What are the recommended prenatal care steps for a 28-year-old newly pregnant woman with a history of cerebral palsy (CP)?

Prenatal Care Recommendations for a 28-Year-Old Pregnant Woman with Cerebral Palsy

Women with cerebral palsy require increased surveillance during prenatal care due to higher risks of adverse pregnancy outcomes, particularly preterm birth. 1

Initial Prenatal Assessment

• Comprehensive neurological evaluation:

  • Assess baseline motor function, spasticity, and mobility limitations
  • Document any facial weakness or asymmetry 2
  • Evaluate for comorbidities commonly associated with CP (epilepsy, chronic pain, musculoskeletal problems)

• Multidisciplinary consultation:

  • Early referral to maternal-fetal medicine specialist
  • Neurology consultation to optimize management of CP during pregnancy
  • Anesthesiology consultation to plan for labor analgesia and potential cesarean delivery

Increased Pregnancy Risks in Women with CP

Women with CP face specific pregnancy risks that require monitoring:

• Higher risk of preterm birth (12.9% vs 4.9% in general population; adjusted odds ratio 2.8) 1
• Increased likelihood of cesarean delivery (aOR 1.9) 1
• Greater chance of induced labor (aOR 1.4) 1
• Higher risk of low 5-minute Apgar scores (aOR 1.8) 1
• Increased risk of small for gestational age infants (aOR 1.6) 1

Recommended Monitoring Schedule

First Trimester (1-13 weeks)

• Complete baseline assessments:
  • Blood pressure monitoring (may be lower than general population) 2
  • Vision and hearing screening 2
  • Medication review (especially anti-epileptic drugs if applicable)
  • Early dating ultrasound

Second Trimester (14-26 weeks)

• Detailed anatomical ultrasound at 18-22 weeks
• Cervical length assessment to screen for preterm birth risk
• Regular blood pressure monitoring
• Assessment of weight gain (may require specialized scales)

Third Trimester (27+ weeks)

• More frequent prenatal visits (every 2 weeks from 28-36 weeks, weekly thereafter)
• Serial growth ultrasounds to monitor for fetal growth restriction
• Fetal well-being assessments
• Development of detailed delivery plan

Special Considerations

Mobility and Positioning

• Adapt examination tables and equipment for mobility limitations
• Provide additional support during examinations
• Consider physical therapy consultation for pregnancy-related postural changes

Medication Management

• Review all medications for safety in pregnancy
• For patients on anti-epileptic drugs:
  • Consider HLA-B*15:02 screening before initiating carbamazepine 3
  • Evaluate risks/benefits of continuing medication during pregnancy
  • For mild symptoms, consider discontinuing AED therapy prior to or during pregnancy 3

Labor and Delivery Planning

• Develop a detailed birth plan addressing:
  • Preferred positioning during labor
  • Pain management options considering CP-related issues
  • Continuous electronic fetal monitoring 3
  • Potential need for assisted delivery or cesarean section
  • Availability of specialized equipment and support

Intrapartum Monitoring

• Continuous electronic fetal monitoring is recommended 3
• Have interventions ready for abnormal fetal heart rate tracings:
  • Position changes
  • Oxygen administration (6-10 L per minute)
  • IV fluid bolus
  • Amnioinfusion for recurrent variable decelerations 3

Postpartum Considerations

• Specialized support for infant care
• Lactation support adapted to mobility limitations
• Assessment of maternal functional status
• Early referral to occupational therapy if needed for infant care skills

Pitfalls and Caveats

• Do not assume all complications are related to CP - standard pregnancy complications must still be ruled out
• Avoid underestimating the woman's ability to participate in her care - focus on capabilities rather than limitations
• Don't neglect psychological support - pregnancy may increase anxiety about ability to care for infant
• Recognize that CP is non-progressive - new neurological symptoms warrant immediate evaluation 2

This comprehensive approach to prenatal care for women with CP acknowledges their increased risks while supporting a positive pregnancy experience and optimal outcomes for both mother and baby.