Abstract
Resumo Objetivo: Investigar associação entre analgesia farmacológica e desfechos do parto. Métodos: Estudo transversal que utilizou amostra representativa dos partos realizados em 2013, em uma maternidade de Belo Horizonte, Minas Gerais. Foram incluídos dados de 978 partos, excluindo-se as cesarianas eletivas. A exposição principal foi o uso de analgesia farmacológica durante o trabalho de parto e o desfecho classificado como parto vaginal, vaginal instrumentalizado e cesariana. Verificou-se a associação entre analgesia e os desfechos do parto por meio de regressão logística multinominal para obter as estimativas de Odds Ratio (OR) com seus respectivos intervalos de 95% de confiança, e o modelo final foi ajustado por idade da mulher, número de partos anteriores, presença de acompanhante ou doula e dilatação cervical no momento da analgesia. Resultados: Do total de nascimentos, 87,1% foram vaginais e 12,9% cesariana. A prevalência do uso de analgesia farmacológica foi 34,2% e do parto instrumentalizado de 8,4%. Cerca de 70% das mulheres tiveram gestação de risco habitual. Mesmo após ajuste por confundidores, o uso da analgesia aumentou em 3,5 vezes a chance de parto instrumentalizado (p<0,0001) e para as mulheres com gestação de alto risco esse aumento foi ainda superior (OR=4,62; p<0,0001). Não houve associação do uso da analgesia com a cesariana (p=0,320). Conclusão: O uso de analgesia farmacológica modifica o desfecho do parto, aumentando as chances de parto instrumentalizado, principalmente em mulheres com gravidez de alto risco. Nesse contexto considera-se importante orientar as mulheres quanto aos potenciais riscos e benefícios da analgesia para uma escolha segura.
Highlights
Pain management is one of the main objectives of care during labor, with two approaches for its relief: pharmacological and non-pharmacological.[1]
A instrumental vaginal delivery is understood as one that requires forceps or use of a vacuum extractor to assist in the expulsive period,(10) and can be indicated by fetal or maternal conditions during the second stage of labor.[11]. It is an important resource for minimizing risks, such as in cases of fetal distress, and may prevent fetal morbidity or death.[10]. In contrast, it has been associated with a higher risk of fetal morbidity and mortality, as well as maternal morbidities. [10,12,13] Laceration of the anal sphincter and of the birth canal, and displacement of the muscles of the pelvic floor are among maternal morbidities; [10,12,13] the neonatal morbidities are facial lesions, cephalo-hematomas, intracranial hemorrhage, ocular lesions, and fractures of the skull bones.[10]
The majority of women had a companion in the delivery room, and some non-pharmacological methods were used for pain relief (97.8% and 89.7%, respectively)
Summary
Pain management is one of the main objectives of care during labor, with two approaches for its relief: pharmacological and non-pharmacological.[1]. The pharmacological approach is aimed at eliminating the physical sensation of pain, and includes several substances and techniques.[1,2] Epidural neuroaxial analgesia is the most often discussed and present in studies, due to its great effectiveness for pain relief. [7] The National Demographic and Health Survey in 2006, showed that only 30.4% of the Brazilian women had access to non-pharmacological and pharmacological measures for pain relief.[8] More recently, the “Nascer in Brazil” (Birthing in Brazil) survey indicated that 33.9% of women with normal risk pregnancies used epidural analgesia for pain relief, but restricted to a certain profile of women: 35 years or more, with a higher educational level, and who received care in a private institution.[5]. It is believed that this study has the potential to support discussions on the use of pharmacological methods in relieving labor pain, and their potential risks
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