Efeito da via de parto na força muscular do assoalho pélvico, em primíparas

Abstract

Objetivo – Determinar a influência da via de parto na força muscular do assoalho pélvico (AP) de primíparas, 4 a 6 meses pósparto. Sujeitos e Métodos – Estudo clínico, de corte transversal, para avaliar a função da musculatura do AP pelo teste da AFA e perineômetro pneumático e classificada em: zero - ausência de contração muscular, um - contração leve, dois - contração moderada não sustentada por 6 segundos e, três - contração normal sustentada por 6 segundos. As 94 mulheres, tinham entre 20 e 30 anos, foram divididas em 3 grupos de acordo com a via de parto: I com 32 primíparas pós-parto vaginal; II com 32 primíparas pós-parto cesárea e III com 30 nulíparas que serviram como grupo controle. A variável independente foi a via de parto e a dependente a força muscular do AP(1). Resultados e conclusões – A mediana e o 1º e 3º quartís da força muscular do AP foram menores (p=0.01) pós-parto vaginal (2.0;1-2) e intermediária pós-parto cesárea (2.0; 2-3) em relação as nulíparas (3.0;2-3) pelo AFA e perineômetro. Aumentou o risco relativo(RR) de exame alterado da força da musculatura do AP pós-parto vaginal (RR=2.579 IC 95%=1.32-5.04 p=0.002); (RR=2.31 IC 95%=1.24- 4.32 p=0.005) e pós-cesárea (RR=1.56 IC 95% = 0.94-2.57 p=0.12); (RR=1.38 IC 95%=0.85-2.23 p=0.29) pela AFA e perineômetro. O parto vaginal diminuiu a força muscular do AP de primíparas e comparando com a cesárea e as nulíparas.

Objective – To evaluate the influence of the route of delivery on pelvic floor (PF) muscle strength, in primiparous patients at 4 to 6 months after delivery. Subjects and methods – A cross-sectional study was undertaken among primiparous women at 4 to 6 months postpartum to evaluate the PF muscle strength by AFA test and pneumatic perineometer, classified in: zero – lack of muscle contraction; one – weak contraction; two – moderate contraction not sustained for 6 seconds and three – normal contraction sustained for 6 seconds. 94 enrolled patients were divided in three groups based upon prior delivery route: I) 32 vaginal delivery with singleton cephalic presentation; II) 32 cesarean delivery; and III) 30 nuliparous patients served as a control group. The independent variable was the route of delivery and the dependent one was the muscle strength of the PF. Data were subjected to Student t test to estimate the relative risk and the Kappa test(1). Results and conclusions – The three subgroups were comparable with respect to maternal age, weight, gestational age and newborn weight. The 1st and the 3rd quartiles of the route of delivery on PF muscle strength were lower (p=0.01) for vaginal delivery (n=32) (2.0;1- 2) and intermediate for cesarean (n=32) (2.0; 2-3) comparing to the nuliparous (3.0; 2-3) by AFA test and pneumatic perineometer. The altered PF muscle strength in primiparous were significantly lower in the vaginal delivery group (RR=2.58, CI 95%=1.32-5.04, p=0.002); (RR=2.31, CI 95%=1.24-4.32, p=0.005); and postcesarean (RR=1.56, CI 95% = 0.94- 2.57, p= 0.12); (RR=1.38, CI 95%=0.85-2.23, p=0.29). Vaginal delivery decreases PF muscle strength when compared with caesarean delivery and control.