OMM: Osteopathic Considerations in Obstetrics

00:01 Osteopathic considerations in obstetrics.

00:05 So to better understand how we could apply OMM to pregnant patients, we have to understand what happens structurally and the different changes thay occur to accommodate the increase weight change and growth of the fetus So what happens is you start off with having increased forward tilt of the head This increased junctional strains as the body's adapting to a different center of gravity.

00:30 Because of the junctional strains, you may have diaphragmatic restrictions, You have rectus abdominis weakening, increased pubic pressure and laxity There's anterior pelvic tilt, you get changes in the ankles and the foot.

00:47 In the spine, that anterior angulation of the cervical region occurs secondary to increased cervical lordosis.

00:56 You may have thoracic kyphosis or decreased kyphosis.

01:03 You usually have increase in lumbar lordosis and also increase in sacral nutation..

01:11 Knee hyperextension could occur and all the gravitational pull on the musculoskeletal system and fascia causes different strains throughout the body.

01:20 and again the center of gravity will shift to accomodate for the growing fetus.

01:25 so the thoracolumbar junction is a really important region to address especially during pregnancy, there's a lot of strain that potentially could occur there We need to have good motion there for proper diaphragmatic excursion so remember that the diaphragmatic crus attaches to that region T10-L2 is also the sympathetic innervation for the bowel, bladder, uterus and the adrenals and the kidneys.

01:54 So if you have any sort of a viscerosomatic facilitation in that area, that could also affect the other organs supplying the same segments.

02:04 This area is also exacerbated facilitated commonly after six sessions because it is also the same dermatome where the incision sites sometimes can overlie.

02:17 So the uterus has its arterial supply form the uterine artery and the ovarian arteries; Venous supply from the uterine venous plexus.

02:27 it's connected with the superior rectal vein and also forms a portal system anastomoses.

02:35 Lymphatic drainage, there's three major drainage routes - the aortic, internal and external iliac lymph nodes and receives parasympathetic supply from S2 to S4 and sympathetic supply from the inferior hypogastric plexus from T12-L2.

02:53 So looking at the different sympathetic innervations for the structures related to pregnancy, we're looking at the ovaries which has a sympathetic supply from T10 to T11.

03:04 Parasympathetic supply comes from the vagus.

03:07 The uterus as mentioned before - sympathetic is from T12-L2.

03:11 And parasympathetic is from the sacral splanchnics S2 to S4 and the uterus and cervix is from again the T12 and L2, and the parasympathetic from S2 to S4.

03:25 So for the ovaries, the blood supply comes from the aorta at the level of L2 and anastomoses with the uterine artery venous drainage of the ovaries from th right side goes to the ovarian vein via the IVC and from the left side goes to the renal vein.

03:45 The ovaries has its lymph drainage drained to the paraortic lymph nodes, parasympathetic innervation comes from the vagus nerve; sympathetic from T10 to T12.

03:59 Mittelschmerz is a condition where patients have painful ovulation.

04:04 So when patients have painful ovulation, usually the afferents also go along T10 and so patients may also complain about back pain around the T10 region and also to the periumbilical area as that is the dermatome.

04:20 Also note that the ovary is fairly close to the appendix so any sort of information at the appendix can sometimes spread and also can influence the ovaries.

04:29 There are different Chapman's points that we should be aware of for these structures So the anterior chapman point for the ovaries lie at the pubic tubercle.

04:39 The anterior uterine chapman point is along the inferior pubic rami and the broad ligament chapman point runs posterior to the IT band.