de Freitas Síssi Sisconeto, Cabral Alana Leandro, de Melo Costa Pinto Rogério, Resende Ana Paula Magalhães, Pereira Baldon Vanessa Santos
Physical Therapy Postgraduate Program, Federal University of Triângulo Mineiro associated to Federal University of Uberlândia, Uberlândia, MG, Brazil.
Postgraduate Program in Health Sciences, Federal University of Uberlândia, Uberlândia, MG, Brazil.
Int Urogynecol J. 2019 Jun;30(6):951-957. doi: 10.1007/s00192-018-3793-1. Epub 2018 Oct 20.
Perineal preparation techniques for childbirth have been used with the aim of reducing perineal tears during the expulsive phase of labor. However, no studies were found to investigate the effects of instrument-assisted stretching versus perineal massage on pelvic floor muscle (PFM) variables. Therefore, the aim of this study was to evaluate the effect of instrument-assisted stretching versus perineal massage on the extensibility and strength of the PFMs.
Primiparous women were randomized to the instrument-assisted stretching (IStr) group (n = 13) and perineal massage (PnM) group (n = 14). The groups participated in eight sessions, twice weekly, beginning at the 34th gestational week. The IStr group underwent the intervention for 15 min using EPI-NO®. The PnM group underwent a perineal massage protocol for 10 min. Each woman was evaluated by a blinded physiotherapist before, after four and after eight sessions for primary (PFM extensibility using the EPI-NO® circumference) and secondary (PFM strength using a manometer) outcomes. Covariate analysis (ANCOVA) was used to compare the groups using the baseline values as a covariate.
Both groups showed an increase in PFM extensibility compared with the evaluations before and after four and eight sessions (PnM group from 17.6 ± 1.8 to 20.2 ± 1.9 cm; IStr group from 19.9 ± 1.6 to 22.9 ± 1.6 cm;p < 0.001). There was no difference between groups. Regarding muscle strength, no statistical differences were observed between evaluations or between groups.
Instrument-assisted stretching and perineal massage increase extensibility and do not alter the strength of PFMs in pregnant women.
分娩时采用会阴准备技术旨在减少分娩用力阶段的会阴撕裂。然而，未发现有研究调查器械辅助伸展与会阴按摩对盆底肌肉（PFM）各项指标的影响。因此，本研究旨在评估器械辅助伸展与会阴按摩对盆底肌肉伸展性和力量的影响。
初产妇被随机分为器械辅助伸展（IStr）组（n = 13）和会阴按摩（PnM）组（n = 14）。两组从妊娠第34周开始，每周两次，共参加八次疗程。IStr组使用EPI-NO®进行15分钟的干预。PnM组进行10分钟的会阴按摩方案。在治疗前、四次疗程后和八次疗程后，由一位不知情的物理治疗师对每位女性进行评估，评估主要指标（使用EPI-NO®周长评估PFM伸展性）和次要指标（使用压力计评估PFM力量）。采用协方差分析（ANCOVA），以基线值作为协变量来比较两组。
与治疗前、四次疗程后和八次疗程后的评估相比，两组的PFM伸展性均有所增加（PnM组从17.6±1.8厘米增加到20.2±1.9厘米；IStr组从19.9±1.6厘米增加到22.9±1.6厘米；p < 0.001）。两组之间无差异。关于肌肉力量，评估之间或组间均未观察到统计学差异。
器械辅助伸展和会阴按摩可增加孕妇盆底肌肉的伸展性，且不改变其力量。
