Estrategia para disminuir la incidencia de patología grave del periné durante el parto

ResumenAntecedentesLa importancia de los desgarros graves del periné durante el parto radica en que son un factor de riesgo para la incontinencia anal. Decidimos establecer una estrategia para disminuir la incidencia de éstos.Material y métodoLa estrategia fue la siguiente: 1) ofertar otras técnicas de analgesia además de la epidural; 2) no aconsejar pujar hasta no tener sensación de pujo; 3) ofertar los pujos e incluso el parto en posición vertical; 4) basarnos en las definiciones del Colegio Americano de Obstetras y Ginecólogos para indicar un parto instrumental; 5) usar como primer instrumento la ventosa, y 6) uso restrictivo de la episiotomía.ResultadosHubo una disminución significativa en la tasa de desgarros graves (1,56 – 0,84%).ConclusionesCon una estrategia consensuada ente matronas y ginecólogos es posible disminuir de forma significativa la incidencia de desgarros graves del periné, lo que se ha conseguido sin modificar la tasa de cesáreas.

BackgroundSevere (third- or fourth-grade) perineal tears during delivery lies in their ability can produce fecal incontinence. We decided to establish a strategy to reduce the incidence of severe tears during delivery.Material and methodsThe strategy was as follows: 1) pain relief options other than epidural were offered; 2) active pushing was delayed until there was maternal urge; 3) upright positions for pushing and delivery were offered; 4) the indication for instrumental delivery was based on the American College of Obstetricians and Gynecologists’ definitions for instrumental delivery, 5) ventouse extraction was used as the instrument of choice, and 6) the use of episiotomy was restricted.ResultsThe rate of severe tears significantly decreased (1.56% – 0.84%).ConclusionsA strategy agreed between midwives and gynecologists can significantly reduce the incidence of severe perineal tears. This reduction was achieved without changing the rate of cesarean sections.