Osteopathic Approach to OB

Question 1

What are the 3 main changes that influence somatic dysfunction in pregnant patients?

Answer 1

Structure and biomechanics
Body fluid/circulation
Hormones

Question 2

How is the spine changed during pregnancy?

Answer 2

exaggerated lordosis of the lower back

Question 3

Answer 3

B. decreased ROM of the lumbar spine

Question 4

What are some “red flag” symptoms that warrant further evaluation or referral?

Answer 4

Severe pain that interferes with function or persistent at night
Increased pain with cough, sneeze, to valsalva
Neurological deficits

Question 5

What should you consider if a pregnant patient complains of “lightening pains”?

Answer 5

peripheral nerve compression; presents as paresthesias in ilioinguinal and genitofemoral nerve distribution

Question 6

Hemodynamic changes in pregnancy?

Answer 6

Increase in interstitial fluids! (pregnancy hormones promote fluid retention)

Question 7

What is the ideal position for a pregnancy to lay in?

Answer 7

left lateral recumbent

Question 8

Answer 8

D. Recommend patient sleeps in left lateral recumbent positioning and apply pressure to the area; picture displays vulvar varicosities)

Question 9

Which trimester is a pregnant expected to experience the most symptoms?

Answer 9

3rd trimester; hemorrhoids, vulvar, and lower extremity varicosities due to sluggish venous return

Question 10

Answer 10

C. Stagnant hypoxia of neutral and vertebral tissues at night

Question 11

Relaxin

Answer 11

elevated during the 1st trimester and declines early in the 2nd trimester; causes widening and mobility of the SI joints and pubic symphysis; higher in women incapacitated by LBP

Question 12

Relative contraindications to OMT during pregnancy?

Answer 12

Premature rupture of membranes
Premature labor (before 37 weeks)

Question 13

Absolute contraindications to OMT during pregnancy?

Answer 13

undiagnosed vaginal bleeding
prolapsed umbilical cord
placental abruption
ectopic pregnancy
placenta previa
abortion
preeclampsia

Question 14

Treatment for hyperemesis gravidarum during the 1st trimester?

Answer 14

treat areas OA-C2 and T5-9

Question 15

Why should you avoid CV4 in the 3rd trimester?

Answer 15

can provoke uterine contractions

Question 16

When is the soonest you can start postpartum OMT?

Answer 16

can start on postpatum day 1; first visit
second visit is 4 weeks postpartum

Question 17

ACOG recommendations on exercise during pregnancy?

Answer 17

30 mins or more of moderate exercise most or all days of the week

Question 18

What are two relative contraindications to exercise during pregnancy?

Answer 18

Intrauterine Growth Restriction (IUGR) in current pregnancy and Unevaluated maternal cardiac arrhythmia