OAT OB Lect Flashcards
What percentage of women report Low Back Pain (LBP)?
60%
3 factors influencing SD in pregnant pts
Change in maternal structure and biomechanics
Body fluid circulation
Hormonal changes
What effect does pregnancy have on scoliosis?
Curvatures do not increase
May develop more pain
Possible increased risk of premature birth
What effect does pregnancy have on rheumatoid arthritis?
Improved sx (conception => 6 weeks postpartum)
What effect does ankylosing spondylitis have on pregnancy?
Aggravated sx (increased stress on SI joints)
Pregnancy sx that warrant further referral/evaluation
Severe pain interfering with fxn (persistent non-positional pain at night)
Increased pain w/ cough, sneeze, valsalva
Hx: bowel/bladder dysfxn, failure to urinate, paresis
Exam: Weakness, sensory defects, abnormal reflexes
Pregnant patients rely on ____ for posture balance, as opposed to ____ in non-pregnant pts
Pregnant patients rely on muscle control for posture balance, as opposed to ligamentous/disc-oriented control in non-pregnant pts
What is the etiology of radicular pain?
Bulging disc (40%)
Herniated disc (10%)
How does radicular pain typically present?
Paresthesias in ilioinguinal and genitofemoral nerve distribution “lightning pain”
LBP resolves in _____ of cases postpartum
80-95%
Risk factors of LBP during pregnancy
Previous hx of LBP
Multiparity
High BMI
Smoking
Age
Strenuous work
Pain during menstruation
How much does interstitial fluid demand increase during pregnancy?
6.5L
Increased demand to pelvic organs due to metabolic demands of fetus
Increase in estrogen, progesterone, adrenal hormones during pregnancy promotes what physiological response?
Fluid retention (tissue edema)
What hemodynamic changes occur during pregnancy?
Increase: CO, blood volume, Plasma volume
Decrease: SVR, BP, hematocrit
What recommendation would you give to a pregnant pt with vulvar varicosities?
LLR position and apply pressure to area
Supine compression of IVC by the uterus causes most pronounced effects after what weeks?
20 weeks
Lymphatic stress in pregnancy caused by fascial torsion, organ hypertrophy, diaphragm restriction have what effect on the pressure gradient?
Makes it less effective
Most lymphatic sx occur in what trimester?
3rd trimester
Increased mass causes increased venous stasis
Low back pain in pregnancy can be caused by stagnant hypoxial of neural and vertebral tissues due to what?
Direct pressure on IVC by uterus => dependent edema moves back into vasculature due to osmotic gradient
Women incapacitated by LBP during pregnancy have higher levels of what hormone?
Relaxin
Relaxin is elevated in what trimester?
1st trimester
Declines early 2nd trimester
What does the hormone relaxin cause?
Widening and mobility of SI joints and pubic symphysis
Begins in 10-12 weeks
What effect does the release of progesterone during pregnancy have on the thoracic cage?
Circumference increases 5-7 cm
Subcostal angle widens 68-103 degrees
Diaphragm pushed superiorly 4cm
Increased tidal volume 30-40%
Indications for OMT during pregnancy
SD
Scoliosis or other pregnancy-associated structural dysfunction
Edema, congestion, or other pregnancy-associated conditions amenable to OMT
Relative contraindications to OMT during pregnancy
Premature preterm rupture of membranes
Premature labor (change in cervix)
Absolute contraindications to OMT during pregnancy
Undiagnosed vaginal bleeding
Prolapsed umbilical cord
Placental abruption
Ectopic pregnancy
Placenta previa
Threatened/incomplete abortion
Severe preeclampsia/eclampsia
Goals of pregnancy OMT
Address all postural stressors
Treat any specific SD (allows body to better compensate for pregnancy chage, saves pt energy, MSK dysfunction increases demands up to 300%)
What areas must be treated for hyperemesis gravidarum?
C2
T5-9
Round ligament pain in the 2nd trimester presents how?
Sharp, stabbing in low abdomen or groin
What trimester is Carpal Tunnel syndrome most common?
2nd trimester
How is diagnosis of pubic symphysis rupture made?
Separation >1cm
Audible crack may be heard, acute pain radiating to back and/or thighs, palpable gap with local tissue edema, waddling gait with increased pain on gait or bending
How long after delivery should you screen for somatic dysfunction?
Day 1 post-partum
Tx prior to resolution of homronal change on ligamentous structures
How long post-partum should the second OSE occur?
4 weeks postpartum (2nd visit)
What are the ACOG recommendations for exercise in pregnancy?
30 min or more, moderate exercise, most/all days of the week
Should the valsalva maneuver be avoided in pregnancy exercise?
Yes, increased BP and intraabdominal pressure may decrease uteroplacental blood flow
Exercise in pregnancy should be avoided at what altitude if pt doesn’t already live at high altitude?
6000 feet
Relative contraindications to aerobic exercise in pregnancy
Intrauterine growth restriction in current pregnancy
Unevaluated maternal cardiac arrhythmia
Poorly controlled type 1 DM
Extreme underweight (BMI <12)
Absolute contraindications to aerobic exercise in pregnancy
Persistent 2nd or 3rd trimester bleeding
Placenta previa >28 weeks
Premature labor during current pregnancy
Ruptured membranes
Preeclampsia/pregnancy-induced HTN
Incompetent cervix
Multiple gestation
IUGR
The PROMOTE study by Dr. Hensel aimed to use OMT on women in what trimester to reduce LBP?
3rd trimester
Tx recommendations for mild carpal tunnel syndrome
Self-limiting
OMT, wrist splints, NSAIDS (but not if pregnant)
Tx recommendations for moderate carpal tunnel syndrome
OMT, wrist splints, NSAIDS, steroid injection
Tx recommendations for severe carpal tunnel syndrome (signs of damage and muscle wasting)
Immediate surgical referral
OMT at initial consult (lol)
What is the spinal curve compensation for pregnancy?
Increased kyphosis and lordosis
