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Flashcards in OAT OB Lect Deck (43)
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1

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

60%

2

3 factors influencing SD in pregnant pts

Change in maternal structure and biomechanics

Body fluid circulation

Hormonal changes

3

What effect does pregnancy have on scoliosis? 

Curvatures do not increase

May develop more pain

Possible increased risk of premature birth

4

What effect does pregnancy have on rheumatoid arthritis?

Improved sx (conception => 6 weeks postpartum)

5

What effect does ankylosing spondylitis have on pregnancy?

Aggravated sx (increased stress on SI joints)

6

Pregnancy sx that warrant further referral/evaluation

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

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

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

8

What is the etiology of radicular pain?

Bulging disc (40%)

Herniated disc (10%)

9

How does radicular pain typically present?

Paresthesias in ilioinguinal and genitofemoral nerve distribution "lightning pain"

10

LBP resolves in _____ of cases postpartum

80-95%

11

Risk factors of LBP during pregnancy

Previous hx of LBP

Multiparity

High BMI

Smoking

Age

Strenuous work

Pain during menstruation

12

How much does interstitial fluid demand increase during pregnancy?

6.5L

Increased demand to pelvic organs due to metabolic demands of fetus

13

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

Fluid retention (tissue edema)

14

What hemodynamic changes occur during pregnancy?

Increase: CO, blood volume, Plasma volume

Decrease: SVR, BP, hematocrit

15

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

LLR position and apply pressure to area

 

16

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

20 weeks

17

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

Makes it less effective

18

Most lymphatic sx occur in what trimester?

3rd trimester

Increased mass causes increased venous stasis

19

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

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

20

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

Relaxin

21

Relaxin is elevated in what trimester?

1st trimester

Declines early 2nd trimester

22

What does the hormone relaxin cause?

Widening and mobility of SI joints and pubic symphysis

Begins in 10-12 weeks

23

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

Circumference increases 5-7 cm

Subcostal angle widens 68-103 degrees

Diaphragm pushed superiorly 4cm

Increased tidal volume 30-40%

24

Indications for OMT during pregnancy

SD

Scoliosis or other pregnancy-associated structural dysfunction

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

25

Relative contraindications to OMT during pregnancy

Premature preterm rupture of membranes

Premature labor (change in cervix)

26

Absolute contraindications to OMT during pregnancy

Undiagnosed vaginal bleeding

Prolapsed umbilical cord

Placental abruption

Ectopic pregnancy

Placenta previa

Threatened/incomplete abortion

Severe preeclampsia/eclampsia

27

Goals of pregnancy OMT

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

What areas must be treated for hyperemesis gravidarum?

C2

T5-9

29

Round ligament pain in the 2nd trimester presents how?

Sharp, stabbing in low abdomen or groin

30

What trimester is Carpal Tunnel syndrome most common?

2nd trimester