Etiopathogenetic aspects of somatic dysfunction formation during pregnancy
Authors: Nenashkina E. N. , Potekhina Yu. P. , Tregubova E. S. , Belash V. O. 
Published: September 2020

Introduction. Changes occuring in a woman′s organism during pregnancy are genetically programmed and have a physiological adaptive character. The range of these changes affect all organism systems and is caused by the need to sustain the mother and the fetus; and the changes severity is causedby gestational age, number of fetuses and individual reserve possibilities of the motherorganism. The development of pregnancy is accompanied by a number of regular structural and functional changes in the woman′s organism, which in turn can serve as a background or cause for the formation of somatic dysfunctions, the level of manifestation and severity of which depend on the compensatory capabilities of the female organism.

The goal of research was to study the occurrence frequency of somatic dysfunction in pregnant women at different stages of pregnancy and to compare it with anatomical and physiological changes in the woman′s organism.

Materials and methods. It was examined 162 healthy pregnant women aged 25 to 45 years, with a gestation period of 7 to 37 weeks. The average age was 33±2,1 year, the proportion of the first-time mothers was 62 %. The distribution of women by trimester of pregnancy was as follows: I trimester — 42 people, II trimester — 60 people, III trimester — 60 people. There were no statistically significant differences in the age of the subjects in these three groups (p>0,05). The study lasted from February 2019 to March 2020. Each patient was examined by an osteopath during the initial treatment.

Results. A statistically significant increase in the incidence of somatic dysfunctions (SD) of the thoracic region (p<0,05) and the pelvic region (p<0,001) was found from the first to the third trimester of pregnancy. SD of the lumbar region appeared only in the second trimester, and in the third trimester the occurrence frequency of these SD has not changed. It is these three regions that experience the most pronounced structural and functional changes, which are increasing with the pregnancy development. The most significant changes occur in the pelvic region, both in its structural component (bones, joints, muscles, ligaments) and in the visceral component (growing uterus). In addition, the most significant changes in blood and lymph circulation occur in the pelvic region. According to our observations, somatic dysfunctions of the pelvic region occurred in 7,1 % of the examined patients in the first trimester, in 25 % — in the second trimester, and in 63,3 % — in the third trimester. Among local SD, there is a statistically significant increase in the occurrence frequency of SD of the thoracic diaphragm, the pubic joint and impaired mobility of the uterus (p<0,01) with an increase in the duration of pregnancy, which is natural. As the size of the uterus increases, there is a decrease in the mobility of the thoracic diaphragm, which is most pronounced in the 3rd trimester. The pubic joint undergoes increasing stress and structural and functional restructuring as pregnancy progresses. There was a statistically significant difference (p<0,01) in the representation of dominant somatic dysfunctions depending on the duration of pregnancy, the predominance in the 3rd trimester of pregnancy in most women (63,3 %) of the dominant SD of the pelvic region.

Conclusion. The functional changes occurring in the body of a pregnant woman have not only specific characteristics associated with the period of pregnancy, but also serve as a background condition that predisposes to the formation of specific somatic dysfunctions. As pregnancy progresses, the somatic dysfunctions of the pelvic and thoracic regions come to the fore; these SD are most likely associated with changes in the postural balance of a pregnant woman, due to changes in anatomically-topographic relationships due to the growth of the pregnant uterus.