Acute improvement in hemodynamic control after osteopathic manipulative treatment in the third trimester of pregnancy

Abstract

Objectives The physiological changes that occur during pregnancy, including increased blood volume and cardiac output, can affect hemodynamic control, most profoundly with positional changes that affect venous return to the heart. By using Osteopathic Manipulative Treatment (OMT), a body-based modality theorized to affect somatic structures related to nervous and circulatory systems, we hypothesized that OMT acutely improves both autonomic and hemodynamic control during head-up tilt and heel raise in women at 30 weeks gestation. Design One hundred subjects were recruited at 30 weeks gestation. Setting The obstetric clinics of UNTHealth in Fort Worth, Texas. Intervention Subjects were randomized into one of three treatment groups: OMT, placebo ultrasound, or time control. Ninety subjects had complete data (N=25, 31 and 34 in each group respectively). Main outcome measures Blood pressure and heart rate were recorded during 5 min of head-up tilt followed by 4 min of intermittent heel raising. Results No significant differences in blood pressure, heart rate or heart rate variability were observed between groups with tilt before or after treatment (p>0.36), and heart rate variability was not different between treatment groups (p>0.55). However, blood pressure increased significantly (p=0.02) and heart rate decreased (p<0.01) during heel raise after OMT compared to placebo or time control. Conclusions These data suggest that OMT can acutely improve hemodynamic control during engagement of the skeletal muscle pump and this was most likely due to improvement of structural restrictions to venous return.

The influence of an osteopathic treatment on pregnant women on expected date of delivery on the course of parturition and the subjective well-being: A Pilot Study

“…The possibility of reducing overall sympathetic tone with OMT and its incidence of associated potential complications of pregnancyrelated autonomic and hemodynamic conditions (for example pregnancy-induced hypertension and preeclampsia) is of great importance to healthcare and needs further studies. [9] In conclusion, this study confirms the positive effect of OMT on the subjective well-being of the late-term pregnant woman and the onset of delivery -also with only one treatment. Moreover, it reveals the cautious conclusion that OMT could affect the autonomic system.…”

“…In order to prove the effect of OMT to hemodynamic control, a tilt stimulus and/or heel raise effect could be added in further studies. [9] Effects on maternal heart rate Maternal heart rate declined seven beats per minute on average compared pre to 15 minutes post-treatment (p<0.001). As mentioned before, this must be observed and compared at least to a time control group in further studies.…”

The global summit on the efficacy and effectiveness of spinal manipulative therapy for the prevention and treatment of non-musculoskeletal disorders: a systematic review of the literature

“…The control group received dietary modification alone. Hensel 2013 [ 68 ] Pregnant women at the 30th week of pregnancy Experimental trial with physiological outcomes (arterial pressure and heart rate variability) not related to primary prevention of a non-musculoskeletal disorder Holt 2016 [ 69 ] Community-dwelling adults 65 years or older Experimental trial with physiological/ biomechanical outcomes (joint position sense, choice stepping reaction time, postural stability, multisensory processing, health-related quality of life) not related to primary prevention of a non-musculoskeletal disorder Jones 2015 [ 70 ] Patients with dysfunctional breathing SMT was part of a multimodal intervention. The effect of SMT could not be isolated.…”

The Role of Osteopathic Care in Gynaecology and Obstetrics: An Updated Systematic Review

“…The quality assessment of some studies is updated using the RoB 2019 with respect to the previous review. Indeed, the study’s evaluation of Guthrie and colleagues [ 48 ] changed from High to Some concerns, Cleary [ 53 ] from Low/Moderate to Low, Licciardone and colleagues [ 47 ] from Moderate to Some concerns, and in another study from High to Low [ 46 ], and Hensel [ 57 ] from Unclear to High.…”