OMM in Prego

Question 1

What is the role of OMT in the treatment of pain in labor? How does it change the length of labor?

Answer 1

Reduces x2

Question 2

What are the goals of OMT for the prego? (5)

Answer 2

• Prevent complications by increasing homeostasis
• Increase respiratory excursion
• Venous return
• allow easy delivery
• Decreased discomfort

Question 3

What is the cause of the mechanical stress that is added by pregnancy?

Answer 3

Change center of gravity

Question 4

What are the physiological changes with pregnancy?

Answer 4

Increased fluids

Question 5

What happens to the venous/lymphatic return with prego?

Answer 5

Decreased efficacy of lymphatic d/t changes in mechanics

Venous congestion of the CNS

Question 6

What do hormones do to venous and lymphatic return?

Answer 6

Decrease

Question 7

What fraction of pregos experience LBP with prego?

Answer 7

more than half

Question 8

What are the risk factors for the development of LBP in prego? (3)

Answer 8

Heavy labor
Smoking
h/o LBP

Question 9

Where does pain from LBP radiate to with LBP?

Answer 9

Thighs, but not legs

Question 10

True or false: Most women who complain of LBP in pregnancy continue to have pain postpartum

Answer 10

True

Question 11

What happens to the risk of sciatica with each subsequent pregnancy?

Answer 11

Increases

Question 12

What are the things that aggravate LBP?

Answer 12

Prolonged standing and walking

Question 13

What causes the LBP with prego? (per Osteopaths)

Answer 13

Thought is that untreated SDs that are exacerbated from prego

Question 14

What causes the improvement of symptoms of RA with pregnancy? (2)

Answer 14

• Increased cortisol secretion

- Increased alpha-glycoprotein in the maternal serum that decrease inflammation

Question 15

What happens to ankylosing spondylitis with pregnancy?

Answer 15

Aggravated because of increased stress on the SI joint

Question 16

What happens to the spinal curves with pregnancy? Why?

Answer 16

Compensation of anterior pelvic tilt causes an increased lumbar lordosis

Question 17

Is there an increased rupture of lumbar discs with pregnancy?

Answer 17

No

Question 18

What is the more common cause of radicular symptoms in prego?

Answer 18

Direct pressure on the nerve root or lumbar plexus by the uterus

Question 19

What happens to the paraspinal muscles posteriorly with pregnancy?

Answer 19

Shorten

Question 20

What is the most common muscle in the back that is affected with pregnancy?

Answer 20

Psoas

Question 21

True or false: the psoas supports the growing fetus

Answer 21

True

Question 22

What is the cause of sacroiliitis?

Answer 22

Excessive connective tissue stretch and microtrauma from the anterior pelvic tilt

Question 23

Posterior pelvic pain often radiates where? Where should it NOT radiate to?

Answer 23

Below the knee, but NOT into the ankle or foot

Question 24

How do you differentiate pelvic pain radiation in pregnancy from sciatica?

Answer 24

neuro exam normal with normal prego pelvic pain

Question 25

What is the effect of scoliosis on pregnancy? Why?

Answer 25

If curvature is greater than 25 degrees, then increases chances of a premature birth d/t increased relaxin secretion

Question 26

The apex of the baby's skull affects what joint motions in the mother?

Answer 26

pelvis and sacral

Question 27

What causes the plantar surface of the foot change with pregnancy?

Answer 27

Increased weight

Question 28

Why muscle fatigue with prego?

Answer 28

Moving more weight

Question 29

What causes the increased rib dysfunction with pregnancy?

Answer 29

increased breast weight

Question 30

What causes the increased incidence of HA with prego?

Answer 30

Decreased venous drainage

Question 31

What are the goals of OMM to the pelvis with pregnancy?

Answer 31

Increase circulation to pelvis to meet the metabolic needs of fetal development

Question 32

Back pain at night after lying in pregnancy?

Answer 32

Changes in osmotic forces

Question 33

What is the most important OMT treatment for prego women?

Answer 33

Address venous and lymphatics

Question 34

What causes hemorrhoids/varicosities with pregnancy?

Answer 34

Sluggish venous return

Question 35

What causes CNS congestion with prego?

Answer 35

Reversal of venous flow into vertebral and spinal membranes

Question 36

What is the name of the venous plexus that is contained within the spine? What is its drainage dependent on?

Answer 36

- Valveless venous vertebral plexus | - Drainage dependent upon the testing pressure within the thorax and abdomen

Question 37

What is the effect of relaxin?

Answer 37

Increases the mobility of the SI joint and symphysis pubis AND increased laxity of the ligaments of the pelvis

Question 38

What structure secretes relaxin in pregnancy?

Answer 38

Corpus luteum

Question 39

What happens to the levels of relaxin throughout pregnancy?

Answer 39

Increased in 1st trimester, then decreases

Question 40

What structures produce progesterone in the 2nd and 3rd trimester?

Answer 40

Placenta

Question 41

What is the effect of progesterone on fluid levels?

Answer 41

Increases retention

Question 42

What increases the tidal volume in pregnant women?

Answer 42

Changes in the thoracic cage and increased relaxin and progesterone levels

Question 43

What are the spinal SNS levels for the uterus?

Answer 43

T10-L1

Question 44

What is the parasympathetic innervation to the uterus?

Answer 44

S2-S4

Question 45

What causes the sacroiliitis with pregnancy?

Answer 45

Laxity produced by relaxin placing extra strain on the SI joints

Question 46

What are the areas to treat for hyperemesis gravidarum?

Answer 46

C2 and T5-T9

Question 47

What is the sacral dysfunction that is caused by birthing? Why?

Answer 47

BST Flexion of the back

Question 48

What are the three stages of pregnancy prior to labor and delivery? When does each occur?

Answer 48

1. Structural stage (1-28 wks) 2. Congestive stage (28-36) 3. Preparatory stage (36-delivery)

Question 49

What should be done in the structural stage (1-12 weeks) of pregnancy? What sort of OMM techniques are appropriate?

Answer 49

H and P Address SDs Any treatment style is appropriate

Question 50

What are the structural changes in the 12-28 weeks? (3)

Answer 50

- anterior pelvic tilt - Increased lumbar lordosis - Compensatory thoracic kyphosis and cervical suboccipital strain

Question 51

What is the main goal of OMM treatment for the congestive stage of pregnancy?

Answer 51

Restoring motion of the diaphragms

Question 52

True or false: any treatment style is appropriate for the congestive stage

Answer 52

True

Question 53

What OMM motion should be optimized during the prep stage?

Answer 53

Craniosacral motion

Question 54

OMM for labor and delivery?

Answer 54

- thoracic and lumbar spine - innominates - restrictions of the SI joint

Question 55

True or false: any treatment style is appropriate for the labor and delivery stage

Answer 55

False--aggressive styles are not well tolerated

Question 56

True or false: isolytic correction of the pubic bone during labor/deliver stage is NOT appropriate

Answer 56

True

Question 57

What area should be focused on in the recovery stage (postpartum stage)

Answer 57

SI joint | Sacrum

Question 58

True or false: smoking is a risk factor for the development of LBP in pregnancy

Answer 58

True

Question 59

True or false: race is a risk factor for the development of LBP i pregnancy

Answer 59

False-- is not

Question 60

True or false: multiparous women generally complain more often of LBP

Answer 60

False--less

Question 61

What happens to the following in pregnancy: - Chest circumference - Subcostal angle - Diaphragm

Answer 61

- Increased chest circumference - Increase subcostal angle - Diaphragm push superiorly 4 cm, but increases in excursion

Question 62

What is the OMT treatment that should be considered if labor is not progressing (prior to starting oxytocin)?

Answer 62

Thoracolumbar stimulation