1. Physiotherapy in Obstetrics & Gynecology

2. OBSTETRICS 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.

3. 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

4. Effect of Childbirth on the Pelvic Floor
Neurological compromise
Muscular impairment
Episiotomy (second degree perineal tear)

5. Pelvic floor dysfuntion
Prolapse
Urinary or faecal incontinence
Pain and hypertonus
Specific exercises:
Kegel’s exercise
Contract relax (hold for 3-5 seconds)
Quick contractions (15-20 reps)
Elevator exercise

6. Interventions for pelvic floor
Patient education
Neuromuscular re-education
Biofeedback

7. Changes during pregnancy Musculoskeletal system
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.

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

13. General Guidelines for Exercise Instruction

14. Contraindications to exercise

15. Precautions

16. Suggested sequence for Exercises

17. Postural Exercises 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.

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

20. Strengthening of
External Rotators
Corner Press Out

21. ABDOMINAL EXERCISES Head Lift 1. Corrective ex. for diastesis recti
Head lift with pelvic tilt
Head Lift

22. 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

23. 4 Quadruped pelvic tilt ex.

24. Stabilization Exercises

25. 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.

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

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

28. 3. Modified squatting
Supported squatting using a chair or wall.
Wall slide.

29. 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.

30. RELAXATION & BREATHING EX
1. 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 relaxes 3. In this position pt. take deep diaphragmatic breathing. 4. Other methods of relaxation are a. mental imagery. b. muscle settings

31. POST NATAL EXERCISES
Ex. Can be started as soon as after delivery as the women feels able to ex.
All prenatal ex. Can be performed safely in postpartum period.
Before starting ex. Proper assessment of position & consistency of the fundus of the uterus should be done
Monitoring of lower limb edema, varicosities.
Care & advise on breast feeding & baby care.

32. 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

33. CESAREAN CHILDBIRTH Postsurgical pain. Risk of adhesion.
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
Risk of pneumonia
Postsurgical pain.
Risk of adhesion.
Formation at incisional site.
Risk of vascular complication.
Faulty posture.
Pelvic floor dysfunction.
Abdominal weakness

35. PREGNANCY INDUCED PATHOLOGY

36. 1.Modified abdominal muscle ex. With crossed hand over the abdomen.
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

37. 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.

38. 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.

39. Sitting posture in coccydynia
Correction for diastasis recti

40. THANKYOU
THANKS