Relação entre a pressão muscular perineal no puerpério e o tipo de parto

Abstract

ResumoObjetivo: relacionar o tipo de parto e as características do períneo com valores da pressão muscular perineal (PMP) mensurada em primíparas nas posições deitada e sentada com a musculatura perineal em repouso e em contração máxima. Métodos: estudo quantitativo do tipo transversal, realizado em maternidade conveniada ao Sistema Único de Saúde (SUS) do município de São Paulo. A casuística, obtida por conveniência, foi de 95 primíparas de termo. A avaliação ocorreu entre o 40º e o 45º dia. Realizaram-se entrevista, exame físico e mensuração da PMP por meio do perineômetro de Kegel. A mensuração foi realizada nas posições deitada e sentada, com a musculatura em repouso e em contração máxima, sendo considerada a média de três aferições para cada posição e estado muscular. Resultados: 76,8% (73) das primíparas tiveram parto vaginal e 23,2% (22) cesárea. No pós-parto vaginal, observou-se períneo íntegro em 18,9% (18), com rotura perineal em 24,2% (23) e com episiotomia em 33,7% (32). Os valores obtidos da PMP foram em: posição deitada/musculatura em repouso, 18,9 mmHg; deitada/musculatura em contração máxima, 30,7 mmHg; sentada/musculatura em repouso, 34,5 mmHg; sentada/musculatura em contração máxima, 46,5 mmHg. Conclusão: não houve associação entre o tipo de parto e as condições perineais e a pressão muscular perineal. , day with an interview, physical examination and measurement of PMF using a perineometer of the Kegel type. The measurement was carried out in the lying and seated positions, muscular status (at rest and in maximum contraction), and the average of three measures for each position and muscular state were considered. Results: 76.8% (73) of the women had vaginal delivery and 23.2% (22) cesarean section. After vaginal delivery, intact perineum in 18.9%, (18), perineal rupture in 24.2% (23), and episiotomy in 33.7% (32) were observed. Obtained values of the PMF were: lying position muscular rest 18. 9 mmHg, lying position maximum contraction: 30,7 mmHg, seated position muscular rest: 34.5 mmHg, seated positions maximum muscular contraction: 46.5 mmHg. Conclusion: there was association between the type and the characteristics of the delivery and PMF. PALAVRAS-CHAVE:

Intervenção fisioterapêutica em mulheres com incontinência urinária associada ao prolapso de órgão pélvico

“…However, perineal protection is not always guaranteed by the surgical incision because of the difficult recovery of the muscles incised. In the present study, 68.4% of the participants had episiotomy and still developed UI, confirming the findings of Menta and Schirmer 15 .…”

“…Perhaps this delay is due to the fact that the most prevalent type of UI was mild and moderate and women with this degree of incontinence often do not seek help 1 and/or the fact that many women are unaware that UI can be treated, considering it a natural result of delivery and the aging process 20,21 . UI can arise during pregnancy but is usually related to pelvic floor neuromuscular damage during vaginal delivery, mainly in first-time mothers 5,15 .…”

“…It is known that parity influences the development and/or the severity of UI 15 . However, the role of prolapse in UI is still unclear and it is not known whether it influences the outcomes of physical therapy treatment for UI.…”

Perineal Muscle Strength During Pregnancy and Postpartum: the Correlation Between Perineometry and Digital Vaginal Palpation

“…To evaluate the PF muscles and diagnose disorders in the genitourinary and anal tracts, different exams are used: magnetic resonance, manometry, anal endosonography, translabial ultrasound, electromyography, perineometry, digital vaginal palpation, and neurophysiological and urodynamic studies of the PF (2,(5)(6)(7)(8)(10)(11)(12)(13) .…”

“…Perineometry and digital vaginal palpation are the most frequently used methods to measure PFMS in clinical practice (11)(12)(13) . Evaluating PFMS can be essential in determining the type of treatment for women who present certain morbidities in the genitourinary tract (14) .…”