Método Materna®: fundamentos e organização do raciocínio fisioterapêutico na gestação de alto risco e no puerpério em terapia intensiva

The admission of high-risk pregnant women and postpartum patients to intensive care units (ICUs) brings together pregnancy-related physiological changes, obstetric complications, and systemic consequences of critical illness. Although hemodynamic stabilization and organ support are immediate priorities, preserving maternal function should also be part of care planning. This article presents the Materna® Method as a conceptual framework for organizing physiotherapeutic clinical reasoning, structured around seven domains: therapeutic movement; muscle activation; respiratory training; pelvic floor exercises; recovery; neuroregulation and hemodynamic and metabolic responses; and continuous assessment. The potential application of these domains to critically ill high-risk pregnant and postpartum patients is discussed, including preeclampsia, obstetric hemorrhage, sepsis, cardiopulmonary complications, and gestational diabetes. The proposed approach integrates clinical assessment, risk analysis, functional goal setting, and individualized progression of interventions, always according to maternal condition and multidisciplinary care. Gestational diabetes does not, by itself, indicate ICU admission; however, it may modify obstetric risk and requires consideration of metabolic status during critical illness and the postpartum period. The Materna® Method may help systematize maternal critical care physiotherapy, provided that its operational definitions, safety, reproducibility, and effectiveness are investigated progressively, without assuming outcomes that have not yet been demonstrated.