Role of Physiotherapist in
Obstetric and Gynecological Conditions
Role of Physiotherapist in
Obstetric and Gynecological Conditions
Purvi K Changela MPT (Musculoskeletal Conditions and Sports) MIAP MIFT
Assistant Professor Shri KK Sheth Physiotherapy College Rajkot, Gujarat, India
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[email protected] Role of Physiotherapist in Obstetric and Gynecological Conditions First Edition: 2016 ISBN: 978-93-86107-06-0 Printed at
Dedicated to My Family and My Teachers
Preface
Role of Physiotherapist in Obstetric and Gynecological Conditions is an overview of dysfunctions that take place during adolescence, childbearing years, menopause and beyond in women’s life and how physiotherapy intervention would improve women’s functional independence and quality of life. The physiotherapist is recognized as an important team member with specific role in specialized training in the assessment and treatment of a range of health conditions that can affect women’s life. Over the past two decades, increasing moves towards ‘measuring’ health outcome have influenced much of health care and indeed much of the physiotherapy profession. But the level of understanding and incorporation into physiotherapy practice is variable despite increasing national and international professional guidelines. The book focuses on the correlation of the physiotherapy with the medical aspect which has hardly been studied in the past. This book is intended to provide study material which will help the undergraduate and postgraduate students to widen their knowledge towards physiotherapy management in obstetric and gynecological problems. Chapter 1 gives brief overview of number of health issues in women’s lifespan which can be effectively emphasized by health care, including physiotherapy. Chapter 2 contains a thorough explanation of pelvic anatomy. It also describes the changes found during the pregnancy and are well supported by figures to make the point very clear. Chapter 3 explains the menstrual cycle and the normal fetal development. It also includes the physiological changes during the pregnancy and risk and complications involved with it. The chapter is enriched with so many tables and diagrams making it easy to remember. Chapter 4 mentions diagnostic and screening tests during pregnancy with its reliability and validity. Chapter 5 includes the detailed description of the physiology of labor, premonitory signs of labor, difference between false and true labor pain, physiological and psychological changes occurring during each stage of labor. Chapter 6 describes the role of the physiotherapists in women’s health who assist with various changes that occur in the childbearing year as well as basic antenatal exercise programs designed for each patient. Chapter 7 highlights the role of exercises in general feeling of well-being as well as improving all aspects of pregnancy, delivery and postpartum with colorful pictures and research evidence. Chapter 8 discusses how to work with the various changes which occur during pregnancy. It also includes how physiotherapy helps with the overall transitional period leading to a happier, healthy, problem-free pregnancy and beyond by minimizing related discomforts with physiotherapy. Chapter 9 shows importance of specialty of physiotherapy in normal labor and delivery and assists in examining the baby to free from birth injury and congenital deformities. Chapter 10 provides useful information of a physical therapy exercise and health education program in improving postnatal wellbeing and reducing the risk for postnatal complications. Chapter 11 elaborates the long-term consequences of changes in ovarian hormonal levels during menopause, which includes morbidities like cardiovascular diseases, osteoporosis, problems related to memorization, urinary incontinence, and how the physiotherapy will be helpful to restore function, improve mobility, relieve pain, and prevent or limit permanent physical disabilities of patients.
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Role of Physiotherapist in Obstetric and Gynecological Conditions
Chapter 12 includes symptoms, diagnosis, treatment, and prevention of women’s reproductive health issues. Chapter 13 shows needs of all women at pre- and postoperative stage, which include any relevant advice and treatment appropriate to promote the health in the shortand long-term. Chapter 14 gives detailed knowledge about the type of incontinence, severity, clinical symptoms, the underlying cause, special investigation and recommends physiotherapy approaches which are best suited to condition. The effort is made to provide study material with reference to different books of obstetric and gynecological conditions and research publications. All the readers are requested to provide their valuable suggestions regarding this book so that in the next edition modification can be done. Feel free to contact at
[email protected]. I hope to get the best response. Purvi K Changela
Acknowledgments
First and foremost, I would like to thank my husband Dr Milin Nandani for standing beside me throughout my career and help me write this book. He has been my inspiration and motivation for improving my knowledge and career forward. He is my rock, and I dedicate this book to him. This title could not have been completed without the help of some very important and special people. I would like to thank my beloved parents, Mr Kantilal Changela and Mrs Hiraben Changela and grandparents for allowing me to follow my ambitions. I am thankful to my in-laws, who have always supported me throughout my career and authoring this book and I really appreciate it. I would like to specially thank my brother and sisters for trusting me, to guide and develop the new ideas about the concept and title of this book. I would also like to thank my colleagues and my co-staff for supporting and inspiring me to write such a book. Students were always motivational as they find difficulty to read the subject from different books and so I got inspired to write the book under current title. I would like to sincerely thank Dr Sarlaben Bhatt (Ex-Principal Shri KK Sheth Physiotherapy College) and Dr Bhavesh Patel (MD Medicine), and my uncle, for their unconditional support and sharing their insight knowledge towards the current title. I would like to thank Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President), Mr Tarun Duneja (Director–Publishing) and Ms Samina Khan (Executive Assistant to Director–Publishing) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for giving me an opportunity to share my knowledge with the student community. Lastly, I would like to thank each and everyone who have directly or indirectly helped me in completing the current title. I expect the students will appreciate the book and the book will help them in expanding their knowledge towards the said subject.
Contents
Chapter 1. Women’s Health Care in Physical Therapy
The Physiotherapists as Health Promoters 2 Awareness on Utilization of Maternal Health Education and Services 2 Barriers to Utilization of Maternal Health Services 3 Quality of Maternal Health Services 3 Changing Definition of Women’s Health-implication for Health Care 3 Role of Physiotherapist in Women’s Health Education 4 Role of Physiotherapy in Health-related Quality of Life 7
Chapter 2. Anatomical Consideration
10
Female Pelvis Anatomy 10 The Perineum 23 The Female Reproductive Tract 24 The Breast 27 The Urinary Tract 29 The Anorectal Region 31 Anatomical Consideration and Physiotherapy 32
Chapter 3. Physiology of Pregnancy
The Female Reproductive Cycle 35 Pregnancy and Fetal Development 40 Physiological Changes in Pregnancy 41 Risk and Complications during Pregnancy
35
59
Chapter 4. Pregnancy Tests and Special Investigations
1
66
Clinical Manifestations of Early Pregnancy 66 Diagnosis of Pregnancy 66 First Trimester 67 Second Trimester 69 Third Trimester 69 Screening Tests during Pregnancy 70
Chapter 5. Physical and Physiological Changes of Normal Labor and the Puerperium Causes of Onset of Labor 73 Clinical Picture of Labor 74 Stages of Normal Labor 76
73
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Role of Physiotherapist in Obstetric and Gynecological Conditions
Events in Different Stages of Labor 76 Mechanism of Normal Labor 80 Process of Normal Labor 83 Labor Pain 85 Management of Normal Labor 90 Induction of Labor 101 Abnormal Progression of Labor 102 The Puerperium 107 Management of Normal Puerperium 110 Complications in the Puerperium 112
Chapter 6. Antenatal Care and Role of Physiotherapy
Chapter 7. Exercises and Pregnancy
146
Biomechanical and Anatomical Considerations for Exercise Guidelines in Pregnancy 147 Benefits of Exercises during Pregnancy for Women 148 Safety of Exercise during Pregnancy 148 Physiologic Considerations Affecting Exercise during Pregnancy 149 Pregnancy Presents a Unique Motivation to Begin or Continue an Exercise Program: Guidelines for Exercise during Pregnancy 149 Exercise Programing, Testing and Monitoring 153 Exercise Environment 153 Nutrition Guidelines 158 Exercise during the Postpartum Period 158 Recommended Exercises for Pregnant Women 159
Chapter 8. Pregnancy Discomforts and Role of Physiotherapy
118
The Maternity Team Care 119 The Aims of Antenatal Care 119 Antenatal Education— “Preparation for Birth and Beyond” 119 Routine Antenatal Care 121 Preconceptual Care 123 “Birth, Baby and Beyond” —Planning and Leading Labor and Childbirth Preparation Classes in Community 125
168
Back and Pelvic Girdle Pain 170 Nerve Compression Syndromes 179 Circulatory Disorders 180 Other Problems 182
Chapter 9. Preparation for Labor and Physiotherapy Goals of Preparation for Labor and Birth 191 Preparation for Labor 191 Relaxation Techniques 192
190
Contents
Breathing Awareness 193 Positions in Labor 195 Massage in Labor 196 Pain Relief Strategies 200
Chapter 10. Physical Therapy and Postpartum Care
Planning Postnatal Care 209 Postpartum Physical/Mental Changes 210 Postnatal Care 211 Postnatal Physiotherapy 214 Plan of Care 215 Postnatal Fitness Classes in the Community 225 Postnatal Problems 230 After-effects of Instrumental Intervention 236 Long-term Postnatal Problems 242
Chapter 11. The Climacteric
267
The Role of Physical Therapy in Gynecological Disorders 267 Gynecological Health 267 Gynecological Disorders 269 Disorders of Pelvic Function 276 Further Gynecological Conditions of Relevance to the Physiotherapist 279 Sexuality 283 Premenopausal Women 284 In The Climacteric 284 In Older Age 284
Chapter 13. Role of Physiotherapy in Gynecological Surgery
250
Physiology of Menopause 251 Physical Symptoms 251 Physical Changes during Menopause 252 Postmenopausal Problems 254
Chapter 12. Role of Physiotherapy in Gynecological Conditions
209
Gynecological Excision Surgeries 287 Ovarian Surgeries 290 Pelvic Radiotherapy 291 Gynecological Repair Surgery 291 Surgical Treatment of Stress Incontinence 292 Complications of Gynecological Surgery 292 Physiotherapy Care of Patients Undergoing Gynecological Surgery 293 Postoperative Physiotherapy 296
287
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Role of Physiotherapist in Obstetric and Gynecological Conditions
Chapter 14. Continence and Incontinence
Urinary Continence and Micturition 306 Summary of Factors Which Favor Normal Urinary Functioning Lower Urinary Tract Dysfunction 313 Incontinence of Urine 313 Physiotherapy Assessment 317 Physiotherapy Treatment 330
305 311
Appendices
Glossary Index
1. Changes During Different Phases of Life of a Woman
341
2. Obstetrics and Gynecology PT Assessment
345 349 355
Chapter
1 Women’s Health Care in Physical Therapy
Chapter Outline y The physiotherapists as health promoters y Awareness on utilization of maternal health
y Changing definition of women’s health -
education and services y Barriers to utilization of maternal health services y Quality of maternal health services
y Role of physiotherapist in women’s health
INTRODUCTION y The term “women’s health” typically connotes reproductive function and, in particular women’s capacity to produce and nurture children. This focus is a legacy of the medical conception of women’s health that emerged in the second half of the 19th century, when ideas about biological determinism and fundamental differences between the sexes were becoming prominent. y Women’s health is based on an allencompass-ing view of health whereby, McComas and Harris (1996) point out that “Women’s health involves women’s emotional, social, cultural, spiritual and physical well-being, and it is determined by the social, political and economic context of women’s lives as well as a woman’s biology.” y Women’s Health is one of the major concerns world wide. The focus of the
implication for health care education
y Role of physiotherapy in health related quality of life
women’s health has been increased from year 1975 which is called as the “International Year Of Women's Health” encompasses a broad spectrum of issues that can be treated by physiotherapy and other healthcare team. y A focus on health issues relevant to females has been increasing over last two decades. The multiple roles that women play tend to give low priority to their personal lives. Women always place the needs of other before their and hence priority to their health, exercise or any form of relaxation is given least preference. y Women undergo many physiological, hormonal and emotional changes throughout their life span. From adolescence to menarche, marriage to child bearing years and later menopause and beyond a women’s body is undergoing several changes thereby influencing the health of various systems and the mind.
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