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Publication
Efecto del masaje perineal prenatal en la promociĆ³n de la integridad perineal: estudio piloto
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Abstract(s)
La EnfermerĆa de Salud Materna y ObstĆ©trica exige del Enfermero Especialista una actuaciĆ³n cualificada, sustentada en competencias tĆ©cnicas, cientĆficas y relacionales, que abarcan la responsabilidad profesional, Ć©tica y legal, la mejora continua de la calidad, la gestiĆ³n de los cuidados y el desarrollo de aprendizajes profesionales. El EstĆ”gio de Natureza Profissional (ENP) constituye, en este itinerario formativo, una etapa esencial para la consolidaciĆ³n de dichas competencias. En este contexto, el presente informe refleja el proceso de adquisiciĆ³n y desarrollo de las competencias especĆficas de la especialidad, teniendo como eje central la profundizaciĆ³n del conocimiento sobre el masaje perineal en el perĆodo prenatal.
Objetivos: Realizar una apreciaciĆ³n crĆtico-reflexiva sobre la adquisiciĆ³n y desarrollo de las competencias especĆficas del Enfermero Especialista en Salud Materna y ObstĆ©trica (EESMO), con Ć©nfasis en el fortalecimiento de las competencias asistenciales y de investigaciĆ³n llevadas a cabo durante el ENP.
MetodologĆa: El presente informe ofrece una reflexiĆ³n crĆtica sobre las actividades realizadas durante el ENP, conforme a las directrices legales generales y las establecidas por la Ordem dos Enfermeiros, evidenciando la adquisiciĆ³n de las experiencias obligatorias. Integra tambiĆ©n un estudio piloto aleatorizado y controlado, titulado āEfecto del masaje perineal prenatal en la promociĆ³n de la integridad perinealā. La muestra estuvo compuesta por 63 gestantes de bajo riesgo, de las cuales 34 fueron asignadas al grupo de intervenciĆ³n y 29 al grupo control. Las participantes del grupo de intervenciĆ³n recibieron una sesiĆ³n educativa estructurada sobre la tĆ©cnica del masaje perineal y fueron orientadas a realizarla diariamente, entre 5 y 10 minutos, desde la semana 34 de gestaciĆ³n hasta el parto, mediante automasaje o con la asistencia de una persona significativa, registrando cada sesiĆ³n en un formulario individual. El grupo control recibiĆ³ la atenciĆ³n habitual.
Mediante cuestionarios y revisiĆ³n de la Cartilla de Salud de la Gestante y de la Cartilla de Salud Infantil se recogieron y analizaron variables relacionadas con el conocimiento, viabilidad y aceptabilidad de la intervenciĆ³n propuesta, ademĆ”s de variables sociodemogrĆ”ficas, clĆnico-obstĆ©tricas, neonatales. Para el anĆ”lisis del efecto de la
intervenciĆ³n sobre el trauma perineal, se incluyeron exclusivamente las participantes con parto eutĆ³cico (n = 24). Los datos fueron analizados mediante el software SPSS (versiĆ³n 29), utilizando anĆ”lisis descriptivo y analĆtico. El estudio fue aprobado por el ComitĆ© de Ćtica de la ULSNE, con el parecer n.Āŗ 23/2024.
Resultados: En lo que respecta el ENP, se cumplieron los objetivos propuestos para esta etapa formativa, permitiendo la integraciĆ³n efectiva de los conocimientos adquiridos a lo largo del curso con la prĆ”ctica clĆnica. En cuanto al estudio piloto, se observĆ³ una alta aceptabilidad y adherencia a la intervenciĆ³n (5,11 sesiones/semana, 9,5 minutos por sesiĆ³n, durante 4,77 semanas), aplicada mediante automasaje o asistida por la persona significativa para la participante (54% vs. 45%). Solo el 19% de las participantes referĆa conocimiento previo sobre el masaje perineal prenatal. La integridad perineal se asociĆ³ significativamente con una mayor duraciĆ³n del tratamiento (5,67 vs. 3,74 semanas; p=0,037) y mayor duraciĆ³n media por sesiĆ³n (10,66 vs. 7,27 minutos; p=0,041). Aunque no se alcanzĆ³ significaciĆ³n estadĆstica (p=0,193), se identificĆ³ una tendencia favorable en el grupo que realizĆ³ el masaje, con mayor proporciĆ³n de perinĆ© Ćntegro (50,0% vs. 16,7%) y menor tasa de episiotomĆa (16,7% vs. 50,0%) en comparaciĆ³n con el grupo control.
ConclusiĆ³n: El ENP y la reflexiĆ³n crĆtica desarrollada a lo largo de este proceso permitieron consolidar, mediante la elaboraciĆ³n del presente informe, la adquisiciĆ³n y fortalecimiento de las competencias esenciales para la prĆ”ctica especializada en EnfermerĆa de Salud Materna y ObstĆ©trica. El masaje perineal prenatal se revelĆ³ como una intervenciĆ³n viable y bien aceptada por las gestantes, incluso en un contexto donde su conocimiento previo es escaso. Este estudio piloto aporta evidencia preliminar relevante para el diseƱo de futuros ensayos clĆnicos aleatorizados de mayor escala y representa una de las primeras contribuciones experimentales sobre el tema en el contexto
nacional.
Maternal and Obstetric Health Nursing requires the Specialist Nurse to perform in a qualified manner, supported by technical, scientific, and relational competencies that encompass professional, ethical, and legal responsibility, continuous quality improvement, care management, and the development of professional learning. The Professional Nature Internship (ENP) constitutes, in this training path, an essential stage for consolidating these competencies. In this context, this report reflects the process of acquisition and development of the specific competencies of the specialty, with a central focus on deepening knowledge about perineal massage during the prenatal period. Objectives: To carry out a critical-reflective assessment of the acquisition and development of the specific competencies of the Specialist Nurse in Maternal and Obstetric Health (EESMO), with emphasis on strengthening the care and research competencies developed during the ENP. Methodology: This report offers a critical reflection on the activities carried out during the ENP, in accordance with the general legal guidelines and those established by the Ordem dos Enfermeiros (Portuguese Nursing Council), demonstrating the acquisition of the mandatory experiences. It also includes a randomised and controlled pilot study, entitled āEffect of Prenatal Perineal Massage on the Promotion of Perineal Integrity.ā The sample consisted of 63 low-risk pregnant women, of whom 34 were assigned to the intervention group and 29 to the control group. The participants in the intervention group received a structured educational session on the perineal massage technique and were instructed to perform it daily, for 5 to 10 minutes, from week 34 of pregnancy until delivery, by self-massage or with the assistance of a significant other, recording each session on an individual form. The control group received usual care. Through questionnaires and a review of the Maternal and Child Health Booklets, variables related to knowledge, feasibility, and acceptability of the proposed intervention were collected and analysed, in addition to sociodemographic, clinical-obstetric, and neonatal variables. For the analysis of the effect of the intervention on perineal trauma, only participants with eutocic delivery (n = 24) were included. The data were analysed using SPSS software (version 29), with descriptive and analytical analysis. The study was approved by the Ethics Committee of ULSNE, under opinion no. 23/2024. Results: Regarding the ENP, the objectives proposed for this training stage were achieved, allowing for the effective integration of the knowledge acquired throughout the course with clinical practice. As for the pilot study, high acceptability and adherence to the intervention were observed (5.11 sessions/week, 9.5 minutes per session, over 4.77 weeks), applied through self-massage or assisted by a significant person (54% vs. 45%). Only 19% of the participants reported prior knowledge of prenatal perineal massage. Perineal integrity was significantly associated with longer duration of treatment (5.67 vs. 3.74 weeks; p=0.037) and longer average session duration (10.66 vs. 7.27 minutes; p=0.041). Although statistical significance was not reached (p=0.193), a favourable trend was identified in the massage group, with a higher proportion of intact perineum (50.0% vs. 16.7%) and a lower episiotomy rate (16.7% vs. 50.0%) compared to the control group. Conclusion: The ENP and the critical reflection developed throughout this process enabled the consolidation, through the drafting of this report, of the acquisition and strengthening of the essential competencies for specialised practice in Maternal and Obstetric Health Nursing. Prenatal perineal massage proved to be a viable and well-accepted intervention among pregnant women, even in a context where prior knowledge of it is limited. This pilot study provides relevant preliminary evidence for the design of future large-scale randomised clinical trials and represents one of the first experimental contributions on the topic in the national context.
Maternal and Obstetric Health Nursing requires the Specialist Nurse to perform in a qualified manner, supported by technical, scientific, and relational competencies that encompass professional, ethical, and legal responsibility, continuous quality improvement, care management, and the development of professional learning. The Professional Nature Internship (ENP) constitutes, in this training path, an essential stage for consolidating these competencies. In this context, this report reflects the process of acquisition and development of the specific competencies of the specialty, with a central focus on deepening knowledge about perineal massage during the prenatal period. Objectives: To carry out a critical-reflective assessment of the acquisition and development of the specific competencies of the Specialist Nurse in Maternal and Obstetric Health (EESMO), with emphasis on strengthening the care and research competencies developed during the ENP. Methodology: This report offers a critical reflection on the activities carried out during the ENP, in accordance with the general legal guidelines and those established by the Ordem dos Enfermeiros (Portuguese Nursing Council), demonstrating the acquisition of the mandatory experiences. It also includes a randomised and controlled pilot study, entitled āEffect of Prenatal Perineal Massage on the Promotion of Perineal Integrity.ā The sample consisted of 63 low-risk pregnant women, of whom 34 were assigned to the intervention group and 29 to the control group. The participants in the intervention group received a structured educational session on the perineal massage technique and were instructed to perform it daily, for 5 to 10 minutes, from week 34 of pregnancy until delivery, by self-massage or with the assistance of a significant other, recording each session on an individual form. The control group received usual care. Through questionnaires and a review of the Maternal and Child Health Booklets, variables related to knowledge, feasibility, and acceptability of the proposed intervention were collected and analysed, in addition to sociodemographic, clinical-obstetric, and neonatal variables. For the analysis of the effect of the intervention on perineal trauma, only participants with eutocic delivery (n = 24) were included. The data were analysed using SPSS software (version 29), with descriptive and analytical analysis. The study was approved by the Ethics Committee of ULSNE, under opinion no. 23/2024. Results: Regarding the ENP, the objectives proposed for this training stage were achieved, allowing for the effective integration of the knowledge acquired throughout the course with clinical practice. As for the pilot study, high acceptability and adherence to the intervention were observed (5.11 sessions/week, 9.5 minutes per session, over 4.77 weeks), applied through self-massage or assisted by a significant person (54% vs. 45%). Only 19% of the participants reported prior knowledge of prenatal perineal massage. Perineal integrity was significantly associated with longer duration of treatment (5.67 vs. 3.74 weeks; p=0.037) and longer average session duration (10.66 vs. 7.27 minutes; p=0.041). Although statistical significance was not reached (p=0.193), a favourable trend was identified in the massage group, with a higher proportion of intact perineum (50.0% vs. 16.7%) and a lower episiotomy rate (16.7% vs. 50.0%) compared to the control group. Conclusion: The ENP and the critical reflection developed throughout this process enabled the consolidation, through the drafting of this report, of the acquisition and strengthening of the essential competencies for specialised practice in Maternal and Obstetric Health Nursing. Prenatal perineal massage proved to be a viable and well-accepted intervention among pregnant women, even in a context where prior knowledge of it is limited. This pilot study provides relevant preliminary evidence for the design of future large-scale randomised clinical trials and represents one of the first experimental contributions on the topic in the national context.
Description
Mestrado em parceria com a Escola Superior de SaĆŗde do IPVC e UTAD
Keywords
Matrona Cuidado prenatal PerinĆ© EpisiotomĆa Desgarros perineales