OMM for the Pregnant Patient Flashcards
What are the 3 general things that contribute to somatic dysfunction in pregnant patients?
- Biomechanics
- Body fluid and circulation
- Hormones
What is the effect of pregnancy in patients with Scoliosiis?
May increase pain and premature birth
– does not affect curvature
What is the effect of pregnancy on RA patients?
Improved symptoms during pregnancy
What is the effect of pregnancy on patients with Ankylosing Spondylitis and why?
Worsens symptoms
–> increased stress on joints
Mechanical stress on the body causes what main symptom in pregnancy?
Low back pain
Describe the structural changes that occur to the body with pregnancy
Anterior tilt of the pelvis
- -> Lordosis of the lower back
- -> Kyphosis of the upper back
What does the structural changes in the body cause to occur to the vertebral facets and IV discs?
Increased stress on the facets
Increased shear stress on the discs
With the postural changes that occur to the body with pregnancy, what happens to the ligaments/muscles?
Overworked/more laxity trying to maintain balance and posture
If a pregnant patient presents with low back pain, what other symptoms require further evalulation?
Neurological symptoms:
- changes in sensation, strength, DTRs, UI
- pain with cough, sneezing, valsalva
What are the common etiologies of low back pain in pregnant women?
Peripheral nerve compression, radiculopathy
Postural/muscle weakness
Will low back pain of pregnancy resolve?
Most resolve postpartum!!
What causes the lymphatic stress with pregnancy?
Increased interstitial fluid
Increased estrogen, progesterone, adrenal hormones that cause fluid retention
In relation to the lymphatics with pregnancy, there is reduced fluid removal. What does that cause to be increased and decreased? (3 each)
Increased: CO, blood and plasma volume
Decreased: vascular resistance, BP, hematocrit
In relation to the lymphatics with pregnancy, there is reduced fluid removal. What does that cause to be increased and decreased? (3 each)
Increased: CO, blood and plasma volume
Decreased: vascular resistance, BP, hematocrit
With lymphatic and venous stress, there is more fluid in the tissues than can be ____
Removed
What can the uterus compress especially if the mother is lying supine?
IVC compressed
What position should a pregnant lady lay in order to avoid compression of the IVC?
Left lateral recumbant
If the IVC is compressed, what are the effects of that?
Decreased preload, CO and vascular resistance
Especially in the 3rd trimester, what symptoms will arise due to decreased venous flow?
Varicosities
Hemorrhoids
If there is decreased venous flow, what can that cause to occur?
Hypoxia of neural and vertebral tissues
=> delayed low back pain
If a pregnant lady presents with delayed low back pain, what occurred?
Decreased venous flow
–> hypoxia of neural and vertebral tissues
=> Delayed low back pain
What hormone is elevated in the first trimester that contributes to the laxity of joints and pain?
Relaxin
What hormone aids in changing the thoracic cage mechanics and causes more fluid retention?
Progesterone
What are some basic indications for OMM in the pregnant patient?
- SD
- Scoliosis and other structural conditions
- Edema/congestion
