Pregnancy In the Acute Care Setting Part I

1. Pregnancy In the Acute Care SettingPart I Women’s Health Overview Implications for Physical Therapy Jane Frahm, PT, BCIA PFMD Rehab Institute of Michigan/WSU

2. SYSTEMIC CHANGES THAT OCCUR DURING PREGNANCY

3. 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%

4. Excretory/Renal Changes COMMON URINARY DYSFUNCTIONS • Ureter Obstruction or Bladder Compression can occur with uterine growth • Urge Incontinence • Retention • Pyelonephritis or Kidney Infection

5. 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

6. 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

7. 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!

8. GI SYSTEM • Nausea and Vomiting • Mild to severe 50 – 60% Usually abates by wk 14-16 •  Intestinal & gallbladder motility

9. MUSCULOSKELETAL SYSTEM • Postural Compensations • Compression Syndromes • Abdominal Wall/DiastasisRecti • Pelvic Girdle - Symphysis Pubis Symphysitis, Ligamentous laxity, or Separation • LBP • S-I Dysfunction

10. TYPICAL POSTURAL CHANGES • Forward head, Rounded shoulders, hyper- lordosis, Hyperextended knees, Pronated feet • COG shift  • Muscle shortening or elongation (promotes stretch weakness or adaptiveshortening)

11. NINE MONTH GESTATION Both demonstrate increased lordosis Black leotard-forward head • SHORTENED: Hip flexors, low back, pectorals • ELONGATED: Neck and upper back, abdominals • EXTRA WEIGHT on pelvic floor

12. HIGH RISK PREGNANCY 25% of the OB Population has less than optimal outcome for mother or child

13. 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, AbruptioPlacenta • Incompetent Cervix • Pre-eclampsia, Eclampsia, DIC - disseminating intravascular coagulation • Multiple Gestation

14. 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. • Eclampsia When 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.

15. PRE-EXISTING CONDITIONS – HIGH RISK STATUS • Diabetes • Cardiac Anomalies • Pulmonary Anomalies • Systemic Infection, Fever • HTN • Neoplasm • Chronic disability - neurological, spinal cord injury