The Antenatal Period (1).pptx gyneacology

Polyneuropathies are a group of disorders that affect multiple peripheral nerves, leading to damage and dysfunction. Here are some key aspects:

_Types:_

1. _Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)_: Autoimmune disorder causing nerve damage.
2. _Diabetic Neuropathy_: High blood sugar damages nerves.
3. _Charcot-Marie-Tooth Disease_: Genetic disorder affecting nerve function.
4. _Guillain-Barré Syndrome_: Autoimmune disorder causing rapid nerve damage.
5. _Vasculitic Neuropathy_: Inflammation of blood vessels damages nerves.

_Symptoms:_

1. _Numbness_
2. _Tingling_
3. _Pain_
4. _Weakness_
5. _Fatigue_
6. _Loss of reflexes_
7. _Sensory loss_

_Causes:_

1. _Autoimmune disorders_
2. _Diabetes_
3. _Genetic mutations_
4. _Infections_
5. _Vitamin deficiencies_
6. _Toxins_
7. _Trauma_

_Diagnosis:_

1. _Medical history_
2. _Physical examination_
3. _Electromyography (EMG)_
4. _Nerve conduction studies (NCS)_
5. _Blood tests_
6. _Imaging studies_

_Treatment:_

1. _Medications_ (e.g., pain relievers, immunosuppressants)
2. _Physical therapy_
3. _Occupational therapy_
4. _Lifestyle modifications_ (e.g., diet, exercise)
5. _Alternative therapies_ (e.g., acupuncture, massage)

Note: This is not an exhaustive list, and it's essential to consult a healthcare professional for proper diagnosis and treatment.Polyneuropathies are a group of disorders that affect multiple peripheral nerves, leading to damage and dysfunction. Here are some key aspects:

_Types:_

1. _Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)_: Autoimmune disorder causing nerve damage.
2. _Diabetic Neuropathy_: High blood sugar damages nerves.
3. _Charcot-Marie-Tooth Disease_: Genetic disorder affecting nerve function.
4. _Guillain-Barré Syndrome_: Autoimmune disorder causing rapid nerve damage.
5. _Vasculitic Neuropathy_: Inflammation of blood vessels damages nerves.

_Symptoms:_

1. _Numbness_
2. _Tingling_
3. _Pain_
4. _Weakness_
5. _Fatigue_
6. _Loss of reflexes_
7. _Sensory loss_

_Causes:_

1. _Autoimmune disorders_
2. _Diabetes_
3. _Genetic mutations_
4. _Infections_
5. _Vitamin deficiencies_
6. _Toxins_
7. _Trauma_

_Diagnosis:_

1. _Medical history_
2. _Physical examination_
3. _Electromyography (EMG)_
4. _Nerve conduction studies (NCS)_
5. _Blood tests_
6. _Imaging studies_

_Treatment:_

1. _Medications_ (e.g., pain relievers, immunosuppressants)
2. _Physical therapy_
3. _Occupational therapy_
4. _Lifestyle modifications_ (e.g., diet, exercise)
5. _Alternative therapies_ (e.g., acupuncture, massage)

Note: This is not an exhaustive list, and it's essential to consult a healthcare professional for proper diagnosis and treatment.Polyneuropathies are a group of disorders that affect multiple peripheral nerves, leading to damage and dysfunction. Here are some key aspects:

_Types:_

1. _Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)_: Autoimmune disorder causing nerve damage.
2. _Diabetic Neuropathy_: High blood sugar damages nerves.
3. _Charcot-Mar

1. The Antenatal Period Dr. Zermeen Zerish; PT

2. Aims of Antenatal Care To promote and maintain optimal physical and emotional maternal health throughout pregnancy To recognize and treat correctly medical or obstetric complications occurring during pregnancy To detect foetal abnormalities as early as possible To prepare for and inform both parents about pregnancy, labour , the puerperium and the subsequent care of their baby The overriding goal is that pregnancy will result in a healthy mother and a healthy infant

3. Antenatal Care Options Water births Home birth Team/caseload midwifery/domino (domiciliary midwife in and out) Gp /midwifery shared care Midwifery-led units General practitioner units Consultant care Consultant obstetric units Private obstetric care/independent midwives

4. Routine Antenatal Care Occurs between 12 and 14 weeks’ gestation, but realistically ranges from 9 to 16 weeks Booking visit Woman’s social history Family history Medical history Psychological history Past obstetric history Body mass index (BMI)

5. Subsequent visits Anomaly scan’ at 20 weeks Monthly visits from 24–26 weeks Fortnightly visits from 32–34 weeks to 40 weeks Weekly visits until delivery Blood pressure Urine Weight Oedema Fundal height and the ‘lie’ of the foetus Foetal movements Foetal heart rate Other tests Blood tests Haemoglobin levels Sexually transmitted infection Blood group Haemoglobinopathies Routine Antenatal Care

6. Antenatal Screening Aims to detect foetal abnormalities, either by: Maternal serum screening Nuchal translucency (NT) measurement

7. Maternal Serum Screening: Alpha fetoprotein (AFP) level High levels may indicate neural tube defects (NTDs) such as spina bifida Hormone levels Ultrasound Scanning: Measure the nuchal translucency , an area of subcutaneous fluid at the nape of the foetal neck Increase thickness may indicate Down’s syndrome At least one anomaly scan at around 20 weeks’ gestation,for detection of certain abnormalities Spina bifida Cardiac abnormalities Antenatal Screening

8. Chorionic Villus Sampling: Technique which is carried out transabdominally Fragments of placental chorionic villi are removed ultrasound guidance and inspected for genetic foetal abnormalities such as Down’s syndrome . Performed early in pregnancy between 11 and 13 weeks’ gestation. 1% miscarriage Antenatal Screening

9. Amniocentesis Test a small amount of amniotic fluid is withdrawn transabdominally . Give an indication of genetic abnormalities such as Down’s syndrome. 1 % risk of triggering a miscarriage. Antenatal Screening

10. Every organ system within the mother’s body will alter and adjust according to the demands made upon it by the growing foetus Exercising weekly prepregnancy reduces risk of back pain during pregnancy Genetic counselling should be available to parents with a family history of hereditary disease Disorders, as well as identified risk factors for maternal morbidity and mortality should be treated and stabilised before conception Preconceptual Care

11. Infertility/ Subfertility : The causes of infertility can be divided into: Male factors Female factors Combination of the two Hormonal treatment may be advocated for a woman failing to ovulate Preconceptual Care

12. Early Pregnancy: An early introduction is essential to patient regarding: Ergonomic back-care education Understanding of stress and its control Importance of physical health Strength Endurance Activities can be included for: The pelvic floor Abdominal muscles Legs Arms Preconceptual Care

13. Antenatal Classes Concerned with women to prepare for and cope with labour pain Couples should be helped to check and increase their knowledge of the physiological changes of pregnancy, labour and the puerperium . Couples should be shown ways that may be useful for coping with the physical changes of pregnancy and their associated discomforts. Couples should be guided towards a realistic understanding of labour . Couples should be encouraged to consider the profound change in lifestyle that parenthood brings, and the emotional maturity necessary to manage successfully their additional responsibilities. Couples should be encouraged to talk and air any fears, ask questions , and be helped to obtain satisfactory answers in an open environment

14. ‘Early Bird’ Classes: The classes will probably be shared by physiotherapists with: Midwives Dieticians Health visitors Dentists Doctors Antenatal Classes

15. Following essential subjects be included in the physiotherapist’s part of the sessions: Pregnancy back care Symphysis pubis dysfunction (SPD ) Pelvic floor and pelvic-tilting exercises Exercises for circulation and cramp Fatigue The effects of stress on body and mind Emotional reactions Advice on lifestyle Stress and relaxation Antenatal Classes

16. Antenatal Classes Back Care

17. Antenatal Classes Back Care

18. Antenatal Classes Pelvic Tilting

19. Antenatal Classes Relaxation Posture

20. Exercise and Pregnancy The physiological changes that occur when a woman exercises, particularly in aerobic exercise, are primarily to maintain the woman’s internal homeostasis during the exercise period

21. Maternal Risks: Greater risk of musculoskeletal trauma Joint laxity Postural changes Impair balance and coordination as the centre of gravity alters Cardiovascular system I ncrease in blood volume Cardiac output and resting pulse Decrease in the systemic vascular resistance Exercise and Pregnancy

22. Calories small increase in the number of calories per day needed during pregnancy and this is mostly significant in the last trimester. Hypoglycaemia is more likely to happen during a resting and fasting state. Thermoregulation Increase in basal metabolic rate and heat production Respiratory changes Increase in minute ventilation by almost 50% Increase in oxygen uptake with an increase in oxygen consumption of 10–20 % Increase in resting oxygen requirement Exercise and Pregnancy

23. Foetal Risks: Foetal distress Redistribution of blood flow away from the splanchnic organs Foetal growth and development Foetal malformations Teratogenic effects of a raised maternal core temperature Preterm labour Exercise may trigger uterine contractions Exercise and Pregnancy

24. Contraindications to Exercise

25. Guidelines for Exercise Jerky, bouncing, ballistic movements and activities should be avoided. Regular mild to moderate exercise sessions, at least three times a week , are safer than intermittent bursts of activity . A careful ‘warm-up’ should precede vigorous exercise, which must always be followed by a ‘cool-down’ or gradual decline in activity. Flexibility and mobility follow the warm-up section, avoiding ballistic stretching . All main muscle groups should be included and positions stretching at the extreme range of movement avoided.

26. Strenuous exercise must be avoided in hot, humid weather, or when the pregnant woman is pyrexial . The maternal heart rate should not exceed 140 b.p.m . and vigorous exercise should not continue for longer than 15 minutes. Fluid must be taken before, during and after exertion to avoid dehydration , and energy intake must be sufficient for the needs of pregnancy as well as the exercise. Guidelines for Exercise

27. It is essential that those accustomed to a sedentary lifestyle should start with low intensity physical activity. Walking , swimming, stationary bicycling or yoga are probably ideal, with gradual increases in activity levels according to a woman’s own individual tolerance capacity . An aerobic component should be in the mode best suited to the individual , using large muscle groups and being rhythmical in nature, i.e . brisk walking, cycling, aerobic dance Guidelines for Exercise

28. Avoid supine positions after the first trimester. Avoid standing motionless for long periods of time. Exercise should be decided by the limitations imposed by pregnancy Use the BORG rating of perceived exertion (RPE) aiming between 12 and 14 or the ‘talk test’ Guidelines for Exercise

29. List of signs and symptoms from the ACSM (1995) are considered significant and, if apparent, would need medical review: Any signs of bloody discharge from the vagina Any ‘ gush’ of fluid from the vagina (premature rupture of membranes) Sudden swelling of ankles, hands or face Persistent, severe headaches or visual disturbance, or both; unexplained spell of faintness or dizziness Swelling, pain and redness in the calf of one leg Guidelines for Exercise

30. Elevation of pulse rate or blood pressure that persists after exercise , excessive fatigue, palpitations and chest pain Persistent contractions (6–8 hours) that may suggest onset of premature labour Unexpected abdominal pain Insufficient weight gain (1.0 kg/month during the last two trimesters) Absence of or reduced foetal movements Guidelines for Exercise

31. Swimming & Water Exercise in Pregnancy The perfect pregnancy exercise Buoyancy of the water supports the mother’s increasing body weight Toning and strengthening activity which increases her physical fitness and endurance Women should ‘warm up’ prior to their main swim, and ‘cool down’ following it

32. Pilates Central core of stability concentrating on abdominal and pelvic floor muscles Help maintain and retrain: Posture Coordination Abdominal muscles Pelvic floor muscles

33. Diet & Weight Gain in Pregnancy During pregnancy, the body works more efficiently, saving energy by adjustments in physical activity and adapting its metabolic rate An extra need of 300 calories per day in the second and in the third trimester A normal weight gain of 11–15 kg (25–35 lb) is expected Breastfeeding is often advocated to help lose weight retained postpartum

34. Nutrients Folic Acid Prevent of neural tube defects Found in: Vegetables (cauliflower, peas, tomatoes) Oranges Breakfast cereals Yeast extract A daily supplement of folic acid 0.4mg/day Calcium Needed for bone, teeth and gum formation Found in: Dairy products Sardines Dried fruit

35. Omega-3 Fatty Acids For development of brain and neural development Found in: Mackerel Salmon Sardines and other oily fish Flaxseed Iron To combat anaemia Found in: Red meat Beans Nuts Green vegetables With vitamin C for good absorption Nutrients

36. Dietary Fibre Prevent the constipation Found in Fruit Vegetables Nuts and pulses Bread and cereals Nutrients

37. Foods to Avoid Liver Excessive vitamin A associated with congenital malformations Dark Fish Contain high levels of mercury Affect the development of the foetal nervous system Peanuts Children with allergies, including peanut allergy, with unknown reason It is thought that they may develop during pregnancy Avoid peanuts both during pregnancy and whilst breastfeeding

38. Caffeine Suggest to limit it to 300mg/day Found in: Tea Coffee Cola drinks Chocolate Associated with low birth weight babies and miscarriage Smoking Foods to Avoid

39. Medication in Pregnancy The most sensitive time for embryonic damage is in the first trimester avoid unnecessary medication during pregnancy

40. Planning & Leading Labour & Parentcraft Classes Class Arrangements Explore the perceived needs of the prospective clientele Adapting the classes according to the needs of the group

41. Week 1: Introductions Tackle immediate problems and worries A suitable, short general programme of exercises to promote comfort, mobility and strength When to come into hospital (early signs of labour ) and what to bring into hospital A 6- Week Course

42. Week 2: Stages, Signs And Length Of Labour , Birth Plans/Choices Labour First stage of labour Relaxation A discussion on the causes and effects of stress, and coping strategies A 6- Week Course

43. Week 3: Coping With The First Stage Of Labour Coping strategies for early stage of labour TENS The first stage progresses: positions, breathing awareness, massage and visualisation techniques. Week 4: Pain Relief and other Possibilities Medical pain relief, including the use of Entonox , pethidine and epidurals Discussion of the end of the first stage, transition and the second stage of labour Positions for the second stage Foetal monitoring, episiotomies, assisted deliveries, vacuum extraction and forceps. A 6- Week Course

44. Week 5: Further Possibilities In Labour , And Feeding Baby Third stage of delivery, the use of syntometrine Induction of labour , caesarean delivery The first feed and the postnatal care of woman and baby in hospital Breastfeeding, benefits of breastfeeding for babies and mothers A 6- Week Course

45. Week 6: Parenthood & Getting Back into Shape! Care of the new baby, a 24-hour job Transition to parenthood, adjustment to relationships Postnatal depression Postnatal exercises A 6- Week Course