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Michigan State University

Osteopathic Recognition Resource Library: Obstetrics

Purpose: to provide links to journal articles that can be used for journal clubs in any specialty to support the milestones for OR.

OMM for OB

Case Study
1. A 23 year-old G1P0 at 33 weeks and 5 days comes in to see you for a regular prenatal visit.  She is normotensive, no proteinuria or glucosuria, and has no history of lower extremity edema.  To this point she has gained 21 pounds during pregnancy.  Fetal heart tones, uterine growth, and all physical examination results fall within normal limits.  Her only new complaint is constant pain in the lumbosacral region, which is starting to limit her capacity to exercise daily.  
Upon examination, she has increased lumbar lordosis, a nutated sacrum, and tightness bilaterally in the upper glutes and lateral lumbar region.  You also note that her hip flexors are tight and that she is not firing her glutes.  She does not, however, have signs of burning pain on her anterolateral thighs.
Using myofascial, muscle energy, counterstrain, and balanced ligamentous techniques, you treat her lumbar, sacral, pelvic and lower extremities, focusing on mobility, stretching, and muscle balance.  You recommend that that she go to pregnancy yoga classes and swim, and cash in the certificate for a pregnancy massage that she was given at her baby shower.
 
 
Readings
  • Foundations Volume 2, Chapter 31 “Obstetrics”
  • Foundations Volume 2, Chapter 52
  • Foundations Volume 3, Chapter 64, "Low Back Pain in Pregnancy"
  • Jang J, Hsiao KT, Hsiao-Wecksler ET. Balance (perceived and actual) and preferred stance width during pregnancy. Clinical Biomechanics. Volume 23, Issue 4, Pages 468-476 (May 2008) 
  • King, Hollis H. et.al. Osteopathic Manipulative Treatment in Prenatal Care: A Retrospective Case Control Design Study. J A O A Vol 103 No 12 December 2003.
  • Licciardone JC, Buchanan S, Hensel KL, King HH, Fulda KG, Stoll ST. Osteopathic manipulative treatment of back pain and related symptoms during pregnancy: a randomized controlled trial. Am J Obstet Gynecol. 2010 Jan;202(1):43.e1-8. Epub 2009 Sep 20.
  • Bonus Reading with bibliography on pregnancy and low back pain:  A dissertation-length study of OMT in 3rd trimester Pregnancy:  Hensel, Kendi Lee. Osteopathic Manipulative Medicine in Pregnancy: Acute Physiological and Biomechanical Effects.  May, 2009, 157 pp.

OMM for OB Questions

1.  According to King, et al, which of the following labor and delivery complications are associated with OMM treatments of pregnant women?
a. Increased occurrence of meconium-stained amniotic fluid
b. Increased occurrence of postterm delivery
c. Increased occurrence of cesarian section
d. Increased occurrence of use of forceps
e. a and c
d. b and d
e. a and d
f. b and c
g. none of the above

 
2. A 24 year-old G1P1 s/p NSVD with epidural, who had given birth to a 8# 12oz boy at 39 weeks and 6 days comes to her 6-week post-partum check.  While she had some minor low back pain late in the pregnancy, she now complains of increased low back pain since the delivery.  Upon exam, she has a positive standing flexion test on the left, negative seated flexion test, and superior pubes and anterior iliac crest on the left.  Lumbar findings are negative. 
 
 
 
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