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Normal anatomy of female pelvis

Physiotherapy in Obstetrics & Gynaecology By MOHD. JAVED MPT(ORTHO)-1ST YR. APOLLO COLLEGE, DURG C.G. Obstetrics concerns itself with pregnancy, labour, delivary &the care of the mother after child birth

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Normal anatomy of female pelvis

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  1. Physiotherapy inObstetrics & Gynaecology ByMOHD. JAVEDMPT(ORTHO)-1ST YR.APOLLO COLLEGE, DURGC.G.

  2. 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.

  3. Normal anatomy of female pelvis

  4. Physiotherapy in obstetrics condition From the moment of conception pregnancy profoundly alters the women physiology. There is change in all body system to fulfill the requirement of the body.

  5. 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

  6. Physiological changes during pregnancy • Pregnancy wt. gain - 9.70 to 14.55 kg. • Changes in reproductive system. • Urinary system -kidney increases by 1cm. • Changes in pulmonary system. • CVS.

  7. Physiological changes during pregnancy • Musculoskeletal system. a. Stretching of abdominal muscles b. Decrease in ligamentous tensile strength. c. Hyper mobility of joints due to ligamentous laxity. d. Pelvic floor drops as much as 2.5 cm.

  8. 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.

  9. Exercises in pregnancy Prenatal exercises Preparation for labour Postnatal exercises

  10. 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

  11. General goals & plan for exercise programs

  12. General Guidelines for Exercise Instruction

  13. 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.

  14. strenuous activities should be avoided. • avoid prolong period of standing specially in third trimester. • adequate caloric intake, increase to 300 kcal./day for ex. during preg. & 500 kcal./day for ex. during lactation. • low resistance & high repetitions ex. is recommended, avoid valsalva maneuvers. • stop ex. if any unusual symptoms occur.

  15. Contraindications to exercise……….

  16. 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.

  17. Persistent vaginal bleeding. • Fetal distress. • IUGR. • Incomplete cervix • Thrombophlebitis &pulmonary embolism. • Pre-eclampsia • polyhydraminos / oligohydraminos • Acute infection

  18. 2.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 • Pain of any kind.

  19. Suggested sequence of exercise.

  20. 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.

  21. Selected exercise techniques

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

  23. Posture exercise: Includes:- • Strengthening exercise • Stretching exercise

  24. 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.

  25. Self Scalen streching Scalens stretching by therapist

  26. Low back extensors stretching Manual Back Stretch

  27. Self Back Stretching

  28. Hip adductor stretching : - Tailor’s Sitting Position

  29. Strengthening Exercise . • Upper neck flexors lower neck &upper thoracic extensors • Scapular retractors &depressor • Shoulder external rotators • Hip & knee extensors • Ankle dorsi flexors

  30. Strengthening of External Rotators Corner Press Out

  31. ABDOMINAL EXERCISES: - 1. Corrective ex. for diastesis recti • Head lift • Head lift with pelvic tilt Head Lift

  32. 2. Trunk curls 3. Leg sliding Leg Sliding Hook lying with posterior pelvic tilt Maintain pelvic tilt as the feet slide along the floor away from the body

  33. 4 Quadruped pelvic tilt ex.

  34. Stabilization Exercises. • These ex are progression for developing dynamic control of the pelvis &LL . • These may be performed throughout the pregnancy & postpartum period. • caution – the women to maintain a relaxed breathing pattern & exhale during the exertion phase of each ex. • Alternate hip & knee extension with one leg stationary on a mat. • Progression is alternate hip & knee extension &flexion with both LL moving.

  35. 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.

  36. Modified Upper Limb & Lower Limb Exercise. • Modified push ups /standing pushups • Hip extension a. supine bridging

  37. b. All four leg raising a. Quadruple position with posterior pelvic tilt b. Leg is raised only until it is in line with the trunk

  38. 3. Modified squatting These are used • To strengthen the hip &knee extensor. • Stretch the peroneal area. • Supported squatting using a chair or wall. • Wall slide.

  39. PERINEUM & ADDUCTOR FLEXIBILITY • 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.

  40. RELAXATION & BREATHING EX • Relaxation & Breathing exercise. Are given with the following objectives • To obtain rest during preg. • To help the mother regain normal health afterwards by preventing unnecessary fatigue • Most common method of relaxation is MITCHELLS METHOD.

  41. 4. Patient position in kneeling forward on to one’s arm on a cushion placed on a seat of a chair. 5. In this position wt. of the fetus lies on the anterior abdominal wall & pelvic floor relaxes 6. In this position pt. take deep diaphragmatic breathing. 7. Other methods of relaxation are a. mental imagery. b. muscle setting – “Jacobson’s Method”

  42. PREPERATION FOR LABOUR A prog. of labour training consist of • Body awareness & labour/ positioning during labour. • Relaxation during labour. • Breathing during labour. • Massage during labour.

  43. Positioning During Labour 1st stage of labour – In this stage uterus anteverts Forwards leaning facilitates ante version Woman should be encouraged To change position during first stage of labour

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

  45. KEGALS EX. DURING 1ST STAGE OF LABOUR • These are labourinducing exercise. In 1st half an hour –supine to sitting every 5 min. In 2nd half an hour – do supine to sitting every 4 min.

  46. 2. POSITIONING DURING 2ND STAGE OF LABOUR. Commonly used positions are • Lithotomy • Dorsal (recumbent) • Lateral & semirecument

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