Fatores maternos, fetais e assistenciais associados à ocorrência de lacerações perineais e episiotomias

Abstract

The contemporary obstetric model may expose women to interventions, which can be associated with perineal trauma due to episiotomy and severe spontaneous lacerations. Other factors are still described in the literature as generators of such outcomes, such as: instrumental delivery, nulliparity, prolonged expulsive, fetal macrosomia, shoulder dystocia, evasiveness of position. Thus, it is fundamental to detect which factors may or may not be modifiable, so that we create conditions for more favorable maternal perineal outcomes. OBJECTIVE: To identify the maternal, fetal and care factors associated with the occurrence of severe perineal lacerations and the need for episiotomies in a reference maternity hospital in Fortaleza, CE. METHODS: A cross - sectional study was conducted with retrospective data from 974 women who had a vaginal birth between May and October 2015, of fetal births, with more than 20 weeks of gestation and weighing more than 500 grams. In the statistical analysis, associations between the dependent variables (episiotomy and perineal lacerations) and independent variables (maternal, fetal and care) were performed using chi-square or Fisher's test and the Kruskal-Wallis test. Level of statistical significance 5% was considered. The study was approved by the Research Ethics Committee. RESULTS: The rate of episiotomy was 6.4% and that of severe perineal laceration was 2.8%. There was a significant difference in the rates of episiotomy and laceration, with physician assistance being associated with a higher chance of episiotomy (OR = 5.3, 95% CI, 95% % 2.25-12.83). Maternal (parity), fetal/neonatal factors (cephalic presentation, full term gestational age, Apgar at 1 st/5 minutes and greater fetal weight) and care (labor induction, early amniotomy, presence of the companion, use of analgesia pharmacological and early oxytocin, instrumentalized birth with forceps, place of birth, obstetric complications, labor and delivery time, and the use of non-pharmacological methods of pain relief) showed an influence on the occurrence of perineal lacerations and/or episiotomies. CONCLUSION: Maternal, fetal/neonatal and care factors, among them the childbirth care professional, influenced the perineal outcomes. Above all, we must highlight that a model of collaborative practice, with a multiprofessional team acting within its area of competence, contributes to better perinatal outcomes.