INTRAPARTUM PHYSIOTHERAPEUTIC INTERVENTION AND ITS REPERCUSSION ON OBSTETRIC AND NEONATAL VARIABLES: A TRANSVERSAL STUDY
Keywords: Labor. First Stage of Labor. Second Stage of Labor. Physiotherapy Techniques. Lacerations. Pelvic Floor.
Introduction: Clinical practice shows benefits to parturients regarding the presence of a physiotherapist in obstetric care. However, the scope of scientific evidence that supports such practice is still incipient in the literature. Objective: This dissertation covers two studies that had as objectives to verify in a separate way, the comparison of obstetric outcomes, such as the duration of labor (TP) and expulsion period of women undergoing physical therapy during labor with those who did not receive such assistance; and the relationship between intrapartum physical therapy, perineal trauma, obstetric and neonatal variables. Methods: Analytical observational cross-sectional studies, carried out at the Ana Bezerra University Hospital (HUAB), Santa Cruz, Rio Grande do Norte, Brazil, with parturient women aged between 18 and 40 years, nulliparous, primiparous and multiparous, with a single fetus and gestational age between 37 and 42 weeks of gestation. In the first study, the dependent variables were duration of labor and the expulsive period, and the independent variables were intrapartum physiotherapeutic resources. The Kruskal-Wallis and Mann-Whitney tests were used to compare the observed obstetric results. In the second study, the dependent variable was perineal trauma (episiotomy and spontaneous perineal lacerations) and the independent variables were: intrapartum physical therapy intervention, physical therapy resources, obstetric, sociodemographic and neonatal variables. Bivariate analysis (chi-square) was performed between the dependent and the independent variables. Binary Logistic Regression was applied to verify whether the independent variables would be predictors of perineal trauma. For all analyses, a significance level of p<0.05 was adopted. Results: There were no statistically significant differences regarding the duration of labor and expulsion period between the groups with physical therapy monitoring and without this assistance, in the active (p=0.14) and latent (p=0.80) phases. A statistically significant difference was observed between women who had physical therapy follow-up in different phases of the TP, in which those who underwent physiotherapy in the active phase had a shorter TP than those who underwent it in the latent phase (p=0.012). There was a significant association between perineal trauma versus: slow and deep breathing in the expulsive period (p=0.026), previous pregnancies (p=0.001) and number of vaginal deliveries (PV) (p=0.001). In the multivariate analysis, there was a decrease in perineal trauma of 59.8% (OR: 0.402 95%CI: 0.164; 0.982) in women who received respiratory guidance during the expulsion period by physical therapists, whereas women with up to two PV have 5 .38 (OR: 5.380 95%CI: 1.817; 15.926) times more likely to have perineal trauma when compared to those with more than two PV. Conclusion: The results of this study suggest that women who had intrapartum physiotherapeutic follow-up and were not admitted early (active phase), had a shorter TP than those who were admitted in the latent phase and that such assistance seems to have a positive impact on the pelvic floor of pregnant women low risk or usual risk.