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Flashcards in OAT OB Lect Deck (43)
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1
Q

What percentage of women report Low Back Pain (LBP)?

A

60%

2
Q

3 factors influencing SD in pregnant pts

A

Change in maternal structure and biomechanics

Body fluid circulation

Hormonal changes

3
Q

What effect does pregnancy have on scoliosis?

A

Curvatures do not increase

May develop more pain

Possible increased risk of premature birth

4
Q

What effect does pregnancy have on rheumatoid arthritis?

A

Improved sx (conception => 6 weeks postpartum)

5
Q

What effect does ankylosing spondylitis have on pregnancy?

A

Aggravated sx (increased stress on SI joints)

6
Q

Pregnancy sx that warrant further referral/evaluation

A

Severe pain interfering with fxn (persistent non-positional pain at night)

Increased pain w/ cough, sneeze, valsalva

Hx: bowel/bladder dysfxn, failure to urinate, paresis

Exam: Weakness, sensory defects, abnormal reflexes

7
Q

Pregnant patients rely on ____ for posture balance, as opposed to ____ in non-pregnant pts

A

Pregnant patients rely on muscle control for posture balance, as opposed to ligamentous/disc-oriented control in non-pregnant pts

8
Q

What is the etiology of radicular pain?

A

Bulging disc (40%)

Herniated disc (10%)

9
Q

How does radicular pain typically present?

A

Paresthesias in ilioinguinal and genitofemoral nerve distribution “lightning pain”

10
Q

LBP resolves in _____ of cases postpartum

A

80-95%

11
Q

Risk factors of LBP during pregnancy

A

Previous hx of LBP

Multiparity

High BMI

Smoking

Age

Strenuous work

Pain during menstruation

12
Q

How much does interstitial fluid demand increase during pregnancy?

A

6.5L

Increased demand to pelvic organs due to metabolic demands of fetus

13
Q

Increase in estrogen, progesterone, adrenal hormones during pregnancy promotes what physiological response?

A

Fluid retention (tissue edema)

14
Q

What hemodynamic changes occur during pregnancy?

A

Increase: CO, blood volume, Plasma volume

Decrease: SVR, BP, hematocrit

15
Q

What recommendation would you give to a pregnant pt with vulvar varicosities?

A

LLR position and apply pressure to area

16
Q

Supine compression of IVC by the uterus causes most pronounced effects after what weeks?

A

20 weeks

17
Q

Lymphatic stress in pregnancy caused by fascial torsion, organ hypertrophy, diaphragm restriction have what effect on the pressure gradient?

A

Makes it less effective

18
Q

Most lymphatic sx occur in what trimester?

A

3rd trimester

Increased mass causes increased venous stasis

19
Q

Low back pain in pregnancy can be caused by stagnant hypoxial of neural and vertebral tissues due to what?

A

Direct pressure on IVC by uterus => dependent edema moves back into vasculature due to osmotic gradient

20
Q

Women incapacitated by LBP during pregnancy have higher levels of what hormone?

A

Relaxin

21
Q

Relaxin is elevated in what trimester?

A

1st trimester

Declines early 2nd trimester

22
Q

What does the hormone relaxin cause?

A

Widening and mobility of SI joints and pubic symphysis

Begins in 10-12 weeks

23
Q

What effect does the release of progesterone during pregnancy have on the thoracic cage?

A

Circumference increases 5-7 cm

Subcostal angle widens 68-103 degrees

Diaphragm pushed superiorly 4cm

Increased tidal volume 30-40%

24
Q

Indications for OMT during pregnancy

A

SD

Scoliosis or other pregnancy-associated structural dysfunction

Edema, congestion, or other pregnancy-associated conditions amenable to OMT

25
Q

Relative contraindications to OMT during pregnancy

A

Premature preterm rupture of membranes

Premature labor (change in cervix)

26
Q

Absolute contraindications to OMT during pregnancy

A

Undiagnosed vaginal bleeding

Prolapsed umbilical cord

Placental abruption

Ectopic pregnancy

Placenta previa

Threatened/incomplete abortion

Severe preeclampsia/eclampsia

27
Q

Goals of pregnancy OMT

A

Address all postural stressors

Treat any specific SD (allows body to better compensate for pregnancy chage, saves pt energy, MSK dysfunction increases demands up to 300%)

28
Q

What areas must be treated for hyperemesis gravidarum?

A

C2

T5-9

29
Q

Round ligament pain in the 2nd trimester presents how?

A

Sharp, stabbing in low abdomen or groin

30
Q

What trimester is Carpal Tunnel syndrome most common?

A

2nd trimester

31
Q

How is diagnosis of pubic symphysis rupture made?

A

Separation >1cm

Audible crack may be heard, acute pain radiating to back and/or thighs, palpable gap with local tissue edema, waddling gait with increased pain on gait or bending

32
Q

How long after delivery should you screen for somatic dysfunction?

A

Day 1 post-partum

Tx prior to resolution of homronal change on ligamentous structures

33
Q

How long post-partum should the second OSE occur?

A

4 weeks postpartum (2nd visit)

34
Q

What are the ACOG recommendations for exercise in pregnancy?

A

30 min or more, moderate exercise, most/all days of the week

35
Q

Should the valsalva maneuver be avoided in pregnancy exercise?

A

Yes, increased BP and intraabdominal pressure may decrease uteroplacental blood flow

36
Q

Exercise in pregnancy should be avoided at what altitude if pt doesn’t already live at high altitude?

A

6000 feet

37
Q

Relative contraindications to aerobic exercise in pregnancy

A

Intrauterine growth restriction in current pregnancy

Unevaluated maternal cardiac arrhythmia

Poorly controlled type 1 DM

Extreme underweight (BMI <12)

38
Q

Absolute contraindications to aerobic exercise in pregnancy

A

Persistent 2nd or 3rd trimester bleeding

Placenta previa >28 weeks

Premature labor during current pregnancy

Ruptured membranes

Preeclampsia/pregnancy-induced HTN

Incompetent cervix

Multiple gestation

IUGR

39
Q

The PROMOTE study by Dr. Hensel aimed to use OMT on women in what trimester to reduce LBP?

A

3rd trimester

40
Q

Tx recommendations for mild carpal tunnel syndrome

A

Self-limiting

OMT, wrist splints, NSAIDS (but not if pregnant)

41
Q

Tx recommendations for moderate carpal tunnel syndrome

A

OMT, wrist splints, NSAIDS, steroid injection

42
Q

Tx recommendations for severe carpal tunnel syndrome (signs of damage and muscle wasting)

A

Immediate surgical referral

OMT at initial consult (lol)

43
Q

What is the spinal curve compensation for pregnancy?

A

Increased kyphosis and lordosis