Evolução dos achados eletromiográficos dos músculos do assoalho pélvico de gestantes com diabete melito gestacional
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Data
2017-02-21
Autores
Prudencio, Caroline Baldini [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Foi realizado estudo de coorte prospectiva para analisar a evolução dos achados eletromiográficos dos músculos do assoalho pélvico de gestantes com diabete melito gestacional entre 24-30 e 36-40 semanas gestacionais. O estudo foi conduzido no Centro de Investigação Clínica e Experimental do Diabete na Gestação da Faculdade de Medicina de Botucatu /UNESP com 52 gestantes divididas em dois grupos: (DMG) 26 gestantes com diabete melito gestacional e (NG) 26 gestantes normoglicêmicas. Foi realizado eletromiografia dos músculos do assoalho pélvico de nulíparas ou primíparas com cesariana prévia diagnosticadas com diabete melito gestacional da American Diabetes Association. Os critérios de não elegibilidade foram diabete clínico, mais de duas gestações, prolapso genitais ou cirurgia uroginecológicas, doenças neurológicas, exercício físico e tabagismo. Previamente a eletromiografia foi realizado instrução sobre a anatomia e funcionalidade do assoalho pélvico. Partes do protocolo de Glazer foram aplicadas entre 24-30 semanas gestacionais e reaplicadas entre 36-40 semanas gestacionais para analisar a evolução no recrutamento em repouso, nas contrações fásicas e tônica. O recrutamento foi analisado pelo cálculo do root mean square normalizado pelo pico das contrações fásicas entre 24-30 semanas gestacionais que foi considerado como parâmetro inicial de contração dos músculos do assoalho pélvico. Os dados demográficos e obstétricos demonstraram-se homogêneos entre os grupos. Em relação a evolução do recrutamento dos músculos do assoalho pélvico no grupo DMG houve diminuição estatística no repouso (p=0,042) e na contração tônica (p=0,044) entre 24-30 e 36-40 semanas gestacionais quando comparadas com o grupo NG. Demonstrando que o diabete melito gestacional diminuiu a atividade do assoalho pélvico durante o repouso e contração tônica entre 36-40 semanas gestacionais.
Objective: To analyze the impact of gestational diabetes mellitus (GDM) on pelvic floor muscle (PFM) electromyography (EMG) activity progress from 24–30 to 36–40 weeks of gestation. Methods: We conducted a prospective cohort study at the Perinatal Diabetes Research Center, Botucatu Medical School/UNESP/Brazil. PFM EMG was performed in nulliparous or primiparous women with one previous elective cesarean delivery and GDM diagnosed by the American Diabetes Association criteria. The exclusion criteria were clinical diabetes, >2 pregnancies, previous prolapse or anti-incontinence surgery, neurological diseases, genital prolapse and smoking. A careful explanation of the muscle anatomy and functionality of the PFM was given before EMG assessment. Modified Glazer protocol analysis was performed at 24–30 and 36–40 weeks of gestation to assess progress on recruitment in rest-activity, and fast and hold contractions. The recruitment was analyzed by the root mean square normalized to the maximal fast contraction at 24–30 weeks of gestation. Results: Fifty-two pregnant women were assigned to 2 groups: the GDM (n=26) and normoglycemic (NG) (n=26). The demographic and obstetric data showed homogeneity between the groups. PFM activity progress was decreased in rest-activity (P=0.042) and hold contraction (P=0.044) at 36–40 weeks of gestation in the GDM group relative to that in the NG group. Conclusion: GDM decreased PFM activity in rest-activity and during hold contraction between 24–30 and 36–40 weeks of gestation.
Objective: To analyze the impact of gestational diabetes mellitus (GDM) on pelvic floor muscle (PFM) electromyography (EMG) activity progress from 24–30 to 36–40 weeks of gestation. Methods: We conducted a prospective cohort study at the Perinatal Diabetes Research Center, Botucatu Medical School/UNESP/Brazil. PFM EMG was performed in nulliparous or primiparous women with one previous elective cesarean delivery and GDM diagnosed by the American Diabetes Association criteria. The exclusion criteria were clinical diabetes, >2 pregnancies, previous prolapse or anti-incontinence surgery, neurological diseases, genital prolapse and smoking. A careful explanation of the muscle anatomy and functionality of the PFM was given before EMG assessment. Modified Glazer protocol analysis was performed at 24–30 and 36–40 weeks of gestation to assess progress on recruitment in rest-activity, and fast and hold contractions. The recruitment was analyzed by the root mean square normalized to the maximal fast contraction at 24–30 weeks of gestation. Results: Fifty-two pregnant women were assigned to 2 groups: the GDM (n=26) and normoglycemic (NG) (n=26). The demographic and obstetric data showed homogeneity between the groups. PFM activity progress was decreased in rest-activity (P=0.042) and hold contraction (P=0.044) at 36–40 weeks of gestation in the GDM group relative to that in the NG group. Conclusion: GDM decreased PFM activity in rest-activity and during hold contraction between 24–30 and 36–40 weeks of gestation.
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Palavras-chave
Diabetes, Electromyography, Pelvic floor, Pregnancy