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Glazer TA, Gunderson KA, Deroo E, Shaffrey EC, Mann H, Matabele MN, Minter RM, Iruretagoyena JI, Rectenwald JE. Providing a Safe Pregnancy Experience for Surgeons: A Review. JAMA Surg 2024:2822314. [PMID: 39141361 DOI: 10.1001/jamasurg.2024.0979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
Importance Childbearing has been a particular barrier to successful recruitment and retention of women in surgery. Pregnant surgeons are more likely to have major pregnancy complications, such as preterm delivery, intrauterine growth restriction, infertility, and miscarriage, compared with nonsurgeons. The average obstetric complication rate for surgeons ranges between 25% and 82% in the literature and is considerably higher than that in the general US population at 5% to 15%. Observations The risks that pregnant surgeons experience were individually analyzed. These risks included missed prenatal care; musculoskeletal hazards, such as prolonged standing, lifting, and bending; long work hours; overnight calls; exposure to teratogenic agents, such as ionizing radiation, anesthetic gases, chemotherapy agents, and methyl methacrylate; and psychological stress and discrimination from the long-standing stigma associated with balancing motherhood and professional life. Conclusions and Relevance A clear, translatable, and enforceable policy addressing perinatal care of surgeons was proposed, citing evidence of the risks reviewed from the literature. A framework of protection for pregnant individuals is essential for attracting talented students into surgery, retaining talented surgical trainees and faculty, and protecting pregnant surgeons and their fetuses.
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Affiliation(s)
- Tiffany A Glazer
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Kirsten A Gunderson
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison
| | - Elise Deroo
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison
| | - Ellen C Shaffrey
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison
| | - Hayley Mann
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison
| | - Maya N Matabele
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Rebecca M Minter
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison
- University of Wisconsin School of Medicine and Public Health, Madison
| | - J Igor Iruretagoyena
- University of Wisconsin School of Medicine and Public Health, Madison
- Department of Obstetrics and Gynecology, University of Wisconsin Hospitals and Clinics, Madison
| | - John E Rectenwald
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison
- University of Wisconsin School of Medicine and Public Health, Madison
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Music HE, Bailey JP, Catena RD. Upper extremity kinematics during walking gait changes through pregnancy. Gait Posture 2023; 104:97-102. [PMID: 37356228 DOI: 10.1016/j.gaitpost.2023.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 05/24/2023] [Accepted: 06/21/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Thirty percent of adults in the United States use wearable fitness devices as of 2020 [1], such as fitness watches, to monitor and track health and physical activity parameters. Physical changes during pregnancy may impact wrist worn device accuracy. The arms may be needed as compensation during walking because thorax axial rotation may be inhibited by pelvic tilt during pregnancy [2]. METHODS To examine arm motion changes, twenty-three pregnant women (28 ± 4 y) were tested in four-week intervals ( ± 2 weeks) at 18-, 22-, 26-, 30- and 34-weeks' gestation. Kinematic data were measured during self-selected speed walking. Segment angles and angular velocities were analyzed over time. Linear regressions were used to analyze the correlations between arm motion and the other kinematic variables. RESULTS Arm range of motion significantly increased (p = 0.006) over gestation, but leg, thorax, and pelvis range of motions did not significantly change. Arm range of motion was correlated with pelvis (r2 =0.311, p = 0.001, β = 1.724) and leg (r2 = 0.285, p = 0.004, β = 1.520) range of motion and gait velocity (r2 =0.566, p = 0.001, β = 39.110). Arm velocities significantly increased (p < 0.012), as did leg velocities (p < 0.022) over gestation time, but thorax and pelvis rotational velocities did not significantly change over time. Arm velocity was correlated with leg velocity in both flexion (r2 =0.598, p = 0.001, β = 1.61) and extension (r2 =0.568, p = 0.001, β = 1.35). SIGNIFICANCE Arm swing increases over the course of gestation during walking, which does not follow the exact pattern of changes seen in the legs, thorax, and pelvis. These results show that a typical gait analysis of lower body motions may miss important biomechanical changes or compensations at different points over pregnancy. Future studies should examine why these changes may occur. Studies should also be conducted to see if arm changes impact outcome parameters from fitness watches and affect their validity as an exercise tracker during pregnancy.
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Ramachandra P, Kumar P, Bø K, Arun Maiya G. Comparison of static postural sway characteristics between pregnant and non-pregnant women. J Biomech 2023; 154:111618. [PMID: 37207544 DOI: 10.1016/j.jbiomech.2023.111618] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/30/2023] [Accepted: 05/03/2023] [Indexed: 05/21/2023]
Abstract
The present study aimed to compare the postural sway between pregnant and non-pregnant women during eight different sensory conditions including those in which vision, proprioception, and base of support are compromised. Forty primigravidae at the 32nd week of pregnancy and forty non-pregnant women who were matched for age and anthropometric measurements participated in this cross-sectional comparison study. Static posturography equipment was used to record the anteroposterior sway velocity, mediolateral sway velocity, and velocity moment during normal stance and when vision, proprioception, and base of support were compromised. Pregnant women (mean age: 25.4) demonstrated a larger median velocity moment and mean anteroposterior sway velocity compared to non-pregnant women (mean age:24.4) across all tested sensory conditions (p < 0.05). Although mediolateral sway velocity did not show any statistically significant difference, the ANCOVA results suggested that there was a statistically significant difference in mediolateral sway velocity in Eyes open feet apart condition on the firm surface [F (1,77, p = 0.030, ηp2 = 0.121] and Eyes closed feet apart condition on the firm surface [F (1,77, p = 0.015, ηp2 = 0.15] between pregnant and non-pregnant women. There was a larger velocity moment and anteroposterior postural sway velocity in pregnant women in their third trimester compared to non-pregnant women when exposed to different sensory conditions. Title: Comparison of static postural sway characteristics between pregnant and non-pregnant women.
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Affiliation(s)
- Preetha Ramachandra
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Pratap Kumar
- Department of Reproductive Medicine and Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Kari Bø
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway and Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway.
| | - G Arun Maiya
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.
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KEPENEK VAROL B, ODABAŞI D, DOĞAN BE, GÜLENER G, SELÇUK A, YAZICI-GÜLAY M, AKSOY H. ÜÇÜNCÜ TRİMESTERDA AYAKKABI UYGUNLUĞU, DÜŞME KORKUSU VE FİZİKSEL AKTİVİTE ARASINDAKİ İLİŞKİ. TÜRK FIZYOTERAPI VE REHABILITASYON DERGISI 2023. [DOI: 10.21653/tjpr.1119262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Purpose: Pregnancy is a time of intense physiologic and physical changes, especially in third trimester. The aim of this study was to investigate the relationship between the footwear suitability, fear of falling and physical activity in third trimester of pregnancy.
Methods: One hundred twenty-three pregnant women aged between 18-40 years and a gestational age of 28 weeks and above were included the study. The Footwear Assessment Score was used to assess the suitability of the footwear. The fear of falling of the participants was measured using the Falls Efficacy Scale-International, and the physical activity level was measured using the International Physical Activity Questionnaire - short form.
Results: A low negative correlation (r = -0.215; p < 0.05) was found between physical activity and fear of falling, and a low positive correlation (r = 0.256; p < 0.01) was found between footwear suitability and physical activity in pregnant women. There was no statistically significant relationship (r = -0.120; p = 0.185) between footwear suitability and fear of falling.
Conclusion: According to the findings of the current study, it can be concluded that a more appropriate choice of shoes as the level of physical activity increases among pregnant women, and physical activity may reduce the fear of falling during pregnancy. Future studies are needed to investigate footwear suitability during pregnancy in more detail.
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Wakkar A, Patil SP. Assessment of knee and ankle proprioception during the third trimester of pregnancy and postpartum period among primiparous women: An observational longitudinal study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:241. [PMID: 36177431 PMCID: PMC9514273 DOI: 10.4103/jehp.jehp_311_22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/29/2022] [Indexed: 05/14/2023]
Abstract
BACKGROUND Pregnant women experience falls, particularly in the third trimester. In this population, physiological changes, as well as ligament laxity, might influence joint proprioception and do not return to normal during the postpartum period. The prevalence of falls during pregnancy and postpartum periods imposes a need to study proprioception in pregnant women and the postpartum period. MATERIALS AND METHOD An observational longitudinal study was conducted in June 2018 in outpatient clinic Chinchwad Pune. A total of 36 primiparous women were included in the study by using purposive sampling. The mean and standard deviation of the age was 25.92 (2.59). Proprioception was assessed for the knee joint and the ankle joint during the third trimester of pregnancy and 6th and 12th week postpartum. Outcomes included were the Joint Reposition Test for both knee and ankle joints using UTHSCSA Image Tool Software 3.0. Repeated-measure ANOVA was performed for the normally distributed data, and nonparametric test Friedman's test was performed for data that were not distributed normally. The data was statistically analyzed using the SPSS software version 26. The level of significance was set at 0.05, confidence intervals of 95% were used. RESULT The result revealed significant (P < 0.05) improvement in both knee and ankle proprioception during the third trimester of pregnancy and postpartum period 6th and 12th week. CONCLUSION Knee proprioception and ankle proprioception were found to improve significantly during the postpartum period 6th and 12th weeks compared to the third trimester of pregnancy but do not return to the prepregnancy state.
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Affiliation(s)
- Aditya Wakkar
- Clinical Therapist, Private Clinic, Mumbai, Maharashtra, India
| | - Shubhangi P. Patil
- Department of Community Health Physiotherapy, Ravi Nair Physiotherapy College, Sawangi (Meghe), Wardha, Maharashtra, India
- Address for correspondence: Dr. Shubhangi P. Patil, Department of Community Health Physiotherapy, Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha, Maharashtra, India. E-mail:
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Hrvatin I, Rugelj D. Risk factors for accidental falls during pregnancy - a systematic literature review. J Matern Fetal Neonatal Med 2021; 35:7015-7024. [PMID: 34139937 DOI: 10.1080/14767058.2021.1935849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Falls during pregnancy occur in 25-27% of women and can cause serious harm to both the mother and the fetus. The objective of this systematic review was to identify intrinsic and extrinsic risk factors for falls during pregnancy by reviewing original studies and addressing possible forms of prevention. METHODS We searched PubMed, Cochrane library, and Web of Science databases for studies assessing risk factors for falling after a fall has occurred or by using posturographic assessment. RESULTS Fourteen studies were included in the review. The identified extrinsic risk factors include slippery floors, cluttered areas, uneven ground, inappropriate shoes, hurrying, walking on stairs, carrying additional loads, poor lighting or obstructed view, sedentary lifestyle and working in physically demanding jobs. The identified intrinsic factors include age less than 30, height more than 160 cm, advanced pregnancy, unintended pregnancy, multiparity, hyperemesis gravidarum, low back pain, gestational diabetes, increase in abdominal circumference, lower ankle stiffness and joint laxity. Physical activity, maternity support belts, and education are possible strategies for fall prevention. CONCLUSION Our systematic review identified 13 intrinsic and 11 extrinsic risk factors for falling during pregnancy. With the knowledge of risk factors and the optimal prevention strategy, healthcare providers could incorporate this information in the treatment of pregnant women and reduce the risk of falling.
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Affiliation(s)
- Ivana Hrvatin
- Faculty of Health Sciences, Biomechanical Laboratory, University of Ljubljana, Ljubljana, Slovenia
| | - Darja Rugelj
- Faculty of Health Sciences, Biomechanical Laboratory, University of Ljubljana, Ljubljana, Slovenia
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Danna-Dos-Santos A, Magalhães AT, Silva BA, Duarte BS, Barros GL, Silva MDFC, Silva CS, Mohapatra S, Degani AM, Cardoso VS. Upright balance control strategies during pregnancy. Gait Posture 2018; 66:7-12. [PMID: 30134216 DOI: 10.1016/j.gaitpost.2018.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 07/16/2018] [Accepted: 08/07/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Morphological and physiological changes during pregnancy are considered to interfere with the mechanisms of postural control and potentially increase the risk of falling. A clear understanding of these mechanisms is important to improve pre-natal care and reduce the fall risk in this population. OBJECTIVES This study focused on investigating how pregnancy affects postural control in each trimester of pregnancy by analyzing pelvic inclination and body sway behavior. Our main hypothesis was that balance control and posture would change during pregnancy. More specifically, pregnancy would increase sway amplitude, anterior pelvic tilt, and body sway regularity in time. STUDY DESIGN Forty women formed four groups: non-pregnant women (NP) and women at their first, second, and third trimester of pregnancy (P1, P2, and P3, respectively). All participants performed (1) postural evaluation of the pelvic inclination using a digital system of postural analysis and (2) instrumented posturography using a force platform to collect the coordinates of the body's center of pressure (COP) during quiet bipedal stance for 120 s. Kruskal-Wallis H test and post-hoc Mann-Whitney U tests were used to investigate the effects of pregnancy (NP, P1, P2, and P3) on pelvic inclination angle and postural indices computed from the COP signals. RESULTS Results revealed significant larger body sway accompanied by a more regular medial-lateral pattern of oscillation and a more synchronized anterior-posterior and medial-lateral sway already at the first trimester of pregnancy. The averaged COP migrated posteriorly at third trimester of pregnancy and the anterior pelvic tilt increased at second and third trimesters. CONCLUSIONS Our results indicate the existence of changes in posture and balance metrics even at early stages of pregnancy. We suggest the use of posturography as one of screening tools for postural instability and fall risk during pregnancy.
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Affiliation(s)
- Alessander Danna-Dos-Santos
- Department of Physical Therapy, Western Michigan University, 1903W Michigan Ave., Kalamazoo, MI 49008-5383, USA; Synergy Applied Medical and Research, Missoula, MT, USA.
| | - Alessandra T Magalhães
- Biosignal Laboratory, School of Physical Therapy, Federal University of Piauí, Parnaíba, Piauí, Brazil.
| | - Baldomero A Silva
- Biosignal Laboratory, School of Physical Therapy, Federal University of Piauí, Parnaíba, Piauí, Brazil.
| | - Biara S Duarte
- Biosignal Laboratory, School of Physical Therapy, Federal University of Piauí, Parnaíba, Piauí, Brazil.
| | - Glena L Barros
- Biosignal Laboratory, School of Physical Therapy, Federal University of Piauí, Parnaíba, Piauí, Brazil.
| | - Maria De Fátima C Silva
- Biosignal Laboratory, School of Physical Therapy, Federal University of Piauí, Parnaíba, Piauí, Brazil.
| | - Cristiano S Silva
- Biosignal Laboratory, School of Physical Therapy, Federal University of Piauí, Parnaíba, Piauí, Brazil.
| | | | | | - Vinicius S Cardoso
- Biosignal Laboratory, School of Physical Therapy, Federal University of Piauí, Parnaíba, Piauí, Brazil.
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