Osteopathic Approach to the OB pt

Question 1

risk factors lower back pain pregnany

Answer 1

multiple prenancy
increased maternal age
young gravida
heavy manual labor
previous history of back pain

Question 2

radicular pain:
what kind of disc problem?
paresthesia where?
name for severe pain with compression sacral plexus

Answer 2

bulging discs not herniated
ilioinguinal and genitofemoral nerve
lightening pain

Question 3

pelvic inlet

Answer 3

iliopectineal line/pube to sacrum

Question 4

lymphatic stresses occur when and what are symptoms

Answer 4

3rd trimester

hemorrhoids, vulvar and lower extremity varicosities

Question 5

loss of balance, back pain, gait change, constipation and gerd in what trimester

Answer 5

3rd

Question 6

ankylosing spondylitis and pregnancy

Answer 6

aggravated by pregnancy

incereased stress on SI joints

Question 7

diagnosis of rupture of pubic symphisis

Answer 7

audible crack
separation greater than 1 cm
acute pain radiating to back and or thighs
palbale gap with edema
waddling gait

WAASP

Question 8

home exercise during first trimester?

Answer 8

yes

Question 9

first visit post partum

Answer 9

day 2 post partum

screen for SD
treat
evaluate sacral mechanics

Question 10

relative contraindications

Answer 10

premature rupture of membranes (PROM)

premature labor

Question 11

treatment 3rd trimester

Answer 11

address edema

viscerosomatics GI: T5-9
adrenal and ovaries: T10-L2

avoid cranial

Question 12

mid pelvis

Answer 12

strucutes btwn inlet and outlet

Question 13

scoliosis and pregnancy

Answer 13

more pain and risk of premature birth

curvatures do not increase

Question 14

3 general areas of somatic dysfunction in OB pt

Answer 14

change in maternal structure and biomechanics
body fluid circulation
hormonal changes

Question 15

first trimester what do you do on visits

0-13 weeks

Answer 15

complete history

physical

• look for dysfunction
• postural exam
• thoracic inlet/cage
• pelvis and sacrum
• CRI (pt may die without checking CRI)

Question 16

who did the study on pain reduction with omt

what other study

Answer 16

dr. hensel

hemodynamic control

Question 17

focuses on using MS system to affect arterial, venous, and lymph flow

Answer 17

respiratory model

Question 18

indications of omt in prego lady

Answer 18

somatic dysfunction
scoliosis
edema

Question 19

treatment first trimester:

hyperemesis gravidarum

Answer 19

treat C2 and T5-9

Question 20

prep stage last 4 weeks

Answer 20

weekly visits

structural, lymphatic, psychological balance

evaluate pelvic diameters

Question 21

rheumatoid arthritis and pregnancy

Answer 21

improved symptoms

from conception to 6 weeks post partum (cortisol and glycoprotein increase)

Question 22

warning signs to terminate exercise

Answer 22

vaginal bleed
dyspnea before exertion
dizziness
HA
chest pain
muscle weakness
calf pain or swelling 
perterm labor
decreased fetal movement
amniotic fluid leakage

Question 23

model of osteopathic treatment: viscerosomatics

Answer 23

neurological

Question 24

does mechanical stress decrease reflexes or cause muscle weakness

Answer 24

no

Question 25

outlet

Answer 25

pubes, ischeial tuberosity, coccyx

Question 26

venous stress and pain

Answer 26

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

Question 27

pregnancy affect on paraspinal muscles?

on abdominal muscles?

Answer 27

shortened paraspinal

overstretched abdominal

Question 28

physiological stresses in preganancy

Answer 28

increased fluid (6.5 L)

increase estrogen, progesterone, and adrenal hormones contribute to this

Question 29

sacral mechanics post partum

Answer 29

anterior sacral base may be there (cranial extension)

assocaited with fatigue, depression, low energy

Question 30

mothers center of gravity shifts ____

Answer 30

forward

Question 31

treatment 14-26 weeks

Answer 31

fascial release

treat sacrum and pelvis

carpal tunnel syndrome

Question 32

5 stressors on body caused by pregancy

Answer 32

mechanical stress
physiological stress
lymphatic stress
venous stress
hormonal stress

Question 33

hormonal stresses: relaxin

Answer 33

widening and mobility of SI joints and pubic symphis

can cause low back pain

Question 34

increased or decreased lordosis of lumbar spine with pregnancy

Answer 34

increased

Question 35

progesterone promotes what

Answer 35

fluid retention

Question 36

treatment rupture of pubic symphysis

Answer 36

bed rest

omm

Question 37

absolute contraindications

Answer 37

anything that harms mom or fetus: laundry list you can look up if you want

mnemonic is PUP PETS

Question 38

increased or decreased kyphosis of thoracic spine with pregnancy

Answer 38

increased

Question 39

mechanical stress in pregnancy from what

Answer 39

postural change
excessive connective tissue stretch and microtrauma (SI)

posterior pelvic pain that radiates posterior thigh to knee

Question 40

venous stresses can cause what

Answer 40

increased abdominal cavity pressure

also CNS congestion: HA, nausea, light headed

Question 41

second trimester (14-26 wks)
what SD would you find

Answer 41

evaluate for somatic dysfunction

anterior pelvis (forward torsion)

increased pelvic tilt

increase lumbar lordosis

compensatory increase of thoracic kyphosis

Question 42

increase in interstitial fluids and uterus size in what trimester

Answer 42

3rd

Question 43

second post partum visit is when

Answer 43

6 weeks post partum

SD
future contraception
f/u chronic problems