A Case Study
Srilatha. S1, B. Sujatha2
1Postgraduate, Urology and Obstetrics Physiotherapy, Saveetha College of Physiotherapy,
Saveetha Institute of Medical and Technical Sciences, Chennai.
2Assistant Professor, Saveetha College of Physiotherapy,
Saveetha Institute of Medical and Technical Sciences, Chennai.
BACKGROUND: Gestational hypertension is one of the leading causes of maternal morbidity and mortality.(1). Pregnancy induced hypertension is defined as systolic blood pressure >140mmhg and diastolic blood pressure >90mmhg. Mild PIH is defined as SBP 140-149mmhg and DBP 90-99mmhg(3) Hypertensive disorders may result in fetal complication, such as growth restriction, oligohydramnios, placental abruption, preterm birth and preinatal death(1 )(1,2) The prevalence of all pregnancies with some form of hypertension can be up to 10%, with the rates of diagnosis varying according to the country and population studied and the criteria used to establish the diagnosis.(3). Gestational hypertension is associated with short and long term issues for mother and child. The aim of the study was to evaluate the effects of exercise during pregnancy on the risk of gestational hypertensive disorders. CASE REPORT: A 28 years primi pregnant women came with complain loss of established BP control, symptoms/signs such as headache, blurred vision, right upper quadrant or epigastric pain, and diagnosed to have gestational hypertension (SBP 140 mmhg and DBP 90 mmhg) with gestational age of 22weeks. CONCLUSION: Aerobic exercise for about 30- 60 mins two to seven times per week during pregnancy as compared with being more sedentary is associated with a significantly reduced risk of gestational hypertensive disorder, gestational hypertension and cesarean delivery(1).
Women experiences pregnancy as the most pleasant situation during life. Pregnancy induced hypertension is defined as systolic blood pressure >140mmhg and diastolic blood pressure >90mmhg. Mild PIH is defined as SBP 140-149mmhg and DBP 90-99mmhg(4). This leads to major cause of maternal, fetal and new born morbidity and mortality. It complicates 6-7% in primiparous and 2-4% in multiparous(5).
Cardiovascular changes during pregnancy includes(3) Increased maternal plasma-volume, cardiac output and heart rate, decreased maternal systemic vascular resistance and arterial blood pressure(4,46)(6) regardless of the type of hypertension during pregnanc, there is a high risk of cardiovascular disease, chronic kidney disease and diabetes mellitus.
Four categories of hypertensive disorders of pregnacy:
A) Pre- eclampsia/eclampsia
B) Chronic (pre existing) hypertension
C) Preeclampsia superimposed on chronic hypertension
D) Gestational hypertension
It is diagnosed by Systolic blood pressure of 140mmhg or greater and/or diastolic blood pressure of 90mmhg or greater on at least two occasion more than 4h apart while resting. diagnostic triggers include new or suddenly worsening proteinurie, hypertension and proteinuria onset before 20 weeks gestation. Exercise may contribute to a reduction in blood pressure levels and cardiovascular conditioning in pregnant women.(7) The American college of obstetrician and gynaecologists recommends moderate- intensity exercise at least three times a week.(1) exercise in pregnancy reduces oxidative stress, may improve endothelial function and could reduce hypertension.(3) maternal exercise has been associated with lowering of blood pressure and an increase in aerobic and cardiovascular conditioning.(1) the incidence of caesarean delivery was decreased by 16% in the exercise group.(5) pregnancy induced hypertension may lead to increased feta and neonatal mortality, preterm labour, low birth weight, intrauterine growth restriction, abruption of placenta, increased caesarean section delivery, obesity, heart and, persisting second or third trimester bleeding, placenta previa, incomplete cervix, intrauterine growth restriction, uncontrolled type 1 diabetes, serious cardiovascular, respiratory or systemic disorders. Relative contraindications to exercise: history of spontaneous abortion, premature labour, mild/moderate cardiovascular or respiratory disease, anaemia or iron deficiency, malnutrition or eating disorders or other significant medical condition
Most studies show that Aerobic exercises steadily reinforce on gestational hypertension. The purpose of this study was to find the effectiveness of aerobic exercise on pregnant women who is experiencing mild hypertension (BP-≥135mmhg of systolic BP and ≥85mmhg of diastolic BP).
This case study details a patient who experiences mild hypertension in pregnant women. Her condition was evaluated and treated successfully and conservatively with Physical Therapy.
Informed consent was signed by the patient prior to the study. A 28 years primi pregnant women came with complain loss of established BP control, symptoms/signs such as headache, blurred vision, right upper quadrant or epigastric pain, and diagnosed to have gestational hypertension (SBP 140mmhg and DBP 90mmhg) with gestational age of 22weeks.
General OBG assessment was taken. Vitals were monitored during each visit.
Demographic and other information (pregravid weight and height 0, parity, occupational activity, previous physical activity habits, smoking status, previous preterm birth and previous miscarriage were obtained at the first prenatal visit either by reviewing the medical records or by questionnaire.
Blood pressure was measured using sphygmomanometer. patient was made to sit on an arm rest chair comfortably. blood pressure was checked before and after the intervention. BP was measured before and after 15 mins, i.e after the arrival and after the exercise regimen respectively.
Beck's Depression Inventory – questionnaire was used pre and post the treatment and the score was evaluated to know the difference.
Patient was made to sit comfortably and protocol was explained. Pre and post vitals where recorded. The exercise session includes 40mins, 2 days/week which includes 10mins of warm up phases and 20mins of aerobic training and 10 mins of cool down phase.
Exercise regimen is mentioned in table
The subject underwent the treatment protocol with proper guidance and safety and there was a significant result in decreasing the BP in hypertensive disorders during pregnancy.
Physical activity and regular exercise promote health in general population. American college of Obstetricians and Gynecologists recommends moderate- intensity physical exercise every day or at least three times a week, even in pregnant women who were previously inactive. It may protect against pre-eclampsia by reducing the maternal concentration of oxidative substances (oxidative stress); stimulating vascularity and placental growth and preventing endothelial dysfunction. Maternal exercise may be preventive tool for hypertension.(3) the incidence of cesarean delivery was decreased by 16%.(1) epidemiological evidence suggests that women who participate in regular physical activity have reduced risk of developing pregnancy-induced hypertension(3). Intervention focusing on reducing modifiable risk factors should be incorporated into prenatal care to improve health of the mother. Without exercises during pregnancy, women are 3 times more likely to develop hypertension, 1.5 times more likely to gain excessive weight, and 2.5 times more likely to give birth to a macrosomic infant(3). Aerobic exercise for about 30- 60 mins two to seven times per week during pregnancy as compared with being more sedentary is associated with a significantly reduced risk of gestational hypertensive disorder, gestational hypertension and cesarean delivery(1).
1. Elena r. Magro-Malosso et al: Exercise during pregnancy and risk of gestational hypertensive disorders: a systematic review and meta- analysis. 2017 Nordic Federation of societies of obstetrics and gynecology, Acta obstetrica et gynecologica scandinavica 96 (2017) 921-931.
2. Sibai B, Dekker G, Kupferminc M. Pre-eclampsia. Lancent. 2005; 365: 785-99.
3. Ruben Barakat, PhD; Mireia pelaez, PhD et al: Exercise during pregnancy protects against hypertension and macrosomia: randomized clinical trails. May 2016 American Journal of obstetrics and gynaecology 649.e1
4. Evangelia kintiraki, Sophia papakatsika et al: pregnancy induced hypertension. HORMONES 2015, 14(2):211-223
5. Mahboobeh Aalami, Farzaneh Jafarnejad et al: the effects of progressive muscular relaxation and breathing control technique on blood pressure during pregnancy. 2016 Iranian journal of nursing and Midwifery research published by Wolters Kluwer- Medknow.
6. Ouzounian JG, Elkayam U, 2012 Physiologic changes during pregnancy and delivery. Cardiol Clin 30:317-32
7. Yeo S. Prenatal stretching exercise and autonomic responses: preliminary data and a model for reducing preeclampsia. J Nurs Scholarsh. 2010; 42 (2):113-21.
Received on 04.06.2019 Modified on 04.07.2019
Accepted on 01.08.2019 © RJPT All right reserved