EPISIOTOMY AND SEVERE PERINEALLACERATION: ASSOCIATED OBSTETRIC AND CARE FACTORS
S. R. FEITOZA 1, C. T. LIMA1, S. V. AGUIAR 1, A. P. BILHAR 2,K. L. AUGUSTO 3, S. L. DO NASCIMENTO 4, S. A.KARBAGE 1, E. GONCALVES 1, F. C. DE ALMEIDA 1,L. MATOSO 1, L. S. BEZERRA1;
1SaúdeMaterno Infantil, Federal Univ. of Ceara, Fortaleza, Brazil,2UNIFESP, Fortaleza, Brazil, 3Laparoscopy andMinimally invasive surgery, Maternidade Escola Assis Chateaubriand,Fortaleza, Brazil, 4Univ.e Federal do CearŸ, Fortaleza,Brazil.
Introduction: Severe perineallacerations affect the anal sphincter (third-degree) and the rectalmucosa (fourth-degree), and have the potential to cause importantsequelae in patients. The Non-Pharmacological Methods for Pain Relieffor delivery have been introduced with the movement of “humanizationat birth” and its recommendations for childbirth care are usedduring labor. Few studies have evaluated the influence of theseNon-Pharmacological versus pharmacological analgesia, oxytocin use,position of the parturient at delivery, among others, and theprevalence of severe perineal lacerations.
Objective: toevaluate the prevalence and the relationship between the occurrenceof severe perineal lacerations and episiotomies and obstetric andcare factors, during normal spontaneous vaginal delivery, in amulti-disciplinary care tertiary maternity based on "humanizationat birth" strategies.
Methods: Retrospective cohortanalysis using an electronic clinical database at University referralcentre for high-risk pregnancies was performed. All vaginal births oflive fetuses weighing more than 500 grams consecutively from May toNovember 2015 were Included in the study. Sociodemographic, obstetricand care data were collected and divided into three groups, accordingto the outcome of the pelvic floor: 1) intact perineum and / orlaceration of 1st and 2nd degrees; 2) severe laceration (3rd and 4thdegree) and 3) episiotomy. Statistical analysis was performed usingthe chi-square test and ANOVA (p<0,05). The study was submitted tothe Ethics Committee of institution (1,311,781). Because it was aquestion of searching in medical records, we needed the Term offaithful depositary, dispensing with the Term of Free and InformedConsent.
Results: A total of 869 deliveries were analyzed.The mean age of the parturients was 23.46 (± 6.74). Regardingperineal lesion outcomes, 90.90% (n = 749) presented intact perineumand / or laceration of 1st and 2nd degrees; 2.79% (n = 23) severelacerations and 6.31% (n = 52) episiotomy. Of the total deliveries,only nine were performed with forceps and two of these had third andfourth degree lacerations, the other seven had an episiotomy withoutperineal laceration. The Obstetrician resident attended 201 (23%)births, the preceptor obstetrician attended 338 (39%) deliveries, 322(37%) the obstetrician nurse and 8 had no registration. Severeperineal laceration occurred equally among professionals: eight forpreceptor obstetricians, six for obstetrics residents and eight fornurse. The factors related to the increased rate of episiotomy wereoxytocin use in the 1st and 2nd stages, use of pharmacologicalanalgesia, weight of the pregnant woman at the first prenatal visit,prolonged labor and delivery time. Use of non-pharmacological methodsfor pain relief (used indistinctly in all deliveries, even those whoprogressed to severe perineal laceration), mother’s weight at thelast prenatal visit, presentation of the first fetus and position ofthe parturient at delivery were not related to increase rates ofsevere laceration or episiotomy. The factors related to the increasein the rates of severe laceration were early labor induced andprolonged time of the expulsive period.
Conclusions: Ourprevalence of episiotomy and severe perineal laceration in amulti-disciplinary care tertiary maternity based on "humanizationat birth" strategies is low. Only some important obstetricfactors (early labor induced and prolonged time of the expulsiveperiod) are related to the increase in these rates.
References:Correa Junior MD, Júnior RP Selective Episiotomy: Indications,Techinique, and Association with Severe Perineal Lacerations Rev BrasGinecol Obstet Vol. 38 No. 6/2016