Antenatal Physiotherapy

Assessment and Management

Dr. Preetha R. MPT, PhD
Associate Professor
Department of Physiotherapy,SOAHS, MAHE,
Manipal
preetha.r@manipal.edu
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 Contents

• Definition
• Role of Physiotherapy
• Antenatal Investigations
• Trimester-wise complaints
• Physiotherapy Evaluation
• Physiotherapy Management

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 Definition
• Period between conception until birth.

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 Role of physiotherapy
• To promote and maintain optimal
physical and emotional maternal health
through out pregnancy

• To recognize and treat the

complications occurring during
pregnancy

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• To prepare for and inform both parents
about pregnancy,labour,puerparium and
the subsequent care of the baby

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 First trimester investigations
• Routine blood/urine tests

• Early anomaly scan-crown rump length

• NT scan-Dual marker test

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 Ultrasound
• To confirm –intrauterine or
extrauterine
• To confirm fetal heart beat
• To diagnose multiple pregnancy
• To estimate gestational age
• To confirm the wellbeing of pregnancy

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• TVS better than TAS
• Gestational sac,yolk sac,amnion and
early embryo
• GS-4.5 weeks
• Yolk sac-earliest embryonic landmark
• Cardiac activity seen by 40th menstrual
day

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 Second trimester investigations
• Triple test (α-fetoprotein, unconjugated
oestriol, β-human chorionic
gonadotrophin (HCG) )

• Quadruple Test-(α-fetoprotein,
unconjugated oestriol, β-human chorionic
gonadotrophin (HCG) and Inhibin A )

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• Anomaly scan

• Growth scans-Head Circumference,

Femoral Length, Abdominal
Circumference, Bi-Parietal Diameter

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• GTT-Sugar Profile

• Cervix length

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Third trimester investigations
• Growth scans

• AFI-Amniotic fluid index

• DFMC-Daily fetal movement chart

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 Prevalence of musculoskeletal
dysfunctions during pregnancy

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 Preetha Ramachandra, Arun G Maiya, Pratap Kumar, Asha Kamath.
Prevalence of Musculoskeletal Dysfunctions among Indian Pregnant Women.
Journal of Pregnancy. Volume 2015, Article ID 437105

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 Antenatal assessment

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 Evaluation
• Name:

• Age: EDD:

• Occupation: LMP:

• Address:

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• Height:

• Weight:

• BMI:

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• Chief complaints
• Present pregnancy history
• Past obstetrical history
• Past medical history
• Family history
• Past Menstrual history
• Personal history

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 On Observation

Chloasma Striae gravidarum

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 Linea nigra

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• Facial puffiness

• Flanks, flattened umbilicus

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• Edema

• Posture evaluation

• Visual inspection of foot posture

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 On palpation:

• Trigger points

• Spasm in muscles

• Pitting/non pitting edema

• Tenderness in joints (if mentioned in

complaints)

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 On examination:
Musculoskeletal system:

• Pain: VAS, Body chart, nature, intensity,

duration, aggravating & relieving factors
• Movement examination

• ASIS/medial malleolus of tibia in level

• ROM/Laxity of joints: (Beightons scoring

for laxity of joints)
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Posterior pelvic pain provocation test:

• The patient is supine,the hip is flexed to

90°, and the knee is bent. The examiner
applies posterior shearing force to the
sacroiliac joint through the femur.

• The test is said to be positive when the

women feels a pain that she recognizes in
her buttocks distal and lateral to the L5–
S1 area near the sacroiliac joints
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• Tightness - Pectorals, hamstrings, calf
muscles, hip flexors

• MMT for upper limb and lower limb

(Adapted positions)

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• Special tests based on the joints
affected

• Foot evaluation- FPI-6

• Measurement of navicular height

truncated

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 Respiratory system evaluation
• Type of breathing; chest symmetry;
chest expansion

• Auscultatory finding:

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• Neurological:

• Sensation (tingling, numbness)

• Perform the upper limb tissue tension
tests
• Proprioception especially of ankle
• Reflexes
• Balance
• Gait
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• Urinary: Frequency, incontinence,
prolapse

• Anal incontinence

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• Functional Endurance/ Fatigue:
• 6 minute walk test
• Fatigue severity scale

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• Physical activity
• Pregnancy physical activity
questionnaire
• PAR-Med X For pregnancy

• Quality of life:
• WHOQOL-Bref

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• Problem list:

• Short term goals:

• Long term goals:

• Management:

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 SI joint Assessment
• History
• Palpation
• Examination
o Level of ASIS
o Level of medial malleolus of tibia

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 Posterior innominate of left side

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Muscular correction of
posterior innominate
 Mobilization correction of
posterior innominate

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 Anterior innominate of left side

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 Muscular correction of anterior
innominate

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 Mobilization correction of anterior
innominate

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 Home program for right posterior
innominate

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 Home program for left anterior
innominate

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 Exercises
• Static gluteals
• Pelvic floor exercises
• Pelvic tilting exercises
• Ergonomics

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 Musculature to work on for proper
stability of SI joint
• Internal and external Obliques aid in force closure
of SIJ
• Transversus Abdominus inserts into dorsolumbar
fascia and abdominal aponeurosis to act as
primary SIJ stabilizer
• Ipsilateral Latissimus dorsi and contralateral
Glutes Maximus,Erector spinae and multifidus
creates forced closure
• Gluteus medius, minimus ,Tensor fascia lata and
hip adductors creates frontal plane stability
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 Trochanteric belt using cloth

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 Preparation for labour

• Positions.
• Relaxation technique.
• Breathing technique.
• Transcutaneous electrical nerve
stimulation
• Massage.
• Hot and cold packs.
 Disadvantages of Hyperventilation

• Adrenaline

• blood vessels to constrict

• Reduced oxygen to muscles

• Pain and decreased production of estrogen

• Slows labour
 Advantages of rhythmic
breathing
• Rhythmic breathing

• Promotes physical relaxation by reducing

muscle tension

• Promotes emotional relaxation by reducing

anxiety
• Squatting and kneeling increases antero
posterior diameter and also inter tuberous
diameter

• Walking, swaying, lunging, flexing and

extending the legs facilitate fetal rotation
or descent which in turn mitigates the pain
• The effects of gravity can help the baby
move down more quickly.

• Changing positions helps to ensure a

continuous oxygen supply to the fetus,
rather than causing supine hypotension
 Second Stage Of Labour:
• Supported squat.
• Squatting.
• Semi upright position.
• Sit propped up with cushions.
 TENS during labour

• 2 types of TENS:
Burst train tens:
Low frequency bursts (<4 Hz) of higher
frequency stimulation has both properties
of conventional TENS and acupuncture
TENS.
 Brief intense TENS:

• It is high frequency (> 100 Hz), long pulse

duration (>150 ms). It is used for short
period of time (10 to15 minutes) due to
fatigue generated in the nerves from this
intense type of stimulation.

• The effect is almost instantaneous owing

to the localized blocking of nerve
contraction.
 Placement Of Electrodes:
• Two electrodes are placed at the level of
T10-L1 and other two at the level of S2-
S4.
 MASSAGE
• Firm, smooth stroking or kneading
massage.

• HOT: Hot water bottle, warm moist towel,

heated rice filled pack, warm blanket.
 Summary

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 Thank you

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