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OS Exam #2 > Osteopathic Considerations for the Obstetrical Patient > Flashcards

Osteopathic Considerations for the Obstetrical Patient Flashcards

1
Q

What are 3 general areas of SD in OB pts?

A
  • change in maternal structure and biomechanics
  • Body fluid circulation
  • hormonal changes
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2
Q

What are some changes that take place during preggo?

A
  • center of gravity forward
  • inrceased lumbar lordosis
  • increased thoracic kyphosis
  • shortened paraspinal muscles
  • overstretched abdominal muscles
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3
Q

Effect of preggo on scloliosis?

A
  • curvatures do not increase
  • may develop more pain
  • possible increased risk of premature birth
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4
Q

effect of preggo on RA

A

-improved symptoms actually

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5
Q

Effect of preggo on ankylosing spondylitis

A
  • aggravated by preggo

- due to increased stress on SI joints

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6
Q

What are some etiologies of back pain in preggo?

A
  • postural changes
  • excessive CT stretching and microtrauma (SI region)
  • Posterior pelvic pain
  • Radicular pain
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7
Q

Difference between herniated disc and bulging disc

A
  • herniated has a tear

- bulging does not

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8
Q

where will we find paresthesia’s in a preggo woman?

A
  • ilioinguinal and genitofemoral nerve distribution

- Lightning pains

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9
Q

What are some risk factors for LBP during preggo?

A
  • multiple preggos
  • increaed maternal age
  • young gravida
  • heavy manual labor
  • previous history of low back pain
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10
Q

What happens to a lady’s fluid level during preggo?

A
  • increase 6.5 L over course of preggo
  • increased demand to pelvic organs for metabolic needs
  • also increase in Estrogen, progesterone, and adrenal hormones… promotes fluid retention
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11
Q

What happens to the lymphatic flow during preggo?

A

-decreases

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12
Q

Causes of decreased lymphatic flow

A
  • fascial torsions
  • organ hypertrophy
  • diaphragm restriction
  • most symptoms occur in 3rd trimester
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13
Q

What can we tell a preggo person to do to limit the pressure on her vena cava?

A

-limit the time that she is supine

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14
Q

Why are there venous stresses in a pregnant lady?

A

-more blood gets to the tissues than can be returned or removed by the venous and lymphatic systems… so it backs up

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15
Q

Why might a woman have back pain at night that wakes her up?

A
  • increased venous return at night
  • the dependent edema moves back into vasculature do to osmotic force changes
  • direct pressure on vena cava by uterus/fetus…. decreased venous flow in pelvis
  • develop a stagnate hyyposia of neural and vertebral tissues
  • results in delayed low back pain that awakens the patient
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16
Q

When is relaxin elevated?

A
  • during the first trimester and decline early in second trimester
  • widens and mobilizes the SI joints and pubic symphysis
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17
Q

What do women incapacitated by LBP have higher levels of?

A

-relaxin!

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18
Q

How does progesterone affect a pregnant woman?

A
  • increases the circumfrence of thoracic cage
  • widens subcostal angle
  • pushes diaphragm superiorly
  • increased tidal volume
  • promotes fluid retention….congestion happens
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19
Q

Indications for OMT in OB pt?

A
  • SD
  • Scoliosis or structural condition associated with preggo
  • edema, congestion, or other pregnancy associated condition amendable to OMT
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20
Q

Relative contraindication to OMT for ob pts?

A
  • premature rupture of membranes

- premature labor

21
Q

absolute contraindications to OMT for OB pts?

A
  • undiagnosed vaginal bleeding
  • prolapsed umbilical cord
  • placental abruption
  • ectopic preggo
  • placenta previa
  • threatened or incomplete abortion
  • severe pre-eclampsia/eclampsia….low seizure threshold
22
Q

What are the goals of tx for OB pts OMM

A
  • address all postural stressors

- treat any specific somatic dysfunctions

23
Q

What are the 5 models of osteopathic treatment?

A
  • Biomechanical
  • Neurological
  • Respiratory/circulatory
  • Bioenergy
  • Psychobehavioral
24
Q

When talking about stages of treatment, what do we want to do in the first trimester (0-13 weeks)?

A
  • complete history
  • physical
  • just make sure we know everything to start off with about them
25
Q

What tx do we do in 1st trimester?

A
  • tx any SD’s that are found
  • hyperemesis gravidarum: treat areas C2 and T5-9
  • Home exercise… maintain good ab tone
26
Q

What are ACOG recommendations for Home exercise?

A
  • avoid activityes that could risk falling or abdominal trauma
  • avoid scuba diving
  • 30 minutes or more, moderate exercise, most/all days of the week
27
Q

What are some warning signs to terminate exercise?

A
  • vag bleeding
  • dyspnea prior to exertion
  • dizziness
  • headache
  • chest pain
  • muscle weakness
  • calf pain or swelling
  • preterm labor
  • decreased fetal movement
  • amniotic fluid leakage
28
Q

What doe we do with these pts in the 2nd trimester?

A
  • Monthly visits

- evaluate for SD

29
Q

What can we expect to find in 2nd trimester?

A
  • pelvis rotating anterior about a right/left axis (forward torsion)
  • increased pelvic tilt
  • increase in lumbar lordosis
  • Compensatory increase of thoracic kyphosis: may produce cervical strain
30
Q

What treatments do we do in 2nd trimester (14-26 weeks)?

A
  • fascial release (indirect/direct): good for ab wall pain
  • Tx sacrum and pelvis- use any modality that is comfortable for the patient
  • Carpal Tunnel Syndrome: common in preggo due to edematous state, so just stretch it or something
31
Q

What happens in the 3rd trimester with the pt?

A
  • mechanical and structural changes maximal
  • increased complaints
  • increase in interstitial fluids
  • increase in uterus size
32
Q

What do we do for tx in the 3rd trimester (27-40 weeks)?

A
  • address edema: MFR, ST, lymphatics (eff and petrassage)
  • Viscerosomatics
  • pelvic diaphragm for constipation
33
Q

What do we need to avoid because it can provoke uterine contractions?

A

-Avoid cranial!!!!

34
Q

What are the viscerosomatics for upper GI?

A

-T5-9

-

35
Q

viscerosomatics for adrenal and ovaries?

A

-T10-L2

36
Q

What do we need to do for the preparatory stage (last 4 weeks)?

A
  • evaluate pevic diameters: inlet, mid pelvis, outlet

- anticipate delivery problems

37
Q

What is the inlet?

A

-iliopectineal line/pube to sacrum

38
Q

What is the mid-pelvis

A

-structures beween the inlet and outlet

39
Q

What is the outlet?

A

-pubes, ischial tuberosities, coccyx

40
Q

What do we do for labor?

A
  • evaluate lumbosacral region and pelvis
  • thoracic spine ST may regulate uterine contractions via sympathetics
  • expect df’s in: innominates, sacrum, pubic symphysis
  • women do not tolerate aggressive modalities during labor
41
Q

Diagnosis of rupture of pubic symphysis?

A
  • separation> 1 cm
  • audible crack (jesus)
  • due to wedging effect of head at birth
  • acute pain radiating to back and/or thighs
  • palpable gap wtih local tissue edema
42
Q

What will the gait look like with people who have rupture of pubic symphysis?

A

-waddling gait

43
Q

Tx of rupture of pubic symphysis

A
  • conservative
  • bed rest-lateral recumbent
  • pelvic binder- reduces separation
  • OMM as needed
  • may cause pain in subsequent preggos
44
Q

What do we do on first visit 2 days postpartum?

A
  • screen for SD
  • tx prior to resolution of hormonal changes on ligamentous structures: relaxin
  • evaluate sacral mechanics: lithotomy position encourages anterior sacral base (cranial extension)
45
Q

What symptoms are associated with cranial extension df?

A
  • fatigue
  • depression
  • low energy
46
Q

What do we do at the 2nd visit 6 weeks post-partum?

A
  • review structural changes
  • screeen for SD
  • assess need for future contraception*
  • advise any follow up care for chronic problems
47
Q

What was the PROMOTE study by Dr. Hensel?

A
  • sees if OMT works in 3rd trimester
  • 7 txs over 9 weeks
  • goal was to reduce LBP and improve functioning
  • significant tx effects for pain and functioning in OMT and ultrasound group
  • no higher likelihood of conversion to high-risk status in OMT group
48
Q

What did the study show with regards to hemodynamic control

A

-BP increased and HR decreased in OMT group after heel raise

OS Exam #2 (2 decks)

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