Prosthetic treatment of women with lower limb absence during pregnancy & the postpartum period: A chart review.

Background: Little information is available for women with lower limb absence (LLA) and their prosthetists regarding expectations for prosthetic treatment during and after pregnancy. A main concern is prosthesis use and what adjustments may be required to sustain mobility.

Objectives: This study examines the prosthetic treatment of women with LLA to understand what specific prosthetic interventions occurred during the perinatal period and to gather information from the prosthetists regarding key learnings to be shared with others.

Methodology: This study was a retrospective review of clinical records for women with LLA who received prosthetic care across Canada. Between January - May 2023, all 19 women who participated in a previous study on LLA and pregnancy consented to have their prosthetist contacted. Prosthetists were asked to complete a structured survey documenting appointment details, socket and alignment adjustments made during the perinatal period and key learnings in providing care to this population.

Findings: 15 prosthetists were contacted to complete surveys for the 19 participants. Reviews of clinical records were completed between April - August 2023 by 7 prosthetists covering 18 pregnancies from 11 women with LLA (two bilateral transtibial, two unilateral transtibial, four unilateral transfemoral, and three unilateral rotationplasty). Socket adjustments were required in 11/18 pregnancies with common methods including circumferential stretching and localized adjustments. Alignment adjustments to existing sockets were only required in two pregnancies. Additional sockets were required in six pregnancies when the existing socket could no longer be adjusted to achieve comfort, most often during the first six months of pregnancy (the first or second trimester). Everyone who had a socket adjustment during pregnancy required additional socket adjustments or new sockets in the postpartum period. Prosthetists observed wide variations in physiological changes and prosthetic fit during the perinatal period and shared prosthetic management techniques to address residual limb volume changes. A data collection framework was also proposed to support the ongoing collection of this data to include a wider diversity of women and experiences.

Conclusion: A wide range of prosthetic treatment interventions may occur during pregnancy and the postpartum period. While prosthetists and women with LLA can anticipate that socket and alignment changes may be necessary, sometimes none are required. By preparing for potential fluctuations in prosthetic fit and addressing each individual's needs, prosthetists can help minimize disruptions to mobility throughout pregnancy.