WO2019197348A1

WO2019197348A1 - Postural device for pregnant women

Info

Publication number: WO2019197348A1
Application number: PCT/EP2019/058831
Authority: WO
Inventors: Vanessa Bueno Lopez; Manel Casellas Caro; Elena CARRERAS MORATONAS; Ramon MARTINEZ DE SARASA I PARDAS
Original assignee: Fundació Hospital Universitari Vall D'hebron - Institut De Recerca; Stimulo Design S.L.
Priority date: 2018-04-09
Filing date: 2019-04-08
Publication date: 2019-10-17
Also published as: ES1213089U; ES1213089Y

Abstract

The postural device comprises a body (2) delimited by a lower base (2a), a front wall (2b), a dorsal wall (2c), two side walls (2d), and a support surface (2e) defined between said walls (2b, 2c, 2d). The support surface (2e) comprises a first space (3) defining a first concave curved surface (S3) next to the front wall (2b), configured to allow the knee of a pregnant woman (P) to be supported; and a second space (4) defining a second concave curved surface (S4) extending from the first hole (3) to the dorsal wall (2c), configured to allow the lower leg portion of the pregnant woman (P) to be supported.

Description

POSTURAL DEVICE FOR PREGNANT WOMEN

Field of invention

This invention refers to a postural device for pregnant women, especially a device that facilitates modified Sims position and that favours rotation of occipito-posterior persistent to occipito-anterior fetal variety when the pregnant woman adopts the Sims position on the same side of the fetal dorsum during delivery and carries peridural analgesia.

Background to the invention

The term dystocia literally means difficult, laborious, slow delivery. It is a delivery process that evolves abnormally, because of alterations in the three elements that interact in delivery: motor (uterine dynamics), fetus and the birth canal. These dystocias may be resolved spontaneously or require medical or surgical intervention, assuming an increased maternal-fetal risk. In the context of delivery, fetal

presentation is the part of the fetus that first enters the pelvic canal in delivery. In the course of delivery, by vaginal touch, the relationship between the reference point of the fetal part and the maternal pelvis can be known, this is called fetal position, and allows us to know how the fetus moves through the birth canal.

The optimal position of the fetus during delivery is the cephalic presentation with the back of the head (occiput) directed towards the anterior part of the mother's pelvis. When the head position is posterior, the fetal occiput is oriented towards the posterior quadrants of the maternal pelvis. In this case, it is associated with more painful, prolonged labour and difficult delivery, and is associated with increased maternal- fetal morbidity.

The literature agrees that 40% of women in labour usually have a posterior fetal variety. Of this percentage, between 90-95% rotate to the previous variety, with the rest persisting in this malposition.

One of the maternal positions that can help to rotate the fetal head during delivery is the modified Sims Position, adopting the lateral decubitus position on the same side of the fetal dorsum, with the lower leg on the axis of the body and the upper leg bent at an approximate angle of 90°, elevated and supported, with a slight internal thigh rotation. In this position, the fetal occiput is directed towards the maternal sacrum, delaying the moment of contact of the fetal head with the maternal pubis. In this way, flexion of the fetal head is promoted, and rotation to an occipito-anterior position is facilitated. Thus, a pelvic asymmetry is achieved by increasing the diameters of the middle and lower narrow parts of the pelvis. In addition, the sacrum is in a free condition to perform sacral counternutation and nutation, and thus to further increase the diameters of the maternal pelvis.

Nowadays, most hospitals have "leg" type devices that, installed on corresponding stretchers or surgical tables, allow the leg to be supported. However, these devices are not suitable for carrying out the modified Sims Position described above as they do not provide correct knee and leg support, do not allow internal rotation of the knee and are uncomfortable.

The existence of postural devices to carry out the modified Sims Position described above, as well as their use in intrapartum situations (during dilatation) to facilitate the adoption of said position by pregnant women is thus unknown.

The postural device of the present invention can be used in the clinical/hospital setting to facilitate the adoption of the modified Sims position by the pregnant woman. This increases comfort with respect to the leg and internal rotation of the knee is achieved in all cases. It can be used to rotate fetal heads with later persistent varieties, as well as in the labour final stage, when the head is in a second plane with respect to the pelvis, so as to favour the descent thereof by minor pelvis transverse diameter opening.

The postural device of the present invention can also be used in the domestic field by pregnant women during the third trimester of pregnancy, when abdominal volume begins to be considerable. This often causes difficulties in maintaining a comfortable stretched position, with the difficulty in falling asleep that this entails. In these cases, it is recommended for the woman to adopt a lateral position in order to avoid compression of the vena cava and thus to improve venous return and utero-placental flow. Many pregnant women report pain in her hips or lower abdomen, and resort to cushions or pillows between the legs, which may alleviate discomfort initially, but remain insufficient for positions maintained over time, as might occur during night rest. The use of the postural device of the present invention can facilitate comfort of the pregnant woman in stretched position in these cases.

Summary of the invention The postural device for pregnant women of the present invention comprises a body delimited by a lower base, a front wall, a dorsal wall, two side walls, and a support surface defined between said walls.

This device is characterized in that the support surface comprises:

- a first space next to the front wall, configured to allow the knee of a pregnant woman to be supported; and

- a second space extending from the first space towards the dorsal wall, configured to allow the lower leg portion of the pregnant woman to be supported.

Preferably, a first concave curved surface is defined by the first space to facilitate knee support.

Preferably, a second concave curved surface is defined by the second space to facilitate lower leg portion support.

Preferably, the first space extends transversely between two concave curved entry recesses arranged in the side walls, which facilitate placement of the leg on the device by the patient during use.

Preferably, the first space borders with the front wall by a first convex curved delivery area.

Preferably, the second space extends longitudinally from an intermediate recess in the first space to an exit recess in the dorsal wall.

Preferably, the second space widens longitudinally towards the dorsal wall.

Preferably, the second space borders with each of the side walls by a second flat delivery area.

Preferably, the body has a length of 45 to 55 cm, and a maximum width of 35 to 45 cm. These values are the ones resulting in the ideal angle to get into the modified Sims position.

Preferably, the body has a frontal height and a dorsal height, wherein the frontal height is lower than the dorsal height, defining a substantially triangular or wedge- shaped shape of that body.

Preferably, the frontal height is 18 to 25 cm, while the dorsal height is 35 to 45 cm.

Preferably, the body has a frontal width of 15 to 20 cm, and a dorsal width of 25 to 35 cm.

Preferably, the body has a minimum height of 15 to 16 cm in the first space.

Preferably, the support surface has a longitudinal section that defines an upper contour formed by:

- a convex section starting from the front wall;

- a concave section adjacent to the convex section; and

- an inclined section starting from the concave section and extending up to the dorsal wall.

Preferably, the bottom base, the front wall and the dorsal wall are substantially flat, while the two side walls are substantially curved.

Preferably, the supporting surface borders with the front wall, the dorsal wall and the two side walls by blunt edges to prevent the patient's leg and/or abdomen from compressing unpleasantly. In the same way, preferably, the front and dorsal walls border with the two side walls also by of blunt edges.

Preferably, the body is made of high-density foam or any other material with similar properties, so that it is not deformed by the weight of the limb and so that the limb can be held in an elevated position. According to a particular embodiment, the postural device of the present invention for domestic application may be made from other materials and even have an inflatable character so as to facilitate its storage.

Preferably, the body includes a removable cover fitted over it, so that it can be washed after use.

Preferably, the removable cover comprises an impermeable inner surface and an outer surface made of fabric or synthetic leather, among other possible materials. The use of the postural device in intrapartum situations implies that it can come into contact with body fluids. The impermeable nature of the removable sleeve inner surface prevents these fluids from leaking into the foam and therefore offers increased durability to the device. On the other hand, the textile nature of the removable cover outer surface prevents sweating caused by prolonged skin contact.

Brief description of the drawings

A brief description of a series of drawings are given below that help to better understand the invention and that are expressly related to one embodiment of said invention which is presented as a non-limiting example of the same.

Figure 1 shows a perspective view of the postural device of the present invention. Figure 2 shows a front view of figure 1.

Figure 3 shows a side view of figure 1.

Figure 4 shows a plan view of figure 1.

Figure 5 shows a sectional view taken along line A-A in figure 4.

Figure 6 shows one example of application of the postural device of the present invention.

Detailed description of the invention

As it can be seen from figures 1 and 2, the postural device (1 ) for pregnant women of the present invention comprises a body (2) delimited by a lower base (2a), a front wall (2b), a dorsal wall (2c) , two side walls (2d), and a support surface (2e) defined between these walls (2b, 2c, 2d).

The lower base (2a), the front wall (2b) and the dorsal wall (2c) are substantially flat, while the two side walls (2d) are substantially curved.

The supporting surface (2e) borders with the front wall (2b), the dorsal wall (2c) and the two side walls (2d) by blunt edges (5) to prevent the patient's leg and/or abdomen (P) from compressing unpleasantly. Similarly, the front (2b) and dorsal (2c) walls border with the two side walls (2d) by blunt edges (5).

This device (1 ) is characterised in that the supporting surface (2e) comprises:

- a first space (3) next to the front wall (2b), configured to allow the knee of a pregnant woman (P) to be supported; and - a second space (4) extending from the first space (3) towards the dorsal wall (2c), configured to allow the lower leg portion of the pregnant woman (P) to be supported

A first concave curved surface (S3) is defined by the first space (3) to facilitate support of the knee. Likewise, the first space (3) extends transversally between two concave curved entry recesses (31 ) arranged in the side walls (2d), which facilitate placement of the leg on the device (1 ) by the patient (P), figure 6. In turn, the first space (3) borders with the front wall (2b) by means of a first convex curved delivery area (32).

A second concave curved surface (S4) is defined by the second recess (4) to facilitate support of the lower leg portion, figure 6. In addition, the second space (4) extends longitudinally from an intermediate recess (33) of the first space (3) to an exit recess (41 ) arranged in the dorsal wall (2c). The second space (4) widens

longitudinally towards the dorsal wall (2c). Finally, the second space (4) borders with each of the side walls (2d) by means of a second flat delivery area (42).

As it can be seen from figures 3 and 4, the body (2) preferably has a length (L) of 45 to 55 cm, and a maximum width (W) of 35 to 45 cm. Likewise, the body (2) has a frontal height (Hf) and a dorsal height (Hd), wherein the frontal height (Hf) is lower than the dorsal height (Hd), defining a substantially triangular or wedge-shaped shape thereof. The frontal height (Hf) is preferably 18 to 25 cm, while the dorsal height (Hd) is preferably 35 to 45 cm. In turn, the body (2) has preferably a frontal width (wf) of 15 to 20 cm, and a dorsal width (wd) of 25 to 35 cm.

As it can be seen from figure 5, the body (2) has a minimum height (h) in the first hole (3), preferably of 15 to 16 cm.

On the other hand, the supporting surface (2e) has a longitudinal section that defines an upper contour (2_S) formed by:

- a convex section (2_CV) starting from the front wall (2b);

- a concave section (2_CC) adjacent the convex section (2_CV); and

- an inclined section (2,) starting from the concave section (2_CC) and extending up to the dorsal wall (2c).

The body (2) is made of high-density foam (7), so that it is not deformed by the weight of the limb and can thus hold the limb in an elevated position.

The body (2) comprises a removable cover (6) fitted on top thereof, so that it can be washed after use. The removable cover (6) comprises an impermeable inner surface (S_6i) and an outer surface (S_6e) made of fabric or synthetic leather.

Figure 6 shows one example of the application of the postural device (1 ) of the present invention. Specifically, the pregnant woman or patient (P) is placed in lateral decubitus position on the same side of the fetal dorsum, so that the pregnant uterus rests on the bed. The leg and the upper knee are bent towards the bed and resting on the postural device (1 ). The knee rests on the first space (3), while the lower leg portion rests on the second space (4).

The other leg remains stretched. The upper hip is in flexion of more than 90° and with internal rotation while the lower hip is in extension. The patient (P) is supported on the socket, the femur head and greater trochanter, as in the modified maternal Sims position without postural device (1 ).

With this position, a pelvic asymmetry is achieved by increasing the diameters of the middle and lower narrow parts of the pelvis. The sacrum also has freedom of movement to perform sacral nutation and counternutation which increases the pelvic diameters as the fetus passes through the minor pelvis. The woman remains in this position until the fetal head rotates or labour occurs.

Claims

1. Postural device for pregnant women, comprising a body (2) delimited by a lower base (2a), a front wall (2b), a dorsal wall (2c), two side walls (2d), and a support surface (2e) defined between said walls (2b, 2c, 2d), said device (1 ) being

characterised in that the support surface (2e) comprises:

- a first space (3) next to the front wall (2b), configured to allow the knee of a pregnant woman (P) to be supported; and

- a second hole (4) extending from the first hole (3) to the dorsal wall (2c), configured to allow the lower leg portion of the pregnant woman (P) to be supported.

2. Postural device according to claim 1 , wherein a first concave curved surface (S₃) is defined by the first space (3).

3. Postural device according to any of the claims 1 to 2, wherein a second concave curved surface (S₄) is defined by the second space (4).

4. Postural device according to any of the claims 1 to 3, wherein the first space (3) extends transversally between two concave curved entry recesses (31 ) arranged in the side walls (2d).

5. Postural device according to any of the claims 1 to 4, wherein the first space (3) borders with the front wall (2b) by a first convex curved delivery area (32).

6. Posture device according to any of the claims 1 to 5, wherein the second space (4) extends longitudinally from an intermediate recess (33) of the first space (3) to an exit recess (41 ) arranged in the dorsal wall (2c).

7. Postural device according to any of the claims 1 to 6, wherein the second space (4) widens longitudinally towards the dorsal wall (2c).

8. Postural device according to any of the claims 1 to 7, wherein the second space (4) borders with each of the side walls (2d) by a second flat delivery area (42).

9. Postural device according to any of the claims 1 to 8, wherein the body (2) has: - a length (L) of 45 to 55 cm; and

- a maximum width (W) of 35 to 45 cm.

10. Postural device according to any of the claims 1 to 9, wherein the body (2) has a frontal height (Hf) and a dorsal height (Hd), wherein the frontal height (Hf) is lower than the dorsal height (Hd).

11. Postural device according to claim 10, wherein by the frontal height (Hf) is 18 to 25 cm; and wherein the dorsal height (Hd) is 35 to 45 cm.

12. Postural device according to any of the claims 1 to 11 , wherein the body (2) has:

- a front width (wf) of 15 to 20 cm; and

- a dorsal width (wd) of 25 to 35 cm.

13. Postural device according to any of the claims 1 to 12, wherein the body (2) has:

- a minimum height (h) of 15 to 16 cm in the first space (3).

14. Postural device according to any of the claims 1 to 13, wherein the support surface (2e) has a longitudinal section that defines an upper contour (2_S) formed by:

- a convex section (2_CV) starting from the front wall (2b);

- a concave section (2_CC) adjacent to the convex section (2_CV); and

- an inclined section (2 ) starting from the concave section (2_CC) and extending up to the dorsal wall (2c).

15. Posture device according to any of the claims 1 to 14, wherein the lower base (2a), the front wall (2b) and the dorsal wall (2c) are substantially flat; and wherein the two side walls (2d) are substantially curved.

16. Posture device according to any of the claims 1 to 15, wherein the support surface (2e) borders with the front wall (2b), the dorsal wall (2c) and the two side walls (2d) by blunt edges (5).

17. Postural device according to any of the claims 1 to 16, wherein the body (2) is made of high-density foam (7).

18. Postural device according to any of the claims 1 to 17, wherein the body (2) includes a removable cover (6) fitted over it.

19. Postural device according to claim 18, wherein the removable cover (6) comprises an impermeable inner surface (S_6i) and an outer surface (S₆E) made of fabric or synthetic leather.