Impact of Intrapartum Physiotherapy on the Pelvic Floor: A Cross-Sectional Study
DOI:
https://doi.org/10.11606/issn.2176-7262.rmrp.2024.218895Keywords:
Labor, Pelvic floor, Physiotherapy modalitiesAbstract
Introduction: Perineal trauma can occur during vaginal delivery due to spontaneous perineal lacerations or episiotomy. However, further studies are needed to investigate whether intrapartum physiotherapeutic care can impact outcomes related to labor and delivery, such as perineal trauma. Objective: To examine the relationship between intrapartum physiotherapeutic intervention, perineal trauma, obstetric, and neonatal variables. Methods: Analytical observational cross-sectional study conducted at Ana Bezerra University Hospital (HUAB), Santa Cruz, Rio Grande do Norte, Brazil. A survey and data analysis were performed on parturients aged 18 to 40 years, primiparous and multiparous, with a single fetus and gestational age between 37 and 42 weeks. The study’s dependent variable was perineal trauma (episiotomy and spontaneous perineal lacerations), and the independent variables included intrapartum physiotherapeutic intervention, physiotherapeutic resources, obstetric, sociodemographic, and neonatal variables. Bivariate analysis (Chi-square) was conducted between the dependent and independent variables. Binary Logistic Regression was applied to determine whether independent variables predicted perineal trauma. A significance level of p<0.05 was adopted. Results: Data were collected from 171 women with a mean age of 26.0 (±5.7) years and a mean gestational age of 39.3 (±1.3) weeks. Of these, 48.5% were nulliparous, and 77.8% experienced perineal trauma, with spontaneous perineal lacerations (64.9%) predominating, particularly grade 1 (35.1%). 22.2% had an intact perineum, and 12.9% underwent episiotomy. 67.3% of women were accompanied by physiotherapists during labor. A significant association was found between perineal trauma and slow and deep breathing during the expulsion phase (p=0.026), previous pregnancies (p=0.001), and number of vaginal deliveries (VD) (p=0.001). In multivariate analysis, a 59.8% reduction in perineal trauma was observed (OR:0.402 95% CI: 0.164; 0.982) in women who received respiratory guidance during the expulsion phase. Meanwhile, women with up to two VDs have 5.38 times more chances of presenting perineal trauma compared to those with more than two VDs (OR: 5.380 95% CI: 1.817; 15.926). Conclusion: The results of this study suggest that respiratory techniques guided by physiotherapists during the expulsion phase appear to have a positive impact on the pelvic floor of low-risk or habitual-risk parturients.
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