It is an exciting opportunity for delegates to enhance their medical knowledge, meet like-minded ultrasound professionals, participate in the Society sessions and celebrate the Congress' 30th anniversary in Scotland! New UOG Journal video clip illustrating the use of intraoperative ultrasound through a laparoscopic probe to locate borderline ovarian tumors, thus ensuring complete excision of the disease and sparing healthy ovarian parenchyma. With less than six weeks to go for the 29th World Congress on Ultrasound in Obstetrics and Gynecology, the September Newsletter has more information and updates about what to expect from the Congress.
Read the newsletter to find out more. Articles on other topics include a study on cardiac maladaptation in obese pregnant women at term and a study on hemoperitoneum as a precursor of deep pelvic endometriosis. Also out this month are a new Virtual Issue on non-invasive prenatal testing and a study on the impact of the HYPITAT-I trial on obstetric management and outcome in pregnancies complicated by gestational hypertension or mild pre-eclampsia in The Netherlands, which has an accompanying press release.
ISUOG Outreach provides intensive hands-on training in ultrasound supported by essential theoretical knowledge, in underserved regions of the world. See our Outreach page for a list of current training projects. Registration is now open. Find out more. More information.
Basic Training Upcoming courses and educational resources. Endometriosis and gynecologic oncology: do they have something in common? Register now. Doppler and maternal vascular imaging January , London, UK and live streamed globally. Modern management in twins: all you need to know 04 February , Dallas, USA and live streamed globally. Join us today. High quality research. CME platform. This is the target goal of the Journal?
This publication attempts to cover all aspects of obstetrics and gynecology in an interdisciplinary approach among gynecologists, epidemiologists, pathologists, oncologists, radiologists, microbiologists, surgeons, urologists, neonatologists, geneticists, and so on. The first target goal of CEOG is to publish high quality papers in a timely manner.
Research papers, editorial reviews, case reports, technical notes, book reviews, and letters to the Editor are published. Reproductions are not allowed without the written consent of the Publisher. All photocopy fees should be paid to the Copyright Clearance Center, Inc. Luc, Apt. ABSTRACT: Physical activity in all stages of life maintains and improves cardiorespiratory fitness, reduces the risk of obesity and associated comorbidities, and results in greater longevity.
Physical activity in pregnancy has minimal risks and has been shown to benefit most women, although some modification to exercise routines may be necessary because of normal anatomic and physiologic changes and fetal requirements. Women with uncomplicated pregnancies should be encouraged to engage in aerobic and strength-conditioning exercises before, during, and after pregnancy. Obstetrician—gynecologists and other obstetric care providers should carefully evaluate women with medical or obstetric complications before making recommendations on physical activity participation during pregnancy.
Although frequently prescribed, bed rest is only rarely indicated and, in most cases, allowing ambulation should be considered. Regular physical activity during pregnancy improves or maintains physical fitness, helps with weight management, reduces the risk of gestational diabetes in obese women, and enhances psychologic well-being. An exercise program that leads to an eventual goal of moderate-intensity exercise for at least 20—30 minutes per day on most or all days of the week should be developed with the patient and adjusted as medically indicated.
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Additional research is needed to study the effects of exercise on pregnancy-specific outcomes and to clarify the most effective behavioral counseling methods, and the optimal intensity and frequency of exercise. Similar work is needed to create an improved evidence base concerning the effects of occupational physical activity on maternal—fetal health. Regular physical activity in all phases of life, including pregnancy, promotes health benefits.
Pregnancy is an ideal time for maintaining or adopting a healthy lifestyle and the American College of Obstetricians and Gynecologists makes the following recommendations:. Physical activity , defined as any bodily movement produced by the contraction of skeletal muscles 1 in all stages of life maintains and improves cardiorespiratory fitness, reduces the risk of obesity and associated comorbidities, and results in greater longevity.
Women who begin their pregnancy with a healthy lifestyle eg, exercise, good nutrition, nonsmoking should be encouraged to maintain those healthy habits. Those who do not have healthy lifestyles should be encouraged to view the preconception period and pregnancy as opportunities to embrace healthier routines. Exercise , defined as physical activity consisting of planned, structured, and repetitive bodily movements done to improve one or more components of physical fitness 1 , is an essential element of a healthy lifestyle, and obstetrician—gynecologists and other obstetric care providers should encourage their patients to continue or to commence exercise as an important component of optimal health.
In , the U. Department of Health and Human Services issued physical activity guidelines for Americans 2. For healthy pregnant and postpartum women, the guidelines recommend at least minutes per week of moderate-intensity aerobic activity ie, equivalent to brisk walking.
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This activity should be spread throughout the week and adjusted as medically indicated. The World Health Organization and the American College of Sports Medicine have issued evidence-based recommendations indicating that the beneficial effects of exercise in most adults are indisputable and that the benefits far outweigh the risks 3 , 4. Physical inactivity is the fourth-leading risk factor for early mortality worldwide 3. In pregnancy, physical inactivity and excessive weight gain have been recognized as independent risk factors for maternal obesity and related pregnancy complications, including gestational diabetes mellitus GDM 5—7.
Some patients, obstetrician—gynecologists, and other obstetric care providers are concerned that regular physical activity during pregnancy may cause miscarriage, poor fetal growth, musculoskeletal injury, or premature delivery. For uncomplicated pregnancies, these concerns have not been substantiated 8— In the absence of obstetric or medical complications or contraindications Box 1, Box 2 , physical activity in pregnancy is safe and desirable, and pregnant women should be encouraged to continue or to initiate safe physical activities Box 3.
In women who have obstetric or medical comorbidities, exercise regimens should be individualized. Pregnancy results in anatomic and physiologic changes that should be considered when prescribing exercise. The most distinct changes during pregnancy are increased weight gain and a shift in the point of gravity that results in progressive lordosis. These changes lead to an increase in the forces across joints and the spine during weight-bearing exercise. Strengthening of abdominal and back muscles could minimize this risk.
Blood volume, heart rate, stroke volume, and cardiac output normally increase during pregnancy, while systemic vascular resistance decreases. These hemodynamic changes establish the circulatory reserve necessary to sustain the pregnant woman and fetus at rest and during exercise.
In pregnancy, there are also profound respiratory changes. Because of a physiologic decrease in pulmonary reserve, the ability to exercise anaerobically is impaired, and oxygen availability for strenuous aerobic exercise and increased work load consistently lags. The physiologic respiratory alkalosis of pregnancy may not be sufficient to compensate for the developing metabolic acidosis of strenuous exercise. Decreases in subjective work load and maximum exercise performance in pregnant women, particularly in those who are overweight or obese, limit their ability to engage in more strenuous physical activities Aerobic training in pregnancy has been shown to increase aerobic capacity in normal weight and overweight pregnant women 16— Temperature regulation is highly dependent on hydration and environmental conditions.
During exercise, pregnant women should stay well-hydrated, wear loose-fitting clothing, and avoid high heat and humidity to protect against heat stress, particularly during the first trimester Although exposure to heat from sources like hot tubs, saunas, or fever has been associated with an increased risk of neural tube defects 20 , exercise would not be expected to increase core body temperature into the range of concern.
At least one study found no association between exercise and neural tube defects Despite the fact that pregnancy is associated with profound anatomic and physiologic changes, exercise has minimal risks and has been shown to benefit most women. Most of the studies addressing fetal response to maternal exercise have focused on fetal heart rate changes and birth weight. Studies have demonstrated minimum-to-moderate increases in fetal heart rate by 10—30 beats per minute over the baseline during or after exercise 23— Three meta-analyses concluded that the differences in birth weight were minimal to none in women who exercised during pregnancy compared with controls 27— However, women who continued to exercise vigorously during the third trimester were more likely to deliver infants weighing — g less than comparable controls, although there was not an increased risk of fetal growth restriction 27— A cohort study that assessed umbilical artery blood flow, fetal heart rates, and biophysical profiles before and after strenuous exercise in the second trimester demonstrated that 30 minutes of strenuous exercise was well tolerated by women and fetuses in active and inactive pregnant women.
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Regular aerobic exercise during pregnancy has been shown to improve or maintain physical fitness 8, 9 , Although the evidence is limited, some benefit to pregnancy outcomes has been shown, and there is no evidence of harm when not contraindicated. Observational studies of women who exercise during pregnancy have shown benefits such as decreased GDM 6, 30—32 , cesarean and operative vaginal delivery 9, 33 , 34 , and postpartum recovery time 9 , although evidence from randomized controlled trials is limited.
In those instances where women experience low-back pain, water exercise is an excellent alternative Studies have shown that exercise during pregnancy can lower glucose levels in women with GDM 36 , 37 , or help prevent preeclampsia Exercise has shown only a modest decrease in overall weight gain 1—2 kg in normal weight, overweight, and obese women 39 , Pregnancy is an ideal time for behavior modification and for adopting a healthy lifestyle because of increased motivation and frequent access to medical supervision. Patients are more likely to control weight, increase physical activity, and improve their diet if their physician recommends that they do so The principles of exercise prescription for pregnant women do not differ from those for the general population 2.
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A thorough clinical evaluation should be conducted before recommending an exercise program to ensure that a patient does not have medical reasons to avoid exercise. Box 3 lists examples of safe and unsafe physical activities in pregnancy. Women with uncomplicated pregnancies should be encouraged to engage in physical activities before, during, and after pregnancy.
Because blunted and normal heart-rate responses to exercise have been reported in pregnant women, the use of ratings of perceived exertion may be a more effective means to monitor exercise intensity during pregnancy than heart-rate parameters For moderate-intensity exercise, ratings of perceived exertion should be 13—14 somewhat hard on the 6—20 Borg scale of perceived exertion Table 1. As long as a woman can carry on a conversation while exercising, she is likely not overexerting herself Women should be advised to remain well hydrated, avoid long periods of lying flat on their backs, and stop exercising if they have any of the warning signs shown in Box 4.
Pregnant women who were sedentary before pregnancy should follow a more gradual progression of exercise. Although an upper level of safe exercise intensity has not been established, women who were regular exercisers before pregnancy and who have uncomplicated, healthy pregnancies should be able to engage in high-intensity exercise programs, such as jogging and aerobics, with no adverse effects. High-intensity or prolonged exercise in excess of 45 minutes can lead to hypoglycemia; therefore, adequate caloric intake before exercise, or limiting the exercise session, is essential to minimize this risk Prolonged exercise should be performed in a thermoneutral environment or in controlled environmental conditions air conditioning with close attention paid to proper hydration and caloric intake.
In studies of pregnant women who exercised in which physical activity was self-paced in a temperature-controlled environment, core body temperatures rose less than 1. Finally, although physical activity and dehydration in pregnancy have been associated with a small increase in uterine contractions 47 , there is only anecdotal evidence that even strenuous training causes preterm labor or delivery.
Participation in a wide range of recreational activities is safe. Activities with high risk of abdominal trauma should be avoided Box 3. Scuba diving should be avoided in pregnancy because of the inability of the fetal pulmonary circulation to filter bubble formation For lowlanders, physical activity up to 6, feet altitude is safe in pregnancy Several reviews have determined that there is no credible evidence to prescribe bed rest in pregnancy, which is most commonly prescribed for the prevention of preterm labor.
Patients prescribed prolonged bed rest or restricted physical activity are at risk of venous thromboembolism, bone demineralization, and deconditioning. Obese pregnant women should be encouraged to engage in healthy lifestyle modification in pregnancy that includes physical activities and judicious diets 5. Obese women should start with low-intensity, short periods of exercise and gradually increase as able.