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This study aimed to evaluate the profile of knowledge of Brazilian women about the physical therapist’s role in women’s health. The women answered an online questionnaire containing: socioeconomic, demographic data, knowledge about the role of physical therapy in women’s health, and current health conditions. Descriptive analyses were carried out to characterize the sample, levels of knowledge and self-report of pelvic floor dysfunctions, and the association between general knowledge, self-report of dysfunctions, and knowledge of the sub-areas of physical therapy in women’s health. In total, 446 women from all regions of Brazil participated: 86.3% from the Southeast, 9.4% from the South, 1.6% from the Northeast, 1.3% from the Midwest, and 1.3% from the North. The mean age was 30.1±10.5 years; the self-report of pelvic floor dysfunctions was 20.4% urinary incontinence, 27.6% sexual dysfunctions, 25.8% intestinal symptoms, and 6.7% chronic pelvic pain. Of the participants, 61% had some knowledge about the role of physical therapy in women’s health and 96.9% would like to know more about this specialty. Although many women are aware of this area, a minority has been referred to or has undergone specialized physical therapy treatment for women’s health. There was a statistically significant association between the level of knowledge of women about the physical therapist’s role in women’s health with the self-report of pelvic floor dysfunctions and the level of knowledge of the sub-areas of performance.

The aims of this study were to perform a cross-cultural adaptation of the Vulvovaginal Symptoms Questionnaire (VSQ) into Brazilian Portuguese (VSQ-Br) and evaluate its measurement properties (structural validity, construct validity, internal consistency, and reliability).Cross-cultural adaptation was conducted through the translation, synthesis, and back-translation of the VSQ-Br. Subsequently, 314 women completed the Pelvic Floor Impact Questionnaire, Pelvic Floor Disorders Inventory, Medical Outcomes Study 36-Item Short-Form Health Survey, and VSQ-Br. Seven to 10 days later, participants completed the VSQ-Br for the second time. Data were submitted for confirmatory factor analysis. Cronbach α was used to verify internal consistency, and construct validity was assessed using Pearson correlation coefficient ( r ). Reliability was calculated using the intraclass correlation coefficient.Confirmatory factor analysis showed that the questions were grouped into four domains (symptoms, emotions, life impact, and sexual impact). The model showed good fit (0.95). The Cronbach α in this study was 0.85, reflecting adequate internal consistency. Adequate reliability was confirmed, with an intraclass correlation coefficient total score of 0.80. The VSQ-Br had a weak correlation with the pelvic domain of the Pelvic Floor Disorders Inventory, the pelvic organ prolapse domain of the Pelvic Floor Impact Questionnaire, and pain, vitality, and the social aspect domains of the Medical Outcomes Study 36-Item Short-Form Health Survey.The VSQ-Br was validated and had acceptable measurement properties for assessing vulvovaginal symptoms in Brazilian women.

Objectives: to analyze protocols and direct Brazilian women to prevent perinatal seizures during the CO VID-19 pandemic, based on the positive perinatal experience. Methods: exploratory analysis of document analysis. In the first phase, from April 11 to May 14, in order to search for words with keywords, 402 documents were found. The second phase consisted of reading the set of selected documents and dividing them into categories. The analysis was carried out in light of the guidelines for a positive perinatal experience of the World Health Organization. Results: as well as directing flow detection phase protocols to mice that show or do not receive COVID-19 symptoms and are being updated with new evidence of systemic evidence. It appears that there are several guidelines for prenatal, partial and puerperium, divergences in some documents for example umbilical cord clamping, skin-to-skin contact, newborn bath. Conclusions: analyze the permissible conclusions that most recommendations are in line with preconceived notions of positive perinatal experience, but is necessary to adaptation to the Brazilian context.

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Introduction and hypothesis The differential diagnosis of urinary symptoms may allow health professionals to establish a therapeutic objective and to choose the appropriate treatment for the patient's complaint. The aim of this study was to cross-culturally adapt the Three Incontinence Questionnaire (3IQ) into Brazilian Portuguese (3IQ-Br) and to analyze test-retest reliability, construct, and criterion validity in women. Methods The cross-cultural adaptation of the 3IQ-Br included forward-translation, back-translation, and consensus among an expert committee. Participants with and without urinary incontinence (UI) completed the 3IQ-Br, King's Health Questionnaire (KHQ), and Questionnaire for Female Urinary Incontinence Diagnosis (QUID-Br). Only women with UI answered 3IQ-Br after 7–10 days. Test-retest reliability and construct validity were analyzed using the Cohen linear kappa (k). The 3IQ-Br accuracy was analyzed using the area under the curve (AUC) of the receiver-operating characteristic (ROC) curve, considering the sensitivity and specificity to correctly classify women with and without UI. Results The reliability of each question from the 3IQ-Br was considered substantial in the test-retest. The agreement among 3IQ-Br, QUID-Br, and KHQ was almost perfect for UI diagnosis (k > 0.8). The 3IQ-Br was considered to have good accuracy in distinguishing women with UI considering the KHQ (AUC 0.83, 95% confidence interval [CI] 0.78 to 0.87, p < 0.001), and fair to the QUID-Br (AUC 0.73, 95% CI 0.68 to 0.78; p < 0.001). Conclusions The results of this study showed that this version of the 3IQ-Br has acceptable measurement properties for identifying and differentiating UI symptoms in Brazilian women. 2018/26718-9

Cheerleaders perform high-impact maneuvers that can be associated with pelvic floor dysfunction. We hypothesized that female cheerleaders would report more symptoms of pelvic floor dysfunction and fewer symptoms of premenstrual syndrome than nonathletic women. This cross-sectional study included high-performance female cheerleaders and young nonathletic, nulliparous, and normal-weight females. Demographics, sports practices, and pelvic floor dysfunction data were collected through an electronic questionnaire. Urinary symptoms were collected through the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and King’s Health Questionnaire. Intestinal symptoms were collected through the use of Criterion F of item C3, referring to functional constipation of Rome III and Fecal Incontinence Severity Index. Data on sexual function were collected through the Female Sexual Function Index. Data on pelvic organ prolapse were obtained through the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS). In addition, questions about premenstrual syndrome—dysmenorrhea, irritability, headache, tiredness, fluid retention, and constipation—were collected through the Menstrual Symptom Questionnaire. The comparison between groups of the quantitative variables was performed using the Mann-Whitney U test. Odds ratios (OR) and 95% confidence intervals (CI) were estimated for comparison between groups on the occurrence of pelvic floor muscle dysfunction symptoms. A significance level of 5% was adopted. A total of 156 women (78 cheerleaders and 76 nonathletes) completed the electronic questionnaire. Anal incontinence was the most prevalent symptom of pelvic floor muscle dysfunction. Cheerleaders were 2.3 times more likely to report symptoms regarding anal incontinence than nonathletic women. For the other symptoms of pelvic floor dysfunction, no statistical differences between the groups were found. Cheerleaders reported fewer symptoms of tiredness and constipation during the premenstrual period than did nonathletic women. Pelvic floor dysfunction, particularly anal incontinence, appears to be more prevalent among cheerleaders than among nonathletic women. In addition, cheerleaders demonstrated fewer symptoms of tiredness and constipation during the premenstrual period.

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The literature presents controversial results regarding the role of delivery mode in pelvic floor muscle (PFM) function after birth. Some studies showed a greater impairment of PFM function after vaginal delivery compared with cesarean section, while others have not identified a significant difference between these two modes of delivery. This study aimed to investigate whether there was a difference in short-term PFM function after childbirth in primiparous women who underwent cesarean section compared with those who underwent vaginal delivery. Up to December 2018, the PubMed-MEDLINE, CINAHL, Embase, Bireme, Scopus, Web of Science, and Science Direct databases were searched. Two independent reviewers performed the selection process based on titles, abstracts, and full-text reading. Observational studies comparing PFM function after cesarean section versus vaginal delivery in primiparous women were included. PRISMA guidelines and Cochrane recommendations were followed. Methodological quality of the primary studies was assessed through the checklist proposed by the Joanna Briggs Institute for cross-sectional studies. Random effects meta-analysis was performed to synthesize evidence regarding PFM strength in primiparous woman after vaginal delivery compared with cesarean section. The GRADE approach was applied to classify the quality of the evidence. Eleven studies met the inclusion criteria and were included in this review. A total of 1726 primiparous women were analyzed after childbirth. Five studies were included in the meta-analysis. No difference in PFM strength after childbirth was identified when cesarean section was compared with vaginal delivery [standardized mean difference (SMD): −0.15, 95% confidence interval (CI): −0.85 to 0.56]. Differences in PFM strength were identified when patients who underwent cesarean section were compared with those with an episiotomy or instrumented vaginal delivery (SMD: −12.51, CI 95%: −24.57 to −0.44), favoring the cesarean section group. In both cases, the quality of evidence was classified as very low because of the observational design of the included studies and population heterogeneity. There was no difference in short-term PFM strength after childbirth between primiparous women who underwent cesarean section or vaginal delivery, as assessed through vaginal manometry. However, we identified reduced PFM strength in women who underwent an episiotomy or instrumented vaginal delivery compared with those who underwent cesarean section. Nevertheless, this conclusion should be cautiously considered as the observational design of the primary studies and possible heterogeneity among the primiparous women included in the studies contributed to reducing the quality of the evidence synthesized. Future primary studies with longitudinal designs and long-term follow-up periods are needed to strengthen the quality of evidence and provide more conclusive evidence to guide clinical practice.

Objective This study aimed to adapt the Questionnaire for Urinary Incontinence Diagnosis (QUID) into Brazilian Portuguese (QUID-Br) and evaluate its measurement properties, given as reliability, validity, and responsiveness in women with urinary incontinence. Study design It was a methodological study which enrolled 168 women (mean age = 55.1, standard deviation = 17.9 years old). Translation and cross-cultural adaptation were done and subsequently analysis of the measurement properties of QUID-Br were tested: structural validity (by exploratory and confirmatory factory analysis) internal consistency (Cronbach’s α) construct validity (Pearson Correlation), and test-retest reliability (Intraclass Correlation Coefficient). Results The QUID-Br two-factor was confirmed showing two domains with three items each: stress urinary incontinence (SUI) and urge urinary incontinence (UUI). Furthermore, QUID-Br showed acceptable internal consistency for both scales (Cronbach’s α > 0.70), reliability [intraclass correlation coefficient (ICC = 0.85 for SUI and 0.87 for UUI)] with 95 % confidence interval (CI) and construct validity - with all the hypothesis raised a priori being confirmed. Conclusions The results of the present investigation showed that the QUID-Br is a valid, reliable, and consistent instrument to be administered to Brazilian women and its use is recommended in clinical practice and research.

Although aging is considered a risk factor for pelvic floor muscle dysfunction (PFMD), the effect of aging on the function of the pelvic floor muscles (PFM) remains unclear.To compare PFM function and activity in nulliparous women in different age groups.This was a cross-sectional study in which 70 women with ages between 18 and 69 years were divided into five age groups for evaluation. Initially, medical histories were taken, and then the PFM function was assessed using digital palpation (Modified Oxford Scale), manometry and surface electromyography (sEMG). The Kruskal-Wallis test was applied to check the differences between the groups. The Spearman correlation coefficient was used to verify the correlations between age and PFM function, manometry values and sEMG. A significance level of 5% was adopted.No significant differences were observed between the different age groups in PFM digital palpation, manometry values and sEMG. There was a low negative correlation between age root mean square and peak of sEMG signals.This study found no difference in PFM function and activity between nulliparous women in the five different age groups. Future long-term large prospective studies are required to confirm these findings.

Este estudo teve como objetivo verificar a presença de sinais e sintomas de disfunção do trato urinário inferior em gestantes. Trata-se de uma pesquisa de campo, de corte transversal, realizada em Unidades Básicas de Saúde no interior do Estado de São Paulo. A amostra foi composta por primigestas, que realizavam acompanhamento pré-natal em Unidades Básicas de Saúde. Foi aplicado um questionário com questões sobre o funcionamento do trato urinário inferior. A coleta ocorreu durante junho e julho de 2008. Foram avaliadas 18 gestantes e 100% apresentava algum sinal ou sintoma de disfunção do trato urinário. Nove (50%) relataram perder urina em alguma situação, das quais 6 (66,7%) apresentaram incontinência urinária aos esforços. Em 5 (55,5%) gestantes do estudo, a incontinência urinária teve iní­cio no 2º trimestre de gestação. Conclui-se que todas as gestantes avaliadas apresentaram sinais e sintomas de disfunção do trato urinário inferior a partir do segundo trimestre de gestação, das quais metade apresentava perda involuntária de urina, principalmente, aos esforços.Palavras-chave: incontinência urinária, gravidez, Fisioterapia.

Introduction: The type of delivery may be a determining factor for the development of discomfort in the immediate postpartum period. Objective: To identify the discomfort related by women in the immediate postpartum period and to compare them among those submitted to vaginal delivery and cesarean. Methods: Cross‑sectional analytical study developed in a public maternity hospital with medical records that contained information of physical therapy evaluation of postpartum women attended from February to November 2011. Results: A total of 346 records were included in this study. Immediate postpartum complaints: abdominal pain (31.5%), edema (19.1%), low back pain (18.2%), neck pain (9.8%) and discomfort in the lower limbs (5.8%). Cesarean was the mode of delivery that caused greater discomfort related to the presence of abdominal pain (p=0.001), neck pain (p=0.017) and edema (p=0.017). Conclusion: The findings suggest that women who undergo cesarean are vulnerable to greater morbidity compared to vaginal delivery during the immediate postpartum period.

Introdução: A cirurgia para a retirada do câncer de mama leva a repercussões no corpo da mulher e influencia diretamente sua postura. Objetivo: Identificar as alterações posturais em mulheres submetidas a tal procedimento e compará-las com o tipo de cirurgia. Métodos: Foi avaliada a postura de 23 voluntárias selecionadas por conveniência por meio do software SAPO. Resultados: Das mulheres avaliadas, 52,2% apresentaram rotação de cabeça à esquerda e elevação de ombro à direita, 56,5%, elevação da pelve à esquerda, e 65,2%, inclinação de tronco à esquerda. Em 100% das mulheres observou-se anteriorização da cabeça, 87% tiveram deslocamento posterior do tronco e 82,6% demonstraram ter anteversão pélvica. Não foi encontrada diferença significativa entre os tipos de cirurgia. Conclusão: As mulheres apresentaram alterações no alinhamento da cabeça, do ombro, da pelve e do tronco. Porém, essas alterações não foram diferentes quando comparados os tipos de cirurgia.

OBJETIVO: Objetivou-se, neste estudo, compreender o significado de ser acompanhante de uma mulher em trabalho de parto e parto. Os sujeitos do estudo foram 12 acompanhantes de parturientes assistidas em uma maternidade. MÉTODOS: A abordagem metodológica utilizada foi a qualitativa e a análise dos dados foi fundamentada na técnica de análise de conteúdo. RESULTADO: Os significados observados para a participação do acompanhante foram: "dar força", "ficar junto/ao lado" e "observar tudo". No espaço hospitalar de domínio médico, o acompanhante relatou que "quem faz é o médico"; algumas vezes se perceberam "sem coragem" e "sem atitude". CONCLUSÃO: Diante de tais resultados, verificou-se que é preciso dar voz aos agentes envolvidos diretamente no processo de parturição, que muitas vezes sentem-se intimidados pelos profissionais de saúde, desencorajados de participar, ou assumindo um papel fiscalizador na tentativa de obter uma assistência segura para a parturiente.OBJETIVO: En este estudio se tuvo como objetivo, comprender el significado de ser acompañante de una mujer en trabajo de parto y parto. Los sujetos del estudio fueron 12 acompañantes de parturientas asistidas en una maternidad. MÉTODOS: El abordaje metodológico utilizado fue el cualitativo y el análisis de los datos se fundamentó en la técnica del análisis de contenido. RESULTADOS: Los significados observados para la participación del acompañante fueron: "dar fuerza", "quedarse junto/al lado" y "observar todo". En el espacio hospitalario de dominio médico, el acompañante relató que "quien hace es el médico"; algunas veces se percibieron "sin coraje" y "sin actitud". CONCLUSIÓN: Frente a tales resultados, se verificó que es preciso dar voz a los agentes involucrados directamente en el proceso del parto, que muchas veces se sienten intimidados por los profesionales de salud, cohibidos de participar, o asumiendo un papel fiscalizador en el intento de obtener una asistencia segura para la parturienta.PURPOSE: The aim of this study was to understand what it means to be a companion of women during the labor and delivery processes. METHODS: The sample consisted of 12 companions of women giving birth in a Brazilian maternity. A qualitative design was used to conduct the study. Data from interviews were examined with content analysis. RESULTS: The findings suggest that being a companion means, "to give support," "to be together/at the side" and "to observe everything." In the domain, observing medical care in a hospital setting, companions stated, "the physician does all the work"; and sometimes companions regarded themselves "without courage" and "without attitude." CONCLUSION: It is necessary to give a voice to companions during the labor and delivery processes. Companions very often feel intimidated by health professionals, discouraged, or just assuming an observer role when attempting to support women giving birth.

A dor perineal no pós-parto é uma das morbidades mais comuns que acometem as mulheres no período puerperal. Recursos farmacológicos e não farmacológicos têm sido investigados para aliviar tal sintoma. A crioterapia é uma técnica frequentemente utilizada na clínicaobstétrica, porém existem poucos estudos que fundamentam tal terapêutica. Diante disso, este estudo teve como objetivo geral avaliar o efeito da crioterapia no alívio da dor da região perineal em primíparas submetidas ao parto normal com episiotomia. Os objetivos específicos foram: mensurar a dor perineal em primíparas submetidas ao parto normal com episiotomia por meio instrumento unidimensional de dor, caracterizar a dor perineal por meio de instrumento de avaliação multidimensional de dor, verificar quais atividades realizadas pelas puérperas dentro da maternidade estavam limitadas pela presença da dor, verificar o efeito da crioterapia no alívio da dor imediatamente após a aplicação e uma hora pós-tratamento, verificar a temperatura da região perineal antes, durante e depois da crioterapia e a correlação com a intensidade da dor, verificar possíveis efeitos adversos provocados pela crioterapia e verificar a opinião das puérperas sobre o tratamento. Trata-se de um estudo do tipo ensaio clínico aleatório e controlado realizado em uma maternidade localizada no interior do estado de São Paulo. Foram selecionadas aleatoriamente 50 mulheres primíparas que apresentavam dor perineal após o parto vaginal com episiotomia, divididas em 26 mulheres no grupo controle e 24 no grupo experimental. Foi utilizado um formulário para a coleta de dados sócio-demográficos, sobre a assistência ao parto e os dados do recém-nascido; para avaliar a dor foi utilizada a escala numérica compartimentada em 11 pontos e os descritores do questionário McGill; também foi utilizado um formulário sobre as atividades funcionais desempenhadas pelas puérperas que estavam limitadas pela dor; por fim, foi aplicado um questionário sobre a opinião das mulheres sobre a terapêutica. A técnica de crioterapia utilizada consistiu de bolsa plástica no formato de um absorvente, contendo gelo triturado, aplicada durante 20 minutos. Foram realizadas três avaliações em ambos os grupos: avaliação inicial onde era questionada a intensidade da dor pela escala numérica e a aplicação do questionário McGill; avaliação dois: realizada após 20 minutos da primeira avaliação, sendo que no grupo experimental foi realizada após a crioterapia; avaliação três: realizada após uma hora da segunda avaliação. Este trabalho foi aprovado pelo Comitê de Ética da EERP/USP. Verificou-se alívio da dor para o grupo experimental comparado ao controle na segunda avaliação e na terceira avaliação (p=0,000). As puérperas de ambos os grupos apresentavam limitadas as funções de sentar, deitar e deambular. A dor perineal foi caracterizada pelas puérperas como latejante, que repuxa, que esquenta, ardida, dolorida, chata, incômoda, que prende e que deixa tenso. A média da temperatura perineal antes da crioterapia foi a 34,5o C, baixando para 23,4ºC após a técnica. Uma hora após o tratamento a média passou para 33,7ºC. Foi encontrada correlação positiva entre a intensidade da dor e as modificações da temperatura perineal. Sobre a satisfação das mulheres com a crioterapia 87,5% referiram estar satisfeitas com o recurso e 12,5% referiram estar muito satisfeitas. A crioterapia mostrou-se eficaz no alívio da dor perineal, entretanto, são necessários demais estudos que possam elucidar questões tais como tempo de alívio do sintoma, intervalo entre as aplicações e os efeitos sobre demais sinais e sintomas do processo inflamatório. Postpartum perineal pain is among the most common morbidities affecting women in the puerperal period. Studies have been conducted to assess the effectiveness of pharmacological and non-pharmacological resources to relief this symptom. Cryotherapy is a frequently used clinical-obstetric technique, but few studies have provided the foundations of this therapeutics. In this view, this study had the purpose to: assess the effect of cryotherapy in providing pain relief of the perinal region of primiparae submitted to natural childbirth with episiotomy using a one-dimensional pain instrument; characterize perineal pain using a multidimensional pain assessment tool, verify what activities performed by the puerperae in the maternity were limited due to the presence of pain; verify the effect of cryotherapy in relieving pain immediately after it application, and one hour later; verify the temperature of the perineal region before, during, and after cryotherapy, and the correlation with the intensity of pain, verify the possible adverse effects caused by cryotherapy; and verify the puerperaes opinion about the treatment. This is a controlled and random clinical trial carried out in a maternity in the interior of Sao Paulo state, and it was approved by the EERP/USP Research Ethics Committee. Fifty primiparae with perineal pain after vaginal delivery with episiotomy were randomly selected and 26 were assigned to the control group and 24 to the experimental group. A form was used to collect socio-demographic data, as well as information about care during the delivery and regarding the newborn; an 11-point numerical scale and descriptors from the McGill questionnaire were used to assess the pain. In addition, a form was used to assess the functional activities performed by the puerperae that were limited due to the pain. Finally, a questionnaire was applied to obtain the womens opinion about the therapy. The cryotherapy technique used consisted of a plastic bag in the shape of an absorbent pad, containing ground ice, which was applied for 20 minutes. Three assessments were performed in both groups: an initial assessment, in which the women were asked about the intensity of the pain using the numerical scale and by administering the McGill questionnaire. The second assessment was performed 20 minutes after the first, and in the experimental group it was performed after the cryotherapy. The third assessment was performed one hour after the second. This study was approved by the EERP/USP Ethics Committee. It was verified there was pain relief in the experimental group compared to control in the second and third assessment (p=0.000). On the other hand, the women reported feeling pain again in the third assessment. The puerperae from both groups had limited functions when sitting, laying down, and walking. The puerperae characterized the perineal pain as pulsing, pulling, hot, stinging, hurting, annoying, troublesome, tight and tense. The average perineal temperature before cryotherapy was 34.5 o C, dropping to 23.4 o C after the technique. One hour after the treatment, the average lowered to 33.7 o C. There was a positive correlation between the intensity of pain and the changes in perineal temperature. As for the womens satisfaction toward the cryotherapy, 87.5% reported being satisfied with the resource and 12.5% reported being much satisfied. Cryotherapy was effective in relieving perineal pain, however further studies are needed in order to elucidate issues like time of symptom relief, interval time between applications, and the effects over other signs and symptoms of the inflammatory process.

Highlights • Cesarean section births postpartum had higher pain intensity during movement compared to vaginal delivery births. • In postpartum, cesarean births showed greater functional limitation for selected movements than vaginal births. • Parity had no association with the functional limitations complaint., Objectives To identify women's complaints about pain in the immediate postpartum of vaginal delivery and cesarean section; to measure the intensity of pain in postpartum women at rest and with selected movements and to compare the activity limitations in relation to the mode of delivery and parity. Method Observational, descriptive, cross-sectional study. Eighty-six women, in the immediate postpartum period after vaginal delivery (n = 43) and cesarean section (n = 43), were evaluated for physical discomforts and their difficulty in performing functional activities. Results Abdominal pain (mean differences = −39.5%; 95% CI = −57.3 to −21.8%), neck pain (mean differences = −16.3%; 95% CI = −32.3 to −0.3%) and edema (mean differences = −41.4%; 95% CI = −63.3 to −20.4%) were reported of cesarean women postpartum. Perineal pain (p

Trata-se de um estudo descritivo realizado com cinquenta mulheres em pós-parto vaginal com episiotomia. Objetivou-se mensurar e caracterizar a dor perineal em primíparas submetidas ao parto normal com episiotomia e verificar as atividades limitadas pela dor. Para avaliação da dor foi utilizada a Escala Numérica e o Questionário McGill, bem como um formulário para analisar as atividades que estavam limitadas. A média de dor perineal encontrada foi cinco. As categorias sensorial e avaliação subjetiva foram as mais selecionadas no Questionário McGill. A dor perineal foi caracterizada como latejante, que repuxa, que esquenta, ardida, dolorida, chata, incômoda, que prende e que deixa tensa. Sentar, deitar e deambular foram as atividades mais limitadas. Em conclusão, foi possível verificar a presença de dor perineal nas puérperas causada pela episiotomia e identificar que as atividades de sentar, deitar e deambular estavam limitadas por este sintoma. This is a descriptive study, involving fifty women after vaginal delivery with episiotomy. The study aimed to measure and to characterize the perineal pain in primiparae who have had a natural childbirth with episiotomy and to verify the activities limited by the perineal pain. For evaluation of perineal pain, a Numeric Scale and the McGill Pain Questionnaire were used, as well as another questionnaire to analyze the activities limited. In the Numeric Scale, the median of perineal pain referred were five. The sensory and subjective evaluation categories were the most selected in the McGill questionnaire. The perineal pain was characterized as pulsing, pulling, hot, stinging, hurting, annoying, troublesome, tight and tense. The most limited activities were sitting, laying down (onto the bed), and walking. In conclusion, it was possible to verify the presence of perineal pain between women in the postpartum period caused by episiotomy and identify the activities of sitting, lying down and walking were limited for this symptom. Se realizo un estudio descriptivo de cincuenta mujeres después del parto vaginal con episiotomía. Objetivó-se medir y caracterizar el dolor perineal en primíparas sometidas al parto normal con episiotomía y verificar las actividades limitadas por el dolor perineal. Para la evaluación del dolor se utilizo la Escala Numérica, el Cuestionario de del Dolor de McGill y un cuestionario para analizar las actividades limitadas. En la Escala Numérica, la media de dolor fue cinco. Las categorías de evaluación sensorial y subjetiva fueron los más seleccionados en el cuestionario McGill. La dolor perineal se caracterizó como palpitante, de esfuerzo, que se calienta, quema, duele, aburrido, incómodo, y deja que mantiene estrechos. Sentado, tumbado y caminar son las actividades más limitados. Finalización: fue posible verificar la presencia de dolor perineal entre primíparas causada por la episiotomia e identificar las actividades de sentado, acostado y caminando se vieron limitados por en este síntoma. Universidade Federal de São Paulo (UNIFESP) Departamento de Ciências da Saúde Curso de Fisioterapia Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto Departamento de Biomecânica, Medicina Física e Reabilitação do Aparelho Locomotor Universidade de São Paulo Escola de Enfermagem de Ribeirão Preto Programa de Pós-Graduação Enfermagem em Saúde Pública UNIFESP, Depto. de Ciências da Saúde Curso de Fisioterapia SciELO

OBJETIVO: Objetivou-se, neste estudo, compreender o significado de ser acompanhante de uma mulher em trabalho de parto e parto. Os sujeitos do estudo foram 12 acompanhantes de parturientes assistidas em uma maternidade. MÉTODOS: A abordagem metodológica utilizada foi a qualitativa e a análise dos dados foi fundamentada na técnica de análise de conteúdo. RESULTADO: Os significados observados para a participação do acompanhante foram: "dar força", "ficar junto/ao lado" e "observar tudo". No espaço hospitalar de domínio médico, o acompanhante relatou que "quem faz é o médico"; algumas vezes se perceberam "sem coragem" e "sem atitude". CONCLUSÃO: Diante de tais resultados, verificou-se que é preciso dar voz aos agentes envolvidos diretamente no processo de parturição, que muitas vezes sentem-se intimidados pelos profissionais de saúde, desencorajados de participar, ou assumindo um papel fiscalizador na tentativa de obter uma assistência segura para a parturiente. PURPOSE: The aim of this study was to understand what it means to be a companion of women during the labor and delivery processes. METHODS: The sample consisted of 12 companions of women giving birth in a Brazilian maternity. A qualitative design was used to conduct the study. Data from interviews were examined with content analysis. RESULTS: The findings suggest that being a companion means, "to give support," "to be together/at the side" and "to observe everything." In the domain, observing medical care in a hospital setting, companions stated, "the physician does all the work"; and sometimes companions regarded themselves "without courage" and "without attitude." CONCLUSION: It is necessary to give a voice to companions during the labor and delivery processes. Companions very often feel intimidated by health professionals, discouraged, or just assuming an observer role when attempting to support women giving birth. OBJETIVO: En este estudio se tuvo como objetivo, comprender el significado de ser acompañante de una mujer en trabajo de parto y parto. Los sujetos del estudio fueron 12 acompañantes de parturientas asistidas en una maternidad. MÉTODOS: El abordaje metodológico utilizado fue el cualitativo y el análisis de los datos se fundamentó en la técnica del análisis de contenido. RESULTADOS: Los significados observados para la participación del acompañante fueron: "dar fuerza", "quedarse junto/al lado" y "observar todo". En el espacio hospitalario de dominio médico, el acompañante relató que "quien hace es el médico"; algunas veces se percibieron "sin coraje" y "sin actitud". CONCLUSIÓN: Frente a tales resultados, se verificó que es preciso dar voz a los agentes involucrados directamente en el proceso del parto, que muchas veces se sienten intimidados por los profesionales de salud, cohibidos de participar, o asumiendo un papel fiscalizador en el intento de obtener una asistencia segura para la parturienta.

This study provides an update on the use of Transcutaneous Eletric Nerve Stimulation (TENS) as a non-pharmacological resource of postoperative pain relief. National and international references regarding the use of TENS for the relief of postoperative pain had been selected, highlighting its mechanism of action, parameters of application, contraindications, side-effect and results. TENS is a non-pharmacological resource that has its mechanism of action based on the gate theory. It consists of a device that emits electric impulses in the skin through electrodes. It is a low cost technique, easily applicable, presents few collateral effects, good effectiveness related to the reduction of the painful perception, allowing early mobilization and reduced pharmacological analgesic consumption. TENS represents another option in the control of postoperative pain and should be inserted in a multiprofessional context.

O diabetes mellitus tipo 1 pode desencadear alterações biomecânicas e urinárias que podem produzir alterações adicionais às existentes em um período gestacional regular. O objetivo deste estudo foi avaliar a Influência do diabetes tipo 1 na biomecânica corporal e queixas urinárias no terceiro trimestre de gestação, para tanto foram desenvolvidos três estudos. O Estudo I descreve possíveis alterações causadas pelo diabetes mellitus tipo 1 no controle postural de gestantes. O estudo II avalia a influência do diabetes mellitus tipo 1 na dor lombar de gestantes. O estudo III avalia a presença e os sintomas de incontinência urinária em gestantes com diabetes tipo 1. Foram avaliadas 40 gestantes no terceiro trimestre gestacional alocadas em dois grupos iguais: grupo controle (GC) e o grupo diabetes tipo 1 (GDM1). No grupo controle (GC), as médias da idade gestacional foi 31,15(±3,91) semanas, da idade materna 31(±4,12) anos e do índice de massa corporal (IMC) 27,40(±3,00) kg/m2. Para o GDM1 as médias da idade gestacional foi de 30,35(±3,87) semanas, da idade materna 25(±0,92) anos, do IMC 26,71(±5,84) kg/m2 , tempo de diagnóstico do diabetes 12,55 (±6,20) anos, e a hemoglobina glicada (HbA1c) 6,87(±1,57) %. No estudo I as variáveis relacionadas ao controle postural foram avaliadas por fotogrametria pelo software ALCimagem-2000 versão 1.5 (ALCimagem® - Belo Horizonte, Brasil), com a análise dos ângulos de protrusão da cabeça; lordose cervical; cifose torácica; lordose lombar; anteversão pélvica; flexão do joelho, ângulos tibiotarsais; e inclinação do pé. O equilíbrio foi avaliado por baropodometria - MatScan XL (MatScan- Tekscan® - South Boston, EUA), mensurando a distância da trajetória anteroposterior e mediolateral do centro de pressão, a amplitude e velocidade média de deslocamento do centro de pressão (com olhos abertos e fechados). No estudo II a análise da intensidade e o impacto da dor lombar, foi feito pela Escala Visual Numérica, questionário Oswestry e por algômetro digital PTR 200 (Instrutherm® - São Paulo, Brasil). Foram avaliados os músculos quadrado lombar, longuíssimo torácico, glúteo médio e multífido. No estudo III foram avaliados os impactos na continência urinária pelo International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). Para a análise estatística o teste Shapiro-Wilk e Levene foram aplicados e, na presença de normalidade, o teste t de Student comparou os grupos e na ausência de normalidade, o teste U de Mann Whitney analisou os grupos. Os resultados do estudo I apontaram que o GDM1 apresentou: alterações na análise postural com menor ângulo de protrusão da cabeça, de anteversão pélvica, e maiores ângulos de lordose cervical, cifose torácica e lordose lombar. Na baropodometria, a distância e a amplitude de deslocamento anteroposterior do centro de pressão com os olhos abertos e fechados, foram maiores no GDM1. Nos resultados do estudo II o GDM1 apresentou maiores pontuações na Escala Visual Numérica para a dor lombar, e menor limiar de dor à pressão nos músculos quadrado lombar, longuíssimo torácico, glúteo médio e multífido testados pela algometria. Os resultados do estudo III mostraram uma maior pontuação no ICIQ-SF do GMD1. Os achados do estudo I sugerem que o diabetes mellitus tipo 1 no terceiro trimestre de gravidez está associado a alterações posturais, aumento da amplitude e deslocamento anteroposterior do centro de pressão com os olhos abertos e fechados durante a manutenção da postura ortostática estática. Os resultados do estudo II apontam que a presença de diabetes mellitus tipo 1, durante o terceiro trimestre de gestação, está relacionada com aumento da dor lombar e a menor pressão necessária para desencadear dores nos músculos que podem desencadear dor nessa região. Os resultados do estudo III apontam para maior prevalência de incontinência urinária e piores impactos gerados por ela em mulheres diabéticas tipo 1, durante o terceiro trimestre de gestação. Type 1 diabetes mellitus can trigger biomechanical and urinary changes that can produce changes in addition to those existing during a regular gestational period. The aim of this study was to evaluate the influence of type 1 diabetes on body biomechanics and urinary complaints in the third trimester of pregnancy, for which three studies were developed. Study I describes possible changes caused by type 1 diabetes mellitus in the postural control of pregnant women. Study II assesses the influence of type 1 diabetes mellitus on low back pain in pregnant women. Study III assesses the presence and symptoms of urinary incontinence in pregnant women with type 1 diabetes. Fourty pregnant women in the third gestational trimester were allocated into two equal groups: control group (GC) and type 1 diabetes group (GDM1). In the CG, the mean gestational age was 31.15 (± 3.91) weeks, the maternal age was 31 (± 4.12) years and the body mass index (BMI) 27.40 (± 3.00) kg / m2. For GDM1, the mean gestational age was 30.35 (± 3.87) weeks, maternal age 25 (± 0.92) years, BMI 26.71 (± 5.84) kg / m2, diagnosis of diabetes 12.55 (± 6.20) years, and glycated hemoglobin (HbA1c) 6.87 (± 1.57)%. In study I, the variables related to postural control were evaluated by photogrammetry using the ALCimagem-2000 software version 1.5 (ALCimagem® - Belo Horizonte, Brazil), with the analysis of the head protrusion angles; cervical lordosis; thoracic kyphosis; lumbar lordosis; pelvic anteversion; knee flexion, tibiotarsal angles; and inclination of the foot. Balance was assessed by baropodometry equipment - MatScan XL (MatScan-Tekscan® - South Boston, USA), measuring the anteroposterior and mediolateral distance trajectory of the center of pressure, amplitude and average speed of displacement of the center of pressure (with open and closed eyes).In study II, the analysis of the intensity and impact of low back pain was performed using the Visual Numeric Scale, the Oswestry questionnaire and a digital algometer PTR 200 (Instrutherm® - São Paulo, Brazil) that evaluated quadratus lumborum, longissimus, gluteus medius and multifidus muscles. In study III for the assessment the impacts on urinary continence, the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) was applied. For statistical analysis the Shapiro-Wilk and Levene test were applied and, in the presence of normality, the Student t test compared the groups and in the absence of normality, the Mann Whitney U test analyzed the groups. The results of study I show that GDM1 presented: changes in postural analysis with a lower head protrusion and pelvic anteversion anlges, and higher cervical lordosis, thoracic kyphosis and lumbar lordoses angles. In baropodometry, the anteroposterior distance and the amplitude of the center of pressure displacement with eyes open and closed were higher in GDM1. In the results of study II, GDM1 had higher scores on the Visual Numeric Scale for low back pain and lower pressure pain threshold in quadratus lumborum, longissimus, gluteus medius and multifidus muscles. The results of study III showed a higher score on the ICIQ-SF of GMD1. The findings of study I suggest that type 1 diabetes mellitus in the third trimester of pregnancy is associated with postural changes, and increased anteroposterior displacement of the pressure center with open and closed eyes during the maintenance of static orthostatic posture. The results of study II show that the presence of type 1 diabetes mellitus, during the third trimester of pregnancy, is related to increased low back pain and lower pressure necessary to get pain in the muscles that can trigger pain in this region. The results of study III point to a higher prevalence of urinary incontinence and worse impacts generated by it in type 1 diabetic women, during the third trimester of pregnancy.

OBJETIVOS: Avaliar a efetividade da massagem perineal de Thiele e a efetividade da eletroestimulação intravaginal no tratamento de mulheres com dor pélvica crônica (DPC) e dispareunia causada por espasmo dos músculos pélvicos, comparar as duas técnicas e seus efeitos sobre a dor, risco de ansiedade e depressão e na função sexual. MÉTODOS: Foi realizado um estudo clínico randomizado, com alocação aleatória dos sujeitos da pesquisa em grupos paralelos, grupo A: 14 mulheres tradadas com massagem perineal e grupo B: 16 mulheres tradadas com eletroestimulação intravaginal. Foram incluídas mulheres com diagnóstico de DPC e dispareunia superficial causada por espasmo de músculos pélvicos, foram excluídas mulheres com dispareunia sem espasmo de músculos pélvicos, mulheres grávidas, menopausadas e que constassem em seus prontuários: vasculopatias, neuropatias, diabetes ou tireoideopatias. Foram recrutadas no Ambulatório de Dor Pélvica Crônica (AGDP) do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade São Paulo (HC/FMRP- USP). Sendo realizadas avaliações através de exame físico e aplicação dos questionários EVA, McGILL, HAD e FSFI e coleta de dados demográficos. Após término do tratamento essas mulheres foram reavaliadas com a periodicidade de uma, quatro, doze e 24 semanas por um avaliador alheio ao tipo de tratamento por elas realizado. RESULTADOS: Não foram encontradas diferenças significativas quando comparada a efetividade de uma técnica em relação à outra em nenhum dos tempos de reavaliação. Porém foram encontrados resultados significativos dentro de cada grupo entre os tempos antes do tratamento e depois do tratamento (1, 4, 12 e 24 semanas após). Em relação à melhora da dor (EVA, McGILL) e função sexual (FSFI), não foram encontradas diferenças significativas em relação às técnicas de tratamento e o risco para ansiedade e depressão. CONCLUSÃO: As duas modalidades de tratamento foram efetivas na melhora da dor, sugerindo assim o uso delas separadamente ou em associação nos casos de DPC associado a dispareunia superficial secundária a espasmos de músculos pélvicos. OBJECTIVES: Evaluate the effectiveness of Thiele perineal massage and the effectiveness of intravaginal electrostimulation in treating women with Chronic pelvic pain (CPP) and dyspareunia caused by spasm of the pelvic muscles, to compare two techniques and their pain effects, anxiety and depression risks and sexual function. METHODS: Was realized a clinical trial randomized with random allocation of people in parallel groups. Group A:14 women treated with perineal massage and group B:16 women treated with intravaginal electrostimulation. Inclusion criteria: Women with CPP and superficial dyspareunia caused by spasms of the pelvic muscles diagnosed and exclusion criteria: Dyspareunia without spasm in pelvic muscles, pregnant, menopause and with medical records of vasculopathies, neuropathies, diabetes, thyroid disease. These women were recruited in the Clinic of Chronic Pelvic Pain of the Hospital of Ribeirão Preto Medical School of the University of São Paulo (HC/FMRP-USP). Evaluation with physical examination and application of VAS, McGill pain, HAD and SFIF and the collection of demographic data were performed. After end of treatment these women were re-evaluated after 1, 4, 12 and 24 weeks follow-up by a foreign evaluator to the type of treatment. RESULTS: No significant differences were found when comparing the effectiveness of one technique in relation to the other in any of the reevaluation times. However, significant results were found within each group between pre-treatment and post-treatment times (1, 4, 12, and 24 weeks post-treatment). In relation to the improvement of pain (EVA, McGILL) and sexual function (FSFI), no significant differences were found regarding treatment techniques and the risk for anxiety and depression. CONCLUSION: The two treatment modalities were effective in improving pain, thus suggesting their use separately or in combination in cases of DPC associated with superficial dyspareunia secondary to pelvic muscle spasms.

A ausência de estudos nacionais e limitações metodológicas relacionadas às pesquisas que já avaliaram a repercussão do treinamento dos músculos do assoalho pélvico (TMAP) sobre o trabalho de parto, parto e resultados perinatais constituíram a fundamentação científica para o desenvolvimento desta pesquisa cujo objetivo foi verificar a influência de um programa de TMAP realizado durante a gravidez sobre variáveis inerentes ao parto e aos resultados perinatais. Trata-se de ensaio clínico prospectivo randomizado e controlado que incluiu 42 gestantes nulíparas de baixo risco. As voluntárias fizeram parte de um grupo controle (GC) que não treinou os músculos do assoalho pélvico (MAP) ou de um grupo de treinamento (GT) que realizou um treino intensivo e supervisionado dos MAP por 16 semanas. As voluntárias de ambos os grupos foram avaliadas com 20 e 36 semanas de idade gestacional (IG). Uma pesquisadora cega em relação à distribuição dos grupos fez a análise dos prontuários das participantes da pesquisa sendo coletadas as seguintes informações: IG na ocasião do parto; tipo de parto; duração do período expulsivo; tempo total de trabalho de parto; ocorrência de laceração e o seu grau; apresentação do recém-nascido; peso; tamanho; sexo e escores de Apgar dos recém-nascidos (RN). A análise estatística utilizou-se de procedimentos PROC FREQ e PROC MEANS do software SAS 9.0, modelos ANOVA, contrastes ortogonais baseados na distribuição t, modelos lineares de efeitos mistos, teste exato de Fisher, modelo de regressão quantílica e coeficiente de correlação de Pearson. No GC, 9,53% tiveram parto normal, 23,81% parto normal com episiotomia médio lateral (EML), 19,04% parto fórceps e 47,62% parto cesárea. No GT, 23,81% das mulheres tiveram parto normal, 38,1% parto normal com EML, 14,28% parto fórceps e 23,81% foram submetidas a cesárea. Não houve diferença estatística entre os grupos em relação a IG no momento do parto (p= 0,72); tipo de parto (p= 0,23); duração do período expulsivo (p= 0,28), tempo total de trabalho de parto (p= 0,91), ocorrência de laceração perineal (p= 0,66); peso (p= 0,43), tamanho (p= 0,61) e escores de Apgar dos RN (p= 1,00). Não houve relação entre o tipo de parto com uma melhor média de pico de perineometria na 36ª semana de IG entre os grupos (p= 0,15). Também não se observou diferença estatística entre as avaliações (20 e 36 semanas) em relação ao tipo de parto entre os grupos (p=0,61). Concluiu-se que não houve influência do programa de TMAP realizado durante a gravidez nas variáveis maternas e perinatais avaliadas neste estudo. The lack of national studies and methodological limitations related to studies that have evaluated the impact of the pelvic floor muscles training (PFMT) on labor, delivery and perinatal outcomes were the scientific basis for the development of this research that aimed to verify the influence of a program of PFMT performed during pregnancy on variables inherent in the delivery and perinatal results. This is a prospective clinical randomized controlled trial that include 42 nulliparous women ate low risk. The volunteers were part of a control group (CG) that did not train their pelvic floor muscles (PFM) or a training group (TG) has done extensive training and supervision of PFM for 16 weeks. The volunteers of both groups were evaluated with 20 and 36 semanas de idade gestacional (IG). A blind researcher for distribution of the groups made the analysis of records of study participants. Were collected the following informations: GA at birth, type of delivery, duration of second stage, the total time of labor, incidence of laceration and the extent, presentation of the newborn, weight, size, gender, and Apgar score of newborns (NB). Statistical analysis was used procedures PROC FREQ and PROC MEANS of SAS 9.0, ANOVA models, orthogonal contrasts based on t-distribution models, linear mixed effects, Fisher\'s exact test, quantile regression and correlation coefficient of Pearson. In CG, 9.53% had vaginal delivery, 23.81% vaginal delivery with episiotomy, 19.04% forceps delivery and 47.62% cesarean section. In TG, 23.81% of women had vaginal delivery, 38.1% vaginal delivery with episiotomy, 14.28% forceps delivery and 23.81% underwent cesarean section. There was no statistical difference between the groups regarding GA at delivery (p = 0.72), type of delivery (p = 0.23), duration of second stage (p = 0.28), total work time delivery (p = 0.91), occurrence of perineal lacerations (p = 0.66), weight (p = 0.43), size (p = 0.61) and Apgar scores of NB (p = 1, 00). There was no relationship between the type of delivery with a best average in the peak of perineometer at 36 weeks of GA between the groups (p = 0.15). Also there was no statistical difference between the ratings (20 and 36 weeks) in relation to type of delivery between groups (p = 0.61). It was concluded that there was no influence of the PFMT program performed during pregnancy on maternal and perinatal variables evaluated in this study.