Implementation of care practices to prevent and repair perineal trauma in childbirth

Santos, Rafael Cleison Silva dos; Riesco, Maria Luiza Gonzalez

doi:10.1590/1983-1447.2016.esp.68304

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Original Articles • Rev. Gaúcha Enferm. (Online) 37 (spe) • 2016 • https://doi.org/10.1590/1983-1447.2016.esp.68304 copy

Implementation of care practices to prevent and repair perineal trauma in childbirth

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To implement care practices for perineal trauma prevention and repairing in normal birth.

Method

Quasi-experimental study conducted at Hospital da Mulher Mãe-Luzia, in Macapá, AP, Brazil. Seventy-four (74) nurses and obstetricians and 70 post-partum women were interviewed and the records of 555 patients were analyzed. The study was conducted in three stages: pre-audit and baseline audit (phase 1); educational intervention and implementation of best practices (phase 2); post-implementation audit (phase 3). Data was analyzed by comparison of the results of phases 1 and 3.

Results

Following the educational intervention, a lower number of health professionals encouraged directed pushing, performed episiotomies and repaired first-degree lacerations; more women reported lithotomy position; more patient records indicated the use of Vicryl™ to suture the perineal mucosa and skin.

Conclusion

The educational intervention improved birth care and perineal outcomes. Nevertheless, gaps were identified in the implementation of evidence, as well as inappropriate perineal care management

Evidence-based practice; Parturition; Obstetric nursing

Practices used in childbirth	Professionals				p-value*

	Phase 1		Phase 3

	n	%	n	%
Recommends lithotomy position in childbirth	42	100	32	100
Always or most often	22	52.4	12	37.5	0.059
Rarely or never	20	47.6	20	62.5	0.059
Encourages directed pushing	42	100	32	100
Always or most often	19	45.0	6	18.8	0.009
Rarely or never	23	55.0	26	81.2	0.009
Uses technique of perineal trauma prevention	42	100	32	100
Always or most of the times	29	69.0	19	59.0	0.425
Rarely or never	13	31.0	13	41.0	0.425
Performs episiotomy	42	100	32	100
Always or most often	7	16.7	1	3.1	0.021
Rarely or never	35	83.3	31	96.9	0.021
Repairs 1st degree laceration	42	100	32	100
Always or most often	16	38.1	6	18.8	0.011
Rarely or never	26	61.9	26	81.2	0.011
Performs rectal examination after 3rd or 4th degree lacerations repair	42	100	32	100
Always or most often	26	61.9	23	71.9	0.232
Rarely or never	16	38.1	9	28.1	0.232
Mucosa suturing technique	42	100	32	100
Interrupted	3	7.0	3	9.4	0.250
Continuous simple	13	31.0	13	40.6
Continuous anchored	26	62.0	16	50.0
Muscular layer suturing technique	42	100	32	100
Interrupted	23	54.8	17	53.1	0.932
Continuous simple	7	16.6	7	21.9
Continuous anchored	12	28.6	8	25.0
Skin suturing technique	42	100	32	100
Interrupted	23	54.8	16	50.0	0.641
Continuous simple	10	23.8	13	40.6
Continuous anchored	5	12.0	1	3.1
Intradermal	4	9.4	2	6.3
Suturing material (thread) in the mucosa	42	100	32	100
Vicryl^®	7	16.7	6	18.7	0.864
Catgut	10	23.8	7	21.9
Chromic catgut	25	59.5	19	59.4
Suturing material (thread) in the muscular layer	42	100	32	100
Vicryl^®	6	14.3	7	21.9	0.125
Catgut	5	11.9	6	18.7
Chromic catgut	31	73.8	19	59.4
Suturing material (thread) in the skin	42	100	32	100
Vicryl^®	12	28.5	6	18.8	0.089
Catgut	18	43.0	13	40.6
Chromic catgut	12	28.5	13	40.6

Variable	Interviewed postpartum women				p-value*

	Phase 1		Phase 3

	n	%	n	%
Lithotomy position in childbirth	35	100	35	100
Yes	27	77.1	34	97.1	0.028
No	8	8.6	1	2.9	0.028
Directed pushing	35	100	35	100
Yes	8	22.9	9	25.7	1.000
No	27	77.1	26	74.3	1.000
Kristeller’s maneuver	35	100	35	100
Yes	2	5.7	5	14.3	0.428
No	33	94.3	30	85.7	0.428
Perineum	35	100	35	100
Spontaneous laceration	21	60.0	13	37.1	0.155
Intact	12	34.3	17	48.6
Episiotomy	2	5.7	5	14.3
Perineal repair	23	100	18	100
Yes	17	73.9	14	77,8	1.000
No	6	26.1	4	22.2	1.000
Anesthesia in perineal repair	17	100	14	100
Yes	14	82.4	13	92.9	0.607
No	3	17.6	1	7.1	0.607

Variable	Interviewed postpartum women

	Phase 1		Phase 3

	n	%	n	%
Perineal pain 1-2 days after childbirth*	17	100	14	100
Spontaneous	-	-	1	7.0
Related to activities (walking, sitting, urinating, evacuating or breastfeeding)	16	94.0	11	79.0
Painless	1	6.0	2	14.0
Perineal pain 10-12 days after childbirth*	12	100	14	100
Spontaneous	-	-	2	14.3
Related to activities (walking, sitting, urinating, evacuating or breastfeeding)	7	66.7	8	57.1
Painless	4	33.3	4	28.6
Did not answer the phone	6	-	-	-
Perineal pain 30 days after childbirth*	11	100	13	100
Spontaneous	-	-	-	-
Related to activities(walking, sitting, urinating, evacuating or breastfeeding)	7	63.6	5	38.5
Painless	4	36.4	8	61.5
Did not answer the phone	6	-	1	-
Satisfaction with perineal repair 1-2 days after childbirth ^†	15	100	12	100
Satisfied/Very satisfied	4	26.7	8	66.7
Dissatisfied/Somewhat satisfied	11	73.3	4	33.3
Does not know	2	-	2	-
Satisfaction with perineal repair 10-12 days after childbirth ^†	11	100	14	100
Satisfied/Very satisfied	6	54.5	10	71.4
Dissatisfied/Somewhat satisfied	5.	45.5	4	28.6
Does not know	1	-	-	-
Did not answer the phone	5	-	-	-
Satisfaction with perineal repair 30 days after childbirth ^†	11	100	13	100
Satisfied/Very satisfied	7	63.6	8	61.5
Dissatisfied/Somewhat satisfied	4	36.4	5	38.5
Did not answer the phone	6	-	1	-

Variable	Postpartum women according to the patients’ records				P-value*

	Phase 1		Phase 3

	n	%	n	%
Lithotomy position in childbirth	291	100	264	100
Yes	74	57.4	63	62.4
No	55	42.6	38	37.6	0.527
No record	162		163
Perineum	236	100	172	100
Spontaneous laceration	147	62.3	105	61.0	0.642
Intact	73	30.9	51	29.7
Episiotomy	16	6.8	16	9.3
No record	55	-	92	-
Degree of perineal laceration	103	100	70	100
First	40	38.8	30	42.9	0.905
Second	57	55.4	36	51.4
Third	6	5.8	4	5.7
No record	44	-	35	-
Repair of perineal lacerations	137	100	95	100
Yes	126	92.0	78	82.1	0.039
No	11	8.0	17	17.9	0.039
No record	10	-	10	-
Type of suturing material in the mucosa	62	100	32	100
Vicryl®	3	4.8	9	28.1	0.006
Catgut	5	8.1	3	9.4
Chromic catgut	54	87.1	20	62.5
No record or not applicable	156	-	181	-
Type of suturing material in the muscle	49	100	24	100
Vicryl®	3	6.1	5	20.8	0.087
Catgut	3	6.1	3	12.5
Chromic catgut	43	87.8	16	66.7
No record or not applicable	169	-	189	-
Type of suturing material in the skin	49	100	24	100
Vicryl®	5	10.2	6	25.0	0.033
Catgut	19	38.8	3	12.5
Chromic catgut	25	51.0	15	62.5
No record or not applicable	169	-	189	-

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[1] Corresponding author: Rafael Cleison Silva dos Santos. E-mail: rcleison@unifap.br