Rubneide Barreto Silva Gallo

Massage reduced severity of pain during labour: a randomised trial.

QUESTION Does massage relieve pain in the active phase of labour? DESIGN Randomised trial with concealed allocation, assessor blinding for some outcomes, and intention-to-treat analysis. PARTICIPANTS 46 women pregnant at ≥ 37 weeks gestation with a single fetus, with spontaneous onset of labour, 4-5cm of cervical dilation, intact ovular membranes, and no use of medication after admission to hospital. INTERVENTION Experimental group participants received a 30-min lumbar massage by a physiotherapist during the active phase of labour. A physiotherapist attended control group participants for the same period but only answered questions. Both groups received routine perinatal care. OUTCOME MEASURES The primary outcome was pain severity measured on a 100mm visual analogue scale. Secondary outcomes included the Short Form McGill Pain Questionnaire, pain location, and time to analgesic medication use. After labour, a blinded researcher also recorded duration of labour, route of delivery, neonatal outcomes, and the participants satisfaction with the physiotherapist during labour. RESULTS At the end of the intervention, pain severity was 52mm (SD 20) in the experimental group and 72mm (SD 15) in control group, which was significantly different with a mean difference of 20mm (95% CI 10 to 31). The groups did not differ significantly on the other pain-related outcome measures. Obstetric outcomes were also similar between the groups except the duration of labour, which was 6.8hr (SD 1.6) in the experimental group and 5.7hr (SD 1.5) in the control group, mean difference 1.1hr (95% CI 0.2 to 2.0). Patients in both groups were satisfied with the care provided by the physiotherapist. CONCLUSION Massage reduced the severity of pain in labour, despite not changing its characteristics and location.

Efeito do banho de chuveiro no alívio da dor em parturientes na fase ativa do trabalho de parto

JUSTIFICATIVA E OBJETIVOS: A dor no trabalho de parto e influenciada nao apenas pelas caracteristicas individuais das parturientes, mas tambem por suas experiencias psicologicas e por fatores culturais, etnicos, sociais e ambientais. O objetivo deste estudo foi avaliar o efeito do banho de chuveiro no alivio da dor, durante a fase ativa do trabalho de parto. METODO: Trata-se de um ensaio clinico controlado, do tipo intervencao terapeutica, com 34 parturientes, admitidas no pre-parto para assistencia ao processo de parturicao, que receberam a terapeutica banho de chuveiro, por 30 minutos. Avaliou-se o grau de dor por meio da escala analogica visual (EAV). RESULTADOS: Pela EAV obteve-se um grau de 80 mm antes e 55 mm depois da terapeutica, havendo reducao da dor das pacientes em trabalho de parto ativo, com dilatacao cervical de 4 a 5 cm. CONCLUSAO: Houve reducao significativa da intensidade da dor pela EAV na fase ativa do trabalho de parto, apos a aplicacao da terapeutica do banho de chuveiro.

Transcutaneous electrical nerve stimulation (TENS) reduces pain and postpones the need for pharmacological analgesia during labour: a randomised trial

QUESTIONS In the active phase of the first stage of labour, does transcutaneous electrical nerve stimulation (TENS) relieve pain or change its location? Does TENS delay the request for neuraxial analgesia during labour? Does TENS produce any harmful effects in the mother or the foetus? Are women in labour satisfied with the care provided? DESIGN Randomised trial with concealed allocation, assessor blinding for some outcomes, and intention-to-treat analysis. PARTICIPANTS Forty-six low-risk, primigravida parturients with a gestational age > 37 weeks, cervical dilation of 4cm, and without the use of any medications from hospital admission until randomisation. INTERVENTION The principal investigator applied TENS to the experimental group for 30minutes starting at the beginning of the active phase of labour. A second investigator assessed the outcomes in both the control and experimental groups. Both groups received routine perinatal care. OUTCOME MEASURES The primary outcome was pain severity after the intervention period, which was assessed using the 100-mm visual analogue scale. Secondary outcomes included: pain location, duration of the active phase of labour, time to pharmacological labour analgesia, mode of birth, neonatal outcomes, and the participants satisfaction with the care provided. RESULTS After the intervention, a significant mean difference in change in pain of 15mm was observed favouring the experimental group (95% CI 2 to 27). The application of TENS did not alter the location or distribution of the pain. The mean time to pharmacological analgesia after the intervention was 5.0hours (95% CI 4.1 to 5.9) longer in the experimental group. The intervention did not significantly impact the other maternal and neonatal outcomes. Participants in both groups were satisfied with the care provided during labour. CONCLUSION TENS produces a significant decrease in pain during labour and postpones the need for pharmacological analgesia for pain relief. TRIAL REGISTRATION NCT01600495.

Grau de dilatação cervical e solicitação da analgesia regional por parturientes com membranas corioamnióticas íntegras e rotas

BACKGROUND AND OBJECTIVES: Several factors change pain intensity during parturition, such as parity, chorioamniotic membranes rupture, cervical dilatation, in addition to cultural and environmental influences. So, this study aimed at checking the number of regional analgesia requests and the level of cervical dilatation at analgesia request by parturients with intact chorioamniotic membranes and those with chorioamniorrhexis. METHOD: This is a descriptive and retrospective study which analyzed 208 medical charts of primiparous parturients, 129 with intact chorioamniotic membranes and 79 with chorioamniorrhexis, assisted by the Women Health Center of Ribeirao Preto, SP, from November 2008 to May 2009. Mann-Whitney and Chi-square tests were used for statistical analysis with significance level p < 0.05 and 95% confidence interval. RESULTS: Regional analgesia was requested by 87.9% of the parturients selected for this research. Mean cervical dilatation for intact membrane patients was 6.26 ± 1.67 cm and for those with chorioamniorrhexis it was 6.11 ± 1.75 cm, without significant difference between groups (p = 0.12). With regard to the type of analgesia there has been predominance of double block, without significant differences between groups (p = 0.84). CONCLUSION: Most parturients have requested double block regional analgesia with mean cervical dilatation of 6 cm, with no difference between intact and ruptured chorioamniotic membranes.

Sequential application of non-pharmacological interventions reduces the severity of labour pain, delays use of pharmacological analgesia, and improves some obstetric outcomes: a randomised trial

QUESTION Among women in labour, does sequential application of non-pharmacological interventions relieve labour pain, shorten labour, and delay pharmacological analgesia use? DESIGN Randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis. PARTICIPANTS Eighty women admitted in labour at the end of a low-risk pregnancy. INTERVENTION Participants in the experimental group received three interventions for up to 40minutes each in particular stages of labour: exercise on a Swiss ball at 4 to 5cm of cervical dilation; lumbosacral massage at 5 to 6cm dilation; and a warm shower at >7cm dilation. Participants in the control group received usual maternity unit care. Participants in both groups were encouraged to try not to avoid or delay use of pharmacological analgesia. OUTCOME MEASURES Pain severity was reported on a visual analogue scale. Maternal and neonatal data were collected from official birth records. Satisfaction with care was recorded with a questionnaire. RESULTS Some participants took analgesic medication before the study was complete, so pain was analysed with a last observation carried forward approach. In this analysis, the experimental group had significantly lower pain severity immediately after: exercises (MD 24mm, 95% CI 15 to 34), massage (14mm, 95% CI 4 to 25), and showering (17mm, 95% CI 5 to 29), which allowed delayed and reduced use of analgesic medication. Other significant benefits included: faster expulsion (MD 18minutes, 95% CI 5 to 30), improved neonatal status, and higher maternal satisfaction. No adverse effects were identified. CONCLUSION This sequence of non-pharmacological interventions significantly reduced labour pain from 4cm to beyond 7cm of cervical dilation, as reflected in decreased and delayed use of analgesic medication. Women in labour could be encouraged to use these interventions, especially if they seek to minimise or delay use of analgesic medication. TRIAL REGISTRATION NCT01389128. [Gallo RBS, Santana LS, Marcolin AC, Duarte G, Quintana SM (2018) Sequential application of non-pharmacological interventions reduces the severity of labour pain, delays use of pharmacological analgesia, and improves some obstetric outcomes: a randomised trial. Journal of Physiotherapy 64: 33-40].

Swiss ball to relieve pain of primiparous in active labor

JUSTIFICATIVA E OBJETIVOS:A bola suica tem sido amplamente utilizada nos diversos setores da saude. E considerada eficaz no alivio da dor e evolucao do trabalho de parto, porem ha poucos estudos. O objetivo deste trabalho foi avaliar o efeito da bola suica no alivio da dor e na duracao da fase ativa do trabalho de parto em primigestas.METODOS:Trata-se de um estudo randomizado e controlado com 40 primigestas divididas em grupo controle e grupo bola, que realizaram exercicios de mobilidade pelvica durante 30 minutos na fase ativa do trabalho de parto. A dor foi mensurada por meio da escala de categoria numerica, antes e apos a terapeutica, por um pesquisador auxiliar. A duracao do trabalho de parto foi investigada por meio do partograma.RESULTADOS:Foi observada reducao significativa da dor no grupo de estudo (p<0,001). Nao houve diferenca entre os grupos quanto a duracao do trabalho de parto (p=0,37).CONCLUSAO:A bola suica foi um recurso efetivo no alivio da dor no inicio desse periodo, devendo ser incentivada pelos profissionais de saude que assistem parturientes.

Localização da dor no início da fase ativa do trabalho de parto

BACKGROUND AND OBJECTIVES: Pain, which is an individual and multifactorial sensation associated or not to tissue injury, may be influenced by psychological, biological, socio-cultural and economic factors. There are scales and questionnaires which enable its location and measurement during labor. This study aimed at identifying the most frequent pain location during early active labor stage. METHODS: Clinical trial assessing 87 primiparous women with gestational age above 37 weeks, cervical dilatation between 4 and 5 cm, with adequate uterine dynamics for this labor stage. Participated in this study pregnant woman with spontaneous labor, not using drugs during this period and without associated risk factors; pain was evaluated with the body diagram for location and spatial distribution of pain during one labor stage. RESULTS: It was observed during early active labor stage that most patients have reported pain in the infra-pubic and lumbar region (78%), followed by infra-pubic (20%) or lumbar (2%) region alone. CONCLUSION: Pain during active labor stage with cervical dilatation from 4 to 5 cm was predominant in infra-pubic and lumbar regions.