Effects of oxytocin induction on early postpartum hemorrhage, perineal integrity, and breastfeeding: a case-control study

SUMMARY OBJECTIVE: The aim of this study was to evaluate the postpartum hemorrhage, perineal integrity, and breastfeeding results of mothers who underwent oxytocin induction in the first stage of labor in the early postpartum period. METHODS: This single-center observational case-control study was conducted in the obstetric unit of a public hospital in Istanbul. The study sampling included 44 pregnant women who received oxytocin induction (case group) and 44 pregnant women who did not receive oxytocin (control group). The Personal Information Form, LATCH Breastfeeding Assessment Tool, Breastfeeding Self-Efficacy Scale, Redness, Edema, Ecchymosis, Discharge, and Approximation Scale, and Postpartum Hemorrhage Collection Bag were used in data collection, and pad follow-up was carried out. RESULTS: The amount of hemorrhage in the first 24 h of the postpartum period and the mean Redness, Edema, Ecchymosis, Discharge, and Approximation Scale score were significantly higher in the case group. While 47.7% of the oxytocin-induced women had 1st or 2nd, and 11.4% had 3rd or 4th degrees of lacerations, 20.5% of the control group had 1st or 2nd, and 2.3% had 3rd or 4th degrees of lacerations. There was no significant difference between the mean scores of the Breastfeeding Self-Efficacy Scale and LATCH Breastfeeding Assessment Tool in both groups. CONCLUSION: According to the study findings, it was determined that oxytocin induction administered in the first stage of labor increased hemorrhage and perineal trauma in the early postpartum period but did not affect the results of breastfeeding. Clinical Trial Registration Number: NCT04441125.

Laceração de canalículo lacrimal em centro de referência do centro-oeste paulista / Lacrimal canaliculus laceration in a reference center in the Center-West of the state of São Paulo

RESUMO Objetivo: Descrever as características clínico-epidemiológicas, técnicas cirúrgicas e resultado do tratamento das lacerações canaliculares operadas em nosso serviço. Métodos: Estudo retrospectivo, realizado de janeiro de 2012 a junho de 2020, considerando-se as lesões de canalículo lacrimal operadas em um serviço de referência. Dados demográficos, características das lesões, detalhes das cirurgias e resultado do tratamento foram obtidos de prontuários eletrônicos e analisados estatisticamente. Resultados: Foram incluídos 26 portadores de lesões canaliculares, com idade entre 2 e 71 anos, sendo 73,1% homens. A lesão acometia o canalículo superior em 53,9%; 80,8% pacientes procuraram pelo serviço nas primeiras 24 horas, e 46,2% tiveram a cirurgia realizada entre 24 e 72 horas após o traumatismo. Todos os pacientes tiveram intubação mono ou bicanalicular, e o tempo transcorrido entre a cirurgia e a retirada do silicone, variou de zero a 183 dias. Após a cirurgia, 21 pacientes (80,8%; p<0,05) não apresentaram complicações, 2 (7,7%) evoluíram com obstrução canalicular, 2 (7,7%) com granuloma e 1 (3,8%) com ectrópio de ponto lacrimal. Conclusão: As lesões de canalículo encontradas em nossa prática são mais comuns em crianças ou homens jovens, acometem mais o canalículo superior e as nossas condutas levam a sucesso no tratamento na maior parte dos casos. As grandes controvérsias no assunto persistem, como o tipo e o tempo de permanência do tubo de silicone na via lacrimal. Somente estudos com grandes amostras podem consolidar esses conceitos.

ABSTRACT Objective: To describe the clinical and epidemiological characteristics, surgical techniques, and results of the canalicular laceration treatment at our service. Methods: A retrospective study was carried out from January 2012 to June 2020, considering canalicular injuries operated at a reference center. Demographic data, lesion characteristics, surgical details, and treatment outcomes were obtained from electronic medical records and were statistically analyzed. Results: Twenty-six cases of people with canalicular lesions aged between 2 to 71 years old were included, of whom 73.1% were men. The superior canaliculus was affected in 53.9%; 80.8% of patients searched for care within the first 24 hours, and 46.2% had the surgery performed between 24-72 hours after trauma. All patients had mono or bicanalicular intubation and the time elapsed between surgery and silicone removal ranged from 0 to 183 days. After surgery, 21 patients (80.8%, p<0.05) did not present any complications, two (7.7%) evolved with canalicular obstruction, two (7.7%) with granuloma, and one (3.8 %) with lacrimal puncta ectropion. Conclusion: In our practice, canalicular injuries are more common in children or young men, affecting mainly the superior canaliculus, and treatment success using our approach can be achieved in most of the cases. However, great controversies remain on the subject, such as type of intubation and when to remove the silicone tube from the lacrimal pathway. Larger series are required to consolidate controversial concepts.

Pediatric canalicular laceration repair using the Mini Monoka versus Masterka monocanalicular stent / Correção de laceração canalicular pediátrica usando os stents monocanaliculares Mini-Monoka versus Masterka

ABSTRACT Purpose: One of the most important disadvantages of using Mini Monoka stents in pediatric canalicular laceration repair is premature stent loss. In this study, we aimed to compare clinical outcomes between the use of Mini Monoka and Masterka monocanalicular stents in children and discuss the potential causes of premature stent loss. Methods: The medical records of 36 patients who underwent surgical repair of canalicular lacerations were retrospectively reviewed. Children aged <18 years who underwent canalicular laceration repair with either Mini Monoka or Masterka and had at least 6 months of follow-up after stent removal were included in the study. The patients' demographics, mechanism of injury, type of stent used, premature stent loss, and success rate were analyzed. Success was defined as stent removal without subsequent epiphora and premature stent loss. Results: Twenty-seven children fulfilled our study criteria, and their data were included in the analyses. Mini Monoka was used in 14 patients (51.9%), whereas Masterka was used in 13 patients (48.1%). The preoperative clinical features, including age, sex, and mechanism of injury, were similar between the two groups. The mean age was 8.3 ± 5.5 years in the Mini Monoka group and 7.8 ± 5.9 years in the Masterka group (p=0.61). Three patients in the Mini Monoka group (21.4%) underwent reoperation due to premature stent loss. No premature stent loss was observed in the Masterka group. As a result, the rate of success was 78.6% in the Mini Monoka group, whereas it was 100% in the Masterka group (p=0.22). Conclusions: Even though the two groups did not show any statistically significant difference in success rate, we did not observe any premature stent loss in the Masterka group. Further studies with larger and randomized series are warranted to elaborate on these findings.

RESUMO Objetivo: Uma das desvantagens mais importantes do uso de stents Mini Monoka no reparo de lacerações canaliculares pediátricas é a perda prematura do stent. Neste estudo, objetivamos comparar os resultados clínicos dos stents monocanaliculares Mini Monoka e Masterka em crianças e discutir as possíveis causas da perda prematura do stent. Métodos: Foram incluídos nesta revisão retrospectiva 36 pacientes <18 anos de idade que se submeteram ao reparo cirúrgico de uma laceração canalicular com um stent Mini Monoka ou Masterka e tiveram pelo menos 6 meses de acompanhamento após a remoção do stent. Foram analisados os dados demográficos, o mecanismo da lesão, o tipo de stent utilizado, a ocorrência de perda prematura de stent e o sucesso da intervenção. O sucesso foi definido como a ausência de epífora após a remoção do stent, sem a perda prematura deste. Resultados: Vinte e sete pacientes preencheram os critérios do presente estudo e foram incluídos nas análises. O stent Mini Monoka foi usado em 14 pacientes (51,9%), enquanto o Masterka foi usado em 13 pacientes (48,1%). As características clínicas pré-operatórias, incluindo idade, sexo e mecanismo de lesão, foram semelhantes entre os dois grupos. A média de idade foi de 8,3 ± 5,5 anos no grupo Mini Monoka e de 7,8 ± 5,9 anos no grupo Masterka (p=0,61). Três pacientes do grupo Mini-Monoka (21,4%) tiveram que ser operados novamente por perda prematura do stent. Nenhuma perda prematura do stent foi observada no grupo Masterka. Como resultado, a taxa de sucesso foi de 78,6% no grupo Mini Monoka e de 100% no grupo Masterka (p=0,22). Conclusões: Embora nenhuma diferença estatisticamente significativa tenha sido detectada entre os dois grupos em termos de taxas de sucesso, não observamos nenhuma perda prematura de stent no grupo Masterka. São necessários mais estudos, com séries maiores e randomizadas, para chegar a maiores conclusões sobre esses achados.

Comparison of medium-term clinical effects of arthroscopic double row repair between traumatic and degenerative medium supraspinatus tear / 中华创伤骨科杂志

Objective:To compare the medium-term clinical effects of arthroscopic double row repair between traumatic and degenerative medium supraspinatus tear.Methods:A retrospective study was conducted to analyze the clinical data of 23 patients who had been treated for traumatic or degenerative medium supraspinatus tear by the same arthroscopic double row repair and postoperative rehabilitation at Sports Medicine Center, The First Hospital Affiliated to Army Medical University between January 2015 and August 2020. They were assigned into 2 groups according to different tears. In the traumatic group of 8 cases of traumatic medium supraspinatus tear, there were 5 males and 3 females with an age of (46.1±4.3) years and a tear size of (1.3±1.0) cm 2. In the degenerative group of 15 cases of degenerative medium supraspinatus tear, there were 4 males and 11 females with an age of (59.9±8.1) years and a tear size of (4.1±1.1) cm 2. At preoperation and the last follow-up, the shoulder pain was evaluated by visual analogue scale (VAS), and the shoulder function by American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score and Simple Shoulder Test (SST); the improvements in active range of motion (ROM) of the shoulder were recorded at the last follow-up. Results:The 2 groups were comparable because there was no significant difference between them in the general clinical data ( P>0.05). The traumatic and degenerative groups were followed up for (40.3±11.2) and (36.4±12.4) months, respectively. At the last follow-up, the improvements in range of anterior flexion and internal rotation vertebral rank in the degenerative group [55.3°±33.6° and (4.1±1.3) ranks] were significantly greater than those in the traumatic group [27.5°±22.5° and (2.3±1.9) ranks] ( P<0.05). At the last follow-up, the VAS, ASES, Constant-Murley, and SST scores in the degenerative group were improved respectively by (3.7±0.8), (40.9±14.0), (38.4±9.4), and (6.5±1.4) points compared with their preoperative values, significantly greater than those in the traumatic group [(2.3±0.7), (19.6±14.6), (19.2±7.9), and (3.8±0.7) points] ( P<0.05). Conclusion:Arthroscopic double row repair can achieve significant medium-term improvements in shoulder function for both traumatic and degenerative medium supraspinatus tears, but the improvements may be grater for the degenerative ones.

Resultados del taller para residentes de ginecoobstetricia en reparación de episiotomías y desgarros obstétricos / Results of workshop for obstetrics and gynecology residents on episiotomy and injury obstetric tear repair

Resumen OBJETIVO: Evaluar los conocimientos, satisfacción y nivel de confianza de los médicos residentes de Ginecología y Obstetricia luego de haber participado en un taller de simulación de reparación de episiotomías y desgarros perineales severos. MATERIALES Y MÉTODOS: Estudio observacional y transversal efectuado en residentes de la especialidad de Ginecología y Obstetricia en junio del 2022. Se aplicaron cuestionarios de conocimientos antes y después del taller, una encuesta de satisfacción y nivel de confianza, así como una lista de cotejo para valorar el desempeño en la ejecución de la técnica de reparación de episiotomías y desgarros. Se utilizó estadística descriptiva y prueba de t pareada para la comparación antes y después de las muestras relacionadas. Se consideró significancia estadística una p < 0.05. RESULTADOS: Se incluyeron 37 médicos residentes de todos los grados académicos. La media de la evaluación preprueba fue de 14.89 ± 0.54 puntos y 15.81 ± 0.41 puntos en la posprueba (p = 0.233). Durante la práctica de reparación de la episiotomía, 34 de los 37 residentes reconocieron estructuras anatómicas y todos seleccionaron adecuadamente el material de sutura. En el taller de desgarros perineales 25 de 37 reconocieron las estructuras anatómicas y todos, menos uno, seleccionaron adecuadamente el material. CONCLUSIONES: El taller con modelos animales de simulación tiene un alto grado de satisfacción y nivel de confianza; sin embargo, en este estudio no se observó mejoría en los conocimientos. Este efecto positivo en los médicos en vías de especialización permite identificar, de manera oportuna, las lesiones del esfínter anal, llevar a cabo una correcta reparación y, en consecuencia, disminuir la incidencia de disfunciones asociadas con el traumatismo obstétrico perineal.

Abstract OBJECTIVE: To assess the knowledge, satisfaction and level of confidence of Gynaecology and Obstetrics residents after participating in a simulation workshop on episiotomy and severe perineal tear repair. MATERIALS AND METHODS: Observational and cross-sectional study carried out in residents of the speciality of Gynaecology and Obstetrics in June 2022. Knowledge questionnaires were administered before and after the workshop, a satisfaction and confidence level survey, as well as a checklist to assess the post-workshop episiotomy and tear repair technique. Descriptive statistics and paired t-test were used for pre- and post-test comparison. A p < 0.05 was considered statistically significant. RESULTS: Thirty-seven resident physicians of all academic grades were included. The mean pre-test assessment was 14.89 ± 0.54 points and 15.81 ± 0.41 points at post-test, p = 0.233. During episiotomy repair practice, 34 of the 37 residents recognized anatomical structures and all selected suture material appropriately. In the perineal tears workshop 25 of 37 recognized anatomical structures and all but one selected material appropriately. CONCLUSIONS: The workshop with simulation animal models has a high satisfaction and confidence level; however, no improvement in knowledge was observed in this study. This positive effect on trainee doctors allows early identification of anal sphincter injuries, correct repair and consequently a decrease in the incidence of dysfunction associated with perineal obstetric trauma.

Influencing factors for shoulder stiffness after rotator cuff tear / 中华创伤骨科杂志

Objective:To study the influencing factors for shoulder stiffness after rotator cuff tear.Methods:The data of 228 patients were retrospectively analyzed who had been diagnosed with rotator cuff tear by arthroscopic surgery at Department of Articular Surgery, Hospital Affiliated to Chengde Medical College from June 2019 to May 2021. Their baseline data were recorded immediately after admission, including possible risk factors for shoulder stiffness. The patients were divided into a stiffness group and a non-stiffness group based on passive range of motion of shoulder joint. Univariate and multivariate analyses were performed to find out the influencing factors for shoulder stiffness after rotator cuff tear.Results:Preliminary univariate analysis showed that advanced age, smoking history, misdiagnosis history, no standardized physiotherapy history, high body mass index (BMI) and long duration of disease were all likely risk factors for shoulder stiffness in patients with rotator cuff tear ( P<0.05). Multivariate analysis confirmed that advanced age( OR=1.474, 95% CI: 1.013~2.145, P=0.043), smoking history( OR=2.239, 95% CI: 1.147~4.368, P=0.018), no standardized physiotherapy history( OR=0.167, 95% CI: 0.065~0.424, P<0.001), high BMI( OR=3.029, 95% CI: 1.657~5.536, P<0.001) and long duration of disease ( OR=1.775, 95% CI: 1.384~2.276, P<0.001) were the risk factors for shoulder stiffness. Conclusion:Age>60 years, smoking history, misdiagnosis history, no standardized physiotherapy history, high body mass index and long course of disease may be the important influencing factors for shoulder stiffness after rotator cuff tear.

Risk factors for rotator cuff tear and corresponding prediction efficacy / 中华创伤杂志

Objective:To analyze the risk factors for rotator cuff tear and evaluate the corresponding prediction efficacy.Methods:A case-control study was conducted in 69 patients with rotator cuff tear admitted to Affiliated Hospital of Qingdao University from June 2020 to June 2021 (rotator cuff tear group) and 51 normal volunteers or medical examiners (normal control group). There were 55 males and 65 females, with the age range of 34-77 years [(58.2±7.2)years]. Body mass index (BMI) ranged from 19.5-32.4 kg/m 2 [(25.4±2.5)kg/m 2]. Univariate analysis was performed for the correlation of gender, age, history of hypertension, history of smoking, history of diabetes, BMI, angle of humeral greater tuberosity and notch angle of humeral greater tuberosity with rotator cuff tear in the two groups. Factors with statistically significant differences were included in multivariate Logistic regression analysis to determine the independent risk factors for rotator cuff tear. Spearman correlation analysis was used to find factor correlation between the two groups. The receiver operating characteristic (ROC) curve of relevant factors for the diagnosis and prediction of rotator cuff tear was analyzed. Results:Univariate analysis showed that age, angle of humeral greater tuberosity and notch angle of humeral greater tuberosity related to rotator cuff tear (all P<0.05). On the contrary, gender, history of hypertension, history of smoking, history of diabetes and BMI were not correlated with rotator cuff tear (all P>0.05). Multivariate Logistic regression analysis showed significant correlations of angle of humeral greater tuberosity and notch angle of humeral greater tuberosity with rotator cuff tear (all P<0.05). Spearman correlation analysis showed that age was not correlated with angle of humeral greater tuberosity and notch angle of humeral greater tuberosity ( r=0.09, 0.13, all P>0.05), but there was significant positive correlation between angle of humeral greater tuberosity and notch angle of humeral greater tuberosity ( r=0.76, P<0.01). When the optimal cutoff values of angle of humeral greater tuberosity and notch angle of humeral greater tuberosity were 70.05° and 150.55°, the area under the ROC curve (AUC) for predicting rotator cuff tear was 0.79 (95% CI 0.71-0.87, P<0.01) and 0.81 (95% CI 0.74- 0.89, P<0.01). Conclusions:Angle of humeral greater tuberosity and notch angle of humeral greater tuberosity are independent factors for rotator cuff tear, and larger angles suggest higher prevalence of rotator cuff tear. Besides, the notch angle of humeral greater tuberosity has relatively better predictive performance.

Application of unprotected perineum delivery technique for natural childbirth in primiparas / 中国基层医药

Objective:To investigate the application effects of unprotected perineum delivery technique for normal vaginal delivery in primiparas.Methods:A total of 260 primiparas who underwent natural childbirth in Tengzhou Central People's Hospital between January 2019 and September 2020 were included in this study. They were randomly assigned to undergo childbirth either with an unprotected perineum delivery technique (study group, n = 130) or the conventional delivery technique (control group, n = 130). Delivery-related indicators were compared between the two groups. Results:The rate of first-degree perineal tear in the study and control groups was 71.52% and 29.23%, respectively, the rate of second-degree perineal tear were 7.16% and 3.16%, respectively, and the episiotomy rate in the two groups were 21.32% and 67.51%, respectively. There were significant differences in rate of first-degree perineal tear, rate of second-degree perineal tear and episiotomy rate between the two groups ( χ2 = 7.19, 7.03, 8.35, all P < 0.05). The length of hospital stay in the study and control group was 3.27 ± 5.79 days and 5.18 ± 7.26 days, respectively. The numerical rating scale score of postpartum perineal pain in the two groups was 1.23 ± 2.51 points and 3.24 ± 2.79 points, respectively. The incidence of postpartum complications was 3.33% and 11.67%, respectively. There were significant differences in length of hospital stay, numerical rating scale score of postpartum perineal pain and incidence of postpartum complications between the two groups ( t = 2.23, 2.06, χ2 = 2.52, all P < 0.05). There were no significant differences in length of second stage of labor and Apgar score in new born infants between the study and control groups (all P > 0.05). Conclusion:Unprotected perineum delivery technique can greatly decrease episiotomy rate, alleviate perineal tear, reduce pain, reduce complications, shorten length of hospital stay, and improve quality of obstetric care.

Clinical practice guideline for prevention and management of perineal tear during vaginal delivery / 中华围产医学杂志

Perineal tear is a common complication of vaginal delivery and will seriously affect the quality of life of these women, if is severe. Given to there was no evidence-based clinical guideline for the prevention and management of perineal tear in China, this evidence-based guideline was developed, based on the methods of WHO handbook for guideline development. Systematic reviews were conducted according to the Cochrane handbook and GRADE was used to assess the quality and certainty of the evidence. Detailed recommendations are provided for 19 clinical questions in the prevention and management of perineal laceration, aiming to guide clinical practice and improve the quality of life of this group of women.

Massagem perineal pré-natal para prevenção do trauma: piloto de ensaio clínico randomizado / Masaje perineal prenatal para la prevención del trauma: piloto de ensayo clínico aleatorizado / Antenatal perineal massage for trauma prevention: a pilot randomized clinical trial

Resumo Objetivo Avaliar a adesão de gestantes e acompanhantes à realização da massagem perineal digital durante a gestação e seu efeito na prevenção do trauma perineal no parto e na redução de morbidade associada nos 45 e 90 dias pós-parto. Métodos Estudo piloto de ensaio clínico randomizado com 153 gestantes de risco habitual, 78 mulheres no grupo de intervenção realizaram a massagem perineal digital e 75 mulheres do grupo controle receberam os cuidados habituais. Para a análise do desfecho principal (trauma perineal) e dos desfechos secundários, permaneceram em cada grupo 44 mulheres que tiveram parto vaginal. A intervenção foi realizada pela gestante ou acompanhante de sua escolha, diariamente, a partir de 34 semanas de gestação, por 5 a 10 minutos. Resultados A massagem perineal foi fator de proteção para edema nos primeiros 10 dias pós-parto (RR 0,64 IC95%0,41-0,99) e perda involuntária de gases nos 45 dias pós-parto (RR0,57 IC95%0,38-0,86). O ajuste residual ≥ 2 observado na análise das condições do períneo pós-parto mostrou uma tendência das mulheres do grupo intervenção terem períneo íntegro. As mulheres e os acompanhantes que realizaram a massagem perineal aceitaram bem a prática, recomendariam e fariam novamente em futura gestação. Conclusão A massagem perineal digital realizada diariamente, a partir de 34 semanas de gestação, foi uma prática bem aceita pelas mulheres e acompanhantes deste estudo. Apesar de não proteger a mulher de trauma perineal, esta prática reduziu o risco de edema 10 dias pós-parto e incontinência de gases 45 dias pós-parto. Registro Brasileiro de ensaio clínico: RBR-4MSYDX

Resumen Objetivo Evaluar la participación de mujeres embarazadas y acompañantes en la realización del masaje digital perineal durante el embarazo y su efecto en la prevención del trauma perineal durante el parto y en la reducción de la morbilidad asociada con los 45 y 90 días post parto. Métodos Estudio piloto de ensayo clínico aleatorizado con 153 mujeres embarazadas con riesgo normal, 78 mujeres en el grupo de intervención realizaron el masaje digital perineal y 75 mujeres del grupo control recibieron los cuidados habituales. Para el análisis del desenlace principal (trauma perineal) y de los desenlaces secundarios, permanecieron en cada grupo 44 mujeres que tuvieron parto vaginal. La intervención la realizó la mujer embarazada o el acompañante por ella elegido, diariamente, a partir de las 34 semanas de embarazo, por 5 a 10 minutos. Resultados El masaje perineal fue factor de protección para el edema en los primeros 10 días postparto (RR 0,64 IC95%0,41-0,99) y la pérdida involuntaria de gases en los 45 días post parto (RR0,57 IC95%0,38-0,86). El ajuste residual ≥ 2 observado en el análisis de las condiciones del perineo postparto mostró una tendencia en las mujeres del grupo intervención a que tengan el perineo íntegro. Las mujeres y los acompañantes que realizaron el masaje perineal recibieron bien la práctica, la recomendarían y la harían nuevamente en un futuro embarazo. Conclusión El masaje digital perineal realizado diariamente, a partir de las 34 semanas de embarazo, fue una práctica bien recibida por las mujeres y acompañantes de este estudio. Pese a que no protege a la mujer de un trauma perineal, esta práctica redujo el riesgo de edema a los 10 días post parto y la incontinencia de gases 45 días post parto.

Abstract Objective To evaluate the adherence of pregnant women and companions to the performance of digital perineal massage during pregnancy and its effect on the prevention of perineal trauma during childbirth and on the reduction of associated morbidity at 45 and 90 days postpartum. Methods A pilot study of a randomized clinical trial with 153 normal risk pregnant women; 78 women in the intervention group underwent digital perineal massage and 75 women in the control group received usual care. For the analysis of the main outcome (perineal trauma) and secondary outcomes, 44 women who had vaginal delivery remained in each group. The intervention was performed daily by the pregnant woman or the companion of her choice from 34 weeks of gestation during 5-10 minutes. Results Perineal massage was a protective factor for edema in the first 10 days postpartum (RR 0.64 95%CI 0.41-0.99) and involuntary gas loss at 45 days postpartum (RR0.57 95%CI 0.38-0.86). The residual adjustment ≥ 2 observed in the analysis of perineal conditions postpartum showed a trend of women in the intervention group having an intact perineum. The women and companions who performed perineal massage accepted the practice well, recommended it and would do it again in a future pregnancy. Conclusion The digital perineal massage performed daily from 34 weeks of gestation was a practice well accepted by women of this study and their companions. Although not protecting women from perineal trauma, this practice reduced the risk of edema at 10 days postpartum and gas incontinence at 45 days postpartum. Brazilian Clinical Trial Registry: RBR-4MSYDX

Aplicabilidade de algoritmo de apoio à decisão na avaliação perineal para o parto / Aplicabilidad de algoritmo para respaldar la decisión en la evaluación perineal para el parto / Applicability of decision support algorithm in perineal assessment for childbirth

Resumo Objetivo Desenvolver um algoritmo para avaliação perineal na assistência ao parto e aferir sua aplicabilidade e acurácia utilizando um protótipo de sistema de suporte à decisão. Métodos Pesquisa aplicada de desenvolvimento tecnológico, constituída pela construção de algoritmo, avaliação por profissionais com expertise na área, criação de um protótipo de Sistema de Apoio à Decisão usando ferramentas on-line e avaliação de sua aplicabilidade e acurácia durante a assistência a 305 partos realizados por enfermeiros. Os dados foram analisados por estatística descritiva, teste Qui-quadrado e exato de Fisher além do coeficiente de Kappa para avaliar a concordância entre o procedimento indicado pelo sistema e o realizado pelo profissional. Resultados Houve concordância entre a sugestão do algoritmo e a decisão do profissional em 93,1% dos partos; em 6,9% o profissional decidiu caminhos opostos ao recomendado. Os profissionais que optaram por seguir a sugestão do algoritmo obtiveram como desfecho a integridade perineal ou a ocorrência de lacerações de 1°grau. Os que optaram por não seguir a recomendação houve ocorrência de lacerações de 2º ou 3º graus em 28,6% das parturientes. Já na análise de acurácia, o algoritmo sugeriu que a episiotomia deveria ser realizada em 45 dos 305 partos assistidos. Verificou-se associação entre divergências de conduta e número de eventos adversos (p=0,001). Conclusão O algoritmo mostrou-se ferramenta útil para a avaliação perineal na assistência ao parto.

Resumen Objetivo Desarrollar un algoritmo para la evaluación perineal en la asistencia al parto y determinar su aplicabilidad y precisión utilizando un prototipo de sistema para respaldar la decisión. Métodos Investigación aplicada de desarrollo tecnológico, constituida mediante la construcción del algoritmo, evaluación de profesionales con experiencia en el área, creación de un prototipo de Sistema para Respaldar la Decisión usando herramientas en línea y evaluación de su aplicabilidad y precisión durante la atención a 305 partos realizados por enfermeros. Los datos fueron analizados mediante estadística descriptiva, prueba χ2 de Pearson y prueba exacta de Fisher, además del coeficiente Kappa para evaluar la concordancia entre el procedimiento indicado por el sistema y el realizado por el profesional. Resultados Hubo concordancia entre la sugerencia del algoritmo y la decisión del profesional en el 93,1 % de los partos, en el 6,9 % el profesional decidió un camino opuesto al recomendado. Los profesionales que optaron por seguir la sugerencia del algoritmo obtuvieron como resultado la integridad perineal o episodios de desgarro de primer grado. Los que optaron por no seguir la recomendación, tuvieron episodios de desgarros de segundo y tercer grado en el 28,6 % de las parturientas. Por otro lado, en el análisis de precisión, el algoritmo sugirió que la episiotomía debería ser realizada en 45 de los 305 partos atendidos. Se verificó relación entre divergencias de conducta y número de eventos adversos (p=0,001). Conclusión El algoritmo demostró ser una herramienta útil para la evaluación perineal en la atención a partos.

Abstract Objective To develop an algorithm for perineal assessment in childbirth care and assess its applicability and accuracy using a decision support system prototype. Methods This is applied research of technological development, consisting of the construction of an algorithm, assessment by professionals with expertise in the area, creation of a Decision Support System prototype using online tools and assessment of its applicability and accuracy during care for 305 childbirths performed by nurses. Data were analyzed using descriptive statistics, chi-square and Fisher's exact tests, in addition to the Kappa coefficient to assess the agreement between the procedure indicated by the system and that performed by professionals. Results There was agreement between the algorithm's suggestion and professional decision in 93.1% of childbirths. In 6.9%, professionals decided opposite paths to the recommended one. The professionals who chose to follow the algorithm's suggestion had perineal integrity or the occurrence of first-degree tear as an outcome. Those who chose not to follow the recommendation had second- or third-degree tears in 28.6% of parturient women. In the accuracy analysis, the algorithm suggested that episiotomy should be performed in 45 of the 305 assisted childbirths. There was an association between divergences in conduct and the number of adverse events (p=0.001). Conclusion The algorithm proved to be a useful tool for perineal assessment in childbirth care.

Important aspects during advanced lingual laceration management: report of 2 cases / Aspectos importantes para o manejo das lacerações complexas da língua: relato de 2 casos

ABSTRACT Intraoral injuries affect the stomatognathic system, creating difficulties in mastication and speech articulation, especially when they affect the tongue. In this context, the quality of the suture and local care are important to proper recovery and the patient's brief return to their normal functions. Oral lacerations resulting from trauma require specific approaches. Treatments of this type of trauma may primarily be performed by professionals who conduct emergency care; however, they may require the attention of specialists. This article contains recommendations for the primary approach, treatment, and postoperative care of complex lacerations in the tongue.

RESUMO As lesões intraorais afetam o sistema estomatognático, gerando dificuldades na mastigação e na articulação da fala, principalmente quando afetam a língua. Nesse contexto, a qualidade da sutura e o cuidado local são importantes para a recuperação adequada e o breve retorno do paciente às suas funções normais. As lacerações orais resultantes de trauma requerem abordagens específicas. Os tratamentos desse tipo de trauma podem ser realizados principalmente por profissionais que realizam atendimento de emergência; no entanto, eles podem exigir a atenção de especialistas. Este artigo contém recomendações para a abordagem primária, tratamento e cuidados pós-operatórios de lacerações complexas da língua.

Management of pediatric canalicular lacerations with the RS-1 silicone tube and the conventional silicone tube / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the clinical effecacy of the RS-1 silicone tube and the conventional silicone tube in the management of pediatric canalicular lacerations.<p>METHODS: We retrospectively reviewed the medical records of 48 pediatric patients(48 eyes)with canalicular lacerations admitted for primary repair in the Department of Ocular Trauma of Hebei Eye Hospital from January 2015 to June 2018. The patients were divided into two groups according to the treatment of method: Group A(25 patients, the conventional silicone tube), Group B(23 patients, the RS-1 silicone tube). The management of pediatric canalicular lacerations were performed under general anesthesia. The silicone tube was removed about 3mo after surgery. The surgical time, clinical efficacy and complications were compared.<p>RESULTS: The mean surgical time between the two groups was 44.92±14.45min in Group A and 31.78±7.40min in Group B, which was statistically significant difference(<i>t</i>=4.02, <i>P</i><0.01). The clinical efficacy of the two groups was compared. Group A: 20 patients were cured(80%), 2 patients were improved(8%), 3 patients were failed(12%), and the functional success rate was 88%. Group B: 19 patients were cured(82%), 2 patients were improved(9%), 2 patients were failed(9%), the functional success rate was 91%, which was not statistically significant difference(χ2=0.14, <i>P</i>>0.05). The incidence of complications(32% <i>vs</i> 9%)including lower lacrimal point and mild eyelid eversion(1 patient 4% <i>vs</i> 1 patient 4%), slit canaliculus(2 patients 8% <i>vs</i> 1 patient 4%), early tube extrusion(3 patients 12% <i>vs</i> 0%), and nasal mucosal injury(3 patients 12% <i>vs</i> 0%)in Groups A and B, respectively, were comparable. There was statistically significant difference in the incidence of complications between the groups(χ2=3.94, <i>P</i><0.05).<p>CONCLUSION: There is no statistically significant difference with the two different types of silicone tube, which have good clinical efficacy, in the management of pediatric canalicular lacerations. But the RS-1 silicone tube is easier to operate, shorter surgical time, less complications and easier to removed.

Arrow Ocular Injury

@#Pediatric ocular trauma; though the number is small, can lead to a devastating lifetime impact due to its risk of amblyopia (if it occurs before the age of seven) and also loss of vision. We are reporting a case of a young 12-year-old-boy who was struck unintentionally by an arrow to the eye by another friend during sports activity. The arrow pierced the right eyebrow just below the orbital roof then perforated the globe from the superior orbit pointing downwards piercing the floor of the orbit fracturing the maxillary roof. Emergency scleral repair was done; however, there was no useful vision left. Arrow injury to the eye is a rare occurrence but leads to severe consequences given its high velocity and projectile in nature. The incidence is low and highly avoidable if precautionary measures are taken.

Posições verticalizadas no parto e a prevenção de lacerações perineais: revisão sistemática e metanálise / Posiciones verticales en el parto y prevención de laceraciones perineales: revisión sistemática y metaanálisis / Upright positions in childbirth and the prevention of perineal lacerations: a systematic review and meta-analysis

RESUMO Objetivo Investigar se a adoção de posições verticalizadas pela mulher, no parto, comparada à posição litotômica, previne lacerações perineais. Método Revisão sistemática com metanálise. As buscas foram realizada nas bases de dados: LILACS, Medline/PubMed, CINAHL, Cochrane Library, Web of Science, Science Direct e Scopus. As buscas na literatura cinzenta foram conduzidas nas bases Google Scholar e OpenGrey. Também foram consideradas as listas de referências dos artigos incluídos. Para análise da qualidade metodológica dos artigos, utilizou-se a ferramenta da colaboração Cochrane e a ACROBAT-NRSI. Resultados Foram elencados 26 estudos e 8 foram selecionados para a metanálise. O nível de evidência científica foi classificado pelo Sistema GRADE e considerado alto. Não houve diferença estatística significativa entre posições verticalizadas em relação as posições horizontais. Apesar dessa constatação, as posições verticalizadas apresentaram índices reduzidos de lacerações perineais graves. Conclusão A adoção de posições verticalizadas, no parto normal, pode ser encorajada pelos profissionais, pois pode evitar lacerações perineais graves, porém, não é possível afirmar com precisão a eficácia destas em detrimento das posições horizontais para o desfecho períneo íntegro.

RESUMEN Objetivo Investigar si la adopción de posiciones verticales por parte de la mujer en el parto, en comparación con la posición de litotomía, previene las laceraciones perineales. Método Revisión sistemática con metaanálisis. Se realizaron búsquedas en las siguientes bases de datos: LILACS, Medline/PubMed, CINAHL, Cochrane Library, Web of Science, Science Direct y Scopus. Se realizaron búsquedas en la literatura gris en las bases de datos Google Scholar y Opengray. También se examinaron las listas de referencia de los artículos incluidos. La herramienta de colaboración Cochrane y el ACROBAT-NRSI se utilizaron para analizar la calidad metodológica de los artículos. Resultados Se enumeraron 26 estudios y se seleccionaron 8 para el metaanálisis. El nivel de evidencia científica fue clasificado por el Sistema GRADE y considerado alto. No hubo una diferencia estadística significativa entre las posiciones verticales y las horizontales. A pesar de este hallazgo, las posiciones verticales presentaban bajas tasas de laceraciones perineales graves. Conclusión La adopción de posiciones verticales en el parto normal puede ser fomentada por los profesionales, ya que puede evitar desgarros perineales severos, sin embargo, no es posible afirmar con exactitud su eficacia en detrimento de las posiciones horizontales para el resultado perineal completo.

ABSTRACT Objective To investigate whether the adoption of upright positions by women during childbirth prevents perineal lacerations compared to the lithotomy position. Method A systematic review with meta-analysis. The searches were carried out in the databases: LILACS, Medline/PubMed, CINAHL, Cochrane Library, Web of Science, Science Direct and Scopus. Searches in the gray literature were conducted on Google Scholar and OpenGrey databases. Reference lists of included articles were also considered. The Cochrane collaboration tool and ACROBAT-NRSI were used to analyze the methodological quality of the articles. Results There were 26 studies listed and 8 were selected for the meta-analysis. The level of scientific evidence was classified by the GRADE System and considered high. There was no statistically significant difference between upright positions in relation to horizontal positions. Despite this finding, the upright positions showed reduced rates of severe perineal lacerations. Conclusion Adopting upright positions in normal delivery can be encouraged by professionals as it can prevent severe perineal lacerations; however, it is not possible to accurately affirm their effectiveness to the detriment of horizontal positions for an intact perineum outcome.

Factors related to perineal outcome after vaginal delivery in primiparas: a cross-sectional study / Factores relacionados con el resultado perineal tras parto vaginal en primíparas: estudio transversal / Fatores relacionados ao desfecho perineal após parto vaginal em primíparas: estudo transversal

Abstract Objective: Identify the associations between perineal outcome in primiparas and interventions during labor and delivery, newborn weight and APGAR score. Method: Document-based, correlational, retrospective, quantitative study conducted in a tertiary maternity hospital in the state of Ceará, between July 2017 and January 2018. The independent variables were labor induction, amniotomy, non-pharmaceutical methods for relieving pain, forceps, episiotomy, Kristeller maneuver, position in the expulsion stage, shoulder dystocia, and newborn weight and APGAR score, and the dependent variable was perineal outcome. Pearson's chi-square test and Fisher's exact test were used. Results: A total of 226 normal-risk primiparas who had a vaginal delivery. An association was found between horizontal position in the expulsion stage and episiotomy, and between not performing an episiotomy and perineal tearing. The other variables (labor, delivery and neonatal) did not have any effect on perineal tearing. Conclusion: Interventions, with the exception of episiotomies, did not have an influence on the occurrence of perineal trauma, but they do need to be carefully assessed. Deliveries in a horizontal position were associated with a higher likelihood of performing an episiotomy.

Resumen Objetivo: Identificar las asociaciones entre el resultado perineal en primíparas y las intervenciones ocurridas durante el trabajo de parto, parto, peso y APGAR del recién nacido. Método: Estudio documental, correlacional, retrospectivo, cuantitativo, llevado a cabo en una maternidad terciaria en el estado de Ceará, entre julio de 2017 y enero de 2018. Las variables independientes fueron inducción del parto, amniotomía, métodos no farmacológicos de alivio del dolor, fórceps, episiotomía, maniobra de Kristeller, posición en el período expulsivo, distocia de hombro, peso y APGAR del recién nacido, y la variable dependiente fue el resultado perineal. Se emplearon las pruebas de Chi cuadrado de Pearson y la exacta de Fisher. Resultados: Participaron 226 primíparas de riesgo habitual que parieron por vía vaginal. Se verificó asociación entre la posición horizontal en el período expulsivo del parto y episiotomía, y entre la no realización de episiotomía y laceración perineal. La otras variables de trabajo de parto, parto y neonatal no interfirieron en la ocurrencia de laceración perineal. Conclusión: Acciones intervencionistas, salvo la episiotomía, no influenciaron la ocurrencia de trauma perineal, sin embargo requieren evaluación juiciosa. El parto en la posición horizontal se relacionó con la mayor posibilidad de realización de episiotomía.

Resumo Objetivo: Identificar as associações entre o desfecho perineal em primíparas e as intervenções ocorridas durante o trabalho de parto, parto, peso e APGAR do recém-nascido. Método: Estudo documental, correlacional, retrospectivo, quantitativo, realizado em uma maternidade terciária no estado do Ceará, entre julho de 2017 e janeiro de 2018. As variáveis independentes foram indução do parto, amniotomia, métodos não farmacológicos de alívio da dor, fórceps, episiotomia, manobra de Kristeller, posição no período expulsivo, distocia de ombro, peso e APGAR do recém-nascido, e a variável dependente foi o desfecho perineal. Foram utilizados o teste de Qui-quadrado de Pearson e o teste exato de Fisher. Resultados: Participaram 226 primíparas de risco habitual que pariram por via vaginal. Verificou-se associação entre posição horizontal no período expulsivo do parto e episiotomia, e entre a não realização de episiotomia e laceração perineal. As outras variáveis de trabalho de parto, parto e neonatal não interferiram na ocorrência de laceração perineal. Conclusão: Ações intervencionistas, com exceção da episiotomia, não influenciaram a ocorrência de trauma perineal, porém requerem avaliação criteriosa. O parto na posição horizontal relacionou-se a maior probabilidade de realização de episiotomia.

Síndrome de Mallory-Weiss. Reporte de caso y breve revisión de la literatura / Mallory-Weiss syndrome. Case report and brief review of the literature

Resumen Introducción El síndrome de Mallory-Weiss se caracteriza por el desgarro longitudinal de la mucosa de la unión gastroesofágica. En el presente trabajo hemos realizado una breve revisión de la literatura de utilidad para el estudiante de medicina y la hemos acompañado de un caso clínico para ilustrar el contenido aquí desarrollado. Caso Paciente del sexo masculino, de 40 años de edad, que acudió al servicio de urgencias de nuestra institución por presentar hematemesis, melena, datos de hipovolemia, e hipo de 2 días de evolución. Como antecedentes de importancia refirió consumo de alcohol a razón de 15 copas cada tercer día. Durante la endoscopía diagnóstica se identificó en la unión esofagogástrica, un coágulo adherente a la mucosa de 5 mm, con lo que se diagnosticó un desgarro de Mallory-Weiss. El tratamiento se realizó mediante endoscopía. Se optó por una inyección local de adrenalina con colocación posterior de liga. El paciente fue dado de alta sin complicaciones. Conclusión Los estudios realizados sobre el síndrome de Mallory-Weiss han permitido actualizar la información que se tiene al respecto. El avance tecnológico y científico ha incrementado las tasas de éxito del manejo de esta identidad.

Abstract Introduction Mallory-Weiss syndrome is characterized by the longitudinal tear of the mucosa of the gastroesophageal junction. In the present work we have made a brief review of the literature useful for the medical student and we have accompanied a clinical case to illustrate the content developed here. Case A 40-year-old male attended the emergency department of our institution due to hematemesis, melena, hypovolemia, and 2-day history of hiccups. The patient referred alcohol consumption at a rate of 15 drinks every third day. During diagnostic endoscopy, a mucosal adherent clot of 5 mm was identified in the gastric esophageal junction, and a Mallory-Weiss tear was diagnosed. The treatment was performed by endoscopy. We opted for a local injection of Adrenaline with subsequent endoscopic ligation. The patient was discharged without complications. Conclusion The studies carried out on the Mallory-Weiss Syndrome have made it possible to update the information available. The technological and scientific advance has increased the success rates of the management of this identity.

Arthroscopic bursal layer-only double-row suture-bridge repair for delaminated rotator cuff tear difficult to reposit / 中华创伤骨科杂志

Objective To evaluate the clinical efficacy of arthroscopic bursal layer-only double-row suture-bridge repair for delaminated rotator cuff tear which is difficult to reposit in comparison with separate double-layer repair and whole-layer repair.Methods From May 2013 through June 2016,82 patients with delaminated rotator cuff tear difficult to reposit were treated at Department of Joint Surgery,The Affiliate Hospital to Chengde Medical University.They were 47 males and 35 females with a mean age of 53.0 ± 7.9 years.They were divided into 3 groups according to their surgical procedures.In group A,28 cases were treated by arthroscopic whole-layer double-row suture-bridge procedure;in group B,29 cases were treated by arthroscopic separate double-layer double-row suture-bridge procedure;in group C,25 cases were treated by arthroscopic bursal layer-only double-row suture-bridge procedure.The 3 groups were compared in terms of University of California Los Angeles (UCLA) score,American Shoulder and Elbow Surgeons (ASES) score,visual analogue scale (VAS),Constant shoulder score,range of motion of shoulder joint and rotator cuff retear preoperatively and postoperatively.Results The patients in the 3 groups were comparable because their preoperative general data showed no significant significances (P ＞ 0.05).The operation time for groups A,B and C was respectively 105.5 ±5.6 min,117.4 ±6.9 min and 88.0 ±4.2 min,showing significant differences between the 3 groups (P ＜ 0.05).The 82 patients were followed up for 21 to 24 months (average,23.3 months).At 24 months postoperatively,UCLA,ASES,VAS,Constant score,shoulder anteflexion and lateral extorsion were respectively 32.4 ± 2.5,12.8 ± 0.9,1.0 ± 1.1,93.4 ± 5.6,158.3° ± 9.3°and 58.9°±5.0°in group A,32.2±2.5,12.9±1.0,0.9±1.0,92.8±6.0,156.4°±9.5°and 59.3°± 5.6° in groups B,and32.4±2.4,12.9±0.9,0.7±0.9,94.3±5.2,156.0°±9.5°and57.6°°5.4°in group C,showing no significant differences between the 3 groups (P ＞ 0.05).The occurrence of rotator cuff retear in groups A,B and C were respectively 17.9％ (5/28),13.8％ (4/29) and 12.0％ (3/25),showing no significant differences between the 3 groups (P ＞ 0.05).Conclusions In repair of delaminated rotator cuff tear difficult to reposit,although the arthroscopic bursal layer-only double-row suture-bridge repair is similar to conventional arthroscopic whole-layer double-row suture-bridge repair and arthroscopic separate double-layer double-row suture-bridge repair in functional recovery and range of motion of the shoulder and incidence of rotator cuff retear,it can reduce obviously operation time and make the operation easier.

Updates in emergency department laceration management

Lacerations are a common reason for patients to seek medical attention, and are often acutely managed in the emergency department. Recent studies pertaining to closure techniques, sedation and analgesia, advances in wound care, and various other topics have been published, which may enhance our understanding of this injury and improve our management practices. This article will review pertinent studies published in the past few years relevant to laceration management. Understanding the current literature and appreciating which areas warrant further investigation will help us optimize outcomes for patients who sustain laceration injuries.

Perineal care and outcomes in a birth center / Resultados y cuidados perineales en un centro de parto normal / Desfechos e cuidados perineais em centro de parto normal

ABSTRACT Objective: to analyse the perineal outcomes in childbirth and post-partum perineal care in a freestanding birth centre. Method: a cross-sectional study, with data collection performed in the women's birth records forms from Casa Angela, a freestanding birth centre, São Paulo, Brazil, in 2016-2017 (n=415). The following data was analysed: occurrence and perineal tear degree; maternal, neonatal and birth care-related variables; perineal suture prevalence; complications in wound healing and natural methods on perineal care. Data were subjected to descriptive, inferential and multiple analyses. Results: in 11.8% of women, the perineum was kept intact, 61.9% had spontaneous first-degree tear and 26.3% had second-degree tear. The variables related to the occurrence and higher spontaneous degree tears were maternal age and second period of childbirth >2 hours. The protective factors against the occurrence and higher degree tears were number of previous vaginal childbirths and maternal position different from vertical during childbirth. Perineal suture was performed in 16.0% and 70.6% of women with spontaneous first- and second-degree tears, respectively. The main perineal complications after birth were edema (53.6%) and pain (29.4%); and the perineal suture increased the chance for these complications (OR=2.5; 95%CI 1.5-4.3). Perineum icepack compress was used in 53.8% of women during post-partum period. Conclusion: maternal and health-care related factors were associated to the prevalence and degree of spontaneous perineal tear. First-degree spontaneous perineal tears were prevalent and sutured in a low number of women. There were more complications in the wound healing process when the perineal suture was performed, regardless the tear degree. The number of natural methods in post-partum perineal care was higher than the use of medicines.

RESUMEN Objetivo: analizar los resultados perineales en el parto y el cuidado perineal post-parto en un Centro de Parto peri-hospitalario. Método: estudio transversal con recolección de datos en los registros de parto de las mujeres que dieron a luz en el Centro de Parto Casa Angela, que atiende al parto peri-hospitalario, en São Paulo, Brasil, en 2016-2017 (n=415). Se analizaron: ocurrencia y grado de los desgarros perineales y variables maternas, neonatales y asistenciales relacionadas; prevalencia de reparación perineal; complicaciones en la cicatrización; métodos naturales del cuidado perineal. Los datos se analizaron por estadística descriptiva e inferencial, con análisis bivariado y múltiple. Resultados: el perineo se mantuvo intacto en el 11,8% de las mujeres, el 61,9% tuvieron desgarros de primer grado, y el 26,3% de segundo grado. Las variables relacionadas con la ocurrencia y el mayor grado de los desgarros fueron la edad de la madre y el período expulsivo del parto >2 horas. Los factores protectores contra la ocurrencia y el mayor grado de los desgarros fueron el número de partos vaginales anteriores y la posición materna diferente de la vertical durante el parto. La reparación perineal se realizó en el 16% y el 70,6% de las mujeres con desgarros de primer y segundo grado, respectivamente. Las complicaciones perineales predominantes fueron edema (53,6%) y dolor (29,4%) y la reparación aumentó la probabilidad de estas complicaciones (OR=2,5; 95%IC 1,5-4,3). La compresa de hielo en el perineo se utilizó en el 53,8% de las mujeres en el período post-parto. Conclusión: los factores maternos y asistenciales se asociaron con la prevalencia y el grado del desgarro perineal. Hubo predominio de desgarros de primer grado, reparados en un pequeño número de mujeres. Cuando se realizó la reparación perineal, hubo más complicaciones en el proceso de cicatrización, independientemente del grado del desgarro. La cantidad de métodos naturales en el cuidado perineal después del parto fue superior al uso de medicamentos.

RESUMO Objetivo: analisar os desfechos perineais no parto e o cuidado perineal pós-parto em um Centro de Parto peri-hospitalar. Método: estudo transversal, com coleta de dados nos prontuários das mulheres que deram à luz no Centro de Parto peri-hospitalar Casa Angela, em São Paulo, Brasil, em 2016-2017 (n=415). Foram analisados: ocorrência e grau da laceração perineal e variáveis maternas, neonatais e assistenciais relacionadas; prevalência de reparo perineal; complicações na cicatrização e métodos naturais de cuidado perineal. Os dados foram analisados por estatística descritiva e inferencial, com análise bivariada e múltipla. Resultados: o períneo manteve-se íntegro em 11,8% das mulheres, 61,9% tiveram lacerações de primeiro grau e 26,3% de segundo grau. As variáveis relacionadas à ocorrência e maior grau das lacerações foram idade materna e período expulsivo do parto >2 horas. Os fatores protetores contra a ocorrência e o maior grau das lacerações foram número de partos vaginais anteriores e posição materna diferente da vertical durante o parto. O reparo perineal foi realizado em 16% e 70,6% das mulheres com lacerações de primeiro e segundo graus, respectivamente. As complicações perineais predominantes foram edema (53,6%) e dor (29,4%) e o reparo aumentou a chance dessas complicações (OR=2,5; 95%IC 1,5-4,3). A compressa de gelo no períneo foi usada em 53,8% das mulheres no pós-parto. Conclusão: fatores maternos e assistenciais associaram-se à prevalência e grau da laceração perineal. Houve predomínio das lacerações de primeiro grau, reparadas em um número reduzido de mulheres. Quando o reparo perineal foi realizado, houve mais complicações no processo de cicatrização, independentemente do grau da laceração. O número de métodos naturais no cuidado perineal após o parto foi superior ao uso de medicamentos.