • Pay attention to posture • Exercise • Swimming • Pillow support in bed • Ask for assistance when lifting heavy objects • Heat/cold • Massage • Support belt • Wear supportive low heel shoes

19. Benefits of Exercise During Pregnancy • Maintenance/improvement of maternal fitness • Control of excess weight gain • Improved posture and appearance • Increased energy • Improved sleep • Decreased incidence of back pain • Improved self-esteem • Decreased incidence of varicose veins • Decreased water retention • Decreased level of tension • Possible decrease in complications during labour • Shortened labour • More rapid postpartum recovery

20. Disadvantages of Not Exercising • Studies have shown that women who exercise do not experience an increase in: • Premature Rupture of Membranes (PROM) • When the membranes that hold the amniotic fluid break too early. • Congenital Abnormalities

21. Risk Reduction • Pre-Eclampsia (Toxemia) • Occurs only during pregnancy and the postpartum period • Affects 5-8% of all pregnancies • Causes blood vessels to constrict resulting in high blood pressure and a decrease in blood flow to organs and uterus. • Having high blood pressure before pregnancy puts you at risk, also having a BMI of 30 or more • Characterized by high blood pressure and presence of protein in the urine • Symptoms: excess swelling of hands and feet, headaches, changes in visions, vomiting blood, ringing in the ears • Occurs in the 2nd or 3rd trimesters

22. Kinesiologist’s Role

23. Exercises During Pregnancy • Low impact aerobics • Water aerobics • Walking • Kegels • Pilates • Yoga • Cycling • Swimming

24. Kegels • Help prepare body for labour • Kegel exercises are easy to do - can be done anywhere • Kegels help strengthen the pelvic floor muscles • Many women do kegel exercises to prevent incontinence

25. Yoga (prenatal) • Help with breathing and relaxation • Promote feelings of well-being • Energizing • Stress relief • Improve posture • Meet others who are facing the same challenges • Note: Avoid positions lying on the back

26. Walking • Vary the intensity • Less impact on the knees and ankles • Easy way to start exercising • Supportive shoes • Water bottle • Spray bottle • Maintain good posture

27. Swimming • Uses large muscle groups of the legs and arms • No strain on ligaments • Feeling of weightlessness • Improved circulation • Water Temp 18-25 °C

28. Exercises to Avoid During Pregnancy • Ball sports • Contact sports: ultimate fighting, wrestling, football • Sports that involve bouncing, leaping, a sudden change of direction (increased joint laxity from hormones make joints susceptible to sprains) • Exercises that put you at risk for falls: rollerblading, horseback ridding, skiing • After 1st trimester avoid exercise in the supine position • Lying in the prone position • Lifting heavy free weights

29. Contraindications to Exercise • Pregnancy induced hypertension • Premature rupture of membranes • Preterm labor during the prior or current pregnancy • Persistent 2nd or 3rd trimester bleeding • There should be an evaluation to determine whether an exercise program is appropriate if the woman has conditions such as: • Cardiac disease, constrictive lung disease • Chronic hypertension • Severe anemia • Chronic bronchitis • Extreme obesity • Extreme underweight • History of an extremely sedentary lifestyle • Orthopedic limitations • Heavy smoker

32. Recommendations for Exercise • Beginners • non weight bearing activities pose the least risk of injury • 20 – 30 minutes of activity a day at a comfortable pace • Previously active women • participation in aerobic activities are generally safe • Exercise in high altitudes is not recommended • Running • can be continued late into pregnancy to maintain fitness, less than 45 min • Weight training • light weights and moderate reps will maintain flexibility and muscle tone and reduce the risk of joint/ligament injury • Should be able to converse while exercising – vigorous exercise offers no benefits during pregnancy, only more complications • Listen to your body – stop if you feel breathless, nausea, dizzy, tired • Pulse should NEVER exceed 140 beats per minute!

33. Recommendations for Exercise • Positions/Posture: • Avoid lying on your back after 12th week of pregnancy • Abdominal exercises • Avoid standing for long periods • Avoid back swaying (lordosis) – cat back stretch, strengthen abdominals • Rounded upper back (kyphosis) – chest stretches, upper back strengthening • Avoid valsalva maneuver – increase blood and intra-abdominal pressure • Avoid lying in the prone position after the 1st trimester

34. Pelvic Tilts

35. Side Leg Lifts

36. Alternating Arm/Leg Raise

37. Precautions for Exercise • Dehydration and hyperthermia: • Avoid exercise in hot humid environments • Drink plenty of liquids – prior, during, after • Appropriate clothing may help dissipate heat • Hot tubs/saunas • Poor Balance: • Centre of gravity shifts as pregnancy progresses • Exercise cautiously • Pay attention to changes to terrain • Muscle cramps and soreness: • Stretch muscles and warm-up before exercising • Wear supportive well cushioned shoes

38. Don’t over do it! • Watch for dizziness, blurred vision, nausea, shortness of breath • Stop or slow down • Heart rate should not exceed 140-145 beats per minute • Contact doctor the following occur: vaginal bleeding, uterine contractions, leaking amniotic fluid

39. And Finally…

40. Exam Question 1 Of the following, which are contraindications to exercise during pregnancy? • A) Pregnancy induced hypertension • B) Premature rupture of membranes • C) Persistent 2nd or 3rd trimester bleeding • D) Preterm labor during the prior or current pregnancy • E) All of the above

41. Exam Question 2 What is the hormone responsible for excessive joint laxity found in pregnant women. • A) relaxin • B) progesterone • C) testosterone • D) estrogen • E) gonadotropin

42. Exam Question 3 What are some good exercises for a pregnant woman? • A) Swimming • B) Kegals • C) Ultimate Fighting • D) A and C • E) A and B