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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
Preventive measures
Physiological changes during pregnancy
Pregnancy wt. gain - 9.70 to 14.55 kg.
CVS.
Physiological changes during pregnancy
Musculoskeletal system.
a. Stretching of abdominal muscles
1. Prenatal exercises
2. Preparation for labour
3. Postnatal exercises
Prenatal Exercise:
Abdominal exercise
Stabilization exercise
Includes:-
Strengthening exercise
Stretching exercise
STRETCHING EXERCISES
Head Lift
2. Trunk curls
3. Leg sliding
Leg Sliding
Forwards leaning
facilitates ante version
Woman should be
encouraged
To change position
during first stage of
labour
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.
KEGALS EX. DURING 1ST STAGE OF LABOUR
These are labour inducing exercise.
Lithotomy
Dorsal (recumbent)
4.Visual imagery.
sitting standing
feeding
others
lying
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 pneumonia
2. 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
GOAL PLAN OF CARE
1.Improve pulmonary Breathing ex. Coughing
function & decrease the &huffing.
risk of pneumonia
2.Decrease incisional 2. Postnatal TENS
pain associated with support incision with
coughing hands when coughing.
3. Friction massage &
3. Prevent postsurgical scar mobilisation.
adhision formation
4.Prevent postsurgical 4.Active leg ex. ,early
vascular complication ambulation
5.Correct posture & 5.Postural instruction
protected activities of &positioning for ADL
daily living
6. Pelvic floor ex.
6. Prevent pelvic floor
dysfunction
7. Abdominal ex.
7. Develop abdominal
strength
SUGGESTED ACTIVITIES FOR THE PT.
WITH A CS.
.1. Exercises
All prenatal ex. Should be done.
The women should be instructed to begin
preventive ex. As soon as possible during
recovery period.
Ankle pumping activities &early ambulation to
prevent venous stasis.
Pelvic floor ex. Kegals ex. &pelvic tilting ex.
Abdominal ex. Should be progressed more
slowly.
Deep diaphragmatic breathing
Women should wait at least 6 to 8 wk before
resuming vigrous ex.
2. COUGHING & HUFFING
huffing is a forceful outward breath using the
diaphragm rather then abdominal to push air out of
lungs.
The abdominals are pulled up &in rather then
pushed out causing decreased abdominal pressure
& less strain on the incision.
Support the incision with pillows or hands during
cuffing or huffing.& say “HA” forcefully while pulling
in abdominal muscle.
3. EX TO RELIEVE INTESTINAL GES PAINS
Abd. Massage or kneading while lying on the left
side.
Pelvic tilting ex.
4.SCAR MOBILISATION
HIGH RISK PREGNANCY
A pregnancy that is complicated by disease or
problem that put the mother or fetus at risk for
illness or death . Condition may be preexisting be
induced by pregnancy or an abnormal
physiological reaction during preg.
compress
5.Circulatory problem 5. –prolonged standing
avoided
varicose vein of leg
ankle ex. ,calf stretching
vulval varicose vein
- raising foot end of standing
leg cramps should bed.
-thrombosis & deep kneading massage
- thromboembolism - stocking & breathing ex.
6. Stress incontinence 6. pelvic floor ex