All exercise programs for high-risk populations should be individually established based on diagnosis, limitations, physical therapy examination and evaluation, and consultation with the physician. Activities must address patient needs but should not further complicate the condition.

Develop good rapport with the patient and instill trust. Closely monitor the patient during all activities; re-evaluate her after each treatment and note any changes. It is also important to teach the patient self-monitoring techniques so that she will be alert to adverse reactions and respond appropriately.
• Prolonged static positioning is a primary concern. The position of choice for the high-risk patient is left side-lying, which is optimal for reducing pressure on the inferior vena cava and for maximizing cardiac output, thereby enhancing maternal and fetal circulation.

• Some exercises, especially abdominal exercises, may stimulate uterine contractions. If this occurs, modify or discontinue them.

• Monitor and report any uterine contractions, bleeding, or amniotic fluid loss.

• Do not allow the Valsalva maneuver to occur. Avoid any activities that increase intra-abdominal pressure. Body mechanics and postural instruction will stimulate abdominal contractions, so be sure the patient does not strain and closely monitor for adverse symptoms.

• Keep the exercises simple. Have the patient do them slowly, smoothly, and with minimal exertion.

• Many high-risk pregnancies result in cesarean deliveries, so educate the woman about cesarean delivery rehabilitation.

• Incorporate maximum muscle efficiency into each movement.

• Teach the patient self-monitoring techniques.

Management Guidelines-High-Risk Pregnancy

Potential Impairments and Functional Limitations:

Primary functional limitation is inability to be out of bed and prolonged static positioning which contributes to the following:

Joint stiffness and muscle aches

Muscle weakness and disuse atrophy

Vascular complications including risk of thrombosis and decreased uterine blood flow

Decreased proprioception in distal body parts

Constipation caused by lack of exercise

Postural changes

Boredom

Emotional stress; patient may be at risk of losing the baby

Guilt from the belief that some activity caused the problem or that the patient did not take good enough care of herself

Anxiety about her home situation, older children, finances or the impending birth

Buy the Book that holds this excerpt: Therapeutic Exercise: Foundations and Techniques (Therapeutic Exercise: Foundations & Techniques)

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