Navegando por Palavras-chave "Períneo"

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    Aplicabilidade de um algoritmo de apoio à decisão no processo de avaliação perineal na assistência ao parto
    (Universidade Federal de São Paulo (UNIFESP), 2020-07-30) Cesar, Monica Bimbatti Nogueira [UNIFESP]; Barbieri, Marcia [UNIFESP]; Gabrielloni, Maria Cristina; http://lattes.cnpq.br/6036198226664377; http://lattes.cnpq.br/9352140129630269; http://lattes.cnpq.br/9217981072607049; Universidade Federal de São Paulo
    Introduction: Among childbirth’s care actions and procedures, two topics are debatable: the perineal evaluation and the decision to either preserve the perineum intact or to perform an episiotomy. There is a lack of evidence-based methods and decision criteria, potentially leading to professional distress regarding maternal practice, besides morbidity due to lacerations in the vaginal canal and perineal region. The use of algorithms, implemented via decision support computer systems (DSS), can standardize evaluations involving multiple variables and suggest a course of action aligned to assistance assurance and to scientific evidence. Objective: To evaluate the applicability of an algorithm to support conscious and safe decisions about maintaining or not perineal integrity in childbirth care. Materials and method: Applied research of technological development. Relevant information acquired in the literature led to the initial algorithm design, which senior healthcare professionals reviewed and validated. In order to evaluate its applicability on the field, this algorithm based the writing of an online mobile decision support system (DSS) prototype. After approval by the Research Ethics Committee, a pilot test took place: obstetric nurses of a public hospital in São Paulo made use of the algorithm in the form of the mobile DSS prototype for two months to support their decisions during 305 vaginal births. Nurses filled out assessment forms about the applicability of DSS. Results: Ten out of twelve study participating professionals declared they would certainly recommend DSS use during perineal evaluation to fellow nurses. Two declared being uncertain about its usage. The study’s data show concordance between DSS suggested procedure and professional’s decision in 93.1% of deliveries. When professionals decided to follow DSS's recommendation, results were favorable to mothers: unfavorable cases, like 2nd or 3rd-degree postpartum laceration, remained as low as 13.4%. Contrarily, when professionals decided not to follow DSS recommendations, such unfavorable cases’ frequency raised to 28.6%. Regarding newborn unfavorable scenarios, like 5-minute Apgar score scoring less than 7, when professionals decided to follow DSS’ recommendations incidence remained as low as 0.4%. That rate raised to 9.5% when professionals did not follow the system’s recommendations. There is a correlation between conduct divergence and number of adverse events (p = 0.001): when DSS recommendation was followed by participating professionals, the incidence of adverse events topped 33.3%. On the other hand, when participants’ actions diverged from DSS recommendation, incidence raised to 66.7%. Thus, it is clear adverse events incidence tends to be lower when DSS recommendations are followed. Conclusion: The proposed Algorithm, implemented as a mobile DSS prototype for perineal assessment, proved to be an applicable and useful tool to guide professionals during delivery care. We believe the continuity of this study may lead to significant improvement and utility of the algorithm and its implementations through more elaborated Decision Support Systems.
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    Avaliação Quantitativa Da Extensibilidade Da Musculatura Do Assoalho Pélvico De Gestantes Com Medidor Da Elasticidade Perineal
    (Universidade Federal de São Paulo (UNIFESP), 2017-10-30) Paschoal, Aline [UNIFESP]; Nakamura, Mary Uchiyama [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    The objective of this study was to compare the measurements of the pregnant women pelvic floor muscles extensibility between those obtained by the Epi-no® device and Perineal Elasticity Gauge (MEP). Methods: An observational cross-sectional study was done with a consecutive sample, in which 62 healthy pregnant women between 20 and 40 years old and more than 35 weeks gestational age were included. Patients with cognitive impairment and/or neurological disease, urogenital malformation, vulvovaginitis, latex allergy and candidates to cesarean section in this current pregnancy, such as iterative cesarean section, were excluded. The evaluation of perineal extensibility methods were the Epi-no® and the MEP. A formula based on a linear regression method was developed. This equation calculates an adjusted Epi-no® value from the MEP values. In addition, Pearson's correlation was applied to verify the degree of relationship between both variables. Results: The studied population has predominance of brown and white, married or mixed, nonprimigravida, multiparous and with complete secondary education. Regarding the measurements obtained from the Epi-no® balloon perimetry, an average of 18.9 cm was observed. The Pearson correlation analysis was performed in the normal distribution data. The obtained value (0.621) shows that there is a moderate correlation between the variables. However, this finding was identified as mild correlation by the Kappa correlation test, when the measurements were classified into three groups (restrictive perineum, moderate extensibility and good extensibility). Conclusion: Comparing the measurements of the pregnant women pelvic floor musculature extensibility obtained by Epi-no® device with those obtained by the MEP, there is a relationship between both, from a mild to moderate agreement.
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    Efficacy of pelvic floor muscle training and hypopressive exercises for treating pelvic organ prolapse in women: randomized controlled trial
    (Associação Paulista de Medicina - APM, 2012-01-01) Bernardes, Bruno Teixeira [UNIFESP]; Resende, Ana Paula Magalhães [UNIFESP]; Stüpp, Liliana [UNIFESP]; Oliveira, Emerson [UNIFESP]; Castro, Rodrigo de Aquino [UNIFESP]; Jármy Di Bella, Zsuzsanna Ilona Katalin [UNIFESP]; Girão, Manoel João Batista Castello [UNIFESP]; Sartori, Marair Gracio Ferreira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de Uberlândia Department of Gynecology and Obstetrics
    CONTEXT AND OBJECTIVE: Previous studies have shown that women with pelvic floor dysfunctions present decreased cross-sectional area (CSA) of the levator ani muscle. One way to assess the effects of training programs is to measure the CSA of the muscle, using ultrasonography. The aim here was to evaluate the efficacy of pelvic floor muscle training and hypopressive exercises for increasing the CSA of the levator ani muscle in women with pelvic organ prolapse. DESIGN AND SETTING: Prospective randomized controlled trial at the Urogynecology outpatient clinic of Universidade Federal de São Paulo (UNIFESP). METHODS: Fifty-eight women with stage II pelvic organ prolapse were divided into three groups for physiotherapy: a pelvic floor muscle training group (GI); a hypopressive exercise group (GII); and a control group (GIII). The patients underwent transperineal ultrasonographic evaluation using a transducer of frequency 4-9 MHz. The (CSA) of the levator ani muscle was measured before physiotherapy and after 12 weeks of treatment. RESULTS: The groups were homogeneous regarding age, number of pregnancies, number of vaginal deliveries, body mass index and hormonal status. Statistically significant differences in CSA were found in GI and GII from before to after the treatment (P < 0.001), but not in relation to GIII (P = 0.816). CONCLUSIONS: The CSA of the levator ani muscle increased significantly with physiotherapy among the women with pelvic organ prolapse. Pelvic floor muscle training and hypopressive exercises produced similar improvements in the CSA of the levator ani muscle.
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    Parturient perineal distensibility tolerance assessed by EPI-NO: an observational study
    (Instituto Israelita de Ensino e Pesquisa Albert Einstein, 2014-03-01) Nakamura, Mary Uchiyama [UNIFESP]; Sass, Nelson [UNIFESP]; Elito Junior, Julio [UNIFESP]; Petricelli, Carla Dellabarba; Alexandre, Sandra Maria [UNIFESP]; Araujo Júnior, Edward [UNIFESP]; Zanetti, Míriam Raquel Diniz [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective: To determine how parturient women tolerate the use of a perineal distensibility assessment technique using the EPI-NO device. Method: An observational study with a total of 227 full-term parturient women was performed. During the evaluation with EPI-NO, parturient patients were asked about their sensation of discomfort. The degree of discomfort was measured using the Visual Analogue Scale, with a score from zero to 10. The Mann-Whitney test was applied to assess perineal distensibility measured by EPI-NO and the degree of discomfort caused by the test according to parity. The relation between perineal distensibility and discomfort was analyzed by using the Spearman correlation test (r). Result: The test with EPI-NO caused only slight discomfort (mean Visual Analogue Scale of 3.8), and primiparous women reported significantly greater discomfort (mean Visual Analogue Scale of 4.5) than did multiparous (mean Visual Analogue Scale=3.1), with p<0.001 women. A negative correlation was observed, in other words, the greater the perineal distensibility on the EPI-NO, the lower the pain reported by the patients (r=-0.424; p<0.001). Conclusion: The assessment of perineal distensibility with EPI-NO was well tolerated by the parturient women.
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    Prevenção e reparo do traumatismo perineal: uma revisão de literatura
    (Universidade Federal de São Paulo, 2021) Silva, Eduarda Ferreira [UNIFESP]; Goldman, Rosely Erlach [UNIFESP]; Westphal, Flavia [UNIFESP]; http://lattes.cnpq.br/7832457453349192; http://lattes.cnpq.br/1203039738181639; http://lattes.cnpq.br/7195995926596989
    Objetivo:analisar na literatura as evidências disponíveis sobre as estratégias de prevenção e o reparo do trauma perineal.Método: revisão de literatura do tipo integrativa realizada bases de dadosMedical Literature Analysis and Retrieval System on-line (MEDLINE/PubMed) e Biblioteca Virtual em Saúde (BVS). Adotou-se a pergunta de pesquisa: Quais as evidências científicas acerca de medidas de prevenção e reparo de lesões perineais no parto?Para a busca nas bases de dados, utilizou-se o cruzamento dos descritores: períneo, prevenção, laceração, reparo. Estabeleceu-se como critérios de inclusão: artigos publicados de janeiro de 2015 a dezembro de 2020, nos idiomas português, inglês e espanhol. A busca totalizou 320 produções e, após a aplicação dos critérios de elegibilidade,obteve-se a amostra de 22 estudos. Para extraçãoe síntese das informações utilizou-se um instrumento e foram consideradas as variáveis de identificaçãodo estudo e aspectos metodológicos com classificação do nível de evidência. Resultados: a maioria dasproduções foram realizadas no ano de 2019 (31,8%), sendo em sua totalidade publicadas em língua inglesa e desenvolvidas, em sua maioria, nos continentes americano e europeu (31,8% cada), seguida do continente africano (13,63%), asiático (18,18%) e Oceania(9,09%). Foram estabelecidas duas categorias temáticas, sendo aprimeira, prevenção da lesão perineal que enfatiza a massagem perinealrealizadano pré-natal, as posições maternas no período expulsivoprincipalmente a liberdade na escolha, aplicação de compressas mornas no período expulsivo, a escolha da técnica hands offtem benefícios e se mostra protetor para lesão perineal,manobra de ritgenmodificadae não existem estudos que confirme a prevenção de laceração com o uso de dispositivos de dilatação do assoalho pélvico.Na segunda categoria, reparo do trauma perinealde lacerações de primeiro e segundo grau, destaca-se a técnica da sutura contínua com o uso de fio cirúrgico adequado, o uso de cola cirúrgica e a habilidade e competência do profissional no reconhecimento e reparação do trauma perineal. Considerações finais: identificou-se que diversas práticas podem ser realizadas na prevenção e reparo do trauma perineal, no entanto as evidências demonstraram que a habilidade do profissional pode propiciar o melhor desfecho para a mulher, possibilitando uma recuperação com menos dor e redução dos danos físicos e emocionais. Sendo importante que cada prática seja individualizada, levando em consideração os fatores de risco que atuam diretamente ou indiretamente sobre o períneo.
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    Relação entre a pressão muscular perineal no puerpério e o tipo de parto
    (Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2006-09-01) Menta, Silmara [UNIFESP]; Schirmer, Janine [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Ministério da Saúde Área Técnica Saúde da Mulher
    PURPOSE: to determine the values of perineal muscular force (PMF) in the lying and seated positions and to identify the values of PMF between first pregnancy, according to type and the characteristics of the vaginal delivery and cesarean section. METHODS: study of the transversal type, performed in a maternity of Brazilian Public the Health System (SUS) in the city of São Paulo. The sample consisted of 95 primiparae at term. Evaluation occurred between the 40th and 45 th, 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.