Effect of daily immersion on the edema of pregnancy

Physiological Effects of Aquatic Exercise in Pregnant Women on Bed Rest

This pilot study examined the effectiveness of an Aquatic Exercise Program (AEP) provided by an occupational therapist for pregnant women on hospitalized bed rest. Researchers conducted a retrospective analysis of medical records of hospitalized pregnant women comparing those who attended an AEP (n = 19) to a control group who received no AEP (n = 12). Statistical tests were used to assess evidence of differences in length of gestation as well as blood pressure and amniotic fluid index (AFI) at discharge. Women who received an AEP had increased AFI and length of gestation compared to the control group. This study supports the use of an AEP as an intervention for pregnant women on prescribed bed rest. Further research is recommended to validate these findings with a larger sample.

Immersion in water during labor and delivery

Immersion in water has been suggested as a beneficial alternative for labor, delivery, or both and over the past decades has gained popularity in many parts of the world. Immersion in water during the first stage of labor may be associated with decreased pain or use of anesthesia and decreased duration of labor. However, there is no evidence that immersion in water during the first stage of labor otherwise improves perinatal outcomes, and it should not prevent or inhibit other elements of care. The safety and efficacy of immersion in water during the second stage of labor have not been established, and immersion in water during the second stage of labor has not been associated with maternal or fetal benefit. Given these facts and case reports of rare but serious adverse effects in the newborn, the practice of immersion in the second stage of labor (underwater delivery) should be considered an experimental procedure that only should be performed within the context of an appropriately designed clinical trial with informed consent. Facilities that plan to offer immersion in the first stage of labor need to establish rigorous protocols for candidate selection, maintenance and cleaning of tubs and immersion pools, infection control procedures, monitoring of mothers and fetuses at appropriate intervals while immersed, and immediately and safely moving women out of the tubs if maternal or fetal concerns develop.

Immediate blood pressure changes and aquatic physiotherapy

OBJECTIVE

No studies to date have examined the effect on Blood pressure (BP) when pregnant women participate in aquatic physiotherapy (AP) classes; although, previous studies have indicated that there may be a detrimental outcome to the pregnant mother and fetus when there is a significant rise in the maternal BP. At least three components may contribute to BP changes: temperature, exercise, and immersion. This study examines BP changes in pregnant women attending AP classes.

METHOD

An experimental same-subject, repeated measures design was employed. Forty-five sets of data were collected from pregnant women attending routine, existing, nonaerobic AP classes. Blood pressure measurements were taken preimmersion, 2-5 minutes after entering the pool, immediately following the 50 minute AP class (while immersed), and 8-12 minutes after exiting the water.

RESULTS

Systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) data were analyzed using a repeated measures analysis of variance (ANOVA). For all sets of data a highly significant difference was observed (p = 0.0000). Post-hoc Tukey test results showed BP to decrease significantly on entering the water (MAP mean difference of 10.52 mm Hg, 95% CI 8.75 to 12.29), to remain at this low level postexercise while still immersed, and then return to preimmersion values 8-12 minutes after exiting the water.

CONCLUSION

These results indicate that AP classes are safe for nonhypertensive pregnant women in their third trimester. The use of AP in the antenatal care of women with unstable BP or who are hypertensive needs further research.

Single-blind trial addressing the differential effects of two reflexology techniques versus rest, on ankle and foot oedema in late pregnancy

This single-blind randomised controlled trial explored the differential effects of two different foot reflexology techniques with a period of rest on oedema-relieving effects and symptom relief in healthy pregnant women with foot oedema. Fifty-five women in the third trimester were randomly assigned to one of the three groups: a period of rest, 'relaxing' reflexology techniques or a specific 'lymphatic' reflexology technique for 15 min with pre- and post-therapy ankle and foot circumference measurements and participant questionnaire. There was no statistically significant difference in the circumference measurements between the three groups; however, the lymphatic technique reflexology group mean circumference measurements were all decreased. A significant reduction in the women's symptom mean measurements in all groups (p<0.0001) was apparent. A 'perceived wellbeing' score revealed the lymphatic technique group (p<0.0001) significantly increased their wellbeing the most, followed closely by relaxing techniques (p<0.001) and then the control rest group (p<0.03). Lymphatic reflexology techniques, relaxing reflexology techniques and a period of rest had a non-significant oedema-relieving effect. From the women's viewpoint, lymphatic reflexology was the preferred therapy with significant increase in symptom relief.

The effect of immersion on haemodynamic and fetal measures in uncomplicated pregnancies of nulliparous women

OBJECTIVE

To evaluate the effect of immersion in water on maternal haemodynamic measures and fetal heart rate patterns in healthy nulliparous women.

DESIGN

A randomised cross-over study.

PARTICIPANTS

Twenty pregnant women were studied between 26-29 weeks and between 34-37 weeks of gestation.

METHODS

The women were either immersed in water for 35 minutes or rested on a bed for a similar period of time. Maternal blood pressure, thoracic electrical bioimpedance, urine and blood samples, and fetal heart rate patterns were obtained before and after immersion or bedrest.

RESULTS

Compared with bedrest and pre-immersion values, immersion resulted in a significant decrease in blood pressure, which returned to baseline values within 1.5 hour. Urine production increased for a short period after immersion, but 24 hour samples showed no difference compared with bedrest. Sodium, potassium and creatinine levels in urine remained constant. No significant changes were found for the other haemodynamic measures. There were no effects on fetal heart rate nor on its variation.

CONCLUSION

In healthy pregnant women immersion for 35 minutes has a clear effect on blood pressure and urine production. However, these effects are short lasting.

Water exercise in pregnancy

Exercise in the water offers several physiological advantages to the pregnant woman. The hydrostatic force of water pushes extravascular fluid into the vascular spaces, producing an increase in central blood volume that may lead to increased uterine blood flow. This force is proportional to the depth of immersion. The increase in blood volume is proportional to the woman's edema. A marked diuresis and natriuresis accompanies the fluid shifts. The buoyancy of water supports the pregnant women. Water is thermoregulating. Studies of pregnant women exercising in the water have shown less fetal heart rate changes in the water than on land in response to exertion. Pregnant women's heart rates and blood pressures during water exercise are lower than on land exercise, reflecting the immersion-induced increase in circulating blood volume. The physiology of water exercise offers some compensation for the physiological changes of exercise on land that may beneficially affect pregnancy.