PT IN OBSTETRICS

Its an elaborative slide explaining briefly the prestigious process of labour and mainly the physiotherapy required in it for ease of labour

1. PT IN OBSTETRICS By: Muskan Qureshi & Poorva Wadhwa Bpt 4 th Year

2. OBSTETRICS CONCERNS ITSELF WITH PREGNANCY , LABOUR , DELIVERY AND THE CARE OF THE MOTHER AFTER CHILD BIRTH . GYNAECOLOGY IS THE STUDY OF DISEASE ASSOCIATED WITH WOMEN WHICH IN EFFECT MEANS CONDITION INVOLVING THE FEMALE GENITAL TRACT

3. PHYSIOLOGICAL CHANGES DURING PREGNANCY

4. Weight gains during pregnancy from 9.70 to 14.55 kg approximately. Changes in the reproductive system. Urinary system changes – Kidney size increases by 1 cm Changes in the pulmonary system. Changes in the cardiovascular system .

5. Musculoskeletal system changes . Stretching of abdominal muscles . Decrease in ligamentous tensile strength . Hyper mobility of joints due to ligamentous laxity . Pelvic floor drops as much as 2.5 cm.

6. Mechanical changes : a.) COG shifts upwards and forwards . b.) Posture – Shoulder girdle becomes round . Scapular protraction . Upper limb internal rotation . Increase in cervical lordosis . Knee hyper extension . Increase in lumber lordosis . C.) Balance – Patient walks with wider BOS .

7. Aims of Physiotherapist

8. GENERAL GOALS AND PLAN FOR EXERCISE PROGRAM . GOALS Improve posture and correct body mechanics. Upper & Lower extremities strengthening . PLAN OF CARE 1.Train & strengthen postural muscle . 2. Teach correct body mechanics in all positions. And strengthening ex of UL and LL .

9. 3. Prepare for circulatory compromise. 4. Improve awareness and control of pelvic floor muscles. 5 . Maintain abdominal function and correct diastasis recti. 6. Provide information about pregnancy and associated problems 7. Improve relaxation skills. 3. Stretching exercises. 4. Pelvic floor muscles strengthening. 5. Abdominal muscle strengthening ex. 6. Pre-natal and Post-natal information. 7. Relaxation techniques .

10. Labour Labour is defined as the process by which the by-products of conception are expelled from the uterus after 24 th week of pregnancy. STAGES OF LABOUR Stage 1 Stage 2 Stage 3

11. First stage of labour: The first stage of labour is from the commencement of regular uterine contractions effecting dilatation (opening) of the cervix, culminating when the cervix is fully dilated, allowing the passage of the foetus into the birth canal. It can be further subdivided into the latent phase (early labour), where contractions are short and irregular, and the active phase (established labour), where contractions become intense and regular.

12. 2. Second stage of labour When the presenting part has passed through the cervix and is below the ischial spines’. Throughout the second stage women should be encouraged to instinctively bear down as the urge occurs with a contraction, adopting positions which increases the pelvic outlet. Prolonged breath-holding and overzealous pushing should be avoided .

13. 3. Third stage of labour The third stage is defined as the period from the birth of the baby to complete expulsion of placenta and membranes , and control of haemorrhage from the placental site . Placenta should be expelled out within 30 minutes of delivery.

14. POSITIONING DURING LABOUR 1 st Stage of Labour – In this stage uterus anteverts . Forward leaning facilitates ante version . Woman should be encouraged to change positions during first stage of labour .

15. Positions attended during 1 st stage : Sitting with head & and shoulder resting on a table . Standing leaning against a wall either facing or with back support. Stride sitting across a chair resting the head and arms on the back . On all four on floor supported by partner , standing , resting head on his shoulde r

16. Kegel’s Exercise 1 st stage of labour These are labour inducing exercise . In 1 st half an hour – Supine to sitting every 5 min . In 2 nd half an hour – Do supine to sitting every 4 min .

17. 2 . Positions during 2 nd stage of labour . Commonly used positions are: Lithotomy Dorsal ( recumbent ) Lateral & semi-recumbent

18. ADVICE ❗ 1 . Body awareness. Exercise for the abdominal muscles is adapted to the pregnant state. Pelvic rolling with abdominal contraction Alternate hip hitching Crook lying Prone kneeling 2 . Stretching exercises and postures (prepare for delivery positions) . Cross leg sitting Tailor sitting with soles of the feet together Long sitting- stretching the legs apart Squatting . 3 . Do not exercise in supine after 16 week of gestation . 4. Self regulate both the intensity and duration of exercise. 5 . Discontinue activities which have a risk of falling or abdominal trauma .

19. PHYSIOTHERAPY DURING CHILDBEARING PERIOD [GENERAL EXERCISES] AQUANATAL CLASSES &SWIMMING: Exercises while standing in water is gentle on joints. It helps in lessening the swelling in legs of pregnant woman which is a common symptom in pregnancy. The water also supports the weight of baby and moving against water keeps heart rate up.

20. 2. JOGGING AND RUNNING During pregnancy, this helps to relieve constipation, improve mood swings and help maintain adequate body weight. A dvice her to use a belly band to avoid undue belly movement . Since at this time the ligaments and joints become lax therefore the woman should be advised brisk walking to avoid any injury.

21. 3.PELVIC FLOOR MUSCLE EXECISES Helps relieve stress incontinence in pregnant ladies by strengthening the pelvic floor muscles. This strengthening can be done by foll. steps: Sitting and slightly leaning forward. Squeezing and lifting the muscles as if to stop a wee. Holding the squeeze while counting till 8 and then relax for 8 secs. Repetition as per convenience. {KEGELS EXERCISES}

22. 4.PILATES AND YOGA It contains movements to help with core and leg strength, breathing and relaxation, strengthening the pelvic floor and relieving lower back pain. Both of these should be low impact and should be done gently . Advice not to stretch too much. Both of these prepare the woman for childbirth and recovery afterwards .

23. 5. LOW IMPACT AEROBICS Following low-impact exercises could be done during pregnancy after getting clearance from gynaecologist : A. Side leg lifts . B. Standing crane [ using a hand support ]. C. Stationery biking . D. Stair climbing and Walking. E. Treading water etc.

24. Puerperium Puerperium is defined as the six-week period following childbirth during which the woman’s body returns almost to its pre-pregnancy state : • Lactation is initiated and established or suppressed. • The uterus involutes , returning almost to the pre-pregnant size and positions. • The placental site begins to heal and the lochia (blood loss) diminishes to a creamy white discharge . • Perineal trauma and abdominal wounds begin to heal.

25. PT after puerperium The following may be practiced: Deep breathing and circulation exercises for feet and ankles . Pelvic rocking with abdominal contraction. Pelvic floor contractions. The following exercises are suggested for abdominal muscles : • Crook lying, abdominal contraction- stretching hands towards knees. • Lying with one leg bent and shortening the straight leg with abdominal tightening . • Crook lying- rolling both knees to alternate sides . This should be done slowly contracting abdominal muscles before each action. • For cases of diastasis recti : Crook lying- abdominal contraction using cross hands to pull the recti together .

26. CROOK LYING FOR DIASTASIS RECTI

27. PREGNANCY INDUCED PATHOLOGY 1 . Lower back and pelvic pain . 2 . SI Dysfunction. 3.Nerve compression syndrome. E.g. . Carpal tunnel syndrome 4. Circulatory problems: E.g. Varicose vein of leg leg cramps .

28. Benefits of exercises Potential benefits of exercise include: Maintenance of cardiovascular fitness. Maintenance of healthy weight range. Improvement of body awareness, posture . Co-ordination and balance; improvement in circulation; Increase in endurance and stamina. Provision of social interaction with exercise . Enhancing feelings of social and emotional well-being . Possible reduction in problems during labour and delivery. potentially shorter labour. Possible prevention of gestational diabetes. Reduction in minor complaints of pregnancy. More rapid postnatal recovery.

29. Contra-indications Cardiovascular , respiratory, renal or thyroid disease. Diabetes (type 1, if poorly controlled ). History of miscarriage. Premature labour. Foetal growth restriction. Cervical incompetence. Hypertension. V aginal bleeding . R educed foetal movement. Anaemia. B reech presentation . P lacenta praevia .