Physiotherapy in

Obstetrics & Gynecology

OBSTETRICS AND GYNAECOLOGYOBSTETRICS AND GYNAECOLOGY

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.

Importance of pelvic floor

• Provide support for the pelvic organs and their contents

• Withstand increases in intra-abdominal pressure• Contribute to stabilization of the spine/pelvis• Maintain continence at the urethral and anal

sphincters• reproductive function

Effect of Childbirth on the

Pelvic Floor• Neurological compromise• Muscular impairment• Episiotomy (second degree perineal tear)

Pelvic floor dysfuntion

• Prolapse• Urinary or faecal incontinence• Pain and hypertonus• Specific exercises:• Kegel’s exercise

1. Contract relax (hold for 3-5 seconds)2. Quick contractions (15-20 reps)3. Elevator exercise

Interventions for pelvic floor

• Patient education• Neuromuscular re-education• Biofeedback

1. Stretching of abdominal muscles 2. Decrease in ligamentous tensile

strength.

3. Hyper mobility of joints due to ligamentous laxity.

4. Pelvic floor drops as much as 2.5 cm.

Changes during pregnancy Musculoskeletal system

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. Preparation for labour

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

General Guidelines for Exercise Instruction

Contraindications to exercise

Precautions Precautions

Suggested sequence for Exercises

Postural ExercisesPostural ExercisesStretching Stretching

• 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 Strengthening Exercise 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

Corner Press Out

ABDOMINAL EXERCISES1. Corrective ex. for diastesis recti • Head lift • Head lift with pelvic tilt

Head Lift

2. Trunk curls3. Leg sliding

Hook lying with posterior pelvic tilt

Maintain pelvic tilt as the feet slide along the floor away from the body

Leg Sliding

4 Quadruped pelvic tilt ex.

Stabilization ExercisesStabilization Exercises

Pelvic floor exercises

Isometric ex. / kegals ex.

• Pt position – any position

• Instruction - to tighten the pelvic floor as if

attempting to stop urine, &hold for 3 to 5 sec.

• This ex is valuable in treating leaky bladder.

Modified Upper Limb & Lower Limb Exercise.

1. Modified push ups /standing pushups2. Hip extension a. supine bridging

b. All four leg raising

Quadruple position with posterior pelvic tilt

Leg is raised only until it is in line with the trunk

a.

b.

3. Modified squatting

a. Supported squatting using a chair or wall.b. Wall slide.

PERINEUM & ADDUCTOR PERINEUM & ADDUCTOR FLEXIBILITYFLEXIBILITY• Self stretching

1. Women's position supine or side lying .

instruct to abduct the hip &pull the knees towards the sides of her chest & hold the position for as long as comfortable.

2. Sitting – have the women sit on a short stool with the hips abducted & feets flat on the floor.

RELAXATION & BREATHING EXRELAXATION & BREATHING EX1. Patient position in kneeling forward on to one’s arm

on a cushion placed on a seat of a chair.2. In this position wt. of the fetus lies on the anterior

abdominal wall & pelvic floor relaxes3. In this position pt. take deep diaphragmatic

breathing.4. Other methods of relaxation are

a. mental imagery. b. muscle settings

POST NATAL EXERCISES1. Ex. Can be started as soon as after delivery as the

women feels able to ex.

2. All prenatal ex. Can be performed safely in postpartum

period.

3. Before starting ex. Proper assessment of position &

consistency of the fundus of the uterus should be

done

4. Monitoring of lower limb edema, varicosities.

5. Care & advise on breast feeding & baby care.

INITIAL POSTNATAL EX.

Breathing Ex.

Leg exercise

Abdominal exercise

Pelvic tilting exercise

Deep breathing for circulatory & relaxing effect

Foot ankle leg exercise

In crook line position combined with expiration

Crook lying position

Tilt- Relax-Tilt – Relax Exercise

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. Risk of pneumonia2. Postsurgical pain.3. Risk of adhesion.4. Formation at incisional site.5. Risk of vascular complication.6. Faulty posture.7. Pelvic floor dysfunction.8. Abdominal weakness

PREGNANCY INDUCED PATHOLOGY

PATOHLOGY

1. diastesis recti

2. Lower back pain & pelvic pain.

3. SI dysfunctioN

PT MANAGEMENT

1.Modified abdominal muscle

ex. With crossed hand

over the abdomen.

2.In acute condition bed rest

do’s or don’t

gentle heat & massage

pelvic tilting in croock lying

TENS if indicated

3. Modified ex. For SI pain

4. Nerve compression

syndrome

-Carple tunnle syndrome

-Brachial pluxus pain

-Meralgia paraesthetica

-Posterior tibial nerve

compress

5.Circulatory problem

varicose vein of leg

leg cramps

-thrombosis &

-

thromboembolism

4. Splinting

ice packs

elevation of the limb

TENS

5. –prolonged standing avoided

ankle ex. ,calf stretching

- raising foot end of standing should bed.

deep kneading massage

- stocking & breathing ex.

6. Stress incontinence

7. Postural backache

8. coccydynia

6. pelvic floor ex

7. postural correction

8. Ice packs ,heat, US,

TENS,

use of rubber ring to relieve pressure in sitting.

Sitting posture in coccydynia

Correction for diastasis recti

THANKYOU

THANKS