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Care of the Pregnant Patient

Herman & Wallace Pelvic Rehabilitation Institute

Objectives

Upon completion of this continuing education seminar, participants will be able to:
1. Understand common definitions and medical testing used in obstetrics.
2. Avoid all contraindications for evaluation and treatment of the pregnant patient.
3. List 3 major hormones and how each affects the musculoskeletal system during pregnancy.
4. Describe the pregnancy-related physiologic changes in the cardiorespiratory, integumentary, gastrointestinal, urinary, reproductive, immune and musculoskeletal systems during pregnancy.
5. List 2 common conditions that occur in pregnancy for the spine and trunk, abdomen, pelvic floor, pelvic girdle, upper and lower extremities.
6. Instruct in safe exercises and activities for the low-risk and high-risk patient.
7. Educate the patient in methods to prepare physically for birth.
8. Complete medical screening for referral for the pregnant patient.
9. Apply and utilize surface EMG with external sensors for pelvic floor muscles.
10. Market a program of physical therapy care for the pregnant patient.

Target Audience

This continuing education seminar is targeted to physical therapists, occupational therapists, physical therapist assistants, occupational therapist assistants, registered nurses, nurse midwives, and other rehabilitation professionals. Content is not intended for use outside the scope of the learner's license or regulation. Physical therapy continuing education courses should not be taken by individuals who are not licensed or otherwise regulated, except, as they are involved in a specific plan of care.

Agenda

Day One:
7:30 Registration 8:00 Course goals, introductions, pre-test 8:30 Hormonal influences and musculoskeletal changes 10:00 Break 10:15 Spine and Trunk Common Complaints Lecture 11:00 Spine and Trunk Common Complaints Lab 12:00 Lunch 1:00 Pelvic Girdle Common Complaints Lecture 1:45 Pelvic Girdle Common Complaints Lab 2:45 Break 3:00 Abdomen and Pelvic Floor Lecture 3:45 Abdomen and Pelvic Floor Lab 4:45 Break 5:00 Case Study 5:30 Questions, Post-Test 6:00 Adjourn

Day Two:
8:00 Questions, Pre-test 8:30 Exercise in Pregnancy 9:15 High-risk Pregnancy 9:45 Break 10:00 Preparing for Birth 10:30 Marketing, Billing, Resources 11:00 Upper Quarter Common Complaints Lecture 11:45 Lunch 12:30 Upper Quarter Common Complaints Lab 1:30 Break 1:45 Lower Quarter Common Complaints Lecture 2:30 Lower Quarter Common Complaints Lab 3:30 Questions, Post-test 4:00 Adjourn

Description

Evaluating and treating a pregnant patient can be intimidating and daunting. Questions about safety and efficacy of evaluation and intervention arise, and most rehabilitation providers do not feel well prepared in working with women who are pregnant. In a survey of therapists who were members of the American Physical Therapy Association (APTA) Section on Women's Health (SOWH), Krum & Smith (2005) found that "A majority of respondents...had received minimal academic education specific to women's health issues." (p. 31) This 2-day,beginner level continuing education course provides a foundation in women's health education specific to caring for the pregnant patient.

Foundational to diagnosis of the musculoskeletal issues present in the peripartum period is an understand of the amazing changes that occur in a woman's body, and the potential risks and benefits of evaluation and intervention techniques. These physical changes are driven by significant hormonal shifts that are explained during this continuing education course. Hormones such as estrogen, progesterone, relaxin, oxytocin, and prolactin are discussed, and the effects of these and other hormones, some that are present only during pregnancy, are presented. An understanding of typical hormonal effects can allow a therapist to answer a patient's questions and to provide reassurance about the changes that are experienced during pregnancy, or the gestational period.

Some of the musculoskeletal changes and approaches to rehabilitation are similar to those in the non-pregnant population, yet the potential for risks from interventions such as manual therapies, modalities, and exercise approaches must be understood in order to proceed safely with care of the pregnant woman. Participants will learn about contraindications for modalities such as US, TENS, and the applications of specific exercises within safe postures throughout a woman's gestational period. Despite the often-held belief that exercise during pregnancy is unsafe, moderate to vigorous exercise (for the patient who is not high-risk) offers many health benefits towards depression, maternal self-image, weight gain, and even offers benefit to the developing child. (Clapp, 2002) The participant will learn about these benefits, exercise recommendations, as well as guidelines from organizations such as the American Congress of Obstetricians and Gynecologists. For conditions that are specific to the peripartum period, such as pregnancy-related pelvic girdle pain or diastasis recti abdominis (a separation of the rectus abdominis at the midline that can occur in more than half of women according to Boissonnault and Blaschak, (1998) and Spitznagle and colleagues (2007)), this continuing education course instructs in risk factors, clinical diagnostic tests, and interventions including use of pregnancy-support belts and braces.

With higher rates of women carrying multiples and an increase in high-risk pregnancies, therapists must be familiar with medical screening for the pregnant population. In this continuing education course, therapists learn to screen for conditions including thyroid dysfunction, deep vein thrombosis, and pregnancy-related hypertension. In addition to learning how to evaluate and treat the pregnant woman, course instructors will answer your questions about billing and reimbursement for this special population, marketing and the language of obstetrics, special tests during the pregnancy period such as amniocentesis, and preparing the patient for labor and delivery.

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