Pregnancy & rehabilitation for Physiotherapist.pptx

The period of time a fetus develops in the uterus from conception to delivery is known as pregnancy.
It typically lasts just over nine months, or 36-38 weeks.
Pregnancy usually occurs after sexual intercourse,but can also happen through assisted reproductive technologies (ARTs).
A pregnancy test can confirm pregnancy.
A missed period, Nausea, Fatigue, Weight gain, Fluid retention, Indigestion, Food cravings, Light-headedness, and Dizziness.
A normal, regular menstrual cycle pattern is sensitive to changes in body health and environment.
A diagrammatic representation of the events and hormonal control of the menstrual cycle is shown in Figures.
A typical menstrual cycle, lasting around 28 days, involves fluctuations in hormones like estrogen, progesterone, Follicle-Stimulating Hormone (FSH), and Luteinizing Hormone (LH)
Follicular Phase:-
FSH: Initially, FSH stimulates the growth of follicles in the ovaries.
Estrogen: As follicles develop, they produce estrogen, which causes the uterine lining (endometrium) to thicken.
LH: LH levels are relatively low during the early follicular phase.
Ovulation:-
Estrogen Peak: Estrogen levels rise sharply, triggering a surge in LH.
LH Surge: This LH surge leads to ovulation, the release of an egg from the ovary.
Luteal Phase:-
Corpus Luteum: After ovulation, the ruptured follicle transforms into the corpus luteum, which secretes progesterone and some estrogen.
Progesterone: Progesterone helps maintain the thickened uterine lining, preparing it for potential implantation of a fertilized egg.
Early in pregnancy the placenta also produces HCG, which reaches a peak around 8–10 weeks and then declines by 18 weeks to a much lower level that is maintained until after delivery. HCG has been implicated in‘morning sickness’ (Masson et al 1985). It has been suggested that the corpus luteum may remain active throughout pregnancy as a source of relaxin.
It used to be thought that the placenta acted as a barrier to substances in the maternal blood that could be detrimental to the foetus, for example viruses and drugs (including nicotine and alcohol).
Because foetal tissues are more sensitive to the effect of drugs as the foetal liver is immature, metabolism of drugs hardly occurs, so there may be an accumulation over time of a particular drug bound to plasma proteins.
A human pregnancy is calculated as usually lasting about 40 weeks or 280 days. If the date on which the last menstrual flow commenced is known, the estimated date of delivery (EDD) can be calculated by adding 7 days to the date and then adding 9 months; for example:
Date of commencement of last menstrual flow = 8 January
8 January 7 days =15 January
15 January 9 months = 15 October
EDD =15 October
“Alternatively, add 7 days to

1. Pregnancy and Rehabilitation Dr. Nidhi Agarwal Ph.D , MPT HOD, Faculty Of Paramedical Sciences Rama University

2. PREGNANCY PHYSIOLOGY OF PREGNANCY DIAGRAMTIC REPRESENTATION OF HARMONES CHANGES OF PREGNANCY EFFECTS OF HARMONES EXERCISES IN PREGNANCY EFFECTIVE EXERCISES FOR NORMAL DELIVERY CONTENT

3. The period of time a fetus develops in the uterus from conc e ption to delivery is known as pregnancy. It typically lasts just over nine months, or 40 weeks. Pregnancy usually occurs after sexual intercourse,but can also happen through assisted reproductive technologies (ARTs). A pregnancy test can confirm pregnancy. A missed period, Nausea, Fatigue, Weight gain, Fluid retention, Indigestion, Food cravings, Light-headedness, and Dizziness. PREGNANCY

4. Physiology of Pregnancy

5. Figure-1 Figure-2

6. A human pregnancy is calculated as usually lasting about 40 weeks or 280 days. If the date on which the last menstrual flow commenced is known, the estimated date of delivery (EDD) can be calculated by adding 7 days to the date and then adding 9 months; for example: Date of commencement of last menstrual flow = 8 January 8 January 7 days = 15 January 15 January 9 months = 15 October EDD = 15 October “Alternatively, add 7 days to the date of the last menstrual flow and then deduct 3 calendar months. This method of calculating the EDD is known as Naegele’s rule .” Pregnancy is divided for the purpose of description and discussion into three 3-month periods or trimesters: it culminates in labour and the delivery of the foetus and placenta, and is followed by the puerperium, a period of 6–8 weeks during which time the remaining changes of pregnancy revert. For the first 8 weeks it is usual to call the developing baby an embryo;there after to delivery it is called the foetus .

7. The foetus grows within a thin semitransparent sac (the amnion), is bathed in amniotic fluid and is attached to the placenta by the umbilical cord. The fluid is secreted by the placenta, amnion and cord. The foetus drinks it and excretes it as urine; it is said to be replaced every 3 hours. It is of interest that where foetal kidneys are absent or the urethra is blocked there is less fluid than normal (oligohydramnios), and where the foetus has atresia of the oesophagus there may be increased fluid (polyhydramnios). The volume of fluid normally increases throughout pregnancy to its maximum of about a litre at around 38 weeks of gestation. It contains a variety of substances including proteins, sugars, oestrogens , progesterone, prostaglandins and cells from foetal skin. This is the fluid withdrawn at amniocentesis. A baby is said to be ‘full term’ at a gestational age of 37 or more weeks, providing it weighs more than 2500 g. Survival is good over 34 weeks and is poorer under 28 weeks, although survival following birth at 23 weeks’ gestation has now been achieved.

8. A baby is said to be of low birthweight if it weighs less than 2500 g at birth. Very low birthweight infants (VLBW) are those below 1500 g at birth and extremely low birthweight infants (ELBW) as less than 1000 g at birth (Halliday 1992, cited in Lindsay 1997). A ‘preterm’ baby is one when the gestational age is less than 37 weeks. The term ‘extremely preterm’ is used for those born at or before 26 weeks (Rutter 1995).

9. C hanges of pregnancy

10. Effects of progesterone 1. Reduction in tone of smooth muscle: (a) food may stay longer in the stomach; peristaltic activity is reduced (b) water absorption in the colon is increased leading to tendency to constipation (c) uterine muscle tone is reduced; uterine activity is damped down (d) detrusor muscle tone reduced (e) dilatation of the ureters favouring urine stasis with elongation to accommodate the increasing size of the uterus; this may contribute to the likelihood of urinary tract infections (f) urethral tone reduced, which may result in stress incontinence (g) reduced tone in the smooth muscle of the blood vessel walls leading to dilation of blood vessels, lowered diastolic pressure. 2. Increase in temperature (0.5–1°C). 3. Reduction in alveolar and arterial PCO2 tension, hyperventilation 4. Development of the breasts’ alveolar and glandular milk-producing cells. 5. Increased storage of fat.

11. Effects of oestrogens 1. Increase in growth of uterus and breast ducts. 2. Increasing levels of prolactin to prepare breasts for lactation; oestrogens may assist maternal calcium metabolism. 3. May prime receptor sites for relaxin (e.g. pelvic joints, joint capsules, cervix). 4. Increased water retention, may cause sodium to be retained. 5. Higher levels result in increased vaginal glycogen, predisposing to thrush.

12. Effects of relaxin Gradual replacement of collagen in target tissues (e.g. pelvic joints, joint capsules, cervix) with a remodelled modified form that has greater extensibility and pliability. Collagen synthesis is greater than collagen degradation and there is increased water content, so there is an increase in volume. 2. Inhibition of myometrial activity during pregnancy up to 28 weeks when women become aware of Braxton Hicks contractions. 3. May have a role in the remarkable ability of the uterus to distend and in the production of the necessary additional supportive connective tissue for the growing muscle fibres . 4. Towards the end of pregnancy, rising levels of relaxin effect softening of the collagenous content of the cervix ( Verralls 1993). 5. May have a role in mammary growth. 6. Affects relaxation of the pelvic floor muscles ( Verralls 1993).

13. Fig -B Fig-A

14. fig-A , It can be seen in that in the final 2–3 weeks the fundal height drops; this is because the foetal head has entered the pelvic inlet, which may cause an increased frequency of micturition. The head will be said to be ‘engaged’ when its greatest diameter has passed through the brim of the pelvis . This drop in fundal height is particularly noticed by the primigravida; in multigravidae the foetal head may not engage until labour begins owing to lax uterine and abdominal muscles (Sweet 1997a). At the end of pregnancy abdominal palpation is used to determine how much of the foetal head remains above the pelvic brim. This is estimated in fifths (Fig. B ) or by using the terms ‘unengaged’, ‘engaging’, ‘engaged’.

15. Pregnancy back care

16. Pelvic floor and Pelvic-tilting exercises Abrief explanation of the role of the pelvic floor using a model of a pelvis should be given by the women’s health physiotherapist teaching pelvic floor muscle (PFM) contractions. Mason et al (2001) showed that women who had learnt and practised PFM contractions during pregnancy experienced less urinary incontinence postpartum than those who had not learnt the skill antenatally. A study comparing PFM ability with a nulliparous group and a group of women at 10 months postpartum with no incontinence symptoms demonstrated the former had increased muscle power and endurance, again indicating the importance of exercising this muscle during the postpartum period (Marshall et al 2002). Where the group is large, pelvic tilting can be demonstrated while sitting on the edge of a chair (Fig. 4.7). The group should understand that this exercise can be helpful for maintaining abdominal muscle strength (particularly the transversus abdominis muscle), correcting posture and easing backache, and that it can be done in a standing position (Fig. 4.8) as well as crook lying, side lying and prone kneeling (Fig. 4.9)

17. Exercises for circulation and cramp An explanation should be given as to how pregnancy can affect leg circulation, and women who travel long distances and have sedentary jobs should especially be encouraged to carry out frequent foot and ankle exercises. Ankle dorsiflexion and plantar flexion, and foot circling carried out for 30 seconds regularly, should be suggested; women should be advised not to cross the knees when sitting. The technique of stretching in bed with the foot dorsiflexed and not plantar flexed for preventing and easing calf cramp should also be shown. Additional suggestions for cramp relief include avoiding long periods of sitting, a pre-bedtime walk, calf stretches, a warm bath, and foot and ankle exercises in bed before going to sleep.

18. Fatigue

19. The effects of stress on body and mind An attempt should be made to elicit the causes and the effects of stress from the group itself. The Mitchell method of physiological relaxation(using breathing and muscle contraction to reduce tension and stress.) Other stress-coping strategies, such as music, a warm bath or shower, a walk or exercise, dancing and massage, should be discussed PRINCIPLES OF MITCHELL METHOD:- Diaphragmatic breathing exercise Isotonic contraction Postural alignment Benefits of the Mitchell Technique :- Can be used to relax the whole body or parts of it Can help reduce muscle tension caused by stress

20. EXERCISES IN PREGNANCY

21. Antenatal exercises are those exercises performed by women during pregnancy, which stimulate the blood circulation and gives a feeling of well being.

22. Improves the circulation of mother and baby. Reduction in ache and pain of pregnancy.(Backache and cramps) Improves the stamina and gives the mother more energy to cope with the growing demands of the pregnancy. Improves the body posture and body awareness. More controlled weight gain. Improves the sleeping pattern. Reduction in minor ailments ofpregnency such as Stiffiness , tension , constipation, sleeplessness. Advantages of exercises

23. Minimizes varicose vein and swelling due to improved circulation. Enhance the psychological well-being. Ensure an effective bearing down in labour and speedy return to normal postnatal.

24. Perform exercises regularly, Plan a regularly schedule that is thrice a week Dress comfortably Void before exercise Avoid jerking and bouncing ( eg :- Jogging and running) Exercise on firm surface Drink fluid during exercise when needed and after exercises Wear supportive shoes.

25. Decrease exercise level as pregnancy progress. Take your pulse every 10-15 minutes, if it is more than 140 beats per minutes, slow down until it reaches to maximum 90bpm. Rest 10 minutes at left lateral position after exercises. Takes an increase in calories to replace those burned during exercise. Don’t do exercise if you feel shortness of breath, pain , cramping, vaginal bleeding and nausea.

26. Breathing exercise Circulating exercise Leg Shoulder Stretching exercises Leg Arm Neck

27. Abdominal exercises Pelvic tilting and back stretching exercise Pelvic floor exercise ( Kigel’s exercise) Transervse exercise Tailor sitting exercise Hip hitching exercise

28. To strengthen the muscles of respiration. To increase the maternal and feto -placental oxygenation. TECHNOQUE: Sit comfortably with eye closed and concentrate on breathing. Breath in through the Nose and out through the mouth, Repeat it five times

29. Purpose :

30. Sit on a chair with back straight, move feet up and down. Repeat it 10 times. Sitting on a chair , move feet inwards and outwards . Repeat it 10 times. Sitting on a chair make a circle with both feet at anticlock wise direction and vice versa. Repeat it 10 times

31. During pregnancy, gentle shoulder circling exercises  can help relieve tension and prevent rounded shoulders .

32. PURPOSE Stretching can help with back pain, hip and pelvic pain, and other pregnancy discomforts Backward stretch Start on all fours, then arch your back toward your heels. 

33. Stretches for your back Backward stretch : Start on all fours, then arch your back toward your heels.  Cat stretch : Rest on all fours, then round your shoulders and stretch your back up.  Pelvic tilt : Stand against a wall, then pull your belly button toward your spine.  Neck stretch : Turn your head to one side, then pull your chin toward your collarbone.  Stretching start as soon as the end of your second trimester

34. Pelvic tilting Stand with feet apart , squat down hold for as you are comfortable and back to standing position . Repeat it 5 times LEG Exercise

35. Stand with facing a wall with feet apart , far enough to keep arm straight,move body towards the wall and holds it 2 second . Repeat it 5 times

36. Sit on a chair with straight back , look upwards and brings back head to neutral position. Repeat it 5 times Sitting:- turn head to left and then to right. Repeat it 5times Sitting:- Bring ear towards the left shoulder and then right ear towards right shoulder . Repeat it five times

37. Kegel exercises, also known as pelvic floor exercises, can help strengthen pelvic muscles during pregnancy.  They can also help with bladder control and prepare for childbirth. Benefits :- Bladder control : Kegel exercises can help control the urge to urinate and prevent urinary incontinence . Childbirth : Kegel exercises can help with pushing during labor and delivery . Pelvic organ prolapse : Kegel exercises can help prevent pelvic organ prolapse 

38. How to do Kegel exercises  Contract and relax the muscles around your pelvic floor Work up to contracting and relaxing the muscles for longer periods of time, such as 10 seconds Do more repetitions as it becomes easier  In the second trimester, which is around 14 weeks pregnant .  NOTE:- Focus on both the contraction and the release of the muscles  Make Kegel exercises a lasting part of your daily routine  Quality is more important than doing a lot of Kegels incorrectly

39. Walking: Walking is a great exercise to start with. ... Squats: This simple-looking exercise is amazingly effective. ... Kegels: Kegel exercises help strengthen the pelvic floor muscles. ... Prenatal yoga: ... Pelvic Tilts: ... Perineal massage: ... Breathing exercises: Effective Exercises for a Normal Delivery

40. REFRENCES Adewole I F, Franklin O, Matiluko AA 1993 Cervical ripening and induction of labour by breast stimulation. African Journal of Medical Science 22(4):81–85. Bewley C 1997 Medical conditions Crowley P 2002 Interventions for preventing or improving the outcome of delivery at or beyond term (Cochrane Review). In: The Cochrane Library, Issue 4. Update Software, Oxford. Durnin J V 1989 Energy requirements of pregnancy. Lancet ii:895–900. Elliott J P, Flaherty J F 1984 The use of breast stimulation to prevent postdate pregnancy. American Journal of Obstetrics and Gynecology 149:628–632 Fransden V A 1963 The excretion of oestriol in normal human pregnancy. Munksgaard , Copenhagen. Gross S, Librach C, Cecutti A 1989 Maternal weight loss associated with hyperemesis gravidarum: a predictor of fetal outcome. American Journal of Obstetrics and Gynecology 160:906–909. Hansen A, Jensen D V, Larsen E et al 1996 Relaxin is not related to symptom-giving pelvic girdle relaxation in pregnant women. Acta Obstetrica et Gynecologica Scandinavica 75(3):245–249. Irons D W, Sriskandabalan P, Bullough C H 1994 A simple alternative to parenteral oxytoxics for the third stage of labour . International Journal of Gynaecology and Obstetrics 46(1):15–18 Tomten S E 1996 Prevalence of menstrual dysfunction in Norwegian long-distance runners participating in the Oslo Marathon games. Scandinavian Journal of Medical and Sports Science 6(3):164–171. Tookey P, Peckham C S 1996 Neonatal herpes simplex virus infection in the British Isles. Paediatric Perinatal Epidemiology 10:432–442. Yki-Jarvinen H, Wahlstrom T, Seppala M 1983 Immunohistochemical demonstration of relaxin in the genital tract of pregnant and non pregnant women. Journal of Clinical Endocrinology 57(3):451–454. Zarrow M X, McClintock J A1966 Localisation of 131-I-labelled antibody to relaxin . Journal of Endocrinology 36:377–387. https://www.google.com/search?q=definition+of+pregnancy&oq=DEFINITION+OF+PREG&gs_lcrp=EgZjaHJvbWUqBwgBEAAYgAQyBggAEEUYOTIHCAEQABiABDIHCAIQABiABDIHCAMQABiABDIHCAQQABiABDIHCAUQABiABDIHCAYQABiABDIHCAcQABiABDIHCAgQABiABDIHCAkQABiABNIBCTEwOTA5ajBqN6gCCLACAfEFKNmiTue6SVA&sourceid=chrome&ie=UTF-8