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
What are the 2 relative contraindications for OMM in a pregnant woman?
Premature labor
Premature rupture of membranes
What are the 5 ABSOLUTE contraindications for OMM in a pregnant woman?
- Umbilical cord prolapse
- Vaginal bleeding
- Placenta previa
- Placental abruption
- Pre-eclampsia
What are the 5 absolute contraindications for OMM in a pregnant woman?
- Umbilical cord prolapse
- Vaginal bleeding
- Placenta previa
- Placental abruption
- Pre-eclampsia
What decreases the risk of the mother having low back pain with pregnancy?
Established exercise routine BEFORE pregnancy
What does OMM allow for the patient’s body to do?
Save energy
Better compensate the changes occurring
In the 1st trimester, if a pregnant patient presents with Hyperemesis Gravidarum, what levels should you treat?
OA - C2
T5- T9
What SNS and PNS levels correlate to the pelvic organs?
SNS: T10-L2
PNS: S2-S4
What are 2 common conditions that occur during the 2nd trimester?
Constipation
Carpal Tunnel Syndrome
If a pregnant patient presents with constipation, what should you do?
Pelvic diaphragm release
How long can you treat a pregnant patient supine?
Through the 2nd trimester
Why should you avoid the supine position once the patient is into the 3rd trimester?
Hypotensive
During the 3rd trimester, the patient will have more MSK complaints, edema and fluid retention. What 2 conditions should you NOT do?
CV4
Pedal pump
When addressing edema in a 3rd trimester patient, what condition should you NOT do?
Pedal pump
– other pumps fine
Why should you avoid CV4 with a 3rd trimester patient?
May induce uterine contractions
You may also want to decrease the SNS output during the 3rd trimester. What are the levels of GI, ovaries/adrenal/uterus, bladder?
GI = T5 - T9 Ovaries/adrenal/uterus = T10 - L2 Bladder = S2 - S4
With labor, what techniques are most indicated?
ST or MFR – just guide
What is a potential birth complication that results in a palpable gap, crack, waddle and pain of the patient?
Rupture of the pubic symphysis
With postpartum OMT, when should it start?
First visit = First day postpartum
With the first postpartum OMT, why do you want to treat that early?
Treat prior to return of Relaxin to normal levels benefits the ligaments
When is the 2nd postpartum visit?
4 weeks postpartum
Besides the usual contraindications, what are 3 contraindications against exercising during pregnancy?
Intrauterine growth restriction
Multiple gestations at risk for preterm birth
Unevaluated maternal cardiac arrhythmia
