Obstetric Lab Flashcards
OMT in Obstetrics
Allow for ease of adaptation to the change in forces of the gravid patient, allowing for efficient changes in posture and mechanics
Evaluate and treat the obstetrical patient early, throughout, and after her pregnancy to help her body accommodate the structural and systemic changes that will occur
Incorporate OSE and treatment into regular obstetrical visits
contraindications for OMT in preggers
Undiagnosed vaginal bleeding Threatened or incomplete abortion Ectopic pregnancy Placenta previa (painless bleeding) Placental abruption (painful bleeding) Premature rupture of membranes (preterm) Preterm labor -- Relative contraindication Prolapsed umbilical cord Severe preeclampsia/eclampsia -- Low seizure threshold Other surgical or medical emergencies
PROMOTE study
Pregnancy Research on Osteopathic Manipulation Optimizing Treatment Effects
Prospective, randomized, placebo-controlled, and blinded clinical trial
Evaluated efficacy of OMT protocol for pain during 3rd trimester pregnancy
Protocol based on physiologic theory, structure and function interrelationship
12 well-defined, standardized OMT techniques
20-minute protocol
Refer to posted article for physiologic theory behind techniques***
PROMOTE Protocol
Seated forward-leaning thoracic spine articulation
Supine cervical soft tissue
Occipitoatlantal decompression
Thoracic inlet myofascial release
Lateral recumbent scapulothoracic soft tissue (NEW)
Lateral recumbent lumbosacral soft tissue (NEW)
Abdominal diaphragm myofascial release
Pelvic diaphragm myofascial release (NEW)
Sacroiliac articulation (NEW)
Frog-leg sacral release (NEW)
Anterior or posterior innominate muscle energy
Pubic symphysis decompression
Compression of the fourth ventricle (will not cover today)
Seated Forward-leaning Thoracic Spine Articulation: REVIEW
Physician controls upper extremity and thorax
Physician’s knee blocks against patient’s knee to stabilize the participant on the table
Contact on transverse process or costotransverse junction
Patient is drawn forward to restrictive barrier
Low-velocity, medium-amplitude springing is applied until release is felt
Component of sidebending or rotation may be added
Focus may be on rib or segmental motion
Reassess
Supine CervicalSoft Tissue Kneading: REVIEW
Contact medial aspect of cervical paraspinal muscles
Draw anteriorly in a kneading fashion
Continue until relaxation of tissues
Reassess
Occipitoatlantal Decompression: REVIEW
Contact is on occiput as close to condyles as possible
Tension is applied toward the patient’s orbits
Traction is created between the fingers by moving the elbows slightly medially
Respiratory assistance may be used to enhance release
Position is held until release is felt and motion is improved, at least 20-30 seconds
Reassess
Thoracic Inlet MFR: REVIEW
Anterior contact is across sternoclavicular junction and ribs 1 and 2
Posterior contact is T1-2 and costovertebral junction
Assess rotation with sidebending and flexion/extension
Use all 3 planes to approach barrier (direct) or position of ease (indirect) to point of balance
Hold 20-60s until tissue creep indicates a release of tissue tension
Reassess
Lateral Recumbent ScapulothoracicSoft Tissue: NEW
Part 1:
Contact is on the superior and inferior medial angles of the scapula with the soft tissue
Patient’s arm over the physician’s caudad arm
The cephalad hand initiates a circular motion into the shoulder, and the scapula is carried laterally in a rhythmical fashion to release muscular attachment
The caudad hand contacts the rhomboids and paraspinal muscles along the medial border of the scapula
Fascial restrictions are then assessed in superior/inferior, medial/lateral, and rotary motions
Scapula is taken either directly or indirectly to balance point and held for 20-60 s or until release is palpated
Recheck
Part 2:
Patient’s arm is moved to drape over physician’s cephalad arm
Contact is broad over the superior aspect of the shoulder, with the caudad hand’s thenar eminence engaged in the posterior axillary fold
Tissue texture is assessed
Compressive force is applied into the axillary and subscapular tissues in a rhythmic fashion until a change in tissue texture is felt
Recheck
Lateral Recumbent Lumbosacral Soft Tissue: NEW
Physician’s arms are braced on the patient’s axilla and iliac crest
Contact is medial aspect of lumbar (up to lower thoracic) paraspinal muscles
Three motions are then applied rhythmically:
Physician’s arms carry patient’s arms and ilia apart to stretch and sidebend the lumbar area
Physician’s arms twist to push the patient’s shoulder posteriorly and her iliac crest anteriorly
Lateral motion is applied with hands to “bowstring” the muscles
Repeat to softening of muscles throughout the lumbar region
Recheck
Abdominal Diaphragm Myofascial Release: REVIEW
Contact either with fingers spread over lower ribs laterally or anteroposteriorly diaphragm MFR with hands at subxiphoid and thoracolumbar junction
Assess rotation with sidebending and flexion/extension
Use all 3 planes to approach barrier (direct) or position of ease (indirect)
Add respiratory cooperation to assist in release
Hold 20-60 s or until release is felt
Recheck
Pelvic Diaphragm MFR: NEW
Posterior contact is on sacral apex and coccyx with fingers toward contralateral ischial tuberosity
Anterior contact is across and slightly above the pubic symphysis
Assess rotation with sidebending and flexion/extension
Use all three planes to approach barrier (direct) or position of ease (indirect)
Hold until release is felt
Reassess
Sacroiliac Articulation: NEW
Use pelvic compression test (ASIS compression test)
Contact is on the patient’s flexed knee and hip with mild compression to engage the femur into the acetabulum
The hip is externally rotated and circumducted into a straightened (extended) position, maintaining compression
Then the hip is internally rotated and circumducted into a straightened (extended) position, maintaining compression
Repeat 4-5 times until motion improves
Repeat on opposite side
Reassess
Frog-leg Sacral Release: NEW
Contact is on the sacrum with fingers at the base and palm at apex
Patient’s hips and knees are flexed with feet together
Sacrum is taken to a point of ligamentous balance with respiratory assistance
Ask patient to hold in inhalation if sacral base is more posterior/ counternutated
Ask patient to hold in exhalation if sacral base is more anterior/ nutated
As patient holds breath in most useful phase, she lets her knees fall to the sides and straightens her legs, inferior traction is applied to the sacrum
Repeat 3-5 times, until motion is significantly more symmetrical
Reassess
Innominate Muscle Energy: REVIEW
Posterior or Anterior Innominate Muscle Energy
Pubic Symphysis Decompression (“Shotgun Pubes”)
