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What are the different systems that adapt during pregnancy?
- endocrine
- CV
- respiratory
- neuro-muscular
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What are some enlarged glands in pregnancy?
adrenal, thyroid, parathyroid
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What hormones increase in pregnancy?
- progesterone (if stop increasing at 10-12 wk, have miscarriage)
- estrogen
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What's teh difference between glucose intolerance adn gestational diabetes?
- intolerance = 1 abnormal level
- diabetes = 2 abnormal levels
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What are some characteristics about gestational diabetes?
- 33-50% probability in subsequent pregnancies
- 50% increase in lifetime risk
- increase risk of HTN
- increase incidence in larger babies and obesity in the kids
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What are characteristics of preeclampsia?
- increase in swelling
- headaches
- BP steadily rising
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What increases and decreases in the CV system with pregnancy?
- increases: blood volume 40-50% by 32-34 wks, cardiac output (SV, and RHR by 15%)
- decrease: maxHR, PV resistance, SBP decreases 10 mmHG, DBP decreases 15 mmHG
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What are some characteristics of supine hypotension syndrome?
- supine symptoms of hypotension
- will usually have to lay on L side because of compression of infereior vena cava
- influenced by fetus size, maternal and fetal position
- verbally screen in supine position
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What are some symptoms of supine hypotension syndrome?
- Increase in HR
- decrease in pulse pressure in spine
- decrease SOA/nausea/vomitting
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What are some increases and decreases in the respiratory system due to pregnancy?
- increases: tidal volume, respiratory rate, oxygen consumption
- decreases: airway resistance; total, residual, and functional volume
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What are some changes to the neuromusculoskeletal system due to pregnancy?
- muscle and joint pain
- nerve entrapment syndromes
- pregnancy related osteoporosis
- increase risk in ankle sprains and knee injuries if continue exercising
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What are some benefits to the mother to continue exercising during pregnancy?
- decrease BP, body fat, insulin needs, musculoskeletal pain
- improved glucose tolerance
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What are some benefits to the fetus with exercises during pregnancy?
- decreased birth weight, body fat and body mass
- follow up studies show the kid weighs less, decrease sum of skin folds and less upper arm fat
- decreases incidence of obestity/DM
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What are some absolute contraindications to exercise during pregnancy?
- hemodynamically significant heart disease
- restrictive lung disease
- incomptetent cervix or cerclage
- multiple gestation
- persistent 2nd and 3rd trimester bleeding
- placenta previa (after 26 wks)
- premature labor
- premature rupture of membrances
- preeclampsia
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What predictors of pre term labor can make an exception to absolute contraindications?
- fetal fibronectin: increases 7-10 days before labor so can check that with bloodwork
- cervix: do vaginal exam and check cervix
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What are some relative contraindications to exercising while pregnant?
- severe anemia
- unevaluated maternal cardiac arrythmia
- chronic bronchitis
- poorly controlled type I DM
- extreme morbid obesity
- extremely underweight (BMI <12)
- intrauterine growth retardation
- poorly controlled HTN
- hyperthyroidism
- seizure disorder
- orthopedic limitations
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What should teh exercise prescription be during pregnancy?
- consult MD, screen for contraindications, PARmed-X for pregnancy
- mode, frequency, and intensity based on pre-exercise level
- educate pt on: heat dissipation, adequate fluid intake, when to reduce exercise (RPE), when to stop exercise
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