Antenatal Care

By:

Dr. Radwa Mohamed

Antenatal Period

Definition:

It is the period during pregnancy aims to

monitor and promote the wellbeing of a mother

and her fetus, and to provide information,

advice and reassurance as well as monitoring,

screening and treatment where necessary.

Date of starting physical therapy program:

Depends on the medical advisor and should be

before the woman increases her weight.

Who provide antenatal care?

Antenatal educators:

1. Obstetritian,

2. Pediatrition,

3. Obsteric physiotherapist &

4. Dietition

Each team member reinforce the role of the

others and this requires good communication

with regular contact to operate an effective

referral system.

Aims of adequate antenatal care

Prevent & treat physical or psychological

defect.

Prepare the parents for the birth & care

of the infant.

Give confidence to the woman in her own

abilities through an understanding of her

body changes during pregnancy & after

birth.

Psychological preparation for

pregnant women

Most primigravidae women experience an

increase in anxiety during pregnancy and have

fears about childbirth due to:

– Baby will die in uterus.

– Baby will not be born normally.

– Baby will not be healthy.

– Childbirth will be traumatic and pain relief will

not be provided.

– Drugs taken during pregnancy may cause birth

defects .

– Birth-child will alter the relationship between the

woman and her husband.

The greater the anxiety, the greater the

chance that labour will be more difficult.

So the pregnant women should talk about

their anxieties. The team members must

describe to them, the changes which are

occurring in their bodies and explain the

purpose of investigation they make.

Physical preparation for pregnant

women

Physical plane should include certain

anatomical structure of :

– The bony pelvis, its size and shape.

– Its position in the body in relation to posture.

– The attachment of pelvic inlet and outlet.

– The attachment of the muscle of the pelvic floor.

– The development of muscles, ligaments, joints.

– The role of pelvic floor muscles and abdominal

muscles during labour.

A selected number of illustration will greatly helpful.

Physical therapy group classes

Advantages: 1. Time saving.

2. Allow meeting

between pregnant

woman with another

at the same state so,

give psychological

support.

3. Helps to emphasize

the view that

pregnancy is

physiological process.

Role of physiotherapist during

pregnancy

Assess physical health & identify any

musculoskeletal or neuro-mascular

problems.

Advices on back care, standing, sitting

& lying.

Lifting advices.

Treat any problem with appropriate P.T skills

as:

1. Pubic pain.

2. Lumbar pain.

3. Sacroiliac pain.

4. Cramps.

Teach methods for controlling tension & pain.

1. Relaxation tech.

2. Breathing awareness.

Teaching positions that may be used for

each stage of labour.

1st stage:

Walking, sitting, massaging & modified

side lying.

2nd stage:

TENS to relief pain.

3rd stage:

Relaxation & breathing awareness.

Model of P.T program for

normal pregnant women

From 4th to 6th month :

Instruction about anatomy & physiology

of female pelvic structures.

Training for:

1) Deep breathing ex.

2) Relaxation training.

3) Postural correction.

From the end of 6th month till the end of 8th

month :

All previous in addition to:

Pelvic rocking ex.

Leg & foot ex.

Pelvic floor ex.

Abdominal ex.

Core stability ex.

Pectoral strengthing ex.

During the last month ( woman & her

partner):

All previous in addition to:

Instruction about onset of labour.

Stages of labour.

Walking in fresh air.

Teaching panting breathing.

Explanation about effect of TENS on

pain.

Avoid supine hypotension syndrome.

Supine Hypotension syndrome.

When a pregnant woman lies on her back

, the weight of the growing uterus presses

the inferior vena cava against the

vertebrae, obstructing blood flow from

the lower extremities.

Occurs in late pregnancy (7th- 9th Month).

Causes decreased blood return from the heart

and consequently decreased cardiac output and

hypotension.

Woman feels light headache and nauseous, may

produce less blood flow to the placenta.

Obstetric examination Lie:

The relation between the long axis of the fetus & that

of the uterus (feto-pelvic relationship).

Longitudinal, transverse or oblique.

Presentation:

The part of the fetus that is closest to the birth canal.

1. Cephalic=by occiput (vertex, sinciput, brow or

face).

2. Breech.

3. Shoulder.

Presentation

(A) vertex

(B) sinciput

(C) brow

(D) face

Position:

The relation of the occiput to the Rt. or Lt. side of

the mother directed anteriorly or postriorly.

Common positions in cephalic presentation:

Lt. occiput anterior (60%).

Rt. occiput anterior.

Rt. occiput posterior.

Lt. occiput posterior.

positions in cephalic presentation

Attitude:

The relation between fetal parts to each others,

usually flexion. Extension is rare.

Engagement:

The passage of a widest transverse diameter of the

presenting part through the pelvic inlet (at level

of ischial spines).

Crowning:

The passage of a widest transverse diameter of the

presenting part through the pelvic outlet (at

level of coccyx).

Pelvic inlet and outlet

Reassurance & Advices

Ex.

Travelling.

Sleep & rest.

Breasts.

Bowel habits.

Clothes.

Baths.

Teeth.

Sexual

intercourse.

Warning signs.

Diet in pregnancy.