What are 3 factors that influence somatic dysfunction in pregnant patients?
- Change in maternal structure & biomechanics
- body fluid circulation
- hormonal changes
Scoliosis in pregnancy
- curvatures do not increase
- may develop more pain
- possible increased risk of premature birth
Rheumatoid arthritis in pregnancy
-symptoms improve: conception to 6 weeks pp
Ankylosing spondylitis in pregnancy
- aggravated by pregnancy
- due to increased stress on SI joints
Relative contraindications to OMT in OB pt
- premature preterm rupture of membranes
- premature labor
Absolute contraindcations to OMT in OB pt
- undiagnosed vaginal bleeding
- prolapsed umbilical cord
- placental abruption
- ectopic pregnancy
- placenta previa
- threatened or incomplete abortion
- severe pre-eclampsia/eclampsia
if pt presents with hyperemesis gravidarum, what areas do you treat?
Treat C2 and T5-9
5 model approach in 1st trimester
biomechanical: SD of C/T/L, ribs, pelvis, sacrum
Neuro: T10-L2 pelvic organs SNS & S2-S4 pelvic organs PNS
Resp-Circ: fascial or diaphragm restrictions, lymph techniques
met-ener-imm: prenatal vit, hyperemesis gravidarum
behavioral: smoking/alc/caff/drugs screening, sexual behavior screen, exercise
5 model approach in 2nd trimester
Monthly visits ok to treat mom in supine position through 2nd trimester
Biomechanical: SD of C/T/L, low back pain, pelvis, sacrum, abd wall MFR
Neuro: CTS- MFR techniques, round ligament pain–treat with ant cs at L3-5
resp-circ: rib raising, diaphragm, effleurage/petrissage
met-ener-imm: prenatal vit, constipation
behavioral: home stretches, exercise
Treating constipation in second trimester
pelvic diaphragm release & stool softeners
What are some common SDs in the second trimester?
- forward torsion
- anterior innominate rot
- increase in lumbar lordosis (and compensatory increase in thoracic kyphosis)
- round ligament pain: sharp, stabbing in lower abd or groin
- carpal tunnel
Carpal tunnel syndrome in pregnancy
Common in preg (esp 2nd trimester) due to increased fluid retention, congestion, and edematous state
- tx: stretches, night time splinting, MFR to wrist
- often resolves pp
5 model approach for 3rd trimester
biomechanical: treat LBP, assess gait changes
Neuro: GI- T5-9, ovaries/uterus- T10-L2, bladder S2-4
resp-circ: lymph emphasis! effleurage & petrissage
met-ener-imm: gerd
behavioral: drink plenty of fluids, elevate head of bed, dietary modification for gerd, build support for delivery
What should evaluate in the prep stage (last 4 wks)?
pelvic diameters to anticipate delivery problems!!
- inlet: iliopectineal line/pube to sacrum
- mid-pelvis: structures between inlet & outlet
- outlet: pubic bone, ischial tuberosities, coccyx
Rupture of pubic symphysis s/s
- acute pain radiating to back &/or thighs
- palpable gap with local tissue edema
- waddling gait with increased pain while walking or bending
- separation greater than 1 cm
- audible crack often heard
Potential causes of rupture of pubic symphysis
- fetal macrosomia
- precipitous labor/rapid second stage
- intense uterine contractions
- forceps delivery
TX of rupture of pubic symphysis
bed rest
pelvic binder to reduce separation
OMM–indirect tx of spine & pelvis as needed
Relative contraindications to aerobic exercise in preg
- intrauterine growth restriction
- unevaluated maternal cardiac arrhythmia
- poorly controlled T1DM
- extremely underweight
Absolute contraindications to aerobic exercise in preg
- persistent 2nd or 3rd trimester bleeding
- placenta previa >28 wks gestation
- premature labor
- ruptured membranes
- preeclampsia
- incompetent cervix
- mult gestation (triplets or more)
- intrauterine growth restriction
PROMOTE study- dr hensel
400 women in 3rd trimester assigned to usual care & OMT, or usual care & placebo US tx
- 7 tx over 9 wks
- goals: reduce LBP & improve functioning
- tx effects for pain & functioning in OMT
- no higher likelihood of conversion to high-risk status in OMT group
Post pelvic pain s/s
- distal & lateral to lumbrosacral junction
- radiates down posterior thigh to knee
- no muscle weakness or sensory impairment
- normal 2/4 reflexes
- pain may be due to relaxation of ligaments
lymph stresses in pregnancy
decrease in efficiency of excess fluid removal
Most symptoms in 3rd trimester: hemorrhoids, vulvar & LE varicosities
Hormonal stresses in pregnancy
relaxin elevated during 1st trimester & declines in early 2nd
-leads to widening & mobility of SI joints & pubic symphsyis
-starts at 10-12 wks
Progesterone
-changes configuration of thoracic cage: cicrumgference increases, subcostal angle widens, diaphragm pushed up
-promotes fluid retention
-leads to congestion
