Pregnancy in the acute care setting part i
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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. SYSTEMIC CHANGES THAT OCCUR DURING PREGNANCY. EXCRETORY/RENAL SYSTEM.

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Pregnancy In the Acute Care Setting Part I

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Pregnancy in the acute care setting part i

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


Pregnancy in the acute care setting part i

SYSTEMIC CHANGES THAT OCCUR DURING PREGNANCY


Excretory renal system

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

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

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

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

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

GI SYSTEM

  • Nausea and Vomiting

    • Mild to severe 50 – 60% Usually abates by wk 14-16

  •  Intestinal & gallbladder motility


Musculoskeletal system

MUSCULOSKELETAL SYSTEM

  • Postural Compensations

  • Compression Syndromes

  • Abdominal Wall/DiastasisRecti

  • Pelvic Girdle - Symphysis Pubis Symphysitis, Ligamentous laxity, or Separation

  • LBP

  • S-I Dysfunction


Typical postural changes

TYPICAL POSTURAL CHANGES

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

  • COG shift 

  • Muscle shortening or elongation (promotes stretch weakness or adaptiveshortening)


Pregnancy in the acute care setting part i

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


High risk pregnancy

HIGH RISK PREGNANCY

25% of the OB Population has less than optimal outcome for mother or child


High risk pregnancy1

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


High risk pregnancy2

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.


Pre existing conditions high risk status

PRE-EXISTING CONDITIONS – HIGH RISK STATUS

  • Diabetes

  • Cardiac Anomalies

  • Pulmonary Anomalies

  • Systemic Infection, Fever

  • HTN

  • Neoplasm

  • Chronic disability - neurological, spinal cord injury


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