OGY
ASSESSME
NT
PRESENTAT
ION
TABLE OF
CONTENTS
01
DEMOGRAPHIC DATAON PALPATION
04
It becomes a part of patients medical To assess the texture of patient’s
record, because race and ethnicity tissue,to locate particular anatomical
affects patients health position
02
HISTORY
05
ON EXAMINATION
As this may impact the Here you could describe the topic of
gynaecological problem . the section
03
ON OBSERVATION
06 PFD
It is done to spot a change in
patient’s condition quickly 2
INTRODUCTION
The role of the Obstetric Physiotherapist is to
promote health throughout the childbearing
period to help the woman adjust advantageously
to the physical and psychological changes of
pregnancy and the post-natal period so that the
stresses of childbearing are minimised.
Antenatally and post-natally she advises on
physical activity associated with both work and
leisure and is a specialist in selecting and
teaching appropriate exercises to gain and/or
maintain fitness including pelvic floor education.
3
DEMOGRA
PHIC DATA
DEMOGRAPHIC
DATA
PERSONAL DATA: OCCUPATION:
NAME: To address patient / To build
rapport WHAT WORK :
AGE: 25 - 35 HOW MANY HOURS
GENDER: Female A DAY:
BMI: Weight/(Height)^2=kg/m^2 TILL WHAT MONTH:
ADDRESS: Area of living, Locality
MARITAL STATUS: DATES:
AGE : DATE OF ASSESSMENT:
OCCUPATION OF DATE OF ADMISSION:
FATHER:
YEARS OF DATE OF OPERATION:
MARRIAGE:
RELIGION: 1 1 DATE OF DISCHARGE:
5
CHIEF
COMPLAIN
TS
Low back ache Nausea
Radiating Pain
Blood pressure High Vomiting
Weakness
Headache Frequency of
Swelling in both limbs Micturation
Cramps
6
HISTOR
Y
HISTORY
TYPES OF
ABORTION
GPAL and MENSTRUAL
HISTORY
G[Gravida]: How many times pregnancy conceive
P[Pariety]: Pregnancy conceive more than 20 weeks
A[Abortion]: Occur in the first 3 month
Types of the abortion like the complete, incomplete , missed ,
recurrent and inevitable.
L[Live Birth]: Present live child(girl,boy or twins)
LMP :
EDD= LMP+9 Momth+7 Days
(Naegele’s Formula)
8
ANTENATAL
HISTORY
Complain & Complication
Physical Activity: During the 9 month any household work, any
physical activity,occupational work
Regular check up: Every day/week/month
Weight:
Pre pregnancy weight:
Post pregnancy weight:
Blood pressure:
Trimestar symptoms:
Immunization History:Tetanus Dose(TT) If , Multigravida TT
Booster
Primygravida 3 TT Dose
Drug History: May be patient is taking Iron/Calcium/
Follic acid tablet
9
PERINATAL
HISTORY Duration of the gestation:
Pre term[ 8 to 8.5 month]
Pre mature[6 to 7 month]
Pre full term
Rupture of the plasma membrane
Still Birth
Intra uterine death
COMPLAIN
&COMPLICATIO
N: During the
delivery of the baby
any complication
Duration of the Labour:
Primy: 10 to 12 hr
Multi: 2 to5 hr
1
0
COMPLAIN
POSTNATAL &COMPLICAT
HISTORY ION
Any complication
after the delivery e.g: PPH
DELIVERY
LSCS
Normal Delivery
Episiotomy
Per vagina
lBleeding[LOCHIA]:
Rubra[1-5 days]
Silosa[6-10 days]
Alba[11-15 days]
Breastfeeding History:
1
1
NEONATAL
HISTORY
BABY NEONATE
WEIGHT REFLEXES
Moroe reflex
Sucking Reflex
BOY NORMAL Rooting Reflex
GIRL 2.5 to 3 kg Palmargrasp Reflex
Stepping Reflex
TWINS Babinski sign
Plantargrasp Reflex
CRY INCUBATION
IMMEDIATE
Yes/No
CRY Reason
YES/NO How Long
12
NEONATE
REFLEXES
NEONATE
REFLEXES
NEONATE
REFLEXES
APGAR
SCORE
01
Mercury is the closest planet to the
Sun and the smallest one in the
Solar System—it’s only a bit larger
than our Moon
02
Venus has a beautiful name and is
the second planet from the Sun. It’s
terribly hot—even hotter than
Mercury
HISTORY OF
INCONTINEN
HISTORY CE
SURGICAL
HISTORY:
Type
Duration
Site of the incision
Any other related surgeries
MEDICAL
HISTORY:
e.g; Diabetes/Hypertension/Drug
Allergies/Any other STD
Infections
1
7
PERINATAL
HISTORY
PERSONAL HISTORY:
Appetite
Sleep
Bowel&Bladder Control
Any bad habit
DRUG HISTORY:
FAMILY HISTORY:
Hereditary Diseases
1
8
SOCIOECONOMI
CAL HISTORY:
Kuppuswamy
scale
1
9
ENVIRONME
NTAL
HISTORY
01
Area
02
Flat/Appartment
If app, then On which floor
& use of stairs or
not
03 Type of toilet :Indian /
Western
PSYCOLOGICAL
HISTORY
Stress Edinburgh
Scale[DASS] postnatal
depression scale
USES:
was developed for screening
postpartum women in
outpatient, home visiting
settings, or at the 6 –8 week
postpartum examination
2
1
ON
OBSERVATI
ON
ECTOMORPHI
HISTORY C
Thin , prominence of structures
from ectoderm.
MESOMORPHI
C
Muscular , prominence of
structures from mesoderm.
ENDOMORPH
IC
Heavy , fat body built ,
prominence of structures of
endoderm.
2
3
BREATHIN
G
PATTERN:
01 Thoraco abdominal
02 Abdominal thoracic
POSTURE
POSTURE SUPINE
Forward head with chin pushing forward and straining of
HEAD neck.
Rounded shoulders.
SHOULDERS
SPINE Increase in lumbar lordosis and Anterior pelvic tilt.
Locking of the knees.
KNEES JOINT
Decrease in arch of foot.
ANKLE JOINT
2
5
POSTURE FIG.01A FIG.01B FIG.02A FIG.02B
FIG.01A:Sway backed posture of a
women at 14 weeks gestation.
FIG.01B:Sway backed posture of the same
women has maintained its characteristics
by 36 weeks gestation.
FIG.02A : A women with lordotic
posture observedat 16 weeks gestation
FIG.02B : The same women has an
incresed lordosis and kyphosis at 38 weeks
gestation
26
FIG.03A FIG.03B
POSTURE
FIG.03A: At 15 weeks, this women
demonstrates a lordotic posture with a
convex curve which appears to extend
into mid-thoracic region and degree of
lordosis appears to be less exaggerated
than that of women in FIG.O2B
FIG.03B : Progression of postural curves
occurs in the same direction
27
POSTURE FIG.04A FIG.04B FIG.04C
FIG.04A:Posture of primigravida at 14
weeks
FIG.04B : Posture at 36 weeks gestation
FIG.04C : Posture at 12 weeks postnataly
28
POSTURE FIG.04A FIG.04B FIG.04C
FIG.04A:Posture of primigravida at 14
weeks
FIG.04B : Posture at 36 weeks gestation
FIG.04C : Posture at 12 weeks postnataly
29
POSTURE
GAIT
Neuromechanical adaptations to pregnancy refers to the change in postural parameters
as well as gait pattern.
● The body's posture changes as the pregnancy progresses. The pelvis tilts and the back
arches to help keep balance. Poor posture occurs naturally from the stretching of
the woman's abdominal muscles as the fetus grows.
● Altered lower extremity kinetics and kinematics.
‘Duck' , ‘ Penguin’ or ‘ Waddle gait’
What is a waddling gait? And what
causes waddling gait in a pregnant
woman?
The first trimester, is a period of changes in the hormonal system and the level of some
of these hormones may affect the structure of movements
● There is an initial increase of relaxin levels,until the peak value in the 12th week,
followed by a decline until the 17th week
● This relaxin hormone relaxes the body's muscles, joints and ligaments. The effect
centers on the joints of the pelvis.
● It remodels pelvic connective tissue and leads to laxity in the ligamentous and
connective tissues. There will be gradual softening of pelvic cartilage and
connective tissue Relaxed sacroiliac joints and symphysis pubis “Waddling gait”
GAIT
SKIN CHANGES
LINEA
Pigmentation Areolas, SKIN
Pigmentation Areolas,
nipples, genitalia, axilla nipples, genitalia, axilla
NIGRA
Darkening of the vulva and CHANGES
Darkening of the vulva and
face Chloasma or the ‘mask face Chloasma or the ‘mask
of pregnancy’ : Blotches over of pregnancy’ : Blotches over
forehead, cheeks and around forehead, cheeks and around
the eyes the eyes
STRETCH BREAST
As early as 2-4 weeks of
pregnancy, unusual tenderness
MARKS OR
Need for skin to stretch rapidly over
CHANGES
and tingling, breasts become
nodular and lumpy Oestrogen-
STRIAE
the enlarging body Can be
aggravated by the hormonally
the duct system and
progesterone- alveoli Increased
mediated softening of collagen and
by unnecessary weight gain Can
breast weight plus increased
develop over buttocks, abdomen or blood supply
breasts and may become pigmented
33
ON
PALPATI
ON
ON PALPATION
Tenderness :-
Site :-
Grade:-
1-patient complain of pain
2 -patient complain of pain and wiences
3 -patient complain of pain and withdrawal of limb
4-patient not allow to touch
Scar:-
Site:-
Healed/unhealed:-
Mobile/adherent:-
35
ON PALPATION
SPASM
Back muscle,
Lower limb muscle,
Calves
Abdominal muscle Hand
muscle
TEMPERAT
The strong muscle activity
EDEM
URE
results in heat production ,
Presence A
of edema in
there may be a slight rise in
temperature ,the women feel
pregnancy is generally
hot and perspire . However , normal at the site of
redistribution of blood often ankle , wrist . Pitting
results in the feet being very edema usually seen in
cold . pregnancy.
36
PAIN
ASSESSM
ENT
PAIN
SIDE:right,left
ASSESSMEN MODE OF ONSET:sudden,incidious,gradual
ANTENATAL:
T DURATION: acute , sub-acute or chronic
TYPE /QUALITY: sharpshooting,dull
aching,burning
PAIN SITE 24 HR PATTERN: morning,night or troughout the
day.
AGGRAVATING FACTOR:Prolonged
sitting,and standing,walking . Forward
bending and twisting
RELIEVING FACTOR: Rest,supported
sitting.
VISUAL ANALOG
SCALE:
At activity:
No pain Worst pain
At rest:
No pain Worst pain
3
8
LABOUR PAIN
FIRST STAGE: The main cause of the first stage of
labour is thought to be directly associated with
dilation of the cervix and distension of the lower
uterine segment around the descending presenting
fetal parts.
SECOND STAGE and DURING DELIVERY : It
will be felt chiefly in the soft tissues of perineal
region.
pain in the perineal region increases. It is mainly
experienced as the pelvic outlet is pushed open by
the fetus, affecting the symphysis pubis, sacroiliac
and sacrococcygeal joints.
Individuals vary greatly in the way they
perceive,interpret and respond to pain.
39
PAIN SITES
DURING LABOUR
PAIN
SIDE:right,left
ASSESSMEN MODE OF ONSET:incidious,
POSTNATAL:
T DURATION: acute
TYPE /QUALITY: sharpshooting, dull
aching,burning
PAIN SITE 24 HR PATTERN: morning,night or troughout the
day.
AGGRAVATING FACTOR:Prolonged
1. Site of episiotomy sitting,and standing,walking . Forward
bending and twisting
2. Abdominal pain
RELIEVING FACTOR: Rest,supported
3. Spinal pain: sitting.
cervical, thoracic, VISUAL ANALOG
SCALE:
low back, sacro- At activity:
iliac, coccyx and
epidural pain. No pain Worst pain
4. Pubic symphisis At rest:
pain.
Worst pain
5. Pelvic pain No pain
4
1
ON
EXAMINATI
ON
VITALS
BLOOD PRESSURE -
<120mmHg / <80mmHg
Oxygen saturation
HEART RATE - SpO2 (%) - 95-100%
72/min
RESPIRATORY
RATE - 12-14/min
Temperature – 36.5-
37.3 C* / 96.8-99.5 F*
4
3
RANGE OF
MOTION
ROM
• Within the permissible range
• Ballistic movements should be avoided
• End range pressure should be avoided
• Hypermobility of joints due to laxity of
ligaments
• Restricted trunk movements
• If edema present then restricted range at
that joint
4
4
RANGE OF
MOTION
ROM OF LUMBAR ROM OF HIP
SPINE JOINT
4
5
ENDFEEL
NORMAL
Bone To Bone - elbow extension
Soft Tissue Approximation - knee flexion
Tissue Stretch - ankle dorsiflexion, shoulder lateral rotation, finger
extension
ABNORMAL
Early Muscle Spasm - protective spasm following injury
Late Muscle Spasm - spasm due to instability or pain
Mushy Tissue Stretch - tight muscle
Spasticity - upper motor neuron lesion
Hard capsular - frozen shoulder
Soft capsular - synovitis, soft tissue edema
Bone to bone - osteophyte formation
Empty - acute subacromial bursitis
Springy block - meniscus tear
46
OEDEMA
GIRTH MEASUREMENT :
Generally done at 3 levels,
considering the area of
maximum bulk on the
unaffected side.
CAUSES :
-Prolonged pushing labour
-Pelvic congestion
-Dysfuctional urinary tract
-Temperature on the postnatal HOW TO EXAMINE THE
ward OEDEMA?
Before examination of the oedematous part ,
observation should be done first.
Oedema is known as gravitational -After observation the pressure should be
given on soft tissue of the
oedema. oedematous part by the thumb of the
-Pedal oedema is common during therapist and wait until the skin
rebounds.
pregnancy.
-Areas: hands,face,legs,ankles,feet.
4
7
DIASTASIS
RECTI
Separation of rectus abdominis muscles in the middle at the
linea alba.”
INCIDENCE:
-Frequently seen in childbearing woman.
-may occur in pregnancy:
~Hormonal effects on the connective tissues.
~Biomechanical changes
-May develop during labor.
~ During second stage
-Can occur above , below or at the level of umbilicus.
-Less common in women with good abdominal muscle tone
before pregnancy.
48
DIASTASIS RECTI
ASSESSMENT
PATIENT’S POSITION: Hook
lying.
PROCEDURE:
-Have the patient slowly raise her head
SIGNIFICANCE: and shoulders off the floor, reaching her
-May produce LBP hands toward the knees, until the spine
-Activity limitations of scapulae leaves the floor.
-Decreased fetal protection -Place the one hand horizontally across
-Potential for herniation the midline of the abdomen at the
umbilicus.
EXAMINATION: -If the separation exists , fingers will
-Why examination is important? sink into the gap.
-When to check? - The visible bulge between the rectus
~After 3 days of normal delivery. bellies may be appreciated.
~Probably after 6 weeks in c- -Numbers of fingers that can be placed
section. between the rectus muscle bellies
~Instuctions for self-test. measures the diastasis.
- <2 cms or <2 fingers is considered as
normal.
- >2 cms or >2 fingers is considered as
abnormal.
4
9
URINARY
INCONTINENCE
Involuntary loss of urine that is objectively
demonstrable.”
TYPES:
1. Urethral Incontinence
2. Detrusor overactivity / reflex Incontinence
3. Urodynamic stress Incontinence
4. Nocturnal enuresis Incontinence
5. Giggle Incontinence
6. Functional Incontinence
7. Urge Incontinence
8. Orgasmic Incontinence
50
INCONTINENCE
ASSESSMENT
EXAMINATIO
N
FORM
51
PAD TEST:
Is performed to quantify objectively urine loss in stress or urge incontinence.
Procedure:
Measure the pre pad weight.
Make the patient wear it.
The patient is asked not to void until the end of the test.
The patient drinks 500 mL of sodium-free liquid (e.g. distilled water) within 15 minutes, then sits or rests to the
end of the first half hour.
In the next half hour the patient walks around, climbs up and down of stairs, and performs the following
exercises: standing up from sitting
coughing vigorously
running on the spot for 1 minute
bending down to pick up a small object
washing the hands under cold running water for 1 minute.
At the end of 1 hour the pad is removed and weight is checked;
any difference from the starting pad weight constitutes fluid loss, and this is recorded.
An increase of up to 1 g is considered normal because of possible discharge and sweating.
5
2
EOMETER/ VAGINAL
OMETER/ PERITRON
Is an gold standard method to assess as well as treat.
Purpose: to measure the strength of PFM.
01
TYPES: Records pressure changes
02
Monitors the electromyographic activity
PATIENT’S POSITION: crook lying
PROCEDURE : A vaginal pressure probe is used, which is usually
covered for use with a condom; if necessary a little lubricant jelly is
applied.
Patients should be asked if they wish to introduce the probe themselves,
and every care should be taken to maintain their dignity.
Ask the patient to lift and squeeze
The voluntary contraction is recorded
An explanation of the examination
OBSERVATIO
PER VAGINAL procedure to the patient N
Patient’s position: crook lying position
EXAMINATION Cover the upper limb and trunk.
Ask the patient to pull the muscles around
vagina towards themselves and hold
without having any pressure on
abdomen.
Therapist must observe the contractions near
PALPATION vagina.
Therapist must wear gloves.
Therapist’s one hand on the vagina
and other on abdomen.
Ask the patient to pull the muscles
and therapist feels the
contraction.
EXAMINATI
ON
Ask the patient to relax.
Therapist must wear gloves.
Therapist inserts two fingers in the
distal 1/3rd of vagina.
Ask the woman to lift inward and
squeeze around the finger.
54
GRADING
C/T/D
• Contracture can be caused due to any traumatic
injury, burns or severe muscle or bone injury
which can later form tightness and deformity,
does not happen in every case
Example - if any accident occur with pregnant
lady !
56
CHEST
EXPANSION
• Access the heart and lungs for signs of disease
• With the enlargement of uterus, especially in later months, there
is elevation of diaphragm by 4 cm
• Diaphragmatic excursion is increased by , 1-2 cm and breathing
becomes Diaphragmatic.
• The subcostal angle decreases from 68° to 103° , the transverse
diameter of chest expands by 2cm and chest circumference
increases by 5-7 cm
•A state of hyperventilation occurs during pregnancy, leading to
increase in tidal volume.
• It is probably due to progesterone acting on the respiratory
centre and also to increase in sensitivity of the centre to CO2 , the
women feels shortness of breath.
57
CHEST EXPANSION
6 MIN.WALK
TEST
• The 6 min walk test is a simple , non invasive excercise
test that measures the distance an individual is able to cover
by walking for 6 min.
• PROCEDURE:-
The object of the test is to walk as far as possible for six
minutes.
You will walk at your normal pace to a chair or cone, and
turn around. And you continue to walk back and forth for
six minutes.
The 6-min walk distance ranges from 400 to 700 m
59
International classification of
tioning, disability and health )
PFD
GOALS
1. Provide information about pregnancy
and associated problems.
2. Improve relaxation skill and stress
management.
3. Improve posture and gait within
available limits.
4. Improve awareness and control of
pelvic floor muscles.
5. Maintain muscle length and and bulk
to improve circulation.
6. Decrease incisional pain (if LSCS or
episiotomy is done).
7. Prevent postsurgical adhesion
formation.
8. Develop abdominal strength.
6
2
REFERENCES
● MARGARET POLDEN AND JILL MANTLE.Physiotheraphy in obstretics and gynaecology. Jaypee
● HIRALAL KONAR. D.C Dutta ‘s Textbook of Obstretics. Jaypee
● CAROLYN KISNER and LYNN ALLEN COLBY.Therapuetic Exercise foundation and techniques. Jaypee
● CHANGELA PURVI K . Role Of Physiotherapist In Obstetric And Gynecological Conditions.Jaypee
● RUTH SAPSFORD ,JOANNE BULLOCK and SEU MARKWELL.Women's Health: A Textbook for
Physiotherapists .
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3
THANK
S
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