OB patient, jons cox Flashcards
What occurs in pregnancy to arterial venous system
venous system can not keep up with excess arterial supply so lymphatics play crucial role
hyperSAN tone causes what
constriction lymph flow
dysfunction in MSK system can increase E requirement by how much
300%
When is OMT avoided in pregnancy
PROM, premature labor, abruptio placenta, ectopic pregnancies
ddx Low back pain in OB patient
biomechanical instability lumbosacral plexopathy neuropathy spinal facet spondylolisthesis congenital disorders discogenic trauma
factors that contribute to low back pain in OB
multifetal gestation spinal curves (scoliosis) leg length inequality weight gain ligamentous laxity somatic dysfunction
most common cause low back pain in pregnacy
biomechanical instability
postural effects of pregnancy
increased anterior pelvic tilt
lumbar spin lordosis
thoracic spin kyphosis
compensatory posture in pregnancy
shoulders back head forward sacrum nutates, ribs flare feet flatten stance widens in ambulation
what can occur with increased lumbar lordosis
increased load on facets
shearing intervertebral disc spaces
posterior paraspinal muscles shorten and unbalanced by overstretched abdominals
psoas mm shorten
what can occur with increased anterior elvic rotation
strain lumbar and SI joints
relaxin and Estrogen change pubic symphysis how
widens begining 10th-12th week
can refer to low back and medial thighs
which area is at hgiher risk for spondylolisthesis in women who have had children before
L4-5
What do you need to rule out for complaint of hip pain
transient osteoporisis and avascular necrosis of femoral head
clinical setting of transient osteoporisis
rare. 3rd trimester
pain increases with weightbearing
limited ROM
sudden or insidious
Tx for transient osteoporosis of hip
reduced weightbearing (bedrest or wheelchair)
Dx for transient osteoporosis of hip
XR
MRII
pelvic US
Sx avascular necrosis of femoral head
pain in hip, pelvis, groin with weight bearing in 3rd trimester
may radiate to knee thigh or back
Dx avascular necrosis femoral head
hip ROM
Tx avascular necrosis of femoral head
reduced weightbearing to allow revascularization
women who have lumbo pelvic pain in pregnancy are at icnreased risk for what
postpartum depression
what is meralgia paresthetica
burning and numbness at waistband and lateral thigh
Tx LBP in pregnant women
avoid excess heat nurtion- vit D, Ca, fish oil, Mg exercise: gentle, normal temp maternity back supports and sacroiliac support accupuncture OMT
indications for OMT in pregnancy
SD present
scoliosis or other structural condition
edema, congestion or other pregnancy assoc condition amenable to OMT
CI to OMT in pregnancy women
unDx vaginal bleeding threatened abortion ectopic placenta previa placental abruption PROM preterm labor prolapsed umbilical cord severe preeclampsia and eclampsia
Stages of Tx in preganncy
structural
congestive
preparatory
Recovery and maintenance
what is the early structural stage of pregnancy
0-12 weeks
what do you examine in early structural stage
postural thoracic inlet fascia thoracic cage pelvis and sacrum viscerosomatic chapmans CRI
what are the sympathetics to uterus
T10-L2
parasympathetics to cervi
S2-S4
anterior chapman stomach hyeracidity
5th intercostal space mid clavicular line to L of sternum
anterior chapman liver/gallbladder
6th intercostal space from mid clavicular line to R of sternum
posterior chapman stomach hyperacidity
intertransverse space, midway spinous and transverse processes
between 5th and 6th vertebrae on L
posterior chapman liver gallbladder
intertransverse space midway spinous and transverse processes
between 6th and 7th on R
ant chapman ovaries
round ligaments from upper border pubic bone to attachment of mm on lower border
ant chapman uterus
laterally on sides pubic symphysis
ant chapman broad ligament
trochanter down to outer aspect femur within 2 “ knee joint
post chapman ovaries
intertransverse space between 9th and 10th vertebrae and 10th adn 11th vertebrae
post chapman uterus
tip of TP or L5 toward iliac crest
post chapman broad ligament
between PSIS and spinous process L5
ant chapman fallopian tube
midway from acetabelum and sciatic notch
chapman for spastic constipation or colitis
TP of L2, TP of L4 and traingular area reaching across to iliac crest
Tx areas for hyperemesis gravidarum
C2 and T5-9
expect what SD in late structual stage
pelvis rotated anterior
increase in lumbar lordosis
compensatoy thoracic kyphosis
Tx for late structural stage
fascial release (direct/indirect) anterior counterstrain points L3-5 may help round ligament pain Tx sacrum and pelvis with any modality comfortable to patient
spinal changes in mid to late pregnancy
increased lumbar lordosis
increased thoracic kyphosis
increased cervical lordosis
when is the congestive stage of pregnancy
28-36 weeks
what occurs in congestive stage
gravitational effects on the uterus accentuate abdominal fascial drag on inguinal tissues
increase interstitial fluids
increase uterus size
what cuases edema in congestive stage
the increased uterus can become a vlave to the vv of lower extremity
some some get hypotensice if supine
common complaints during congestive stage
loss of balance, back pain, gait changes
GERD, constipation, hemorrhoids, leg edema
techniques for congestive stage
myofascial, soft tissue, effleurage, petrissage
viscerosomatics for upper GI
T5-9
viscersomatics to adrenal, ovaries and uterus
T10-L2
why avoid cranial Tx in congestive stage
may induce uterine contractions
Tx what areas in congestive stage
sacral, lumbar, thoracic, cervical
what typ eof lymph in congestive stage
pectroal traction
how do you treat thoacolumbar jucntion in congestive stage
diaphragm and vertebrae
goal of preparatory stage of pragnangcy
maintain good structural balance and lymphatic flow
how do you influence contractions via sympathetics
work thoracic spine
what will Tx sacral base do in labro
influence cervical dilation via parasypathetics
what can be used to influence uterine contractions
CV4
when do start recorvery and maintenance stage
post partum day 2
goal of first recovery and maintenance visit
screen SD
assist body to return to normal state
evaluate sacrum
a bilateral flexed sacrum and extended L5 is assoc with what Sx
fatigue, depression and low energy
when is the final visit for recovery and maintenance
6 weeks post partum
plan for final recovery and maintenance visit
screen SD
review strucutal changes
advise follow up for chronic problems
