Poster 165: Pregnancy Outcomes Among Women With Physical Disabilities Seen in an Integrated Care Clinic

Abstract

Objectives: To determine obstetric and disability-related pregnancy complications among physically disabled women seen by an integrated-care team and to evaluate their pregnancy outcomes. Design: Retrospective chart review. Setting: Rehabilitation hospital outpatient interdisciplinary clinic. Participants: 36 physically disabled subjects were identified with pregnancies confirmed by urine and serum human chorionic gonadotropin or ultrasound from 755 charts reviewed. Clinic, therapy, and labor and delivery charts were reviewed from pregnancy diagnosis to 6-week postpartum or pregnancy termination. The interdisciplinary team included obstetrics and gynecology, physiatry, physical, occupational, and speech therapy, anesthesiology, pulmonology, and social work. Physical disability diagnoses included cervical spinal cord injury (SCI) (25%), thoracic SCI (30.6%), cerebral palsy (25%), brain injury (8.3%), and others (11%) such as spinal muscular atrophy, multiple sclerosis, Marfan’s syndrome, and transverse myelitis. Interventions: Not applicable. Main Outcome Measures: Disability Rating Scale and FIM instrument. Results: 45 pregnancies were documented in 36 subjects (mean age, 26y; range, 17−40y): 35 unplanned pregnancies with 11 elective abortions performed; 1 spontaneous abortion; 2 intrauterine fetal demise (IUFD); and 31 viable infants. 36.4% of infants were delivered by cesarean section, 12.1% required assisted delivery, and 97.8% delivered under epidural anesthesia. 21.2% of mothers attempted breastfeeding. Obstetric and disability-related complications were reported according to type and level of disability. Further obstetric complications included: urosepsis with IUFD, cocaine abuse with IUFD, uterine atony, retained placenta, chorioamnionitis, pre-eclampsia, pyelonephritis, and multiple urinary tract infections. Disability-related complications included: autonomic dysreflexia, muscle fatigue impairing swallow function, respiratory distress requiring ventilator support, increased spasticity, hospitalization for pain management, adjustments to wheelchair seating and positioning, change in bladder management, and functional status decline requiring increased physical assistance with body habitus changes. Conclusions: Disabled women can successfully experience pregnancy and childbirth with proper measures for identification, prevention, and management of obstetric and disability-related complications through comprehensive interdisciplinary care.