Introduction: Perineal trauma at birth is distressing for women and can cause serious short and long term morbidity. Aim: Investigate the prevalence and predictive factors of intact perineum after normal vaginal birth among Portuguese women who had spontaneous vaginal births. Methods: A descriptive, cross-sectional, retrospective study was carried out among pregnant women who had spontaneous vaginal births, between January 1, 2017, and December 31, 2017, in a single birth centre in Portugal. Following ethical approval, the prevalence of intact perineum was calculated and multivariate analysis with logistic regression was carried out, to identify the predictive factors of having an intact perineum after spontaneous vaginal birth. Results: A total of 1748 pregnant women had spontaneous vaginal births. Four hundred and forty-one women (25.2%) had intact perineum whereas in 1307 (74.8%) of women, the perineum was not intact. First-degree tears occurred in 23.2% (405/1748) of women, second-degree tears occurred in 4% (70/1748) of women while three women (0.2%) experienced a third-degree tear. The rate of episiotomies was 43.8% (766/1748). Episiotomy and first-degree tears occurred in 2.6% (45/1748), episiotomy and second-degree tears occurred in 0.7% (12/1748), while episiotomy and third-degree tears occurred in 0.3% (6/1748) of women. Having a previous caesarean section reduced the odds of intact perineum by 60%, while nulliparity reduced the odds by 70%. For every 250 grams increase in birth weight, the odds of sustaining an intact perineum were decreased by 13%. Alternative birth positions (excluding lithotomy) doubled the odds of maintaining an intact perineum. Conclusion: The prevalence of intact perineum is 25,2%. Predictive factors for intact perineum include birth weight, parity, previous caesarean section and birthing position. Recognizing these factors could support and facilitate the management of spontaneous vaginal birth to promote an intact perineum. Further research is needed to gain better understanding of this phenomenon.

Parto eutócico versus cesariana eletiva e o impacto no desenvolvimento de competências da criançaVaginal delivery versus elective cesarean section and the impact on children's skill development Parto eutócico frente a cesárea electiva e impacto en el desarrollo de las competencias del niño Sílvia Manuela Leite Rodrigues*; Paulo Manuel Marques Silva** ResumoEnquadramento: A cesariana é associada a diferente desenvolvimento de competências na criança. Deste modo, o tipo de parto pode influenciar a saúde da criança. Objetivos: Verificar se existem diferenças significativas entre os nascidos de parto eutócico e os nascidos de cesariana eletiva no desenvolvimento de competências aos 2 anos. Metodologia: Estudo do tipo observacional e transversal. Amostra constituída por 400 díades. Utilizada a metodologia quantitativa, através da análise multivariada com o Generalized Linear Models no IBM SPSS Statistics, version 18.0. Resultados: Os nascidos de cesariana apresentam menor índice de competências locomotoras mas entre os parâme-tros normais para a idade. Apresentam um menor índice de competências manipulativas, visuais, de fala e linguagem e de autonomia pessoal comparativamente aos de parto eutócico. Nos índices de competências cognitivas, de audição e linguagem e de interação social não existem diferenças entre os grupos. Conclusão: Verificam-se diferenças significativas entre o desenvolvimento de algumas competências aos 2 anos de idade entre os nascidos de cesariana eletiva e os nascidos de parto eutócico. Palavras-chave: desenvolvimento infantil; parto AbstractBackground: Caesarean section is associated with different development outcomes in children. In this way, the type of delivery can influence the health of the child. Objectives: To investigate the existence of differences in skill development up to the age of 2 between children who were born by vaginal delivery and those born by elective cesarean section. Methodology: Observational and cross-sectional study with a sample composed of 400 dyads, using a quantitative methodology based on a multivariate analysis with Generalized Linear Models in IBM SPSS Statistics, version 18.0. Results: Children born by cesarean delivery scored lower in the locomotor skill domain, but still within the normal parameters for their age. They also scored lower in the manipulative, visual, speech and language, and self-care skill domains than those born by vaginal delivery. No differences were found between groups in the cognitive, hearing and language, and interactive-social skills. Conclusion: Significant differences were found in the development of some skills at 2 years of age between children born by elective cesarean section and those born by normal delivery. Keywords: child development; parturition ResumenMarco contextual: La cesárea se asocia con el diferente desarrollo de las competencias en el niño. De este modo, el tipo de parto puede influir en la salud del mismo. Objetivos: Comprobar si existen diferencias significativas entre los nacidos por parto eutócico y los nacid...

Purpose: Childbirth is a known risk factor for postpartum sexual dysfunction. Perineal massage and warm compresses technique during second stage of labor could reduce perineal trauma. However, women experience perineal pain and dyspareunia regardless of the presence or absence of perineal trauma after spontaneous vaginal birth. Although the influence of this perineal technique protection in sexual dysfunction never was investigated. Compare postpartum sexual function in women undergoing combined perineal massage and warm compresses and those undergoing hands-on technique during second stage of labor. Methods: An randomised controlled trial (PeMWaC - Perineal Massage and Warm Compresses) was enrolled at Hospital of Braga from March 1st, 2019 to December 31st, 2020. Eight hundred forty eight women were recruited, of whom 496 (62%) completed the Female Sexual Function Index (FSFI) at 3 and 6 months postpartum. A sub-analisys of primary data was performed to assess postpartum sexual dysfunction the FSFI Score was applied at 3 and 6 months postpartum. Sexual dysfunction was defined by FSFI score <26.55. Results: At 3 months postpartum, overall FSFI scores were not statistically different between the intervention and control groups. When evaluating by each FSFI domain, satisfaction domain had significant lower scores in satisfaction (p=0.048) at 3 months postpartum. At 6 months postpartum, overall FSFI scores were not statistically different between the intervention and control groups. The perineal trauma in relation to perineal protection techniques was not significantly associated with sexual dysfunction at 3 and 6 months postpartum. FSFI scores at 3 or 6 months postpartum was not statistically different between exclusive breastfeed and not exclusive breastfeed women. Conclusion: PeMWac was not associated with postpartum sexual dysfunction.

Purpose: The influence of perineal trauma in pelvic floor dysfunction (PFD) has been described. Although the perineal massage and warm compresses techniques during the second stage of labor reduce perineal trauma, but the impact of combined perineal massage and warm compresses technique in PFD has never been investigated. To evaluate the effects of combined perineal massage and warm compresses or hands-on technique on PFD symptoms at 3 and 6 months. Methods: Randomised controlled trial (PeMWaC - Perineal Massage and Warm Compresses) was carried out at Hospital of Braga from March 1st, 2019 to December 31st, 2020. The sample included 496 women (242 perineal massage and warm compresses and 254 hands-on) who had a singleton term spontaneous vaginal delivery. A sub-analysis of primary data was performed to assess postpartum PFD symptoms, Pelvic Floor Distress Inventory-20 (PFDI-20) survey was applied at 3 and 6 months postpartum. Results: Of the 800 women recruited, 496 were included, 48.8% with combined perineal massage and warm compresses and 51.2% with standard-care. Frequency of intact perineum (p<0.001) and vaginal tears (p<0.001) were significantly higher in combined perineal massage and warm compresses. At 3 months postpartum, women undergoing standard care during the second stage of labor had higher Urinary Distress Inventory (UDI) score and global score with no differences at 6 months. After controlling for confounding variables, combined perineal massage and warm compresses technique were associated with lower UDI scores at 3 months postpartum. Conclusion: Combined perineal massage and warm compresses technique, seems to be associated with a lower prevalence of early PFD symptoms, mainly regarding urinary distress.