How to Managing the Pregnant Women

Stress, pain, and muscles imbalances from faulty postures.

Poor body mechanics; related to lack of knowledge, changing body size and caring for growing child.

Lower extremity edema and discomfort from altered circulation, varicose veins.

Pelvic floor dysfunction.

Organ prolapse.

Hypertonus.

Poor episiotomy healing.

Suggest that your patients discuss with their physicians any guideline or restrictions to exercise before engaging in an exercise program, either in a class or an a one-to-one basis. As always, follow your state practice act for physical therapy referral, evaluation, and treatment.

Examination- Individually examine each women before participation to screen for per-existing musculature problems, posture, and fitness level.

Education- Educate your patients that increased uterine cramping may occur with moderate activities; this is acceptable as long as the cramping stops when the activity is completed. Teach your patient all exercise guideline and precautions so that exercise may be carried out safely at home. Include the following:

1- Do not exceed 5 minutes of supine positioning at any one time after first trimester of pregnancy to avoid vane cava compression by the uterus. Educate your patients that compression of the vena cava also occurs with motionless standing. For supine exercise, place a small wedge or rolled towel under the right hip to lessen the effects of uterine compression on abdominal vessels and improve cardiac output. The wedge the patient. slightly toward the left. This modification is also helpful during examination and treatment when the patient is positioned supine.

2- To avoid the effects of orthostatic hypertension, instruct the women to always rise slowly when moving from lying down or sitting to standing positions. Fig- leti hui seedtha pignat (To prevent inferior vena cava compression when the patient is lying supine, a folder towel can be placed under the right side of the pelvis so the patient is tipped slightly to the left.)

3- Discourage breath-holding and avoid activities that tend to elicit the Valsalva maneuver because this may lead to undesirable downward forces on the uterus and pelvic floor. In addition, breath-holding causes stress to the cardiovascular system in term of blood pressure and heart rate.

4- Break frequently for fluid replenishment. The risk of dehydration during exercise is increased in pregnancy.

5- Encourage complete bladder emptying before exercise. A full bladder places increased stress on an already weakened pelvic floor.

6- Include appropriate warm-up and cool-down activities.

7- Modify or discontinue any exercise that causes pain.

8- Limit activities in which single-leg weight bearing is required, such as standing leg kicks. Besides possible loss of balance, these activities can promote sacroiliac or public symphysis discomfort.

Stretching/Flexibility- Choose stretching exercise that are specific to a single muscle or muscle group; do not involve several group at once. Asymmetric stretching or stretching multiple muscle group can promote joint instability.

1- Avoid ballistic movement.
2- Do not allow any joint to be taken beyond its normal physiologic range.
3- Use caution with hamstring and adductor stretches.

Muscle Performance- Recommendation and adaptations for pelvic floor training, general strengthening, and cardiopulmonary conditioning during pregnancy and postpartum are described in the exercise section of this articles. Exercise to prepare for labor and delivery are also described in the exercise section.

Overexertion or Complication- Observe participants closely for signs of overexertion or complication. The following signs are reasons to discontinue exercise and contact a physician.

1- Persistent pain, especially in the chest, pelvic girdle, or low back
2- Leakage of amniotic fluid
3- Uterine contractions that persist beyond the exercise session
4- Vaginal bleeding
5- Decreased fetal movements
6- Persistent shortness of breath
7- Irregular heartbeat
8- Tachycardia
9- Dizziness/faintness
10- Swelling/pain in the calf
11- Difficulty in walking

Healthy Women Response

Studies have shown that healthy women for who continue to run throughout pregnancy deliver on the average of 5 to 7 day's sooner compared with controls. and late pregnancy without risk of preterm labor or premature of the membranes. Women who wish to continue strenuous or competitive exercise or participate in specific athletic training require close supervision by a specialist during pregnancy.

Keep in mind when developing intervention programs that most modalities are contraindicated in pregnancy. Superficial heart or ice may be beneficial along with manual technique prenatally to relieve pain/spasm and resistance, are often indicated for pelvic instability, Electric stimulation may be added postpartum to modulate pain and to stimulate muscle contractions, respectively. Ultrasound may be helpful in cases of poor episiotomy healing and painful scar tissue.