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244 Cards in this Set

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Pregnancy is NOT a medical condition. It has been medicalized because of?
litigation
How many pregnancies throughout year in US?
~6 million
The WHO estimates _______________ women worldwide will die in a pregnancy/birth/post death.
1/2 million worldwide dead
Leading cause of death and disability among women (repro age) in dev. countries?
MATERNAL MORTALITY
Common FATAL complications of pregnancy
post partum hemorrhage, sepsis, comp of unsafe abortions, prolonged/obstructed labor, hypertension (eclampsia)
Maternal Mortality is the annual number of deaths of women from pregnancy related causes, when pregnant or ?
within 42 days of termination of pregnancy per 100,000 live births
Annual number of deaths of infants under 1 year of age per _____ live births
INFANT mortality
poverty, war, subjugation, lack of medication
Things which could affect infant mortality
termination of pregnancy before the 28th week
abortion
bleeding before the 28th week
threatened abortion
non-viable embryo/fetus separated from placenta
incomplete or inevitable abortion
3-4 consecutive abortions occuring at a specific time during pregnancy
Habitual abortion (natural causes)
Is a more natural birth process in countries w/ high or low infant mortality?
LOW
The US is ranked 46th in infant mortality. What does not matter?
advanced medicine technology (only reduces maternal mortality) and adequate health care
CP: 21 yr old white female w severe ankle swelling, fatigue, sensitivity to cold, mild dyspepsia 2 weeks
grossly overweight w/ pedal edema;move toaANTI inflammatory diet, Incr. VO2 max via exercise, Incr. HDL, lower LDL
Amenorrhea is strongly suggestive of
pregnancy (or gymnastics or some other weird stress)
Describe fatigue of pregnancy
EARLY and LATE, unknown cause; physiological shift of vital force. Plan around it!
Describe breast pain/swelling of pregnancy
Early chgs are hormonal. Lasts the whole pregnancy. Aggravate fibrotic breasts. FITTING BRA!
Describe nausea/vomiting/dyspepsia of pregnancy
Homones in FIRST trimester ONLY! Often dismissed as something else at first.
woman with LBP and severe fatigue
heart disease or heart attack
cholasma/melasma
mask of pregnancy and skin lightening (skin changes)
linea nigra and stria gravidarum
stretch marks of pregnancy
palmer erythema
50% pregnant women have flushed palms
why increased urinatins during 1st trimester
increased plasma volume and pressure on bladder and late sx in 3rd trimester (pressure)
Not only does your vagina run during pregnancy but so does your nose. Why?
ESTROGEN elevated -edema nasa mucosa/nosebleeds. Do upper CMT. No OTC sprays.
PTYALISM
excessive BITTER saliva produced in 1st trimester. Suck on Meyer lemons, parsley, fennel
3 highly probable specific indicators of pregnancy (test question)
hCG test/preg test, Braxton-Hicks contractions, Fundal height
4 very definitive specific indicators of P* (test question)
Fetal movement/ Fetal heartbeat/ Funic souffle (soft flowing fetal cardiac sounds)/ Fetal ultrasound
2 pregnancy tests
Urine OTC dip (~4 weeks pas 1st day LMP) & Serum bld test for hCG = MOST ACCURATE
why is hCG most accurate test for P*? (test question)
can detect prior to 1st missed period as early as 7-9 days after conception*****(test question)
4 false postives for hCG (rare in true pregnancy)
1. testicular tumor 2. ovarian tumor 3. Miscarriage 4. Hydatidiform Mole
trophoblast proliferation and chorionic villi swelling that has (+) hCG
HYDATIDIFORM MOLE
MOLAR pregnancy rate in US
1 in 1500 **(test)
signs of MOLAR pregnancy (test)
Marked elevated hCG, Marked nausea & vomiting, Pregnancy-induced HTN before 24 weeks, Vaginal bleeding universal
How to tx a molar pregnancy
removal/curettage of uterus, 1 year metastasis monitoring, watch for carotene or protein deficiency
7th week softening of uterine ISTHMUS (via internal palpation) (test)
HEGER'S sign (vs. Goodell's sign which is softening of cervix)

H-IS
(HEGER'S + ISTHMUS = HIS)
BLUISH discoloration of the cervix (test)
CHADWICK's sign

CHAD turned BLUE after he was SERVED
8th week feel increased blood PULSATION through uterus (test)
OSIANDER'S sign
softening of CERVIX (test)
GOODELL's sign (vs. Heger's sign which is softening of uterine isthmus)
DNA test during pregnancy
AMNIOCENTESIS
DNA test during pregnancy. Can cause TRANSVERSE DIGITAL DEFICIENCY due to villi removal.
CHORIONIC VILLUS test
BALLOTMENTS
INTERNAL: bimanual palpation to feel for FLOATING fetus ~ 14th wk. EXTERNAL: by 24th wk.
What are vitals to watch out for in 1st trimester? (test)
High blood sugar. If untreated leads to HEART & PELVIC abnormalities (organ differentiation)
PARA (test)
# of live births (> 20 weeks)
GRAVIDA (test)
# of pregnancies
GRAVIDA (test)
pregnant woman
PRIMAgravida (test)
first pregnancy
MULTIgravida (test)
pregnant more than once
NULLIgravida (test)
never nor currently pregnant
MULTIpara [t]
2 or more pregnancies DELIVERED
NULIpara [t]
NO pregnancy progresses BEYOND gestational age of ABORTION
PARTURIENT [t]
CURRENTLY in LABOR
PUERPERA [t]
a woman who has RECENTLY given birth
first trimester fetus [t]
EMBRYO
START of second trimester fetus is called?
FETUS
when able to survive, finally in 3rd trimester, a fetus is called a ?
BABY!
EDD
Estimated Date of Delivery
NAGLE'S RULE
First day LMP, subtract 3 months, add 7 days to get EDD [Est Date of Delivery]
How long is a full term pregnancy?
40 weeks or ~ 9 months (use Nagle's rule to figure EDD)
Trimester 1 weeks:
0-13 weeks
Trimester 2 weeks:
14-26 weeks
Trimester 3 weeks:
27-40 weeks
Range of entire pregnancy in weeks
38-42 weeks
If you have read this far and can't figure that these are all test [t] questions,
then make your own cards and type (test) at the end of every sentence. No more of that here.
Besides blood sugar, what are two other vital signs to definitely monitor during P*?
WEIGHT & BLOOD PRESSURE
Average weight gain in P*
25-35lbs (Overweight gain <25lbs, Underweight gain up to 40lbs, Twins gain up to 45lbs)
Which vitals are critical to monitor every visit?
Weight and Blood pressure
4 types of female PELVISES
gynecoid, android, anthropoid, platypelloid
GYNECOID
[50%] cylindrical, rounded pelvis, equal width & length *MOST COMMON
ANDROID
HEART SHAPED pelvis. 2nd most common. Wide at FUNDUS, narrow at CANAL
ANTHROPOID
LONGER than wide pelvis
PLATYPELLOID
WIDER pelvis -difficult delivery
How is clinical PELVIMETRY (shapes gynecoid, android, anthropoid, platypelloid) assessed?
Vaginally by licensed practitioner. Estimates pelvic inlet.
feto-pelvic disproportion can be due to?
Too large to birth naturally or too small. Too large could be due to gestational diabetes.
Basic lab tests in first trimester:
hCG, CBC, UA, ABO
If LOW level of hCG in 1st trimester?
FETAL DEMISE. High level means multiple fetuses, incorrect gestation date.
Why do a CBC in 1st trimester?
ANEMIA; 'physiologic anemia' decreased HCT w/ normal Hb, checked at 28 and 36 wks
How is urinalysis done in 1st trimester?
dipstick test for glucose & protein
Why is ABO test done in 1st trimester?
Rh Factor typing
What is Rh Factor?
RBC antigen (rhesus factor) = INCOMPATIBILITY ISSUE if mom (-) and fetus (+). SENSITIZATION for next pregnancies
How to fix opposite Rh factor problem or just prophylactically prevent it?
RHOGAM dose in 28th week when baby's blood can cross placenta and cause mother to mount fatal attack against non-self
Rhogam is an Rh _____________ given at _____ th week/at birth/at miscarriage/at abortion
immunoglobulin, 28th (beginning of 3rd trimester is 27th week)
Why should multiple or early DOPPLER ULTRASOUND be AVOIDED?
damages the embryo's fast growing cells
What are some VIABLE reasons for ULTRASOUND during pregnancy?
Uncertain menstrual dates, # of fetuses, fetal presentation & lie, vaginal bleeding, pelvic pain (ectopic?), uterus small or large, premature labor
Further reasons for ultrasound during pregnancy…
adjunct to amniocentesis, hx of congenital anomalies, suspected fetal demise, abnormal maternal blood screening results
test that screens for NEURAL TUBE DEFECTS
ALPHA-FETOPROTEIN. Done at beginning of 2n trimester/16-18 weeks
Why alpha fetoprotein test for neural tube defects?
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
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
MacDonald's rule translated
At week 20, fundal height in cm. (measured from pubic symph. to top of uterus) should be same as # of weeks of pregnancy
SNOUT
test with high SeNsitivity, good for ruling OUT (sensitivty-negative-rule out!)
SPIN
test with high SPecificity, good for ruling IN (specificity - positive - rule in)
Prenatal testing in 2nd/3rd trimester (2)
1-hour glucose screen, Group B streptococci screen
Non-stress prenatal test (>28 weeks)
Meas response of fetal HR to fetal movements. NORMAL: 2 accelerations in 10-20 min, lasting @ least 15 seconds
The fetal heart rate activity test is considered a ____________ test
non-stress
At least 3 discrete gross body movements
Fetal MOVEMENT
at least 1 episode of limb EXTENSION to FLEXION
fetal TONE
at lease 1 episode of breathing for 30 seconds
fetal BREATHING
at least 1 pocket of fluid measuring 2 cm
AMNIOTIC FLUID
Reasons to perform special genetic testing for P*?
age > 35-40 years old, elevated AFP or hCG, prev. stillbirth, sibling or close relative w chromosomal abnorm, Parent w transmissible abnormality
Why and when to do AMNIOCENTESIS
Over 35 y.o.a. Done @ 16 weeks gestation. 30 ml. removed. NEURAL TUBE DEFECT detection. Chance 1-3% fetal death.
Why and when to do CHORIONIC VILLUS sampling?
done at 9-12 weeks. 10-20 mg. villi removed. RISK OF TRANSVERSE DIGITAL DEFICIENCY. 1-5% fetal death chance.
LEOPOLD'S MANEUVER
Trying to determine fetal LIE (position of head)

LEOPOLD'S LIE.
LIE of fetus
long axis of fetus compared to long axis of mother
ATTITUDE of fetus
fetal flexion or extension of SPINE
Named for what bony part of fetus is going to pop out first
PRESENTATION: vertex, breech, brow, facial, shoulder (yikes)
boney part of fetus related to presentation
DENOMINATOR
relation to mother's pelvis
POSITION of fetus
What is normal PRESENTATION of fetus?
VERTEX
What is MOST DANGEROUS presentation of fetus and why?
FACIAL= BLOCKS AIRWAY and cervical spine in hyperextension
Really really bad presentation ?
SHOULDER (arm) or foot comes out first
Risk of BREECH birth?
ANOXIA and cervical spine injured
Normal menstrual cycle
ovulation (mid cycle day 14 of 28)

endometrial tissue prepped

corpus luteum degenerates if unfertilized

normal menses occurs
2 phases of menstrual cycle and one divider?
FOLLICULAR phase
OVULATION (divider)
LUTEAL phase
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)
Produces PROGESTERONE in case there is a pregnancy
CORPUS LUTEUM

(will degenerate if nothing happens)
Required for true pregnancy?
IMPLANTATION

*can have fertilization w/ an IUD but not implantation
Hormones of PREGNANCY
hCG, Progesterone, Relaxin, Estriol, Estrogen
Stimulates and maintains the CORPUS LUTEUM
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.
Peak of hCG?
7-10 weeks
LIMITS activity of womb but later SOFTENS the cervix and reduces contractions
RELAXIN - inhibits contractility w/ progesterone

assists breast growth, renal dilation
Induces smooth muscle relaxation throughout body (uterus) and prepares endometrium for implantation
PROGESTERONE - inhibits contractility w/ relaxin
to 'pro' gest something is to ?
prepare it, as in PRO GESTerone

induces smooth mm relaxation thorughout body (uterus) and BALANCES the actions of estrogen
I think I'll have some SOFT CERVE ice cream and RELAX
RELAXIN SOFTENS the CERVIX
Troph is to grow, as in maintain, so __________ grows and maintains the corpus (body) luteum.
hCG
Human Chorionic GonadoTROPIN
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
2 types of ESTROGEN:
Estradiol - ovarian

Estriol- placenta- large increase production depends on precursors from fetal adrenal glands
Your mother builds you up and placates you and finally kicks you out of the house:
Estrogen:
BUILDS TISSUES
PLACENTA
UTERINE CONTRACTILITY
human Placental LACTOgen (hPL)
increases blood GLUCOSE levels and is ANTI-insulin
Give that baby some sugar!
hPL
Human Placental Lactogen

*lactose is sugar, and that's what it does.
At what week should hCG drop?
11th

*if not, may mean multiple fetuses or molar pregnancy
pro-LACT-in does what?
MILK LET DOWN
As in prepares and maintains breast for LACTation
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?
Uterine muscle contraction (how'd you know?)

Enhances delivery of placenta, too, because you don't want to leave that laying around up there.
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?
progesterone

Periods suck because of hormonal politics that are really only useful during pregnancy.
AMNIOTIC fluid peaks?
38-39 weeks
Too much amniotic fluid
POLYhydraminos
Not enough amniotic fluid
OLIGOhydraminos
How is amniotic fluid maintained?
Fetus itself...(mother provides the H2O)
*fetus begins to swallow and inspire amniotic fluid, then excretes it through kidneys
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
OLIGOhydraminos is a fetal _____ problem
kidney - not enough being excreted

*risk: no mechanical barrier/PROTECTION between baby and getting bounced around
Placenta FUNCTIONS [3]
PRODUCTION (hCG, estriol/estrogen)
EXCHANGE
PROTECTION**
placental PREVIA
placental problem:
LOW, PARTIAL, TOTAL where it is placed.
Should be high up in uterus, otherwise could obstruct.
the placental PRODUCTION includes
hCG
estrogen
estriol
the placental EXCHANGE includes
digestion via exchange or resorption of oxygen, nutrients, water, electrolytes, pH balance
the placental PROTECTION includes
MECHANICAL barrier, maternaL IMMUNOGLOBULINS
placental PREVIA
LOW, PARTIAL, TOTAL placement within uterus (should be high)
placental ABRUPTIO
SEPARATION

an abrupt break up
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
PREVIA of placenta
implantation of placenta somewhere other than above the fetus
placental ABRUPTIO is more frequent with _____ use and _____
cocaine
and hydraminos

EMERGENCY. Mother may bleed to death
placenta SENILE
OLD placenta. Forgets to come out.

Placenta loses blood supply and atrophies. Remains. Has to be surgically expelled.
placenta ACCRETA (superficial)
ABNORMAL ADHERENCE (accretion) to uterine wall
placental INCRETIA
partial uterine wall adherence into myometrium

Incredulous, my endometrium shouted, "let go!" but the damned thing was half stuck, IN/encroached in the wall.
placental PERCRETA
full penetration of placenta through the myometrium and into the abdominal cavity. Requires hysterectomy.

MY PERCRETA made me HYSTERICAL so I had it removed.
accreta of placenta
uterine wall penetration:
increta - half stuck, half through myometrium
percreta - all the way through, requires hysterectomy
Hear fetal HEART sounds with ___________ in the first _____ weeks gestation. ****
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}
TIME highest risk for MISCARRIAGE
1st trimester
Do/do not put a hot pack on low back in pregnancy?
NO.

No hot tubs, etc. Air travel ok.
All embryo body ORGANS are formed in the ____ week.
8

*8 organs play in Saint Patrick's cathedral.
Lack of FOLATE and DIABETES can cause?
HEART & PELVIC deformities
2nd trimester is called the ________ trimester! (hear harps playing)
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.
QUICK 2 GOLD
2nd trimester is GOLDEN.

Mother feels first movements as QUICKENING.
DIASTASIS RECTI is not only a concern of Marfan's patients, but also of
mothers in the 2nd trimester

[separation of linea alba]
SPONGY GUMS
2nd trimester (sounds golden, alright)
Heartburn, constipation common.
Secreting colostrum for milk.
When can the baby recognize the parent's voices and becomes light sensitive?
Guess? It's the 2nd GOLDEN trimester

QUICK 2 GOLD
3rd trimester milestones:
BRAXTON-HICKS CONTRACTIONS
&
LIGHTENING (baby descends to pelvic inlet)
Average length of pregnancy`
32 weeks***
Webster breech protocol is to
get rid of uterine torsion
LBP in pregnancy
postural changes
ligament laxity
decreased abdominal fcn

Relieved w/ rest or a change in position and external stabilization
Where is pregnancy pain the worst?
lateral to L5-S1 deep in buttock

4x greater than LBP
Radiates to knee
Why rib pain?
Upward movement of uterus
Often on R side

Soft tissue work/mobilization
ROUND LIGAMENT PAIN
stretches, hypertrophies
Lower abdomen/inguinal pain
Attaches to sacrum and P.symph.
Soft tissue work to round ligament
Reason for Webster technique
Align pelvis, round ligament tone, and abdominal muscle tone
Check for MOST leg resistance w/ Webster's and the short side is the
PS sacrum
Adjust the side of INCREASED resistance
Find the trigger point on the OPPOSITE of sacral rotation.
UTI can cause premature _________
contractions
MOST COMMON etiology of ACUTE abdominal pain in pregnancy
**APPENDICITIS

-Surgery required
Choleocystitis and bowel obstruction in pregnant women
same sx as non pregnant women

choleocystitis more common in older, fat women
HYPER-EMESIS GRAVIDARUM
morning sickness

ie, an emetic makes you vomit, like castor oil
Avoid hyperemesis gravidarum by ?
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
When should you notify a midwife if you have morning sickness?
inability to continue normal ADLs, continues after 16 weeks, strong cravings for non-food items PICA*** means iron-deficiency anemia
PICA
craving a non-food item

pregnancy - means iron-deficient anemia potentially
Traditional approach to morning sickness
avoid offensive odors, eat small meals and bland food
Food remedies for vomiting
raspberry or chamomile tea
ginger
Meyer lemons
chiropractic for mid thoracic spine
Acupressure good for morning sickness. Which points to avoid?
Large intestine 4 & spleen 6
When to use acupuncture points that bring on labor?
lg intestine 4 and spleen 6 AFTER first 8 months only
GESTATIONAL DIABETES can cause
heart and pelvis defects in fetus
Risk factors for gestational diabetes
high maternal age, obesity, previous heavy baby, family hx of DM, previous stillbirth, smoking
IF gestational DM, the baby can be
TOO DAMNED BIG!
Too much sugar makes a fat baby, difficult delivery, respiratory distress, hypoglycemic episodes, jaundice
if Gestational DM, risk to mother
pre-eclampsia (HTN and proteinurea = early delivery vs. organ failure and potential death to mother and child), UTI, difficult delivery, physical injury
Regarding HTN in pregnancy, you must
DO the CORRECT method of taking blood pressure

140/90 same as nonpreg people
PIH
Pregnancy-Induced Hypertension

Common finding: HTN, proteinurea, swelling of face.

PRE-ECLAMPSIA
describe clinical signs of pre-eclampsia
sudden weight gain
high blood pressure
edema
Risk factors for pre-eclampsia
nulliparity, >40yo, family hx PIH, chronic HTN in mother, DM, multiple gestation
OBESITY (12x risk)**
If allowed to persist, pre-eclampsia:
VISUAL CHANGES
SEIZURES

poor placental perfusion, decreased mom renal function, hyper-reflexia
Pain meds for labor
DEMEROL crosses placenta, depresses respiration, inhibits breastfeeding
EPIDURALs cause longer labor, fevers, antibiotic nec, jaundice
EFFACEMENT (s&t)
COMPLETE DILATION OF CERVIX statge of labor means SHORTENING AND THINNING ***

a short, thin rock effacement
When does the delivery actually end?
With the delivery of the PLACENTA
STATION ZERO of labor

"she's a go!"
baby head at level of
ISCHIAL SPINES
Station Zero is baby head at level of ischial spines.
ENGAGED level?
ENGAGED is -2
describe levels of STATIONS during delivery
-3..-2 (engaged)...-1...0 (ischial spines)...+1...+2...+3
Initial phase of labor
FLEXION of cervical spine
Internal rotation, then
cervical extension. Complete extension is not until crown.
Baby's neck only goes into extension after
crown.
RESTITUTION
external rotation (after crown) of the head and neck and baby's shoulders are through!
Most traumatic way to be born
C-section
Post partum cause
extreme DROP of progesterone
antibody/immune system for baby in mother's milk first couple of weeks
COLOSTRUM
FOREMILK & HINDMILK
FOREMILK: satisfies baby hunger (high fat)

HINDMILK: where EFA comes from
Contraindications to breastfeeding
ill mother
ill infant
very premature infant
impurity in milk
breast deformity
PCB's
Pro's of breastfeeding
NATURAL IMMUNITY
PROPER NUTRIENTS per stage
LESS DIGESTIVE PROBLEMS
HIGHER IQ levels
HEALTHY BONE development
chiropractor's role for breastfeeding comfort?
cervical spine health
Maternal nutrition has profound effect on pregnancy and outcome. Need at least?
400 mcg of FOLIC ACID
18 mg of IRON daily
PRIOR to pregnancy
Food precautions
generic -wash veggies, cook food thoroughly
Limit mercury intake (tuna)
Take Omega 3
Caution unsafe herbal teas/supplements
FAS complications
Fetal Alcohol syndrome:
mental retardation, birth defects, abnormal facial features, delayed development, vision/hearing/behavior
Tobacco use during pregnancy linked to
Um...just don't.

Low birth weight, miscarriage, SID
No _______ first trimester.
caffeine.

Linked to low birth weight, vasoconstriction, miscarriage
Herbs to avoid in preg
BLACK AND BLUE COHOSH
TANSY AND RUE
SAFE herbs
Red Raspberry leaf
contraindications to preg exercise
incompetent cervix
placenta previa or abruptia
recent hx of vaginal bleeding
rupture of membranes
premature labor contractions
intrauterine growth retardation
precautions to exercise
Multiple gestations (twins! yikes!)
Anemia
Systemic infection
Extreme fatigue
MSK complaints
Diastasis recti
domestic violence
the willful intimidation, physical assault, battery, sexual assault, and /or other abusive behavior perpetrated by an intimate partner against another
leading cause of injury in women 15-44 years of age
physical violence
Percentage of abusive relationships that include sexual abuse
40-45%
Threats and coercive tactics are considered to be _________/________abuse
emotional/psychological
cost of abuse in economic terms
exceeds 5.8 billion per year
Who gets abused?
85% are women
1 in 4 women experience domestic violence
African American and Native American at higher risk for REPORTED abuse
Causes of abuse
WITNESSING violence in the home as a child
POOR SELF ESTEEM
SUBSTANCE ABUSE
LOSS OF HEALTH or WAGE earning capacity
signs of violence
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
ABCD validate
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
Give the abused a copy of the
VICTIM'S RIGHTS NOTICE
What not to say...
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?"
As a chiropractor, for God's sake, take
x-rays!

They are court evidence.
anterior /superior SACRUM to uterus
BROAD ligament
anterior/lateral uterus to ISCHIUM (via other fascial attachments)
ROUND ligament

R-ISCHIUM. Rishium.
sacral nerve roots
NEUROLOGICAL IMPAIRMENT
3 possible reasons for bleeding during first trimester and how they would be dx?
* Miscarriage dx by ultra sound
* Placenta Previa dx by ultra sound
* UTI dx by lab test- urine sample
3 non specific signs of pregnancy and other reasons for them
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.
Increased hCG
Increased cHG= hydataform mole or multiple fetuses
progesterone
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.
hPL
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.
Prolactin
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.
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.  
ESTROGEN DOMINANCE
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.
BIO IDENTICAL HORMONES
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.
QUESTIONS for DOMESTIC abuse victim
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