Associação da episiotomia e laceração perineal grave com disfunção do assoalho pélvico no pós-parto remoto

Detalhes bibliográficos
Autor(a) principal: Lima, Clara Taína Silva
Data de Publicação: 2018
Tipo de documento: Dissertação
Idioma: por
Título da fonte: Repositório Institucional da Universidade Federal do Ceará (UFC)
Texto Completo: http://www.repositorio.ufc.br/handle/riufc/37965
Resumo: To evaluate the association between episiotomy and severe perineal laceration (third and fourth degreen) with the presence of urinary incontinence (UI), contractile function and ultrasonographic findings of the pelvic floor muscles (PFM) in the postpartum remote. Materials and Methods: Product 1 – A Systematic Review and Meta-Analysis of observational studies evaluating the association between perineal childbirth lesions and morphological alterations pf PFM evaluated by ultrasound was performed. Product 2 – cross-sectional observational study. It was performed with primiparous women from the Maternity School Assis Chateaubriand (MEAC), who were in the period from 12 to 36 months after term vaginal delivery. Women with urogenital tract infection, history of gynecological or rectal cancer, previous surgeries in the PFM, carriers of demyelinating diseases of the spinal cor dor who became pregnant again were excluded. The records of all women who had vaginal delivery between May and November 2015 were analyzed, and from this analysis, women who suffered severe perineal laceration and those who underwent episiotomy were identified. The women were selected to composse three groups: 1) women who underwent episiotomy (n=12); 2) women who suffered severe perineal laceration (n=9) and 3) women who maintained intact perineum (n=12). The initial evaluation consisted of a clinical and sociodemographic questionnaire, and the International Consulation on Incontinence Questionnaire – Short Form (ICIQ-SF). The physical evaluation was composed of Pelvic Organ Prolapse Quantification System (POP-Q) measurements, digital MAP palpation and perineometry. Statistical analyzes were performed using the Chi-square and U Mann-Whitney tests. Results: Product 1 – Both episiotomy and severe perineal laceration are associated with a greater likelihood of avulsion of the anus levator muscle (OR = 1,77, 95% CI 1,25-2,51) (OR = 4,31, 95% CI 2,34-7,91), respectively; defects of the sphincters (OR = 2,82, 95% CI 1,71-4,67) and increased urogenital hiatos área compared to women who did not experience these obstetric lesions. Product 2 – there was no relationship between the presence of UI and perineal traumas or muscle function (tone, pain, genital hiatos, perineal body, strength and resistance). However, it was possible to observe a statistical difference in muscle tone (p = 0.006) and perineal body size (p = 0.047) between groups. The presence of UI before (p = 0.021) and during (p = 0.025) gestation were related to the development of UI in the postpatum period. Conclusions: Episiotomy and severe perineal laceration are related to the presence of lesions in the MAP visualized by the US, but clinically we did not observe a relation with the presence of UI. Therefore, there is uncertainty regarding the changes seen by the US being decisive for having UI.
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spelling Associação da episiotomia e laceração perineal grave com disfunção do assoalho pélvico no pós-parto remotoEpisiotomiaLesões do Ligamento Cruzado AnteriorIncontinência UrináriaDiafragma da PelveUltrassomTo evaluate the association between episiotomy and severe perineal laceration (third and fourth degreen) with the presence of urinary incontinence (UI), contractile function and ultrasonographic findings of the pelvic floor muscles (PFM) in the postpartum remote. Materials and Methods: Product 1 – A Systematic Review and Meta-Analysis of observational studies evaluating the association between perineal childbirth lesions and morphological alterations pf PFM evaluated by ultrasound was performed. Product 2 – cross-sectional observational study. It was performed with primiparous women from the Maternity School Assis Chateaubriand (MEAC), who were in the period from 12 to 36 months after term vaginal delivery. Women with urogenital tract infection, history of gynecological or rectal cancer, previous surgeries in the PFM, carriers of demyelinating diseases of the spinal cor dor who became pregnant again were excluded. The records of all women who had vaginal delivery between May and November 2015 were analyzed, and from this analysis, women who suffered severe perineal laceration and those who underwent episiotomy were identified. The women were selected to composse three groups: 1) women who underwent episiotomy (n=12); 2) women who suffered severe perineal laceration (n=9) and 3) women who maintained intact perineum (n=12). The initial evaluation consisted of a clinical and sociodemographic questionnaire, and the International Consulation on Incontinence Questionnaire – Short Form (ICIQ-SF). The physical evaluation was composed of Pelvic Organ Prolapse Quantification System (POP-Q) measurements, digital MAP palpation and perineometry. Statistical analyzes were performed using the Chi-square and U Mann-Whitney tests. Results: Product 1 – Both episiotomy and severe perineal laceration are associated with a greater likelihood of avulsion of the anus levator muscle (OR = 1,77, 95% CI 1,25-2,51) (OR = 4,31, 95% CI 2,34-7,91), respectively; defects of the sphincters (OR = 2,82, 95% CI 1,71-4,67) and increased urogenital hiatos área compared to women who did not experience these obstetric lesions. Product 2 – there was no relationship between the presence of UI and perineal traumas or muscle function (tone, pain, genital hiatos, perineal body, strength and resistance). However, it was possible to observe a statistical difference in muscle tone (p = 0.006) and perineal body size (p = 0.047) between groups. The presence of UI before (p = 0.021) and during (p = 0.025) gestation were related to the development of UI in the postpatum period. Conclusions: Episiotomy and severe perineal laceration are related to the presence of lesions in the MAP visualized by the US, but clinically we did not observe a relation with the presence of UI. Therefore, there is uncertainty regarding the changes seen by the US being decisive for having UI.Avaliar a associação entre episiotomia e laceração perineal grave (terceiro e quarto graus) com a presença da incontinência urinária (IU), função contrátil e achados ultrassonográficos dos músculos do assoalho pélvico (MAP) no pós-parto remoto. Materiais e Métodos: Produto 1 - foi realizada uma Revisão Sistemática e Meta-análise de estudos observacionais que avaliaram a associação entre lesões perineais do parto e as alterações morfológicas dos MAP avaliadas pelo ultrassom (US). Produto 2 – estudo observacional de corte transversal. Realizado com mulheres primíparas oriundas da Maternidade Escola Assis Chateaubriand (MEAC), que estavam no período de 12 a 36 meses após parto vaginal a termo. Foram excluídas mulheres com infecção no trato urogenital, histórico de câncer ginecológico ou retal, cirurgias prévias nos MAP, doenças desmielinizantes da medula espinhal ou que engravidaram novamente. Os prontuários de todas as mulheres que tiveram parto vaginal entre maio a novembro de 2015 foram analisados, e a partir dessa análise, foram identificadas as mulheres que sofreram laceração perineal grave e as que realizaram episiotomia. As mulheres foram selecionadas para compor três grupos: 1) mulheres que foram submetidas à episiotomia (n=12); 2) mulheres que sofreram laceração perineal grave (n=9) e 3) mulheres que mantiveram o períneo íntegro (n=12). A avaliação inicial foi composta por um questionário clínico e sociodemográfico, e International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). A avaliação física foi composta por medidas do Pelvic Organ Prolapse Quantification System (POP-Q), palpação digital dos MAP e perineometria. As análises estatísticas foram realizadas com os testes Qui-quadrado e U de Mann-Whitney.Resultados: Produto 1 -Tanto a episiotomia quanto a laceração perineal grave estão associadas à maior probabilidade de avulsão do músculo levantador do ânus (OR=1,77, 95% CI 1,25-2,51) (OR=4,31, 95% CI 2,34-7,91), respectivamente; defeitos dos esfíncteres do ânus (OR 2,82, 95% CI 1,71-4,67) e aumento da área do hiato urogenital em comparação com mulheres que não sofreram essas lesões obstétricas. Produto 2 - não se observou relação entre a presença da IU com os traumas perineais ou com a função muscular (tônus, dor, hiato genital, corpo perineal, força e resistência). Porém, foi possível observar diferença estatística na alteração do tônus muscular (p=0,006) e no tamanho do corpo perineal (p=0,047) entre os grupos. A presença de IU antes (p=0,021) e durante (p=0,025) a gestação tiveram relação com o desenvolvimento de IU no pós-parto. Conclusões: A episiotomia e a laceração perineal grave se relacionam com a presença de lesões nos MAP visualizadas pelo US, porém clinicamente não observamos relação com a presença da IU. Logo, há uma incerteza com relação as alterações visualizadas pelo US serem determinantes para ter IU.Nascimento, Simony Lira doLima, Clara Taína Silva2018-12-10T17:02:33Z2018-12-10T17:02:33Z2018-03-22info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisapplication/pdfLIMA, C. T. S. Associação da episiotomia e laceração perineal grave com disfunção do assoalho pélvico no pós-parto remoto. 2018. 69 f. Dissertação (Mestrado Profissional em Saúde da Mulher e da Criança) - Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, 2018.http://www.repositorio.ufc.br/handle/riufc/37965porreponame:Repositório Institucional da Universidade Federal do Ceará (UFC)instname:Universidade Federal do Ceará (UFC)instacron:UFCinfo:eu-repo/semantics/openAccess2018-12-10T17:02:33Zoai:repositorio.ufc.br:riufc/37965Repositório InstitucionalPUBhttp://www.repositorio.ufc.br/ri-oai/requestbu@ufc.br || repositorio@ufc.bropendoar:2024-09-11T18:34:14.514362Repositório Institucional da Universidade Federal do Ceará (UFC) - Universidade Federal do Ceará (UFC)false
dc.title.none.fl_str_mv Associação da episiotomia e laceração perineal grave com disfunção do assoalho pélvico no pós-parto remoto
title Associação da episiotomia e laceração perineal grave com disfunção do assoalho pélvico no pós-parto remoto
spellingShingle Associação da episiotomia e laceração perineal grave com disfunção do assoalho pélvico no pós-parto remoto
Lima, Clara Taína Silva
Episiotomia
Lesões do Ligamento Cruzado Anterior
Incontinência Urinária
Diafragma da Pelve
Ultrassom
title_short Associação da episiotomia e laceração perineal grave com disfunção do assoalho pélvico no pós-parto remoto
title_full Associação da episiotomia e laceração perineal grave com disfunção do assoalho pélvico no pós-parto remoto
title_fullStr Associação da episiotomia e laceração perineal grave com disfunção do assoalho pélvico no pós-parto remoto
title_full_unstemmed Associação da episiotomia e laceração perineal grave com disfunção do assoalho pélvico no pós-parto remoto
title_sort Associação da episiotomia e laceração perineal grave com disfunção do assoalho pélvico no pós-parto remoto
author Lima, Clara Taína Silva
author_facet Lima, Clara Taína Silva
author_role author
dc.contributor.none.fl_str_mv Nascimento, Simony Lira do
dc.contributor.author.fl_str_mv Lima, Clara Taína Silva
dc.subject.por.fl_str_mv Episiotomia
Lesões do Ligamento Cruzado Anterior
Incontinência Urinária
Diafragma da Pelve
Ultrassom
topic Episiotomia
Lesões do Ligamento Cruzado Anterior
Incontinência Urinária
Diafragma da Pelve
Ultrassom
description To evaluate the association between episiotomy and severe perineal laceration (third and fourth degreen) with the presence of urinary incontinence (UI), contractile function and ultrasonographic findings of the pelvic floor muscles (PFM) in the postpartum remote. Materials and Methods: Product 1 – A Systematic Review and Meta-Analysis of observational studies evaluating the association between perineal childbirth lesions and morphological alterations pf PFM evaluated by ultrasound was performed. Product 2 – cross-sectional observational study. It was performed with primiparous women from the Maternity School Assis Chateaubriand (MEAC), who were in the period from 12 to 36 months after term vaginal delivery. Women with urogenital tract infection, history of gynecological or rectal cancer, previous surgeries in the PFM, carriers of demyelinating diseases of the spinal cor dor who became pregnant again were excluded. The records of all women who had vaginal delivery between May and November 2015 were analyzed, and from this analysis, women who suffered severe perineal laceration and those who underwent episiotomy were identified. The women were selected to composse three groups: 1) women who underwent episiotomy (n=12); 2) women who suffered severe perineal laceration (n=9) and 3) women who maintained intact perineum (n=12). The initial evaluation consisted of a clinical and sociodemographic questionnaire, and the International Consulation on Incontinence Questionnaire – Short Form (ICIQ-SF). The physical evaluation was composed of Pelvic Organ Prolapse Quantification System (POP-Q) measurements, digital MAP palpation and perineometry. Statistical analyzes were performed using the Chi-square and U Mann-Whitney tests. Results: Product 1 – Both episiotomy and severe perineal laceration are associated with a greater likelihood of avulsion of the anus levator muscle (OR = 1,77, 95% CI 1,25-2,51) (OR = 4,31, 95% CI 2,34-7,91), respectively; defects of the sphincters (OR = 2,82, 95% CI 1,71-4,67) and increased urogenital hiatos área compared to women who did not experience these obstetric lesions. Product 2 – there was no relationship between the presence of UI and perineal traumas or muscle function (tone, pain, genital hiatos, perineal body, strength and resistance). However, it was possible to observe a statistical difference in muscle tone (p = 0.006) and perineal body size (p = 0.047) between groups. The presence of UI before (p = 0.021) and during (p = 0.025) gestation were related to the development of UI in the postpatum period. Conclusions: Episiotomy and severe perineal laceration are related to the presence of lesions in the MAP visualized by the US, but clinically we did not observe a relation with the presence of UI. Therefore, there is uncertainty regarding the changes seen by the US being decisive for having UI.
publishDate 2018
dc.date.none.fl_str_mv 2018-12-10T17:02:33Z
2018-12-10T17:02:33Z
2018-03-22
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/masterThesis
format masterThesis
status_str publishedVersion
dc.identifier.uri.fl_str_mv LIMA, C. T. S. Associação da episiotomia e laceração perineal grave com disfunção do assoalho pélvico no pós-parto remoto. 2018. 69 f. Dissertação (Mestrado Profissional em Saúde da Mulher e da Criança) - Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, 2018.
http://www.repositorio.ufc.br/handle/riufc/37965
identifier_str_mv LIMA, C. T. S. Associação da episiotomia e laceração perineal grave com disfunção do assoalho pélvico no pós-parto remoto. 2018. 69 f. Dissertação (Mestrado Profissional em Saúde da Mulher e da Criança) - Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, 2018.
url http://www.repositorio.ufc.br/handle/riufc/37965
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dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
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dc.format.none.fl_str_mv application/pdf
dc.source.none.fl_str_mv reponame:Repositório Institucional da Universidade Federal do Ceará (UFC)
instname:Universidade Federal do Ceará (UFC)
instacron:UFC
instname_str Universidade Federal do Ceará (UFC)
instacron_str UFC
institution UFC
reponame_str Repositório Institucional da Universidade Federal do Ceará (UFC)
collection Repositório Institucional da Universidade Federal do Ceará (UFC)
repository.name.fl_str_mv Repositório Institucional da Universidade Federal do Ceará (UFC) - Universidade Federal do Ceará (UFC)
repository.mail.fl_str_mv bu@ufc.br || repositorio@ufc.br
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