Pregnancy

Question 1

What is pregnancy?

Answer 1

normal physiological process
Full term: 40 weeks, 3 trimesters

10-15 out of 100,000 births result in maternal deaths; lack of prenatal care is a big factor

Question 2

Occupational therapy relevance for pregnancy

Answer 2

High risk pregnancy
- adaptations (might be bed bound)
- energy conservation

Education/independent living facilities

Pregnant patients in other areas such as ortho and psych

Physical body changes may require adaptive equipment

Question 3

How does pregnancy occur?

Answer 3

24 hour window of opportunity
Ovum is fertilized and becomes a zygote
- floats around for 7-9 days
- implants most often in the upper portion of the uterine wall
- the placenta is the exchange vessel
* abrupto placenta: placenta pulls away from uterine wall and can cause bed rest, premature birth, or spontaneous abortion
* placenta previa: placenta covers the mother’s cervix

Question 4

Role of hormones during pregnancy

Answer 4

Human chorininc gonadotropin (HCG): released immediately after conception; makes pregnancy test positive

Relaxin: released almost immediately; allows pelvis to spread; targets all joints
- makes them more prone to sprains

Estrogen: produced by placenta to help mainatin pregnancy

Progesterone: decreases the contraction of uterus

Prolactin: increases by 10x at conception, doesn’t release until birth; causes milk production

Question 5

How does pregnancy effect the cardiovascular system?

Answer 5

Blood circulation increases by 45%
Cardiac output increases 30-50% by the 24th week
Heart rate increases 10-15 bpm
Clotting factor increases - hypercoagulation
- Deep vein thrombosis (DVT): forms in deep veins, usually legs; not a big deal if it’s below the knee
- Pulmonary embolism: when a DVT throws a clot in the lungs

Question 6

How does pregnancy effect the respiratory system?

Answer 6

Uterus displaces the diaphragm
- Alveolar ventilation increases to compensate for potential O2 loss

Question 7

How does pregnancy effect the renal/urinary system?

Answer 7

Bladder tone decreases
Capacity increases
Volume increase by 25%

Question 8

How does pregnancy affect the gasto-intestinal system?

Answer 8

Decrease in esophagus tone and increase in abdominal pressure
- acid reflux
Morning sickness??? could be hereditary or maybe hormonal

Question 9

How does pregnancy affect the integumentary system?

Answer 9

Freckles, moles, and scars enlarge and darken
Stria gravidarum (stretch marks)
Sebaceous glands increase production

Question 10

How does pregnancy affect the musculoskeletal system?

Answer 10

Waddling gate
- back pain
- ligament laxity
- increased risk for injury
Center of gravity shifts
- shifts to between mother and baby; top heavy
Clumsy
Increase in carpal tunnel
- surgery at this time isn’t recommended because it will typically go away after birth
- therapy can help
SI joint may displace

Question 11

Immune responses during pregnancy

Answer 11

The body accepts this foreign body and immune system slightly decreases.

TORCH: group of maternal infections with similar effects
(T)oxoplasmosis: can lead to parasites, microcephalous, hydrocephalus, spina bifida, and death
(O)ther agents: teratogens (poison)
- chemicals, alcohol, drugs (including meds), and STDs
(R)ubella-German measels
- if caught in 1st trimester, high rate of birth defect
(C)ytomegalovirus: small brain, brain damage
- can be in common cold
- particularly dangerous in 1st trimester
(H)erpes/ HIV - AIDS: various effects

Question 12

Maternal systems disorders during pregnancy

Answer 12

Lack of folic acid is linked to neural tube defects
Obesity
- linked to neural tube defects
- spina bifida
Diabetes mellitus
- big babies
- heart defects
Drugs and physical agents
- fetal alcohol syndrome (FAS)
- learning disabilities
- behavioral
- skeletal deformities and microcephaly

Question 13

Chromosomal defects during pregnancy

Answer 13

Downs Syndrome - triplication of 21
- intellectual disabilities (IQ up to 69, normal is 100)
- semian crease
- poor FM control

Question 14

Metabolism and nutrition for pregnancy

Answer 14

23-25 pound weight gain
If you’re eating well, supplements aren’t needed.
If baby needs certain nutrients, they take it from mom.

Question 15

Labor and delivery

Answer 15

1st Stage (1-24 hours)
- pain is “low”
- Braxton-Hick’s contractions
- Amniotic sac rupture
- premature rupture
- complete at 10cm

2nd Stage
- PAIN
- full dilation
- begin to push
- episiotomies: incision from vaginal opening to anal opening to assist with delivery and prevent tearing, easier to sew
- breech: feet first
- transverse: arm/side first
- Cesarean sections - 1/4 in the US… why? because there’s more diversity

3rd Stage
- Separation and delivery of the placenta
- risk of infection if placenta isn’t delivered whole, without tears or rips and can lead to maternal death

Question 16

Postpartum

Answer 16

Delivery to 6 weeks out
Lactation begins 2-43 days after delivery
- Colostrum - immunoglobins: produced immediately after or sometimes before delivery
- Suppression: medications have been linked to stroke
Uterus
- normal in 10 days
- contraction after delivery help the uterus get back to normal
- infection: at risk for infection; can result in blood clots
Pelvic floor muscles
- fits more in OT frame of reference than PT

Question 17

What can go wrong during prenancy?

Answer 17

Spontaneous abortions
- usually in first trimester
- often happen because something is wrong with fetal development of mother’s ability to carry the pregnancy (like hormones)

Preterm labor
- before 37 weeks
- 7-9% of pregnancies occur preterm
- increased risk of behavioral and medical problems
- 23 weeks for viability
- miscarriage at 24 weeks would be called a preterm delivery

Question 18

Factors effecting pre-term delivery

Answer 18

poor prenatal care
family history
drugs and alcohol
nonwhite race
low socioeconomic status
younger than 17, older than 35
medical problems
smoking
preeclampsia
- before you have a seizure of BP and pulse skyrocket
infections
trauma
*preterm delivery can be tied to genetics

Ectopic: egg is fertilized and implanted in fallopian tube; will result in death of baby and possibly mother
Gestational diabetes mellitus: if developed with first baby. will develop with others; not serious and can’t be treated

Question 19

Causes of preeclampsia

Answer 19

nulliparty - never had a baby
extremes of age
family history
previous episodes
hypertension or renal disease
diabetes
multiple births

Question 20

Symptoms of preeclampsia

Answer 20

headaches, blurred vision, confusion, pulmonary edema
abdominal pain
excessive weight gain
hepatic rupture
CVA
fetal retardation or death

treatment
- meds, rest, induction of labor

Preeclampsia/Eclampsia: formally called toxemia
- BP increases more than 30 systolic and 15 diastolic
- BP greater than 140/90 after 20 weeks
- increase protein in urine
- edema in face and hands
- eclampsia - seizure activity with preeclampsia

Question 21

What are stages of neonatal development?

Answer 21

embryo - conception to 9th week
- all organs and structure are present

fetal period (9-42)
- not as susceptible to teratogens

Neonate
- once the cord is cut

Question 22

What is a neonate?

Answer 22

first month of life
38-42 weeks
7#
19”
SGA (small for gestational age): below 10%
LGA (large for gestational age): above 10%
LBW
VLBW/ELBW

Question 23

What is a healthy neonate?

Answer 23

big head
swollen face
subcutaneous fat
short neck and extremities- flexed posture
red skin
lanugo (skin protectant)
vernix caseosa (lubricant to keep skin protected)

Question 24

Test for all neonates

Answer 24

APGAR
- done at 1 and 5 minutes after birth; another at 10 minutes if needed
- scale of 0-10 and measures:
- heart rate
- respiratory effort
- reflex irritability (grimace)
- muscle tone
- color
*reflex irritability and respiratory effect are usually done together

Question 25

Preterm infant

Answer 25

22-23 weeks is limit for viability
- if delivery before then, no extreme measures will be taken
26-28 weeks
- lean look because no muscle tone
- floppy
- no creases because no fat deposits
- thin skin
- excessive lanugo and ceseosa

Question 26

Problems with preterm delivery

Answer 26

Respiratory failure
- surfactant levels 28-30 weeks
- meconium aspiration: inhaling first bowel movement, leads to brain damage
- poor inspiration/fatigue
- immature medullary respiratory control: forget to breathe
- BPD (bronchopulmonary dysplasia): iatrogenic; results from baby being on a ventilator; constant flow of air crushes the alveolus; can be temporary or lifelong
- born before 28 weeks will have to go on a ventilator

Hypothermia
- hypothalamus and fat
- slow weight gain

Cardiac failure

Anemia

Renal insufficiency

Intracranial hemorrhage

Retinopathy

Question 27

Postmaturity pregnancy

Answer 27

After 42 weeks
Rare
Placenta insufficiency: baby may not known when to deliver but the placenta does; it will stop functioning by 42 weeks starving the baby
Long and thin, not fat
Meconium aspiration is common
Can suffer from a skull fracture and clavicle fracture during delivery
Subdural hematomas

Question 28

Apnea in newborns

Answer 28

Periods of not breathing
Immature medullary respiratory centers
SIDS
Pinch/pull: pinch them or pull their toes to make them cry and start breathing again