Adriana de Souza Caroci

Analysis of pelvic floor musculature function during pregnancy and postpartum: a cohort study

AIM To compare the measurements of womens pelvic floor musculature strength (PFMS) during pregnancy and postpartum period. BACKGROUND Pregnancy and childbirth can have an influence on the muscles and pelvic floor and can cause morbidities of womens genito-urinary tract. DESIGN A prospective cohort study. METHODS There were included 226 primigravidae women, attended by community health services in the city of Itapecerica da Serra, Sao Paulo, Brazil. The participants were followed in four stages: (1) within 12 weeks of pregnancy; (2) between 36-40 weeks of pregnancy; (3) within 48 hours after childbirth; (4) 42-60 days after childbirth. Data were collected from February 2007-August 2008. The pelvic floor musculature strength was evaluated by perineometry and digital vaginal palpation in stages 1, 2 and 4. The final sample included 110 women who completed all four stages of the study. RESULTS The pelvic floor musculature strength of the women did not change significantly during pregnancy or after delivery (anova: p = 0·78). In all three examined stages, a low-intensity pelvic floor musculature strength was prevalent (in mmHg: stage 1 = 15·9; stage 2 = 15·2, stage 4 = 14·7), with scores from 0-3 on the Oxford scale. The pelvic floor musculature strength did not differ in relation to maternal age, skin colour, conjugal status, dyspareunia, stool characteristics, type of delivery, or conditions of the perineum. An interaction between maternal nutritional state and newborns weight may affect the pelvic floor musculature strength (manova: p = 0·04). CONCLUSION Pregnancy and childbirth did not reduce significantly pelvic floor musculature strength. The perineometry and digital vaginal palpation used to assess the pelvic floor musculature strength were well accepted by the women. RELEVANCE TO CLINICAL PRACTICE In clinical practice, digital vaginal palpation is effective for supporting the diagnosis of urinary, intestinal and sexual dysfunctions. Perineometry use is particularly important together with the performance of perineal exercises with biofeedback in the treatment these disorders.

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

En la practica clinica, la palpacion vaginal digital auxilia en el diagnostico de disfunciones urinarias, intestinales y sexuales, en cuanto la perineometria es mas utilizada para realizar ejercicios perineales con biofeedback. El objetivo fue verificar se existe correlacion entre los valores de la Fuerza Muscular Perineal (FMP) evaluada por la perineometria utilizando el perineometro electronico, y por medio de la palpacion digital vaginal, utilizando la escala de Oxford. El estudio deriva de una cohorte prospectiva, con 330 mensuraciones en 110 mujeres. La recoleccion de datos ocurrio en 2007 y 2008, en servicios de salud de Itapecerica de la Serra, en Sao Paulo. La evaluacion fue realizada en tres momentos: hasta 12 semanas de gestacion; entre 36 y 40 semanas; y, entre 42 y 60 dias posparto. El coeficiente de Spearman indico una fuerte correlacion positiva entre los dos metodos de evaluacion, en los tres momentos (p<0,0001). Se concluye que ambos metodos son validos para mensurar la FMP durante la gravidez y despues del parto.Digital vaginal palpation performed during clinical practice can help diagnose urinary, intestinal and sexual disorders, while perineometry is more useful for performing perineal exercises with biofeedback. This study verifies whether there is a correlation between values of Pelvic Floor Muscle Strength (PFMS) obtained through perineometry performed with an electronic perineometer and through digital vaginal palpation using the Oxford scale. This is a prospective cohort study with 330 measurements carried out in 110 women. Data were collected from 2007 to 2008 in the health service system in Itapecerica da Serra, São Paulo, Brazil. Evaluations were carried out at three points in time: up to 12 weeks of pregnancy; between 36-40 weeks; and between 42-60 days postpartum. The Spearman coefficient indicated a strong positive correlation between the two evaluation methods for the three evaluations (p<0.0001). The conclusion is that both methods are valid for measuring PFMS during pregnancy and after delivery.

Urinary incontinence related to perineal muscle strength in the first trimester of pregnancy: cross-sectional study

Objetivo Analizar la fuerza de los musculos del suelo pelvico (FMSP), la continencia urinaria y la calidad de vida en mujeres en el primer trimestre del embarazo. Metodo Estudio transversal cuyo muestra incluyo 500 mujeres que comenzaron la atencion prenatal en un servicio del sector de salud complementaria en Guarulhos, SP, en 2012-2013. La FMSP fue evaluada por la perineometria y las mujeres embarazadas con incontinencia urinaria (IU) respondieron al International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Resultados Muestran que edad materna (OR=1,06 IC95% 1,02-1,11) y IU previa (OR=15,12; IC95% 8,19-27,92) son las variables que, en conjunto, mejor explican la ocurrencia de IU al inicio del embarazo. La media del escore ICIQ-SF fue 8,2 (d.p.=3,9), considerado como de impacto moderado en la calidad de vida. Conclusion Las embarazadas con mas edad y con IU previa tienen chance mayor de presentar IU en el primer trimestre del embarazo.Objective To analyze pelvic floor muscle strength (PFMS), urinary continence and quality of life related to urinary incontinence (UI) of women in the first trimester of pregnancy. Method Cross-sectional study with a sample of 500 women who started prenatal care in a complementary healthcare facility in Guarulhos, state of São Paulo, from 2012 and 2013. Pelvic floor muscle strength was evaluated through perineometry. The pregnant women who presented UI answered the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Results It was found that maternal age (OR=1.06; CI95% 1.02-1.11) and prior UI (OR=15.12; 95%CI 8.19-27.92) are the variables that, in tandem, best explain the occurrence of UI at the beginning of pregnancy. The mean score on the ICIQ-SF was 8.2 (SD=3.9), considered a moderate impact on quality of life. Conclusion Older pregnant women with prior UI are more likely to have UI in the first trimester of pregnancy.

Evaluation of perineal muscle strength in the first trimester of pregnancy

OBJECTIVES: to analyze the Pelvic Floor Muscle Strength (PFMS) of pregnant women with one or more vaginal or cesarean deliveries; to compare the PFMS of these with pregnant women with the PFMS of primiparous women. METHODS: cross-sectional study with women up to 12 weeks pregnant, performed in Itapecerica da Serra, São Paulo state, from December 2012 to May 2013. The sample consisted of 110 pregnant women with one or more vaginal deliveries or cesarean sections and 110 primigravidae. The PFMS was evaluated by perineometry (Peritron(tm)) and vaginal digital palpation (modified Oxford scale). RESULTS: the average PFMS in pregnant women with a history of vaginal delivery or cesarean section was 33.4 (SD=21.2) cmH2O. From the Oxford scale, 75.4% of the pregnant women with previous vaginal or cesarean deliveries presented grade ≤ 2, and 5.5% grade ≥ 4; among the primiparae, 39.9% presented grade ≤ 2, and 50.9% grade ≥ 4, with a statistically significant difference (p<0.001). From the perineometry, there was no statistically significant difference between the PFMS and age, type of delivery, parity, body mass index, and genitourinary tract symptoms, however, there was a statistically significant difference between the pregnant women with and without a history of episiotomy (p=0.04). In the palpation, none of the variables showed a statistically significant difference. CONCLUSION: pregnancy and childbirth can reduce the PFMS.OBJETIVOS: analizar la Fuerza Muscular del Suelo Pelvico (FMSP) de embarazadas con uno o mas partos normales o cesareas; comparar la FMSP de estas embarazadas con la FMSP de primigestas. METODO: estudio transversal con embarazadas hasta 12 semanas de embarazo, realizado en Itapecerica de la Serra, SP, de diciembre de 2012 a mayo de 2013. La muestra fue de 110 embarazadas con uno o mas partos normales o cesareas y 110 primigestas. La FMSP fue evaluada por la perineometria (Peritron(tm)) y palpacion digital vaginal (escala de Oxford modificada). RESULTADOS: el promedio de la FMSP en embarazadas con antecedentes de parto normal o cesarea fue 33,4 (de=21,2) cmH2O. Por la escala de Oxford, 75,4% de las embarazadas con partos o cesareas anteriores presentaron grado ≤ 2 y 5,5%, grado ≥ 4; entre las primigestas, 39,9% presentaron grado ≤ 2 y 50,9%, grado ≥ 4, con diferencia estadisticamente significativa (p<0,001). Por la perineometria, no hubo diferencia estadisticamente significativa entre la FMSP y edad, tipo de parto, numero de partos anteriores, indice de masa corporal y sintomas del tracto genitourinario, pero hubo entre las embarazadas con y sin antecedente de episiotomia (p=0,04). En la palpacion, ninguna de las variables mostro diferencia estadisticamente significativa. CONCLUSION: el embarazo y el parto pueden reducir la FMSP

Avaliação da força muscular perineal durante a gestação e pós-parto: correlação entre perineometria e palpação digital vaginal

En la practica clinica, la palpacion vaginal digital auxilia en el diagnostico de disfunciones urinarias, intestinales y sexuales, en cuanto la perineometria es mas utilizada para realizar ejercicios perineales con biofeedback. El objetivo fue verificar se existe correlacion entre los valores de la Fuerza Muscular Perineal (FMP) evaluada por la perineometria utilizando el perineometro electronico, y por medio de la palpacion digital vaginal, utilizando la escala de Oxford. El estudio deriva de una cohorte prospectiva, con 330 mensuraciones en 110 mujeres. La recoleccion de datos ocurrio en 2007 y 2008, en servicios de salud de Itapecerica de la Serra, en Sao Paulo. La evaluacion fue realizada en tres momentos: hasta 12 semanas de gestacion; entre 36 y 40 semanas; y, entre 42 y 60 dias posparto. El coeficiente de Spearman indico una fuerte correlacion positiva entre los dos metodos de evaluacion, en los tres momentos (p<0,0001). Se concluye que ambos metodos son validos para mensurar la FMP durante la gravidez y despues del parto.Digital vaginal palpation performed during clinical practice can help diagnose urinary, intestinal and sexual disorders, while perineometry is more useful for performing perineal exercises with biofeedback. This study verifies whether there is a correlation between values of Pelvic Floor Muscle Strength (PFMS) obtained through perineometry performed with an electronic perineometer and through digital vaginal palpation using the Oxford scale. This is a prospective cohort study with 330 measurements carried out in 110 women. Data were collected from 2007 to 2008 in the health service system in Itapecerica da Serra, São Paulo, Brazil. Evaluations were carried out at three points in time: up to 12 weeks of pregnancy; between 36-40 weeks; and between 42-60 days postpartum. The Spearman coefficient indicated a strong positive correlation between the two evaluation methods for the three evaluations (p<0.0001). The conclusion is that both methods are valid for measuring PFMS during pregnancy and after delivery.

Implementation methodology of practices based on scientific evidence for assistance in natural delivery: a pilot study

OBJETIVOPresentar metodologia de transferencia del conocimiento para mejorar los resultados maternos en el parto normal en base a evidencias cientificas.METODOEstudio de intervencion llevado a cabo en maternidad de Itapecerica da Serra, SP, con 50 puerperas y 102 fichas clinicas de julio a noviembre de 2014. Se utilizo la herramienta PACES, del Instituto Joanna Briggs, que consiste de pre auditoria clinica (fase 1), implantacion de buenas practicas (fase 2) y auditoria post implantacion (fase 3). Se analizaron los datos, comparando resultados de las fases 1 y 3 con prueba exacta de Fisher y nivel de significacion del 5%.RESULTADOSLa posicion vertical fue adoptada por la mayoria de las puerperas con diferencia estadistica entre las fases 1 y 3. Por las fichas, se verifico un incremento significativo de bano, deambulacion y masaje para alivio del dolor. En las demas practicas y resultados, no hubo diferencia estadistica. Se identificaron las barreras y dificultades para la implantacion de la practica basada en evidencias. Se hizo el refinamiento de las variables y la validacion de las tecnicas e instrumentos de recoleccion de datos y la intervencion propuesta.CONCLUSIONEl estudio senalo posibilidades de la metodologia de implantacion de practicas basadas en evidencias cientificas en la asistencia al parto normal.

Avaliação da força muscular perineal no primeiro trimestre da gestação

OBJECTIVES: to analyze the Pelvic Floor Muscle Strength (PFMS) of pregnant women with one or more vaginal or cesarean deliveries; to compare the PFMS of these with pregnant women with the PFMS of primiparous women. METHODS: cross-sectional study with women up to 12 weeks pregnant, performed in Itapecerica da Serra, São Paulo state, from December 2012 to May 2013. The sample consisted of 110 pregnant women with one or more vaginal deliveries or cesarean sections and 110 primigravidae. The PFMS was evaluated by perineometry (Peritron(tm)) and vaginal digital palpation (modified Oxford scale). RESULTS: the average PFMS in pregnant women with a history of vaginal delivery or cesarean section was 33.4 (SD=21.2) cmH2O. From the Oxford scale, 75.4% of the pregnant women with previous vaginal or cesarean deliveries presented grade ≤ 2, and 5.5% grade ≥ 4; among the primiparae, 39.9% presented grade ≤ 2, and 50.9% grade ≥ 4, with a statistically significant difference (p<0.001). From the perineometry, there was no statistically significant difference between the PFMS and age, type of delivery, parity, body mass index, and genitourinary tract symptoms, however, there was a statistically significant difference between the pregnant women with and without a history of episiotomy (p=0.04). In the palpation, none of the variables showed a statistically significant difference. CONCLUSION: pregnancy and childbirth can reduce the PFMS.OBJETIVOS: analizar la Fuerza Muscular del Suelo Pelvico (FMSP) de embarazadas con uno o mas partos normales o cesareas; comparar la FMSP de estas embarazadas con la FMSP de primigestas. METODO: estudio transversal con embarazadas hasta 12 semanas de embarazo, realizado en Itapecerica de la Serra, SP, de diciembre de 2012 a mayo de 2013. La muestra fue de 110 embarazadas con uno o mas partos normales o cesareas y 110 primigestas. La FMSP fue evaluada por la perineometria (Peritron(tm)) y palpacion digital vaginal (escala de Oxford modificada). RESULTADOS: el promedio de la FMSP en embarazadas con antecedentes de parto normal o cesarea fue 33,4 (de=21,2) cmH2O. Por la escala de Oxford, 75,4% de las embarazadas con partos o cesareas anteriores presentaron grado ≤ 2 y 5,5%, grado ≥ 4; entre las primigestas, 39,9% presentaron grado ≤ 2 y 50,9%, grado ≥ 4, con diferencia estadisticamente significativa (p<0,001). Por la perineometria, no hubo diferencia estadisticamente significativa entre la FMSP y edad, tipo de parto, numero de partos anteriores, indice de masa corporal y sintomas del tracto genitourinario, pero hubo entre las embarazadas con y sin antecedente de episiotomia (p=0,04). En la palpacion, ninguna de las variables mostro diferencia estadisticamente significativa. CONCLUSION: el embarazo y el parto pueden reducir la FMSP

Incontinência urinária relacionada à força muscular perineal no primeiro trimestre da gestação: estudo transversal

Objetivo Analizar la fuerza de los musculos del suelo pelvico (FMSP), la continencia urinaria y la calidad de vida en mujeres en el primer trimestre del embarazo. Metodo Estudio transversal cuyo muestra incluyo 500 mujeres que comenzaron la atencion prenatal en un servicio del sector de salud complementaria en Guarulhos, SP, en 2012-2013. La FMSP fue evaluada por la perineometria y las mujeres embarazadas con incontinencia urinaria (IU) respondieron al International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Resultados Muestran que edad materna (OR=1,06 IC95% 1,02-1,11) y IU previa (OR=15,12; IC95% 8,19-27,92) son las variables que, en conjunto, mejor explican la ocurrencia de IU al inicio del embarazo. La media del escore ICIQ-SF fue 8,2 (d.p.=3,9), considerado como de impacto moderado en la calidad de vida. Conclusion Las embarazadas con mas edad y con IU previa tienen chance mayor de presentar IU en el primer trimestre del embarazo.Objective To analyze pelvic floor muscle strength (PFMS), urinary continence and quality of life related to urinary incontinence (UI) of women in the first trimester of pregnancy. Method Cross-sectional study with a sample of 500 women who started prenatal care in a complementary healthcare facility in Guarulhos, state of São Paulo, from 2012 and 2013. Pelvic floor muscle strength was evaluated through perineometry. The pregnant women who presented UI answered the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Results It was found that maternal age (OR=1.06; CI95% 1.02-1.11) and prior UI (OR=15.12; 95%CI 8.19-27.92) are the variables that, in tandem, best explain the occurrence of UI at the beginning of pregnancy. The mean score on the ICIQ-SF was 8.2 (SD=3.9), considered a moderate impact on quality of life. Conclusion Older pregnant women with prior UI are more likely to have UI in the first trimester of pregnancy.

Fuerza muscular del suelo pélvico en primíparas según el tipo de parto: estudio transversal

ABSTRACT Objectives: to compare the pelvic floor muscle strength in primiparous women after normal birth and cesarean section, related to the socio-demographic characteristics, nutritional status, dyspareunia, urinary incontinence, perineal exercise in pregnancy, perineal condition and weight of the newborn. Methods: this was a cross-sectional study conducted after 50 - 70 postpartum days, with 24 primiparous women who underwent cesarean delivery and 72 who had a normal birth. The 9301 PeritronTM was used for analysis of muscle strength. The mean muscle strength was compared between the groups by two-way analysis of variance. Results: the pelvic floor muscle strength was 24.0 cmH2O (±16.2) and 25.4 cmH2O (±14.7) in postpartum primiparous women after normal birth and cesarean section, respectively, with no significant difference. The muscular strength was greater in postpartum women with ≥ 12 years of study (42.0 ±26.3 versus 14.6 ±7.7 cmH2O; p= 0.036) and in those who performed perineal exercises (42.6±25.4 11.8±4.9 vs. cmH2O; p = 0.010), compared to caesarean. There was no difference in muscle strength according to delivery type regarding nutritional status, dyspareunia, urinary incontinence, perineal condition or newborn weight. Conclusion: pelvic floor muscle strength does not differ between primiparous women based on the type of delivery. Postpartum women with normal births, with higher education who performed perineal exercise during pregnancy showed greater muscle strength.Objetivos: comparar a forca muscular do assoalho pelvico em primiparas no pos-parto normal e cesariana, relacionando-a as caracteristicas sociodemograficas, estado nutricional, incontinencia urinaria, dispareunia, exercicio perineal na gestacao, condicao perineal e peso do recem-nascido. Metodo: estudo transversal realizado entre 50 e 70 dias de pos-parto, com 24 primiparas submetidas a cesariana e 72 ao parto normal. Utilizou-se PeritronTM 9301 para analise da forca muscular. Comparou-se as medias da forca muscular entre os grupos pela Analise de Variância a dois fatores. Resultados: a forca muscular do assoalho pelvico foi de 24,0 cmH2O(±16,2) e 25,4 cmH2O(±14,7) em primiparas pos-parto normal e cesariana, respectivamente, sem diferenca significativa. A forca muscular foi maior nas mulheres de pos-parto normal com ≥12 anos de estudo (42,0±26,3 versus 14,6±7,7 cmH2O; p=0,036) e que realizaram exercicio perineal (42,6±25,4 versus 11,8±4,9 cmH2O; p=0,010), comparadas as de cesariana. Nao houve diferenca na forca muscular segundo o tipo de parto quanto ao estado nutricional, incontinencia urinaria, dispareunia, condicao perineal e peso do recem-nascido. Conclusao: a forca muscular do assoalho pelvico nao difere entre primiparas quanto ao tipo de parto. Mulheres pos-parto normal com maior escolaridade e que realizaram exercicio perineal na gestacao, tem maior forca muscular.

Força muscular do assoalho pélvico em primíparas segundo o tipo de parto: estudo transversal

ABSTRACT Objectives: to compare the pelvic floor muscle strength in primiparous women after normal birth and cesarean section, related to the socio-demographic characteristics, nutritional status, dyspareunia, urinary incontinence, perineal exercise in pregnancy, perineal condition and weight of the newborn. Methods: this was a cross-sectional study conducted after 50 - 70 postpartum days, with 24 primiparous women who underwent cesarean delivery and 72 who had a normal birth. The 9301 PeritronTM was used for analysis of muscle strength. The mean muscle strength was compared between the groups by two-way analysis of variance. Results: the pelvic floor muscle strength was 24.0 cmH2O (±16.2) and 25.4 cmH2O (±14.7) in postpartum primiparous women after normal birth and cesarean section, respectively, with no significant difference. The muscular strength was greater in postpartum women with ≥ 12 years of study (42.0 ±26.3 versus 14.6 ±7.7 cmH2O; p= 0.036) and in those who performed perineal exercises (42.6±25.4 11.8±4.9 vs. cmH2O; p = 0.010), compared to caesarean. There was no difference in muscle strength according to delivery type regarding nutritional status, dyspareunia, urinary incontinence, perineal condition or newborn weight. Conclusion: pelvic floor muscle strength does not differ between primiparous women based on the type of delivery. Postpartum women with normal births, with higher education who performed perineal exercise during pregnancy showed greater muscle strength.Objetivos: comparar a forca muscular do assoalho pelvico em primiparas no pos-parto normal e cesariana, relacionando-a as caracteristicas sociodemograficas, estado nutricional, incontinencia urinaria, dispareunia, exercicio perineal na gestacao, condicao perineal e peso do recem-nascido. Metodo: estudo transversal realizado entre 50 e 70 dias de pos-parto, com 24 primiparas submetidas a cesariana e 72 ao parto normal. Utilizou-se PeritronTM 9301 para analise da forca muscular. Comparou-se as medias da forca muscular entre os grupos pela Analise de Variância a dois fatores. Resultados: a forca muscular do assoalho pelvico foi de 24,0 cmH2O(±16,2) e 25,4 cmH2O(±14,7) em primiparas pos-parto normal e cesariana, respectivamente, sem diferenca significativa. A forca muscular foi maior nas mulheres de pos-parto normal com ≥12 anos de estudo (42,0±26,3 versus 14,6±7,7 cmH2O; p=0,036) e que realizaram exercicio perineal (42,6±25,4 versus 11,8±4,9 cmH2O; p=0,010), comparadas as de cesariana. Nao houve diferenca na forca muscular segundo o tipo de parto quanto ao estado nutricional, incontinencia urinaria, dispareunia, condicao perineal e peso do recem-nascido. Conclusao: a forca muscular do assoalho pelvico nao difere entre primiparas quanto ao tipo de parto. Mulheres pos-parto normal com maior escolaridade e que realizaram exercicio perineal na gestacao, tem maior forca muscular.