الفهرس 
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Abstract
The strength of the pelvic floor muscles can decrease during pregnancy and after delivery owing to the physiological processes and changes in the anatomical position of the pelvis and in the shape of the pelvic floor muscles. Interventions during pregnancy can reduce the occurrence of pelvic floor symptoms and problems during childbirth resulting from these changes (Assis et al., 2017).
Pelvic floor muscles training during pregnancy is beneficial to both the body and mind. It can promote pelvic floor blood circulation,strengthen the pelvic floor muscle tension, and reduce venous compression caused by the pregnant uterus and pelvic fat deposition.It can also promote psychological well-being, facilitate natural childbirth, reduce the need for cesarean section, and reduce the occurrence of dystocia. Finally, it can help to prevent stress urinary incontinence, uterine prolapse, postpartum sexual dysfunction, and other conditions (Luo, 2014).Nurses play an important role in caring for the pregnant women during antenatal period. So, they should have a comprehensive knowledge base regarding techniques, advantages and contraindications of pelvic floor muscles exercise during pregnancy in order to be able to teach pregnant women how to detect the right muscle and how to perform pelvic floor muscles exercise effectively(Rikard-Bell &Iyer, 2014). The purpose of the current study was to assess the effect of structured pelvic floor exercise protocol during pregnancy on labor progress. The present study was conducted at Maternal and Child
Health Centers (Quibli and Bahari) at Shebin El-Kom , University hospital , Teaching Hospital and other private centers according to place of labor. A quasi-experimental design was used in carrying out the study.Non probability (purposive) sample that consists of (74)pregnant women. The participants were divided into two groups by randomization. Each of the 74 women was asked to pick a piece of paper containing a number; those who selected number 1were assigned to the study group and those who selected number 2 were assigned to the control group. This 1- The study group which included (37) pregnant women undergo pelvic floor muscle exercise training during the third trimester and were evaluated during labor using partograph. 2- The control group which included (37) pregnant women did not perform pelvic floor muscles exercise and were also evaluated during labor using partograph. Inclusion criteria of the participants:Both groups have the following criteria:a- Age: not more than 35 years old. b- Gestational age: 29 weeks gestation (third trimester).c- Type of pregnancy: single normal pregnancy. d- Gravidity: up to gravida 3.
e- Parity: up to para 2.Throughout the course of the present study, data were collected using four instruments which were developed by the researcher after reviewing related literature and validating them by a jury of qualified expert. Also, their reliability was computed. Instruments were as follows:Instrument I: Socio-Demographic Data Questionnaire included socio-demographic data, previous obstetric history, past medical and family history and current pregnancy data.Instrument II: Antenatal follow-up assessment tool included date of visit, expected date of the delivery (EDD), weight, vital signs and abdominal examination for detecting gestational age and the fetal heart rate (FHR) Instrument III: Pelvic floor muscle exercise checklist included a follow up of exercise application which contained number of weeks of exercise application, number of exercise frequency per day and duration of each contraction and relaxation and checklist for exercise application.Instrument IV: Partograph included maternal condition, fetal condition and labor progress.An approval from the committee of Hearing and Ethics was obtained from Faculty of Nursing, Menoufia University on 12/7/2017. Approaches to ensuring ethics were considered in the study regarding confidentiality and informed consent. The researcher introduced herself to the participants and explained the purpose of the study in order to obtain their acceptance to be recruited in the study as well as to gain their cooperation. Confidentiality was achieved by the use of closed sheets with the names of participants replaced by numbers. All women were informed that the information they provided during the study would be kept confidential and used only for statistical purpose and after finishing the study, the findings would be presented as a group data
with no personal participants’ information remained. After the explanation prior to enrollment in the study, informed consent was obtained verbally from all women. Each woman was informed that participation in the study was voluntary, and that she could withdraw from the study whenever she decided to. Each one was given the opportunity to freely refuse participation. They were free to ask any question about the study details. Upon the completion of data collection, each answer was coded and scored. The researcher coded the data into a coding sheet so that data could be prepared for computer use. Data was statistically analyzed using (Statistical Package for the Social Sciences, version 22, SPSS Inc. Chicago, IL, USA). The findings of this study supported the two study hypotheses. The pregnant women who followed pelvic floor exercise protocol during pregnancy experienced better progress of labor and shorter duration of labor than those who did not follow.
The findings of the present study showed that: There was no statistically significant difference between the study groups regarding socio-demographic characteristics, previous
obstetrics history and current pregnancy. There was no statistically significant difference between the study groups regarding gestational age, condition of membrane and cause of admission to labor unit. There was a highly statistically significant difference regarding cervical dilation on admission to labor unit among the study groups. There was a highly statistically significant difference regarding effacement on admission to labor unit among the study groups. There was no statistically significant difference regarding station and duration of uterine contraction on admission to the labor unit among the study groups. There was a statistically significant difference regarding the frequency of uterine contractions on admission to the labor unit
among the study groups. There was no statistically significant difference regarding the progress in the cervical dilatation among the study groups. There was a statistically significant difference regarding the progress in effacement and station among the study groups. There was a statistically significant difference regarding frequency of uterine contraction during the first stage of labor among the study groups. There was no statistically significant difference regarding duration of uterine contractions throughout the first stage of labor among the study groups.
There was a highly statistically significant difference regarding duration of the first, second and third stages of labor among the study groups. The findings showed that the pelvic floor muscles exercise during pregnancy had a more positive effect on labor progress and labor duration.