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Physiological Changes with Pregnancy

Musculoskeletal

  • ↑ BMR

  • Weight gain of 20–25 lbs

  • ↑ Rib cage circumference

  • ↓ Spinal curves

  • ↑ Ligamentous laxity

  • Postural changes

  • Change in center of gravity

Cardiovascular

  • ↑ Blood volume

  • ↑ RBC mass

  • Iron deficiency

  • ↑ Leukocyte count

  • ↑ Coagulation factors

  • ↑ Cardiac capacity

  • ↑ Size of heart

  • ↑ Cardiac output & ↑ HR

Pulmonary

  • Voice changes

  • Difficulty breathing through the nose

  • ↑ Pulmonary dead space

  • ↓ Residual volume

  • ↑ Tidal volume

  • ↑ Alveolar ventilation

  • ↑ Respiratory rate

  • ↑ O2 consumption

  • ↑ CO2 output

Integumentary

  • Vascular spiders

  • Palmar erythema

  • ↑ Sweating

  • Striae gravidarum (stretch marks)

  • Hyperpigmentation

Gastrointestinal

  • ↓ pH of oral cavity with ↑ risk of tooth decay

  • Tender/bleeding gums

  • Gastric reflux

  • ↓ GI motility

  • ↑ Water absorption resulting in constipation

  • ↓ Risk of gallstones

Endocrine

  • Enlarged adrenal & thyroid glands

  • Enlarged parathyroid & pituitary glands

Urogenital

  • ↑ Urinary stasis with ↑ risk of infection

  • ↑ Glomerular filtration rate

  • Obstruction of uterus on inferior vena cava resulting in LE edema

  • ↑ Urinary output

Source: Boissonnault WG (2005).

Precautions During Pregnancy

  • Avoid x-ray exposure in 1st trimester

  • Avoid supine for more than a few minutes after 4th month

  • Avoid rapid, uncontrolled bouncing mov'ts

  • Avoid overheating

  • Avoid electrical stimulation & heating modalities to the abdominal region

  • Avoid prone lying in the 3rd trimester

  • Avoid taking aspirin, NSAIDs, & decongestants

Red Flags When Exercising During Pregnancy

  • Calf swelling or pain

  • Chest pain

  • Leakage of amniotic fluid

  • Premature labor

  • ↓ Fetal mov't

  • Dizziness/headache

  • Vaginal bleeding

Musculoskeletal Complications

  • LBP, SI px, nerve entrapment due to ↑ fluid volume (CTS)

  • Mm cramps secondary to uterine pressure resulting in LE ischemia

  • Pubic symphysis dysfunction

  • Diastasis recti abdominis

  • Restless leg syndrome (iron deficiency)

Cardiovascular & Pulmonary Complications

  • Preeclampsia = rapidly progressive disorder that occurs after 20 weeks of pregnancy-h/a, blurred vision, edema, ↑ BP, proteinuria

  • DVT

  • Dyspnea

  • Pregnancy-induced hypertension = h/a, blurred vision

  • LE edema & varicose veins

Integumentary Complications

  • Hyperpigmentation

  • Palmar erythema

  • Dermatoses

Gastrointestinal Complications

  • GI px = nausea & vomiting may lead to dehydration, hypokalemia, & wt loss

  • ↓ Motility may result in constipation

  • Heartburn/gastric reflux

  • Hemorrhoids

  • ↑ Risk of gallstones

  • Toxoplasma gondii (toxoplasmosis)-parasite-can be transmitted across the placenta

Hepatic Complications

  • Although the liver is affected by physiological changes during pregnancy & the bilirubin excretion may be challenging in the 2nd half of pregnancy, liver tests are rarely abnormal.

  • Liver pathology may be preexisting or nonpregnancy-related ...

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