Obstetric and Gynaecology Physiotherapy

Obstetrics concerns itself with pregnancy, labour, delivary &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.

Gynaecology Physitherapy

Therapeutic exercises may be prescribed to pregnant women for several reasons:

• Primary conditioning unrelated to pregnancy.
• Impairments related to physiological changes of pregnancy, such as back pain ,faulty posture, or leg cramps.
• Physical &physiological benefits.
• Preventive measures

Physiological changes during pregnancy

• Pregnancy wt. gain to kg.
• Changes in reproductive system.
• Urinary system -kidney increases by 1cm.
• Changes in pulmonary system.
• CVS.

Physiological changes during pregnancy

Musculoskeletal system.

a. Stretching of abdominal musclesb. Decrease in ligamentous tensile strength.c. Hyper mobility of joints due to ligamentous laxity.d. Pelvic floor drops as much as 2.5 cm.

Exercises in pregnancy

• Prenatal exercises
• Preparation for labour
• 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

Prepare for circulatory compromise
4. Improve awareness & control of pelvic floor musculature5. Maintain abdominal muscle function & correct diastesis recti6. Provide information about preg. & associated problem7. Improve relaxation skill3. Stockings, stretching ex.4. Pelvic floor muscle strengthen5. Abd. Muscle strengthen ex.6. Prenatal & postnatal information7. Relaxation tech.

General Guidelines for Exercise Instruction

• Physical examination is must prior to engaging a pt. in an Exercise Programme.
• Each person should be individually evaluated for preexisting Musculo -skeletal problems, posture & fitness level
• Exercise regularly, at least thrice a week
• Avoid ballistic movements & rapid change in directions.
• include warm-up & cool down session
• avoid an anaerobic pace.

Contraindications

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.

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

General rhythmic activities to warm-up.

• Gentle selective stretching
• Aerobic activities for CVS conditioning
• UL &LL strengthening ex.
• Abdominal ex
• Pelvic floor ex.
• Relaxation /cool down activities
• Educational information [if any] & postpartum ex. Education.

Selected exercise techniques

Postural exercise.

• Abdominal exercise
• Stabilization exercise
• Pelvic motion training & strengthening.
• Modified UL & LL strengthening.
• Perineum &adductor flexibility.
• Relaxation &breathing exercise

Strengthening exercise Stretching exercise

• Strengthening exercise
• Stretching exercise
• Posture 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.

GOAL

1. Decrease stiffness
2. Maintain muscle length & bulk to improve circulation.
3. Improve proprioception
4. Improve posture within available limits.
5. Stress management & enhance relaxation .
6. Enhance postpartem recovery.
7. PLAN OF CARE
8. Positioning instruction ,joint motion at available ROM.
9. Stretching & strengthening ex. Within limits imposed by physician.
10. Movement activities for many body parts as possible.
11. modified posture instruction.
12. relaxation tech.
13. Ex instruction &home program for postpartum period.

EX. PROGRAM FOR HIGH RISK PREGNANCY

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.ROM INSTRUCTIONslow active full ROM of all the joints.Teach movement in gravity eleminated position.