masterThesis
Intervenção fisioterapêutica intraparto e sua repercussão nas variáveis obstétricas e neonatais: um estudo transversal
Fecha
2021-09-02Registro en:
MELO, Jordânia Abreu Lima de. Intervenção fisioterapêutica intraparto e sua repercussão nas variáveis obstétricas e neonatais: um estudo transversal. 2021. 73f. Dissertação (Mestrado em Ciências da Reabilitação) - Faculdade de Ciências da Saúde do Trairi, Universidade Federal do Rio Grande do Norte, Natal, 2021.
Autor
Melo, Jordânia Abreu Lima de
Resumen
Introduction: The scope of scientific evidence supporting physical therapy intervention in
obstetric care is still incipient in the literature. Objective: The dissertation comprises two
studies, the first aimed to compare the obstetric outcomes of women undergoing physical
therapy during labor (PT) with those who did not receive such assistance and to associate nonpharmacological methods (NFM) with the phases of TP; and the second was to verify the
relationship between intrapartum physical therapy, perineal trauma, obstetric and neonatal
variables. Methods: Cross-sectional analytical observational study, carried out at the Ana
Bezerra University Hospital (HUAB), Santa Cruz, Rio Grande do Norte, Brazil, with parturient
women aged between 18 and 40 years, with varying degrees of parity, single fetus and
gestational age between 37 and 42 weeks of gestation. In the first article, data from 118 women
were collected, the dependent variables were duration of labor and the expulsion period, and
the independent variables were intrapartum physical therapy resources. The Kruskal-Wallis and
Mann-Whitney tests were used to compare the observed obstetric results. In the second study,
data were collected from 171 women, the dependent variable was perineal trauma (episiotomy
and spontaneous perineal lacerations) and the independent variables were: intrapartum physical
therapy intervention, physical therapy resources, obstetric, sociodemographic and neonatal
variables. A bivariate analysis (chi-square) was performed between the dependent and
independent variables, and Binary Logistic Regression was applied to verify whether the
independent variables would be predictors of perineal trauma. For all analyses, a significance
level of p<0.05 was adopted. Results: When comparing the obstetric outcomes of women
undergoing physical therapy during RT with those who did not receive such assistance, it was
observed that there were no statistically significant differences regarding the duration of RT
and expulsion period between the groups with physical therapy monitoring and without this
assistance, in the active (p=0.14) and latent (p=0.80) phases. However, there was a higher
frequency of application of MNF by women accompanied by physical therapists. When the
relationship between intrapartum physical therapy, perineal trauma, obstetric and neonatal
variables was verified, a significant association was observed between perineal trauma versus:
slow and deep breathing in the expulsive period (p=0.026), previous pregnancies (p=0.001) and
number of vaginal deliveries (PV) (p=0.001). In the multivariate analysis, a 59.8% decrease in
perineal trauma was observed (OR: 0.402 95%CI: 0.164; 0.982) in women who received
respiratory guidance during the expulsion period by physical therapists, whereas women with
up to two PV have 5 .38 (OR: 5.380 95%CI: 1.817; 15.926) times more likely to have perineal
trauma when compared to those with more than two PV. Conclusion: The results of this study
suggest that parturients accompanied by physical therapists during PD had more access to nonpharmacological resources and that breathing techniques guided by these professionals during
the expulsion period seem to have a positive impact on the pelvic floor of low-risk or usual-risk parturients.