Pregnancy

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a slideshow about pregnancy

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Pregnancy

  1. 1. Pregnancy <ul><li>Advanced Sports Medicine 4134 </li></ul><ul><li>Dr. Paulo Sanzo </li></ul><ul><li>November 30, </li></ul><ul><li>2005 </li></ul><ul><li>Jeff Ploen </li></ul><ul><li>Jessica French </li></ul><ul><li>Jen Wright </li></ul><ul><li>Ben MacKay </li></ul>
  2. 2. Pregnancy
  3. 3. First,
  4. 4. Then,
  5. 5. And THEN
  6. 6. General Overview of Nine Months of Pregnancy From Conception to Birth
  7. 7. The First Trimester <ul><li>Lasts from conception to the twelfth week of pregnancy </li></ul><ul><li>3 periods during the first trimester: </li></ul><ul><ul><li>The Germinal Period </li></ul></ul><ul><ul><ul><li>Fertilized egg travels and implants in wall of uterus </li></ul></ul></ul><ul><ul><ul><li>Implantation occurs 10-14 days after conception </li></ul></ul></ul><ul><ul><li>The Period of the Embryo </li></ul></ul><ul><ul><ul><li>Lasts from third through eighth week of pregnancy </li></ul></ul></ul><ul><ul><ul><li>Major organs and anatomical structures begin to form </li></ul></ul></ul><ul><ul><li>The Period of the Fetus </li></ul></ul><ul><ul><ul><li>Lasts from ninth week of pregnancy until birth </li></ul></ul></ul><ul><ul><ul><li>All major organs continue rapid growth and become interconnected </li></ul></ul></ul>
  8. 8. The Second Trimester <ul><li>Fetus assumes distinct human appearance </li></ul><ul><li>The nails harden and skin thickens, as well as the eye lashes, eye brows, and scalp hair appear during fifth and sixth months </li></ul><ul><li>Fetus’s visual and auditory senses are functional </li></ul>
  9. 9. The Third Trimester <ul><li>All organ systems mature rapidly </li></ul><ul><li>Fetus prepares for birth </li></ul><ul><li>Fetus reaches ‘age of viability’, the point at which the fetus can survive outside of the uterus </li></ul><ul><li>Fetus shows better-organized gross motor activity, and sleepiness/ waking activity </li></ul><ul><li>Towards end of ninth month, fetus is positioned head-down with limbs curled up in ‘fetal position’ </li></ul>
  10. 11. Teratogens <ul><li>External agents such as viruses, drugs, chemicals and radiation that can harm a developing embryo or fetus. </li></ul><ul><li>Time when organ system or body part is at highest risk of effects from teratogens is known as ‘sensitive period’. </li></ul><ul><li>Effects of teratogens on a body part or organ system are worst during the period when that structure is forming and growing most rapidly. </li></ul>
  11. 12. Teratogens <ul><li>The same defect can be caused by different teratogens. </li></ul><ul><li>A variety of defects can be caused by a single teratogen. </li></ul><ul><li>The longer the exposure or the higher the ‘dose’ of the teratogen, the more likely it is that serious harm will be done. </li></ul><ul><li>The long-term effects of a teratogen often depend on the quality of the postnatal environment. </li></ul>
  12. 14. Subjective Assessment <ul><li>When pregnant female comes to you, the kinesiologist, you should ask: </li></ul><ul><ul><li>Name </li></ul></ul><ul><ul><li>Age </li></ul></ul><ul><ul><li>Medical history </li></ul></ul><ul><ul><li>Genetic history </li></ul></ul><ul><ul><li>Previous surgeries </li></ul></ul><ul><ul><li>Current/past medications </li></ul></ul><ul><ul><li>If they have ever or are using “street drugs” or smoking </li></ul></ul><ul><ul><li>Alcohol/caffeine use </li></ul></ul><ul><ul><li>Occupation and current working status </li></ul></ul><ul><ul><li>Marital status and children </li></ul></ul>
  13. 15. Objective Assessment <ul><li>When observing the client, evaluate: </li></ul><ul><ul><li>Height </li></ul></ul><ul><ul><li>Weight </li></ul></ul><ul><ul><li>BMI </li></ul></ul><ul><ul><li>Blood Pressure </li></ul></ul><ul><ul><li>General alignment </li></ul></ul><ul><ul><li>Range painful movement </li></ul></ul>
  14. 16. Conditions During Pregnancy <ul><li>Constipation </li></ul><ul><ul><li>Affects half of pregnant women </li></ul></ul><ul><ul><li>Causes: </li></ul></ul><ul><ul><ul><li>increase in progesterone </li></ul></ul></ul><ul><ul><ul><li>the colon absorbing more water </li></ul></ul></ul><ul><ul><ul><li>worse in first 13-14 weeks </li></ul></ul></ul><ul><ul><li>Treatment: </li></ul></ul><ul><ul><ul><li>Drink plenty of fluids </li></ul></ul></ul><ul><ul><ul><li>Eat high fiber foods </li></ul></ul></ul><ul><ul><ul><li>Take fiber supplements – psylium husks, Metamucil, Ex-Lax </li></ul></ul></ul><ul><ul><ul><li>EXERCISE! </li></ul></ul></ul>
  15. 17. Conditions During Pregnancy <ul><li>Fatigue </li></ul><ul><ul><li>Almost all women report increased fatigue in the 1st trimester. </li></ul></ul><ul><ul><li>Causes: </li></ul></ul><ul><ul><ul><li>Body is working harder </li></ul></ul></ul><ul><ul><ul><li>More levels of progesterone, </li></ul></ul></ul><ul><ul><li>Treatment: </li></ul></ul><ul><ul><ul><li>Take naps </li></ul></ul></ul><ul><ul><ul><li>Drink plenty of fluids, but avoid fluids 2-3hr before bed. Lac </li></ul></ul></ul><ul><ul><ul><li>Exercise </li></ul></ul></ul><ul><ul><ul><li>Gentle stretches before bedtime can help prevent nighttime cramping </li></ul></ul></ul><ul><ul><ul><li>Eat foods rich in protein </li></ul></ul></ul>
  16. 18. Conditions During Pregnancy <ul><li>Back Ache </li></ul><ul><li>Many women experience back aches during 2nd and 3rd trimesters </li></ul><ul><ul><li>Causes: </li></ul></ul><ul><ul><ul><li>Poor posture </li></ul></ul></ul><ul><ul><ul><li>Extra weight </li></ul></ul></ul><ul><ul><ul><li>Change in centre of gravity </li></ul></ul></ul><ul><ul><ul><li>Hormones </li></ul></ul></ul><ul><ul><li>Treatment: </li></ul></ul><ul><ul><ul><li>Pay attention to posture </li></ul></ul></ul><ul><ul><ul><li>Exercise </li></ul></ul></ul><ul><ul><ul><ul><li>Swimming </li></ul></ul></ul></ul><ul><ul><ul><li>Pillow support in bed </li></ul></ul></ul><ul><ul><ul><li>Ask for assistance when lifting heavy objects </li></ul></ul></ul><ul><ul><ul><li>Heat/cold </li></ul></ul></ul><ul><ul><ul><li>Massage </li></ul></ul></ul><ul><ul><ul><li>Support belt </li></ul></ul></ul><ul><ul><ul><li>Wear supportive low heel shoes </li></ul></ul></ul>
  17. 19. Benefits of Exercise During Pregnancy <ul><li>Maintenance/improvement of maternal fitness </li></ul><ul><li>Control of excess weight gain </li></ul><ul><li>Improved posture and appearance </li></ul><ul><li>Increased energy </li></ul><ul><li>Improved sleep </li></ul><ul><li>Decreased incidence of back pain </li></ul><ul><li>Improved self-esteem </li></ul><ul><li>Decreased incidence of varicose veins </li></ul><ul><li>Decreased water retention </li></ul><ul><li>Decreased level of tension </li></ul><ul><li>Possible decrease in complications during labour </li></ul><ul><li>Shortened labour </li></ul><ul><li>More rapid postpartum recovery </li></ul>
  18. 20. Disadvantages of Not Exercising <ul><li>Studies have shown that women who exercise do not experience an increase in: </li></ul><ul><ul><li>Premature Rupture of Membranes (PROM) </li></ul></ul><ul><ul><ul><li>When the membranes that hold the amniotic fluid break too early. </li></ul></ul></ul><ul><ul><li>Congenital Abnormalities </li></ul></ul>
  19. 21. Risk Reduction <ul><li>Pre-Eclampsia (Toxemia) </li></ul><ul><ul><li>Occurs only during pregnancy and the postpartum period </li></ul></ul><ul><ul><li>Affects 5-8% of all pregnancies </li></ul></ul><ul><ul><li>Causes blood vessels to constrict resulting in high blood pressure and a decrease in blood flow to organs and uterus. </li></ul></ul><ul><ul><li>Having high blood pressure before pregnancy puts you at risk, also having a BMI of 30 or more </li></ul></ul><ul><ul><li>Characterized by high blood pressure and presence of protein in the urine </li></ul></ul><ul><ul><li>Symptoms: excess swelling of hands and feet, headaches, changes in visions, vomiting blood, ringing in the ears </li></ul></ul><ul><ul><li>Occurs in the 2nd or 3rd trimesters </li></ul></ul>
  20. 22. Kinesiologist’s Role
  21. 23. Exercises During Pregnancy <ul><li>Low impact aerobics </li></ul><ul><li>Water aerobics </li></ul><ul><li>Walking </li></ul><ul><li>Kegels </li></ul><ul><li>Pilates </li></ul><ul><li>Yoga </li></ul><ul><li>Cycling </li></ul><ul><li>Swimming </li></ul>
  22. 24. Kegels <ul><li>Help prepare body for labour </li></ul><ul><li>Kegel exercises are easy to do - can be done anywhere </li></ul><ul><li>Kegels help strengthen the pelvic floor muscles </li></ul><ul><li>Many women do kegel exercises to prevent incontinence </li></ul>
  23. 25. Yoga (prenatal) <ul><li>Help with breathing and relaxation </li></ul><ul><li>Promote feelings of well-being </li></ul><ul><li>Energizing </li></ul><ul><li>Stress relief </li></ul><ul><li>Improve posture </li></ul><ul><li>Meet others who are facing the same challenges </li></ul><ul><li>Note: Avoid positions lying on the back </li></ul>
  24. 26. Walking <ul><li>Vary the intensity </li></ul><ul><li>Less impact on the knees and ankles </li></ul><ul><li>Easy way to start exercising </li></ul><ul><li>Supportive shoes </li></ul><ul><li>Water bottle </li></ul><ul><li>Spray bottle </li></ul><ul><li>Maintain good posture </li></ul>
  25. 27. Swimming <ul><li>Uses large muscle groups of the legs and arms </li></ul><ul><li>No strain on ligaments </li></ul><ul><li>Feeling of weightlessness </li></ul><ul><li>Improved circulation </li></ul><ul><li>Water Temp 18-25 °C </li></ul>
  26. 28. Exercises to Avoid During Pregnancy <ul><li>Ball sports </li></ul><ul><li>Contact sports: ultimate fighting, wrestling, football </li></ul><ul><li>Sports that involve bouncing, leaping, a sudden change of direction (increased joint laxity from hormones make joints susceptible to sprains) </li></ul><ul><li>Exercises that put you at risk for falls: rollerblading, horseback ridding, skiing </li></ul><ul><li>After 1st trimester avoid exercise in the supine position </li></ul><ul><li>Lying in the prone position </li></ul><ul><li>Lifting heavy free weights </li></ul>
  27. 29. Contraindications to Exercise <ul><li>Pregnancy induced hypertension </li></ul><ul><li>Premature rupture of membranes </li></ul><ul><li>Preterm labor during the prior or current pregnancy </li></ul><ul><li>Persistent 2nd or 3rd trimester bleeding </li></ul><ul><li>There should be an evaluation to determine whether an exercise program is appropriate if the woman has conditions such as: </li></ul><ul><ul><li>Cardiac disease, constrictive lung disease </li></ul></ul><ul><ul><li>Chronic hypertension </li></ul></ul><ul><ul><li>Severe anemia </li></ul></ul><ul><ul><li>Chronic bronchitis </li></ul></ul><ul><ul><li>Extreme obesity </li></ul></ul><ul><ul><li>Extreme underweight </li></ul></ul><ul><ul><li>History of an extremely sedentary lifestyle </li></ul></ul><ul><ul><li>Orthopedic limitations </li></ul></ul><ul><ul><li>Heavy smoker </li></ul></ul>
  28. 30.   CI   CI LOW FREQUENCY   CI INTERFERENTIAL   CI TENS           LASER CI CI PULSED SHORTWAVE   CI ULTRASOUND (NON THERMAL)     NON THERMAL Pregnancy (anywhere)   Pregnancy (around foetus) CONTRAINDICATION/PRECAUTION
  29. 31. see modality details P ULTRA VIOLET RADIATION   P COLD THERAPY     BIOFEEDBACK (NO STIMULATION)     OTHER           HOT PACK CI CI MICROWAVE CI CI SHORTWAVE (CONT/PULSED)     WAX     INFRARED     HEAT Pregnancy (anywhere)   Pregnancy   (around feotus)    CONTRAINDICATION/PRECAUTION
  30. 32. Recommendations for Exercise <ul><li>Beginners </li></ul><ul><ul><li>non weight bearing activities pose the least risk of injury </li></ul></ul><ul><ul><li>20 – 30 minutes of activity a day at a comfortable pace </li></ul></ul><ul><li>Previously active women </li></ul><ul><ul><li>participation in aerobic activities are generally safe </li></ul></ul><ul><ul><li>Exercise in high altitudes is not recommended </li></ul></ul><ul><li>Running </li></ul><ul><ul><li>can be continued late into pregnancy to maintain fitness, less than 45 min </li></ul></ul><ul><li>Weight training </li></ul><ul><ul><li>light weights and moderate reps will maintain flexibility and muscle tone and reduce the risk of joint/ligament injury </li></ul></ul><ul><li>Should be able to converse while exercising – vigorous exercise offers no benefits during pregnancy, only more complications </li></ul><ul><li>Listen to your body – stop if you feel breathless, nausea, dizzy, tired </li></ul><ul><li>Pulse should NEVER exceed 140 beats per minute! </li></ul>
  31. 33. Recommendations for Exercise <ul><li>Positions/Posture: </li></ul><ul><ul><li>Avoid lying on your back after 12th week of pregnancy </li></ul></ul><ul><ul><li>Abdominal exercises </li></ul></ul><ul><ul><li>Avoid standing for long periods </li></ul></ul><ul><ul><li>Avoid back swaying (lordosis) – cat back stretch, strengthen abdominals </li></ul></ul><ul><ul><li>Rounded upper back (kyphosis) – chest stretches, upper back strengthening </li></ul></ul><ul><ul><li>Avoid valsalva maneuver – increase blood and intra-abdominal pressure </li></ul></ul><ul><ul><li>Avoid lying in the prone position after the 1st trimester </li></ul></ul>
  32. 34. Pelvic Tilts
  33. 35. Side Leg Lifts
  34. 36. Alternating Arm/Leg Raise
  35. 37. Precautions for Exercise <ul><li>Dehydration and hyperthermia: </li></ul><ul><ul><li>Avoid exercise in hot humid environments </li></ul></ul><ul><ul><li>Drink plenty of liquids – prior, during, after </li></ul></ul><ul><ul><li>Appropriate clothing may help dissipate heat </li></ul></ul><ul><ul><li>Hot tubs/saunas </li></ul></ul><ul><li>Poor Balance: </li></ul><ul><ul><li>Centre of gravity shifts as pregnancy progresses </li></ul></ul><ul><ul><li>Exercise cautiously </li></ul></ul><ul><ul><li>Pay attention to changes to terrain </li></ul></ul><ul><li>Muscle cramps and soreness: </li></ul><ul><ul><li>Stretch muscles and warm-up before exercising </li></ul></ul><ul><ul><li>Wear supportive well cushioned shoes </li></ul></ul>
  36. 38. Don’t over do it! <ul><li>Watch for dizziness, blurred vision, nausea, shortness of breath </li></ul><ul><li>Stop or slow down </li></ul><ul><li>Heart rate should not exceed 140-145 beats per minute </li></ul><ul><li>Contact doctor the following occur: vaginal bleeding, uterine contractions, leaking amniotic fluid </li></ul>
  37. 39. And Finally…
  38. 40. Exam Question 1 <ul><li>Of the following, which are contraindications to exercise during pregnancy? </li></ul><ul><ul><li>A) Pregnancy induced hypertension </li></ul></ul><ul><ul><li>B) Premature rupture of membranes </li></ul></ul><ul><ul><li>C) Persistent 2nd or 3rd trimester bleeding </li></ul></ul><ul><ul><li>D) Preterm labor during the prior or current pregnancy </li></ul></ul><ul><ul><li>E) All of the above </li></ul></ul>
  39. 41. Exam Question 2 <ul><li>What is the hormone responsible for excessive joint laxity found in pregnant women. </li></ul><ul><ul><li>A) relaxin </li></ul></ul><ul><ul><li>B) progesterone </li></ul></ul><ul><ul><li>C) testosterone </li></ul></ul><ul><ul><li>D) estrogen </li></ul></ul><ul><ul><li>E) gonadotropin </li></ul></ul>
  40. 42. Exam Question 3 <ul><li>What are some good exercises for a pregnant woman? </li></ul><ul><ul><li>A) Swimming </li></ul></ul><ul><ul><li>B) Kegals </li></ul></ul><ul><ul><li>C) Ultimate Fighting </li></ul></ul><ul><ul><li>D) A and C </li></ul></ul><ul><ul><li>E) A and B </li></ul></ul>
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