13. Osteopathic Approach to the OB Patient Flashcards
How does scoliosis change during pregnancy?
May develop more pain
-possible increase risk of premature birth
How does rheumatoid arthritis pain change during pregnancy?
Actually gets better
How is ankylosing spondylitis changed during pregnancy?
Aggravated by pregnancy
-due to stress on SI joints
What’s the number one complaint of pregnant women?
Low back pain
Increase:
Anterior Tilt
Lordosis
Increase kyphosis
How does an increase in lordosis of lumbar spine cause pain?
Increase stress across the vertebral facets and increased shear forces across IV discs
What causes the mechanical back pain seen in pregnancy? (3)
Postural changes
Muscle weakness
Excessive connective stretching
-SI region
Poster pelvic pain
- distal and lateral to lumbosacral junction
- radiates down posterior thigh to knee
What are some red flag warnings in pregnant patients with low back pain that warrant some additional evaluation?
- severe pain interferes with function
- increase pain w cough, sneeze, valsalva
- Neuro deficits
- -bladder and bowel issues, weakness, sensory deficits
Which cause of back pain follows a nerve pattern and is due to herniated/bulging disc?
Radicular pain
Which cause of back pain presents as lightning pains and paresthesias in ilioinguinal and genitofemoral nerve distribution?
Peripheral n compression
What are some risk factors for LBP during pregnancy?
Multiparity
High BMI
Smoking
Age
Why does lymphatic stress increase during pregnancy?
Increase in fluid to support the fetus
Estrogen, progesterone, and adrenal hormones promote fluid retention
How does said fluid build up during pregnancy cause pain?
Decreased lymphatic flow results in:
- fascial torsions
- organ hypertrophy
- diaphragm restriction
Which way should women lie during pregnancy?
Left lateral recumbent increase CO in moms
-supine allows infant puts stress on IVE
What causes the low back pain seen with venous stresses?
Decreased flow in pelvis results in stagnant hypoxia of the neural and vertebral tissues=Back pain
What hormone is associated with some of the back pain seen during pregnancy? (2)
Relaxin
-causes joint laxity, especially in SI joints where a lot of pregnant women have pain
Progesterone
-causes fluid build-up=decreased oxygen and increased waste
Indications for OMM in a pregnant patients?
SD
Scoliosis
Edema or congestion
Relative contraindications in pregnant patient?
Premature rupture of membranes
Premature labor
Absolute contraindications in pregnant patient?
Undiagnosed vaginal bleeding
Placental previa/abruption
Ectopic pregnancy
Threatened abortion
Etc.. anything that can cause the fetus to abort/maternal harm
What biomechanical treatments can you do for pregnant patients?
Less forceful stuff: Soft tissue, mfr, stills, fpr, blt to:
- Junctions of body: C, T, L
- Sacrum, innominates
What lymphatic treatments should you do during pregnancy?
Fascial diaphragms
-inlet, resp, pelvic
NOT PEDAL PUMP
What neurologic treatments could you do for pregnant patient?
Seated paraspinal inhibition to decrease sympathetics
Dr Z said rib raising, but I’m pretty sure that increases?
What areas of the body can you treat to increase estrogen, decrease Sym, and increase PSym?
T10-L2 inhibition to decrease pelvic organ vasoconstriction, and increase Sym
S2-S4: pelvic organ dilation
What treatment should you avoid in third trimester?
CV4
-can provoke uterine contractions
What is the best way to approach somatic dysfunction after the mom has given birth?
Jump on them early
-treating dysfunction prior to resolution of hormonal changes on ligamentous structures (before 6 weeks)
What are the relative contraindications for exercise during pregnancy? (2)
Intrauterine growth restriction
Unevaluated maternal cardiac arrhythmia
What are the absolute contraindications to aerobic exercise during pregnancy?
Incompetent cervix Multiple gestations Growth restriction of infant Persistent second or third trimester bleeding Placenta previa/abruption Preeclampsia
