Extra care should always be taken when managing pregnant patients. In the consideration of both maternal and foetal safety, certain treatment positions and postures are discouraged. The first obvious position that is contraindicated is the prone position in order to protect the developing foetus.
Additionally, if the PT intervention takes the form of exercise, then the type of exercise chosen should not pose any significant risk of trauma (especially to the abdomen) or risk of falls to the patient. Accordingly, any form of exercise (or treatment) that requires the patient to adopt the supine position for a prolonged time should be avoided in the second and third trimesters. Ref 1.
Being in the supine position can restrict or affect blood flow to the baby because the heavy uterus in the supine position can place pressure on the vena cava. Ref 2. The vena cava lies on the right side of the body. During pregnancy the enlarged uterus also naturally leans towards the right side (as it moves up and out of the pelvis after 12 weeks). This can make the vena cava prone to becoming compressed while lying on the right side as well as lying in supine. The resultant reduction of blood flow back to the heart can indirectly affect the blood flow to the baby as well. Ref 2.
One of the American College of Obstetricians & Gynaecologists (ACOG) published Guidelines for Exercise is that no exercise should be undertaken in the supine position after week 16. Ref 3.
Ref 1; Gibbs R.S. et al. Danforth’s Obstetrics and Gynecology. 2008. 10th Edition. Wolters Kluwer|Lippincott Williams & Wilkins publishers.Chapter 1. Prenatal Care. Table 1.6. Recommendations For Exercise in Pregnancy. Pg 17.
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