Fisioterapia no Período Puerperal: Revisão Sistemática

O puerperio e um periodo cronologicamente variavel, de âmbito impreciso, durante o qual se desenrolam todas as manifestacoes involutivas e de recuperacao da genitalia materna havidas apos o parto. A relevância e a extensao desses processos sao proporcionais ao vulto das transformacoes gestacionais experimentadas e diretamente subordinadas a duracao da gravidez. A fisioterapia e de grande importância para melhor recuperacao das mulheres no pos-parto. Seu papel consiste na recuperacao, prevencao e tratamento de alteracoes nos diversos sistemas. O objetivo deste estudo foi identificar as principais intervencoes fisioterapicas durante o puerperio nas bases de dados e analisar as dificuldades encontradas pelas puerperas durante essa fase. Trata-se de um estudo de revisao sistematica, onde foi realizada uma busca referente ao tema abordado em artigos publicados na base de dados BSV (Biblioteca Virtual de Saude), LILACS (Literatura Latino - Americana e do Caribe em Ciencias da Saude), MEDLINE (Literatura Internacional em Ciencias da Saude), SCIELO (Scientific Eletronic Library Online) e Google Academico, no periodo de fevereiro a maio de 2012. Diante dos estudos identificou-se que as principais intervencoes fisioterapicas durante o puerperio foram estimulacao eletrica nervosa transcutânea (TENS), exercicios para os musculos do assoalho pelvico, de respiracao e reeducacao diafragmatica, orientacoes quanto a postura e amamentacao, exercicios abdominais isometricos, de circulacao para os membros inferiores, crioterapia, massagens abdominais e deambulacao. Dentre as principais dificuldades enfrentadas pelas puerperas, podemos citar as intercorrencias mamarias relacionadas a lactacao (dor, fissuras mamares, mastites, ingurgitamento mamario), incontinencia urinaria, dores incisionais associadas ao corte e episiotomia, sintomas gastrointestinais (constipacoes, timpanismo, dor abdominal) e diastase dos musculos reto-abdominais (DMRA). Diante disso concluimos que a fisioterapia no periodo puerperal visa promover atraves de suas intervencoes durante essa fase, uma melhor adaptacao da mulher a nova realidade corporal que segue ao nascimento de seu filho. Palavras-chave : periodo pos-parto, fisioterapia, saude da mulher. ABSTRACT The puerperium is a period chronologically variable, during which occurs all of involute manifestations and recovery of maternal genitalia after the birth. The relevance and the extension about these process are proportional to the figure of the gestational transformations experimented and directly subordinates during the pregnancy.¬¬ Physical therapy is of a great importance for better recovery of women after childbirth. Its role in recovery, prevention and treatment of changes in different systems.The objective of this study was to identify the main physiotherapy interventions during the postpartum period in the databases and analyze the difficulties encountered by the women during this phase. It is a systematic review study, where a search was conducted on the topic addressed in articles published in the databases BSV (Virtual Health Library), LILACS (Latin American and Caribbean Health Sciences), MEDLINE (International Literature on Health Sciences), SciELO (Scientific Electronic Library Online) and Google Scholar, in the period from February to May 2012. Considering the studies, it was identified that the main physiotherapy interventions during the after the birth period were transcutaneous electrical nerve stimulation (TENS), exercises the pelvic floor muscles, breathing and reeducation of the diaphragma, guidance about the posture of breastfeeding, isometric abdominal exercises, movement for the legs, cryotherapy, abdominal massage and deambulation. Among the main difficulties faced by the women, we can mention the complications related to breast milk (pain, breast fissures, mastitis, and breast engorgement), urinary incontinence, incisional pain associated with cutting and episiotomy, gastrointestinal symptoms (constipation, bloating, and abdominal pain) and diastases of the rectus-abs Given this we conclude that physical therapy in the postpartum period is intended to promote through their interventions during this phase a better adaptation to the new corporal reality for the women that follows the birth of his son. Key words: postpartum period, physical therapy, women's health.