Transcript Chapter 24 Obstetrics - PHT 1228c Therapeutic Exercise II

Women’s Health:
Obstetrics and Pelvic Floor
Chapter 24
Part V: Special Areas of Therapeutic
Exercise
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OVERVIEW OF PREGNANCY AND
RELATED CONDITIONS
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Characteristics of Pregnancy
 First Trimester Changes
 Second Trimester Changes
 Third Trimester Changes
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Anatomical and Physiological
Changes of Pregnancy
 Weight Gain During Pregnancy
 Changes in Organ Systems
– Uterus and related connective tissue
– Urinary system
• Kidneys
• Ureters
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Anatomical and Physiological
Changes of Pregnancy (cont'd)
 Changes in Organ Systems (cont’d)
– Pulmonary system
• Hormonal influences
• Respiration
– Cardiovascular system
• Blood pressure and volume
• Heart
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Anatomical and Physiological
Changes of Pregnancy (cont'd)
 Changes in Organ Systems (cont’d)
– Musculoskeletal system
• Abdominal muscles
• Pelvic floor muscles
• Connective tissue and joints
– Thermoregulatory system
• Metabolic rate
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Anatomical and Physiological
Changes of Pregnancy (cont'd)
 Changes in Posture and Balance
– Center of gravity
– Balance
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Pelvic Floor Musculature
 Female Pelvic Floor
 Innervation
 Function
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Effect of Childbirth on the Pelvic
Floor
 Neurological Compromise
 Muscular Impairment
 Episiotomy
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Pelvic Floor Dysfunction
 Classification of Pelvic Floor Dysfunction
– Prolapse
– Urinary or fecal incontinence
– Pain and hypertonus
 Risk Factors for Dysfunction
– Childbirth
– Other causes
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Interventions for Pelvic Floor
Impairments
 Patient Education
– Teach the patient about pelvic floor anatomy and function
– Provide individual instruction in exercise performance
 Neuromuscular Re-Education
– Facilitate pelvic floor muscular activation
 Exercise and Biofeedback
– Use biofeedback with instrumentation
– Combined biofeedback with exercise
 Manual Treatment and Modalities
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Diastasis Recti
 Incidence
 Significance
– Functional limitations
– Decreased fetal protection
– Potential for herniation
 Examination for diastasis
recti
 Intervention for diastasis
recti
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Postural Back Pain
 Incidence
 Characteristics
 Interventions
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Sacroiliac/Pelvic Girdle Pain
 Characteristics
 Interventions
– Activity modifications
– Exercise modifications
– External stabilization
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Varicose Veins
 Characteristics
 Interventions
– Exercise modifications
– External support
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Joint Laxity
 Significance
 Interventions
– Exercise modifications
– Aerobic exercise
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Nerve Compression Syndromes
 Causes
 Interventions
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EXERCISE INTERVENTIONS FOR
PREGNANCY, LABOR, AND RELATED
CONDITIONS
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Maternal Response to Aerobic
Exercise
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Blood Flow
Respiratory Rate
Hematocrit Level
Inferior Vena Cava Compression
Energy Needs
Core Temperature
Uterine Contractions
Healthy Woman Response
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Fetal Response to Maternal
Aerobic Exercise
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Blood Flow
Fetal Heart Rate (FHR)
Heat Dissipation
Newborn Status
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Exercise for the Uncomplicated
Pregnancy and Postpartum
 Guidelines for Managing the Pregnant Woman
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Examination
Education
Stretching/flexibility
Muscle performance and aerobic fitness
Precautions
 Recommendations for Fitness Exercise
 Precautions and Contraindications to Exercise
– Absolute contraindications
– Precautions to exercise
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Critical Areas of Emphasis and
Selected Exercise Techniques
 Posture Exercises
 Corrective Exercises for Diastasis Recti
 Abdominal Muscle Exercises
– Head lift
– Head lift with pelvic tilt
 Stabilization Exercises
 Dynamic Trunk Exercises
– Pelvic motion training
– Trunk curls
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Critical Areas of Emphasis and
Selected Exercise Techniques
 Modified Upper and Lower Extremity
Strengthening
– Standing push up
– Supine bridging
– Quadruped leg raising
– Modified squatting
– Scapular retraction
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Critical Areas of Emphasis and Selected
Exercise Techniques (cont'd)
 Perineum and Adductor Flexibility
– Self-stretching
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Pelvic Floor Awareness, Training,
and Strengthening
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Contract-Relax
Quick Contractions
“Elevator” Exercise
Pelvic Floor Relaxation
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Relaxation and Breathing Exercises
for Use During Labor
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Visual Imagery
Muscle Setting
Selective Tension
Breathing
Relaxation and Breathing During Labor
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Unsafe Postures and Exercises
During Pregnancy
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Bilateral Straight-Leg Raising
“Fire Hydrant” Exercise
All-Fours (Quadruped) Hip Extension
Unilateral Weight-Bearing Activities
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Exercise Critical to the Postpartum
Period
 Pelvic Floor Strengthening
 Diastasis Recti Correction
 Aerobic and Strengthening Exercises
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Cesarean Childbirth
 Significance to Physical Therapists
– Surgical risks
– Interventions
• Pelvic floor rehabilitation
• Postsurgical rehabilitation
• Emotional support
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Suggested Activities for the Patient
Following a Cesarean Section
 Exercises
 Coughing or Huffing
 Interventions to Relieve Intestinal Gas Pains
– Abdominal massage or kneading
– Pelvic tilting and/or bridging
– Bridge and twist
 Scar Mobilization
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High-Risk Pregnancy
 High-Risk Conditions
– Premature onset of labor
– Preterm rupture of membranes
– Incompetent cervix
– Placenta previa
– Pregnancy-related hypertension or pre-eclampsia
– Multiple gestation
– Diabetes
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High-Risk Pregnancy (cont'd)
 Management Guidelines and Precautions
– Exercise suggestions with high-risk pregnancies
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Positioning
Range of motion (ROM)
Ambulation/standing
Relaxation techniques, bed mobility, and transfer
activities
• Preparation for labor
• Postpartum exercise instruction
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