OB-GYN

Question 1

Existing stresses (gravity) aggravated by pregnancy

Answer 1

Aggravates AP postural curves

Fascial torsions

Question 2

Why do pregnant patients get congested?

Answer 2

More blood gets to the tissues than can be removed by venous system
Abdominal diaphragm is an extrinsic pump –it has a decreased efficiency due to the changes induced by the spinal curve change

Question 3

Somatic dysfunction in pregnancy can increase energy requirements up to

Answer 3

300%

Question 4

HorMechanical effects of pregnancy hormones

Answer 4

Weakening of muscle and supporting ligaments

Increased fluid retention

Question 5

2 mechanical effects of pregnancy

Answer 5

Changed center of gravity

Organ hypertrophy

Question 6

Physiological stresses of pregnancy

Answer 6

Increased ISF
Increased circulating volume to support the hypertrophy of the organs
Increased fluid retention mediated by estrogen and adrenal hormones

Question 7

Venous stresses of pregnancy

Answer 7

Congestion of CNS
Changes in volume of organs (increase)
Increase cavity pressures
Relative reversal of venous blood flow (valveless system in CNS)

Question 8

Relative CI for OMT during pregnancy (5)

Answer 8

Toxemia of pregnancy (decreased seizure threshold)
PROM
Premature labor
Abruptio placenta
Ectopic pregnancies

Question 9

2 osteopathic principles addressed in OMT of pregnancy

Answer 9

The body has self-regulatory mechanisms which will provide optimal compensation for the stresses of pregnancy if they are free to work efficiently.
Distinctive osteopathic care is based upon the belief and the clinical observations that within the body unit, structure and function are reciprocally interrelated and interwoven with optimum homeostasis.

Question 10

Structural Stage (0-28 weeks) results in

Answer 10

increased fat storage
growth of the uterus
hypertrophy of the breast and other tissues
blood volume expansion
shift on center of gravity
pelvis rocks forward
increased lumbar lordosis
compensatory thoracic kyphosis will develop in cervical/suboccipital area
muscles and ligaments more vulnerable to mechanical stresses

Question 11

Tx of structural stage

Answer 11

Evaluate initial status
past trauma, current problems
manipulation based on exam
addresses pre-existing conditions and body changes related to pregnancy

Question 12

Congestive stage (28-36 weeks)

Answer 12

more fluid accumulates in the tissues than can be effectively removed by the venous and lymphatic systems
congestion is mechanical/hormonal/biological
associated with decreased oxygenation and cellular nutrition
expanding uterus
-“ball valve” between veins of legs and vena cava
-hypotensive when supine
-limits chest volume
-diaphragm must work harder

Question 13

Tx o congestive stage

Answer 13

treat common compensatory pattern to maintain freedom of the fascial pathways and thus improve lymphatic drainage
maintain symmetry of thoracic inlet
relax thoracolumbar junction (diaphragm attachment)
diaphragm doming

Question 14

Preparatory stage (36 weeks-delivery)

Answer 14

maintain good structural balance and support lymphatic flow
build psychological support for delivery
carefully check the craniosacral mechanism

Question 15

What can help with pain control during labor?

Answer 15

Sacral pressure

Question 16

CV4 is used to

Answer 16

induce uterine contraction or to overcome uterine inertia during labor

Question 17

On the 2nd post-partum day

Answer 17

complete structural examination
all forms of manipulation may be used
soft tissue, muscle energy, indirect, counterstrain, cranial, thrust

Question 18

6 weeks post-partum

Answer 18

May be no structural problems if treated adequately during the pregnancy, labor, and delivery
follow-up for chronic problems