Impacto da episiotomia mediolateral na qualidade de vida pós-parto e na função do assoalho pélvico em mulheres assistidas em um serviço de saúde suplementar de Minas Gerais

Abstract

Introduction: Mediolateral episiotomy is a surgical intervention debated due to its implications for the quality of life and function of the pelvic floor in women. Currently, it is recommended restrictively, but there is no precise consensus on its indications. To adequately assess the effect of mediolateral episiotomy, impact measures must be considered in a consistent and reproducible manner, considering symptoms related to pelvic floor function. Objective: to compare the Pelvic Floor Impact Questionnaire (PFIQ-7) quality of life score and the presence of symptoms of pelvic floor dysfunction in women after vaginal birth, submitted or not to mediolateral episiotomy with or without anal sphincter injury. Patients and Methods: The prospective, non-interventional study was carried out from Feb/2020 to Sep/2023, conducted in two units of the same supplementary health hospital network in the metropolitan region of Belo Horizonte, including 79 primiparous women who had vaginal births Patients were allocated into three groups according to the presence of mediolateral episiotomy (COMP) with 25 patients, absence of episiotomy (SEMP) with 29 patients and those who presented anal sphincter injury (gOASIS) at birth with 12 patients.. All patients were evaluated in the postpartum period at one or two moments, the 1st evaluation being between 25 and 160 days after birth and the 2nd evaluation starting 90 days after birth. Outcome variables were considered: the report of symptoms related to the bladder, intestine or vagina and the impact on quality of life due to these symptoms. The impact on quality of life was assessed using the questionnaire, validated in the Portuguese language, PFIQ-7 and its three domains: urinary (UIQ-7), intestinal (CRAIQ-7) and vaginal (POPIQ-7). Results: The results of the study indicated that there were no significant differences between the three groups in relation to demographic and obstetric characteristics, as well as symptoms related to the vagina, bladder and intestine. Comparative analyzes between the groups of the PFIQ-7 questionnaires and their UIQ-7, CRAIQ-7 and POPIQ-7 domains, in the first and second moments of postpartum assessment, did not reveal significant differences, either between the groups or within the same group. between the two assessment moments. Conclusion: The study suggests that mediolateral episiotomy does not negatively impact quality of life in the postpartum period. There was no difference in the impact on quality of life after childbirth related to urinary, intestinal and vaginal symptoms in women undergoing vaginal birth with mediolateral episiotomy, without episiotomy or with anal sphincter injury.