Pregnancy In the Acute Care SettingPart I

Women’s Health OverviewImplications for Physical Therapy

Jane Frahm, PT, BCIA PFMDRehab Institute of Michigan/WSU

SYSTEMIC CHANGES THAT OCCUR DURING

PREGNANCY

EXCRETORY/RENAL SYSTEM

Kidneys, Bladder, ureters, increase functional capacity

Increased urination (polyuria) common in 80-95%

Kidney expands 2º dilatation. of renal pelvis & interstitial fluid

Glomerular Filtration Rate 50%

Excretory/Renal Changes

COMMON URINARY DYSFUNCTIONS Ureter Obstruction or Bladder

Compression can occur with uterine growth

Urge Incontinence

Retention

Pyelonephritis or Kidney Infection

CARDIOVASCULAR CHANGES

Blood volume 40%

Cardiac Output 30-50%, Peak 28-32 wks

Arterial BP Most women see a drop in blood pressure during

pregnancy. This is mainly due to a hormone called progesterone

Inferior Vena Cava 3-11% affected

RESPIRATORY SYSTEM

Dyspnea (SOB) Common 60-70%

RR Unchanged, 02 consumption 14-20%

Tidal Vol. by 200 ml

Br/min 26%, (State of hyperventilation) secondary to progesterone levels

METABOLIC/ENDOCRINE SYSTEM

Estrogen Progesterone Human Placental Lactogen (HPG) Human chorionic gonadotropin (HCG) Relaxin: Produced in Corpus Luteum

Peaks early and late in pregnancy . Also in non pg., after ovulation & thru the

menstrual cycle Softens connective tissue!

GI SYSTEM

Nausea and Vomiting Mild to severe 50 – 60% Usually abates

by wk 14-16

Intestinal & gallbladder motility

MUSCULOSKELETAL SYSTEM

Postural Compensations Compression Syndromes Abdominal Wall/Diastasis Recti Pelvic Girdle - Symphysis Pubis

Symphysitis, Ligamentous laxity, or Separation

LBP S-I Dysfunction

TYPICAL POSTURAL CHANGES

Forward head, Rounded shoulders, hyper- lordosis, Hyperextended knees, Pronated feet

COG shift

Muscle shortening or elongation (promotes stretch weakness or adaptive shortening)

NINE MONTH GESTATION

Both demonstrate increased lordosis

Black leotard-forward head

SHORTENED: Hip flexors, low back, pectoralsELONGATED: Neck and upper back, abdominalsEXTRA WEIGHT on pelvic floor

HIGH RISK PREGNANCY

25% of the OB Population has less

than optimal outcome for mother or child

HIGH RISK PREGNANCY PTL--Pre Term Labor PPROM--Premature, Preterm Rupture of

Membranes IUGR--Intra Uterine Growth Retardation GDM--Gestational Diabetes Mellitus PIH-- Pregnancy Induced Hypertension Placenta Previa, Abruptio Placenta Incompetent Cervix Pre-eclampsia, Eclampsia, DIC -

disseminating intravascular coagulation Multiple Gestation

High Risk Pregnancy Preeclampsia?

Preeclampsia is a condition that typically starts after the 20th week of pregnancy and is related to increased blood pressure and protein in the mother's urine (as a result of kidney problems). Preeclampsia affects the placenta, and it can affect the mother's kidney, liver, and brain.

EclampsiaWhen preeclampsia causes seizures, the condition is known as eclampsia--the second leading cause of maternal death in the U.S. Preeclampsia is also a leading cause of fetal complications, which include low birth weight, premature birth, and stillbirth.

There is no proven way to prevent preeclampsia. Most women who develop signs of preeclampsia, however, are closely monitored to lessen or avoid related problems. The only way to "cure" preeclampsia is to deliver the baby.

PRE-EXISTING CONDITIONS – HIGH RISK STATUS

Diabetes Cardiac Anomalies Pulmonary Anomalies Systemic Infection, Fever HTN Neoplasm Chronic disability -

neurological, spinal cord injury