Physiotherapy management

during postnatal period

1
 Definition
• Postnatal (post meaning "after" and natalis
meaning "of birth") is the period beginning
immediately after the birth of a child and
extending for about six weeks .

2
 Issues
Physical

psychological social

3
 Objectives
• Assisting a new mother’s physical recovery
with a safe, effective and enjoyable exercise
programme

• Addressing to any specific individual needs.

4
 Common postnatal ‘at risk areas’
1. Abdominal area

2.Pelvic floor muscles

3.Low back area

4.Cervical ,thoracic and shoulder areas

5
 Evaluation
• Name: Date of delivery:

• Age: EDD:

• Occupation:
• Address:

6
• Height:

• Weight:

• BMI:

7
 Chief complaints:

• Painful perineum

8
 Painful perineum
• Lacerations can be classified as follows:-
• First degree-perineal laceration extending
through the vaginal mucosa and perineal skin
only
• Second degree-extending into the perineal
muscles

9
• Third degree-involving external anal sphincter

• Fourth degree-involving anal sphincter and

anal mucosa

10
• Bladder control

a)Stress incontinence
b)Urge incontinence

11
• Bowel control

a)Incontinence
b)constipation

12
• Circulatory problems

a)Varicose veins
b)Hemorrhoids
c) Edema
d)Deep vein thrombosis

13
• Breast engorgement, mastitis, tender and
cracked nipples

• Fatigue

• Carpal tunnel syndrome

14
 Six-points engorgement scale: It was developed by Hill &
Humenick.[28] It was used to assess the degree of breast
engorgement which given the scoring ranges from 1 to 6.

(1)for Soft and no changes in breast,

(2)for slight changes in the breast,
(3)for firm and no tender breast, score as
(4)for firm, and beginning tenderness in breast,
(5)for firm and tender of the breast,
(6)for very firm and very tender

15
• Spinal pain

• Pubic symphysis pain

16
 Present history:

• Regarding this pregnancy

• Delivery summary

• Present problems.

17
• Antenatal history:

• Regarding antenatal period of this pregnancy

18
• Past history:
• Regarding previous pregnancy; any medical
problem during that period

• Menstrual history:
• Last menstrual cycle; regular or irregular; any
medications; dysmenorrhea; for how many
days
19
• Obstetrical history:

• Gravida/parity/abortion/live

20
• Medical history:
• Hypertension, diabetes, weight gain of
mother, persisting complications.

• Personal history:

• Psychosocial history:

21
• Investigations:

• Hb

22
• Vital signs:

• HR: Temp:
• RR: BP:

23
 On observation

• General appearance: built/ nourishment

• Posture
• Skin: color, texture, edema ,prominent veins
• Face: chloasma, puffiness
• Abdomen: linea nigera, striae gravidum

24
 On palpation:

• Edema; tenderness; skin temperature; trigger

points, muscle spasm.

25
 On examination
Respiratory system:
• Type of breathing; chest symmetry; chest
expansion
• Auscultatory finding:
• Percussion:

26
• Musculoskeletal:
• Diastasis recti:
• Pain: VAS, Body chart, nature, intensity,
duration, aggravating & relieving factor.
Movement examination
• ROM/Laxity of joints:

27
• Tightness

• MMT

28
Diastasis recti abdominis

29
 Definition
It is the separation of the rectus abdominis muscle
which involve widening of the linea alba with gap
greater than the normal distance between the
rectus bellies (2.5 cm or 2 fingers gap) palpated
above, below or at the level of the umbilicus

30
31
• DRAM more than >2.5 cm is found to be
harmful as it interferes with the stabilization
of trunk, posture, bowel movements and
visceral support

32
• Diastasis Recti Abdominis usually appears in the
second trimester

• Its incidence peaks in the third trimester and remains

high in the immediate postpartum period

• If not during pregnancy , a rectus diastasis can

instead develop during second stage of labor,
particularly if there is excessive breath holding during
pushing
33
 Risk factors
• Multiparous women
• Women who have undergone abdominal
surgery
• Greater weight gain
• Caesarean section
• Larger babies
• Polyhydraminos

34
 Physiological changes related to
diastasis
• Maternal hormones

• Mechanical stress during pregnancy

• Abdominal muscle function

35
 Measuring DRA
• Palpation
• Calipers to measure IRD

36
 Measuring DRA : other methods

• Ultrasound
• Computed tomography
• MRI

Indications:
when the subcutaneous fat is thick
when there is a large abdominal laxity
palpation of the diastasis may be difficult
37
DRA examination

38
39
40
41
42
 There was a relationship between the
presence of DRA and the SPFD diagnoses of
stress urinary incontinence, fecal
incontinence, and pelvic organ prolapse.
 (Spitznagle et al, International Urogynecology
Journal,2007)

43
• Neurological:
• Sensation (tingling, numbness),
• reflexes
• balance
• gait

44
• Urinary:Frequency, incontinence, pelvic floor
examination

45
• Endurance/ Fatigue:
• 6 minute walk test
• Fatigue impact scale

46
• Functional evaluation

• Quality of life Scales

• Maternal postpartum quality of life
• WHOQOL-bref

47
• Problem list:

• Short term goals:

• Long term goals:

• Management:

48
Thank you

49