E01022327 PDF
E01022327 PDF
E01022327 PDF
e-ISSN: 2279-0853, p-ISSN: 2279-0861. Volume 10, Issue 2 (Sep.- Oct. 2013), PP 23-27
www.iosrjournals.org
Abstract: post partum stress and hyper tension is common disorder in women, however moderate to severe
stress and depression may lead to convulsions. A lady having a similar complaint was being treated with
Mitchell relaxation technique, deep breathing exercises and other mobility exercises for a period of 10 weeks.
All the investigations like MRI, ECG, Blood Reports were found normal or near normal. There was no specific
clinical correlation found between any of the investigation report to eclampsia and seizures except level of
stress. There was good reduction found on depression, anxiety and stress. Post partum seizures have reduced to
zero. Hypertension was also able to decline to normal range. From the case it can be concluded that Mitchell
relaxation techniques combined with other stress reliving exercises can be use to treat post partum eclampsia
and related stress. Stress induced convulsion may be treated with such exercises.
Key words: anxiety, depression, mitchell relaxation technique, post eclampsia, stess
I. Introduction
The birth of a child is one of the most intense and emotional experiences in a woman’s life and results
in extremes in the perception of this event. Both traumatically experienced childbirth and stressful events in the
individual life story of a woman can result significant psychological impairments post partum. Depending on
objective and subjective factors, childbirth can act as a significant stressor and trigger for post-traumatic stress
disorder (PTSD), a mental illness which affects a disproportionately high number of women in childbearing age,
with a lifetime prevalence of 10.4–13.8%1
Postpartum depression (PPD), also called postnatal depression, is a type of clinical depression which
can affect women, and less frequently men, typically after childbirth. Studies report prevalence rates among
women from 5% to 25%.Although a number of risk factors have been identified, the causes of PPD are not well
understood. Many women recover with a treatment consisting of a support group or counseling. 2, 3
Post partum convulsions are very rarely to occur; and remained diagnostic enigma. 4
A study shows that there were 54 cases of late postpartum eclampsia among a total of 334 cases of
eclampsia during the study period. Late postpartum eclampsia constituted 56% of total postpartum eclampsia
and 16% of all cases of eclampsia. Convulsions began from postpartum days 3-23 (mean 6). Thirty women
(56%) had been identified as preeclampsia before their convulsions. A history of either severe headache or
visual disturbances before convulsion was elicited in 83% of the patients. Only eight of 62 patients with late
postpartum seizures had identifiable etiologies other than eclampsia. 5
Exact clinical Diagnosis of present given case was remained unclear after detailed clinical evaluation;
however retrospective (for prenatal) stress and anxiety, postnatal stress and anxiety, pre and post eclampsia
thought to have stress induced seizures in this patient. Aim of this study is to check the effects of Mitchell
relaxation technique and other stress reducing exercises on depression, anxiety and stress in post partum women
having post eclampsia and convulsions.
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Effect of Mitchell Relaxation technique and general mobility exercises on post partum eclampsia,
III. Interventions
Retrospective DASS (Depression, Anxiety and Stress Scale) was taken at 36 th week of gestation, 6th
day post delivery, 1 month post delivery, and 3 months post delivery. Blood pressure was continuously
monitored through out the treatment sessions. It may be noted that drugs to relive blood pressure was totally
weaned off by 1 month post delivery. However anticonvulsive drugs were being taken regularly till the end of
this study.
Treatment was started at the 6th day post delivery. Various Exercise protocol had been introduced to reduce
the Depression, Anxiety and Stress focused mentally and physically.
Summary is mentioned in the Table no 1.
Mitchell Relaxation Technique6: (Fig. 1A)
It contents easy breathing and slow movement of almost each of the joint while lying flat on back with no
distraction. Example for shoulder joint is given below.
SLIDE your hands along the floor down towards your knees, pulling your shoulders down. Stop pushing and
let go. ………….Repeat
THINK about the movement.
FEEL the new position of the shoulder joints, feel them loose and down.
10 repetitions for each joint and body was given.
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Effect of Mitchell Relaxation technique and general mobility exercises on post partum eclampsia,
Psychological counseling:
Patient was given psychological counseling every 15 days regarding enjoying mother hood and other
psychological factors by psychologist
IV. Results:
Depression was able to decline on scale from 13(mild) to 10(mild) at the 3 month post delivery.
Anxiety was able to decline on scale from 15(severe) to 4 (normal) at the 3 month post delivery. Stress was able
to decline on scale from 27(severe) to 9 (normal) at the 3 month post delivery. Blood pressure was maintained
around 110/72 mm Hg till the end of treatment without antihypertensive drugs from 1st month post delivery to
3rd month post delivery. There was no convulsion episode found after 15th day post delivery till the end of the
treatment. (Table. 2, Graph 1) (Anticonvulsive drug was being taken as advised by neuro physician.)
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Effect of Mitchell Relaxation technique and general mobility exercises on post partum eclampsia,
Table 2. DASS, Blood pressure and Episodes of Seizures during Prenatal and Post natal duration.
Duration/Variables 36th weeks of 6th day post delivery 1 month post delivery 3 months post
gestations delivery
Depression 13 (Mild) 20 (Moderate) 12 (Mild) 10 (Mild)
Anxiety 15 (Severe) 17 (Severe) 9 (Mild) 4 (Normal)
Stress 27 (Severe) 29 (Severe) 14 (Normal) 9 (Normal)
Total 55 66 35 23
Blood pressure in mm Hg 140/90 132/86 110/70 110/72
Episodes of seizures till 0 2 2 0
A B
Figure 1. Patient performing part of A. mitchell exercises and B. posterior pelvic tilt exercises
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Effect of Mitchell Relaxation technique and general mobility exercises on post partum eclampsia,
VI. Conclusion
Mitchell relaxation techniques combined with other stress reliving exercises can be effective in treating
post partum Stress, Depression and anxiety along with post partum eclampsia. It may be helpful to overcome
stress induced convulsions.
It has been observed that altered posture after the pregnancy can cause mental stress along with pain.
So posture correction exercises have been purposefully added to this patient.
Diaphragmatic excursion may have been adversely hampered due to uterus size. There for Deep
breathing exercise focusing on diaphragmatic excursion have been added to facilitate diaphragm excursion and
ease breath.
Baby care is one of the most difficult thing mother has to deal with after delivery; and eventually lead
to bad posture due to bad postural habits like forward bending and keeping the shoulder forward. Even increased
breast weight can have the faulty kyphotic posture. So proper baby care advice with correct posture have been
taught to this patients. Neuro physician, Gynecologist and a consultant Psychologist were active rehabilitative
team members for this patient’s rehabilitation.
Levetiracetam drug is having a side effect of mood swing and depression; therefore probably we dint get
much improvement in patient’s depression scale. It may be noted that this drug was on till the end of our
treatment so we were not able to correlate the effect of treatment to episodes of convulsion. Stress and
hypertension were thought to be having the factors which lead to convulsions in this patient which can be
effectively managed without antihypertensive drugs. According to physiology, blood pressure tend to decline
after 6th post delivery but here in this patient it was not declined.
Similar study is required with larger sample size.
References
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Depression Scale". Br J Psychiatry 150 (6): 782–6.
[4] Anita Dutta, Toni Tonkin, and Wolf Gelman. “Post partum convulstions- a diagnostic enigma” J R Soc Med. 2006 April; 99(4): 203–
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[5] Lubarsky SL, Barton JR, Friedman SA, Nasreddine S, Ramadan MK, Sibai BM. “Late post partum eclampsia revisited”. Obstet
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