Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
parto?
Bsqueda bibliogrfica
P: embarazadas
I: fisioterapia antenatal
C: no intervencin antenatal
O: lesin obsttrica del esfnter anal
Antenatal
Antenatal prevention
Antenatal care
Pregnancy
Conservative treatment
Physiotherapy
Physical therapy modalities
Training
Intervention
Pelvic floor exercises
Perineal massage
AND
Sphincter lacerations
Disruption
Tears
Faecal incontinence
Perineal trauma
perineal tear
Injury
RESULTADOS DE LA BSQUEDA
38
ESTUDIOS
OBTENIDOS
35
EXCLUIDOS
SELECCIONADOS
CRITERIOS DE EXCLUSIN:
No estrategia primaria
Intervencin no fisioteraputica
Variable principal LOEA
resultados
resultados
Mecanismo de soporte
y continencia
Mecanismo lesional
70% Lesin
perineal (4)
(3)
(1)
1,7-5,4 %
LOEA (5,6)
(2)
IA
(7)
Factores de riesgo(2,3)
LOEA
(4)
(1) Fitzgerald, M. P. Risk factors for anal sphincter tear during vaginal delivery. Obstetrics and Gynecology.2007
(2, 4) Espua, M., Porta, O. Manual de anatoma funcional y quirrgica del suelo plvico.2010.
(3) Laine, K. Prevalence and risk factors for anal incontinence after obstetric anal sphincter rupture. Acta Obstetricia Et Gynecologica Scandinavica, 2011.
(4) Kearney R. Levator ani injury in primiparous women with forceps delivery for fetal distress, forceps for second stage arrest, and spontaneous delivery.
Int J Gynaecol Obstet 2010.
Jallo N. Fam Community Health. Stress management during pregnancy: designing and evaluating a mind-body intervention.2008
Hauck YL.Risk factors for severe perineal trauma during vaginal childbirth: a Western Australian retrospective cohort study. Women Birth. 2015
HandaV.L. Obstet Gynecol 2001. Andrews V. Birth 2006
Objetivos especficos:
Disminuir el dolor
Reducir el riesgo de parto
instrumental
Minimizar los desgarros y las
episiotomas
Facilitar el encajamiento.
Mejorar movilidad sea.
Ensear posturas facilitadoras
biomecnicas.
Adiestrar para la activacin abdominal
en pujo.
Preparar el suelo plvico.
Estimular actitud proactiva,
responsable y realista.
Racinet. Recording expulsive forces during childbirth using intercostal muscle electromyogram: a pilot study. Gynecol Obstet Fertil. 2005
Racinet. Maternal posture during parturition. Gynecol Obstet. 2005
Simkin P. The meaning of labor pain. Birth. 2000
Vayssire, C. Instrumental delivery: clinical practice guidelines from the French College of Gynaecologists and Obstetricians. Eur J Obstet
Gynecol Reprod Biol. 2011
HHCC
A. CONSEJOS
DURANTE EL
EMBARAZO
B. GIMNASIA
PREPARTO
Y TERAPIA MANUAL
C. VALORACIN SP
MASAJE PERINEAL Y
ENTRENAMIENTO SP
B- GIMNASIA PREPARTO
Calais-Germain
Calais-Germain
Calais-Germain
CalaisGermain
(1) Gottvall K. Risk factors for anal sphincter tears: the importance of maternal position at birth. BJOG 2007
(2) Alberts L. Distribution of genital tract trauma in childbirth and related postnatal pain. Birth. 1999
(3) Sapsford RR. Sitting posture affects pelvic floor muscle activity in parous women: an observational study.Aust J Physiother.2006
(4) Walker C. Alternative model of birth to reduce the risk of assisted vaginal delivery and perineal trauma. 2012
B- GIMNASIA PREPARTO
Aprendizaje del pujo:
http://www.diresacajamarca.gob.pe/noticias/se-amplactividades-por-la-semana-de-la-maternidad-saludable-y-segura
El pujo retardado es positivo para reducir los partos difciles en mujeres nulparas.
El Valsalva sostenido en posicin supina est relacionado con mayor lesin.
En expulsivo espontaneo no aumenta el tiempo de expulsivo ni el tiempo dedicado a
empujar.
Sampselle CM. Provider support of spontaneous pushing during the second stage of labor. J Obstet Gynecol Neonatal Nurs. 2005.
Roberts Best practices in second stage labor care: maternal bearing down and positioning.Midwifery Womens Health. 2007.
Fraser WD. Multicenter, randomized, controlled trial of delayed pushing for nulliparous women in the second stage of labor with continuous
epidural analgesia. The PEOPLE (Pushing Early or Pushing Late with Epidural) Study Group. Am J Obstet Gynecol. 2000.
Walker C. Alternative model of birth to reduce the risk of assisted vaginal delivery and perineal trauma. 2012
PFMT
Calais-Blandine
MASAJE PERINEAL
RAPbarcelona, 2015
Reflexiones:
No est demostrado que el MP, PFMT ni el
ejercicio fsico antenatal tengan un efecto
protector del EA.
Parece que el MP puede tener inters
protector en mujeres >30 aos primparas.
La reduccin del dolor moderado y severo en
el posparto es clnica y estadsticamente
significativa.
Sin embargo
Cabe considerar el handicap que supone no poder
aislar las variables que afectan a la gestante para
poder llegar a conclusiones firmes sobre una
intervencin preventiva con fisioterapia.
Muchas gracias!
Laia Blanco
Fisioterapeuta n col 1895
lb@rapbarcelona.com