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ClinE 470 > Pregnancy > Flashcards

Pregnancy Flashcards

1
Q

What CV changes are made during pregnancy?

A

Heart adapts to the increased demands via enlarging the uterus and foetus

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2
Q

How much does the resting HR increase by?

A

25%

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3
Q

How much does the HR increase at each trimester?

A

5-10 bpm first trimester

15 bpm second and third trimester

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4
Q

What happens in the 2nd and 3rd trimester

A
  • increased oestrogen and chronic gonadotropin stimulates the HR increase
  • SNS activation sedentary to maintain BP
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5
Q

how much does Oestrogen and progesterone decrease peripheral vascular

A

20%, and thus must increase to maintain BP

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6
Q

How much does SV increase?

A

25%

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7
Q

Why does the increase in blood volume occur?

A

progesterone increase production if Renin –> sodium reabsorbed –> kidneys reabsorb fluid to the plasma volume

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8
Q

Why is there a LV size increase due to maternal hormones?

A
  • Oestrogen stimulates the myocardial hypertrophy, increasing contractility
  • increase blood volume stimulates some myocardial hypertrophy
  • growth is eccentric vs. concentric
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9
Q

What is the percentage the SV increase by in the 1st trimester?

A

10%

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10
Q

What percentage does blood volume increase in?

A

35-50%

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11
Q

what is the offset of BP?

A

increased volume offset by an increase in venous capacitance = blood pressure is not increased

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12
Q

What does the offset of BP cause

A

problems with postural hypertension

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13
Q

What helps to prevent hyperthermia during exercise?

A

increase in vasodilation at the skin which increases heat loss

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14
Q

Why can pregnant women become anaemic?

A

> increase in plasma volume vs red blood cells (increases 20%)

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15
Q

What is the Hb in pre-pregnancy and in the 3rd trimester

A

150g. L-1

120g. L-1

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16
Q

Why may blood clotting increase

A

relaxation of the blood vessel walls with hormonal changes (to keep BP normal after increase in blood volume) from the pressure of the uterus of the interior vena cava

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17
Q

Why may pregnant women develop varicose veins?

A

exercise assists the blood flow in the legs and feet and helps prevent or minimise these problems

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18
Q

What are the pulmonary adaptations when pregnant?

A
  • elevation of the diaphragm

- uterine enlargement elevated the diaphragm up to 4cm

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19
Q

How much does this reduce reserve volume

A

25%

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20
Q

why does the rib cage flair outwards?

A

as it reduces the filling effectiveness

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21
Q

Why is the work of breathing increase at rate and during exercise?

A

due to the diaphragm resistance

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22
Q

What happens to the respiratory physiological when one is pregnant?

A
  • reduction in total lung capacity occurs
  • inspirational capacity remains the same
  • reserve volume gets squeezed as a consequence
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23
Q

What does an increased plasma progesterone mean?

A

stimulate respiratory centre to be more sensitive to CO2

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24
Q

What occurs with hyperventilation?

A

–> resting hypocapnia (decrease PCO2) –> maternal alkalosis and increased PO2

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25
Q

What does the maternal alkalosis do?

A

protect against foetal acidosis

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26
Q

when does increase in performance in endurance activities occur?

A

first 12-15week, before the increase in BW and uterine size reduces or stops involvement in competitive athletics

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27
Q

What does the increase in performance result from

A

increased blood volume and RBC mass

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28
Q

After the 2nd trimester what happens to the PVO2

A
  • increase O2 demand of foetus

- increase BM

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29
Q

How much does resting O2 increase by?

A

15-30%

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30
Q

What are the reasons behind this?

A
  • enlarging uterus and growing foetus
  • increased breathing rate
  • Uterine contents are subtracted maternal increased by ~ 4%
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31
Q

Why is there an major increase in CHO usage?

A

foetal demands of glucose is large

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32
Q

Why is there an increase in maternal insulin productions

A
  • increase oestrogen causes B-cells hyperplasia in the pancreas
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33
Q

What does increased insulin production cause?

A

hyperinsulinemia

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34
Q

what increases the fat deposition within the mother?

A

stimulation of lipogenesis

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35
Q

what percentage of women have gestational diabetes (GDM)

A

2-3%

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36
Q

what does human placental lactose do?

A

counters insulin effects

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37
Q

reduces CHO use by mother….

A

leaves more CHO for foetus

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38
Q

what does mum have to rely on more?

A

Body fat –> lipolysis –> resulting in reduced adiposity

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39
Q

what percentage of mums with GDM become type II diabetic post 4yrs delivery

A

60%

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40
Q

Why is there increased birth weight?

A

CHO foetus increases birth weight (mores fat)

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41
Q

What can cause birthing problems?

A

disproportionate growth of head and shoulders

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42
Q

If the baby has increased insulin production to counter mothers high glucose, what does this mean?

A
  • insulin is the growth promoter

- baby at risk of low blood glucose post partum

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43
Q

What can maternal exercise help with?

A

lower blood glucose (less insulin required) and increase insulin sensitivity

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44
Q

What is the incidence rate of preeclampsia

A

3-7%

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45
Q

What preeclampsia associated with?

A
  • hypertriglyceridemia
  • insulin resistance
  • SNS overactivity
  • Atherosclerotic lesions in placenta
  • increased leptin
  • increases risk of becoming hypertensive (20% vs. 2%)
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46
Q

is it true that preeclampsia is reported in active women?

A

Yes

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47
Q

By what percentage?

A

35-70%

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48
Q

Why can exercise help preeclampsia?

A
  • reduced levels of C-reactive PRO –> stops endothelium producing NO (nitric oxide) —> less vasodilation
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49
Q

What does an increase rate of NO production cause

A

vasodilation

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50
Q

What is the relationship between decreased leptin and hypertension?

A

leptin can contribute to hypertension because of its role of stimulating the body to burn fat

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51
Q

How can leptin lead to hypertension?

A

stimulates SNS to burn fat- but this increases BP and leads to hypertension

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52
Q

What can increase progesterone (smooth muscle relaxant) and increase uterine size lead to?

A
  • constipation
  • slowing of gastrointestinal motility
  • relaxation of the lower oesophageal sphincter
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53
Q

what can the relaxation of the oesophageal sphincter lead to?

A

increased gastric reflex –> heartburn

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54
Q

what happens to the anterior displacement of enlarging uterus during pregnancy?

A
  • change in CoG

- exaggerates normal lumber lordosis

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55
Q

What can the increase in hormone levels more so progesterone do?

A
  • ligament and joint laxity

- pelvic area susceptible

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56
Q

What occurs when the breasts enlarge?

A
  • CoG moves interiorly and anteriorly

- increased weight contributes to upper back and shoulder pain

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57
Q

What is diastatic recti?

A

separation of abdominal muscles from the midline point

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58
Q

why does diastatic recti occur?

A

enlarging uterus

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59
Q

What is the incidence rate for diastasis recti?

A

~20-90%

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60
Q

what is the average weight gain for a pregnant women?

A

~ 12kg

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61
Q

What elements does this weight gain full under and by how much?

A
  • Fetus 3.5kg
  • Uterus 1kg
  • placenta 0.5kg
  • Amniotic fluid 0.8kg
  • breast enlargement 1.5kg
  • maternal fluid gain 2.0kg
  • maternal fat 2.5kg
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62
Q

what are the effect on the foetus during acute exercise?

A

placental blood flow

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63
Q

How can the uteroplacental blood flow change with exercise?

A

flow to the placenta remains unchanged, but flow of blood in the uterus is reduced

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64
Q

Why might foetal O2 supply not be changed or slightly reduced?

A

increased placental a-vo2 difference –> where the baby extracts more

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65
Q

How quickly does the effects of acute exercise on a pregnant women return back to baseline?

A

20 minutes

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66
Q

What does Foetal Tachycardia at >160bpm mean?

A

The foetal HR increases when the mum is exercises, and circulating maternal catecholamines during exercise

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67
Q

What other effect can foetal tachycardia have?

A

increase maternal core temperature

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68
Q

What is the HR for the classification of foetal bradycardia

A

<120bpm

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69
Q

when in foetal bradycardia, what is the response to hypoxia?

A

reduce foetal O2 demands

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70
Q

When is hypoxia and foetal bradycardia seen?

A

in long duration exercise and post exercise

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71
Q

What is another effect on the foetus during acute exercise?

A

hyperthermia

72
Q

What is the foetal temperature?

A

5 degrees (F)

73
Q

Why is it higher than maternal temperature?

A

baby loses heat via this gradient

74
Q

What is there no evidence for due to as increased sweating, enhanced peripheral vasodilation col the mothers core temperature

A

increased maternal temp during exercise reduce heat gradient, plus reduced uterine blood flow meaning less blood is available to moreve heat, causing foetal hyperthermia and damage

75
Q

Why have birth weight findings for effects of chronic exercise been inconsistent?

A

feotoplacental growth is higher and lower in active mothers

76
Q

What did Clapp et al 2002, find with chronic exercise and foetal effects?

A

mothers who continue to perform a high volume of exercise in mid to late pregnancy, have thinner and lighter babies

77
Q

What can increase norepinephrine and prostaglandin output during exercise stimulate?

A

uterine activity and premature labour –> however no real evidence to support this

78
Q

What did the American College State with absolute contraindications to exercise prior to starting?

A
  • sig. heart disease
  • restrictive lung disease
  • incompetent cervis
  • known risk of premature labour
  • persistent 2nd or 3rd trimester bleeding
  • Placenta preview after 26 weeks
  • ruptured membranes
  • preeclampsia
79
Q

What should occur if women with certain other medical or obstetric conditions do?

A

evaluated carefully in order to ermine whether an exercise program is appropriate

80
Q

What did the American College find with relative contractions to exercise prior to starting?

A
  • severe anemia
  • unevaluated maternal cardiac dysrhythmias
  • chronic bronchitis
  • poor controlled type I diabetes
  • extreme morbid obesity
  • extreme underweight
  • history of sedentary lifestyle
81
Q

What other relative contradictions to exercise prior to starting involve?

A
  • growth restriction
  • poorly controlled hypertension
  • Orthopaedic libations
  • poorly controlled seizures
  • poorly controlled hyperthyroidism
  • heavy smoker
82
Q

If a pregnant individual wants to do exercise what consent form do they need to fill out?

A

PARmed - X for pregnancy

83
Q

Under what circumstances must the individual stop exercise and seek help?

A
  • excessive shortness of breath
  • chest pain or palpitations
  • presynoscpe or dizziness
  • painful uterine contractions or preterm labour
  • leakage of amniotic fluid
  • vaginal bleeding
  • excessive fatigue
  • Abdominal pain, particularly in back or pubic area
  • pelvic girdle pain
  • reduced foetal movement
  • dyspnoea before exertion
  • headache
  • muscle weakness
  • calf pain or swelling
84
Q

Do exercise capabilities decline in pregnancy?

A

Yes

85
Q

How can they decline?

A

Hyperthermia and BP

86
Q

What can be addressed if suffering with hyperthermia?

A
  • adequate hydration
  • appropriate clothing
  • environmental temperature
87
Q

What temperature should a pregnant women no exceed to?

A

37.8 degree/C

88
Q

What temperature should swimming pool water not exceed to?

A

32 degree/ C

89
Q

What can be done to facilitate the high BP better?

A

rise from the flow gradually to avoid an abrupt drop in BP

90
Q

What specific considerations should be taken in the 1st trimester?

A

overheating can impart development of the baby CNS –> neural tube defects in first 28 days of pregnancy

91
Q

What should be considered in the 2nd and 3rd trimester?

A

avoid exercise in supine position or right side

92
Q

Why must women avoid exercise in supine position or right side?

A

decreased Q in most pregnant women, and the position compresses the vena cava –> effect on the venous return

93
Q

What sports should be avoided incase risk of mild abdominal trauma occurs?

A

horseback riding, skiing, water skiing etc.

94
Q

What other two things should be avioded?

A
  • hyperbaric (diving)

- hyperthermia environments

95
Q

What are the PA recommendations by the ACOG, 2002 & RCOG, 2006?

A

moderate exercise for > 30min days/week

96
Q

is participants in competitive sports acceptable and up till which time period?

A
  • Yes

- first 15 weeks

97
Q

At which trimester should the intensity and volume be maintained if not reduced?

A

3rd

98
Q

what occurs in a weight supported exercise e.g. cycling

A

O2 count is the same

99
Q

What happens in a weight bearing exercise e.g. jogging

A

increase in O2 cost proportional to increase BM

100
Q

is blood pH higher than PCO2 lower opposed to non pregnant?

A

Yes

101
Q

why is CHO delivery to muscles reduced?

A
  • reduced liver glycogen stores
  • reduced sympathodrenl activation reduces catecholamine production reducing delivery of CHO to muscles
  • foetal demands CHO
102
Q

What can exercise help control?

A

blood glucose levels in those with gestational diabetes

103
Q

How much aerobic (low impact activities, stationary cycling, swimming, walking and low impact aerobics) can be done?

A

minimum of 3, but preferably all days of the week –> must avoid possibly muscloskeletal injury risk i.e plyometric

104
Q

How much moderate aerobic activity should be achieved per week?

A

150mins

105
Q

At what intensity should they work at?

A

HR 120-160, 40-60-90% HRmax, RPE 12-14

106
Q

Why are the modified HR target zones for mod-intensity aerobic exercise in pregnancy?

A

<20yrs –> 140-155
20-29 –> 135 - 150
30-39 –> 130 - 145
>40 —> 125 - 140

107
Q

What loads can be done with resistance training?

A

light to moderate

108
Q

What should be focused on the greatest?

A

muscle endurace (12-15reps)

109
Q

What RT exercises should be avoided, especially in 3rd trimester?

A

ones requiring vaxsalva’s manoeuvre e.g. weight lifting

110
Q

what stretches should be done?

A

ones that are not taken to the max ROM

111
Q

why is it important not to choose exercises that don’t require too much balance?

A

as the CoG and co-ordination has changed

112
Q

what can cause damage to the connective tissue?

A

jumping, jarring motions, rapid changes of direction

113
Q

what method of cool-down should be done?

A
  • gentle stationary stretching

- low intensity exercise (walking)

114
Q

How many additional kcal have to be increase at each trimester?

A

100kcal. d 1st
300kcal. d 2nd
450kcal. d 3rd

115
Q

What is a solution if the weight gain is not sufficient?

A

reduce time of intensity of exercise

116
Q

What does training induce and help with hypothetically?

A

beta-endorphins

117
Q

How many week postpartum does the physiological and morphologic changes persist?

A

2-6 weeks

118
Q

if delivery was complications, a medical caregiver should be consulted before resuming PA, usually after how many weeks the first postpartum?

A

6-8 weeks

119
Q

how long does it take to return to pre-pregnancy routines if it was a caesarean birth?

A

10-12 weeks

120
Q

How long does it take for changes of ligaments to rectify?

A

3 months

121
Q

why exercise post pregnancy?

A
  • return to pre-pregnancy body mass

- Women who breastfeed and exercise don’t loos excess fat more quickly as they increase EI

122
Q

What RPE scale does not increase breast milk La accumulation?

A

12 RPE

123
Q

How much does Peak VO2 increase after giving back and back to training?

A

10-25%

124
Q

What recommendation of exercise did (CDC-ASCM) in sports medicine (Artal et al., 2003)?

A

accumulation of 30minutes or more over moderate intensity PA - preferably on all days of the week

125
Q

How did Artal et al (2003) define moderate intensity on the METS?

A

3-5

126
Q

What did CDC-ASCM recognise in intense exercise performed 20-60min 3-5 days/wk?

A

results in higher levels of physical fitness

127
Q

What musculoskeletal changes occur during pregnancy?

A

potential to effect musculoskeletal system to rest and during exercise - most obvious weight gain.

128
Q

What can increase in weight gain cause?

A

increased forces across joints such as hips and knees by up to 100% during weight bearing exercises such as running

129
Q

What can large forces cause to the normal joints?

A

discomfort and increase damage to arthritic or previously unstable joints

130
Q

What causes the low back pain in pregnant women and at what percentage?

A

lumber lordosis - contributes to high prevalence (50%)

131
Q

what can the increase in ligament laxity be linked with?

A

influence of increased levels of oestrogen and relaxin

132
Q

What was found with the interaction of uterine activity in exercising pregnant women?

A

minimal or no changes during last 8-wks of pregnancy

133
Q

What has PA been associated with, with the uterine?

A

increase in uterine contractions

134
Q

In non-weight bearing exercises during pregnancy what is there a preferable intake for anaerobic components of this activity type?

A

carbohydrates (CHO)

135
Q

What are the profound alternates in maternal haemodynamics

A

increase blood volume, HR, SV and Q

decrease in systemic vascular resistance

136
Q

what’s the percentage of Q during mid-pregnancy?

A

30-50%

137
Q

How much does most studies show SV increases by the end of the 1st trimester?

A

10%

138
Q

How much does the HR increase by in the 2nd and 3rd trimester?

A

20%

139
Q

how much does mean arterial pressure decrease by in the 2nd trimester?

A

5-10mmHg

140
Q

what is the decreased mean arterial pressure a result of?

A

increased uterine vasculature, uteroplacental circulation

decrease in vascular restriction from skin and kidneys

141
Q

Haemodynamic changes appear to establish circulatory reserve to provide….

A

Nurtrients and O2 to both mother and foetus at rest and during moderate exercise

142
Q

during the 1st trimester, what happens to the supine position?

A

relative obstruction to venous return decreasing Q

143
Q

What responses have been found in non weight bearing and weight bearing exercises?

A

Blunted and normal response

144
Q

Why does the minute ventilation increase to ~ 50% in pregnant women?

A

due to increase in tidal volume

145
Q

How much does arterial O2 increase by?

A

106-108mmHg increase in arterial O2

146
Q

How much does the arterial O2 mean decrease by for the 3rd trimester?

A

101-106 mmHg

147
Q

What happens to the physiological dead space in pregnant women?

A

remains unchanged

148
Q

What happens to the O2 during treadmill aerobic exercise performance?

A

decreased O2 availability

149
Q

What happens with the workload and maximum performance during o2 treadmill aerobic exercise?

A

decreases

150
Q

What was found in pregnant women that are already classified as fit with their workload, maximum performance and acid base balance?

A

No change

151
Q

What is the CV most effected by in thermoregulation control?

A

increased metabolic demands of exercise

152
Q

What thermoregulation factors are elevated above baseline in pregnant women?

A

basal metabolic rate –> heat production

153
Q

What is the body temperature directly related to when exercising?

A

intensity

154
Q

during moderate exercise in a non-pregnant women, how much does the temperate increase in 30 minutes?

A
  1. 5 degree (Celsius)

- reaches plateau if exercise is continued > than 30 minutes

155
Q

Humid conditions, or during very high intensity exercise what happens to the core?

A

continues to rise

156
Q

What is critical to control the heat balance?

A

blood volume

157
Q

How much is the foetal body core temperature then the maternal temperature?

A

~ 1 degrees (celcius)

158
Q

How is hyperthermia defined within pregnant women?

A

excess of 39 degrees (Celsius) during the first 45-60 days

159
Q

What was suggested to be an ideal exercise for pregnant women during immersion and shifting blood volume?

A

swimming

160
Q

What can occur during obstetric events, transient hypoxia to the foetus? and what do these act as?

A

fetal tachycardia and increase in blood pressure

- acting as a protective mechanism –> allowing foetus to facilitate transfer of O2 and decrease CO2 across the placenta

161
Q

What have most studies shown for a minimum of moderate intensity exercise, how does this effect the foetal HR?

A

increase by 10-30 bpm over baseline during or after maternal exercise

162
Q

When will bradycardia occur with the foetal HR?

A

reported to occur at a frequency of 8.9%

163
Q

However, what are the mechanisms leading to foetal bradycardia?

A

vagal reflex, cord compression or fetal head mal-position

164
Q

What has it been found for mothers who have occupations requiring strains or repetitive and strenous actions?

A

deliver earlier and have a tendency to have small for gestational age infants
- however, other reports have failed to confirm this

165
Q

What was found between physical active and fit pregnant women compared to sedentary?

A

weight is not effect by exercise in women who have adequate energy intake

166
Q

What exercises should be avoided when pregnant?

A
  • scuba diving (decompression)
  • supine positioning
  • exercises at risk of falling
167
Q

in addition to aerobic activities, activities that promote musculoskeletal fitness should be….?

A

part of the overall exercise prescription

168
Q

What happened in a study in the Artal paper, where multiple muscle groups were strength trained, and the occurrence of the foetal HR from 28 and 38 weeks gestation?

A

remained unchanged

169
Q

What is the recommended intensity and max HR by ACSM?

A
  • 60-90%

- 50-85%

170
Q

What is the recommended intensity and max HR by ACSM for those that don’t do regular exercise?

A
  • 60-70%

- 50-60%

171
Q

In the royal college of obsteririans and gynaecologist, what can hormonal changes occur?

A

joint laxity and hyper mobility

172
Q

Why should exercise at altitudes over 2500m until 4-5days of exposure take place?

A

lowers uterine blood flow

173
Q

what is reduced in those that exercise?

A

fatigue, varicosities, swelling of extremities

174
Q

What can active women experience?

A

less insomnia, stress, anxiety and depression

175
Q

What is exercise good for in pregnant women?

A
  • improving glycemic control (those with gestational diabetes)
  • coronary heart disease
  • osteoporosis
  • hypertension
    reduced risks of
  • colon cancer
  • breast cancer
  • reduced body fat
176
Q

what should women with gestational diabetes do when exercising?

A
  • monitoring blood glucose
  • regulating meal times
  • scheduling rest periods
  • tracking fetal activity
  • and uterine contractions

ClinE 470 (9 decks)

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