OBG Physiotherapy Assessment

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

D Subjective Examination:
h General Details
• Name
• Age
• Address
• Marital status
- Duration of marriage
- Consanguinity marriage
h 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
h 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
• 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)
h History for Genitourinary System
• Any burning sensations during micturition
• Retention of urine
• Polyuria or Oligouria (Diabetes symptoms)
h History of Incontinence
• Dribbling of urine during coughing, or other activities
• Feeling of something descending down per vaginum
h History for Gastrointestinal System
• Loss of appetite
• Loss of weight
• Constipation
• Heartburn
• Piles
h Pain History
• Onset of symptoms
• Duration of symptoms
• Type & location of pain
• Aggravating and Relieving factors
• Ask similar symptoms felt during previous pregnancies
h Past History
• Any history of Tuberculosis
• Bronchial Asthma
• Blood Pressure
• Diabetes Mellitus
• Hyperthyroidism or Hypothyroidism
• Cardiac Problems
• HIV
• Anemia (sickle cell anemia, thalassemia)
• Any history of seizures or convulsions
• Autoimmune disorders like myasthenia gravis
h Personal History
• Any addiction – smoking or alcoholism
• Sleeping habits
• Lifestyle of the client
 h Drug History
• Any drugs taken during pregnancy
• Allergic to any drugs
• History about contraceptive measures taken
• Any Rh compatibility injections taken during previous pregnancy
h Family History
• History of twin pregnancy in family
• History of congenital defects present in any family member
h 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
h Medical & Surgical History
• Any surgical procedure done during delivery or during previous deliveries
h 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

Û Objective Examination:
< On Observation:
h General condition
• Ectomorph
• Endomorph
• Mesomorph
h Edema (over leg & foot)
h 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)
h Scar (postnatally during LSCS)
h Posture in lying, sitting, & standing
• Rounded shoulders
• Increased cervical lordosis (forward head posture)
 • Increased lumbar lordosis
• Hyper extended knees
• Weight shifted posteriorly to ankle
h Gait
• Wide Base Of Support (BOS)

< On Palpation:
h Tenderness
h Temperature variation of skin
h Spasm
h Scar (healed or unhealed)
h Swelling

< On Examination:
h Vital Signs
• Blood Pressure
• Heart Rate
• Pulse
• Respiratory Rate
h Abdominal Girth & Symphysis Fundal Height (SFH)
h Weight
h 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
• Restricted trunk movements
• If edema present then restricted range at that joint
h Manual Muscle Testing
• Abdominal muscles
• Gluteal muscles Emphasis
• Perineal muscles
h Edema Assessment
• Girth measurement
• Volumetric measurement
h 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
h Sacroiliac Dysfunction Assessment
• Approximation test
• Gapping test
• Sacroiliac Rocking Test (SI Strain)
• Patrick’s Test (FABER test)
h 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

Grades Description
Grade – 1 Contraction held less than 1 second
(Trace)
Grade – 2 Contraction held for 1-3 seconds or
(Weak) fingers not elevated
Grade – 3 Contraction held for 4-6 seconds
(Moderate) and fingers elevated; repeat 3 times
Grade – 4 Contraction held for 7-9 seconds
(Strong) and fingers elevated; repeat 3 times
Rapid contraction with elevation of
Grade – 5
fingers for 7-9 seconds; repeat 4
(Unmistakably Strong)
times

• 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
h Exercise Tolerance Testing
• 6 – minute walk test
• 3 – step test
h Functional Assessment
h Gait Assessment