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Flashcards in OAT OB Deck (23)
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1
Q

What are 3 factors that influence somatic dysfunction in pregnant patients?

A
  • Change in maternal structure & biomechanics
  • body fluid circulation
  • hormonal changes
2
Q

Scoliosis in pregnancy

A
  • curvatures do not increase
  • may develop more pain
  • possible increased risk of premature birth
3
Q

Rheumatoid arthritis in pregnancy

A

-symptoms improve: conception to 6 weeks pp

4
Q

Ankylosing spondylitis in pregnancy

A
  • aggravated by pregnancy

- due to increased stress on SI joints

5
Q

Relative contraindications to OMT in OB pt

A
  • premature preterm rupture of membranes

- premature labor

6
Q

Absolute contraindcations to OMT in OB pt

A
  • undiagnosed vaginal bleeding
  • prolapsed umbilical cord
  • placental abruption
  • ectopic pregnancy
  • placenta previa
  • threatened or incomplete abortion
  • severe pre-eclampsia/eclampsia
7
Q

if pt presents with hyperemesis gravidarum, what areas do you treat?

A

Treat C2 and T5-9

8
Q

5 model approach in 1st trimester

A

biomechanical: SD of C/T/L, ribs, pelvis, sacrum
Neuro: T10-L2 pelvic organs SNS & S2-S4 pelvic organs PNS
Resp-Circ: fascial or diaphragm restrictions, lymph techniques
met-ener-imm: prenatal vit, hyperemesis gravidarum
behavioral: smoking/alc/caff/drugs screening, sexual behavior screen, exercise

9
Q

5 model approach in 2nd trimester

A

Monthly visits ok to treat mom in supine position through 2nd trimester
Biomechanical: SD of C/T/L, low back pain, pelvis, sacrum, abd wall MFR
Neuro: CTS- MFR techniques, round ligament pain–treat with ant cs at L3-5
resp-circ: rib raising, diaphragm, effleurage/petrissage
met-ener-imm: prenatal vit, constipation
behavioral: home stretches, exercise

10
Q

Treating constipation in second trimester

A

pelvic diaphragm release & stool softeners

11
Q

What are some common SDs in the second trimester?

A
  • forward torsion
  • anterior innominate rot
  • increase in lumbar lordosis (and compensatory increase in thoracic kyphosis)
  • round ligament pain: sharp, stabbing in lower abd or groin
  • carpal tunnel
12
Q

Carpal tunnel syndrome in pregnancy

A

Common in preg (esp 2nd trimester) due to increased fluid retention, congestion, and edematous state

  • tx: stretches, night time splinting, MFR to wrist
  • often resolves pp
13
Q

5 model approach for 3rd trimester

A

biomechanical: treat LBP, assess gait changes
Neuro: GI- T5-9, ovaries/uterus- T10-L2, bladder S2-4
resp-circ: lymph emphasis! effleurage & petrissage
met-ener-imm: gerd
behavioral: drink plenty of fluids, elevate head of bed, dietary modification for gerd, build support for delivery

14
Q

What should evaluate in the prep stage (last 4 wks)?

A

pelvic diameters to anticipate delivery problems!!

  • inlet: iliopectineal line/pube to sacrum
  • mid-pelvis: structures between inlet & outlet
  • outlet: pubic bone, ischial tuberosities, coccyx
15
Q

Rupture of pubic symphysis s/s

A
  • acute pain radiating to back &/or thighs
  • palpable gap with local tissue edema
  • waddling gait with increased pain while walking or bending
  • separation greater than 1 cm
  • audible crack often heard
16
Q

Potential causes of rupture of pubic symphysis

A
  • fetal macrosomia
  • precipitous labor/rapid second stage
  • intense uterine contractions
  • forceps delivery
17
Q

TX of rupture of pubic symphysis

A

bed rest
pelvic binder to reduce separation
OMM–indirect tx of spine & pelvis as needed

18
Q

Relative contraindications to aerobic exercise in preg

A
  • intrauterine growth restriction
  • unevaluated maternal cardiac arrhythmia
  • poorly controlled T1DM
  • extremely underweight
19
Q

Absolute contraindications to aerobic exercise in preg

A
  • persistent 2nd or 3rd trimester bleeding
  • placenta previa >28 wks gestation
  • premature labor
  • ruptured membranes
  • preeclampsia
  • incompetent cervix
  • mult gestation (triplets or more)
  • intrauterine growth restriction
20
Q

PROMOTE study- dr hensel

A

400 women in 3rd trimester assigned to usual care & OMT, or usual care & placebo US tx

  • 7 tx over 9 wks
  • goals: reduce LBP & improve functioning
  • tx effects for pain & functioning in OMT
  • no higher likelihood of conversion to high-risk status in OMT group
21
Q

Post pelvic pain s/s

A
  • distal & lateral to lumbrosacral junction
  • radiates down posterior thigh to knee
  • no muscle weakness or sensory impairment
  • normal 2/4 reflexes
  • pain may be due to relaxation of ligaments
22
Q

lymph stresses in pregnancy

A

decrease in efficiency of excess fluid removal

Most symptoms in 3rd trimester: hemorrhoids, vulvar & LE varicosities

23
Q

Hormonal stresses in pregnancy

A

relaxin elevated during 1st trimester & declines in early 2nd
-leads to widening & mobility of SI joints & pubic symphsyis
-starts at 10-12 wks
Progesterone
-changes configuration of thoracic cage: cicrumgference increases, subcostal angle widens, diaphragm pushed up
-promotes fluid retention
-leads to congestion