1.28.15 - Osteopathic in Pregnancy Flashcards
back pain
2/3 pregnant women
contributions to mechanical issues in pregnancy
multifetal gestation spinal curve leg length inequality weight gain ligament laxity SD
low back pain in pregnant women
maternal structure affects pregnancy
pregnancy affects maternal structure
most common cause of LBP in pregnant women
biomechanical instability
pregnancy posture
1 - change in maternal structure
2 - increased body fluid
3 - hormone changes
spinal curves in pregnancy
lumbar lordosis
thoracic kyphosis
compensation to changed posture
shoulder back head forward increased lordosis sacrum nutates** flexion ribs flare feet flatten stance widens
posterior paraspinal muscles
shorten
-unbalanced by overstretched abdominals
psoas also shortens
relaxin levels
increase - result in joint laxity during pregnancy
pubic symphysis widens
10-12 week of pregnancy
refer pain to medial thighs or low back
gets worse with walking
peripheral nerves
susceptible to injury
-compression, traction, ischemia
meralgia paresthetica
lateral femoral cutaneous nerve
-during pregnancy gets neuropathy
lumbosacral plexopathy
prolonged sitting, standing, squatting
-prox-distal lower limb weamness
foot drop**
rare - lumbar disc herniation
foot drop
result of compression of preoneal division of sciatic in pelvis
or compression of common peroneal nerve at fibular head
consider double crush
spondylolisthesis
vertebral body anterior displacement on one below
most common L5-S1
women who have had children - more at L4-5**
important to examine on pregnant patient
hip ROM
- don’t want to miss osteoporosis
- or avascular necrosis of femoral head
pain with weight bearing
osteoporosis of hip
tx - reduce weight bearing
avascular necrosis of femoral head
higher adrenocorticoid metabolism
-also weight gain, E and P increase, increased joint pressure
-diagnosis - hip ROM testing
tx - reduced weight bearing
lumbar epidural venous plexus
IVC thrombosis
posterior placenta
pain with enlarging uterus putting strain on vascular bed connected to placenta
history of trauma
placenta abruption
sudden onset of back pain
postpartum depression
3x more likely in patients with lumbo-pelvic pain in pregnant women
exam in pregnant patient with LBP
ROM, muscle imbalance, leg length, DTR, posture, gait, degree of lordosis
tx of LBP in pregnant
avoid excess heat
nutrition - vit D**, magnesium (muscle relaxant)
CI for OMT during pregnancy
undiagnosed vaginal bleeding
abortion
ectopic
PPROM
indications for OMT during pregnancy
SD
scoliosis
edema, congestion, etc.
structural stage
0-12 weeks
symapthetics to uterus
T10-L2 - contractions and pain
parasympathetics to cervix
S2-4 - dilation
anterior stomach acidity chapmans
rib 5 and 6 MCL to sternum on left
anterior stomach decreased peristalsis chapans
rib 6 an 7 MCL to sternum on left
anterior gallbaldder chapmans
rib 6 and 7 MCL to sternum on right
anterior liver chapmans
rib 5/6 and 6/7 from MCl to sternum on right
anterior pancreas chapmans
rib 7/8 on right close to costochondral junction
posterior liver chapmans
intertransverse space midway SP and TP between T5,6,7 on right
gallbladder posterior chapmans
intertransverse space midway SP and TP T6/7 on right
posterior kidney chapmans
intertransverse space T12 and L1
-midway between SP and TP
stomach peristalsis chapmans posterior
intertransverse space, midway between SP and TP
-between T6/7 on left
stomach acidity chapmans posterior
intertransverse space between Sp and TP between T5/6 on left
broad ligament anterior chapmans
greater trochanter to within 2 inches of knee joint outer aspect of femur
uterus anterior chapmans
upper edge of junction of pubic ramus with ischium
intestinal peristalsis chapmans anterior
constipation**
between ASIS and greater trochanter
rectum anterior chapmans
around lesser trochanter
colon anterior chapmans
spastic constipation or colitis
1-2” wide
-greater troachanter to inch of patella on antero-lateral aspect of femur
right - upper 5th cecum, next 3/5 ascending colon, last 5th beginning of transverse colon
left - 5th above knee end of transverse colon, middle 3/5 descending colon, last 1/5 sigmoid colon
extreme upper end of trochanter on left side - rectosigmoid junction
posterior broad ligament chapmans
between PSIS and spinous process of L5
posterior uterus chapmans
tip of TP of L5 toward ilia crest between PSIS and SP of L5
posteroir vagina chapmans
leukorrhea
-between PSIS and SP of L5, inner femoral condyle, and superiorly from 3-6” on posterior aspect
also upper inner aspect of posteiror thigh 3-5” long and 1.5-2” wide on side of articulation of coccyx with sacrum
posterior clitoris chapmans
articulation of cocyx with sacrum
posterior hemorrhoids chapmans
sacrum close to ilium at lower end of SI joint
-and on ischial tuberosity
posterior colon chapmans
spastic constipation or colitis
TP of L2 to TP of L4
-triangular area reaching across iliac crest
hyperemesis gravidarum
treat C2 and T5-9
as well as related chapmans
constipation chapmans
ASIS and greater trochanter
anterior intestinal peristalsis point
late structural change
12-28 weeks
- pelvis rotated anterior at S2
- increased lumbar lordosis
- compensatory thoracic kyphosis
- cervical lordosis
round ligament pain
anterior counterstrain points L3-5 tx
sharp inguinal pain
broad ligament
carpal tunnel syndrome
increased incidence in pre-eclampsia and HTN
due to edematous state
resolves after delivery
congestive stage
28-36 weeks
graviational effect on uterus**
increased pressure on lymph and venous
edema**
some get hypotensive - lay left lateral recumbent
upper GI VSR
T5-9
cranial during congestive stage
NO
-may provoke uterine contractions
preparatory stage
36 weeks to delivery
weekly visits
maintian structural balance and lymph flow
psych support
influence uterine contractions
sympathetics
influence cervical dilation
parasympathetics
CV4
influence uterine contractions
recovery and maintenance stage
delivery to 6 weeks
-done in 2 visits
golden period
return to normal pre gravid state
post partum depression
b/l flexed sacrum
