ANTENATAL.pdf

ANTENATAL CARE 2023-2024 Dr. Noha Ahmed Fouad Lecturer of Physical Therapy Faculty of Physical Therapy Badr University  OBJECTIVES By the end of this lecture each student should be able to: 1- Identify aims of adequate antenatal care 2- Descri...

ANTENATAL CARE 2023-2024 Dr. Noha Ahmed Fouad Lecturer of Physical Therapy Faculty of Physical Therapy Badr University  OBJECTIVES By the end of this lecture each student should be able to: 1- Identify aims of adequate antenatal care 2- Describe role of physiotherapist during pregnancy 3- How to solve and treat any musculoskeltal problem with appropriate physiotherapy skills 4- Design antenatal class during different trimesters of pregnancy  DEFINITION  Antenatal period is the period during pregnancy  Antenatal : before birth; during or relating to pregnancy. "antenatal care“ relating to the medical care given to pregnant women before their babies are born: Origin From Latin ante (“before”) + Latin nātālis (“natal”), from nāscor (“to be born”) Antenatal preperation for parents should be designed to fulfill the parents expressed needs and should never simply be a forum for professional they think their audience requires Aims of adequate antenatal care: 1. To detect and treat any physical or psychological defect. 2. Prepare the parents for the birth and care of the baby. 3. Give confidence to the woman in her own abilities through an understanding of how her body functions and the various changes occurring during pregnancy and birth.  The earliest antenatal education was concerned with: 1- Couples should be helped to check and increase knowledge of physiological changes of pregnancy, labour and puerperium 2- They should be shown ways useful for coping with physical changes and associated discomfort 3- They should be guided towards understanding of labour 4- They should be encouraged to consider the profound change in lifestyle that parenthood brings and emotional maturity necessary to manage their additional responsibilities 5- They should be encouraged to talk and air any fears, ask questions and be helped to obtain satisfactory answers  It was established that most primigravidae and large number of multigravidae experience an increase in anxiety during pregnancy and have fears about childbirth. The most usual anxieties are that the baby will die in utero, will not be born normally and will not be healthy. The second most common concern will be traumatic and that pain relief will not be provided. Other anxieties related to conception after the birth that drugs taken in pregnancy will cause birth defect. Birth a child will alter the relationship between the woman and her husband.  It is important to have a clear conception of what can be achieved when starting to give instructions on the physical plane in order to help a young woman through phases of childbearing cycle.  At the time when she conceives her first child, the development of certain anatomical structure must be given to her. This applies particularly to the bony pelvis, its shape and size. The importance of its position in the body in relation to posture, the attachment of pelvic inlet and outlet and the attachment of the muscles of the pelvic floor. The development of muscles, ligaments and interstitial tissue or structures such as joints which depend for their function on the state of soft tissue that is influenced by physiological stimuli during pregnancy.  The role of pelvic floor' muscles and abdominal muscles during labour must be explained. A selected number of illustrations will greatly assist the information given by the spoken word.  The method of choice for education must have the following advantage: 1- Time saving 2- Allow meeting between pregnant women with another at the same state of pregnancy 3- The class atmosphere helps to emphasize the view that pregnancy is physiological process. Date of starting physical therapy program????????  ROLE OF PHYSIOTHERAPIST DURING PREGNANCY Physiotherapist sessions during antenatal period should included: 1- Pregnancy back care 2- Symphysis pubic pain 3- Pelvic floor and pelvic tilting exercise 4- Exercise for circulation and cramps 5- Fatigue 6- Effect of stress on body and mined 7- Emotional reactions 8- Stress and relaxation  CONT: ROLE OF PHYSIOTHERAPIST DURING PREGNANCY 1] Assess physical health and identify any musculoskeletal or neuromuscular problems that could be aggravated by pregnancy. The physiotherapist should identify and try to prevent any problem. Pregnant woman should perform:  leg exercises to prevent varicose veins.  Abdominal contractions are taught to be practiced in sitting, lying and standing positions.  Pelvic tilting and postural correction exercise from various positions.  Pelvic floor contractions are taught in stride sitting with elbows resting on the knees. 2] Advise on back care and lifting: back strain is minimized when the spine is held in its normal curves. So it is important to teach the woman how to adapt positions which minimize stress. So, Postural correction exercises are practiced from different positions:  Standing.  Sitting.  Lying position.  Crock lying position. 3] Lifting advices: It involves lifting from a height and carrying as well as lifting from the ground level. The principles to follow when lifting are:  Foot should be apart to increase the base of support.  Any object to be lifted must be held close to the body.  When lifting from the ground, it is important to ensure that the weight is light enough to be lifted comfortably.  When lifting from a height, it is important to hold the object close to the body and to make sure that the height is easy reached 4-Treat any problem with appropriate physiotherapy skills: Pubic pain :is often related to diastasis of the rectus abdominis muscles due to repeated pregnancies. This pain is treated by pelvic support as a firm elastic corset which modified to fit under the main bulb of the baby.  Lumbar pain: may be eased by soft tissue kneading and mobilization  Cramp: occurs most commonly in the calf muscles. It can be relieved by slow, sustained stretch on the muscles, and by foot exercises. 5-Teach methods for controlling tension and pain: Neuromuscular tension: The physiotherapist must teach the pregnant woman how to recognize tension and how to deal with it though:  Relaxation techniques that taught as a mean by reducing stress in all life situation. During labour, relaxation principles can reduce the severity of pain.  Breathing awareness can help with relaxation during painful contraction of labour. 6- Teaching positions that may be used for labour. Also, the different stages of labour must be explained for her.  GENERAL GUIDELINE FOR EXERCISE DURING PREGNANCY 1- Jerky, bouncing movements and activities should be avoided 2- Careful warming up before exercise followed by cooling down and gradual decline in activity 3- Flexibility and mobility follow the warm up , avoid stretching to extreme range of movement 4- Strenuous exercise should be avoided in hot humid weather 5- Maternal heart rate should not exceed 140 b.p.m and vigorous exercise should not continue for more than 15 minutes 6- Fluid must be taken before, during, and after exertions to avoid dehydration  CONTINUE GUIDELINES FOR EXERCISE 7- Women beginig exercise and have a sedentry lifestyle should start with low intensity physical activity ( walking, swimming, stationary bicycling, yoga) with gradual increase in activity level according to women tolerance 8- Aerobic exercise should be done using large group of muscles and being rhythmical in nature ( brisk walking, cycling, aerobic dance) avoid high impact 9- Avoid supine position after first trimester 10- avoid standing motionless for long period of time  MODEL OF PHYSICAL THERAPY PROGRAM FOR NORMAL PREGNANT WOMEN From 4th to 6th month of pregnancy:  Not before the 4th month to avoid abortion and if there is a history of habitual abortion No ante partum exercise is given. This includes:  Instruction about the anatomy and physiology of female pelvis, pelvic joints and muscles especially pelvic floor.  Breathing exercises (deep breathing).  Relaxation in any comfortable position chosen by mother, room must be calm, quite, warm, no air draft, no direct light, light music assist physical and mental relaxation.  Postural correction to avoid postural problems. From the end of 6th month till the end of 8th month of pregnancy: Deep breathing exercise.  Relaxation training.  Pelvic rocking (upward ,backward).  Leg exercises to improve circulation and maintain tone of the muscles which support foot arches, also to prevent edema and varicose veins.  Pelvic floor contraction and relaxation to get pelvic floor muscles strong and elastic.  Abdominal exercises.  Arm exercise for preparation of lactation and to allow free flow of milk During the last month of pregnancy: Instruction about onset of labour. Instruction about Stages of labour. Training for pelvic floor Relaxation training (diversion drill) and walking in open fresh air. Teaching mother panting breathing. Explanation for the TENS and its effect in relieving labour pain.  CONTRAINDICATIONS TO EXERCISE DURING PREGNANCY Absolute contraindications Relative contraindications Cardiovascular disease Women unused to high level Acute infection of excursion Spontaneous abortion Blood diseases e.g anemia Vaginal bleeding or rupture Thyroid diseases membrane Incompetent cervix Controlled diabetes Hypertension Breach presentation in third trimester Fetal distress Pulmonary embolism Extreme obesity or under weight Active thyroid Uncontrolled type 1 diabetes  ADVICES 1- Exercise and Travelling: ▪ The pregnant woman must avoid vigorous exercises as swimming, tennis and cycling especially in the first part of pregnancy, the best exercise is walking in open fresh air, at least one hour daily. ▪ Travelling should be avoided, particularly during the last month especially on hard roads and for a long distances. If there is a history of habitual abortion or premature labours, travelling should be completely prevented. 2. Sleep and Rest: Sleep for at least 8 hours every night Rest in a quiet room for 2 or 3 hours every afternoon. Avoid prone position to avoid intrauterine fetal death. 3. Breasts: Daily washes, massage the nipple with a mixture of glycerine and alcohol to reduce the incidence of cracking. 4.Bowel-habit: Avoid constipation because it leads to straining down, so, piles and genital prolapse may occur. This could be avoided by eating fresh vegetables, milk, performing pelvic floor exercise and taking mild laxatives. 5. Teeth: Regular cleaning at least in the morning and night. 6. Clothes: Should be loose, comfortable, avoid tight breast support. The shoes should be easily fitting, with low heels. 7. Baths: The bath should be tepid and given by a shower. Vaginal douching should be avoided because it leads to ascending infection. 8. Sexual intercourse: Should be avoided in the 1st trimester for fear of abortion and in the last two months for fear of ascending infection. If there is abortion tendency sexual intercourse should be avoided completely. 9. Warning signs: As vaginal bleeding, abdominal pain, severe persistent headache, swelling in lower limbs which demand immediate physician calling. 10. Diet in pregnancy:  Folic acid  Calcium  Omega 3 fatty acide( fish oil)  Iron  Dietary fibers