Manual Physical Therapy During Pregnancy on Post Partum Perineal Trauma and Pain

Study Overview
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Brief Summary
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The purpose of this study is to explore the impact of pelvic floor physical therapy during pregnancy on delivery and the impact on the woman's body and function. Currently there have not been any studies to our knowledge that have examined this relationship and the outcomes for the pregnant patient. The current research that is available is on pelvic floor training and perineal massage during pregnancy with positive outcomes. The questions we are looking to answer include: Does pelvic floor physical therapy during pregnancy decrease the severity of perineal trauma during delivery? Does pelvic floor physical therapy during pregnancy decrease the length of the second stage of labor (pushing)? Does pelvic floor physical therapy during pregnancy decrease the occurrence of emergency C-section?

Detailed Description
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The purpose of this study is to explore the impact of pelvic floor manual physical therapy techniques during pregnancy on delivery and the impact on the woman's body and function. Currently there have not been any studies to our knowledge that have examined this relationship and the outcomes for the pregnant patient. The current research that is available is on pelvic floor training and perineal massage during pregnancy with positive outcomes. Perineal massage is a stretching technique utilized to relax the tissue of the perineum (the area between the vaginal opening and anus), and is considered routine physical therapy standard of care for pregnant women. Myofascial release of the pelvic floor is a specific manual therapy technique to relax the muscles of the pelvic floor which can include the superficial perineal area. Pelvic myofascial release is a technique used for both pregnant women, and women with chronic pelvic pain. In fact, each component of assessment and treatment are routine and standard PT practices (evaluation, manual therapy, exercise, education), however this specific manual therapy treatment protocol has not been studied during pregnancy to assess the benefits on delivery/recovery. The questions we are looking to answer include: Does pelvic floor PT (physical therapy) during pregnancy decrease the severity of perineal trauma during delivery? Does pelvic floor PT during pregnancy decrease the length of the second stage of labor (pushing)? Does pelvic floor PT during pregnancy decrease the occurrence of emergency C-section? Does pelvic floor PT during pregnancy decrease the likelihood and/or severity of postpartum pelvic pain and pelvic dysfunction? By obtaining these findings, it will allow for program design and treatment recommendations within the pregnancy period to minimize delivery trauma and risk for the mother.

Official Title
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Effect of Manual Pelvic Floor Physical Therapy During Pregnancy on Perineal Trauma and Pain in the Post Partum Period

Conditions
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Pregnancy Related, Delivery; Injury, Maternal, Pelvic Floor Disorders

Intervention / Treatment
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* Behavioral: manual physical therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Pregnant women (any pregnancy, first or subsequent) planning for a vaginal delivery 28-34 weeks gestation at the start of treatment Exclusion Criteria: Planned c-section < 18 years old >34 weeks gestation Women on pelvic rest

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Interventional Model Description: single-cohort quasi-experimental longitudinal interventions study
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Pregnant women<br>Physical assessment for women 20-34 weeks gestation including evaluating pain, back and hip range of motion, strength of hip and abdominal muscles, diastasis recti, and strength, amount of scar tissue from previous pregnancies / deliveries, level of muscle overactivity, and the extent of any prolapse of pelvic floor muscles. Treatment: internal and external myofascial release of the pelvic floor muscles, pelvic floor stretching, and instruction diaphragmatic breathing and exercises for postpartum recovery to perform at home. Exercises include: Pelvic floor stretching: happy baby stretch, deep squat, butterfly stretch; Belly breathing; transverse abdominis contraction, transverse abdominis march, bridge, shoulder blade; Instruction and education on perineal massage and posture. | Behavioral: manual physical therapy<br>* Previously described in the arm description<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Quality of Life and Symptoms Distress Inventory | standardized survey to assess level of urinary leakage post partum (0-45 with the higher score indicating greater impairment | 7 weeks | 
| Pregnancy Mobility Index | standardized survey to determine functional mobility post partum (0 - 72 with a higher score indicating greater impairment) | 7 weeks | 
| Delivery type | natural or cesarean section (categorical data) | 7 weeks | 
| Length of labor | length of labor measured in hours | 7 weeks | 
| Amount of perineal tearing | measured in cm | 7 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Manual therapy, physical therapy, post partum