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244 Cards in this Set
- Front
- Back
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Pregnancy is NOT a medical condition. It has been medicalized because of?
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litigation
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How many pregnancies throughout year in US?
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~6 million
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The WHO estimates _______________ women worldwide will die in a pregnancy/birth/post death.
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1/2 million worldwide dead
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Leading cause of death and disability among women (repro age) in dev. countries?
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MATERNAL MORTALITY
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Common FATAL complications of pregnancy
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post partum hemorrhage, sepsis, comp of unsafe abortions, prolonged/obstructed labor, hypertension (eclampsia)
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Maternal Mortality is the annual number of deaths of women from pregnancy related causes, when pregnant or ?
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within 42 days of termination of pregnancy per 100,000 live births
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Annual number of deaths of infants under 1 year of age per _____ live births
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INFANT mortality
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poverty, war, subjugation, lack of medication
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Things which could affect infant mortality
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termination of pregnancy before the 28th week
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abortion
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bleeding before the 28th week
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threatened abortion
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non-viable embryo/fetus separated from placenta
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incomplete or inevitable abortion
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3-4 consecutive abortions occuring at a specific time during pregnancy
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Habitual abortion (natural causes)
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Is a more natural birth process in countries w/ high or low infant mortality?
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LOW
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The US is ranked 46th in infant mortality. What does not matter?
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advanced medicine technology (only reduces maternal mortality) and adequate health care
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CP: 21 yr old white female w severe ankle swelling, fatigue, sensitivity to cold, mild dyspepsia 2 weeks
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grossly overweight w/ pedal edema;move toaANTI inflammatory diet, Incr. VO2 max via exercise, Incr. HDL, lower LDL
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Amenorrhea is strongly suggestive of
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pregnancy (or gymnastics or some other weird stress)
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Describe fatigue of pregnancy
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EARLY and LATE, unknown cause; physiological shift of vital force. Plan around it!
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Describe breast pain/swelling of pregnancy
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Early chgs are hormonal. Lasts the whole pregnancy. Aggravate fibrotic breasts. FITTING BRA!
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Describe nausea/vomiting/dyspepsia of pregnancy
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Homones in FIRST trimester ONLY! Often dismissed as something else at first.
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woman with LBP and severe fatigue
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heart disease or heart attack
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cholasma/melasma
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mask of pregnancy and skin lightening (skin changes)
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linea nigra and stria gravidarum
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stretch marks of pregnancy
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palmer erythema
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50% pregnant women have flushed palms
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why increased urinatins during 1st trimester
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increased plasma volume and pressure on bladder and late sx in 3rd trimester (pressure)
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Not only does your vagina run during pregnancy but so does your nose. Why?
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ESTROGEN elevated -edema nasa mucosa/nosebleeds. Do upper CMT. No OTC sprays.
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PTYALISM
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excessive BITTER saliva produced in 1st trimester. Suck on Meyer lemons, parsley, fennel
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3 highly probable specific indicators of pregnancy (test question)
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hCG test/preg test, Braxton-Hicks contractions, Fundal height
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4 very definitive specific indicators of P* (test question)
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Fetal movement/ Fetal heartbeat/ Funic souffle (soft flowing fetal cardiac sounds)/ Fetal ultrasound
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2 pregnancy tests
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Urine OTC dip (~4 weeks pas 1st day LMP) & Serum bld test for hCG = MOST ACCURATE
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why is hCG most accurate test for P*? (test question)
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can detect prior to 1st missed period as early as 7-9 days after conception*****(test question)
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4 false postives for hCG (rare in true pregnancy)
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1. testicular tumor 2. ovarian tumor 3. Miscarriage 4. Hydatidiform Mole
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trophoblast proliferation and chorionic villi swelling that has (+) hCG
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HYDATIDIFORM MOLE
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MOLAR pregnancy rate in US
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1 in 1500 **(test)
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signs of MOLAR pregnancy (test)
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Marked elevated hCG, Marked nausea & vomiting, Pregnancy-induced HTN before 24 weeks, Vaginal bleeding universal
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How to tx a molar pregnancy
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removal/curettage of uterus, 1 year metastasis monitoring, watch for carotene or protein deficiency
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7th week softening of uterine ISTHMUS (via internal palpation) (test)
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HEGER'S sign (vs. Goodell's sign which is softening of cervix)
H-IS (HEGER'S + ISTHMUS = HIS) |
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BLUISH discoloration of the cervix (test)
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CHADWICK's sign
CHAD turned BLUE after he was SERVED |
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8th week feel increased blood PULSATION through uterus (test)
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OSIANDER'S sign
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softening of CERVIX (test)
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GOODELL's sign (vs. Heger's sign which is softening of uterine isthmus)
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DNA test during pregnancy
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AMNIOCENTESIS
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DNA test during pregnancy. Can cause TRANSVERSE DIGITAL DEFICIENCY due to villi removal.
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CHORIONIC VILLUS test
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BALLOTMENTS
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INTERNAL: bimanual palpation to feel for FLOATING fetus ~ 14th wk. EXTERNAL: by 24th wk.
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What are vitals to watch out for in 1st trimester? (test)
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High blood sugar. If untreated leads to HEART & PELVIC abnormalities (organ differentiation)
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PARA (test)
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# of live births (> 20 weeks)
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GRAVIDA (test)
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# of pregnancies
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GRAVIDA (test)
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pregnant woman
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PRIMAgravida (test)
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first pregnancy
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MULTIgravida (test)
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pregnant more than once
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NULLIgravida (test)
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never nor currently pregnant
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MULTIpara [t]
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2 or more pregnancies DELIVERED
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NULIpara [t]
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NO pregnancy progresses BEYOND gestational age of ABORTION
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PARTURIENT [t]
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CURRENTLY in LABOR
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PUERPERA [t]
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a woman who has RECENTLY given birth
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first trimester fetus [t]
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EMBRYO
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START of second trimester fetus is called?
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FETUS
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when able to survive, finally in 3rd trimester, a fetus is called a ?
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BABY!
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EDD
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Estimated Date of Delivery
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NAGLE'S RULE
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First day LMP, subtract 3 months, add 7 days to get EDD [Est Date of Delivery]
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How long is a full term pregnancy?
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40 weeks or ~ 9 months (use Nagle's rule to figure EDD)
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Trimester 1 weeks:
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0-13 weeks
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Trimester 2 weeks:
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14-26 weeks
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Trimester 3 weeks:
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27-40 weeks
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Range of entire pregnancy in weeks
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38-42 weeks
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If you have read this far and can't figure that these are all test [t] questions,
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then make your own cards and type (test) at the end of every sentence. No more of that here.
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Besides blood sugar, what are two other vital signs to definitely monitor during P*?
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WEIGHT & BLOOD PRESSURE
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Average weight gain in P*
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25-35lbs (Overweight gain <25lbs, Underweight gain up to 40lbs, Twins gain up to 45lbs)
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Which vitals are critical to monitor every visit?
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Weight and Blood pressure
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4 types of female PELVISES
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gynecoid, android, anthropoid, platypelloid
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GYNECOID
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[50%] cylindrical, rounded pelvis, equal width & length *MOST COMMON
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ANDROID
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HEART SHAPED pelvis. 2nd most common. Wide at FUNDUS, narrow at CANAL
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ANTHROPOID
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LONGER than wide pelvis
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PLATYPELLOID
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WIDER pelvis -difficult delivery
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How is clinical PELVIMETRY (shapes gynecoid, android, anthropoid, platypelloid) assessed?
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Vaginally by licensed practitioner. Estimates pelvic inlet.
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feto-pelvic disproportion can be due to?
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Too large to birth naturally or too small. Too large could be due to gestational diabetes.
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Basic lab tests in first trimester:
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hCG, CBC, UA, ABO
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If LOW level of hCG in 1st trimester?
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FETAL DEMISE. High level means multiple fetuses, incorrect gestation date.
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Why do a CBC in 1st trimester?
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ANEMIA; 'physiologic anemia' decreased HCT w/ normal Hb, checked at 28 and 36 wks
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How is urinalysis done in 1st trimester?
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dipstick test for glucose & protein
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Why is ABO test done in 1st trimester?
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Rh Factor typing
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What is Rh Factor?
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RBC antigen (rhesus factor) = INCOMPATIBILITY ISSUE if mom (-) and fetus (+). SENSITIZATION for next pregnancies
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How to fix opposite Rh factor problem or just prophylactically prevent it?
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RHOGAM dose in 28th week when baby's blood can cross placenta and cause mother to mount fatal attack against non-self
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Rhogam is an Rh _____________ given at _____ th week/at birth/at miscarriage/at abortion
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immunoglobulin, 28th (beginning of 3rd trimester is 27th week)
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Why should multiple or early DOPPLER ULTRASOUND be AVOIDED?
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damages the embryo's fast growing cells
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What are some VIABLE reasons for ULTRASOUND during pregnancy?
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Uncertain menstrual dates, # of fetuses, fetal presentation & lie, vaginal bleeding, pelvic pain (ectopic?), uterus small or large, premature labor
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Further reasons for ultrasound during pregnancy…
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adjunct to amniocentesis, hx of congenital anomalies, suspected fetal demise, abnormal maternal blood screening results
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test that screens for NEURAL TUBE DEFECTS
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ALPHA-FETOPROTEIN. Done at beginning of 2n trimester/16-18 weeks
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Why alpha fetoprotein test for neural tube defects?
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Produced by yolk sac and getal GI/liver. High level detect 85% open n.t.d.'s. Inc by multiple gestation, fetal demise, incorrect EDD
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MacDONALD'S RULE
Old MacDonald had a Ruler, e-i-e-i-ooo! |
From 20 weeks gestation, measurements in cm. should be SAME as # of weeks of pregnancy
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MacDonald's rule translated
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At week 20, fundal height in cm. (measured from pubic symph. to top of uterus) should be same as # of weeks of pregnancy
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SNOUT
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test with high SeNsitivity, good for ruling OUT (sensitivty-negative-rule out!)
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SPIN
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test with high SPecificity, good for ruling IN (specificity - positive - rule in)
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Prenatal testing in 2nd/3rd trimester (2)
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1-hour glucose screen, Group B streptococci screen
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Non-stress prenatal test (>28 weeks)
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Meas response of fetal HR to fetal movements. NORMAL: 2 accelerations in 10-20 min, lasting @ least 15 seconds
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The fetal heart rate activity test is considered a ____________ test
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non-stress
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At least 3 discrete gross body movements
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Fetal MOVEMENT
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at least 1 episode of limb EXTENSION to FLEXION
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fetal TONE
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at lease 1 episode of breathing for 30 seconds
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fetal BREATHING
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at least 1 pocket of fluid measuring 2 cm
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AMNIOTIC FLUID
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Reasons to perform special genetic testing for P*?
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age > 35-40 years old, elevated AFP or hCG, prev. stillbirth, sibling or close relative w chromosomal abnorm, Parent w transmissible abnormality
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Why and when to do AMNIOCENTESIS
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Over 35 y.o.a. Done @ 16 weeks gestation. 30 ml. removed. NEURAL TUBE DEFECT detection. Chance 1-3% fetal death.
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Why and when to do CHORIONIC VILLUS sampling?
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done at 9-12 weeks. 10-20 mg. villi removed. RISK OF TRANSVERSE DIGITAL DEFICIENCY. 1-5% fetal death chance.
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LEOPOLD'S MANEUVER
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Trying to determine fetal LIE (position of head)
LEOPOLD'S LIE. |
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LIE of fetus
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long axis of fetus compared to long axis of mother
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ATTITUDE of fetus
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fetal flexion or extension of SPINE
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Named for what bony part of fetus is going to pop out first
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PRESENTATION: vertex, breech, brow, facial, shoulder (yikes)
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boney part of fetus related to presentation
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DENOMINATOR
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relation to mother's pelvis
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POSITION of fetus
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What is normal PRESENTATION of fetus?
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VERTEX
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What is MOST DANGEROUS presentation of fetus and why?
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FACIAL= BLOCKS AIRWAY and cervical spine in hyperextension
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Really really bad presentation ?
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SHOULDER (arm) or foot comes out first
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Risk of BREECH birth?
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ANOXIA and cervical spine injured
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Normal menstrual cycle
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ovulation (mid cycle day 14 of 28)
endometrial tissue prepped corpus luteum degenerates if unfertilized normal menses occurs |
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2 phases of menstrual cycle and one divider?
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FOLLICULAR phase
OVULATION (divider) LUTEAL phase |
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Name the 4 hormones of cycle
Easy FLow Please |
Estradiol (right before ovulation)
Follicle Stimulating Hormone (FSH) during divider phase of ovulation Lutenizing Hormone (peaks during ovulation) Progesterone (swells during luteal phase) |
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Produces PROGESTERONE in case there is a pregnancy
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CORPUS LUTEUM
(will degenerate if nothing happens) |
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Required for true pregnancy?
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IMPLANTATION
*can have fertilization w/ an IUD but not implantation |
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Hormones of PREGNANCY
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hCG, Progesterone, Relaxin, Estriol, Estrogen
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Stimulates and maintains the CORPUS LUTEUM
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hCG
Tells corpus luteum to secrete estrogen/progesterone until placenta takes over in 11th week. Also stims Leydig cells of male fetus to secrete testosterone. |
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Peak of hCG?
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7-10 weeks
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LIMITS activity of womb but later SOFTENS the cervix and reduces contractions
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RELAXIN - inhibits contractility w/ progesterone
assists breast growth, renal dilation |
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Induces smooth muscle relaxation throughout body (uterus) and prepares endometrium for implantation
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PROGESTERONE - inhibits contractility w/ relaxin
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to 'pro' gest something is to ?
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prepare it, as in PRO GESTerone
induces smooth mm relaxation thorughout body (uterus) and BALANCES the actions of estrogen |
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I think I'll have some SOFT CERVE ice cream and RELAX
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RELAXIN SOFTENS the CERVIX
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Troph is to grow, as in maintain, so __________ grows and maintains the corpus (body) luteum.
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hCG
Human Chorionic GonadoTROPIN |
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BUILDS TISSUES like the PLAC-ENTA
(mothers build up your ego and placate you as a child) |
ESTROGEN
Oestra/Mother built up your ego and plac-ated you as a child |
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2 types of ESTROGEN:
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Estradiol - ovarian
Estriol- placenta- large increase production depends on precursors from fetal adrenal glands |
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Your mother builds you up and placates you and finally kicks you out of the house:
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Estrogen:
BUILDS TISSUES PLACENTA UTERINE CONTRACTILITY |
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human Placental LACTOgen (hPL)
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increases blood GLUCOSE levels and is ANTI-insulin
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Give that baby some sugar!
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hPL
Human Placental Lactogen *lactose is sugar, and that's what it does. |
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At what week should hCG drop?
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11th
*if not, may mean multiple fetuses or molar pregnancy |
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pro-LACT-in does what?
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MILK LET DOWN
As in prepares and maintains breast for LACTation |
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If you have gotten this far in graduate science and you haven't yet learned that OXYTOCIN is responsible for the waves of contractions during orgasm, I'm sorry. What would you guess it does for pregnancy?
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Uterine muscle contraction (how'd you know?)
Enhances delivery of placenta, too, because you don't want to leave that laying around up there. |
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Menstrual migraines are caused by progesterone, as is all of the horrible cramping and pain. If oxytocin is responsible for orgasms and uterine contraction, what hormone clearly snuffs it until it's time to induce labor?
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progesterone
Periods suck because of hormonal politics that are really only useful during pregnancy. |
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AMNIOTIC fluid peaks?
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38-39 weeks
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Too much amniotic fluid
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POLYhydraminos
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Not enough amniotic fluid
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OLIGOhydraminos
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How is amniotic fluid maintained?
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Fetus itself...(mother provides the H2O)
*fetus begins to swallow and inspire amniotic fluid, then excretes it through kidneys |
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Which one is more dangerous and why?
POLYhydraminos or OLIGOhydraminos |
POLY=
too much amniotic fluid in uterus Dangerous Requires amniocentesis *baby isn't taking in fluids. Something's wrong. 35% perinatal mortality when POLY |
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OLIGOhydraminos is a fetal _____ problem
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kidney - not enough being excreted
*risk: no mechanical barrier/PROTECTION between baby and getting bounced around |
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Placenta FUNCTIONS [3]
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PRODUCTION (hCG, estriol/estrogen)
EXCHANGE PROTECTION** |
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placental PREVIA
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placental problem:
LOW, PARTIAL, TOTAL where it is placed. Should be high up in uterus, otherwise could obstruct. |
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the placental PRODUCTION includes
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hCG
estrogen estriol |
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the placental EXCHANGE includes
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digestion via exchange or resorption of oxygen, nutrients, water, electrolytes, pH balance
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the placental PROTECTION includes
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MECHANICAL barrier, maternaL IMMUNOGLOBULINS
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placental PREVIA
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LOW, PARTIAL, TOTAL placement within uterus (should be high)
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placental ABRUPTIO
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SEPARATION
an abrupt break up |
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What is the placental PREVIA risk?
SYMPTOMS: ALWAYS... |
can block cervix
SX: BLEEDING, fetal distress (Fetal Heart Rate slows) ALWAYS refer out a bleeding mother |
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PREVIA of placenta
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implantation of placenta somewhere other than above the fetus
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placental ABRUPTIO is more frequent with _____ use and _____
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cocaine
and hydraminos EMERGENCY. Mother may bleed to death |
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placenta SENILE
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OLD placenta. Forgets to come out.
Placenta loses blood supply and atrophies. Remains. Has to be surgically expelled. |
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placenta ACCRETA (superficial)
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ABNORMAL ADHERENCE (accretion) to uterine wall
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placental INCRETIA
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partial uterine wall adherence into myometrium
Incredulous, my endometrium shouted, "let go!" but the damned thing was half stuck, IN/encroached in the wall. |
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placental PERCRETA
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full penetration of placenta through the myometrium and into the abdominal cavity. Requires hysterectomy.
MY PERCRETA made me HYSTERICAL so I had it removed. |
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accreta of placenta
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uterine wall penetration:
increta - half stuck, half through myometrium percreta - all the way through, requires hysterectomy |
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Hear fetal HEART sounds with ___________ in the first _____ weeks gestation. ****
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DOPPLER ULTRASOUND
****8-12 weeks [choose # closest to 9 - think of an elephant w/ a baby cradled in it's trunk like Jungle Book. Number 9 is an elephant head} |
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TIME highest risk for MISCARRIAGE
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1st trimester
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Do/do not put a hot pack on low back in pregnancy?
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NO.
No hot tubs, etc. Air travel ok. |
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All embryo body ORGANS are formed in the ____ week.
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8
*8 organs play in Saint Patrick's cathedral. |
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Lack of FOLATE and DIABETES can cause?
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HEART & PELVIC deformities
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2nd trimester is called the ________ trimester! (hear harps playing)
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GOLDEN!
High rate of progesterone (no contractions) Mother comfortable Baby is off her bladder QUICKENING = 1st sense of baby motion. Happens during this GOLDEN 2nd trimester. |
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QUICK 2 GOLD
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2nd trimester is GOLDEN.
Mother feels first movements as QUICKENING. |
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DIASTASIS RECTI is not only a concern of Marfan's patients, but also of
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mothers in the 2nd trimester
[separation of linea alba] |
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SPONGY GUMS
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2nd trimester (sounds golden, alright)
Heartburn, constipation common. Secreting colostrum for milk. |
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When can the baby recognize the parent's voices and becomes light sensitive?
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Guess? It's the 2nd GOLDEN trimester
QUICK 2 GOLD |
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3rd trimester milestones:
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BRAXTON-HICKS CONTRACTIONS
& LIGHTENING (baby descends to pelvic inlet) |
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Average length of pregnancy`
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32 weeks***
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Webster breech protocol is to
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get rid of uterine torsion
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LBP in pregnancy
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postural changes
ligament laxity decreased abdominal fcn Relieved w/ rest or a change in position and external stabilization |
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Where is pregnancy pain the worst?
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lateral to L5-S1 deep in buttock
4x greater than LBP Radiates to knee |
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Why rib pain?
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Upward movement of uterus
Often on R side Soft tissue work/mobilization |
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ROUND LIGAMENT PAIN
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stretches, hypertrophies
Lower abdomen/inguinal pain Attaches to sacrum and P.symph. Soft tissue work to round ligament |
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Reason for Webster technique
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Align pelvis, round ligament tone, and abdominal muscle tone
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Check for MOST leg resistance w/ Webster's and the short side is the
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PS sacrum
Adjust the side of INCREASED resistance Find the trigger point on the OPPOSITE of sacral rotation. |
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UTI can cause premature _________
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contractions
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MOST COMMON etiology of ACUTE abdominal pain in pregnancy
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**APPENDICITIS
-Surgery required |
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Choleocystitis and bowel obstruction in pregnant women
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same sx as non pregnant women
choleocystitis more common in older, fat women |
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HYPER-EMESIS GRAVIDARUM
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morning sickness
ie, an emetic makes you vomit, like castor oil |
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Avoid hyperemesis gravidarum by ?
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staying well hydrated and use vitamin K, C, and ginger
If still vomiting in 2nd tri, then see gyn because could be hcG level or progesterone levels |
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When should you notify a midwife if you have morning sickness?
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inability to continue normal ADLs, continues after 16 weeks, strong cravings for non-food items PICA*** means iron-deficiency anemia
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PICA
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craving a non-food item
pregnancy - means iron-deficient anemia potentially |
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Traditional approach to morning sickness
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avoid offensive odors, eat small meals and bland food
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Food remedies for vomiting
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raspberry or chamomile tea
ginger Meyer lemons chiropractic for mid thoracic spine |
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Acupressure good for morning sickness. Which points to avoid?
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Large intestine 4 & spleen 6
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When to use acupuncture points that bring on labor?
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lg intestine 4 and spleen 6 AFTER first 8 months only
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GESTATIONAL DIABETES can cause
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heart and pelvis defects in fetus
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Risk factors for gestational diabetes
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high maternal age, obesity, previous heavy baby, family hx of DM, previous stillbirth, smoking
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IF gestational DM, the baby can be
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TOO DAMNED BIG!
Too much sugar makes a fat baby, difficult delivery, respiratory distress, hypoglycemic episodes, jaundice |
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if Gestational DM, risk to mother
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pre-eclampsia (HTN and proteinurea = early delivery vs. organ failure and potential death to mother and child), UTI, difficult delivery, physical injury
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Regarding HTN in pregnancy, you must
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DO the CORRECT method of taking blood pressure
140/90 same as nonpreg people |
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PIH
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Pregnancy-Induced Hypertension
Common finding: HTN, proteinurea, swelling of face. PRE-ECLAMPSIA |
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describe clinical signs of pre-eclampsia
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sudden weight gain
high blood pressure edema |
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Risk factors for pre-eclampsia
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nulliparity, >40yo, family hx PIH, chronic HTN in mother, DM, multiple gestation
OBESITY (12x risk)** |
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If allowed to persist, pre-eclampsia:
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VISUAL CHANGES
SEIZURES poor placental perfusion, decreased mom renal function, hyper-reflexia |
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Pain meds for labor
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DEMEROL crosses placenta, depresses respiration, inhibits breastfeeding
EPIDURALs cause longer labor, fevers, antibiotic nec, jaundice |
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EFFACEMENT (s&t)
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COMPLETE DILATION OF CERVIX statge of labor means SHORTENING AND THINNING ***
a short, thin rock effacement |
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When does the delivery actually end?
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With the delivery of the PLACENTA
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STATION ZERO of labor
"she's a go!" |
baby head at level of
ISCHIAL SPINES |
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Station Zero is baby head at level of ischial spines.
ENGAGED level? |
ENGAGED is -2
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describe levels of STATIONS during delivery
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-3..-2 (engaged)...-1...0 (ischial spines)...+1...+2...+3
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Initial phase of labor
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FLEXION of cervical spine
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Internal rotation, then
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cervical extension. Complete extension is not until crown.
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Baby's neck only goes into extension after
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crown.
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RESTITUTION
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external rotation (after crown) of the head and neck and baby's shoulders are through!
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Most traumatic way to be born
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C-section
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Post partum cause
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extreme DROP of progesterone
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antibody/immune system for baby in mother's milk first couple of weeks
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COLOSTRUM
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FOREMILK & HINDMILK
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FOREMILK: satisfies baby hunger (high fat)
HINDMILK: where EFA comes from |
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Contraindications to breastfeeding
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ill mother
ill infant very premature infant impurity in milk breast deformity PCB's |
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Pro's of breastfeeding
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NATURAL IMMUNITY
PROPER NUTRIENTS per stage LESS DIGESTIVE PROBLEMS HIGHER IQ levels HEALTHY BONE development |
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chiropractor's role for breastfeeding comfort?
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cervical spine health
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Maternal nutrition has profound effect on pregnancy and outcome. Need at least?
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400 mcg of FOLIC ACID
18 mg of IRON daily PRIOR to pregnancy |
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Food precautions
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generic -wash veggies, cook food thoroughly
Limit mercury intake (tuna) Take Omega 3 Caution unsafe herbal teas/supplements |
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FAS complications
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Fetal Alcohol syndrome:
mental retardation, birth defects, abnormal facial features, delayed development, vision/hearing/behavior |
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Tobacco use during pregnancy linked to
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Um...just don't.
Low birth weight, miscarriage, SID |
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No _______ first trimester.
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caffeine.
Linked to low birth weight, vasoconstriction, miscarriage |
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Herbs to avoid in preg
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BLACK AND BLUE COHOSH
TANSY AND RUE |
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SAFE herbs
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Red Raspberry leaf
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contraindications to preg exercise
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incompetent cervix
placenta previa or abruptia recent hx of vaginal bleeding rupture of membranes premature labor contractions intrauterine growth retardation |
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precautions to exercise
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Multiple gestations (twins! yikes!)
Anemia Systemic infection Extreme fatigue MSK complaints Diastasis recti |
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domestic violence
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the willful intimidation, physical assault, battery, sexual assault, and /or other abusive behavior perpetrated by an intimate partner against another
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leading cause of injury in women 15-44 years of age
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physical violence
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Percentage of abusive relationships that include sexual abuse
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40-45%
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Threats and coercive tactics are considered to be _________/________abuse
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emotional/psychological
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cost of abuse in economic terms
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exceeds 5.8 billion per year
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Who gets abused?
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85% are women
1 in 4 women experience domestic violence African American and Native American at higher risk for REPORTED abuse |
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Causes of abuse
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WITNESSING violence in the home as a child
POOR SELF ESTEEM SUBSTANCE ABUSE LOSS OF HEALTH or WAGE earning capacity |
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signs of violence
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CENTRAL injuries (head, neck, back, genitalia)
FINGER PRINT-LIKE BRUISES (bilateral rope burns or bruises) PATTERNED INJURIES (irons) MULTIPLE INJURIES (dff stages of healing ODD PLACES for injuries ADULT BITE MARKS are round |
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ABCD validate
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you are not ALONE
you are not to BLAME you are not CRAZY, what happened to you is a CRIME you do not DESERVE to be abused |
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Give the abused a copy of the
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VICTIM'S RIGHTS NOTICE
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What not to say...
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Don't ask if they are being abused/battered or a victim of domestic violence.
NEVER begin a question with, "why don't you" NEVER begin an inquiry with, "why didn't you?" |
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As a chiropractor, for God's sake, take
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x-rays!
They are court evidence. |
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anterior /superior SACRUM to uterus
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BROAD ligament
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anterior/lateral uterus to ISCHIUM (via other fascial attachments)
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ROUND ligament
R-ISCHIUM. Rishium. |
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sacral nerve roots
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NEUROLOGICAL IMPAIRMENT
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3 possible reasons for bleeding during first trimester and how they would be dx?
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* Miscarriage dx by ultra sound
* Placenta Previa dx by ultra sound * UTI dx by lab test- urine sample |
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3 non specific signs of pregnancy and other reasons for them
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Three non-specific signs of pregnancy could be significant fatigue, nausea/vomiting, and increased urination. Significant fatigue could be caused by anemia. Nausea/vomiting could be caused by a viral or bacterial ‘bug’ that affects the GI tract. The increased urination could be caused by diabetes.
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Increased hCG
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Increased cHG= hydataform mole or multiple fetuses
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progesterone
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Progesterone inhibits uterine contractions and maintains the pregnancy, it prepares the endometrium for implantation, and it inhibits spontaneous uterine contractions. Progesterone is vital to maintaining the pregnancy.
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hPL
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hPL increases circulating fatty acids for the mother’s increased energy demands, increases the mother’s blood glucose levels, and modifies the mother’s metabolism so it becomes more of an insulin antagonist.
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Prolactin
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inhibits ovulation post-partum, it stimulates the mammary glands to produce milk, and it is also the ‘bonding’ hormone that brings the mother and baby close together and is a general stress reliever. Prolactin also has a number of other effects including contributing to surfactant synthesis of the fetal lungs at the end of the pregnancy and immune tolerance of the fetus by the maternal organism during pregnancy.
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SACRAL PUMP
never allow Y-axis rotation during this |
“Sacral pump” – Stand behind the patient’s femur or in front of the tibia, flex the leg and tissue pull I-S with inner eminence onto S2 and I-S onto ASIS. As the patient exhales, apply I-S traction to both the ASIS and Sacrum while flexing the leg further. Repeat procedure to stretch pelvic floor musculature.
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ESTROGEN DOMINANCE
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When there are high, normal, or low estrogen levels are present with little to no progesterone to balance each other out.
Possible causes for this are when progesterone is not made as it normally should be, exposure to xenoestrogens from diet sodas, poor diet, and a lack of exercise. This has the potential to lead to breast cancer and faster aging. |
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BIO IDENTICAL HORMONES
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replacement hormones that are identical in structure to other hormones made in the body but are made artificially in a lab instead of by the body. They are controversial because there are many issues with measuring their levels. They do, however, relieve symptoms of menopause.
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QUESTIONS for DOMESTIC abuse victim
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I noticed you have several bruises, did someone do this to you?
You seem frightened of your partner; has he/she ever hurt you? Has your partner ever used a fist or weapon to hurt or threaten you? These questions would be asked when I am alone with the patient |
