OBG PT ASSESSMENT

Sagar Naik, PT

Obstetrics & Gynecology PT Assessment

Sagar Naik,
PT
Acknowledgement: Dr. Prerana Maam

The obstetric woman may attend the physiotherapy throughout the year. Physiotherapist may have to monitor them and screen them in regular intervals.

Subjective Examination:

General Details Name Age Address Marital status - Duration of marriage - Consanguinity marriage Chief Complains (Present problems of the woman) Period of amenorrhea Nausea, vomiting Musculoskeletal Problems - Low backache - Radiating pain - Numbness or tingling sensations - Cramps Frequency of micturition Weakness Blood pressure Headache, epigastric pain Swelling in both the limbs Obstetric History Gravida & Parity Multiple pregnancies (duration between pregnancies) Number of living children (Boys & Girls, Twins) History of previous deliveries - Full-term normal delivery - Low section cesarean section - Episiotomy

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OBG PT ASSESSMENT

Sagar Naik, PT

Health status of previous baby (any congenital abnormalities) History of previous abortions - Still born or death after birth - Spontaneous abortion or Induced abortion Details about menstruation History of any diseases during pregnancy (pelvic inflammatory disease) History of rubella or cytomegalovirus, toxoplasmosis infection History of dizziness while sudden change of position from lying to sitting or standing (postural hypotension) Any trauma during pregnancy Any itching over the perineal area (piles) Place of delivery Details about anesthesia (postnatally) Type of labour (induced or spontaneous) History of breast-feeding (postnatally) History for Genitourinary System Any burning sensations during micturition Retention of urine Polyuria or Oligouria (Diabetes symptoms) History of Incontinence Dribbling of urine during coughing, or other activities Feeling of something descending down per vaginum History for Gastrointestinal System Loss of appetite Loss of weight Constipation Heartburn Piles Pain History Onset of symptoms Duration of symptoms Type & location of pain Aggravating and Relieving factors Ask similar symptoms felt during previous pregnancies Past History Any history of Tuberculosis Bronchial Asthma Blood Pressure Diabetes Mellitus Hyperthyroidism or Hypothyroidism

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OBG PT ASSESSMENT

Sagar Naik, PT

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Drug History Any drugs taken during pregnancy Allergic to any drugs History about contraceptive measures taken Any Rh compatibility injections taken during previous pregnancy Family History History of twin pregnancy in family History of congenital defects present in any family member Socio-economic History Occupation of the client & her husband Number of family members (any help can be obtained for household activities during pregnancy) Cast and economic status of the client Medical & Surgical History Any surgical procedure done during delivery or during previous deliveries Psychological History Any emotional disturbances Anxiety or depression Any stress to the client during pregnancy Knowledge about the pregnancy and physiological changes, which occur during pregnancy

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Objective Examination: On Observation:
General condition Ectomorph Endomorph Mesomorph Edema (over leg & foot)

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Cardiac Problems HIV Anemia (sickle cell anemia, thalassemia) Any history of seizures or convulsions Autoimmune disorders like myasthenia gravis Personal History Any addiction smoking or alcoholism Sleeping habits Lifestyle of the client

OBG PT ASSESSMENT

Sagar Naik, PT

On Palpation:

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On Examination:

Tenderness Temperature variation of skin Spasm Scar (healed or unhealed) Swelling

Vital Signs Blood Pressure Heart Rate Pulse Respiratory Rate Abdominal Girth & Symphysis Fundal Height (SFH) Weight Range of Motion Within the permissible range Ballistic movements should be avoided End range pressure should be avoided Hypermobility of joints due to laxity of ligaments

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Trophic changes Pregnancy related changes - On face, cloasma gravidarum or pregnancy mask (around cheek, forehead and eyes) - On abdomen, linea nigra (midline from xiphisternum to symphysis pubis) - Striae gravidarum (abdominal walls below umbilicus, thighs and breast) Nail bed Pallor (anemia) Conjunctiva & Tongue Pallor (anemia) Yellowish (jaundice) Scar (postnatally during LSCS) Posture in lying, sitting, & standing Rounded shoulders Increased cervical lordosis (forward head posture) Increased lumbar lordosis Hyper extended knees Weight shifted posteriorly to ankle Gait Wide Base Of Support (BOS)

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OBG PT ASSESSMENT

Sagar Naik, PT

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Restricted trunk movements If edema present then restricted range at that joint Manual Muscle Testing Abdominal muscles Gluteal muscles Emphasis Perineal muscles Edema Assessment Girth measurement Volumetric measurement Diastasis Recti Assessment Hook lying position Slowly actively raise the head and shoulders off the floor, reaching her hands toward the knees, until the spine of the scapulae leaves the floor Place fingers of one hand horizontally across the midline of the abdomen at the umbilicus If separation exists, fingers will sink into the gap The number of fingers that can be placed between the rectus muscle bellies measures diastasis Less than 2 fingers or 2 cms is normal; more than 2 fingers or 2 cms is abnormal Instruct client to performed a self-diastasis test Sacroiliac Dysfunction Assessment Approximation test Gapping test Sacroiliac Rocking Test (SI Strain) Patricks Test (FABER test) Incontinence Assessment (Pelvic Floor Muscle Strength) Perinometry Pervaginal Examination - Examination is done by inserting two fingers (index & middle) wearing sterile gloves - Ask client to squeeze fingers as much as possible & strength of perineal muscles is checked

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OBG PT ASSESSMENT

Sagar Naik, PT

Grades
Grade 1 (Trace) Grade 2 (Weak) Grade 3 (Moderate) Grade 4 (Strong)

Description
Contraction held less than 1 second

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Pad Test - First ask client to void urine and bear pre-weight sanitary pad after drinking 1000 ml of liquid - Ask to rest for 45 minutes and then do exercise for 30 minutes, which includes walking, climbing, coughing, jumping, etc - Pad is again test and weight. Resulting weight would be in grams of urine loss - 1 gram increase is normal to compensate possible discharge and sweating Biofeedback Ask client to cough and check for any dribbling of urine is present or not Exercise Tolerance Testing 6 minute walk test 3 step test Functional Assessment Gait Assessment

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Contraction held for 1-3 seconds or fingers not elevated Contraction held for 4-6 seconds and fingers elevated; repeat 3 times Contraction held for 7-9 seconds and fingers elevated; repeat 3 times Rapid contraction with elevation of Grade 5 fingers for 7-9 seconds; repeat 4 (Unmistakably Strong) times