Professional Documents
Culture Documents
in
Obstetrics & Gynaecology
By
CVS.
Mechanical changes.
a. COG shifts upwards & forwards.
b. posture
*shoulder girdle becomes rounded,
*scapular protraction, upper
*limb internal rotation.
*increase in cervical lordosis.
*knee hyperextension.
*increase in lumber lordosis.
c. balance pt. walks with wider BOS.
Exercises in pregnancy
1.
Prenatal exercises
2.
3.
Postnatal exercises
Prenatal Exercise:
Potential impairments of pregnancy
Development of faulty posture
Upper & lower extremities stress
Altered circulation, varicose vein LL edema
Pelvic floor stress
Abdominal muscle stretch & diastasis recti
Inadequate relaxation skills necessary for
labour & delivery
Development of musculosketal pathologies
GOALS
PLAN OF CARE
7. Relaxation tech.
Contraindications to exercise.
1.
ABSOLUTE CONTRAINDICATIONS
Preg. Induced HTN BP >140/90 mmhg.
Diagnosed heart disease IHD,RHD,CHF.
Premature rupture of membrane.
Placental abruption.
History of preterm delivery.
Recurrent miscarriage.
2.RELATIVE CONTRAINDICATIONS
Diabetes
Anemia's or other blood disorders
Thyroid disorder
Dialated cervix
Extreme obesity / underweight
Breech presentation during third trimester
Multiple gastation
Ex. induced asthma
Peripheral vascular disease
Pain of any kind.
Postural exercise.
Abdominal exercise
Stabilization exercise
Pelvic motion training & strengthening.
Modified UL & LL strengthening.
Perineum &adductor flexibility.
Relaxation &breathing exercise
Posture exercise:
Includes:Strengthening exercise
Stretching exercise
STRETCHING EXERCISES
Upper neck extensors & scalenes
Scapular protractors, shoulder internal rotators
& levetor scapulae
Low back extensors
Hip adductors [caution do not over stretch in
women with pelvic instability]
Ankle planter flexor.
Strengthening Exercise .
Upper neck flexors lower neck &upper
thoracic extensors
Scapular retractors &depressor
Shoulder external rotators
Hip & knee extensors
Ankle dorsi flexors
Strengthening of
External Rotators
ABDOMINAL EXERCISES: 1.
Head Lift
2. Trunk curls
3. Leg sliding
Leg Sliding
Stabilization Exercises.
These ex are progression for developing
dynamic control of the pelvis &LL .
These may be performed throughout the
pregnancy & postpartum period.
caution the women to maintain a relaxed
breathing pattern & exhale during the exertion
phase of each ex.
Alternate hip & knee extension with one leg
stationary on a mat.
Progression is alternate hip & knee extension
&flexion with both LL moving.
b.
3. Modified squatting
These are used
To strengthen the hip &knee extensor.
Stretch the peroneal area.
a.
b.
Self stretching
1.
2.
3.
2.
3.
4.
2. POSITIONING
DURING 2ND STAGE
OF LABOUR.
Commonly used positions
are
Lithotomy
Dorsal (recumbent)
Lateral & semirecument
Transitional
stage
Breathing to
prevent
pushing
fairly deep
breathing
to move the
diaphragm
up &down
together
with a sharp
blow out
through
relaxed lip
2nd stage
1 or 2 deep breaths
in & out, then hold
making the
diaphragm piston
go down repeat
when breath runs
out, after a gulp of
air.
patient.
BACK MASSAGE
1.
2.
3.
4.
5.
6.
ABDOMINAL MASSAGE
1.
Pain experienced over the lower half of the
abdomen in the suprapubic region.
2.
light finger stroking over the site of pain.
LEG MASSAGE
1.
Occasionally labour pain may be perceived in the
thighs & cramps in the calf or foot.
2.
effleurage or kneading relieve pain.
PERINEAL MASSAGE
1. It is done in 2nd stage of labour to encourage
stretching of skin & muscle to prevent tearing/
episiotomy.
POSTNATAL EXERCISES
1.
2.
3.
4.
5.
6.
POSTNATAL EXERCISES
1.
2.
Leg exercise
Abdominal exercise
sitting
standing
feeding
lying
others
CESAREAN CHILDBIRTH
It is an operative procedure whereby the fetuses after
the end of 28th wk. are delivered through an incision
on the abdominal &uterine wall.
Impairments /Problem Due To Cs
1.
2.
3.
4.
5.
6.
7.
8.
Risk of pneumonia
Postsurgical pain.
Risk of adhesion.
Formation at incisional site.
Risk of vascular complication.
Faulty posture.
Pelvic floor dysfunction.
Abdominal weakness
GOAL
1.Improve pulmonary
function & decrease the
risk of pneumonia
2.Decrease incisional
pain associated with
coughing
3. Prevent postsurgical
adhision formation
4.Prevent postsurgical
vascular complication
PLAN OF CARE
Breathing ex. Coughing
&huffing.
2. Postnatal TENS
support incision with
hands when coughing.
3. Friction massage &
scar mobilisation.
4.Active leg ex. ,early
ambulation
5.Postural instruction
&positioning for ADL
6. Pelvic floor ex.
7. Abdominal ex.
.1. Exercises
All prenatal ex. Should be done.
The women should be instructed to begin
preventive ex. As soon as possible during
recovery period.
Ankle pumping activities &early ambulation to
prevent venous stasis.
Pelvic floor ex. Kegals ex. &pelvic tilting ex.
Abdominal ex. Should be progressed more
slowly.
Deep diaphragmatic breathing
Women should wait at least 6 to 8 wk before
resuming vigrous ex.
GOAL
1.
2.
3.
PLAN OF CARE
Decrease stiffness
1.
2.
Improve proprioception
3.
4.
5.
6.
Positioning instruction
,joint motion at available
ROM.
Stretching &
strengthening ex. Within
limits imposed by
physician.
Movement activities for
many body parts as
possible.
4.
modified posture
instruction.
5.
relaxation tech.
6.
Ex instruction &home
program for postpartum
period.
POSITIONING INSTRUCTION
Left side lying position to prevent vena cava
compression, enhance COP & lower extrimity
edema.
Pillow to support body parts & enhance relaxation.
Supine position for short period with wedge placed
under the rt. Hip to decrease IVC compression.
2.
ROM INSTRUCTION
slow active full ROM of all the joints.
3. SUGGESTED EX.
Lying
- supine or side lying with alternate knee to chest .
- ankle pumping .
- shoulder , elbow , fing. Flex. & extn. , reach to
ceiling, arm circle.
- unilateral SLR in supine & side lying position.
- bilateral active ROM in diagonal pattern for UL &
LL
-pelvic tilt, bridging, isometrics for pelvic floor
muscle.
Sitting [may not be allowed]
- all UL joint movement in available ROM.
-cervical movement in available ROM.
4. RELAXATION TECHNIQUE
5. BED MOBILITY & TRANSFER ACTIVITIES
Relaxation tech.
Modified squatting supine, sitting or side lying
with knee to chest.
Breathing
PATOHLOGY
1. diastesis recti
pain.
PT MANAGEMENT
1.Modified abdominal muscle
ex. With crossed hand
over the abdomen.
2.In acute condition bed rest
dos or dont
gentle heat & massage
pelvic tilting in croock lying
TENS if indicated
3. SI dysfunctioN
4. Nerve compression
syndrome
-
Meralgia paraesthetica
4. Splinting
ice packs
elevation of the limb
TENS
5.Circulatory problem
varicose vein of leg
vulval varicose vein
leg cramps
-thrombosis &
thromboembolism
5. prolonged standing
avoided
ankle ex. ,calf stretching
- raising foot end of standing
should bed.
deep kneading massage
- stocking & breathing ex.
6. Stress incontinence
6. pelvic floor ex
7. Postural backache
7. postural correction
8. coccydynia
PHYSIOTHERAPY IN GYNAECOLOGICAL
CONDITIONS
INDICATIONS
1. INFECTIONS
-vulvitis
PT MANAGEMENT
1. in acute phase
-chemtherapy.
-vaginitis
in chronic phase
- cervicitis
- salphingitis
- PID
2. CYST & NEW GROWTH
4.GENITAL PROLAPSE
-cystocele, urethrocele,
-rectocele, enterocele,
- uterine prolapse
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