HSE113 AT1 Case Study 1: Elena and Lucas - Pregnancy and Exercise

This case study examines Elena's pregnancy, focusing on her exercise habits and the physiological changes occurring in both her and her fetus, Lucas. The assignment requires a summary of the case study, detailing Elena's lifestyle, age, activity levels, and dietary habits. It then delves into the structural and physiological changes during fetal development, from conception to the 31st week, including the influence of various factors on prenatal growth. Further, the case study investigates the physiological, structural, endocrine, and cognitive changes Elena experiences during pregnancy and postpartum. It assesses the impact of physical activity before, during, and after pregnancy on both Elena and Lucas, including the physical activity guidelines and potential barriers to exercise. The analysis includes recommendations for postpartum activity, emphasizing the benefits and citing relevant literature to support the points made.

AT1- Case study 1, T1-2020 Student Number: xxxxxxx
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AT1 case study 1 (72 marks available) – Elena and Lucas
Question 1A: Case Study summary (6 marks): Please list the key information you can extract from
the case study to provide some context for the questions which follow. You should include key
information such as lifestyle habits pre-pregnancy, clients’ age (including the foetus’ age), current
activity levels, dietary habits and living arrangements.
Elena is twenty years old, in second preganacy. In order to keep herself healthy during
preganacy – she has quitted the psychsocial habits of drinking alcohol and smoking cigarettes. She
started eating healthy food plus exercising. She ran 5 kilometers for upto four times a week till 25
weeks of preganacy post which she shifted to walking.The foetus is at 31st weeks, healthy.
Question 1B (12 marks): Using chapter two of “Growth, Maturation, and Physical Activity”
complete the table below to define some of the KEY physiological and structural changes which will
occur for the foetus, Lucas, from conception to his current developmental stage.
Egg (zygote) - Embryo Embryo - Foetus Foetal development
Time frame for
each
developmental
stage:
0-2weeks 3-8weeks 9- 31weeks
Recall the key
structural
changes
occurring at
each stage:
 blastocyst develops
 Implantation occurs.
1. Neural tube
formed [1]
2. eyes, mouth,
ears, nose,
head formed.
3. Placenta,
amniotic sac
formed
 heart, limbs, eyes,
palate, external ear
formed
 Central nervous system
formed.
Recall some of
the key
physiological
(movements,
 Vascularization
around placenta
 placental
functions
established
 ‘Startle response’ is
established
 foetal circulation

AT1- Case study 1, T1-2020 Student Number: xxxxxxx
reflexes etc)
developments
that may occur
at each stage:
 human
gonadotrophic
hormone
released [2]
established
Indicate some
of the key
factors that
influence pre-
natal growth
and
development
(use the foetal
development
column):
 Rh factor
 Age
 Drugs
 Environmental
factors
 Infections
Question 1C (2 marks): In ~100 words briefly describe the current developmental phase of Lucas
and what you expect (birth weight range etc) when he is born at full term.
The current developmental status of Lucas is absolutely normal and fine. Both physiological
and the anatomical milsetones have been reached in a normal manner. Considering the 31ST week
structural and the physiological state of the foetus and considering the current state of normal
development, a normal child birth outcome is expected. A birth weight range of almost 2.5 to 4.4 kg,
normal color and normal muscle tone (not hypertonia or hypotonia), without any functional defect and
without any anatomical defect is expected. No complications such as Blue baby syndrome, Floppy
child syndrome, perinatal asphyxia, abnormal heart rate is expected.
Question 2A (12 marks): In the table below list the KEY physiological, structural, endocrine, and
cognitive changes that Elena will experience during pregnancy and into the postpartum period?
Structural Physiological Endocrine Cognitive
During
pregnancy
 Breasts and
 Uterus size
increases [5]
 Heart rate,
blood volume
increases
 Braxton hicks
 Human
gonadotropin
hormone
secretion
 Thryroid
hormone
increases [7]
 Mood swings
 Memory issues
 Executive
functioning
issues
Postpartu
m
(following
delivery of
placenta
can be 6
weeks to 6
months
after
delivery)
 Distented
structures
normalizes
 Lactation
begins
 Involution of
uterus
 Estrogen,
progresteron
e normalises
 Improved
verbal
memnory

AT1- Case study 1, T1-2020 Student Number: xxxxxxx
Question 2B (2 marks): Considering the information provided to you in the case study and the
information you have provided above in the table, briefly describe Elena’s current pregnancy stage
(~100 words).
Considering the information provided to you in the case study and the information you have
provided above in the table, the Elena’s current preganacy state is normal and there are no
complications that has been reported. The structural that is the natomical, the functional that is the
physiological and the cognitive that is the psychological and the endocrinal that is the hormonal
changes as mentioned above in the table are normal and there are no complications as such but in the
post partpum stage, after the baby is born – care must be taken to prevent any post partum maternal
complications [3].
Question 3A (5 marks): In the table below list how physical activity prior to pregnancy, during
pregnancy and postpartum influence the physiological, structural, social and/or cognitive growth of
Lucas?
Structural Physiological Social Cognitive
Pre-
pregnancy
Sets tone for normal
anatomical
development
Sets tone for
functionally normal
child
Improved genetic
transmission of
social skills
Improved genetic
transmission of
cognitive skills
During
pregnancy
Stimulate proper
organogenesis
Improved foetal
circulation
Predispose normal
social development
Imrove neurocognitive
development
Post-
partum
Enhance physical
development
Improve functional
development
Enhance social
development
Normal cognitive
development
Question 3B (5 marks): In the table below list how physical activity prior to pregnancy, during
pregnancy and postpartum influence the physiological, structural, social and/or cognitive
development of Elena?
Structural Physiological Social Cognitive
Pre-
pregnancy
Hypertrophy of
muscles.
improved
cardiovascular status
Develop
intrapersonal skills
Better attention
During
pregnancy
Stimulate
vascularization
Adress the metabolic
needs of patients
Reduce social
anxiety
Better memory and
attention
Post-
partum
Normalizing distended
structures
Improved
cardiovascular status
Maintain
psychosocial health
Enhance recovery
process.
Question 4A (14 marks): In ~200 words and with supporting literature describe the physical activity
guidelines for exercise prior to, during and following pregnancy. Pay particular attention to indicated
and contraindicated exercises. Hint: look to the Pregnancy and Exercise guidelines on the “Better

AT1- Case study 1, T1-2020 Student Number: xxxxxxx
Health Channel” from the Victoria State Government and look to the reading resources provided on
the Cloud.
The physical activity prior to the preganacy were 30 minutes running session that she
continued upto 25th week of preganacy and then switched to 40 minutes walking, that is highly
indicated during preganacy. The exercises prior to, during and post the preganacy help improve the
cardiovascular status, neuromuscular coordionation, posture, weight control, muscular flexibility and
contractibility, stress belief, reduced anxiety and reduced stress relief plus reduction of the pelvic pain
as well as low back pain, improved blood circulation[9]. It has also been seen that indicated exercises
improves circulation. There are certain exercises that are indicated in the preganacy and there are
certain exercises that are contraindicated in the preganacy. The indicated exercises are walking,
swimming, jogging, stationary cycling, floor exercises, aquatic exercises, pilates, yoga and low to
medium insentiy muscle strengthening exercises[10]. In the post preganacy phase, Kegel’s exercise is
very import to strengthen the pelvic floor msucles. Attending the preganacy exercise class is also
recommended. The contraindicated exercises especially during preganacy are heavy lifting, resisted
exercises, squats, high altitude training, lunges, supine position lying and avoiding collision and
contact is very critical. Physical exercises are indicated gradually proceed from low to the medium
intensity and repetitions to normalize to normal body’s status [6].
Question 4B (10 marks): Integrating what you have learned about Elena in the case study with what
you know about the physical activity recommendations, evaluate Elena’s pre-pregnancy and current
physical activity habits (~100 words). Furthermore, consider any potential barriers to physical
activity in the post-partum period and make some recommendations for return to activity following
the birth of Lucas (~200 words). Highlight some of the benefits of postpartum physical activity (~50
words). You should look to cite some relevant literature here to support your points. Hint: look to the
reading resources provided in the Cloud.
In the preganacy stage, she use to run for thirty minutes for about three to four times a week
that she continued for 25 weeks of preganacy and following that she is walking for forty minutes for
three to four times a week. it has been learned that structural and the physiological change in the body
of the mother and in the foetus during the preganacy has different exercise or physical activity needs.
A high to low intensity modification in physical activity is important and energy expenditure,
breathing rate should be calculated as well. The exercise transition has occurred properly.
In the post partum period, the subject can suffer from post partum rheumatoid arthritis, finger
stiffness, low back pain, myalgia, urinary incontinence and arthralgia and sleep disc related spinal and
a range of neurological as well as musculoskeletal issues that can prevent the physical activities from
being undertaken by Elena. Also, it is highly important that the intervention and normalizing

AT1- Case study 1, T1-2020 Student Number: xxxxxxx
strategies for addressing the clinical problems are planned to help Ellena return to normal life[11].
The Kegel’s exercises are very vital in the post natal phase to promote the functionality of the pelvic
floor muscles and prevent incontinence related issues. Walking, swimming, low instensity cardio
execrises are very helpful to help her return to her normal functions and improve undertaking of
physical movements in daily day to day activities without difficulty. These might cause self care
complications in the post partum phase and the added responsibility of caring for the child can lead to
stress and anxiety in the mother. Hence, proper nutrition and sleep should be promoted in the patient
and recreational activities for rexalation promotion is critical as well [12]. Hence, following the birth
of lucas, proper sleep, nutrition and physical activities as well as relaxation exercise is vital.
The post-partum physical activity would help in better the respiratory and the cardiovascular
health of the subject, improve the energy banace and the metabolism process as well. In addition the
flexibility, strength, endurance of the muscles, the neurological firing, mechanical strength of the
skeletal system will be improved and bettered [8]
Reference list (2 marks)
1. Soma-Pillay P, Catherine NP, Tolppanen H, Mebazaa A, Tolppanen H, Mebazaa A.
Physiological changes in pregnancy. Cardiovascular journal of Africa. 2016 Mar;27(2):89.
2. Perales M, Nagpal TS, Barakat R. Physiological Changes During Pregnancy: Main
Adaptations, Discomforts, and Implications for Physical Activity and Exercise. InExercise
and Sporting Activity During Pregnancy 2019 (pp. 45-56). Springer, Cham.
3. Tang Q, Wang L. Physiological changes and implications during the fetal-neonatal transition.
Journal of Clinical Pediatrics. 2016 Jan 1;34(3):223-6.
4. Peng YC, Chou FH. Different Exercise Intensities for Relieving Lumbopelvic Pain in
Pregnant Women. The Journal for Nurse Practitioners. 2019 Mar 1;15(3):249-55.
5. Soma-Pillay P, Catherine NP, Tolppanen H, Mebazaa A, Tolppanen H, Mebazaa A.
Physiological changes in pregnancy. Cardiovascular journal of Africa. 2016 Mar;27(2):89.
6. Palatova TV, Maslyakova GN, Chekhonatskaya ML, Bucharskaya AB, Genina EA,
Bashkatov AN. Functional and morphological changes in the mother-placenta-fetus system
during chronic hypoxia (experimental study). InSaratov Fall Meeting 2018: Optical and
Nano-Technologies for Biology and Medicine 2019 Jun 3 (Vol. 11065, p. 110651W).
International Society for Optics and Photonics.
7. Endendijk JJ, Wijnen HA, Pop VJ, van Baar AL. Maternal thyroid hormone trajectories
during pregnancy and child behavioral problems. Hormones and behavior. 2017 Aug 1;94:84-
92.
8. Downs DS, Leonard KS, Beiler JS, Paul IM. Predictors of Postpartum Exercise According to
Prepregnancy Body Mass Index and Gestational Weight Gain. Journal of Physical Activity
and Health. 2017 Oct 1;14(10):797-807.
9. Ghaffari Z, Vafaei AA, Rashidy-Pour A, Hadjzadeh MA, Hosseini SM. Effects of maternal
hypothroidism during preganacy on anxiety-like behaviors in adulthood rats: Impact of
moderate treadmill exercise. koomesh. 2016 Mar 8:707-17.
10. Levett KM, Sutcliffe KL, Betts D. Using Forbidden Points in Pregnancy: Adverse Outcomes
and Quality of Evidence in Randomized Controlled Trials—A Systematic Narrative Review.
Medical Acupuncture. 2019 Dec 1;31(6):346-60.

AT1- Case study 1, T1-2020 Student Number: xxxxxxx
11. Malek, L., Umberger, W.J., Makrides, M. and ShaoJia, Z., 2017. Predicting healthy eating
intention and adherence to dietary recommendations during pregnancy in Australia using the
Theory of Planned Behaviour. Appetite, 116, pp.431-441.
12. Hayman, M. and Brown, W., 2016. Exercise in the pregnancy and the postpartum period:
New position statement. Sport Health, 34(2), p.10.
Presentation and communication (2 marks)