盆底训练计划对预防会阴创伤的影响：一项半随机对照试验。

Influence of a pelvic floor training programme to prevent perineal trauma: A quasi-randomised controlled trial.

作者信息

Leon-Larios Fatima, Corrales-Gutierrez Isabel, Casado-Mejía Rosa, Suarez-Serrano Carmen

机构信息

Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Spain.

Obstetrics and Gynecology Department, Universitario Virgen Macarena Hospital, Seville, Spain.

出版信息

Midwifery. 2017 Jul;50:72-77. doi: 10.1016/j.midw.2017.03.015. Epub 2017 Mar 27.

DOI:10.1016/j.midw.2017.03.015

PMID:28391147

Abstract

BACKGROUND

perineal injury is common after birth and may be caused by tears or episiotomy or both. Perineal massage has been shown to prevent episiotomies in primiparous women. On the other hand, pelvic floor exercises might have an influence by shortening the first and second stages of labour in the primigravida.

AIM

the aim of this study was to investigate the effects of a pelvic floor training following a birth programme on perineal trauma.

DESIGN

a single-blind quasi-randomized controlled trial with two groups: standard care and intervention.

SETTING

a tertiary, metropolitan hospital in Seville, Spain.

PARTICIPANTS

women (n=466) who were 32 weeks pregnant, having a singleton pregnancy and anticipating a normal birth were randomised. Women in the experimental groups were asked to perform a pelvic floor training programme that included: daily perineal massage and pelvic floor exercises from 32 weeks of pregnancy until birth. They were allocated to an intervention group by clusters (antenatal education groups) randomized 1:1. The control group had standard care that did not involve a perineal/pelvic floor intervention. These women were collected in a labour ward at admission 1:3 by midwives.

RESULTS

outcomes were analysed by intention-to-treat. Women assigned to the perineal/pelvic floor intervention showed a 31.63% reduction in episiotomy (50.56% versus 82.19%, p<0.001) and a higher likelihood of having an intact perineum (17.61% versus 6.85%, p<0.003). There were also fewer third (5.18% versus 13.12%, p<0.001) and fourth degree-tears (0.52% versus 2.5%, p<0.001). Women allocated to the intervention group also had less postpartum perineal pain (24.57% versus 36.30%, p<0.001) and required less analgesia in the postnatal period (21.14% versus 30.82%, p<0.001).

CONCLUSIONS

a training programme composed of pelvic floor exercises and perineal massage may prevent episiotomies and tears in primiparous women. This programme can be recommended to primiparous women in order to prevent perineal trauma.

KEY CONCLUSION

the pelvic floor programme was associated with significantly lower rates of episiotomies and severe perineal trauma; and higher intact perineum when compared with women who received standard care only.

IMPLICATIONS FOR PRACTICE

the programme is an effective intervention that we recommend to all women at 32nd week of pregnancy to prevent perineal trauma.

摘要

背景

产后会阴损伤很常见，可能由撕裂伤或会阴切开术或两者共同导致。会阴按摩已被证明可预防初产妇进行会阴切开术。另一方面，盆底肌锻炼可能通过缩短初产妇第一产程和第二产程产生影响。

目的

本研究旨在调查分娩计划后的盆底肌训练对会阴创伤的影响。

设计

一项单盲半随机对照试验，分为两组：标准护理组和干预组。

地点

西班牙塞维利亚的一家三级城市医院。

参与者

466名怀孕32周、单胎妊娠且预计正常分娩的女性被随机分组。实验组的女性被要求执行一项盆底肌训练计划，包括：从怀孕32周直至分娩，每天进行会阴按摩和盆底肌锻炼。她们按1:1的比例通过整群随机分组（产前教育组）被分配到干预组。对照组接受不涉及会阴/盆底干预的标准护理。这些女性由助产士在入院时按1:3的比例收集到产房。

结果

按意向性分析进行结果分析。被分配到会阴/盆底干预组的女性会阴切开术减少了31.63%（50.56%对82.19%，p<0.001），会阴完整的可能性更高（17.61%对6.85%，p<0.003）。三度撕裂伤（5.18%对13.12%，p<0.001）和四度撕裂伤（0.52%对2.5%，p<0.001）也更少。被分配到干预组的女性产后会阴疼痛也更少（24.57%对36.30%，p<0.001），产后所需镇痛药物也更少（21.14%对30.82%，p<0.001）。