PPOM 2 Week 14 LEC 121-131 WORK IN PROGRESS

(121) Sympathetic Innervation of the Ovaries is done by:

T10–T11

(121) Sympathetic Innervation of the Uterus & Cervix is done by:

T12–L2 (via inferior hypogastric plexus)

(121) Sympathetic Innervation of the Broad Ligament is done by:

T10–L2

(121) Parasympathetic Innervation of the Ovaries is done by:

Vagus nerve

(121) Parasympathetic Innervation of the Uterus & Cervix is done by:

S2–S4 (pelvic splanchnic nerves)

(121) Parasympathetic Innervation of the Broad Ligament is done by:

S2–S4

(121) Anterior Chapman’s Point for Ovaries

Pubic tubercle (lateral to symphysis)

(121) Anterior Chapman’s Point for Uterus

Upper edge of junction of pubic ramus and ischium

(121) Anterior Chapman’s Point for Broad ligament

Outer femur (along IT band)

(121) Posterior Chapman’s Point for Ovaries

T10 transverse process

(121) Posterior Chapman’s Point for Uterus

Lateral sacral base, L5 TP

(121) Posterior Chapman’s Point for Broad ligament

Lateral sacral base / PSIS

(121) physiologic changes of pregnancy - ↑ Lumbar & cervical lordosis

postural adaptations to balance anterior weight; may cause low back pain

(121) physiologic changes of pregnancy - ↑ Thoracic kyphosis or flattening

postural adaptation that counterbalances lumbar curve

(121) physiologic changes of pregnancy - ↑ Sacral nutation and anterior pelvic tilt

postural adaptation that facilitates fetal accommodation in pelvis

(121) physiologic changes of pregnancy - Diaphragm displacement (4 cm upward)

postural adaptation of decreased excursion leading to reduced lymphatic return

(121) physiologic changes of pregnancy - “Sacral sag – fascial drag”

postural adaptation of fascial strain restricting pelvic mobility

(121) physiologic changes of pregnancy - Rectus abdominis weakening

postural adaptation that leads to decreased trunk stability

(121) physiologic changes of pregnancy - Knee hyperextension & altered gait

postural adaptations of gravitational adjustments to center of mass

(121) Cardiovascular Changes in Pregnancy

↑ Plasma volume, ↓ SVR, progesterone-induced vasodilation, IVC compression

(121) Hematologic Changes in Pregnancy

Hypercoagulable (↑ clotting factors, venous stasis)

(121) Respiratory Changes in Pregnancy

Elevated diaphragm, ↑ tidal volume, ↓ residual volume

(121) GI Changes in Pregnancy

↓ LES tone, ↓ motility, ↑ reflux, constipation

(121) GU Changes in Pregnancy

Bladder compression → frequency, incomplete emptying

(121) Endocrine Changes in Pregnancy

↑ Prolactin (milk production), ↑ Oxytocin (letdown, contractions), ↑ Relaxin (ligamentous laxity)

(121) Clinical Implications of Cardiovascular Changes in Pregnancy

Varicosities, pedal edema, need for left lateral recumbent positioning

(121) Clinical Implications of Hematologic Changes in Pregnancy

DVT risk, hemorrhoids

(121) Clinical Implications of Respiratory Changes in Pregnancy

Dyspnea, reduced lymph drainage

(121) Clinical Implications of GI Changes in Pregnancy

GERD, hemorrhoids, nausea

(121) Clinical Implications of GU Changes in Pregnancy

Stress incontinence, ↑ UTI risk

(121) Clinical Implications of Endocrine Changes in Pregnancy

Easier OMT response, increased joint mobility, postpartum tissue vulnerability

(121) Relaxin

Hormone that softens pubic symphysis, increases ligamentous pliability. Originates in Corpus luteum (later placenta), peaks in Late pregnancy; persists 6–12 weeks postpartum

(121) Five Ps of Labor

Passageway, Passenger, Powers, Position, Psyche

(121) Absolute Contraindications to OMM in pregnant patients

Eclampsia or preeclampsia, Vaginal bleeding of unknown cause, Preterm labor, Ruptured membranes, Unstable maternal or fetal condition

(121) Relative Contraindications to OMM in pregnant patients

High-risk pregnancy (placenta previa, abruption), Advanced ligamentous laxity, Recent abdominal surgery (e.g., early post-C-section), Severe instability or pain limiting tolerance, Use of HVLA during pregnancy

(121) Function of Left lateral recumbent positioning

improves venous return and reduces IVC compression

(122) Spine (T1–sacrum) and gynecology

Influences blood and nerve supply to pelvic organs

(122) Pelvis and gynecology

Supports and transmits forces; dysfunction affects the uterus, ovaries, bladder, and lymphatics

(122) Thoraco-Lumbar (T-L) Junction and gynecology

Vital for diaphragmatic excursion, venous return, and lymphatic drainage

(122) Internal Impact/External Manifestation of Pelvic torsion / innominate rotation

Altered uterine position, venous stasis; Low back/pelvic pain

(122) Internal Impact/External Manifestation of Thoracic inlet restriction

Impaired lymphatic/venous drainage; Breast tenderness, mastitis

(122) Internal Impact/External Manifestation of Diaphragmatic restriction

Impeded abdominal pump; Bloating, sluggish bowel movement

(122) Internal Impact/External Manifestation of Scar adhesions

Altered fascial glide; Local pain, organ tethering

(122) Anatomic / Structural Features of Childhood

Growth of spine/pelvis; postural development

(122) Anatomic / Structural Features of Adolescence

Hormonal surges; rapid pelvic and spinal adaptation

(122) Anatomic / Structural Features of Womanhood

Cyclic uterine/ovarian changes, pregnancy and delivery stresses; Support diaphragmatic motion, sacral mechanics, lymph flow

(122) Function of respiratory diaphragm

acts as the main pump for venous and lymphatic drainage

(122) Function of Thoraco-lumbar junction

freedom ensures effective diaphragmatic excursion

(122) Function of pelvic diaphragm

provides counter-support for visceral and lymphatic flow