Selective episiotomy: frequency and associated factors / Episiotomia seletiva : freqÃÃncia e fatores associados




Introduction: Episiotomy is the commonest obstetric procedure worldwide. Historically, its practice began without scientific evidence of its effectiveness, based solely on expertsâ opinions. It was suggested that this procedure would prevent the occurrence of third and fourth-degree lacerations and perineal relaxation, decreasing the possibility of sexual disfunction and subsequent urinary and fecal incontinence. Besides, an irregular laceration would be changed for a surgical cut, easier to repair and to heal. An episiotomy would also prevent fetal injury, as it diminishes the duration of the expulsive period, avoiding neonatal asphyxia, cranial trauma, cerebral hemorrhage and mental retardation, besides protecting premature infants from excessive pressure caused by an excessively distended perineum. Its use was also imposed upon operative and distocic birth. With the medicalization of birth, specially in the beginning of the 20th century, the procedure became routine, reaching a prevalence of over 90% in some countries. Objectives: Revise the current knowledge on episiotomy available on the literature and verify its prevalence in Hospital das ClÃnicas da UFPE in the beginning of the selective episiotomy norm and factors associated with this procedure. Methods: A medical literature review was made through the data banks MEDLINE, SCIELO and LILACS with the keywords episiotomy and determining factors, in the period from 2000 to 2005. Studies with adequate methodology were selected and also systematic reviews. A transversal study was also realized in a sample of 323 women submitted to normal labor with a live infant, from June to August 2000. Results: The available data demonstrates the need of episiotomy only under precise obstetric indications, rejecting its routine and indiscriminate use. The encountered episiotomy prevalence was 37.8% in the period of the study. It was observed significantly higher episiotomy prevalence among teenagers, primigestas and during daytime. It was not observed a significant association between episiotomy and factors associated to the newborn and the professional responsible for the assistance. Conclusion: In spite of what the literature recommends, we observed a higher episiotomy frequency than the international recommendation. The present study shows the need to increment the professional practice aiming to decrease the realization of episiotomy


pediatria episiotomy gravidez parity episiotomia paridade pregnancy

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