The following are adaptations of interventions that have already been described that should be considered for the bed-bound patient with a high-risk pregnancy.

Positioning
• Left side-lying to prevent vena cava compression, enhance cardiac output, and decrease lower extremity edema

• Pillows between the knees and under the abdomen

• Supine positioning for short periods, with a wedge placed under the right hip to decrease inferior vena cava compression

• Modified prone positioning (side-lying, partially rolled toward prone, with pillow under abdomen) to decrease low back discomfort and pressure

Range of Motion (ROM)
• Active ROM of all joints.

• Motions should be slow, nonstressful, and through the full range if possible.

• Teach in a gravity-neutral position if antigravity ROM is too stressful.

• Individualize the number of repetitions and frequency to the woman’s condition.

• Include the following exercises with the patient supine (with wedge under the right hip) or side-lying:
  • Alternate knee to chest
  • Ankle pumping and ankle circles
  • Shoulder, elbow, and finger flexion and extension; reach to ceiling; arm circles
  • Unilateral straight-leg raise in supine or side-lying position
  • Unilateral active ROM in diagonal patterns for the upper and lower extremities
  • Lower extremity abduction and adduction
  • Pelvic tilt, bridging, gluteal setting
  • Abdominal exercises (check for diastasis); these should be very low intensity and closely monitored.
  • Pelvic floor exercises
  • Neck motions: look up/down, turn head left/right.
  • Backward shoulder circles

Ambulation/Standing
• Almost always contraindicated; when allowed, usually will be only to use the bathroom
• Good posture in ambulation
• Tip-toe or heel walking
• Gentle, partial-range squatting
• Lower extremity rotation

Relaxation Techniques, Bed Mobility and Transfer Activities
• Relaxation as in the uncomplicated pregnancy
• Moving up, down, side to side in bed
• Log rolling: incorporate neck, upper and lower extremities to aid movement
• Supine to sitting: use log roll technique assisted by arms

Preparation for Labor
• Relaxation techniques
• Modified squatting: supine, sitting, or side-lying with knees to chest
• Pelvic floor relaxation
• Breathing exercises: minimize forced abdominal exhalations

Postpartum Exercise Instruction
Instructions are the same as previously described in the uncomplicated pregnancy section.

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

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