Obstetrics Flashcards
Screening Questions Pregnant patient
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?
Screening Questions Postpartum patient
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?
How you do position the pregnant patient?
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
Prenatal depression
increase risk of premature birth
possible implications of elevated cortisol levels
Postpartum depression
can affect cognitive development of child
Threaten survival of child
Edinburgh postnatal depression scale
Score 10 or higher is positive
does not screen other conditions (anxiety, phobia, personality disorder)
General DI disorders
nauseam and vomiting
GERD - esophageal reflux
Hyperemesis gravidarum
Severe nausea vomiting
weight loss, electrolyte disturbance
Gall bladder
mimics MSK symptoms/paon
R UQ/Shoulder/scap pain
Thoracic region
Constipation, Motilitu
Discomfort, abdominal bloating
Strain in BM = pelvic floor dysfunction, organ prolapse, hemorrhoids
What are pregnancy urogenital disorders?
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)
Pregnancy Endocrine disorders
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
Supine Hypotension syndrome
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
Cardiovascular disorders
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
LBP
High prevalence, predominantly mechanical
Screen for kidney infection
SI joint pain
direction postural pressure in low back/SI region
Sharp, located in sacral/buttock region
May refer to LE/knee/foot
Sacrolititis
Inflammation of one/both SI joints
SI joint stretch = stress/inflammation
Secondary to UTI
Pubic symphysis pathology
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
Thoracic spine,rib dysfunction
Pain from low rib torsion
3rd trimester
Assess in sitting or sidelying
may persist post parpartum
Headaches
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
Diastasis recti
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
