CASE STUDY - Posterior Occiput Presentation and low back pain at 38 weeks

Case History  : 37 year old woman presents with a posterior presentation at 38 weeks gestation on August 9, 2009.  She is a previous patient.

The patient is pregnant for the 7th time.  She had suffered a miscarriage during the 12th week of a previous pregnancy in July of 2004.  She was referred to our office for care by her midwife. Her previous 5 births were vaginal and reportedly without interventions.  

She is currently complaining of a posterior presentation of her baby and backache of pregnancy.  She also is complaining of water retention which she admits has occurred during all of her previous pregnancies as well.  Her midwife reports this patient’s uterus is normal and is free from uterine myomas and free from any anomalies, such as a bicornuate, septate, or unicornuate uterus.  

Consultation:

She denies having any automobile accident history.

She communicated the following accident history:

This patient has played soccer throughout high school and college.  She sustained many impacts to her knees and suffered from “water on the knee” in her left knee.  She did not have any surgery, fractures or stitches directly related to her involvement in this sport.   

She is a labor and delivery nurse and denies any on the job injuries.

This patient denies smoking.  She reportedly does not drink coffee or tea.  She reports that she eats a well-balanced diet.  She exercises on a regular basis; at least four to five times per week by way of walking on a treadmill.  She claims that she does not get at least eight hours of quality sleep per night.  She is taking pre-natal vitamins as directed by her midwife.  This supplement is not causing digestive distress that is sometimes common with this particular supplement.  She reported being unaware if her amniotic fluid levels were within normal limits.  

Physical Examination –

A thorough examination of her lumbosacral spine was conducted due to her advanced stage of pregnancy and due to her chief complaints of low back pain and posterior presentation of her baby.  Postural evaluation revealed a lumbar hyperlordosis most likely due to her advanced pregnancy.   

Lumbar active range of motion was within normal limits with no noted pain or discomfort except for lumbar extension which caused pain at the lumbosacral area.   

Deep Tendon Reflexes:  Biceps (C5\C6):  left: normal;  right: normal. Brachioradialis (C5\C6):  left: normal;  right: normal. Triceps (C7\C8):  left: normal;  right: normal. Patellar (L2\L4):  left: normal;  right: normal. Hamstrings (L4\L5):  left: normal;  right: normal. Achilles (S1\S2):  left: normal;  right: normal. Cranial Nerve Exam:  Myotome evaluation revealed no weakness in the  upper and lower extremity. Dermatome evaluation revealed no altered sensation to pin prick in the  upper and lower extremity.

Spinal analysis using muscle testing uncovered the following misalignments:

Sacrum was posterior on the left (P-L), Right superior pubic arch, Right anterior trochanter, T4-T7 Posterior, C7 body right, and C2 body left.  

Prone leg checks uncovered a right short leg of ¼. George’s test was found to be negative.    

Using Basic Sacral Occipital analysis, the patient was not found to be a Category.      

All cervical orthopedic tests were found to be within normal limits.  The lumbar orthopedic tests that are not contraindicated during pregnancy were also found to be within normal limits.   

A thermal spinal scan showed areas of mild thermal asymmetries in the cervical spine (specifically C2 through C4) and in the lumbosacral spine (L5-S1) which correlates and supports the initial exam findings.  

Care Plan
Based upon the patient’s history of traumas, previous pregnancies, weeks gestation of current pregnancy and presenting symptoms, the following care plan has be recommended:

Due to the acute level of this patient’s presenting symptom and limited time before the birth of the baby, Specific Prenatal Chiropractic spinal adjustments are recommended two to three times weekly until the birth of the baby.  A 6 week post-partum check up is also recommended to evaluate a continued need for care.  

Treatments

This patient has been a long time patient of this office and regularly receives care when pregnant.  She received her first chiropractic adjustment for this complaint on August 5, 2009.

C2 (BL) was adjusted on the left, manually, in the prone position as was C7 (BR) and T4 (PL).  .  L5 (PR) was also adjusted on the prone position using an instrument.  A right anterior trochanter was adjusted using an instrument in the prone position.  A right superior pubic bone was adjusted in the supine position using an  instrument.  Because of the urgent nature of her condition and the time constraint to make significant changes prior to the start of labor, this patient was also advised to start taking Homeopathic Pulsatilla at 30C potency.

This patient received her second chiropractic adjustment one week later on August 12, 2009.     She reported marked improvement of her primary complaint after the first adjustment. The low back pain that accompanies a posterior presentation was much better.  C4 (BL) was adjusted on the left, manually, in the prone position as was T5 and T12. Her sacrum was adjusted on the left (PL) in the prone position using an instrument.  A right superior pubic bone was adjusted in the supine position using an instrument.   

This patient only received two adjustments as she delivered her baby the following week and wasn’t able to maintain her scheduled care plan at that time.  

Discussion

Because of this patient’s primary complaint of a posterior presentation and concomitant low back pain, it was vital that her pelvis be evaluated thoroughly.  

Left Occiput Anterior LOA is the most common position at the start of labor.  In this position the baby is lined up so as to fit through the pelvis as easily as possible.  

The baby is head down; facing the mother’s back – specifically, the sacrum.  Its left occiput is resting on the left anterior portion of the mother’s pelvis.

In an occiput anterior position, the baby’s head is easily 'flexed', so that the smallest part of its head will be applied to the cervix first. The diameter of its head (suboccipitobregmatic diameter) which has to fit through the pelvis is approximately 9.5 cm.

In a Vertex, Occiput Posterior, the baby’s occiput is resting on the posterior portion of the mother’s pelvis.

• This makes for a more difficult vaginal delivery.  
• It almost always causes a great deal of back labor.  
• The baby cannot fully flex its head in this position
• The diameter of its head (occipitofrontal diameter) which has to enter the pelvis is approximately 11.5cm and can reach up to 12.5 cm.
• If the baby is in the occiput posterior position (right or left) during late pregnancy, it’s possible that it won’t engage (descend into the pelvis) before labor starts.   
• By not engaging, it is harder for labor to start naturally and usually leads to induction of labor with Pitocin.  
  

Furthermore, in the occiput posterior position

• Braxton-Hicks contractions especially painful
• The baby will put a great deal of pressure on the bladder.  
• By not engaging it is likely that the mother may go past her due date and therefore more likely to be induced.   
• Posterior presentation is more of a problem for a first time mother (Primigravid) than it is for subsequent births (Multiparous) because when a mother has given birth before, there is generally more room for the baby to maneuver and rotate during labor.

www.premierpregnancypractic.com

Want to build, grow and perfect your Pregnancy Practice? Let's get on a call to discuss your strategy. The first call is on me! Schedule now

Dr. Karen, just wanted to say wow...I've learned so much and I'm only into the 2nd module. This is the stuff we need to know in everyday practice! I could listen to you all day long!        ~ Dr. Katie Gelesko Stull

CASE STUDY - Severe arm and hand pain and numbness at 36 weeks gestation.

Case History  : 33 year old woman presents with severe arm and hand pain and numbness at 36 weeks gestation.

The patient is pregnant for the 5th time.  She had suffered a miscarriage during the 15th week of a previous pregnancy in July of 2004.  She was referred to our office for care by her midwife. Her previous 3 births were vaginal.  

She is currently complaining of water retention and severe arm and hand pain during this pregnancy.  She denies suffering from this complaint or any others prior to this pregnancy.     Although very painful and consistent, none of her current symptoms are interfering with her activities of daily living.  

Consultation:

She communicated the following automobile accident history:

At age 15, she was a passenger in the front seat of a car when it was impacted at 25 miles per hour on the driver’s side of the car.  She detailed that she hit her stomach but did not receive any medical treatment for her injuries

In the spring of 2005 she was involved in a more serious automobile accident in which the car she was in was totaled.  The patient was seated in the driver’s seat of the car in a parking lot.  Her car was struck in the rear at a high rate of speed by another car.  Her car then lurched forward and impacted a pole.  She sustained injuries to her face as a result of hitting the steering wheel.  She claims that she never received medical care for her injuries.

She is a nurse in a hospital setting and denies any on the job injuries.

Her current complaint of severe arm and hand pain and numbness started a few weeks prior to coming to the office for an evaluation.  She describes that it starts in her fingers and works it way up to her shoulder.  This pain and numbness is bilateral.  She reveals that the discomfort has become more constant in nature and is worse when talking on the phone for extended periods of time.  She also awakens frequently during the night due to the severe discomfort.  

This patient denies smoking.  She reportedly does not drink coffee or tea.  She reports that she eats a well-balanced diet.  She exercises on a regular basis; at least four to five times per week by way of walking on a treadmill.  She claims that she does not get at least eight hours of quality sleep per night due to her current complaint.  She is taking pre-natal vitamins as directed by her midwife.  This supplement is not causing digestive distress that is sometimes common with this particular supplement.  She reported being unaware if her amniotic fluid levels were within normal limits.  

Physical Examination –

A thorough examination of her cervical spine was conducted due to her complaints of arm and hand pain and numbness.  Her lumbar spine was also thoroughly evaluated due to her advanced stage of pregnancy. Postural evaluation revealed a lumbar hyperlordosis most likely due to her advanced pregnancy, a high right shoulder and a high right ilium.  

Cervical active range of motion was within normal limits with the exception of right lateral flexion and left rotation which were both decreased with no noted pain or discomfort.  Lumbar active range of motion was within normal limits with no noted pain or discomfort.   

Palpatory tenderness was noted over the spinous of T10 and also over the right sacroiliac joint.  Spinous percussion was positive at the levels of L3 and C7  

Deep Tendon Reflexes:  Biceps (C5\C6):  left: normal;  right: normal. Brachioradialis (C5\C6):  left: normal;  right: normal. Triceps (C7\C8):  left: normal;  right: normal. Patellar (L2\L4):  left: normal;  right: normal. Hamstrings (L4\L5):  left: normal;  right: normal. Achilles (S1\S2):  left: normal;  right: normal. Cranial Nerve Exam:  Myotome evaluation revealed no weakness in the  upper and lower extremity. Dermatome evaluation revealed no altered sensation to pin prick in the  upper and lower extremity.

Spinal analysis using muscle testing uncovered the following misalignments:

L5 posterior on the right (PR), T10 posterior on the right (PR), T5 Posterior, T1 posterior on the right (PR), C7 body right, C2 body left and a right anterior trochanter.

Prone leg checks uncovered a right short leg of ½ inch and a positive Derefield on the right as well as a right cervical syndrome.  Supine leg checks revealed no short leg.  Although George’s test was found to be negative, the patient complained of ringing in her left ear while performing the test.  

Using Basic Sacral Occipital analysis, the patient was not found to be a Category.      

All cervical orthopedic tests were found to be within normal limits.  The lumbar orthopedic tests that are not contraindicated during pregnancy were also found to be within normal limits.   

A thermal spinal scan showed areas of severe thermal asymmetries in the cervical spine (specifically C1 and C7) which correlates and supports the initial exam findings.  

Care Plan
Based upon the patient’s history of traumas, previous pregnancies, weeks gestation of current pregnancy and presenting symptoms, the following care plan has be recommended:

Due to the acute level of this patient’s presenting symptom, Specific Prenatal Chiropractic spinal adjustments are recommended two to three times weekly for at least three weeks for symptomatic relief.  Once relief is obtained, one to two weekly adjustments is recommended until the birth of the baby.  A 6 week post-partum check up is also recommended to evaluate a continued need for care.  

Treatments

This patient received her first chiropractic adjustment on May 26, 2005.

C2 (BL) was adjusted on the left, manually, in the prone position as was C5 (BR) and T4(PL).  T10 was adjusted (PR) in the prone position using an instrument.  L5 (PR) was also adjusted on the prone position using an instrument.  A right anterior trochanter was adjusted using an instrument also in the prone position.  Due to her primary complaint or arm and hand pain and numbness, her upper extremities were mobilized as well.  It was also recommended that she increase her intake of Vitamin B6 to help with the carpal tunnel type symptoms she was experiencing.  

This patient received her second chiropractic adjustment on June 2, 2005.   She reported marked improvement of her primary complaint after the first adjustment. However, she still had considerable, asymptomatic swelling in both of her hands.   Again C2 (BL) was adjusted on the left, manually, in the prone position as was C5 (BR).  T1 and T10 were adjusted in the prone position, manually.  Manual traction was used in the cervical spine following her adjustment.  

This patient only received two adjustments as she delivered her baby the following week and wasn’t able to maintain her schedule care plan at that time.  

Discussion

Because of this patient’s primary complaint of arm and hand pain and numbness, it was vital that her cervical spine be evaluated thoroughly.  Oftentimes, supplementing one’s diet with foods high in Vitamin B6, symptomatic relief can be obtained.  

Food Sources of vitamin B6 include

• sweet potatoes
• avocados
• brown rice
• sunflower seeds
• chick peas
• salmon
• pork
• chicken
• turkey
• potatoes
• bok choy
• barley
• bananas
• Mangoes

Women who are more like to suffer from a vitamin B6 deficiency normally have a diet lacking in vitamin B6, a history of using oral contraceptives or hormone replacement therapy a diet of foods that contain yellow dye #5, such as some types of macaroni and cheese and pickles and/or have a history of stress.  A typical dose of vitamin B6 for carpal tunnel syndrome is 50 mg 2 to 3 times a day.   It can take up to 6 weeks to notice an improvement in symptoms.  Note:  The maximum intake of B6 from all sources (supplements and food sources) should be less than 200 mg a day

Enzyme supplements such as bromelain may help to reduce tissue swelling associated with carpal tunnel syndrome. It should be mentioned that it can take several weeks to notice results.

www.premierpregnancypractic.com

Want to build, grow and perfect your Pregnancy Practice? Let's get on a call to discuss your strategy. The first call is on me! Schedule now

Dr. Karen, just wanted to say wow...I've learned so much and I'm only into the 2nd module. This is the stuff we need to know in everyday practice! I could listen to you all day long!        ~ Dr. Katie Gelesko Stull

CASE STUDY - Backache of Pregnancy with headaches at 18 weeks

Case History: 30 year old woman presents on January 31, 2007 with backache of pregnancy and headaches.  She is 18 weeks gestation.

The patient is currently pregnant with her second child.  

She is currently complaining of low back pain, tension headaches, digestive troubles with nausea and sinus trouble with this pregnancy.  She also reported suffering from headaches, and back pain prior to this pregnancy.   None of her current symptoms are interfering with her activities of daily living.  

She is currently under the care of a midwife for this pregnancy.  She delivered her first baby in a birthing center.  She hopes to have another birthing center birth with this pregnancy.  Her first baby was delivered vaginally.  

Consultation:
She communicated no automobile accident history:

This patient communicated the following accident history:

She has been an avid tennis player and has had numerous ankle injuries as a result of performing this activity.  She stated that she has had surgery to her right ankle due to the repetitive injuries she has sustained while playing tennis.  Approximately ten years ago she fell on a subway train and sustained a severe bruise to her tailbone.  She did not receive any medical attention for the injury, however.  This patient admits to sustaining an injury to her lower back about 18 years ago while lifting a heavy object at work.  She denies obtaining medical treatment for this injury.  

Her current complaint of low back pain started gradually during her second month of pregnancy.  She describes the pain as being intermittent and as shooting in nature.  She reports her low back pain is worse when walking and is exacerbated when climbing up a flight of stairs.  She explains that the low back pain is primarily at the L5-S1 and that it radiates into her left hip.  She has tried various stretching exercises and pelvic tilting exercises to try and get some relief, but to no avail.  

This patient denies smoking and drinking coffee.  She reportedly drinks one to two cups of tea per day.  She reports that she eats a well-balanced diet.  She does not exercise on a regular basis; at least four to five times per week.  She claims to get at least eight hours of quality sleep per night.  She is taking pre-natal vitamins as directed by her midwife.  She is also taking Zofran for her symptoms of morning sickness.  She reports that although this medication is giving her some mild relief, she is still quite uncomfortable with nausea.    

Physical Examination –

A thorough examination of her lumbar and cervical spines was conducted due to her chief complaint lower back pain and secondary complaints of tension headaches and sinus trouble.  Postural evaluation was within normal limits with the exception of a mild lumbar hyperlordosis most likely due to her advanced pregnancy.  

Cervical active range of motion was within normal limits with no noted pain or discomfort.  Lumbar active range of motion was also within normal limits.  However pain was noted at the L4-S1 region and left ilium during lumbar extension.  

Palpation revealed taut and tender fibers in the trapezius at the cervical, and mid-thoracic regions.  Trigger points and muscle spasms were noted upon palpation of the paraspinal musculature of the lumbar area.  Palpatory tenderness and spasm were also noted bilaterally at the L5-S1 region.      

Deep Tendon Reflexes:  Biceps (C5\C6):  left: normal;  right: normal. Brachioradialis (C5\C6):  left: normal; right: normal. Triceps (C7\C8):  left: normal;  right: normal. Patellar (L2\L4):  left: normal; right: normal. Hamstrings (L4\L5):  left: normal;  right: normal. Achilles (S1\S2):  left: normal; right: normal. Cranial Nerve Exam:  Myotome evaluation revealed no weakness in the upper or lower extremity. Dermatome evaluation revealed no altered sensation to pin prick in the upper and lower extremity.

Spinal analysis using muscle testing uncovered the following misalignments:

Posterior L4 on the right (P-R), Left Sacral Apex Rotation (SAL),  Right PI Ilium, posterior T4 and T6, C5 posterior, ASLP Atlas, and posterior coccyx  on the left (C-PL).  

Prone leg checks uncovered a left short leg of ¼ inch and a positive Derefield.  Supine leg checks also uncovered a left short leg of ¼ inch.  

Using Basic Sacral Occipital analysis, the patient was not found to be a Category.  

Spinous percussion was positive in the cervical and thoracic spine.  Cervical distraction was positive bilaterally, however all other cervical orthopedic tests were found to be within normal limits.  Minor’s sign was positive with radicular pain being noted on the right.  Ely’s test was positive bilaterally.  Kemp’s test was also positive bilaterally with pain being noted in the thoracic spine.  The remaining lumbar orthopedic tests that are not contraindicated during pregnancy were found to be within normal limits.  

A thermal spinal scan showed areas of severe thermal asymmetries in the cervical spine (specifically C6-C7), in the thoracic spine (specifically T7, T8, and T9) and in the lower lumbar sacral areas (specifically L5 and S1) which correlates and supports the initial exam findings and the patient’s presenting history and chief and secondary complaints.  

Care Plan
Based upon the patient’s history of traumas, previous pregnancies, weeks gestation of current pregnancy and presenting symptoms, the following care plan has be recommended:

Due to the acute level of this patient’s presenting symptom Specific Prenatal Chiropractic spinal adjustments are recommended two to three times weekly for at least three weeks for symptomatic relief.  Once relief is obtained, one to two weekly adjustments is recommended until the birth of the baby.  A 6 week post-partum check up is also recommended to evaluate a continued need for care.  

Treatments

This patient received her first chiropractic adjustment on January 31, 2007

Atlas (ASLP) was adjusted using an instrument, in the prone position as was C5 and T6. L4 (PR) was adjusted in the prone position using an instrument.  A Sacral Apex Left, a PL Coccyx and a Right PI ilium were also adjusted in the prone position using an instrument.  

She received her second chiropractic adjustment one day later on February 1, 2007.   She reported a tremendous improvement in both of her chief complaints of low back pain and headaches. She also stated that shortly after her first adjustment she vomited.  The same listings that appeared prior to her first adjustment were present again and adjusted.  In addition, a left anterior trochanter appeared and was adjusted in the prone position using an instrument.  

Re-evaluation , discussion and follow up

This patient’s next adjustment was 5 days later on February 6, 2007.  The exact same listings as her second visit were noted and adjusted on this third visit.  She hadn’t had any headaches since her first adjustment.  Her low back pain was starting to “flare up” again, however and was what brought her back for another adjustment.  Since her first adjustment and the vomiting episode that resulted, she has not had any further nausea complaints and has since discontinued taking the Zofran.  

This patient remained an active member of the practice throughout her entire pregnancy.  On each and every visit, she required adjustments to her trochanters; some visits on the left and some on the right.  In either case the trochanter almost always rotated anteriorly.  Regardless of the misalignment, it was always adjusted using an instrument as before.  Since the hormones relaxin and estrogen soften and relax ligaments, we have found that by using an instrument, we get much better results.  In my experience, low back pain of pregnancy will present many times, with a trochanter rotation.  When it does appear it’s almost always anterior.  However, when a pregnant patient presents with Meralgia Paresthetica as in this case, there will definitely be an anterior trochanter rotation in nearly every instance.  Most usually it will appear on the same side of symptomatology initially and may change sides once changes to the pelvis occur.  

Even though she was able to adhere to the recommended care plan, she and many other pregnant patients, aren’t always  able to obtain substantial, long lasting  symptomatic relief using pre-natal chiropractic care because of the inherent instability of the pregnant spine and pelvis and the pregnancy hormones that lead to said instability.   

www.premierpregnancypractic.com

Want to build, grow and perfect your Pregnancy Practice? Let's get on a call to discuss your strategy. The first call is on me! Schedule now

Dr. Karen, just wanted to say wow...I've learned so much and I'm only into the 2nd module. This is the stuff we need to know in everyday practice! I could listen to you all day long!        ~ Dr. Katie Gelesko Stull

CASE STUDY - Low Back Pain & Breech Baby at 37 weeks

Case History: 32 year old pregnant female presents with low back pain and a breech baby at 37 weeks gestation.

The patient is pregnant with her third child and denies ever experiencing a breech presentation with her previous pregnancies.  

Her main reason for coming to our office for care to is have her pelvis evaluated for its possible contribution to the current breech presentation of her baby and for palliative relief of her low back pain.  

In the past, she has had headaches prior to this pregnancy and is currently complaining of low back pain and water retention; neither of which interfere with her activities of daily living.  She admits to having headaches during her first trimester with this pregnancy and she has an occasional occipital headache.  She is currently under the care of a midwife for this pregnancy.   She does not have a history of any hernias, uterine fibroids, or ovarian cysts.  She had never had any abdominal surgeries.  Her midwife reports this patient’s uterus is normal and is free from any abnormalities that may be contributing to the breech presentation of the baby.  She does mention that during her last pregnancy she experienced high blood pressure during the last few weeks before birth.  Currently, her blood pressure is within normal limits.

Consultation:
She communicated the following accident history:

During her senior year in high school, this patient was involved in an auto accident where she was the driver.  She was struck by another vehicle on the driver’s side of her vehicle.  As a result of this accident she admits to “blacking out”.  She was treated for lacerations to the left side of her face and required stitches for her injuries.  She was released and no further treatment was obtained.    She admitted to another minor automobile accident prior to this one but was unable to give any specific details in its regards.  

This patient also experienced a fairly serious fall down a flight of 14 stairs during her last pregnancy.  She reports that the fall involved her landing on her tailbone; and that it took place during her third trimester of pregnancy.  She denies having any adverse effects due to this fall and maintains that her pregnancy progressed normally.  She did not receive any medical treatment for this injury.   

Although this is her third pregnancy, this is the first time she is carrying a breech baby.   Her previous two pregnancies were delivered vaginally with the aid of the same midwife who is currently caring for her.  

This patient denies smoking.  She reportedly drinks an occasional cup of tea as well as one cup of coffee per day.  She is taking pre-natal vitamins and a B-complex vitamin as directed by her midwife.  Neither supplement is causing digestive distress that is sometimes common with these particular supplements.  She reported being unaware if her amniotic fluid levels were within normal limits or not.  

Physical Examination –

A thorough examination of her lumbar and cervical spine was conducted due to her complaints of occasional headache, constant lower back pain, and breech baby.   Postural evaluation revealed a lumbar hyperlordosis most likely due to her advanced stage of pregnancy.  

Cervical active range of motion was within normal limits except for left rotation which was decreased to 70 degrees.  There was no pain or discomfort present in all cervical ranges of motion.  She did, however, present with functional weaknesses in left and right cervical rotation.  Lumbar active range of motion was within normal with no pain, discomfort or functional weakness.

Palpation revealed taut and tender fibers and palpable nodules in the lumbo sacral region bilaterally from L-3 through Coccyx.  Edema was also noted at the same levels previously mentioned.    

Deep Tendon Reflexes:  Biceps (C5\C6):  left: normal;  right: normal. Brachioradialis (C5\C6):  left: normal;  right: normal. Triceps (C7\C8):  left: normal;  right: normal. Patellar (L2\L4):  left: normal;  right: normal. Hamstrings (L4\L5):  left: normal;  right: normal. Achilles (S1\S2):  left: normal;  right: normal. Cranial Nerve Exam:  Myotome evaluation revealed no weakness in the  upper and lower extremity. Dermatome evaluation revealed no altered sensation to pin prick in the  upper and lower extremity.

Spinal analysis using muscle testing uncovered the following misalignments:

Sacral Apex left, anterior right trochanter, superior pubic bone on the left, posterior L5 on the left, Posterior L3, Posterior T1, T2, T5, T6, C2 body left, and a superior right 1st rib.

Prone leg checks uncovered a right short leg of ¼ inch and a negative Derefield.  Supine leg checks also uncovered a left short leg of ¼ inch.  

Using Basic Sacral Occipital analysis, the patient was not found to be in any Category.

All cervical orthopedic tests were found to be within normal limits.  The lumbar orthopedic tests that are not contraindicated during pregnancy were also found to be within normal limits.  

A thermal spinal scan showed areas of mild to moderate thermal asymmetries in the lower cervical and upper thoracic regions as well as severe thermal asymmetries in the lower lumbar (specifically lumbo-sacral) regions which correlates and supports the initial exam findings.  

Care Plan
Based upon the patient’s history of traumas, previous pregnancies, weeks gestation of current pregnancy, presenting symptoms and breech presentation of her baby, the following care plan has be recommended:

Specific Prenatal Chiropractic spinal adjustments two to four times weekly until baby turns to the vertex position.  Once the baby turns, one to two weekly adjustments are recommended until the birth of the baby.  A 6 week post-partum check up is also recommended to evaluate a continued need for care.  

Treatments

This patient received her first chiropractic adjustment on April 26, 2007.  C2 body left was adjusted manually as was a posterior C5; both in the prone position..  The T1-T2 motor unit and the T5-T6 motor unit were adjusted manually, also in the prone position.  L3(P) and L5 (PL)were adjusted in the prone position using an instrument.  Left sacral apex rotation was corrected in the prone position using an extremely light drop table.  An anterior right trochanter was adjusted in the prone position with an instrument.  A left superior pubic bone was corrected in the supine position, also using an instrument with a slight anterior to posterior and superior to inferior line of drive.  Light contact was held on the left round ligament until the residual spasm subsided.  

Re-evaluation and follow up

The baby turned to a vertex position after the first adjustment.  This patient returned in four days for a follow up chiropractic evaluation.  A brief kinesiological exam revealed a posterior C5, T4, T6 and L3.  All segments were adjusted with an instrument in the prone position.  A posterior Left Sacrum was also corrected in the prone position using an instrument.  The pubic bone misalignment that was corrected during the first adjustment did not present, nor did any round ligament spasm.  The right anterior trochanter, however, was still present and was corrected in the prone position using an instrument.  

Discussion

Since this patient had two non-breech pregnancies prior to this one, it is logical to inquire about any injuries or traumas that may have occurred during or prior to this breech pregnancy.  During her consultation, it was discovered that she indeed had a serious fall during the late third trimester of her last pregnancy.  Luckily, the fall did not cause any complications to that pregnancy.  It is easy to surmise that the trauma she endured to her pelvis at that time may have affected this current pregnancy and the position of this baby.  After a complete physical exam, it was discovered she did experience misalignment to her pelvis, specifically her sacrum and symphysis pubis.  These two areas, when misaligned, often present with a breech presentation.  When these areas of misalignment are corrected, the baby normally turns into the vertex position.  It is easy to conclude there may very well be a connection with these misalignments and the positioning of the baby in utero.  

The evening after her first adjustment, the patient revealed experiencing a tremendous amount of fetal movement.  On April 30, 2007 – four days following her initial chiropractic treatment, the patient visited her midwife where, through the Leopold maneuver, it was determined that the baby had turned into a vertex position.  The vertex positioning of the baby was later confirmed by ultrasound.  

www.premierpregnancypractic.com

Want to build, grow and perfect your Pregnancy Practice? Let's get on a call to discuss your strategy. The first call is on me! Schedule now

Dr. Karen, just wanted to say wow...I've learned so much and I'm only into the 2nd module. This is the stuff we need to know in everyday practice! I could listen to you all day long!        ~ Dr. Katie Gelesko Stull