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ECOS 4 > OMM for the Pregnant Patient > Flashcards

OMM for the Pregnant Patient Flashcards

1
Q

What are the 3 general things that contribute to somatic dysfunction in pregnant patients?

A
  1. Biomechanics
  2. Body fluid and circulation
  3. Hormones
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2
Q

What is the effect of pregnancy in patients with Scoliosiis?

A

May increase pain and premature birth

– does not affect curvature

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3
Q

What is the effect of pregnancy on RA patients?

A

Improved symptoms during pregnancy

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4
Q

What is the effect of pregnancy on patients with Ankylosing Spondylitis and why?

A

Worsens symptoms

–> increased stress on joints

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5
Q

Mechanical stress on the body causes what main symptom in pregnancy?

A

Low back pain

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6
Q

Describe the structural changes that occur to the body with pregnancy

A

Anterior tilt of the pelvis

  • -> Lordosis of the lower back
  • -> Kyphosis of the upper back
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7
Q

What does the structural changes in the body cause to occur to the vertebral facets and IV discs?

A

Increased stress on the facets

Increased shear stress on the discs

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8
Q

With the postural changes that occur to the body with pregnancy, what happens to the ligaments/muscles?

A

Overworked/more laxity trying to maintain balance and posture

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9
Q

If a pregnant patient presents with low back pain, what other symptoms require further evalulation?

A

Neurological symptoms:

  • changes in sensation, strength, DTRs, UI
  • pain with cough, sneezing, valsalva
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10
Q

What are the common etiologies of low back pain in pregnant women?

A

Peripheral nerve compression, radiculopathy

Postural/muscle weakness

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11
Q

Will low back pain of pregnancy resolve?

A

Most resolve postpartum!!

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12
Q

What causes the lymphatic stress with pregnancy?

A

Increased interstitial fluid

Increased estrogen, progesterone, adrenal hormones that cause fluid retention

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13
Q

In relation to the lymphatics with pregnancy, there is reduced fluid removal. What does that cause to be increased and decreased? (3 each)

A

Increased: CO, blood and plasma volume
Decreased: vascular resistance, BP, hematocrit

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14
Q

In relation to the lymphatics with pregnancy, there is reduced fluid removal. What does that cause to be increased and decreased? (3 each)

A

Increased: CO, blood and plasma volume
Decreased: vascular resistance, BP, hematocrit

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15
Q

With lymphatic and venous stress, there is more fluid in the tissues than can be ____

A

Removed

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16
Q

What can the uterus compress especially if the mother is lying supine?

A

IVC compressed

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17
Q

What position should a pregnant lady lay in order to avoid compression of the IVC?

A

Left lateral recumbant

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18
Q

If the IVC is compressed, what are the effects of that?

A

Decreased preload, CO and vascular resistance

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19
Q

Especially in the 3rd trimester, what symptoms will arise due to decreased venous flow?

A

Varicosities

Hemorrhoids

20
Q

If there is decreased venous flow, what can that cause to occur?

A

Hypoxia of neural and vertebral tissues

=> delayed low back pain

21
Q

If a pregnant lady presents with delayed low back pain, what occurred?

A

Decreased venous flow
–> hypoxia of neural and vertebral tissues
=> Delayed low back pain

22
Q

What hormone is elevated in the first trimester that contributes to the laxity of joints and pain?

A

Relaxin

23
Q

What hormone aids in changing the thoracic cage mechanics and causes more fluid retention?

A

Progesterone

24
Q

What are some basic indications for OMM in the pregnant patient?

A
  • SD
  • Scoliosis and other structural conditions
  • Edema/congestion
25
Q

What are the 2 relative contraindications for OMM in a pregnant woman?

A

Premature labor

Premature rupture of membranes

26
Q

What are the 5 ABSOLUTE contraindications for OMM in a pregnant woman?

A
  • Umbilical cord prolapse
  • Vaginal bleeding
  • Placenta previa
  • Placental abruption
  • Pre-eclampsia
27
Q

What are the 5 absolute contraindications for OMM in a pregnant woman?

A
  • Umbilical cord prolapse
  • Vaginal bleeding
  • Placenta previa
  • Placental abruption
  • Pre-eclampsia
28
Q

What decreases the risk of the mother having low back pain with pregnancy?

A

Established exercise routine BEFORE pregnancy

29
Q

What does OMM allow for the patient’s body to do?

A

Save energy

Better compensate the changes occurring

30
Q

In the 1st trimester, if a pregnant patient presents with Hyperemesis Gravidarum, what levels should you treat?

A

OA - C2

T5- T9

31
Q

What SNS and PNS levels correlate to the pelvic organs?

A

SNS: T10-L2
PNS: S2-S4

32
Q

What are 2 common conditions that occur during the 2nd trimester?

A

Constipation

Carpal Tunnel Syndrome

33
Q

If a pregnant patient presents with constipation, what should you do?

A

Pelvic diaphragm release

34
Q

How long can you treat a pregnant patient supine?

A

Through the 2nd trimester

35
Q

Why should you avoid the supine position once the patient is into the 3rd trimester?

A

Hypotensive

36
Q

During the 3rd trimester, the patient will have more MSK complaints, edema and fluid retention. What 2 conditions should you NOT do?

A

CV4

Pedal pump

37
Q

When addressing edema in a 3rd trimester patient, what condition should you NOT do?

A

Pedal pump

– other pumps fine

38
Q

Why should you avoid CV4 with a 3rd trimester patient?

A

May induce uterine contractions

39
Q

You may also want to decrease the SNS output during the 3rd trimester. What are the levels of GI, ovaries/adrenal/uterus, bladder?

A 
GI = T5 - T9
Ovaries/adrenal/uterus = T10 - L2
Bladder = S2 - S4
40
Q

With labor, what techniques are most indicated?

A

ST or MFR – just guide

41
Q

What is a potential birth complication that results in a palpable gap, crack, waddle and pain of the patient?

A

Rupture of the pubic symphysis

42
Q

With postpartum OMT, when should it start?

A

First visit = First day postpartum

43
Q

With the first postpartum OMT, why do you want to treat that early?

A

Treat prior to return of Relaxin to normal levels benefits the ligaments

44
Q

When is the 2nd postpartum visit?

A

4 weeks postpartum

45
Q

Besides the usual contraindications, what are 3 contraindications against exercising during pregnancy?

A

Intrauterine growth restriction
Multiple gestations at risk for preterm birth
Unevaluated maternal cardiac arrhythmia

ECOS 4 (13 decks)

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