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SKENARIO III
FAKULTAS KEDOKTERAN
UNIVERSITAS ISLAM MALANG
Semester Ganjil T.A 2013/2014
SKENARIO 3 Kehamilan pada Atlet marathon
This case study reports the clinical and physiological changes of a 33 year old
elite marathoner undertaking intensive endurance training during and following a twin
pregnancy. Prior to conception, the subject ran 155 km x week(-1) at an intensity
equivalent to 140-180 b x min(-1) which following consultation decreased to 107 +/- 19
km x week(-1) at an intensity equivalent to 130-140 b x min(-1) during pregnancy.
Physical exercise ceased 3 days prior to an elective Caesarean section following a 36
week gestation period and recommenced 8 days following the birth of healthy twins.
Medical assessments conducted ante/post partum indicated that both the twins and
mother were healthy. A field based test demonstrated that running velocity at a steady
state HR of 140 b x min(-1), 150 b x min(-1) and 160 b x min(-1) decreased by 20%, 15%
and 13% respectively between weeks 1 and 32 antepartum. Whole blood lactate ([La-]B),
oxygen uptake (VO2), ventilatory equivalent for oxygen (V(E)/VO2), HR and Borg rating of
perceived exertion (RPE) increased during a laboratory-based submaximal treadmill test
at 29 weeks antepartum in comparison to a test conducted 10 weeks post partum.
What does it mean?
URAIAN:
This case study reports the clinical and physiological changes of a 33 year old elite
marathoner undertaking intensive endurance training during and following a twin pregnancy.
Prior to conception, the subject ran 155 km x week(-1) at an intensity equivalent to 140-180 b
x min(-1) which following consultation decreased to 107 +/- 19 km x week(-1) at an intensity
equivalent to 130-140 b x min(-1) during pregnancy. Physical exercise ceased 3 days prior to an
elective Caesarean section following a 36 week gestation period and recommenced 8 days
following the birth of healthy twins. Medical assessments conducted ante/post partum
indicated that both the twins and mother were healthy. A field based test demonstrated that
running velocity at a steady state HR of 140 b x min(-1), 150 b x min(-1) and 160 b x min(-1)
decreased by 20%, 15% and 13% respectively between weeks 1 and 32 antepartum. Whole
blood lactate ([La-]B), oxygen uptake (VO2), ventilatory equivalent for oxygen (V(E)/VO2), HR
and Borg rating of perceived exertion (RPE) increased during a laboratory-based submaximal
treadmill test at 29 weeks antepartum in comparison to a test conducted 10 weeks post
partum. These data clearly demonstrate that it is possible for an elite endurance athlete to
maintain a high level of cardiovascular fitness during pregnancy with no apparent adverse
effects on maternal or foetal health. This will facilitate an earlier return to international
competition
(http://www.ncbi.nlm.nih.gov/pubmed/10496124)
Daftar Masalah:
Preterm birth
Uterine Malformation and Incompetent Cervix Ultrasonography
Toxic Habits in Pregnancy (smoking, alcohol, ANTENATAL CARE Amniocentesis
illicit drug use) Pregnancy Fetal Biophysical Profile
Poor nutrition Nonstress/Contraction Stress Testing
Lack of prenatal care Primary Prevention Fetal Heart Rate Monitoring
Multiple Births Fetal Blood Scalp
Maternal Infection Blood Analysis
Abnormalities of the Placenta, Umbilical Cord &
Fetal Membranes Maternal History
Disorders of Amniotic Fluid Levels Evaluation of Maternal-Fetal Risk Factors
Mode of Delivery Physical Assessment ANTENATAL=PRENATAL ASSESSMENT OF THE FETUS
Toxemia Intrapartum Monitoring
NEONATAL ASPHYXIA High Risk Conditions
Delivery Date
Estimated Date of Confinement (EDC)
Secondary Prevention None of the methods are exact
Ngeles Rule
Fundal Height
Quickening
Determination of Fetal Heart beat
Delivery Partogram Stages of labour Dx of labour Labour
36 week gestation
These data clearly demonstrate that it is possible for an elite endurance athlete
to maintain a high level of cardiovascular fitness during pregnancy with no
apparent adverse effects on maternal or foetal health