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Abstract
In around 85% of vaginal births, the parturients undergo perineal lacerations and/or episiotomy. The present study aimed to determine the incidence of lacerations and episiotomies among parturients in 2018 in a habitual-risk public maternity hospital in southern Brazil, and to determine the risk and protective factors for such events. A retrospective cross-sectional study. Data were obtained from medical records and analyzed using the Stata software. Univariate and multivariate logistic regressions were performed. Values of p < 0.05 were considered significant. In 2018, there were 525 vaginal births, 27.8% of which were attended by obstetricians, 70.7% by obstetric nurses, and 1.5% evolved without assistance. Overall, 55.2% of the parturients had some degree of laceration. The professional who attended the birth was a significant variable: a greater number of first- and second-degree lacerations, as well as more severe cases, occurred in births attended by nurses (odds ratio [OR]: 2,95; 95% confidence interval [95%CI]: 1,74 to 5,03). Positions at birth that did not enable perineal protection techniques (expulsive period with the "hands-off" method), when analyzed in isolation, determined the risk; however, in the final regression model, this relationship was not confirmed. Although reported in the literature, there were no associations between the occurrence of laceration and age, skin color, or birth weight. In 24% of the births, episiotomy was performed, and doctors performed 63.5% of them. Births attended by nurses resulted in an increased risk of perineal lacerations, of varying degrees. In turn, those assisted by physicians had a higher occurrence of episiotomy.
Highlights
During vaginal birth, some degree of perineal trauma can occur in $ 85% of parturients,[1,2,3,4,5] mainly spontaneous perineal lacerations and episiotomy, or both.[1]
The present study aimed to demonstrate the incidence of spontaneous lacerations and episiotomy in a southern Brazilian habitual-risk public maternity hospital, and to analyze the risk and protective factors associated with the occurrence of perineal lacerations
The frequency of perineal lacerations found in the present study (55.2%) is in line with hat is expected according to a report by the American College of Obstetricians and Gynecologists (ACOG),[9] which describes a range of 53% to 73% of lacerations, predominantly of grades 1 and 2
Summary
Some degree of perineal trauma can occur in $ 85% of parturients,[1,2,3,4,5] mainly spontaneous perineal lacerations and episiotomy, or both.[1]. Perineal lacerations are classified in degrees, according to the injured anatomical structures. First-degree lesions are restricted to the skin and mucosa; in second-degree lesions, the perineal muscles are affected. In third-degree lesions, the anal sphincter is compromised; these lesions are subdivided into: 3A, if less than 50% of the thickness of the external anal sphincter has been compromised; 3B, if more than 50% of the thickness of the external anal sphincter is injured; and 3C, if the internal and external sphincters are affected. The rectal epithelium is injured.[1,2,4,8–12] Grades 1 and 2 correspond to mild lacerations, while 3 and 4 correspond to severe lacerations.[6]
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Schedule a callMore From: Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia
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