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Os Fatores que influenciam a integridade perineal no parto vaginal - projeto de estágio de desenvolvimento de competências clínicas especializadas na área da enfermagem de saúde materna e obstétrica
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O presente relatório tem como objetivo a descrição crítica do processo de aquisição de competências no âmbito do Mestrado em Enfermagem de Saúde Materna e Obstétrica, assim como identificar, através de uma revisão da literatura, os fatores intrínsecos e extrínsecos que influenciam a ocorrência de lacerações perineais durante o trabalho de parto.
Ao longo deste relatório, analisa-se criticamente o processo de desenvolvimento de competências adquiridas nos diferentes contextos de estágio, nomeadamente no âmbito do período pré-natal, do trabalho de parto e do período pós-parto.
Durante o estágio na sala de partos, foi possível verificar a ocorrência de lacerações perineais em várias mulheres durante o trabalho de parto. As lacerações perineais que ocorrem durante este período têm impacto na saúde física e psicológica destas mulheres, pois aquelas que sofrem trauma perineal no parto têm maior probabilidade de experienciar sintomas físicos (dor no local da ferida perineal, infeção da ferida perineal, incontinência urinária, dorsalgia e dispareunia), o que pode levar ao desenvolvimento de sintomatologia negativa do foro psicológico. Releva assim estudar esta temática, de modo que se possam prestar os melhores cuidados relativamente à promoção da integridade perineal, promovendo também, desta forma, uma experiência de parto positiva e favorecendo a recuperação pós-parto.
Através de uma revisão integrativa da literatura, contribuiu-se para a melhoria dos cuidados a estas parturientes, identificando os fatores que as predispõem à ocorrência de lacerações perineais. De acordo com os resultados desta revisão, as intervenções a implementar para promover a integridade perineal poderão passar pela massagem perineal a partir das 34 semanas de gestação, o treino da musculatura do pavimento pélvico na gravidez, incentivar as posições verticais e de flexibilidade do sacro no trabalho de parto, usar lubrificante e compressas quentes durante o segundo estadio do trabalho de parto, assim como o uso da técnica hands on vs. hands off deverá ser ponderada caso a caso.
This report aims to critically describe the process of acquiring skills within the scope of the Master's Degree in Maternal and Obstetric Health Nursing, as well as identifying the intrinsic and extrinsic factors that influence the occurrence of perineal lacerations during labor through a literature review. Throughout this report, the skills acquired in different internship contexts are described, namely in the prenatal period, labor and postpartum period. During the internship in the delivery room, it was possible to verify the occurrence of perineal lacerations in several women during labor. Perineal lacerations that occur during this period have an impact on the physical and psychological health of these women, as those who suffer perineal trauma during childbirth are more likely to experience physical symptoms (pain at the site of the perineal wound, perineal wound infection, urinary incontinence, back pain and dyspareunia), which can lead to the development of negative psychological symptoms. It is therefore important to study this topic, so that the best care can be provided regarding the promotion of perineal integrity, while also promoting a positive birth experience and favoring postpartum recovery. Through an integrative review of the literature, it was explored how the best care could be provided to these women, identifying the factors that predispose to the occurrence of perineal lacerations. According to the results of this review, interventions to be implemented to promote perineal integrity may include perineal massage from 34 weeks of gestation, pelvic floor muscle training during pregnancy, encouraging vertical positions and sacral flexibility during labor, using lubricant and hot compresses during the second stage of labor, and the use of the hands-on vs. hands-off technique should be considered on a case-by-case basis.
This report aims to critically describe the process of acquiring skills within the scope of the Master's Degree in Maternal and Obstetric Health Nursing, as well as identifying the intrinsic and extrinsic factors that influence the occurrence of perineal lacerations during labor through a literature review. Throughout this report, the skills acquired in different internship contexts are described, namely in the prenatal period, labor and postpartum period. During the internship in the delivery room, it was possible to verify the occurrence of perineal lacerations in several women during labor. Perineal lacerations that occur during this period have an impact on the physical and psychological health of these women, as those who suffer perineal trauma during childbirth are more likely to experience physical symptoms (pain at the site of the perineal wound, perineal wound infection, urinary incontinence, back pain and dyspareunia), which can lead to the development of negative psychological symptoms. It is therefore important to study this topic, so that the best care can be provided regarding the promotion of perineal integrity, while also promoting a positive birth experience and favoring postpartum recovery. Through an integrative review of the literature, it was explored how the best care could be provided to these women, identifying the factors that predispose to the occurrence of perineal lacerations. According to the results of this review, interventions to be implemented to promote perineal integrity may include perineal massage from 34 weeks of gestation, pelvic floor muscle training during pregnancy, encouraging vertical positions and sacral flexibility during labor, using lubricant and hot compresses during the second stage of labor, and the use of the hands-on vs. hands-off technique should be considered on a case-by-case basis.
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Integridade do períneo lacerações perineais trabalho de parto Enfermagem de Saúde Materna e Obstétrica