Medical School, Universidade Franciscana, Santa Maria, Rio Grande do Sul, RS, Brazil.
Rev Bras Ginecol Obstet. 2021 Aug;43(8):588-594. doi: 10.1055/s-0041-1735227. Epub 2021 Sep 21.
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 < 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.
在大约 85%的阴道分娩中，产妇会经历会阴裂伤和/或会阴切开术。本研究旨在确定 2018 年在巴西南部一家习惯性风险公立妇产医院中产妇会阴裂伤和会阴切开术的发生率，并确定这些事件的风险和保护因素。
回顾性横断面研究。从病历中获取数据，并使用 Stata 软件进行分析。进行了单变量和多变量逻辑回归分析。 < 0.05 被认为具有统计学意义。
2018 年，共有 525 例阴道分娩，其中 27.8%由产科医生接生，70.7%由产科护士接生，1.5%无医护人员接生。总体而言，55.2%的产妇有不同程度的会阴裂伤。接生的医务人员是一个重要的变量：由护士接生的分娩中，出现更多的一度和二度裂伤，以及更严重的裂伤的情况更多（比值比 [OR]：2.95；95%置信区间 [95%CI]：1.74 至 5.03）。在分娩过程中，如果无法采用会阴保护技术（采用“不接触”手法的娩出期），单独分析这些体位会增加裂伤的风险；然而，在最终的回归模型中，这种关系并没有得到证实。尽管文献中有报道，但会阴裂伤的发生与产妇年龄、肤色或出生体重无关。在 24%的分娩中进行了会阴切开术，其中 63.5%由医生实施。
由护士接生会增加不同程度的会阴裂伤风险。相反，由医生接生的产妇会阴切开术的发生率更高。
