SRINIVAS COLLEGE OF PHYSIOTHERAPY

OBSTETRICS GYNAECOLOGICAL PHYSIOTHERAPY ASSESSMENT

Name of the Patient:-Mrs.vasanthi

Wife of: hari prasad

Age:- 24

Occupation:- housewife

Address: bolar

Marital status:- she is married since 1yr, non-consengenious marriage

GPL:- G1P1L1
IP NO:-11375

Date of admission:-21/09/09

Date of assessment:- 22/09/09

Name of evaluator:-raval viral(INTERN)

BABY  Gender: male

Birth weight:1.9kg

Apgar score: 1 min= 9/10

 5 min=9/10

Head circumference: 34CM

Height: 46cms

Chief complaint:- pain at suture site,

Weakness,

Heavy aching legs.

 HISTORY :-
Menstrual history :- 3-4 days with normal flow

Antenatal history :-

 First Trimester :-
- Last date of Menstruation:18/12/08
- Expected date of Delivery:20/09/09
- Unusual tenderness and tingling in breast: slight tenderness was present
since 2nd month of pregnancy
- Nausea and Vomiting: present in all 3 months
- Back pain: there was no history of backpain
- Habits :e / treatment/ medication: pregnancy confirmed with UPT and
scan in 9wks

 Second Trimester :-
- Back pain: gradually started from 5th month of pregnancy
- Nausea and vomiting: taken medication so nausea and vomiting symptoms
reduced
- Edema of ankle and feet: slight edema of ankle was present
- Fetal movements: quickening at 5 MA
 - Functional status: active
- Special investigation/treatment/medication:
immunisation with 2 doses of T.T.
1st at 16 wk
2nd at 24 wk
Taken folic acid and calcium supplements

 Third Trimester :-
- Edema of ankle and feet: increased in 8th month of pregnancy
- Nausea and vomiting: no h/o nausea n vomiting
- Back pain and other joint pain: no h/o back pain
- Bed rest/ Functionally active: active
- History of Incontinence: urinary symptoms- increased frequency of day n
night

- Fetal movement: h/o lightening was present

- Weight gain: 12kg
- Respiratory problems: no h/o respiratory problems

- Specific investigation/ treatment/medication:

USG done
Impression:- SLIUF with cephalic presentation of FHR of 154 beats/min
Continued to take calcium and iron supplements

Post natal history :-

 Labor History:- On 21/09/09at around 3:30pm she started with labour pain
and at 5:40pm she delivered the baby.
- 1st stage :
- 2nd stage :
- 3rd stage :
- Time /Duration: 2hours (from 3:30pm to 5:30 pm)
 Date of delivery:- 21/09/09
 Any History of:- no h/o any complications during delivery
- Failure to progress :
- In coordinated uterine activity :
- Placental abruption :
 - Labial hematoma :
- Perineal tears :
- Malpresentation like breech/ vertex : vertex
- Mal position :
 Assisted delivery:-
- Episiotomy: done
- Forceps delivery:
- Vacuum Extraction:done
- Caesarean section:
 Drugs taken during delivery:- oxytocin and methacyn given

Past history :-

- D.M : no h/o D.M

- T.B : no h/o T.B
- Bronchial asthma : no h/o bronchial asthma
- History of previous abortion/deliveries : spontaneous abortion at 3 month

- Any other surgeries : no history of any other surgeries

Medical History :-

- Drugs taken presently: amoxycillin

Diclophenac
tinidizole
Ranitidine

Family history:- nothing signigicant

Socioeconomic history:- lower class family

  ON OBSERVATION :
- Built of patient: mesomorphic
- Attitude of limb: left side lying with hip n knee flexed,ankle
plantarflexed
- Alignment of body:
- Swelling: slight swelling at both ankles were present

- Skin changes: no skin changes are present

- Scars : no scars present
- Deformity : no obvious deformity present

- Posture -
Slightly protracted shoulders

 ON PALPATION :-
- Tenderness(pelvic region/ back) :
- Scar : Adherent
Non adherent
- Edema : Pitting
Non pitting- present at both ankles
- Diastasis recti examination : 1finger widthway

 ON EXAMINATION :-
 Vital signs :

Respiratory Pulse rate Blood

rate pressure
 MOTHER  14  90/min  130/80
 CHILD  40  132 

 Motor examination :

- MMT AND JOINT RANGE OF MOTION :

Trunk
 MUSCLE GRADES ( MMT )

- Oblique trunk - 2
- Rectus abdominals - 2
- Back extensors - Not taken

- Transverse abdominals 2

Lower limb

KNEE Flexors 0-130 0-130

degree degree
Extensors 130-0 130-0
degree degree
ANKLE Dorsi flex 0-15 0-15
degree degree
Plantar 0-30 0-30
flex degree degree

- Girth measurement :
 5,8,15 and 23 cms above the base of patella

LEFT SIDE RIGHT SIDE

At 5cms 35.5cms 35.5cms
At 8cms 38cms 38cms
At 15cms 42cms 42.5cms
At 23cms 46cms 46cms

 15 cms below the apex of patella

Left-30cms
 Right-30cms

 Ankle
Left-25cms
Right-25cms
 Respiratory assessment :
- MOTHER:
 Chest expansion:
Nipple level-2cms
Axillary level-3cms
Xiphisternum- 1.5cms
Breathing pattern: thoracoabdominal
- CHILD:
 Auscultation:
 Chest expansion:
Back pain assessment :
Body chart / location : Constant pain / intermittent pain

- Type of pain :
  Sharp and burning, distributed along specific nerves- nerve
 Dull aching, poorly localized and referred to other areas-
muscle
 Localized but referred pain to other areas- joint
 Diffuse, aching especially in one portion- vascular/ischemic
 Pins and needles- present on lateral aspect of thigh

 Aggravating factors and reliving factors:

 24 hours behavior of symptoms :

- Morning symptoms:
- Night symptoms:
- Evening symptoms:
 VAS Scale :

 Urinary incontinence examination:

- Onset :-
- Circumstances of loss:- cough, sneeze, laugh, walk, lift, jump
- Type of loss:- Continuous
Intermittent
On stress
- Urinary symptoms:-
 Frequency of day and night
 Urgency length
 Warning time
 Nocturia
 Nocturnal Enuresis
 Heamaturia
 Straining to void
 Urge incontinence
 Stress incontinence
 Post maturation dribble
 Hesitancy
 FIM Scale:
 Investigations:-
- Blood test: hb level :12gms
VDRL slide test: -ve
Blood group and Rh factorO+ve
- Ultrasound scanning:
- Choronic villus sapling:
- Amniocentesis:
- Alfa fetoprotein:
- Urine test:
 Protein( proteinuria )
 Sugar and ketone level
 Colour
 Presence of chronic gonadotrophen( for pregnancy
confirmation

 Problem
1. weakness n lower limb pain
2. suture pain

 Short term goals

Pelvic floor strengthening to reduce perineum pain
Lower limb strengthening

 Long term goals:

1.To regain fitness

2. strengthening of trunk

3.to prevent long term problems such as backache ,abdominal weakness

 Management
DAY 2:
  Deep breathing exercises with abdominal wall tightening
 Ankle foot exercises with elevation to reduce edema of ankles
 Strengthening exercises:
Static quadriceps and gluteal contractions,
Hip adductor isometrics
Abdominal strengthening exercises-in crook lying, head lift with
abdominal support
Lower abd leg sliding exercise with posterior pelvic tilt

 Pelvic floor strengthening

- Posterior pelvic tilt in supine position with hip and knee flexed.
She has to hold it for 5 seconds and then relaxed. She can
perform same exercise in side lying and standing.
- It should be done 300times/day
- Bladder should be empty while performing this exercise. Instruct
women to tighten pelvic floor like she is attempting to hold the
urine for 5 second and then relax.
- Static contraction of adductors are done in crook lying position
with hold of 5 seconds.
 General mobility exercises: pelvic rocking, hip and knee sliding,
shoulder mobility exercises
DAY 3 :
 Continuing all above exrcises
 Progression in pelvic tilting exe with had and shoulder lift
 Bridging exercises are done with post pelvic tilt.
DAY 4 :
 Alternate SLR

 Diagonal curl up with support to rectus for obliques

 Quadruped position and performing posterior pelvic tilt.

 Correction of posture
- Patient is make to understand about her wrong posture and is
ask to keep shoulder back during her functional activities.
 - In supine position patient is ask to try to touch both shoulders to
plinth and stretch it downwards for stretching of pec minor.
- In sitting patient is ask to retract the shoulder while performing
butterfly position during breathing
- In prone position also she is ask to take shoulder back direction,
this will give resistance as against gravity activity will be
performed.

 Preventive measures:-
 Back care :
1. patient is taught to sit erect
2. while doing household activities like cooking and washing clothes don’t
strain the back with prolonged bending
3. while lifting her baby from the floor or any heavy object bend from the
knees and lift
4. When she gets up from lying position, she has to turn to the one side
and then slowly get up.

 Breast feeding positioning :

1. in sitting position on chair keep two or three pillows on her lap and baby
above it so that back is not strain.
2. in side lying position mother has to keep pillow below her head and
keep back erect with baby on the pillow so that height is increased
3. in long sitting position also she can have back support by keeping pillows
on her back and again pillows on her lap and baby above it.

 Home program :
1. To follow and continue the instructions given for the preventive
measures.
2. Progression of exercise can be done from leg sliding exercise to
alteranate knee flexion and extension in air to cycling movement
in the air.
-post pelvic tilt with both legs raised straight ahead until the range
where she can maintain the posterior pelvic tilt.
Repetitions are kept same for this exercises only resistance is
increased.
3. back strengthening in prone can be done as patient is comfortable
in prone position
4. in prone position from lifting shoulders from plinth to lifting the
arms along it and holding for 5 secs to both arms in 90degree abd
and then shoulders are lifted and 5 secs hold time is given.
5. breathing exercise is taught to patient
diaphragmatic and butterfly position in sitting is taught.