FACTORS ASSOCIATED WITH PERINEAL INTEGRITY IN SPONTANEOUS VAGINAL BIRTH

Introduction: The frequency of perineal trauma in spontaneous vaginal birth is high, occurring in about 85% of deliveries, and may trigger long-term repercussions such as chronic perineal pain, sexual dysfunction, urinary and bowel disorders.(1) With the adoption of protocols for the selective use of episiotomies, it is necessary to study the frequency of perineal traumas and associated factors in order to promote the perineal integrity and the prevention of traumas that may have long-term repercussions for women.

Objective: To identify the frequency of integrity, spontaneous perineal traumas or episiotomy resulting from non-operative vaginal birth and to verify the associated factors.
Method: Cross-sectional, quantitative, prospective study on the frequency of spontaneous perineal trauma or episiotomy and perineal integrity in non-operative vaginal birth in a public hospital in the southern part of the city of São Paulo. The data was collected in July 2018, based on the report in the medical record and the interview with the 68 postpartum women, through a form that included the study variables. The project obtained a favorable opinion from the CEP of the institutions (CAAE: 86560218.6.3001.5452). The data analysis was made by descriptive and inferential statistics by the Spearman test. Significance adopted p = 0.05.
Results: The mean age of women was 25.5 ± 6.7 years, with 16.2% of adolescents. Secundary education had been completed by 41.2%, 38.2% had completed elementary education, and only 4.4% had completed higher education. The primigravidae represented 39.7% of the sample, with mean parity of 1.2 ± 1.5. The mean maternal weight was 72.7 ± 15.1, ranging from 49 to 134 kg. At admission, the mean gestational age was 38.8 ± 1.0 weeks, with only 20.9% reaching 40 or more and the mean number of prenatal visits was 8.3 ± 3.7. The mean duration of labor was 6.5 ± 5.5 hours and 44.1% were induced or augmented with oxytocin. At birth the most adopted position was the semi-sitting in 51.5%, followed by lithotomy in 20,6% and on side position in 16.2%. The professional who assisted more was the obstetric physician in 51.5% followed by the nurse midwife 48.5%. The mean birth weight was 3102.5 ± 377.3 grams. The perineum was classified as intact in 44.1% of deliveries, first and second degree lacerations occurred in 38.2% and 10.3%, respectively, and episiotomy in 7.4% of all deliveries. The factors associated with perineal integrity were the number of previous pregnancies (p=0,001), parity (p=0,000) and weight of the newborn (p=0,037).
Conclusions: The factors associated with perineal integrity were the number of previous pregnancies, parity and weight of the newborn. Understanding more about the factors associated with trauma and perineal integrity helps in their prevention during childbirth.