1

To promote & maintain optimal physical &

emotional maternity health throughout
preg

To recognize & treat correctly medical or

obstetrical complication occurring during
preg

Early detection of any fetal abnormalities

3

 To

prepare for & inform both parents

about
pregnancy, labour & the puerperium and
subsequent baby care

The

overriding goal is that pregnancy will

result in a healthy mother & a healthy
infant
4

General practitioners
Midwives
Obstetric physiotherapist
Dieticians
Obstetricians
Paediatricians
Lab technicians
Health visitors
Ultrasound operators
5

Booking visit
Measurements- BP, urine, weight,
oedema, fundal height, fetal
movements, fetal heart rate, blood
tests, haemoglobin level, STD, blood
group, ultrasound scanning, chorionic
villus sampling, amniocentesis,
alphafetoprotein measurement,
pelvimetry.
6

Antenatal education can be provided in

Obstetric hospital

Community setting

Rural settings

10

11

12

13

Physical changes
Ergonomics
Exercise guidelines
Management of discomfort

14

Relaxation
Breathing
Positioning
Coping skills for labour
Massage

15

16

17

18

19

20

Fatigue
Diet & weight gain
Emotional reaction

21

22

23

Antenatal care of breasts & preparation

for breast feeding

24

25

Jerky, bouncing, ballistic movements &

activities should be avoided
Regular exercise session at least 3
times/week are safer than intermittent
Careful warm up and cool down
Fluid must taken before, during and
after exertion to avoid dehydration

26

Strenuous exercise must be avoided in

hot, humid weather
Maternal heart rate should not exceed 140
beats per minute avoid exercise > 15 mins
Exercise should be decided based on the
limitations imposed by pregnancy
Those accustomed to sedentary lifestyle
should start with low intensity physical
activity
27

28

Hyperthermia
Abnormal heart rate
Decreased utero-placental flow
Increased uterine contractions
Reduced maternal glucose levels
Disruption of maternal endocrine
haemostasis

29

Poor growth of foetus

Blood may be directed away from foetus
to active muscle groups during exercise
Blood flow in the main uterine artery may
decrease during intense exercise,
however blood flow need to be
redistributed before the fetus would be
negatively affected

30

Haemodynamically significant heart disease

Restrictive lung disease

Incompetent cervix/cerclage

Multiple gestation at risk for premature

labour

Persistent second or third trimester bleeding

31

Placenta praevia after 26 weeks

gestation

Premature labour during the current

pregnancy

Ruptured membranes

Pregnancy induced hypertension

32

Severe Anaemia
Unevaluated maternal cardiac
arrhythmia
Chronic bronchitis
Poorly controlled type 1 diabetes
Extreme morbid obesity
Extreme under-weight (body mass index
< 12)
History of extremely sedentary lifestyle
33

Poorly controlled hypertension/preeclampsia

Orthopedic limitations
Poorly controlled seizure disorder
Poorly controlled thyroid disease
Heavy smoker
Intrauterine growth restriction in
current pregnancy
34

Vaginal bleeding

Dyspnoea before exertion

Dizziness

Headache

Chest pain

35

Muscle weakness

Calf pain or swelling (need to rule out

thrombophlebitis)

Pre-term labour

Decreased fetal movement

Amniotic fluid leakage

36

Shorten labor
Make delivery easier
Help to cope with the pain of labor
Help to recover and get back in shape
more rapidly after delivery

37

38

Major
Back & pelvic girdle pain
Sacroiliac dysfunction
Stress incontinence
Urinary frequency

39

40

41

42

Others
Sciatica
Osteitis pubis
Coccydynia
Thoracic spine pain
Osteoporosis
Fibroids
43

Intercostal neuralgia/costal margin pain

Chondromalacia patellae
Restless leg syndrome
Uterine ligament pain
Fatigue
Insomnia & nightmares
Heartburn
Pruritis

44

Nerve compression syndrome

Carpal tunnel syndrome
Brachial plexus lesion
Meralgia paraesthetica
Posterior tibial nerve compression

45

Circulatory disorders
Varicose veins
Haemorrhoids
Cramp
Thrombosis & thromboembolism

46

47

48

49

50

51

Changes are commonly seen in

1. Connective tissue
2. Abdominal muscle
3. Pelvic floor
4. Legs
5. Back
6. Breast
7. Mood

52

Asst carried out 6 weeks post partum

Measurements-BP,
breast/perineum/vaginal examination,
pelvic floor/abdominal muscle strength,
emotional status, family support.
Postnatal establishment of breast
feeding, position of mother & baby,
length & time of feeds
Problem list
53

Diastasis rectii, pelvic floor

54

Breathing exercise
Leg exercises
Pelvic floor exercises
Abdominal exercises
Pelvic tilts

55

Emphasise on above stated exercise &

home prog
Back care advice
Posture & exercises to be carried out in
different posture sitting, lying &
standing

56

Special emphasis on feeding, nappy

changing, baby bathing, carrying/lifting
Baby massage
House hold work & return to work/sport

57

58

59

60

61

Painful perineum
Diastasis recti abdominis
Back pain
Symphysis pubis pain

62

Bladder & bowel problems

Retention of urine
Urgency & urge incontinence
Stress incontinence
Anorectal incontinence
constipation

63

Circulatory problems
Varicose veins
Oedema
Venous thrombosis superficial, deep,
pulmonary embolus, haemorrhoids

64

Psychiatric problems
Maternity blues
Puerperal psychosis
Postnatal depression

65

66

Perineal & vaginal pain

Backache
Diastasis recti abdominis
Mastitis & breast abcess
Stress & faecal incontinence

67

Postnatal depression
Diastasis symphysis pubis
Hair loss
Carpal tunnel syndrome
Tiredness

68

69

Coughing

70

Exercising, posture
Feeding
Pain

71

72

Physiotherapy in obstetrics &

gynaecology Margaret polden
Physiotherapy in obstetrics &
gynaecology Jill mantle
Womens health a textbook for
physiotherapists Ruth sabsford

73

74