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Repro II > Clinical OB/GYN > Flashcards

Clinical OB/GYN Flashcards

1
Q

Sympathetic Innervations

A

Ovaries: T9-10
Uterus: T10-L1
Cervix: T10-L2

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2
Q

Increased sympathetic tone

A

Ovaries: increased vasoconstriction > decreased blood flow
Uterus: increased uterine contraction, increased vasoconstriction
Cervix: relaxes cervix

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3
Q

Parasympathetic innervations

A

Ovaries: Vagus/S2-4
Uterus: S2-4
Cervix: S2-4

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4
Q

Increased parasympathetic tone

A

Ovaries: increased vasodilation > increased blood flow
Uterus: increased relaxation of uterus, increased vasodilation
Cervix: constricts cervix

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5
Q

Ovaries Chapman’s

A

Anterior: pubic tubercles
Posterior: T10 transverse processes

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6
Q

Uterus Chapman’s

A

Anterior: inferior pubic rami
Posterior: L5 transverse processes

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7
Q

Broad ligament Chapman’s

A

Anterior: lateral ITB
Posterior: PSIS

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8
Q

Junction levels

A

Pelvic - L5-S1 (LS)
Thoracic - T12-L1 (TL)
Thoracic inlet (C7, T1, 1st rib) - CT
Suboccipital (OA, AA)

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9
Q

1st trimester postural changes

A
  • More weight bearing on LS junction > sacral extension
  • Pubic shear tenderness at pubic symphysis
  • Posterior rotation of pelvis
  • Decrease of lumbar lordosis
  • Hyperemesis gravidarum > tx w/ parasympathetics, occipitomastoid suture decompression (vagus), sacral rocking/inhibition
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10
Q

Common SD in 1st trimester

A
  • C2 with recurrent SD and T2 locking
  • T4-T8 SD d/t breast tenderness/enlargement
  • Pelvis and sacral; pain at pubic symphysis
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11
Q

2nd trimester postural changes

A
  • Increased lumbar lordosis
  • Anterior rotation of pelvis
  • shortening of paraspinal mm.
  • increase in thoracic kyphosis
  • diaphragm restrictions
  • anterior rotation of shoulder girdle
  • cervical lordosis
  • thoracic and rib pain
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12
Q

Symptoms and SD in 2nd trimester

A
  • Uterus into abdomen > pain over pubic symphysis
  • MFR and CS safest
  • hand and wrist pain from carpal tunnel common (edema causes compression of median n.)
  • De Quervains’ Tenosynovitis common too
  • Tx of pectoral girdle and upper thoracics (sympathetics to UE @ T2-7), stretch of transverse carpal lig., or active articulation of carpal bones
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13
Q

3rd trimester postural changes

A
  • Breast enlargement with increased stress @ T5-8
  • Lumbar lordosis
  • anterior pelvic rotation with exaggerated sacral flexion
  • Compression @ L5-S1
  • Stress on lumbar facets
  • SI and pubic pain
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14
Q

Symptoms and SD in 3rd trimester

A
  • GERD (restrictions in excursion of diaphragm affect GE junction and as fundus enlarges, abdominal contents compressed)
  • pubic symphysis widens (hormonal influence of estrogen and relaxin) > predisposes to pubic shear, LS pain may increase (less able to lie prone), LE edema, constipation, hemorrhoids d/t compression on pelvic organs and vasculature
  • Upper rib SD (exhalation)
  • iliopsoas strain (usually bilateral, pelvic side shift away from tight psoas, increased LS pain), LE edema, constipation, hemorrhoids
  • piriformis syndrome (pain in butt w/ radiation into calf or foot, assoc with piriformis, mid-pole SI, and greater trochanter TPs)
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15
Q

Organic causes of low back pain in pregnancy

A
  • Pyelonephritis (fever/chills), nephrolithiasis
  • preterm labor (<37 weeks)
  • PID/UTI
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16
Q

Primary dysmenorrhea

A

Painful menses w/o underlying pelvic pathology > dx based on hx of crampy pelvic pain during the first 3 days of the menstrual cycle; common in young women and typically 6-12 months after menarche

17
Q

Secondary dysmenorrhea

A

Painful menses caused by an underlying pelvic pathology (endo, fibroids); commonly later in life; dx confirmed through imaging like US

18
Q

Common SD in pelvic pain

A
  • psoas spasm (d/t proximity of psoas to tube can spasm as a result of endo irritation or ureteral stones (pain extends from lower quadrant toward umbilicus and out of pelvis)
  • pubic shear (pain when rising from seated position or when weight bearing on affected side) dx: tenderness over pubic bone with asymmetry
  • SI dysfunction (causes sciatica and LBP with spasm)
19
Q

CI to OMT in pregnancy

A

-undiagnosed vaginal bleeding, ectopic pregnancy, placental abruption, untreated DVT, gestational HTN/pre-eclampsia, unstable maternal vital signs, fetal distress, ruptured membranes (do NOT use HVLA after), premature labor, percussion vibrator below thoracic junction

20
Q

OMT in labor

A
  • Stimulation of T12-L1 by percussive technique can improve quality of contractions
  • Lumbar decompression in left lateral lying
21
Q

Common SD postpartum

A
  • Pubic shear (dx: pubic tenderness/pain w/ weight bearing; tx: vertical shear > gentle leg tug on superior innominate side; ant/post shear > MET
  • bilateral sacral flexion (during deliver sacrum can become locked in flexion); neg seated flexion, - ST, BBT + pain over both SI; tx: frog kick technique or LS decompression
  • hand/wrist SD (De Quervains tenosynovitis and CTS)

Repro II (4 decks)

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