Virginia Research Day 2021

Medical Resident Research Cl inical

07 Retrospective Review of Maternal Morbidity and Obstetrical Interventions Following Intrapartum Osteopathic Manipulative Treatment (OMT)

Introduction: Few studies have demonstrated correlation between osteopathic manipulative treatment (OMT) and its direct impact on parturition. One retrospective study in 2003 revealed that the use of prenatal OMT in pregnant patients significantly decreased the incidence of meconium-stained amniotic fluid, use of forceps during delivery, and likelihood of preterm delivery1. In 2013, OMT during labor was demonstrated to decrease the incidence of vaginal tears and improved both APGAR scores and umbilical pH levels2. Much of the osteopathic literature has focused on improving pregnancy-related concerns solely within the musculoskeletal system, such as back pain or quality of life while intrapartum3. Beyond its structural importance during pregnancy, the musculoskeletal system also provides access to the neuroendocrine and cardiopulmonary systems4. These systems can impact the autonomic nervous system5, venous return, and lymphatic drainage6, which have each demonstrated benefit from OMT in individual studies. It is theorized that treating patients holistically during their pregnancy can affect these systemic variables and influence the need for Edward Via College of Osteopathic Medicine-Virginia Campus VCOM Sports and Osteopathic Medicine Samuel H. Werner, DO; Albert J. Kozar, DO, FAOASM, R-MSK Corresponding author: swerner@vt.vcom.edu

obstetric interventions, ultimately impacting maternal morbidity. Methods: This retrospective study at VCOM Sports and Osteopathic Medicine (VSOM) includes previous patients who received OMT to three or more body regions, within each of four or more visits during a single pregnancy. The VSOM EHR was searched for any office visits from 1/1/2015 to 12/31/2020 which included an ICD-10 pregnancy diagnostic code and then cross-searched for OMT CPT codes. These charts were then searched for both the quantity of OMT visits and of body regions treated, as well as details on their duration of labor and hospital stay, the use of any obstetric interventions, and maternal morbidity. For any charts with absent details, the subjects were contacted to request permission to obtain any missing records from their delivery center. Individuals who had a home birth were excluded from the study, as were non-English speakers. Data gathered from VSOM records regarding parturition outcomes will be compared to the concurrent average rates reported by the corresponding medical

institutions as well as to the national average, as available. Then, the number of OMT sessions and the number of body regions treated at each session will be compared to those outcomes, with correlations drawn as confidence permits. Results: This retrospective study is currently pending IRB approval. It will be completed in time for poster presentation in February 2020. Conclusion: We hope to quantify how intrapartum OMT reduces maternal morbidity and obstetric interventions, by considering patients who were seen iteratively throughout pregnancy thereby allowing the physician to address those chronic and underlying issues which may lead to complications during delivery. Doing so will not only provide impetus for more focused and prospective studies in the future but also provide direction for those seeking a safer and more positive birth experience which requires fewer medical or surgical interventions.

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