HOW OSTEOPATHY COULD HELP OBSTETRICS IN DIAGNOSIS AND THERAPY. PRELIMINARY REPORT ABOUT SAFETY AND EFFICACY OF OSTEOPATHY IN AN OBSTETRICS DEPARTMENT IN ITALY.

Background: Osteopathy is present in a large number of hospitals in Italy, firstly in pediatric departments. It is mainly deals with musculo-skeletal imbalances, but osteopathy states to have a role in improving general health. Few studies about safety and efficacy of osteopathic manipulative treatment (OMT) in Obstetrics have been produced. Objectives: Our long-term study, of which this report is a preliminary communication, is aimed at investigating the effects of OMT during the third trimester of pregnancy on labour and delivery and on the peri-partum parameters of fetal well-being and it is aimed at verifying the prognostic value of a diagnostic dynamic test. Methods: From July 2015, our cross-sectional and analytical controlled study enrolled women, with low-risk singleton pregnancy, referring to the hospitals of the Second District of Liguria (Savona and Pietra Ligure - Italy). The OMT and the diagnostic test were performed at the obstetrics-osteopathic practice of the hospitals, approved by the local Healthcare Director. Nulliparous patients who agreed to submit to OMT were treated at the beginning, mid and late (36-38 weeks) third trimester of pregnancy; patients who were not interested in OMT entered the control group. The values of the transverse diameter of the Michaelis' sacral rhomboid area (PSIS) in changing three different positions (1- vertical kneeling position; 2- hand-to-knee position; 3- kneeling squat position) and their differences were the diagnostic predictive tool. Results: Obstetrical outcomes considered for this study are: normal deliveries (ND), operative deliveries (OD: kiwi and/or >3 Kristeller manouvres), cesarean sections (CS), pharmacological inductions of labour for pregnancy beyond the term, demands for analgesia, use of oxytocin in the first stage of labour, episiotomy rate, presence of meconium-stained fluid, neonatal APGAR score, PROM. Statistical analysis of clinical outcomes: chi-square test and risk ratio (RR) with 95% confidence interval (95%CI). Apgar score was analyzed by Mann-Whitney U test. T-test and area under the ROC curve (θ value) for the transverse sacral diameter were done. Significance from p= 0.05. The low-risk nulliparae in labour were in total 327: 166 for the OMT group and 161 for the control group. The deliveries were between October 2015 and December 2016. It was shown to be significant (OMT vs control): an overall lower rate of dystocia (CS+OD: 19/166 - 11.4% vs 47/161 - 29.1%: p=0.00006; RR 0.39 and 95%CI 0.24-0.63), a lower CS rate during labour (7.8% vs 13.1%: p = 0.05; RR 0.52 and 95%CI 0.27-1.003), a lower OD rate (3.6% vs 16.1%: p=0.00006, RR 0.21 and 95%CI 0.08-0.49) and a lower use of episiotomy (9.8% vs 22.8%: p=0.002; RR 0.42 and 95%CI 0.24- 0.75). Amniotic fluid was less frequently meconium-stained (13.2% vs 23.6%: p = 0.01; RR 0.56 and 95%CI 0.34-0.91). The rate of pregnancy beyond the term, treated with pharmacological induction, was not significantly different (13.2% vs. 19.2%: p = 0.1) but in the OMT group CS+OD was less effective frequency (18.1% vs 54.8%: p = 0.008; RR 0.33 and 95%CI 0.12-0.85). The transverse diameter of Michaelis' losanga adapts in changing positions: 364 triplets of data (ND= 283; CS+OP: 81) are summarized as follow. ND PSIS1: mm. 125,5±13,8 and CS+OD PSIS1: mm. 127,7±16,9 (t-test and ROC: not significant - ns). ND PSIS2: mm. 133,1±14,1 and CS+OD PSIS2: mm. 130,1±17,6 (t-test and ROC: ns). ND PSIS3: mm. 132,9±15,1 and CS+OD PSIS3: mm. 127,7±18,1 (t-test and ROC: ns). ND PSIS2-1: mm. 8,3±3,8 and CS+OD PSIS2-1: mm. 2,5±2,1 (t-test p 0,000 ; ROC θ value: 0, and 95%CI 0,92-0,97). ND PSIS3-1: mm. 7,3±5,9; CS+OD PSIS3-1: mm. 1,1±4,3 (t-test p 0,000 ; ROC θ value: 0,81 and 95%CI 0,76-0,86 ). ND PSIS2-3: mm. 1,1±4,8; CS+OD PSIS2-3: mm. 1,4±3,7 (t-test and ROC: ns). A PSIS2-1 (difference between hand-to-knee position and vertical position) cut-off value of 3,0 mm. shows a True Positive Rate: 0,98; a True Negative Rate: 0,81; False Positive Rate 0,18; False Negative Rate: 0,01. Conclusion: Preliminary data from our experience confirm that osteopathic treatment during the third trimester of pregnancy is safe for both mother and baby, OMT seems to be able to support birth physiology and reduce dystocia. These outcomes potentially result in fewer days of hospitalization and a reduction in risk factors for maternal and neonatal disease. Osteopathy seems also to support midwives and obstetricians in the diagnosis of dystocia by its dynamic approach to external pelvimetry. WHO recommends collaboration and integration between traditional and conventional approaches in medicine. Midwives and osteopaths together could improve the quality of childbirth and delivery, thus affecting the well-being of the infants in the short and long term as well as women's health. [ABSTRACT FROM AUTHOR]