OAT OB Lect

Question 1

What percentage of women report Low Back Pain (LBP)?

Answer 1

60%

Question 2

3 factors influencing SD in pregnant pts

Answer 2

Change in maternal structure and biomechanics

Body fluid circulation

Hormonal changes

Question 3

What effect does pregnancy have on scoliosis?

Answer 3

Curvatures do not increase

May develop more pain

Possible increased risk of premature birth

Question 4

What effect does pregnancy have on rheumatoid arthritis?

Answer 4

Improved sx (conception => 6 weeks postpartum)

Question 5

What effect does ankylosing spondylitis have on pregnancy?

Answer 5

Aggravated sx (increased stress on SI joints)

Question 6

Pregnancy sx that warrant further referral/evaluation

Answer 6

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

Question 7

Pregnant patients rely on ____ for posture balance, as opposed to ____ in non-pregnant pts

Answer 7

Pregnant patients rely on muscle control for posture balance, as opposed to ligamentous/disc-oriented control in non-pregnant pts

Question 8

What is the etiology of radicular pain?

Answer 8

Bulging disc (40%)

Herniated disc (10%)

Question 9

How does radicular pain typically present?

Answer 9

Paresthesias in ilioinguinal and genitofemoral nerve distribution “lightning pain”

Question 10

LBP resolves in _____ of cases postpartum

Answer 10

80-95%

Question 11

Risk factors of LBP during pregnancy

Answer 11

Previous hx of LBP

Multiparity

High BMI

Smoking

Age

Strenuous work

Pain during menstruation

Question 12

How much does interstitial fluid demand increase during pregnancy?

Answer 12

6.5L

Increased demand to pelvic organs due to metabolic demands of fetus

Question 13

Increase in estrogen, progesterone, adrenal hormones during pregnancy promotes what physiological response?

Answer 13

Fluid retention (tissue edema)

Question 14

What hemodynamic changes occur during pregnancy?

Answer 14

Increase: CO, blood volume, Plasma volume

Decrease: SVR, BP, hematocrit

Question 15

What recommendation would you give to a pregnant pt with vulvar varicosities?

Answer 15

LLR position and apply pressure to area

Question 16

Supine compression of IVC by the uterus causes most pronounced effects after what weeks?

Answer 16

20 weeks

Question 17

Lymphatic stress in pregnancy caused by fascial torsion, organ hypertrophy, diaphragm restriction have what effect on the pressure gradient?

Answer 17

Makes it less effective

Question 18

Most lymphatic sx occur in what trimester?

Answer 18

3rd trimester

Increased mass causes increased venous stasis

Question 19

Low back pain in pregnancy can be caused by stagnant hypoxial of neural and vertebral tissues due to what?

Answer 19

Direct pressure on IVC by uterus => dependent edema moves back into vasculature due to osmotic gradient

Question 20

Women incapacitated by LBP during pregnancy have higher levels of what hormone?

Answer 20

Relaxin

Question 21

Relaxin is elevated in what trimester?

Answer 21

1st trimester

Declines early 2nd trimester

Question 22

What does the hormone relaxin cause?

Answer 22

Widening and mobility of SI joints and pubic symphysis

Begins in 10-12 weeks

Question 23

What effect does the release of progesterone during pregnancy have on the thoracic cage?

Answer 23

Circumference increases 5-7 cm

Subcostal angle widens 68-103 degrees

Diaphragm pushed superiorly 4cm

Increased tidal volume 30-40%

Question 24

Indications for OMT during pregnancy

Answer 24

SD

Scoliosis or other pregnancy-associated structural dysfunction

Edema, congestion, or other pregnancy-associated conditions amenable to OMT

Question 25

Relative contraindications to OMT during pregnancy

Answer 25

Premature preterm rupture of membranes Premature labor (change in cervix)

Question 26

Absolute contraindications to OMT during pregnancy

Answer 26

Undiagnosed vaginal bleeding Prolapsed umbilical cord Placental abruption Ectopic pregnancy Placenta previa Threatened/incomplete abortion Severe preeclampsia/eclampsia

Question 27

Goals of pregnancy OMT

Answer 27

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%)

Question 28

What areas must be treated for hyperemesis gravidarum?

Answer 28

C2 T5-9

Question 29

Round ligament pain in the 2nd trimester presents how?

Answer 29

Sharp, stabbing in low abdomen or groin

Question 30

What trimester is Carpal Tunnel syndrome most common?

Answer 30

2nd trimester

Question 31

How is diagnosis of pubic symphysis rupture made?

Answer 31

Separation \>1cm ## Footnote *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*

Question 32

How long after delivery should you screen for somatic dysfunction?

Answer 32

Day 1 post-partum Tx prior to resolution of homronal change on ligamentous structures

Question 33

How long post-partum should the second OSE occur?

Answer 33

4 weeks postpartum (2nd visit)

Question 34

What are the ACOG recommendations for exercise in pregnancy?

Answer 34

30 min or more, moderate exercise, most/all days of the week

Question 35

Should the valsalva maneuver be avoided in pregnancy exercise?

Answer 35

Yes, increased BP and intraabdominal pressure may decrease uteroplacental blood flow

Question 36

Exercise in pregnancy should be avoided at what altitude if pt doesn't already live at high altitude?

Answer 36

6000 feet

Question 37

Relative contraindications to aerobic exercise in pregnancy

Answer 37

**Intrauterine growth restriction in current pregnancy** **Unevaluated maternal cardiac arrhythmia** Poorly controlled type 1 DM Extreme **underweight (BMI \<12)**

Question 38

Absolute contraindications to aerobic exercise in pregnancy

Answer 38

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

Question 39

The PROMOTE study by Dr. Hensel aimed to use OMT on women in what trimester to reduce LBP?

Answer 39

3rd trimester