Avaliação do impacto dos traumas perineais severos no assoalho pélvico: estudo de coorte

Abstract

Objectives: Severe obstetric perineal injuries (OASIS) are related to a significant negative impact on the quality of life of those who suffer them. Such impacts can occur as a result of a series of symptoms, such as anal incontinence (AI), pain, sexual disorders, among others. The present study evaluated the incidence of OASIS, the prevalence of urinary, intestinal and sexual symptoms, as well as their impact on quality of life, in a population of women treated at a tertiary hospital located in northeastern Brazil. Methods: a cohort study was carried out from July 2022 to January 2024, with women who suffered OASIS during childbirth (group with OASIS), these were compared with the control group (group without OASIS), and those who had previous symptoms of pelvic floor dysfunction (PAD). Specific questionnaires (Pelvic Floor Distress Inventory PFDI – 20, Pelvic Floor Impact Questionnaire - PFIQ, Female Sexual Function Index - FSFI, and Short Form SF – 36) were applied in person, during hospitalization (T0), by the researcher and/or UFC fellows, and virtually (Whatsapp, text message) or via telephone contact, three (T1) and six (T2) months after birth . The database was structured in an Excel® spreadsheet and evaluated for normality distribution using the Kolmogorov Smirnov test. The conclusions were based on p values using the traditional cutoff range of 5%, and the descriptive analysis of the variables was carried out using tables and graphs. Results: the incidence of OASIS in the studied period was 1.2%. Primiparity (p=0.03), epidural analgesia (p=0.041), use of a vacuum extractor (p=0.046), and greater newborn (NB) weight (p=0.002) were associated with a greater risk of OASIS. Urinary symptoms were more prevalent in the group with OASIS only at T1 (p=0.01), as well as urinary incontinence (UI), which was more prevalent only at T1 (p=0.047). Intestinal symptoms were more associated with OASIS at T0 (p=0.008) and T1 (p=0.04), and anal incontinence (AI) showed a prevalence of 2.4% at the end of the study. Pelvic symptoms were similar in both groups. In SF – 36, an improvement in quality of life was observed over time. Both groups were dysfunctional in terms of sexuality, with scores below the cutoff point throughout the study, despite the improvement observed. Pain and excitement were worse in the group with OASIS at T2 (p=0.037 and p=0.013 respectively). In the PFDI-20, intestinal and urinary symptoms and the total score were worse in the group with OASIS at T1 (p=0.014, p=0.005, p=0.006), and at T2 only the total score was worse (p=0.048). Urinary, intestinal and general symptoms had a greater negative impact on the quality of life of the group with OASIS at T2 (p=0.028, p=0.04, p=0.017). Conclusion: risk factors for the emergence of OASIS were identified, as well as the physical and quality of life impacts that such injuries cause to these women. There was an association of OASIS with pelvic pain, UI, and sexual dysfunctions.