Terapias complementares no trabalho de parto: ensaio clínico randomizado / Terapias complementarias en el trabajo de parto: ensayo clínico randomizado / Complementary therapies in labor: randomized clinical trial

Resumo OBJETIVO: Avaliar o efeito do banho quente de chuveiro e exercício perineal com bola suíça isolados e de forma combinada, sobre a percepção da dor, ansiedade e progressão do trabalho de parto. MÉTODO: Ensaio clínico randomizado e controlado com 128 parturientes alocadas em três grupos de terapias, banho, bola, isolados e combinados. A percepção da dor e ansiedade foi avaliada antes e trinta minutos após a intervenção terapêutica por meio de escala visual analógica (EVA). RESULTADOS: Houve aumento no escore de dor e redução da ansiedade em todos os grupos, sobretudo quando utilizaram banho de chuveiro. A dilatação cervical, aumentou em todos os grupos de intervenção (p<,001) bem como o número de contrações uterinas, principalmente quem utilizou banho e bola associados como também mostrou menor duração do tempo de trabalho de parto. CONCLUSÃO: As terapias estudadas contribuem para adaptação e bem-estar materno e favorecem a evolução do trabalho de parto.

Resumen OBJETIVO: Evaluar el efecto de la ducha caliente y del ejercicio perineal con pelota suiza, separadamente y de forma combinada, sobre la percepción del dolor, la ansiedad y la progresión del trabajo de parto. MÉTODO: Ensayo clínico aleatorizado y controlado junto a 128 parturientes asignadas en tres grupos de terapias, ducha caliente, pelota suiza separadamente y de forma combinada. La percepción de dolor y de ansiedad se evaluó antes y treinta minutos después de la intervención terapéutica por medio de escala visual analógica. RESULTADOS: Hubo un incremento en la puntuación de dolor y una reducción de la ansiedad en todos los grupos, sobre todo cuando se utilizó la ducha. La dilatación cervical aumentó en todos los grupos de intervención (p<,001) así como el número de contracciones uterinas, principalmente en el grupo que utilizó las dos terapias combinadas, ducha caliente con pelota suiza. Asimismo se constató menor duración del tiempo de trabajo de parto. CONCLUSIÓN: Las terapias estudiadas contribuyen a la adaptación y el bienestar materno y favorecen la evolución del trabajo de parto.

Abstract OBJECTIVE: To evaluate the effect of isolated and combined warm shower bath and perineal exercise with Swiss ball, on perception of pain, anxiety and labor progression. METHOD: Randomized, controlled clinical trial with 128 patients allocated into three groups of therapies: isolated and combined bath and ball. Pain and anxiety perception was evaluated before and thirty minutes after therapeutic intervention through visual analogic scales (VAS). RESULTS: Pain perception score increased, and anxiety decreased in all groups, mainly when using a shower bath. The cervical dilation increased in all groups (p<.001), as well as the number of uterine contractions increased, mainly in the group that used combined bath and ball and also showed shorter labor time. CONCLUSION: The studied therapies contribute to maternal adaptation and well-being and favor labor's evolution.

Fatores associados a taxas de cesárea em hospital universitário / Factors associated with cesarean section rates in a university hospital / Factores asociados a tasas de cesárea en hospital universitario

OBJETIVO: Analisar fatores associados à realização do parto cesariano. MÉTODOS: Estudo transversal realizado em hospital universitário de Florianópolis (SC), de 2001 a 2005. Foram analisados fatores socioeconômicos, de experiências reprodutivas, institucionais e relacionados à prática obstétrica. As informações relativas a 7.249 partos foram obtidas a partir de prontuários clínicos e registros de admissão, parto e pós-parto. Foi utilizada a regressão de Cox na análise para estimar razões de prevalência de cesárea nas categorias das variáveis de interesse. RESULTADOS: As taxas de cesárea aumentaram de 27,5% a 36,5% no período e estiveram acima daquelas devidas a indicações médicas. Após ajuste para confundimento, as taxas de cesárea se mostraram positivamente associadas com cesárea prévia (RP=2,65; IC 95%: 2,31; 3,05), apresentação não-cefálica (RP=2,23; IC 95%: 1,69; 2,95), uso de ocitocina (RP=1,77; IC 95%: 1,43; 2,19), dilatação à admissão (RP=2,74; IC 95%: 2,18; 3,44), e obstetra com taxa de cesárea superior a 35% (RP=1,82; IC 95%: 1,36; 2,42). CONCLUSÕES: Os fatores associados a maior probabilidade de cesárea mostraram a importância de intervenções direcionadas à mulher e sua experiência reprodutiva, assim como mudanças na prática obstétrica.

OBJECTIVE: To assess factors associated to cesarean section. METHODS: A cross-sectional study was conducted in a university hospital in Florianópolis, Southern Brazil, from 2001 to 2005. Socioeconomic, reproductive, obstetric and institutional information were collected. Data from 7,249 deliveries was obtained from medical records and admission, delivery and post-delivery records. Cox regression was used in the analysis to estimate cesarean prevalence ratios in the categories of variables studied. RESULTS: Cesarean rates increased from 27.% to 36.5% during the period studied and they were higher than those associated with medical indications. After adjustment for confounders cesarean rates were positively associated with previous cesarean section (PR=2.65, 95% CI: 2.31;3.05), non-cephalic presentation (PR=2.23, 95%CI: 1.69;2.95), oxytocin use (PR=1.77, 95%CI: 1.43;2.19), dilatation at admission (PR=2.74, 95%CI: 2.18;3.44), and obstetrician profile (>35% of cesarean sections) (PR=1.82, 95%CI: 1.36;2.42). CONCLUSIONS: The factors associated with cesarean section indicate the need of interventions focusing on women and their reproductive experience and changes in obstetrician practice as well.

OBJETIVO: Analizar factores asociados a la realización del parto cesariano.MÉTODOS: Estudio transversal realizado en hospital universitario de Florianópolis, Sur de Brasil, de 2001 a 2005. Fueron analizados factores socioeconómicos, de experiencias reproductivas, institucionales y relacionados con la práctica obstétrica. Las informaciones relativas a 7.249 partos fueron obtenidas a partir de prontuarios clínicos y registros de admisión, parto y post-parto. Fue utilizada la regresión de Cox en el análisis para estimar razones de prevalencia de cesárea en las categorías de las variables de interés. RESULTADOS: Las tasas de cesárea aumentaron de 27,5% a 36,5% en el período y estuvieron encima de aquellas debidas a indicaciones médicas. Posterior al ajuste para confundimento, las tasas de cesárea se mostraron positivamente asociadas con cesárea previa (RP=2,65; IC 95%: 2,31; 3,05), presentación no cefálica (RP=2,23; IC 95%: 1,69; 2,95), uso de ocitocina (RP=1,77; IC 95%: 1,43; 2,19), dilatación al ser admitida (RP=2,74; IC 95%: 2,18; 3,44), y obstetra con tasa de cesárea superior a 35% (RP=1,82; IC 95%: 1,36; 2,42). CONCLUSIONES: Los factores asociados a mayor probabilidad de cesárea mostraron la importancia de intervenciones direccionadas a la mujer y su experiencia reproductiva, así como cambios en la práctica obstétrica.

[ effect of massage on intensity of pain during first stage of labor]

Labor and birth are two important aspects of human life. At the same time, labor pain is a serious concern for every pregnant woman, Massage as a non pharmacological techniques is a way to overcome this difficulty. Research findings demonstrate that massage has especially positive effects in reducing not only pain, but also stress. Our study has been conducted to determine the effects of massage on intensity of pain during the first stage of labor in primiparous women who have attended Isfahan Shahid Beheshti hospital in 2005. In this randomize clinical trial, a total of 75 primiparous women in 38-42 week of low risk pregnancy were randomly divided in 3 groups. First group received 20 minutes of back effleurage massage at the periods of 4-5 cm, 6-7 cm, 8-10 cm, cervical dilation. An emotional support was offered for second group in the same duration of time and the same cervical dilation. Third group just received routine care during labor. In all groups, pregnant women were asked to evaluate their severity of pain before and after intervention. Data being obtained through the visual analogue scale, check list and inspection form. Study result demonstrated that intensity of pain was significantly lower in massage group [p< 0.001]. Intensity of pain in supported group was consistent during 4-5 cm dilatation period and 8-10 cm but during 6-7 cm period there was an increase in severity of pain. In routine care group severity of pain increased in every stage. Receiving back massage is more effective than supporting and routine care for relieving labor pain

Pattern of cervical dilatation in previous lower segment caesarean section patients.

The pattern of cervical dilatation during labour in 100 patients with previous lower segment caesarean section (LSCS) was determined in a prospective partographic study. Eighty-four subjects delivered successfully by vaginal route. The mean initial dilatation rate (IDR) and average dilatation rate (ADR) were 0.884 cm/hour and 1.255 cm/hour respectively. The mean IDR and ADR of the patients who delivered vaginally were 0.96 cm/hour and 1.41 cm/hour respectively, while of those who required repeat LSCS mean IDR was 0.44 cm/hour and mean ADR was 0.42 cm/hour. Hence ADR in cases who required repeat LSCS was significantly slower as compared to those who delivered vaginally (p < 0.01). Most (87.5%) of the cases who required repeat LSCS crossed the alert line as compared to 34.5% of patients who delivered vaginally. The mean admission delivery interval (ADI) was 9.45 +/- 4.29 hours in patients with no previous vaginal delivery and 8.02 +/- 4.83 hours in patients with previous vaginal delivery. The mean durations of 1st and 2nd stages of labour were 11.8 +/- 5.35 hours and 29.4 +/- 27.3 minutes respectively. It is concluded that partographic evaluation is an important aspect in management of labour of such patients.

Partograma con curvas de alerta en pacientes del cono sur de Lima / Partograph with alert linen in pregnancy patients of Lima

Durante los años 1991 y 1992, en el "Hospital María Auxiliadora" se escogió 1500 parturientas, de las cuales 587 fueron nuliparas y 913 multiparas. A todas se les aplicó los siguientes criterios: cronologia del embarazo entre 37 y 41 semanas, ausencia de patología, parto de inicio y evolución espontanea, no medicación durante el parto, pelvis normal, presentación cefálica y recien nacido de 2500 a 4000 gramos con score de Apgar mayor de 6 al nacer. Despues de aplicar estos criterios, reunimos finalmente 317 nuliparas (209 con membranas integras y 108 con membranas rotas) y 306 multiparas (231 con membranas integras y 75 con membranas rotas). Todas las pacientes estuvieron en decubito durante el trabajo de parto y fueron controladas en el centro obstetrico utilizando el partograma diseñado por el CLAP y cuidando de hacer los registros gráficos a partir de los 4 a 5 cms de dilatación cervical en adelante. Los datos de dilatación del cuello uterino en relación al tiempo fueron procesados en computadoras y se calculo el percentil 10, o sea el tiempo máximo aceptable que demora la dilatación cervical de centimetro a centimetro hasta el periodo expulsivo, y con ellos se construyo las curvas de alerta para cada uno de los cuatros subgrupos. La pendiente seguida en el proceso de dilatación del cuello uterino es la misma en nuestras parturientas que las reportadas por el CLAP, pero los tiempos estan recostados un poco hacia la derecha, particularmente en el subgrupo de nuliparas con membranas integras