Osteopathic Approach to the OB pt Flashcards
risk factors lower back pain pregnany
multiple prenancy increased maternal age young gravida heavy manual labor previous history of back pain
radicular pain:
what kind of disc problem?
paresthesia where?
name for severe pain with compression sacral plexus
bulging discs not herniated
ilioinguinal and genitofemoral nerve
lightening pain
pelvic inlet
iliopectineal line/pube to sacrum
lymphatic stresses occur when and what are symptoms
3rd trimester
hemorrhoids, vulvar and lower extremity varicosities
loss of balance, back pain, gait change, constipation and gerd in what trimester
3rd
ankylosing spondylitis and pregnancy
aggravated by pregnancy
incereased stress on SI joints
diagnosis of rupture of pubic symphisis
audible crack separation greater than 1 cm acute pain radiating to back and or thighs palbale gap with edema waddling gait
WAASP
home exercise during first trimester?
yes
first visit post partum
day 2 post partum
screen for SD
treat
evaluate sacral mechanics
relative contraindications
premature rupture of membranes (PROM)
premature labor
treatment 3rd trimester
address edema
viscerosomatics GI: T5-9
adrenal and ovaries: T10-L2
avoid cranial
mid pelvis
strucutes btwn inlet and outlet
scoliosis and pregnancy
more pain and risk of premature birth
curvatures do not increase
3 general areas of somatic dysfunction in OB pt
change in maternal structure and biomechanics
body fluid circulation
hormonal changes
first trimester what do you do on visits
0-13 weeks
complete history
physical
- look for dysfunction
- postural exam
- thoracic inlet/cage
- pelvis and sacrum
- CRI (pt may die without checking CRI)
who did the study on pain reduction with omt
what other study
dr. hensel
hemodynamic control
focuses on using MS system to affect arterial, venous, and lymph flow
respiratory model
indications of omt in prego lady
somatic dysfunction
scoliosis
edema
treatment first trimester:
hyperemesis gravidarum
treat C2 and T5-9
prep stage last 4 weeks
weekly visits
structural, lymphatic, psychological balance
evaluate pelvic diameters
rheumatoid arthritis and pregnancy
improved symptoms
from conception to 6 weeks post partum (cortisol and glycoprotein increase)
warning signs to terminate exercise
vaginal bleed dyspnea before exertion dizziness HA chest pain muscle weakness calf pain or swelling perterm labor decreased fetal movement amniotic fluid leakage
model of osteopathic treatment: viscerosomatics
neurological
does mechanical stress decrease reflexes or cause muscle weakness
no
outlet
pubes, ischeial tuberosity, coccyx
venous stress and pain
increased venous return at night results in back pain 1-2 hours after mom falls asleep
direct pressure on vena cava from fetus/uterus
leads to hypoxia of neural and vertebral tissues = pain
pregnancy affect on paraspinal muscles?
on abdominal muscles?
shortened paraspinal
overstretched abdominal
physiological stresses in preganancy
increased fluid (6.5 L)
increase estrogen, progesterone, and adrenal hormones contribute to this
sacral mechanics post partum
anterior sacral base may be there (cranial extension)
assocaited with fatigue, depression, low energy
mothers center of gravity shifts ____
forward
treatment 14-26 weeks
fascial release
treat sacrum and pelvis
carpal tunnel syndrome
5 stressors on body caused by pregancy
mechanical stress physiological stress lymphatic stress venous stress hormonal stress
hormonal stresses: relaxin
widening and mobility of SI joints and pubic symphis
can cause low back pain
increased or decreased lordosis of lumbar spine with pregnancy
increased
progesterone promotes what
fluid retention
treatment rupture of pubic symphysis
bed rest
omm
absolute contraindications
anything that harms mom or fetus: laundry list you can look up if you want
mnemonic is PUP PETS
increased or decreased kyphosis of thoracic spine with pregnancy
increased
mechanical stress in pregnancy from what
postural change
excessive connective tissue stretch and microtrauma (SI)
posterior pelvic pain that radiates posterior thigh to knee
venous stresses can cause what
increased abdominal cavity pressure
also CNS congestion: HA, nausea, light headed
second trimester (14-26 wks) what SD would you find
evaluate for somatic dysfunction
anterior pelvis (forward torsion)
increased pelvic tilt
increase lumbar lordosis
compensatory increase of thoracic kyphosis
increase in interstitial fluids and uterus size in what trimester
3rd
second post partum visit is when
6 weeks post partum
SD
future contraception
f/u chronic problems
