Avaliação Dos Fatores Determinantes À Realização Da Episiotomia No Parto Vaginal

Abstract

Objetivo: O estudo objetiva conhecer os fatores associados à realização da episiotomia no parto vaginal. Metodologia: Estudo transversal envolvendo 330 partos, de janeiro/2012 a dezembro/2013. Estudou-se a associação das variáveis independentes com a realização da episiotomia por meio de cálculo de razões de prevalência e seus respectivos intervalos de confiança, com nível de significância p < 0,05. Resultados: Na amostra estudada, 224 (67,9%) pacientes não realizaram episiotomia e 106 (32,1%) realizaram o procedimento. A idade média foi de 22,9 (± 5,9) anos e a episiotomia foi mais realizada naquelas com idade inferior a 20 anos [RP 1,61 (IC 95% 1,15; 2,25)] (p = 0,005). As mulheres com mais de 8 anos completos de estudo foram significativamente mais submetidas à episiotomia que as demais [RP 2,34 (IC 95% 1,70; 3,22)] (p < 0,001). Conclusão: A realização da episiotomia nesta população ocorreu com maior prevalência nas parturientes mais jovens e com maior escolaridade.Descritores: Episiotomia; Fatores associados; Parto vaginalEVALUATION OF THE DETERMINANT FACTORS TO EPISIOTOMY IN VAGINAL DELIVERYObjective: This study aims to evaluate the factors associated with its performance in vaginal delivery. Methodology: This is a cross-sectional study carried out with 330 births, from January / 2012 to December / 2013. The association of the independente variables with episiotomy was calculated by prevalence ratios and their respective confidence intervals, with significance level p < 0.05. Results: In the studied sample, 224 (67.9%) patients did not undergo episiotomy and 106 (32.1%) had the procedure. The mean age was 22.9 ± 5.9 years and the episiotomy was more frequently performed in those younger than 20 years old [PR 1.61 (95% CI 1.15; 2.25)] (p = 0.005). Women with more than 8 years of education were significantly more likely to undergo episiotomy than the others [PR 2.34 (95% CI 1.70; 3.22)] (p < 0.001). Conclusion: The episiotomy, in this population, occured more likely in younger and more educated parturients.Descriptors: Episiotomy; Associated factors; Vaginal birthEVALUACIÓN DE LOS FACTORES DETERMINANTES A LA REALIZACIÓN DE LA EPISIOTOMÍA EN EL PARTO VAGINALObjetivo: El estudio tiene como objetivo conocer los factores asociados a la realización de la episiotomía en el parto vaginal. Metodología: Estudio transversal que involucra 330 partos, de enero/2012 a diciembre/2013, para la asociación de las variables independientes con la episiotomía por razones de prevalencia y sus respectivos intervalos de confianza, con p <0,05. Resultados: En la muestra, 224 (67,9%) pacientes no realizaron episiotomía y 106 (32,1%) realizaron el procedimiento. La edad media fue de 22,9 (± 5,9) años y la episiotomía fue más realizada en aquellas con edad inferior a 20 años [RP 1,61 (IC 95% 1,15, 2,25)] (p = 0,005) ). Las mujeres con más de 8 años completos de estudio fueron significativamente más sometidas a la episiotomía que las demás [RP 2,34 (IC 95% 1,70; 3,22)] (p <0,001). Conclusión: La realización de la episiotomía ocurrió con mayor prevalencia en las parturientas más jóvenes y con mayor escolaridad.Descriptores: Episiotomía; Factores asociados; Parto vaginal

Factors associated with the performance of episiotomy

“…Episiotomy may increase bleeding, infection, wound dehiscence, hematoma formation, perineal pain, and extended rupture in the anal and rectal sphincter. There are also possible long-term complications, such as dyspareunia, anorectal dysfunction, and sexual dysfunction (2,10) . It is noteworthy that the use of good practices during labor, recommended by WHO, can reduce the likelihood of unnecessary interventions and have positive effects on the delivery experience of these women (14,16) .…”

“…This procedure's performance in primiparous women is associated with higher chances of obstetric lesions of the anal sphincter (19) . Authors demonstrate that the main arguments of professionals who make the inappropriate use of episiotomy are related to perineal stiffness, (justifying that it could lead to prolonging the period of the detachment of the cephalic pole), as well as to the woman's inexperience with the labor (2) . We reinforce that such arguments are not based on scientific evidence, since the model of childbirth assistance, with excessive use of interventions, is not supported by international guidelines or studies (3,20) .…”

“…It is one of the most common obstetric interventions in the world, and some countries considered it a routine procedure. It consists of the enlargement of the vaginal opening through a surgical incision in the perineum and can be performed by physicians and obstetric nurses (2) . Episiotomy rates increased substantially during the first half of the twentieth century, due to the medicalization process of childbirth and for justifying vaginal births occurring without complications (3) .…”

“…It is known that episiotomy can increase the extension of perineal lacerations and increase the risk of infection for women, hemorrhage, pelvic floor dysfunction, dyspareunia, rectovaginal fistulas, hematomas, among others. Such complications have negative impacts on the parturient's quality of life and the maternal-fetal relationship, in addition to being related to higher expenses in the health system, which increases the length of hospital stay (2,10) .…”

Análise de práticas de atenção ao parto e nascimento em maternidade pública

“…Com relação à realização de episiotomia, neste estudo, encontrou-se taxa abaixo de 30,0%, recomendada pela Organização Mundial da Saúde. Outro estudo realizado em maternidade do Hospital Regional de São José, em Santa Catarina, Brasil, a prevalência de realização de episiotomia foi de 32,1%, sendo maior em parturientes mais jovens e elevada escolaridade (15) .…”