Sonia Maria Junqueira Vasconcellos de Oliveira

Freqüência e critérios para indicar a episiotomia

Trata-se de estudo exploratorio com o objetivo de identificar a frequencia, os tipos e os criterios adotados para indicar a episiotomia. Foram entrevistados 12 medicos e 12 enfermeiras que prestam assistencia a parturiente no Hospital Universitario da Universidade de Sao Paulo. A episiotomia ocorreu em 76,2% dos partos normais; as indicacoes mais frequentes foram: rigidez perineal (28,7%), primiparidade (23,7%), feto macrossomico (11,9%), prematuridade (10,2%). O tipo mais citado foi medio-lateral direito (92,0%), justificado por: aprendizado durante a formacao academica (25,9%), ser adotada rotineiramente (19,4%), menor chance de lesar o esfincter anal (16,1%), menor risco de complicacoes (16,1%). E necessario rever as praticas de atendimento a parturiente, considerando as evidencias cientificas e condutas individualizadas.This is an exploratory study aimed at identifying the frequency, the types and the criteria adopted to recommend episiotomy. Twelve doctors and 12 nurses who attend women giving birth at the University of São Paulos Hospital Universitário were interviewed. Episiotomy was performed in 76.2 percent of the normal births; the most frequent indications were: perineal rigidity (28.7 percent), primiparity (23.7 percent), macrossomic infant (11.9 percent) and prematurity (10.2 percent). The most mentioned type was the right medium-lateral (92.0 percent), and the justifications were: it was learned during academic formation (25.9 percent); it is adopted routinely (19.4 percent); with it there is a lesser chance for causing lesions to the anal sphincter (16.1 percent); with it there is a lesser risk of complications (16.1 percent). The practices for attending women giving birth must be revised taking into account scientific evidences and individualized conducts.

Risk factors for birth‐related perineal trauma: a cross‐sectional study in a birth centre

AIM AND OBJECTIVES To identify maternal, newborn and obstetric factors associated with birth-related perineal trauma in one independent birth centre. BACKGROUND Risk factors for birth-related perineal trauma include episiotomy, maternal age, ethnicity, parity and interventions during labour including use of oxytocin, maternal position at time of birth and infant birth weight. Understanding more about these factors could support the management of vaginal birth to prevent spontaneous perineal trauma, in line with initiatives to reduce routine use of episiotomy. DESIGN Cross-sectional study. METHODS Data were retrospectively collected from one independent birth centre in Brazil, during 2006-2009. The dependent variable (perineal trauma) was classified as: (1) intact perineum or first-degree laceration, (2) second-degree laceration and (3) episiotomy (right mediolateral or median). RESULTS There were 1079 births during the study period. Parity, use of oxytocin during labour, position at time of giving birth and infant birth weight were associated with second-degree lacerations and episiotomies. After adjusting for parity, oxytocin, maternal position at the expulsive stage of labour and infant birth weight influenced perineal outcomes among primiparae only. CONCLUSIONS Although the overall rate of episiotomies in this study was low compared with national data, it was observed that younger women were most vulnerable to this intervention. In this age group in particular, the use of oxytocin as well as semi-upright positions at the time of birth was associated with second-degree lacerations and episiotomies. RELEVANCE TO CLINICAL PRACTICE The use of upright alternative positions for birth and avoidance of use of oxytocin could reduce the risk of perineal trauma from lacerations and need to perform episiotomy.

Tipo de parto: expectativas das mulheres

This descriptive and exploratory study was carried out through interviews with 221 puerperal women who gave birth in Sao Paulo State public maternities located within the capital. The purposes of the work were: 1. to identify the type of childbirth women expected to have--whether vaginal births or cesareans--and why; 2. to verify to what extent womens expectations corresponded to the type of birth they had; 3. to compare medical indications for c-sections with womens understanding of justifications they were given for this intervention. Data revealed that 74.7% of the women expected to have vaginal births and 25.3% expected to have cesarean sections. Vaginal birth, expected by 165 interviewees, occurred in 66.1% of these cases. Among women who expected having vaginal births, the most mentioned justification was that recuperation afterwards was faster. Among women who expected cesareans, the most mentioned justification was a previous c-section. The justifications presented by 61 women for having been submitted to c-sections did not coincide with medical indications for this intervention in 47.5% of the cases.Estudo descritivo e exploratorio, realizado mediante entrevista com 221 puerperas que tiveram parto em maternidades publicas estaduais, localizadas no municipio de Sao Paulo. Teve como objetivos: 1. identificar o tipo de parto esperado pelas mulheres, considerando a via vaginal ou cesariana, e sua justificativa; 2. verificar a ocorrencia do tipo de parto, segundo as expectativas dessas mulheres; 3. comparar a indicacao medica da cesariana com o entendimento das mulheres sobre justificativa dessa intervencao. Os dados revelam que 74,7% tinham expectativa de que o parto fosse normal, e 25,3%, de que fosse cesarea. O parto normal, esperado por 165 entrevistadas, ocorreu em 66,1% dessas mulheres. A justificativa mais citada pelas mulheres para esperar o parto normal foi a recuperacao pos-parto mais rapida e, para a cesarea, ter tido cesarea anterior. As justificativas apresentadas por 61 mulheres para a realizacao da cesariana nao era coincidente com a indicacao medica em 47,5% dos casos.

Women's experiences of perineal pain during the immediate postnatal period: A cross-sectional study in Brazil

OBJECTIVE To identify the severity and prevalence of perineal pain during the post partum in-patient period and associated obstetric, maternal and newborn baby factors following birth. DESIGN Cross-sectional study. SETTING A postnatal ward of a hospital in São Paulo, Brazil. PARTICIPANTS 303 Postnatal women. MEASUREMENTS Interviews and perineal assessment were conducted to evaluate the perineal outcomes (trauma and pain). Data on maternal characteristics and infant anthropometric variables were collected. RESULTS Among all women, 80.5% had perineal trauma (60.7% had episiotomy) and 18.5% reported perineal pain. The mean pain intensity score was 4.8 ± 1.9 on the visual analogue scale. Only maternal age (ORa = 1.08) and performance of episiotomy (ORa = 3.80) remained as independent predictors of perineal pain in the final logistic regression model. KEY CONCLUSIONS Perineal pain in the immediate postnatal period was highly associated with older maternal age and use of episiotomy, although the overall reporting of perineal pain was low. IMPLICATIONS FOR PRACTICE Perineal pain following vaginal birth is associated with interventions during labour as well as with maternal characteristics. Despite the negative impact on a womans daily activities, perineal pain following birth is neglected by care givers and usually not reported by women who may consider it to be a normal outcome of giving birth. Care providers need to ensure all interventions during labour and birth are informed by evidence of benefit and that barriers to implementation of evidence are addressed. Further work is needed to obtain the views of women in Brazil on their health and well-being following birth.

Hipertensão arterial referida em mulheres idosas:prevalência e fatores associados

Estudo transversal que caracterizou a prevalencia da hipertensao arterial referida e identificou os fatores associados. A amostra constou de 1.265 mulheres idosas, residentes no municipio de Sao Paulo, que participaram do Projeto Saude, Bem-estar e Envelhecimento realizado de 2000 a 2001. A hipertensao arterial foi considerada como variavel dependente para fins de analise e das possiveis associacoes. A prevalencia da hipertensao arterial foi 55,3% em mulheres com 60 a 74 anos e 60,7% naquelas com 75 anos e mais. No modelo final de regressao multipla as variaveis que permaneceram como fatores associados a hipertensao arterial referida foram: diabetes (odds ratio=3,43), doenca cardiaca (odds ratio=3,32), idade (odds ratio=1,57), numero de filhos (odds ratio=1,51), indice de massa corporal (odds ratio=1,04), e estado de saude (odds ratio=2,00). Conclui-se que a prevalencia da hipertensao referida e similar aos dados de outros estudos.

Resultados maternos e neonatais em centro de parto normal peri-hospitalar e hospital

OBJECTIVE: To compare maternal and neonatal outcomes in low-risk women assisited in an alongside birth center and at a hospital. METHODS: A cross-sectional study was conducted with a representative sample of low-risk women in Sao Paulo (Southeastern Brazil), from 2003 to 2006. The study included 991 women who delivered a child at the alongside birth center and 325 who delivered a child at a hospital. Data were obtained from medical records. A comparative analysis was performed for all of the women, who were stratified according to parity. The chi-square test and Fishers exact test were used to compare outcomes between women who delivered in alongside birth center and those who gave birth in the hospital. RESULTS: There was a homogeneous distribution of women according to parity (45.4% were nulliparous, and 54.6% had one or more previous deliveries). Statistically significant differences were found in the frequency of amniotomy (more frequent in nulliparous women treated at the hospital), the use of oxytocin during labor, and the use of postpartum analgesia (both more frequent among women of any parity treated at the hospital). The rate of episiotomy was higher in nulliparous women, both in the alongside birth center and at the hospital. Neonatal interventions were more frequent at the hospital and included aspiration of the upper airways, gastric aspiration, gastric lavage, and the use of an open oxygen mask. Other events that occurred with greater frequency at the hospital included caput succedaneum, respiratory discomfort, and admittance to the neonatal unit. There was no difference in Apgar scores at the fifth minute or cases of maternal or perinatal death. CONCLUSIONS: Care at the alongside birth center involved fewer interventions and had maternal and neonatal outcomes similar to those of the hospital setting.

Perineal analgesia with an ice pack after spontaneous vaginal birth: a randomized controlled trial.

INTRODUCTION This study evaluated the effectiveness of an ice pack applied for 20 minutes to alleviate perineal pain after spontaneous vaginal birth. METHODS We conducted a randomized controlled trial at the Amparo Maternal Birth Center in São Paulo, Brazil. Study participants included 114 nulliparous women divided into 3 groups (n = 38 per group): experimental (ice packs on the perineum), placebo (water packs at set temperature), and control (no treatment). RESULTS A numerical scale (0 to 10) was used for pain assessment. A comparison of the average pain at the beginning and after 20 minutes showed a significant reduction of pain (P < .001) in the 3 groups, and the experimental group had a lower average score for pain compared with the control group (1.6 versus 3.3, P = .032). DISCUSSION The use of ice packs for 20 minutes was effective for perineal pain relief after vaginal birth.

Prevalência e fatores associados à prematuridade entre gestantes submetidas à inibição de trabalho de parto prematuro

OBJETIVOS: identificar a prevalencia de parto prematuro em gestantes submetidas ao tratamento de inibicao de trabalho de parto prematuro e analisar os fatores associados. METODOS: estudo transversal, com dados coletados de 163 prontuarios de gestantes submetidas a tratamento de inibicao de trabalho de parto prematuro atendidas em 1995-2000, no Hospital Universitario da Universidade de Sao Paulo, Brasil. A variavel dependente constituiu-se na ocorrencia de parto prematuro e as independentes foram: idade, escolaridade, ocupacao, paridade, companheiro, tabagismo, infeccao urinaria previa, numero de consultas pre-natal e intervalo interpartal. A analise foi feita pelo teste de associacao pelo Qui-quadrado e modelos de regressao logistica univariado e multiplo. RESULTADOS: 66,3% das gestantes tiveram filhos prematuros e, em 22,7% dos casos, o parto ocorreu antes de 34 semanas. Houve associacao estatistica significativa entre parto prematuro e ser nulipara e apresentar numero baixo de consultas pre-natal. CONCLUSOES: atencao especial deve ser dada as gestantes nuliparas e com numero reduzido de consulta pre-natal submetidas ao tratamento de inibicao de trabalho de parto prematuro, com a finalidade de prevenir esse evento.

Perineal Muscle Strength During Pregnancy and Postpartum: the Correlation Between Perineometry and Digital Vaginal Palpation

En la practica clinica, la palpacion vaginal digital auxilia en el diagnostico de disfunciones urinarias, intestinales y sexuales, en cuanto la perineometria es mas utilizada para realizar ejercicios perineales con biofeedback. El objetivo fue verificar se existe correlacion entre los valores de la Fuerza Muscular Perineal (FMP) evaluada por la perineometria utilizando el perineometro electronico, y por medio de la palpacion digital vaginal, utilizando la escala de Oxford. El estudio deriva de una cohorte prospectiva, con 330 mensuraciones en 110 mujeres. La recoleccion de datos ocurrio en 2007 y 2008, en servicios de salud de Itapecerica de la Serra, en Sao Paulo. La evaluacion fue realizada en tres momentos: hasta 12 semanas de gestacion; entre 36 y 40 semanas; y, entre 42 y 60 dias posparto. El coeficiente de Spearman indico una fuerte correlacion positiva entre los dos metodos de evaluacion, en los tres momentos (p<0,0001). Se concluye que ambos metodos son validos para mensurar la FMP durante la gravidez y despues del parto.Digital vaginal palpation performed during clinical practice can help diagnose urinary, intestinal and sexual disorders, while perineometry is more useful for performing perineal exercises with biofeedback. This study verifies whether there is a correlation between values of Pelvic Floor Muscle Strength (PFMS) obtained through perineometry performed with an electronic perineometer and through digital vaginal palpation using the Oxford scale. This is a prospective cohort study with 330 measurements carried out in 110 women. Data were collected from 2007 to 2008 in the health service system in Itapecerica da Serra, São Paulo, Brazil. Evaluations were carried out at three points in time: up to 12 weeks of pregnancy; between 36-40 weeks; and between 42-60 days postpartum. The Spearman coefficient indicated a strong positive correlation between the two evaluation methods for the three evaluations (p<0.0001). The conclusion is that both methods are valid for measuring PFMS during pregnancy and after delivery.

Resultados maternos e neonatais em Centro de Parto Normal peri-hospitalar na cidade de São Paulo, Brasil

The aim of this study was to describe the maternal and perinatal results of care in the alongside hospital birth center Casa de Maria (CPN-CM), located in the city of Sao Paulo. The random sample included 991 women and their newborns, attended between 2003 and 2006. The results showed that 92.2% of women had a companion of her choice during childbirth and the practices commonly used were shower or immersion bath (92.9%), amniotomy (62.6%), walking (47.6%), massage comfort (29.8%) and episiotomy (25.7%). Regarding newborns, 99.9% of them had Apgar scores =7 in the fifth minute, 9.3% received aspiration of the upper airway, no one needed to be intubated and 1.4% were removed to the hospital. The model of care in the CPN-CM provides maternal and perinatal outcomes expected for low obstetric risk women, and means a safe option and less interventionist model in normal childbirth.The aim of this study was to describe the maternal and perinatal results of care in the alongside hospital birth center Casa de Maria (CPN-CM), located in the city of São Paulo. The random sample included 991 women and their newborns, attended between 2003 and 2006. The results showed that 92.2% of women had a companion of her choice during childbirth and the practices commonly used were shower or immersion bath (92.9%), amniotomy (62.6%), walking (47.6%), massage comfort (29.8%) and episiotomy (25.7%). Regarding newborns, 99.9% of them had Apgar scores =7 in the fifth minute, 9.3% received aspiration of the upper airway, no one needed to be intubated and 1.4% were removed to the hospital. The model of care in the CPN-CM provides maternal and perinatal outcomes expected for low obstetric risk women, and means a safe option and less interventionist model in normal childbirth.