Brittany Pousett, Donna Cumming, Clara Phillips, Fae Azhari, Crystal MacKay

PROSTHETIC TREATMENT OF WOMEN WITH LOWER LIMB ABSENCE DURING PREGNANCY & THE POSTPARTUM PERIOD: A CHART REVIEW

Introduction

Prosthetic treatment of women with lower limb absence during pregnancy & the postpartum period: a chart review. Explore prosthetic care for women with lower limb absence during pregnancy & postpartum. Learn about socket/alignment adjustments, mobility solutions, and prosthetist insights.

Abstract

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. Layman's Abstract When women with lower limb absence become pregnant, they often have a lot of questions about what to expect during their pregnancy, particularly in regard to their prosthesis use and mobility. There is very little information available regarding this, leaving women and their prosthetists with many unanswered questions. We sought to address this gap by gathering information on the details surrounding prosthetic treatment during pregnancy and the postpartum period. Women who participated in a previous study provided consent to contact the prosthetist who had provided care to them during and after pregnancy. We asked prosthetists to complete a structured survey using the details written in their clinical records. They documented any adjustments made to the prosthesis, if new sockets were required, and key learnings from their experience. Results from 18 pregnancies and 11 women with transtibial, transfemoral, and rotationplasty amputations were included. There was a wide range of experiences, including some women needing no adjustments and others requiring substantial adjustments and/or new sockets, both during and after pregnancy. This information demonstrates the variety of experiences women can have and allows women and prosthetists plan for the different possibilities they may encounter during and after pregnancy. We also provide a data collection framework to support the ongoing collection of this data in the future to include a wider diversity of women and experiences. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/45142/34057 How To Cite: Pousett B.M, Cumming D, Phillips C, Azhari F, MacKay C. Prosthetic treatment of women with lower limb absence during pregnancy & the postpartum period: A chart review. Canadian Prosthetics & Orthotics Journal. 2025; Volume 8, Issue 1, No. 7. Https://doi.org/10.33137/cpoj.v8i1.45142 Corresponding Author: Brittany Mae Pousett, CP(c), MSc.Affiliations: 1) Barber Prosthetics Clinic, Vancouver, Canada; 2) Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada.ORCID ID: Https://orcid.org/0000-0002-2272-7847E-Mail: brittany@pousett.caTelephone: (604) 321-1115

Review

This retrospective chart review by Pousett et al. addresses a critical and significantly under-researched area concerning prosthetic treatment for women with lower limb absence (LLA) during pregnancy and the postpartum period. The authors correctly identify a substantial knowledge gap, noting the lack of information available to both patients and prosthetists regarding expectations for prosthetic care and adjustments required to maintain mobility. By examining clinical records and gathering insights from prosthetists across Canada, this study aims to provide much-needed guidance on specific prosthetic interventions during the perinatal period, offering valuable practical implications for an underserved population. The methodology involved contacting 15 prosthetists for 19 participants from a previous study, with clinical record reviews eventually completed by 7 prosthetists for 18 pregnancies across 11 women with various types of LLA. Key findings reveal that socket adjustments were frequently required in 11 of 18 pregnancies, commonly via circumferential stretching and localized modifications, while alignment adjustments were less common. Crucially, additional sockets were necessitated in six pregnancies, predominantly during the first six months. A significant observation was that all women requiring adjustments during pregnancy also needed further interventions postpartum. The study highlights wide variations in physiological changes affecting prosthetic fit and compiles practical prosthetic management techniques from experienced clinicians. The proposal of a data collection framework is a forward-looking aspect, aiming to systematize future data capture. This study represents a valuable initial step in an important domain. Its strengths lie in directly tackling a pressing clinical challenge and providing practical, real-world insights for prosthetists and women navigating pregnancy with LLA. While the sample size of 11 women and 18 pregnancies, derived from a previous study and relying on retrospective chart reviews, represents a limitation regarding generalizability and potential for recall bias, the data offers compelling preliminary evidence. The findings underscore the highly individualized nature of prosthetic care during pregnancy, emphasizing the need for proactive monitoring and adaptable treatment plans. The proposed data collection framework is particularly commendable, laying the groundwork for more comprehensive, potentially prospective studies that could involve a larger, more diverse cohort and further refine best practices in this specialized area of care.

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