Prática da episiotomia durante a assistência ao parto: tendência e fatores de risco em uma coorte retrospectiva de cinco anos

Abstract

Introduction: Episiotomy is one of the most commonly performed surgical procedures in the world, although it has been introduced in clinical practice without strong scientific evidence of its benefits. This procedure is often performed in order to prevent third or fourth degree lacerations and to reduce the second period of labor, despite the lack of proof of its effectiveness. Due to the morbidity associated with performing episiotomy during delivery, clinical guidelines and systematic reviews recommend the restrictive use of this procedure. In the literature, the risk factors associated with this practice are controversial. Objective: To analyze the tendency of episiotomy and the risk factors associated with maternal, fetal and care assistance during vaginal delivery in the women attending in the HCU-UFU. Methods: Retrospective cohort with medical records of women admitted to vaginal delivery at HCU-UFU, from January 1, 2013 to December 31, 2017. The medical records were identified using the following codes from the International Classification of Diseases (CID- 10): 080, 081 and 082. Descriptive analyzes were used to characterize the population. Lost data were recovered by means of random multiple imputation. Poisson regression was used to determine the risk of episiotomy according to maternal variables (age, ethnicity, gestational age, parity), fetal (presence of meconium and fetal deceleration) and care assistance (admission in spontaneous labor, induction or increased labor, use of partogram, amniotomy, place of delivery, lithotomy position). Results: A total of 3318 records of women who had vaginal delivery were analyzed. Of these, 1,229 were submitted to episiotomy. The episiotomy occurred at a rate of 37.04%, with a significant decrease during the five years of the study of 63% to 25% (p = 0.000; X2 = 268.570). The risk factors for episiotomy during delivery were: maternal age between 35-39 years (RR = 1.592, 95% CI, 1.118-2.436); black / brown ethnicity (RR = 1,100, 95% CI 1.040- 1.290) and non-use of the partogram during labor assistance (RR = 1,502, 95% CI, 1,230-1,891). Conclusion: Our results show a significant decrease in episiotomy rates over the five years of this study. Health professionals need to be aware of the increased risk of episiotomy in the group of older women, without partogram registered, with black / brown ethnicity and increase efforts to minimize the short- and long-term morbidity associated with this practice. Strategies to reduce unnecessary episiotomy, such as using a partogram and adopting upright positions during childbirth, are also needed.