OB pt Flashcards
What three factors influence SD in pregnant pts?
- change in maternal structure and biomechanics
- body fluid circulation (lymph and venous)
- hormonal changes
How does pregnancy affect pts with Scoliosis? RA? Ankylosing Spondylitis?
a. more pain, premature birth
b. improved sx
c. aggravated
How does forward tilting of the pelvis lead to SD?
What would be alarming to see in LBP of an OB pt?
◦Severe pain that interferes with function, particularly non- positional persistent pain at night
◦Increased pain w/ cough, sneezing, valsalva
◦Neurological deficits
◦ Weakness, sensory deficits, abnormal reflexes
Why should OB pts sleep left lateral recumbent position?
- when supine, uterus can compress the IVC –> red CO/preload/SVR –> inc HR
- CO is higher when pt is LLR
Why is LBP worse at night?
if they sleep on their back –> uterus compresses IVC –> venous congestion –> Stagnant hypoxia of neural and vertebral tissues at night
What hormone leads to widening and mobility of SI joints and pubic symphysis?
Relaxin
women incapacitated by LBP have higher levels
Relative CIs for OMT in pregnancy
◦Premature preterm rupture of membranes
◦Premature labor
Absolute CIs of OMT in pregnancy
◦Undiagnosed vaginal bleeding
◦Prolapsed umbilical cord
◦Placental abruption
◦Ectopic pregnancy
◦Placenta Previa
◦Threatened or incomplete abortion
◦Severe pre-eclampsia/ eclampsia
How do we approach OMT in pregnant pts with the five model approach?
How do we tx Hyperemesis Gravidarum?
tx areas C2 and T5-9
First trimester 5 model approach
Second trimester 5 model approach
Third trimester 5 model approach
5 model approach for labor
OMT not indicated with C-section
When should you treat SD post partum?
prior to resolution of hormonal changes on ligamentous structures (relaxin effects)
Relative CI to aerobic exercise in pregnancy
◦IUGR in current pregnancy
◦ Unevaluated maternal cardiac arrhythmia
◦ Poorly controlled type 1 DM
◦ Extreme underweight (BMI<12)
Absolute CI to aerobic exercise in pregnancy
◦ Persistent second or third trimester bleeding
◦ Placenta Previa >28 weeks gestation
◦ Premature labor during current pregnancy
◦ Ruptured membranes
◦ Preeclampsia/pregnancy-induced hypertension
◦ Incompetent cervix
◦ Multiple gestation at risk for premature labor (triplets or more)
◦ IUG)
