Associação entre traumas perineais e dor perineal no pós-parto imediato.

Abstract

Perineal pain is a frequent complaint after vaginal delivery and may persist for up to one year postpartum. It can occur due to perineal trauma during the expulsive period (laceration or episiotomy) and may also be associated with negative repercussions on maternal well-being, interfering with newborn care, daily life activities, and the resumption of sexual activity. The objectives of this study were to analyze the association between perineal trauma and the presence, intensity, and characteristics of perineal pain, as well as aspects of healing and the interference of pain in daily life activities (DLA) and pelvic floor muscle (PFM) contraction. This is a quantitative cross-sectional observational study with women after vaginal delivery, aged ≥ 16 years, between 6 and 48 hours postpartum, and without clinical complications. It was conducted in the postpartum ward of the Assis Chateaubriand Maternity School (MEAC) between December 2022 and March 2024. The following were used: a standardized form for collecting sociodemographic and clinical data, self-reported pain assessment, and inspection of the perineal region. Perineal pain was assessed using the Numerical Pain Scale (NPS), followed by pain characterization with the Short-Form McGill Pain Questionnaire (SF-MPQ) and its components. To assess perineal healing conditions, inspection was performed using the REEDA Scale (Redness, Edema, Ecchymosis, Discharge, Approximation), followed by the observation of PFM contraction ability. Pain during DLA execution was questioned and measured using the NPS and its interference in DLA. Statistical analyses included the Chi-square test, Wilcoxon test, and multiple logistic regression, considering p<0.05 for statistical significance. A total of 321 postpartum women were included. Perineal pain was reported by 183 (57%) women, 223 (69.5%) suffered perineal trauma and had a higher mean pain intensity (3.27± 2.82) than those without perineal trauma. Among them, 123 (69.2%) had second-degree lacerations and reported a higher mean pain intensity (4.11± 2.65) than those with first-degree lacerations. The presence of perineal trauma increases the likelihood of experiencing perineal pain in the immediate postpartum period by 3.6 times (95% CI: 1.81 - 7.45). The mean REEDA score was 3.57 ± 2.55, with worse perineal healing conditions in second-degree lacerations (4.06 ± 2.58). We conclude that the presence of perineal trauma is associated with the presence and intensity of perineal pain. The more severe the trauma, the greater the intensity of perineal pain and the worse the perineal healing condition. This pain is described as aching and tiring by most women and may interfere with mobility in the immediate postpartum period.