Hypothesis / aims of study
According to IBGE (2009), Brazilian normal delivery rate is 46%, which is considerably lower than the recommended by the World Health Organization (85%).1This low index may be related to the level of education of pregnant women, the fear that the pregnant women have to suffer perineal traumas, as well as spontaneous lacerations and / or episiotomies.2 Aims of study: To describe the clinical and epidemiological profile of delivery in a Brazilian Public Hospital patients from January to April 2017.
Study design, materials and methods
A retrospective descriptive study was conducted with a convenience sample. Data were collected in hospital records, using the patient's full name and registration number to find them medical records in the system. In the medical records, socio-demographic data was collected, such as age, marital status, parity, race and birth were collected. As criteria for the exclusion of medical records, errors in any field, unreadable letters and blank data were deleted from the database.
Results
The total amount of normal delivery between January and April was 117. Of these, 27 were deleted due to lack of data in medical records, leaving 90 complete medical records for analysis. The maternal age groups with the highest percentages were 15-25 years old with 47.78% and 25-35 years old with 38.89%. Under 15 years and above 45 years had smaller percentages, of 1.11% each. The self-reported color with the highest percentage was black race (78.89%), while the lowest percentage was yellow race (4.44%). The highest percentage of marital status was Married (36.67%). Widowed (1.11%) had the lowest percentage. All records are nulliparous, 31.11% are primiparous. 72.22% of the patients had their deliveries unaccompanied, while 27.78% were in company of their choice.. The classification of dilation when entering the obstetric center with the highest percentage was from 5 to 7 cm of dilatation (41.11%) and from 8 to 10 (22.23%) had the lowest percentage. 66.67% of the patients arrived at the obstetrical center with the water breaks, while 25.56% performed the amniotomy procedure, 7.78% had a full-blown delivery. The use of oxytocin during delivery was 53.33%, misoprostol 12.22% and only 5.55% used anesthesia during normal delivery. The position most adopted during the expulsive period was Lithotomy position (81.11%), followed by the position on the stool (11.11%). The instrumental delivery was not used in any of the normal deliveries analyzed. From the 90 medical records analyzed, lacerations occurred in 68.89% of deliveries, of which 56.45% were classified as grade 2. The episiotomy was performed in only 2.22%.
Interpretation of results
The laceration rate of the study is considered high. Laceration is a factor that should be considered regarding the possibility of predisposition for urinary incontinence and other pelvic floor deficiencies.
The rate of patients who arrived at the obstetric center with dilation between 5 and 7 cm was the highest, it is known that the early arrival to the hospital during labor may result in a greater fatigue of the pregnant woman, pushing in the expulsive period outside the appropriate pulling moments, can cause a greater probability of laceration.
In addition, the most common position during labor was lithotomy, a position that does not provide the force of gravity during labor, and is more likely to cause laceration.
Despite the high rate of laceration in the study, it is seen that the hospital where the study was performed maintains a lower rate than other hospitals, considered acceptable for laceration cases.