6130709 Obstetrics Gynecology Physical Therapy Assessment

OBG PT ASSESSMENT

Sagar Naik, PT

Obstetrics & Gynecology PT Assessment PT

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Sagar Naik,

Acknowledgement: Dr. Prerana Ma’am

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:

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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

OBG PT ASSESSMENT

Sagar Naik, PT

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• 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

OBG PT ASSESSMENT

Sagar Naik, PT

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• 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

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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)

OBG PT ASSESSMENT

Sagar Naik, PT

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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:

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

< On Examination:

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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

OBG PT ASSESSMENT

Sagar Naik, PT

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• 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

OBG PT ASSESSMENT

Grades

Description

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

Contraction held less than 1 second

Sagar Naik, PT

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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

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