A pregnant woman needs to be healthy in both the mind and the body to survive her pregnancy. To maintain her over-all well being, caregivers must collaborate with each other for a more holistic and effective care to make sure that the woman and the fetus are both safe.
Musculoskeletal Disorders in a Pregnant Woman
The full function of the musculoskeletal system is needed by the pregnant woman all throughout her pregnancy. The following disorders would be a hindrance to her everyday tasks and should be therefore managed by the caregiver accordingly.
- Scoliosis is the lateral curve of the spine.
- If left uncorrected, scoliosis would progress until it causes deformity, with interferences in respiration and heart functions due to chest compression.
- Pelvic distortion may interfere with birth, especially at the pelvic inlet, and administration of epidural or spinal anesthesia is difficult.
- Scoliosis is more noticeable in girls at the ages of 12 to 14 years old, so it is recommended that they wear a body brace to maintain an erect posture.
- The body brace cannot be worn during the last half of pregnancy, however, while have surgically implanted rods placed on both sides of the vertebrae.
- Surgically implanted rods do not interfere with pregnancy, and the back pain that the women with steel rods experience is also similar to the ones experienced by the average woman.
- Pelvic distortion and cephalopelvic disproportion could happen with scoliosis, so cesarean birth is necessary.
- Vaginal birth could be permitted with close monitoring of the labor process.
Cancer and Pregnancy
A malignant disease that grows within a person’s body could take the life out of the cells. This is a very fatal situation for a pregnant woman, therefore special care and attention should be given to her to save both the baby and the mother.
- The most common malignancies during pregnancy and the childbirth years are cervical, breast, ovarian, thyroid, leukemia, melanoma, and lymphomas.
- Women who opt to bear children at the age of 30 and above are more at risk for malignancies, especially breast cancer.
- If a malignancy is diagnosed in the first trimester, the couple would be asked to make decision between delaying the treatment to decrease teratogenic effects on the fetus, ending the pregnancy to continue the treatment, or continuing the pregnancy and the treatment with the knowledge that the fetus might end up with birth anomalies.
- On the second and third trimesters, the women can receive chemotherapy safely, but with radiation therapy the fetus could be put at risk if exposed directly.
- The cancer from the woman would not metastasize to the fetus because the placenta serves as a barrier and the fetus is capable of resisting foreign cells.
- If surgery to remove a tumor is done during pregnancy, there must be awareness that this might cause anoxia to the fetus during anesthesia.
- Cervical conization could also put the fetus at risk because the procedure might disrupt the pregnancy.
- The incidence of cervical cancer may go down in the future because of the HPV vaccine.
Mental Illness and Pregnancy
The mind is a complicated matter; illness springing from it could affect the entirety of the human being. Dealing with mental illness in pregnancy is a delicate thing yet could be achieved if every caregiver would take part in it.
- Schizophrenia most commonly occurs in young pregnant women; however, depression is seen as the most common mental illness among pregnant women.
- Childbirth and stress may reveal mental illness for the first time because normal levels of stress can still make coping difficult.
- A woman with an existing mental disease must have a psychiatric team and a prenatal group to make sure that the pregnancy would not exacerbate the disease and depression would not complicate the pregnancy.
- Psychotropic medications taken by the woman must be evaluated first because it might cause teratogenic effects to the fetus.
- Mental illness could also occur during the postpartum period.
Practice Quiz: Musculoskeletal Disorders and Mental Illness in Pregnancy
1. Which of the following would be used as a birth method if a woman acquires cephalopelvic disproportion due to scoliosis?
A. Vaginal birth is still permitted.
B. The pregnancy must not be continued and the woman should opt for its termination.
C. The fetus could be delivered via a cesarean birth.
D. The woman is free to choose whether she wants to have a vaginal or a cesarean delivery.
2. The nurse noticed that a 7-month pregnant woman diagnosed with scoliosis still has her body braces on. What should the nurse do?
A. Notify the physician so he could remove the braces.
B. Allow the woman to wear the braces to correct her deformity.
C. Alert the woman that body braces are not recommended for women on the third trimester of their pregnancy.
D. Body braces are not allowed only for women on the first or second trimester of pregnancy.
3. A pregnant woman was diagnosed with cervical cancer on her first trimester. What treatment method would be safe to undergo?
A. Any treatment method could pose a threat to the fetus during the first trimester of pregnancy.
B. Radiation therapy is perfectly safe for the fetus as long as it is not directly exposed.
C. Chemotherapy is safe for pregnant women regardless of what trimester they are presently in.
D. The woman should use both radiation therapy and chemotherapy to speed up the process of killing the malignant cells.
4. A pregnant woman diagnosed with breast cancer is worried that her fetus might also acquire the malignancy. What would be the nurse’s best answer?
A. Continuous chemotherapy would ensure that the fetus would not be put at risk.
B. With radiation therapy, the fetus would be spared from the malignancy.
C. The fetus would still acquire the malignancy because it can cross the placental barrier.
D. The cancer would not metastasize to the fetus because it is protected by the placental barrier.
5. The pregnant woman with mental illness already has a psychotropic drug prescribed before pregnancy. Should the nurse continue to administer the drug?
A. Yes, because it could avoid the exacerbation of the illness.
B. Yes, psychotropic drugs are recommended for pregnant women with mental illness.
C. No, because it could cause fetal harm.
D. No, because the drug would not be effective during pregnancy.
Answers and Rationale
1. Answer: C. The fetus could be delivered via a cesarean birth.
- C: Only cesarean birth is allowed to deliver a fetus with cephalopelvic disproportion.
- A: Vaginal birth is very difficult to perform with CPD and might put the mother and the fetus at risk.
- B: The pregnancy could continue without any difficulties with cesarean delivery as the birth method of choice.
- D: The woman would have no freedom to choose for her birth method as cesarean delivery is the only recommended birth method for CPD.
2. Answer: C. Alert the woman that body braces are not recommended for women on the third trimester of their pregnancy.
- C: Pregnant women are not allowed to wear body braces on the last trimester of pregnancy and therefore should be notified.
- A: The physician can be notified but he would not be the one who will remove the body brace.
- B: Pregnant women on their third trimester are not allowed to wear body braces.
- D: Body braces are only allowed during the first or second trimester of pregnancy.
3. Answer: A. Any treatment method could pose a threat to the fetus during the first trimester of pregnancy.
- A: During the first trimester, it is unsafe for a pregnant woman to receive any therapy for the malignancy because it could cause birth anomalies to the fetus.
- B: Radiation is not completely safe even during the second and third trimesters.
- C: Chemotherapy is only safe for a pregnant woman during the second and third trimesters.
- D: Using both therapies could cause birth anomalies, especially with radiation therapy.
4. Answer: D. The cancer would not metastasize to the fetus because it is protected by the placental barrier.
- D: The cancer could not cross the placenta because of the barrier and the fetus can also resist foreign cells that might invade.
- A: Chemotherapy could be continued but it does not affect the fetus nor would the cancer metastasize to the fetus.
- B: Radiation therapy is unsafe for the fetus because it could cause birth anomalies.
- C: The fetus would not be affected by the cancer because of the placental barrier and its ability to resist foreign cells.
5. Answer: C. No, because it could cause fetal harm.
- C: Psychotropic drugs should be evaluated first because they can cause fetal harm.
- A: Psychotropic drugs may be unsafe for pregnant women.
- B: Psychotropic drugs are not the drug of choice because it can cause fetal harm.
- D: Psychotropic drugs are effective for pregnant women yet might pose a threat to the fetus.
When pregnancy is threatened by diseases, complications might arise from both the mother and the fetus. These cases must be handled delicately because two human beings would be spared or lost depending on the action of care of the caregivers. Our patients’ lives ultimately depend on us.