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To promote & maintain optimal physical & emotional maternity health throughout pregTo recognize & treat correctly medical or obstetrical complication occurring during pregEarly detection of any fetal abnormalities

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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

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General practitionersMidwivesObstetric physiotherapistDieticiansObstetriciansPaediatriciansLab techniciansHealth visitorsUltrasound operators

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Booking visitMeasurements- 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.

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Antenatal education can be provided in

Obstetric hospital

Community setting

Rural settings

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Physical changesErgonomicsExercise guidelinesManagement of discomfort

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RelaxationBreathingPositioningCoping skills for labourMassage

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FatigueDiet & weight gainEmotional reaction

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Antenatal care of breasts & preparation for breast feeding

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Jerky, bouncing, ballistic movements & activities should be avoidedRegular exercise session at least 3 times/week are safer than intermittentCareful warm up and cool downFluid must taken before, during and after exertion to avoid dehydration

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Strenuous exercise must be avoided in hot, humid weatherMaternal heart rate should not exceed 140 beats per minute avoid exercise > 15 minsExercise should be decided based on the limitations imposed by pregnancyThose accustomed to sedentary lifestyle should start with low intensity physical activity

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HyperthermiaAbnormal heart rateDecreased utero-placental flowIncreased uterine contractionsReduced maternal glucose levelsDisruption of maternal endocrine haemostasis

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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

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Haemodynamically significant heart diseaseRestrictive lung diseaseIncompetent cervix/cerclageMultiple gestation at risk for premature labourPersistent second or third trimester bleeding

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Placenta praevia after 26 weeks gestationPremature labour during the current pregnancyRuptured membranesPregnancy induced hypertension

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Severe AnaemiaUnevaluated maternal cardiac arrhythmiaChronic bronchitisPoorly controlled type 1 diabetesExtreme morbid obesityExtreme under-weight (body mass index < 12)History of extremely sedentary lifestyle

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Poorly controlled hypertension/pre-eclampsiaOrthopedic limitationsPoorly controlled seizure disorderPoorly controlled thyroid diseaseHeavy smokerIntrauterine growth restriction in current pregnancy

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Vaginal bleedingDyspnoea before exertionDizzinessHeadacheChest pain

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Muscle weaknessCalf pain or swelling (need to rule out thrombophlebitis)Pre-term labourDecreased fetal movementAmniotic fluid leakage

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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

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Major

Back & pelvic girdle pain

Sacroiliac dysfunction

Stress incontinence

Urinary frequency

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Others

Sciatica

Osteitis pubis

Coccydynia

Thoracic spine pain

Osteoporosis

Fibroids

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Intercostal neuralgia/costal margin pain

Chondromalacia patellae

Restless leg syndrome

Uterine ligament pain

Fatigue

Insomnia & nightmares

Heartburn

Pruritis

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Nerve compression syndrome

Carpal tunnel syndrome

Brachial plexus lesion

Meralgia paraesthetica

Posterior tibial nerve compression

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Circulatory disorders

Varicose veins

Haemorrhoids

Cramp

Thrombosis & thromboembolism

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Changes are commonly seen in

Connective tissue

Abdominal muscle

Pelvic floor

Legs

Back

Breast

Mood

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Asst carried out 6 weeks post partumMeasurements-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 feedsProblem list

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Diastasis rectii, pelvic floor

Breathing exerciseLeg exercisesPelvic floor exercisesAbdominal exercisesPelvic tilts

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Emphasise on above stated exercise & home progBack care advicePosture & exercises to be carried out in different posture sitting, lying & standing

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Special emphasis on feeding, nappy changing, baby bathing, carrying/liftingBaby massageHouse hold work & return to work/sport

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Painful perineumDiastasis recti abdominisBack painSymphysis pubis pain

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Bladder & bowel problemsRetention of urineUrgency & urge incontinenceStress incontinenceAnorectal incontinenceconstipation

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Circulatory problemsVaricose veinsOedemaVenous thrombosis superficial, deep, pulmonary embolus, haemorrhoids

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Psychiatric problemsMaternity bluesPuerperal psychosisPostnatal depression

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Perineal & vaginal painBackacheDiastasis recti abdominisMastitis & breast abcessStress & faecal incontinence

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Postnatal depressionDiastasis symphysis pubisHair lossCarpal tunnel syndromeTiredness

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Coughing

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Exercising, postureFeedingPain

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Physiotherapy in obstetrics & gynaecology Margaret poldenPhysiotherapy in obstetrics & gynaecology Jill mantleWomens health a textbook for physiotherapists Ruth sabsford

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