Cesarian section and physical therapy role

1. ROLE OF Ph Th IN POST
OPERATIVE CASE
(CESAREAN SECTION – HYSTERECTOMY)
BY/ DR. RameZ YousrY

2. Caesarean section or c-section, is a delivr
ey of the
foetus through incisions in anterior abdominal
(laparotomy) and uterine wall (hysterotomy)

3. 1
. -Extreme degree of
contracted pelvic
one or more of the diameters
is reduced and interferes with
normal mechanism of labour.
Degrees of contracted pelvis:
 Minor degree: the true
conjugate is 9-10 cm.
 Modrate degree: the true
conjugate is 8-9 cm.
 Sever degree: the true
conjugate is 6-8 cm.
 Extreme degree: the true
conjugate is less than 6 cm.

4. 2- Cephalopelvic disproportion:
The head of the foetus is too large to come
through the pelvis.
3- Uterine Inertia: Inefficient uterine contraction.

5. 4- Placenta Previa:
Implantation of placenta in the lower uterine
segment.

7. .
11. Prolapse of the
umbilical cord.

9. 13- Cervical dystocia (failure of the cervix to dilate
in spite of strong contraction of the uterus).
14- A previous uterine incision.
15-Fetal distress (HR above 160 or below 100,
irregular ).
16-Bad past obstetric history (baby habitually dies in
the uterus.
17-Failure of labour to progress despite adequate
stimulation.

10. Dead of foetus
Contra-Indications of cesarean
section

11. 1) Elective timing:
(before the onset of labour by one week).
1) Selective timing:
(after the onset of labour, it is preferred).

12. 1- The classical caesarean section :
A midline longitudinal (vertical) incision which allows a larger
space to deliver the baby. However, it is rarely performed today as
it is more prone to complications .
2- The lower uterine segment section :
It is the a procedure most commonly used today; it involves a
transverse cut just above the edge of the bladder and results in
less blood loss and is easier to repair .

14.  when the lower segment is abnormally vascular.
 when the lower segment can not identified due to adhesion.
 when caesarean section is done post mortem.
 When the foetus lie is transverse
and can not be corrected.
 When hysterectomy will follow
caesarean section

15. Disadvantages of classical operation:
 More liable to chest infection.
 More liable to intestinal distension.
 The scar is more liable to rupture.

16. Advantages of the lower segment:
 The wound is extra peritoneal so less risk of infection.
 Healing scar is better.
 The risk of rupture of the scar is less (0.2 %).
 Hemorrhage is less.
 Placenta is away from the incision.
Disadvantages of the lower segment:
 The incision may extend down to the bladder.

17. 1- Respiratory complications:
due to inhibitory effects of pain, immobilization in post operative
period and anesthesia.
So, - encourage deep breathing exercises.
- teach the patient huffing and coughing (the abdomen must
be supported by the patient‫י‬s hands and/or towel)
2- Excessive abdominal pain: due to
- Wound infection.
- Haematoma.
- Excessive localized edema.
- Nerve entrapment syndrome (ilioinguinal or iliohypogastric
nerve)
3- Deep venous thrombosis:
due to hypercoagulability, decrease venous tone.

18. Signs and symptoms of DVT: in about 50%
Edematous limb.
Erythrocyanotic appearance.
Dilated superficial veins.
Elevated skin temperature.
Prophylactic role to prevent DVT:
Early ambulation.
Avoidance of pressure under thighs and calves
Avoidance of sitting with knees acutely flexed.
Deep breathing exercises.
Circulatory and leg exercises.

19. 4- Dependent edema.
(generalized retention of fluid)
aggravated by decreased movements
of the lower limb muscles.
TO PREVENT DEPENDENT EDEMA:
o Vigorous foot and ankle exercises.
o Elevation of L.L.
o If sever apply stoking and intermittent pressure.
5- Intestinal complications.
6- Hemorrhage.

20.  neonatal depression
 fetal injury
 breathing problems

21. It is done when there is inability to stop
bleeding from the uterine incision or
multiple fibroids in old patient.
Cesarean hysterectomy

22.  It is an excision of a portion of both
fallopian tube.
 It is done after 3rd or 4th cesarean
section.
Sterilization during C.S.

23. Pre-operative management
Post- operative management:

24. For elective cases, prior to surgery the mother
is pain free and alert, to prepare her
emotionally and physically for post operative
delivery.
 Pre-operative goals:
1. Improve pulmonary function and prevent post
operative pulmonary complications( pneumonia….)
2. Improve circulation and prevent post operative
circulatory complications (DVD, edema ….)
3. Prepare patient emotionally and physically

25.  Methods:
 Discussion to minimize or eliminate negative feeling about
delivery.
 Demonstrate the patient how to mobilize early with minimum
amount of strain or pain.
 Teach the patient how to cough and huff to get out of
expectoration.
 Deep breathing exercises.
 Circulatory exercise.

26. Post-operative goals:
1. Improve pulmonary function and prevent post
operative pulmonary complications( pneumonia….)
2. Improve circulation and prevent post operative
circulatory complications (DVD, edema ….)
3. Decrease incisional pain associated with coughing,
movement or breast feeding.
4. Improve healing of incision and prevent adhesion
formation.
5. Prevent pelvic floor dysfunction.
6. Improve lactation and prevent sagging of the breast.
7. Correct posture.

27. Methods:
 Deep breathing exercises.
 Circulatory exercise.
 Early ambulation.
 Arm exercises.
 Postural correction.
 Pelvic floor exercises.
 Abdominal strengthening exercises.
 Electrotherapy to decrease incisional pain and to
promote wound healing.
 Positioning instruction.

28.  1st day:
 Breathing ex‫י‬s.
 Circulatory ex‫י‬s.
 Leg ex‫י‬s.
 Static abdominal contraction.
 2nd day:
 Repeat previous ex‫י‬s, add the following:
 Early ambulation to:
 Prevent muscle wasting.
 Prevent constipation.
 Prevent respiratory and vascular complication.
 Arm ex‫י‬s.
 3rd day:
 Repeat previous ex‫י‬s, add the following:
 Pelvic floor ex‫י‬s

29.  4th day:
 Repeat previous ex‫י‬s, add the following:
 Pelvic rocking ex‫י‬s
 Scapular retraction.
 5th day:
 Repeat previous ex‫י‬s, add the following:
 Hip shrugging.
 Postural correction ex‫י‬s.
 6th day:
 Repeat previous ex‫י‬s, add the following:
 Pelvic rotation ex‫י‬s.
 7th day:
 Repeat previous ex‫י‬s, add the following:
 Lateral flexion (1st step)
 Trunk rotation (1st step)
 Trunk flexion (1st step).

30. (A) Post-operative pain relief:-
 Ice packs for 10- 15 min on the treated
area, every 8 hours for 72 hours.
 TENS, Para incisional, pulse width 200us,
frequency 2 Hz (burst mood)

32.  LASER: IR laser / 904 nm, 10 watt power,
reach 20-30 mm.
 After 24 hour post op. then every other
day.

33. 1. Immune system, Increase erythrocyte
rosette formation, igG and phagocytic
index.
2. Accelerate inflammatory phase by alter
the level of prostaglandin
3. Enhance protein synthesis through DNA
and RNA synthesis
4. Bactericidal effect

34.  Intensity (1-2 W/Cm2), for 10- 15min daily
 Mechanism of action:
 Micro massage effect
 Increase temp vasodilatation
white blood cells invade
microorganisms

35.  Promote healing via stimulate growth of
the granulation tissue and prevent
infection by destructing surface organisms
 non infected open wound non-progressed
E1
 progressed E1 surrounding skin

36. In case of infected wound
 Slough fine film of yellowish appearance
E3 and surrounding skin received E1
 Slough definit layer of yellow or green
ues E4 and surrounding skin received E1
 Thick dark brown or black scalp E4 DAILY
the solugh starts to leave the skin
gently cut.

37.  For infected wound
 Dispersive electrode on the back
 2 active electrode paraincisional
 Pulse rate 80-100p/sec for 60 min daily
 Mechnism of action
-Increase circulation
-Bactericidal effect ( sthph., escherichia
coli….)

38.  SWD: for 1 hour twice / day
 Early ambulation
 Static abdominal ex