Pregnancy In the Acute Care Setting Part I Women’s Health Overview Implications for Physical Therapy Jane Frahm, PT, BCIA PFMD Rehab Institute of Michigan/WSU
Jan 22, 2016
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