Obstetrics

Question 1

Screening Questions Pregnant patient

Answer 1

Complications for present pregnancy?

Complications prior pregnancy?

Did present MSK symptoms exist before pregnancy or with prior pregnancies?

Presently experiencing urinary or anal incontinence?

Medications presently taking and what was stopped due to the pregnancy?

Question 2

Screening Questions Postpartum patient

Answer 2

Bed rest during pregnancy?

Type of delivery? Casearean or vaginal birth?

Complications during delivery?

Episiotomy or tears in perineum?

Forces or vacuum extraction?

Incontinence?

Current symptpms?

Question 3

How you do position the pregnant patient?

Answer 3

Exam may need to be altered

Supine hypotension occurs in 10% of women due to the fetus compressing inferior vena cava

Pregnant women have decreased cardiac output while supine resulting in a decrease in uterine blood flow

Prone position AVOIDED for 2nd and 3rd trimester as the fetus extends beyond the brim of pelvis

Question 4

Prenatal depression

Answer 4

increase risk of premature birth

possible implications of elevated cortisol levels

Question 5

Postpartum depression

Answer 5

can affect cognitive development of child

Threaten survival of child

Question 6

Edinburgh postnatal depression scale

Answer 6

Score 10 or higher is positive

does not screen other conditions (anxiety, phobia, personality disorder)

Question 7

General DI disorders

Answer 7

nauseam and vomiting

GERD - esophageal reflux

Question 8

Hyperemesis gravidarum

Answer 8

Severe nausea vomiting

weight loss, electrolyte disturbance

Question 9

Gall bladder

Answer 9

mimics MSK symptoms/paon
R UQ/Shoulder/scap pain
Thoracic region

Question 10

Constipation, Motilitu

Answer 10

Discomfort, abdominal bloating

Strain in BM = pelvic floor dysfunction, organ prolapse, hemorrhoids

Question 11

What are pregnancy urogenital disorders?

Answer 11

UTI - can mimic back/pelvic pain

Acute Cystitis - Bladder inflammation - urinary frequency, burning pain with voiding, suprapubic, sacral pain

Pyelonephritis (kidney infection) - fever nauseam vomiting, costovertebral angle pain

Urinal and anal incontinence - urine/feces leakage, GI gas

Organ prolapse - (slipping) anatomical support dysfunction, uterus, bladder (cystocele), rectum (rectocele)

Question 12

Pregnancy Endocrine disorders

Answer 12

Gestational DM - increased risk of HTN or preeclampsia, may require C section, increase risk of developing type II DM post partum, management - changes to the diet and incorporation of the exercise

CV exercise is more effective than just dietary changes- Upper body exercise recommend due to less trunk stress

Question 13

Supine Hypotension syndrome

Answer 13

Due to fetal pressure on inferior vena cava, Supine reclined or prolonged standing postures, more common in third trimester, relieve by tilting, propping to one side

Question 14

Cardiovascular disorders

Answer 14

HTN

Advanced = preclampsia (20th week of pregnancy)
Due to high BP and protein in urine (trouble filtration)

Eclampsia - onset of seizure activity - persistent headache blurred vision, sensitivity to light, edema, SOB,LBP or abdominal pain

Question 15

LBP

Answer 15

High prevalence, predominantly mechanical

Screen for kidney infection

Question 16

SI joint pain

Answer 16

direction postural pressure in low back/SI region
Sharp, located in sacral/buttock region
May refer to LE/knee/foot

Question 17

Sacrolititis

Answer 17

Inflammation of one/both SI joints
SI joint stretch = stress/inflammation
Secondary to UTI

Question 18

Pubic symphysis pathology

Answer 18

Osteitis Pubis - inflamed due to pressure, late pregnancy

Separation > 10cm after delivery, difficult to WB, walk
Joint stabilization, controlled mobility exercises 6-12 weeks
Possible external brace

Question 19

Thoracic spine,rib dysfunction

Answer 19

Pain from low rib torsion

3rd trimester

Assess in sitting or sidelying

may persist post parpartum

Question 20

Headaches

Answer 20

Migrane - due to increase in estrogen

Tension - postural/mechanical cause, stress induced

Other - ischemic hemmorrhagic stroke, arterial dysfunction

Persistent postpartum - Possible subdural hematoma s/p spinal anesthesia

Question 21

Diastasis recti

Answer 21

2 finger wide separation between rectus abdomins bellies. measured via horizontal palpation w/ curlup,

Linea alba may not return to normal length - converts to linea negra

TA strengthening