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Abstract(s)
Introdução: A episiotomia é uma incisão cirúrgica feita na vagina e região perineal durante o segundo estágio do trabalho de parto com o objetivo de aumentar a abertura vaginal e facilitar o parto. Inicialmente utilizada de forma rotineira, atualmente defende-se o seu uso seletivo. Contudo, a sua aplicação continua a ser alvo de grande discórdia na comunidade médica pois não está isenta de complicações.
Objetivos: Revisão da episiotomia enquanto procedimento cirúrgico de assistência ao parto vaginal e avaliação da sua aplicação no Centro Hospitalar Cova da Beira (CHCB).
Metodologia: O presente estudo trata-se de uma investigação observacional retrospetiva, realizada através de consulta de processos clínicos de utentes do CHCB. Foram incluídas todas as mulheres com partos eutócicos realizados entre 1 de Janeiro de 2017 e 31 de Dezembro de 2017. Excluíram-se partos instrumentalizados, partos gemelares, partos com feto em apresentação pélvica e cesarianas. Os parâmetros avaliados para cada parturiente foram o aparecimento de lacerações perineais espontâneas e realização de episiotomia. Adicionalmente identificaram-se múltiplas variáveis materno-fetais e complicações no pós-parto. A análise estatística foi realizada através do SPSS Statistics versão 23.0.
Resultados: Obteve-se um total de 283 parturientes, com uma taxa de episiotomia de 55,8%. Após análise, as variáveis que demonstraram relação significativamente estatística com a realização de episiotomia são: número de partos vaginais (p-valor 0,000), complicações perineais (p-valor 0,045), anemia pós-parto (p-valor 0,004) e danos nos esfíncteres (p-valor 0,000). Relativamente ao aparecimento de lacerações perineais espontâneas apenas se demonstrou relação com o número de partos vaginais (p-valor 0,000) e administração de analgesia epidural (p-valor 0,023).
Conclusões: Existe uma certa tendência para um uso um tanto liberal da episiotomia, com clara predominância da sua utilização em primíparas. Demonstrou-se ainda associação entre a utilização desta técnica e aumento da incidência de complicações maternas como danos nos esfíncteres, hematomas no períneo e anemia no pós-parto.
Introduction: Episiotomy is a surgical incision performed in the vagina and perineal region during the second stage of delivery to increase the vaginal opening and facilitate childbirth. Initially used routinely, nowadays it is favored its selective use. Nevertheless, episiotomy utilization is not widely accepted in the medical community since it is not free of complications. Objectives: Episiotomy review as a surgical procedure of support of vaginal delivery and study of its application in Centro Hospitalar Cova da Beira (CHCB). Methodology: The present study is a retrospective observational investigation carried out by consulting clinical processes of CHCB patients. All women with vaginal deliveries performed between January 1, 2017 and December 31, 2017 were included. Instrumental deliveries, twin childbirth, deliveries with fetuses in pelvic presentation and cesarean section were excluded. The parameters evaluated for each parturient were the presence of spontaneous perineal lacerations and episiotomy. In addition, multiple maternal and fetal variables and postpartum complications were also identified. Statistical analysis was performed using SPSS Statistics version 23.0. Results: A total of 283 women were included in the study, with an episiotomy rate of 55,8%. After analysis, the variables that demonstrated a statistically significant relationship with episiotomy were: number of vaginal deliveries (p-value 0,000), perineal complications (p-value 0,045), postpartum anaemia (p-value 0,004) and sphincter damage (p-value 0,000). Regarding spontaneous perineal lacerations, only the number of vaginal deliveries (p-value 0,000) and epidural analgesia (p-value 0,023) showed a statistical association. Conclusions: It is observable a certain tendency for a liberal use of episiotomy, with a clear predominance in women in their first delivery. It was also demonstrated an association between the practice of this technique and an increased incidence of maternal complications, such as sphincter damage, perineal haematoma and postpartum anaemia.
Introduction: Episiotomy is a surgical incision performed in the vagina and perineal region during the second stage of delivery to increase the vaginal opening and facilitate childbirth. Initially used routinely, nowadays it is favored its selective use. Nevertheless, episiotomy utilization is not widely accepted in the medical community since it is not free of complications. Objectives: Episiotomy review as a surgical procedure of support of vaginal delivery and study of its application in Centro Hospitalar Cova da Beira (CHCB). Methodology: The present study is a retrospective observational investigation carried out by consulting clinical processes of CHCB patients. All women with vaginal deliveries performed between January 1, 2017 and December 31, 2017 were included. Instrumental deliveries, twin childbirth, deliveries with fetuses in pelvic presentation and cesarean section were excluded. The parameters evaluated for each parturient were the presence of spontaneous perineal lacerations and episiotomy. In addition, multiple maternal and fetal variables and postpartum complications were also identified. Statistical analysis was performed using SPSS Statistics version 23.0. Results: A total of 283 women were included in the study, with an episiotomy rate of 55,8%. After analysis, the variables that demonstrated a statistically significant relationship with episiotomy were: number of vaginal deliveries (p-value 0,000), perineal complications (p-value 0,045), postpartum anaemia (p-value 0,004) and sphincter damage (p-value 0,000). Regarding spontaneous perineal lacerations, only the number of vaginal deliveries (p-value 0,000) and epidural analgesia (p-value 0,023) showed a statistical association. Conclusions: It is observable a certain tendency for a liberal use of episiotomy, with a clear predominance in women in their first delivery. It was also demonstrated an association between the practice of this technique and an increased incidence of maternal complications, such as sphincter damage, perineal haematoma and postpartum anaemia.
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Keywords
Complicações Episiotomia Epidural Hematoma do Períneo Indicações Episiotomia Lacerações Perineais Técnica Episiotomia