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  1. 1. General Overview of Nine Months of Pregnancy FROM CONCEPTION TO BIRTH
  2. 2. The First TrimesterLasts 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
  3. 3. The Second TrimesterFetus 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
  4. 4. The Third TrimesterAll 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‟
  5. 5. 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.
  6. 6. 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.
  7. 7. 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
  8. 8. Objective Assessment When observing the client, evaluate:  Height  Weight  BMI  Blood Pressure  General alignment  Range painful movement
  9. 9. 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!
  10. 10. 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
  11. 11. 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
  12. 12. 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
  13. 13. 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
  14. 14. 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
  15. 15. Exercises During Pregnancy Low impact aerobics Water aerobics Walking Kegels Pilates Yoga Cycling Swimming
  16. 16. 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
  17. 17. 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
  18. 18. 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
  19. 19. 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
  20. 20. 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
  21. 21. 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!
  22. 22. 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