The Maternal and Perinatal Outcomes Associated With the Use of Non-pharmacological in Labor
23 de mayo de 2021 actualizado por: Alessandra Cristina Marcolin, University of Sao Paulo
Evaluation of Maternal and Perinatal Outcomes Associated With the Use of Non-pharmacological in Parturients in Active Phase of Labor
Although there are studies that investigated the use of non-pharmacological pain relief and correction of dystocia during labor, there are few randomized controlled trials, especially related to combined protocols that use such resources.
The use of combined protocols could potentiate the effects of resource use alone, evidencing the need for more studies related to the topic, as well as the effects of these methods on maternal and perinatal outcomes.
In order to verify the effect of these methods in various stages of labor, childbirth and immediately becomes necessary to conduct a randomized controlled trial well-designed and adequate sample size that can make the future systematic reviews that can definitely conclude about the potential effectiveness of protocols that use combined resources to non-pharmacological pain relief in labor.
Aim of our study is to evaluate the effects of a protocol of non-pharmacological resources on pain of pregnant women in the active phase of cervical dilatation and compared with controls.
Descripción general del estudio
Estado
Terminado
Condiciones
Intervención / Tratamiento
Descripción detallada
Labor is a natural physiologic process triggered by mechanical and hormonal events that promote uterine contractions.
Several non-pharmacological resources can be used during labor, such as relaxation techniques and ongoing support, maternal mobility, walking, breathing exercises, massage, Swiss ball, stool, shower, whirlpool and application of transcutaneous electrical stimulation (ENT .)
Despite the role of physiotherapy in labor is not an established practice in public hospitals, it is expected that with the evidence of the benefits of non-pharmacological resources at this time, managers and health professionals validate the importance of interdisciplinary care in pregnancy - postpartum.
The aim of this study is to evaluate the effects of resources on non-pharmacological pain of mothers in the active phase of cervical dilatation when compared to controls.
This research is a randomized, controlled clinical study that includes pregnant women randomly assigned to two groups: Intervention Group (IG) women who will use the following sequence features: ambulation (with cervical dilatation of 4 to 5 cm), alternating stance associated with ENT (cervical dilatation from 6 to 7 cm) and a shower (with dilation> 7 cm) for 40 minutes each resource; Control Group (CG) women who will not use any physical therapy resource, are subject only to routine procedures of maternity care .
For pain assessment will use the Visual Analogue Scale - VAS and the body diagram of the location and spatial distribution of pain.
Results are presented in tables and graphs made to better understand the comparisons between the control and intervention.
To compare maternal morbidity, obstetric and neonatal between groups will be used Fisher's exact test or chi-square.
Tipo de estudio
Intervencionista
Inscripción (Actual)
80
Fase
- No aplica
Contactos y Ubicaciones
Esta sección proporciona los datos de contacto de quienes realizan el estudio e información sobre dónde se lleva a cabo este estudio.
Ubicaciones de estudio
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São Paulo
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Ribeirão Preto, São Paulo, Brasil
- Professor, Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo.
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Criterios de participación
Los investigadores buscan personas que se ajusten a una determinada descripción, denominada criterio de elegibilidad. Algunos ejemplos de estos criterios son el estado de salud general de una persona o tratamientos previos.
Criterio de elegibilidad
Edades elegibles para estudiar
15 años a 30 años (Niño, Adulto)
Acepta Voluntarios Saludables
Sí
Géneros elegibles para el estudio
Femenino
Descripción
Inclusion Criteria:
Agreement of the patient to participate in the study after reading and signing the consent form;
- primigravida;
- Pregnancy unique;
- Gestational age> 37 weeks;
- fetal cephalic presentation;
- chorioamniotic intact membranes;
- spontaneous labor;
- Admission to the beginning of the active phase of dilatation (4 cm cervical dilatation);
- Dynamics between 2 and 4 uterine contractions in ten minutes;
- Lack of maternal and fetal pathologies;
- literate;
- Absence of cognitive problems.
Exclusion Criteria:
Intolerance to non-pharmacological application of resources;
- Increased pain by the woman that prevents the completion of the intervention;
- Want to stop the intervention;
- Suspected acute suffering;
- Indication of cesarean section.
Plan de estudios
Esta sección proporciona detalles del plan de estudio, incluido cómo está diseñado el estudio y qué mide el estudio.
¿Cómo está diseñado el estudio?
Detalles de diseño
- Propósito principal: Tratamiento
- Asignación: Aleatorizado
- Modelo Intervencionista: Asignación paralela
- Enmascaramiento: Único
Armas e Intervenciones
Grupo de participantes/brazo |
Intervención / Tratamiento |
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Comparador activo: Control
Active Comparator: Control Group Pregnant women who receive assistance from the routine CRSM MATER care, not being assisted by the physiotherapist, but that will be evaluated at the same time in the intervention group.
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Other: Routine care Routine care of the institution performed by the staff, without the presence of the researcher that included offering a balanced meal, continuous support with the presence of a partner or family throughout labor, use of oxytocin when prescribed by the staff, use of drug analgesia when requested by the patient.
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Experimental: Intervention Group
Experimental: Intervention Group Pregnant women who receive the application the combination of non-pharmacological resources according to cervical dilation: Walking (with cervical dilation between 4 and 5 cm) Alternating stance associated with ENT (cervical dilatation from 6 to 7 cm) Shower (with dilation> 7 cm);
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Other: Non-pharmacological resources A sequence of non-pharmacological resources were applied to the patient by the researcher according to uterine cervical dilation, as follows:
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¿Qué mide el estudio?
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
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Number of Participants Who Requested Analgesia During the Active Phase of Childbirth
Periodo de tiempo: 10 hours
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Average uterine cervical dilation of the patient who requested analgesia for pain relief.
Data captured from the medical record by the partograph.
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10 hours
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The Moment in Centimeters That Women Requested Analgesia During the Active Phase of Childbirth, Analyzed by Cevical Dilation.
Periodo de tiempo: 10 hours
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Moment when a patient requested analgesia for pain relief. Data captured from the medical record by the partograph. A partogram was used, which is a printed document and allows the registration of all procedures and complications that occurred during labor, showing the conditions of the parturient and the fetus during this phase. This information is noted on a graph that makes it possible to assess all labor and duration. The doctor filled out the partograph and assessed the patient during labor, and she did not know which group belonged to the patient |
10 hours
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Average Duration of the Expulsive Period When Compared to Groups
Periodo de tiempo: Starts with 10 centimeters of dilation until delivery
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Assess the duration of the expulsion period and compare between groups
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Starts with 10 centimeters of dilation until delivery
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Types of Dystocia (Functional, Secondary Stop of Dilation and Fetal Offspring) Between Groups
Periodo de tiempo: 10 hours
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Analyze and compare between the groups the types of dystocia. Dystocia: b.1) Functional dystocia was considered when cervical dilation increased progressively, but with a speed less than 1 centimeter per hour; b.2) Secondary stop of the dilation was considered when there were 2 vaginal touches with the same cervical dilation in an interval of at least two hours, without being total. b.3) Secondary descent stop was considered when, with complete dilation of the uterine cervix, the same height of fetal descent was found in two successive touches with an interval of one hour (Protocol Royal College of Obstetricians and Gynecologists, 2012). |
10 hours
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Admission Numbers to a Neonatal Intensive Care Unit Between Groups.
Periodo de tiempo: 10 hours
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Consider and compare neonatal admission to an intensive care unit between groups, attracted by the partogram
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10 hours
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Number of Newborns With Apgar Scores of 1 and 5 Minutes, Less Than or Greater Than 7.
Periodo de tiempo: 10 hours
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Analyze and compare Apgar scores of the 1-min >7 and 5-min >7, between groups. The APGAR score reflects the degree of fetal maturity and predicts healthy child development. It is a scale that can vary from 0 to 10, which 0 is a bad vitality and 10 is an excellent score. When the APGAR score is below 7, especially in the fifth minute, it is a warning sign to give special attention to the newborn. Newborns who have an Apgar in the first minute greater than 7, demonstrate good birth conditions. |
10 hours
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Frequency of Suspected Fetal Distress, Between Groups
Periodo de tiempo: 10 hours
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Evaluate the frequency of suspected fetal distress with the presence of meconium release.
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10 hours
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Medidas de resultado secundarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
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Moment of Rupture of the Chorioamniorex Between the Groups.
Periodo de tiempo: 10 hours
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Observe if the groups had different types of cervical obstetric dilatation when a chorioamniorexis occurred.
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10 hours
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Incidence in the Type of Delivery (Cesarean Section, Normal Delivery With Laceration, Episiotomy, Forceps and Normal Delivery).
Periodo de tiempo: 10 hours
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Type of delivery (cesarean section, normal delivery with laceration, episiotomy, forceps and normal delivery), collected by the partograph found in the medical record.
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10 hours
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Number of Puerperal Women Who Present Hemorrhage in the Immediate Puerperium With Hemodynamic Repercussions Between Groups.
Periodo de tiempo: immediately postpartum up to 2 days after childbirth
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Evaluate and compare the presence of hemorrhage with hemodynamic repercussions between groups (requiring surgical approach and / or blood transfusion)
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immediately postpartum up to 2 days after childbirth
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The Number of Puerperal Infections Between Groups.
Periodo de tiempo: immediately postpartum up to 2 days after childbirth
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Analyze and compare between the groups the number of puerperal infection
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immediately postpartum up to 2 days after childbirth
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Colaboradores e Investigadores
Aquí es donde encontrará personas y organizaciones involucradas en este estudio.
Patrocinador
Investigadores
- Investigador principal: Alessandra C Marcolin, Professor, Faculty of Medicine of São Paulo University
Publicaciones y enlaces útiles
La persona responsable de ingresar información sobre el estudio proporciona voluntariamente estas publicaciones. Estos pueden ser sobre cualquier cosa relacionada con el estudio.
Fechas de registro del estudio
Estas fechas rastrean el progreso del registro del estudio y los envíos de resultados resumidos a ClinicalTrials.gov. Los registros del estudio y los resultados informados son revisados por la Biblioteca Nacional de Medicina (NLM) para asegurarse de que cumplan con los estándares de control de calidad específicos antes de publicarlos en el sitio web público.
Fechas importantes del estudio
Inicio del estudio
1 de mayo de 2012
Finalización primaria (Actual)
1 de enero de 2016
Finalización del estudio (Actual)
1 de enero de 2016
Fechas de registro del estudio
Enviado por primera vez
19 de septiembre de 2011
Primero enviado que cumplió con los criterios de control de calidad
16 de mayo de 2012
Publicado por primera vez (Estimar)
18 de mayo de 2012
Actualizaciones de registros de estudio
Última actualización publicada (Actual)
9 de junio de 2021
Última actualización enviada que cumplió con los criterios de control de calidad
23 de mayo de 2021
Última verificación
1 de mayo de 2021
Más información
Términos relacionados con este estudio
Palabras clave
Otros números de identificación del estudio
- FR444841
Esta información se obtuvo directamente del sitio web clinicaltrials.gov sin cambios. Si tiene alguna solicitud para cambiar, eliminar o actualizar los detalles de su estudio, comuníquese con register@clinicaltrials.gov. Tan pronto como se implemente un cambio en clinicaltrials.gov, también se actualizará automáticamente en nuestro sitio web. .