Análise ultrassonográfica tridimensional transperineal dos efeitos do alongamento perineal com o Epi-no® em gemeligestas - estudo comparativo

Objective: To compare the changes in the pelvic floor of women with multiple pregnancies who practiced muscle stretching with the Epi-no® vaginal dilator, as assessed using transperineal three-dimensional ultrasound (3DUS). Method: This prospective cross-sectional case-control study included nulliparous women in the third trimester of their multiple pregnancies and divided them into the control group (CG, n=9) and EPINO® group (EpiG, n=9). During pretreatment, the women underwent transperineal 3DUS to establish the measurements of the pelvic floor. The CG received guidance regarding pelvic floor muscles, whereas the EpiG underwent weekly physical therapy sessions with the Epi-no® dilator for 20 min/day. Following this treatment, all women were reassessed using transperineal 3DUS, and the diameter of the Epi-no® balloons of the women in the EpiG was measured (epinometry). Paired samples t-test was used for comparative analysis. Results: The EpiG showed improved perineal distensibility, which was evidenced by the increase in sagittal diameter at rest (p<0.01). Transperineal 3DUS among women in the EpiG showed a significant increase in the sagittal measurement (p=0.02), hiatal circumference at rest (p=0.03), and epinometry values (diameter of the Epino® balloon; p<0.01). The increase in epinometry values was directly correlated (p=0.02) with the number of physical therapy sessions. Conclusion: Epi-no® increased pelvic floor distensibility in women with multiple pregnancies, as confirmed using transperineal 3DUS and epinometry. This device promoted an increase in perineal distensibility with a single use; however, better results would be obtained with additional sessions.Objetivo: Comparar as modificações do assoalho pélvico de gemeligestas que realizaram alongamento muscular com o dilatador vaginal Epi-no® utilizando ultrassonografia tridimensional (US3D) transperineal. Método: Estudo prospectivo transversal tipo caso-controle. Foram incluídas gemeligestas nulíparas no terceiro trimestre gestacional divididas em grupo controle (GC, n=9) e grupo Epi-no® (GEpi, n=9). No pré-tratamento, as gestantes realizaram US3D transperineal para avaliar as medidas do assoalho pélvico. O GC recebeu orientações sobre a musculatura do assoalho pélvico e o GEpi fez sessões semanais de fisioterapia com o dilatador Epi-no® 20min/dia. Após tratamento, todas as mulheres foram reavaliadas pela US3D transperineal e as mulheres do GEpi fizeram também a medida do diâmetro (epinometria) do balão do Epi-no®. As comparações foram realizadas pelo teste t-pareado. Resultados: O GEpi apresentou melhora da distensibilidade perineal evidenciada pelo aumento das medidas do diâmetro anteroposterior (AP) em repouso (p<0,01). O GEpi apresentou aumento significativo evidenciado pela US3D transperineal das medidas AP (p=0,02), circunferência do hiato em repouso (p=0,03) e epinometria (p