Revista Brasileira de Ginecologia e Obstetrícia (Nov 2006)
Influência da mobilidade materna na duração da fase ativa do trabalho de parto Influence of maternal mobility on duration of the active phase of labor
Abstract
OBJETIVOS: investigar a influência da mobilidade da parturiente durante a fase ativa do trabalho de parto. MÉTODOS: foi realizado ensaio clínico controlado prospectivo, com análise comparativa entre um grupo de tratamento (n=50) e um grupo controle (n=50), no Centro Obstétrico do Hospital Universitário da Universidade de São Paulo (USP). Os critérios de inclusão foram: primigestas com feto único em apresentação cefálica; idade gestacional entre 37 e 42 semanas; parturientes com pelo menos duas contrações a cada dez minutos e cérvico-dilatação de até 4 cm, além da concordância em assinar o termo de consentimento livre e esclarecido. A evolução para cesárea foi critério de exclusão. Foram acompanhadas por fisioterapeuta durante toda a fase ativa e orientadas a manterem-se em posição vertical e em movimento, de acordo com a fase da dilatação cervical e a descida fetal no canal de parto. O grupo controle teve acompanhamento obstétrico sem a presença do fisioterapeuta. Este grupo foi selecionado retrospectivamente, a partir dos registros de prontuário, seguindo os mesmos critérios de inclusão e exclusão. RESULTADOS: foram acompanhadas 58 primigestas entre 15 e 37 anos. Dessas, 50 mulheres (86,2%) evoluíram para parto vaginal, sendo que oito (13,7%) evoluíram para cesárea e foram excluídas do estudo. Entre as 50 parturientes acompanhadas, a média de duração da fase ativa foi de cinco horas e 16 minutos, enquanto no grupo controle foi de oito horas e 28 minutos (pPURPOSE: to investigate the influence of the maternal mobility during the active phase of labor. METHODS: a prospective clinical trial was conducted through comparative analysis among a treatment group (n=50) and a control group (n=50), in the Obstetric Center of the Hospital Universitário da Universidade de São Paulo (USP). The inclusion criteria were: primigravidae with a single fetus on cephalic presentation, with 37 to 42 weeks of pregnancy, with two uterine contractions every ten minutes and with cervical dilatation until 4 cm, besides the agreement to sign the free and informed consent term. The evolution of labor for cesarean section was the exclusion criteria. The patients were assisted during the active phase of labor by the physiotherapist and encouraged for staying in vertical position and movement, according to each dilatation stage and fetus head progression. The control group had obstetric support without the presence of the physiotherapist; it was selected retrospectively, according to the same inclusion and exclusion criteria. RESULTS: 58 primigravidae between 15 and 37 years old were accompanied; 50 of them (86.2%) evolved to vaginal birth and eight (13.7%) evolved to cesarean section and were excluded. Among the patients who were accompanied, the mean of active phase was five hours and 16 minutes, while in the control group it was eight hours and 28 minutes (p<0.001). This difference was maintained in relation to the amniotic sac either whole or ragged. As for the cervix uterine evanescence, the treatment group showed a smaller period of active phase in association to a thin uterine cervix (p<0.001). In the treatment group, none of the patients used analgesics during the active phase, against 62% of the control group (p<0.001). In this group, all the patients used some kind of anesthesia for delivery; in the treatment group, among those who used anesthesia, 76% did it while the dilatation was 9 or 10 cm and 12% did not use any kind of anesthesia (p<0.05). The average weight of the newborns and the apgar did not show significant difference rates between the two groups. CONCLUSIONS: the good performance of maternal mobility has positive influences on the labor process: it increases the tolerance to pain, avoids the use of drugs during labor, improves the evolution of dilatation and reduces the duration of the active phase.
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