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01.06.2019 | Original Article

Effects of perineal preparation techniques on tissue extensibility and muscle strength: a pilot study

verfasst von: Síssi Sisconeto de Freitas, Alana Leandro Cabral, Rogério de Melo Costa Pinto, Ana Paula Magalhães Resende, Vanessa Santos Pereira Baldon

Erschienen in: International Urogynecology Journal | Ausgabe 6/2019

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Abstract

Introduction and hypothesis

Perineal preparation techniques for childbirth have been used with the aim of reducing perineal tears during the expulsive phase of labor. However, no studies were found to investigate the effects of instrument-assisted stretching versus perineal massage on pelvic floor muscle (PFM) variables. Therefore, the aim of this study was to evaluate the effect of instrument-assisted stretching versus perineal massage on the extensibility and strength of the PFMs.

Methods

Primiparous women were randomized to the instrument-assisted stretching (IStr) group (n = 13) and perineal massage (PnM) group (n = 14). The groups participated in eight sessions, twice weekly, beginning at the 34th gestational week. The IStr group underwent the intervention for 15 min using EPI-NO®. The PnM group underwent a perineal massage protocol for 10 min. Each woman was evaluated by a blinded physiotherapist before, after four and after eight sessions for primary (PFM extensibility using the EPI-NO® circumference) and secondary (PFM strength using a manometer) outcomes. Covariate analysis (ANCOVA) was used to compare the groups using the baseline values as a covariate.

Results

Both groups showed an increase in PFM extensibility compared with the evaluations before and after four and eight sessions (PnM group from 17.6 ± 1.8 to 20.2 ± 1.9 cm; IStr group from 19.9 ± 1.6 to 22.9 ± 1.6 cm;p < 0.001). There was no difference between groups. Regarding muscle strength, no statistical differences were observed between evaluations or between groups.

Conclusions

Instrument-assisted stretching and perineal massage increase extensibility and do not alter the strength of PFMs in pregnant women.

WHO recommendations: intrapartum care for a positive childbirth experience. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO. http://www.who.int/reproductivehealth/publications/intrapartum-care-guidelines/en. Accessed 20 Feb 2018.

Bo K, Frawley HC, Haylen BT, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. Int Urogynecol J. 2017;28:191–213. https://doi.org/10.1002/nau.23107. CrossRefPubMed

Beckmann MM, Stock OM. Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev. 2013;30(4):CD005123. https://doi.org/10.1002/14651858.CD005123.pub3. CrossRef

Kamisan Atan SKL, Langer S, et al. Does the EPI-NO® birth trainer prevent vaginal birth-related pelvic floor trauma? A multicentre prospective randomised controlled trial. BJOG. 2016;123(6):995–1003. https://doi.org/10.1111/1471-0528.13924.CrossRefPubMed

Hillebrenner J, et al. First clinical experiences with the new birth trainer EPI-NO® in primiparous women (Erste klinische Erfahrungen beiErstgebärenden mit einem neuartigen Geburtstrainer Epi-no®). Z Geburtshilfe Neonatol. 2001:205, 12–19.

Kok J, Tan KH, Koh S, et al. Antenatal use of a novel vaginal birth training device by term primiparous women in Singapore. Singap Med J. 2004;45(7):318–23.

Kovacs GT, Heath P, Heather C. First Australian trial of the birth-training device EPI-NO: a highly significantly increased chance of an intact perineum. Aust N Z J Obstet Gynaecol. 2004;44(4):347–8. https://doi.org/10.1111/j.1479-828X.2004.00265.x.CrossRefPubMed

Ruckhabäberle E, Jundt K, Bäuerle M, et al. Prospective randomized multicenter trial with the birth trainer EPI-NO® for the prevention of perineal trauma. Aust N Z J Obstet Gynaecol. 2009;49(5):478–83. https://doi.org/10.1111/j.1479-828X.2009.01044.x.CrossRef

Brito LG, Ferreira CH, Duarte G, Nogueira AA, Marcolin AC. Antepartum use of EPI-NO birth trainer for preventing perineal trauma: systematic review. Int Urogynecol J. 2015;26(10):1429–36. https://doi.org/10.1007/s00192-015-2687-8.CrossRefPubMed

10.

Zanetti MR, Petricelli CD, Alexandre SM, Paschoal A, Araujo Júnior E, Nakamura MU. Determination of a cutoff value for pelvic floor distensibility using the EPI-NO balloon to predict perineal integrity in vaginal delivery: ROC curve analysis. Prospective observational single cohort study. Sao Paulo Med J. 2016;134(2):97–102. https://doi.org/10.1590/1516-3180.2014.8581009.CrossRefPubMed

11.

Sut HK, Kaplan PB. Effect of pelvic floor muscle exercise on pelvic floor muscle activity and voiding functions during pregnancy and the postpartum period. Neurourol Urodyn. 2016;35:417–22. https://doi.org/10.1002/nau.22728.CrossRef

12.

Santos MD, Palmezoni VP, Torelli L, Baldon VSP, Sartori MGF, Resende APM. Evaluation of pelvic floor muscle strength and its correlation with sexual function in primigravid and non-pregnant women: a cross-sectional study. Neurourol Urodyn. 2018 Feb;37(2):807–14. https://doi.org/10.1002/nau.23353.CrossRefPubMed

13.

Palmezoni VP, Santos MD, Pereira JM, Bernardes BT, Pereira-Baldon VS, Resende AP. Pelvic floor muscle strength in primigravidae and non-pregnant nulliparous women: a comparative study. Int Urogynecol J. 2017;28(1):131–7. https://doi.org/10.1007/s00192-016-3088-3.CrossRefPubMed

14.

Laycock J. Pelvic muscle exercise: physiotherapy for the pelvic floor. Urol Nurs. 1994;14:136–40.PubMed

15.

Steel RGD, Torrie JH. Principles and procedures of statistics: a biometrical approach. 2nd ed. New York: McGraw-Hill; 1980. p. 20–90.

16.

McHugh MP, Cosgrave CH. To stretch or not to stretch: the role of stretching in injury prevention and performance. Scand J Med Sci Sports. 2010;20:169–81. https://doi.org/10.1111/j.1600-0838.2009.01058.x.CrossRefPubMed

17.

Nakamura MU, Sass N, Júnior JE, Petricelli CD, Alexandre SM, Júnior EA, et al. Tolerância da parturiente à extensibilidade perineal avaliada pelo EPI-NO: estudo observacional. Einstein. 2014;12(1):22–6. https://doi.org/10.1590/S1679-45082014AO2944.CrossRefPubMedPubMedCentral

18.

Petricelli CD, Resende APM, Júnior JE, Júnior EA, Alexandre SM, Zanetti MRD, et al. Distensibility and strength of the pelvic floor muscles of women in the third trimester of pregnancy. Biomed Res Int. 2014; 2014:Article ID 437867, 6 pages. https://doi.org/10.1155/2014/437867.

19.

Duarte G, Coutinho CM. Mecanismo de parto. In: CHJ F, editor. Fisioterapia na saúde da mulher: teoria e prática. 2nd ed. Rio de Janeiro: Guanabara Koogan; 2011.

20.

Rahn DD, Ruff MD, Brown AS. Biomechanical properties of the vaginal wall: effect of pregancy, elastic fiber deficiency, and pelvic organ prolapse. Am J Obstet Gynecol. 2008;198(5):590.e1–6. https://doi.org/10.1016/j.ajog.2008.02.022.CrossRef

21.

Rosário JLP, Souza A, Cabral CMN, João SMA, Marques AP. Reeducação Postural Global e alongamento estático segmentar na melhora da flexibilidade, força muscular e amplitude de movimento: um estudo comparativo. Fisioter Pesq. 2008;15(1):12–8. https://doi.org/10.1590/S1809-29502008000100003.CrossRef

22.

Endilich PW, Farina GR, Dambroz C, Gonçalves WLS, Moysés MR, Mill JG, et al. Efeitos agudos do alongamento estático no desempenho da força dinâmica em homens jovens. Rev Bras Med Esporte. 2009;15(3):200–3. https://doi.org/10.1590/S1517-86922009000300007.CrossRef

23.

Brasil. Portal Brasil. Número de cesarianas cai pela primeira vez desde 2010. Disponível em: <http://www.brasil.gov.br/saude/2017/03/numero-de-cesarianas-cai-pela-primeira-vez-desde-2010>. Accessed 21 Mar 2018.

24.

Memon H, Handa VL. Pelvic floor disorders following vaginal or cesarean delivery. Curr Opin Obstet Gynecol. 2012;24(5):349–54.CrossRefPubMedPubMedCentral

25.

Oliveira LS, Brito LG, Quintana SM, Duarte G, Marcolin AC. Perineal trauma after vaginal delivery in healthy pregnant women. Sao Paulo Med J. 2014;132(4):231–8. https://doi.org/10.1097/GCO.0b013e328357628b.CrossRefPubMed

26.

Priddis H, Dahlen HG, Schmied V, Sneddon A, Kettle C, Brown C, et al. Risk of recurrence, subsequente mode of birth and morbidity for women who experienced severe perineal trauma in first birth in New South Wales between 2000–2008: a population based data linkage study. BMC Pregnancy Childbirth. 2013;13(89):1–7. https://doi.org/10.1186/1471-2393-13-89.CrossRef

27.

Pergialiotis V, Vlachos D, Protopapas A, Papa K, Vlachos G. Risk factors for severe perineal lacerations during childbirth. Int J Gynecol Obstet. 2014;125:6–14. https://doi.org/10.1016/j.ijgo.2013.09.034.CrossRef

28.

Riesco MLG, Costa ASC, Almeida SFS, Basile ALO, Oliveira SMJV. Episiotomia, laceração e integridade perineal em partos normais: análise de fatores associados. Rev Enferm UERJ. 2011;19(1):77–83.

29.

Svabık K, Shek K, Dietz H. How much does the levator hiatus have to stretch during childbirth? BJOG. 2009;116:1657–62. https://doi.org/10.1111/j.1471-0528.2009.02321.x.CrossRefPubMed

30.

Toozs-Hobson P, Balmforth J, Cardozo L, Khullar V, Athanasiou S. The effect of mode of delivery on pelvic floor functional anatomy. Int Urogynecol J. 2008;19:407–16. https://doi.org/10.1007/s00192-007-0455-0.CrossRef

31.

Krofta L, Otcenasek M, Kasikova E, Feyereisl J. Pubococcygeus-puborectalis trauma after forecps delivery: evaluation of the levator ani muscle with 3D/4D ultrasound. Int Urogynecol J. 2009;20:1175–81. https://doi.org/10.1007/s00192-009-0837-6.CrossRef

32.

Shek KL, Dietz HP. The effect of childbirth on hiatal dimensions. Obstet Gynecol. 2009;113(6):1272–8. https://doi.org/10.1097/AOG.0b013e3181a5ef23.CrossRefPubMed

Titel: Effects of perineal preparation techniques on tissue extensibility and muscle strength: a pilot study
verfasst von: Síssi Sisconeto de Freitas
Alana Leandro Cabral
Rogério de Melo Costa Pinto
Ana Paula Magalhães Resende
Vanessa Santos Pereira Baldon
Publikationsdatum: 01.06.2019
Verlag: Springer International Publishing
Erschienen in: International Urogynecology Journal / Ausgabe 6/2019
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-018-3793-1

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Effects of perineal preparation techniques on tissue extensibility and muscle strength: a pilot study

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

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Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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