Abstract
Identify the associations between perineal outcome in primiparas and interventions during labor and delivery, newborn weight and APGAR score. Document-based, correlational, retrospective, quantitative study conducted in a tertiary maternity hospital in the state of Ceará, between July 2017 and January 2018. The independent variables were labor induction, amniotomy, non-pharmaceutical methods for relieving pain, forceps, episiotomy, Kristeller maneuver, position in the expulsion stage, shoulder dystocia, and newborn weight and APGAR score, and the dependent variable was perineal outcome. Pearson's chi-square test and Fisher's exact test were used. A total of 226 normal-risk primiparas who had a vaginal delivery. An association was found between horizontal position in the expulsion stage and episiotomy, and between not performing an episiotomy and perineal tearing. The other variables (labor, delivery and neonatal) did not have any effect on perineal tearing. Interventions, with the exception of episiotomies, did not have an influence on the occurrence of perineal trauma, but they do need to be carefully assessed. Deliveries in a horizontal position were associated with a higher likelihood of performing an episiotomy.
Highlights
Perineal tears are common in women who have vaginal deliveries and their occurrence may be related to various factors, such as maternal gynecological and obstetric characteristics, obstetric interventions during labor and delivery, and fetus-related aspects
A total of 226 normal-risk primiparas who had had vaginal deliveries participated in the study
When investigating maternal age in a study conducted in two natural birth centers (NBC) in São Paulo (SP) with 317 primiparas, it was noted that the mean age was 21.5 years old (SD = 4.4 years), with a minimum and maximum age of 15 and 37 years, respectively(7), corroborating the findings of the present study
Summary
Perineal tears are common in women who have vaginal deliveries and their occurrence may be related to various factors, such as maternal gynecological and obstetric characteristics, obstetric interventions during labor and delivery, and fetus-related aspects. Such injuries cause increased blood loss, the need for sutures and postpartum pain, and are characterized by trauma in the mucosa and/or muscle of the perineum during detachment of the cephalic pole, as a result of an episiotomy or spontaneous tear(1). A perineal tear is classified as first degree when it involves the frenulum of labia minora, skin of the perineum and vaginal mucosa. Fourth-degree tears cross through the entire rectal mucosa with light exposure, implying rupture of the external and internal anal sphincters(2)
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