00:01
So due to the physiologic
changes during pregnancy,
there are common complaints
that patients may present with
So morning sickness, reflux, wrist and hand
pain and paresthesia, edema, trouble breathing,
constipation, headache, hemorrhoids,
infections, plantar fasciitis and back pain
- all common complaints
that occur with pregnancy.
00:28
There's some typical musculoskeletal
symptoms that occur partly due to the
spinal changes, partly due to the
increased weight that has to be carried,
patients could present with muscle pains,
intercostal neuralgia, costal vertebral pain,
coccydynia, leg pains, headache, thoracic
outlet syndrome, carpal tunnel again,
lower back pain, pubic symphysis pain, round
ligament syndrome and plantar fasciitis.
00:58
Low back pain is a very frequent
preentation during pregnancy,
over 50 percent of pregnant patients will
complain of some form of a lower back pain.
01:06
It's important to consider all
the spinal changes that occur
due to the shift in gravity that increase
weight that the mothers are carrying,
the weakness of the abdominal
muscle and core muscles
so a lot of different things
contribute to lower back pain.
01:21
If a patient presents with shooting pain
going down from the back down to the legs,
it's rarely from a disc.
01:28
During pregnancy, it might be more ligamentous
or due to uterine pressure on the nerve roots.
01:35
Somatic dysfunctions could also increase
neural firing adding and contributing more
to the backpain so we want to definitely
look at potential viscerosomatics.
01:44
We also want to look at how that might
also affect the neuroplacental blood flow
as this is also influenced
by viscerosomatics.
01:54
So for our mothers, there's really not
a lot of safe pain relief medications
to control musculoskeletal
pain or lower back pain
Category A medications which
are considered reasonably safe
for there's a research study done on humans
to show that there's no possible side effect
in fetuses, there's really just no
analgesics that fall into that category.
02:19
Tylenol and NSAIDS are category B but NSAIDS
should be avoided from the third trimester on.
02:26
Stronger medications like Ketorolac,
steroids, and opiods are Category C
Opioids are category D if used
chronically and aspirin is category D.
02:39
So in general, medications taken during
pregnancy there's increased absorption
because there's a
slow GI motility.
02:47
There might be some delayed onset of
the controlled release medication,
or sometimes there's no absorption due
to increased vomiting and discomfort.
02:59
So there's altered dynamics for water and
fat-soluble medications too so you also
have to take into consideration possible
cytochrome P450 metabolism by the placenta.
03:13
So instead of pharmaceuticals,
OMT could be a potential option
to help with treating some
musculoskeletal pains.
03:21
OMT has been shown to be effective and could help with
lower back pain, headaches, labor, postpartum pain.
03:29
It could help with decreasing edema,
helping to relieve some GI complaints,
try to reduce labor time and help with
decreasing postpartum depression.
03:41
Caesarean sections sometimes are
needed if the baby is unable to
pass through the birth canal or
if there's other complications.
03:51
Possible indications for C section
include a previous C section,
failure to progress and
having a breach position.
04:00
So there's two types of incisions - a low
transverse incision and also the vertical.
04:05
The low transverse is obviously preferable
because it's less visible with scarring.
04:10
And so innervation of the uterus is
from T10 to L2, so patients post C-section
you have to check for potential viscerosomatic
reflexes going to the T10-L2 region posteriorly.