Perineal Lacerations: A Retrospective Study in a Habitual-Risk Public Maternity / Lacerações perineais: um estudo retrospectivo em uma maternidade pública de risco habitual

Abstract Objective 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. Methodology 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. Results 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. Conclusion 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.

Resumo Objetivo Aproximadamente 85% dos partos vaginais cursam ou com lacerações perineais e/ou com episiotomia. Este estudo objetivou determinar a incidência de lacerações e episiotomias das parturientes de 2018 de uma maternidade pública de risco habitual, no sul do Brasil, bem como determinar os fatores de risco e proteção para tais eventos. Métodos Estudo transversal retrospectivo, no qual os dados foram obtidos dos prontuários e analisados no programa Stata. Realizaram-se regressões logísticas uni e multivariada. Foram considerados como significantes valores de p<0,05. Resultados Em 2018, aconteceram 525 partos vaginais, sendo 27,8% assistidos por médicos obstetras, 70,7%, por enfermeiros obstetras, e 1,5% evoluíram sem assistência. Ao todo, 55,2% das parturientes apresentaram algum grau de laceração. O profissional que assistiu ao parto foi uma variável que demonstrou significância: um maior número de lacerações de primeiro e segundo graus, bem como casos de maior gravidade, ocorreram em partos assistidos por enfermeiros (razão de probabilidades [RP]: 2,95; intervalo de confiança de 95% [IC 95%]: 1,74 a 5,03). Posições ao nascimento que não permitiam técnicas de proteção perineal (período expulsivo na técnica "sem mãos" [hands off, em inglês]), quando analisadas isoladamente, determinaram o risco; contudo, no modelo final de regressão, essa relação não se confirmou. Apesar de relatada na literatura, não houve associação entre a ocorrência de laceração e a idade, a cor da pele, ou o peso de nascimento. Em 24% dos partos, uma episiotomia foi realizada, tendo os médicos executado 63,5% delas. Conclusão Partos assistidos por enfermeiros resultaram em um maior risco de lacerações perineais, de variados graus. Por sua vez, os assistidos por médicos apresentaram maior ocorrência de episiotomia.

Honrar, Honra. Panel en Homenaje al Aniversario 85 del natalicio del Ministro Dr. Sergio del Valle Jiménez / To honour does one's honour. Panel paying Homage to Dr. Minister Sergio Del Valle Jiménez on occasion of his 85th birthday Anniversary

En homenaje al General de División y Héroe de la República de Cuba, Dr. Sergio del Valle Jiménez, excelente médico obstetra; militante del Movimiento 26 de Julio; combatiente de la Sierra Maestra; Jefe de la Fuerza Aérea al triunfo revolucionario; Jefe del Estado Mayor General de las FAR, cuando el ataque mercenario a Playa Girón y la Crisis de Octubre, momentos difíciles que compartiera con el Comandante en Jefe Fidel Castro Ruz; Ministro del Interior (1968-1979) y Ministro de Salud Pública (1979-1985), se realizó un Coloquio en el Museo de la Revolución _gracias al apoyo solidario de su Director y equipo de especialistas y trabajadores- en vísperas del 85 Aniversario de su natalicio, el 15 de abril. El Panel estuvo integrado por compañeros, quienes compartieron distintas etapas de su vida estudiantil, laboral, de la clandestinidad y la Sierra Maestra, y las responsabilidades asumidas después del triunfo revolucionario. Una nutrida asistencia demostró su interés por conocer más del hombre excepcional a quien se recordaba en ese día. Todos los panelistas coincidieron en que las principales virtudes que destacaron a este admirado médico revolucionario son la honestidad, nobleza, modestia, firmeza revolucionaria, sentido de justicia, decisión y coraje. Dos interesantes intervenciones del público asistente, así lo corroboraban. La Moderadora, en las conclusiones, leyó dos juicios de valor emitidos por el máximo líder de la Revolución Cubana acerca del extraordinario hombre a quien se le rendía tributo, y agradeció a todos su asistencia, especialmente a las decenas de personas, quienes se mantuvieron de pie durante las dos horas del coloquio.

It was carried out a colloquy at the museum of the Revolution to do homage to General of Division and hero of the Republic of Cuba Dr. Sergio del Valle Jiménez, militant of "26 de Julio" movement, combatant at Sierra Maestra mountains, Commander of the Air Force at the Revolutionary triumph in 1959 and General chief of the revolutionary armed forces(FAR) when the mercenary attack in Playa Giron and the so called "October Crisis", these last two difficult moments that he shared with Commander in chief Fidel Castro Ruz, He was also in charge of the Cuban "Ministerio del Interior"during the period 1968 - 1979 and Minister of Public Health for six years (1979 - 1985). We would like to thanks the jointly support of the director of the museum as well as all the specialists and workers of this institution who made possible this activity on the eves of the 85th anniversary of his birthday on April 15th. The panelists of the activity were comrades of Dr.Sergio del Valle who shared different stages of his life as a student, worker, fighter at Sierra Maestra mountains and in charge of different responsabilities he assumed after the revolutionary victory in 1959. All the panelists had total coincidence when expressing the main virtues of this admired revolutionary doctor. Those virtues were honesty, modesty, sense of justice, decision and courage. At the end of the activity the moderator read two important considerations made by the leader of the Cuban revolution about Dr. Sergio del Valle and thanked all the persons who attended the colloquy specially those who remained standing for the two hours the activity lasted.