Análisis causal entre la utilización de analgesia epidural durante el parto (alivio del dolor) y las lesiones perineales :

Abstract

Perineal injuries during childbirth, especially severe perineal injuries, can lead to adverse health outcomes for women both in the short and longer term and can significantly affect women´s quality of life. The use of epidural analgesia during childbirth, instrumental deliveries and primiparity are some of the predisposing factors associated with severe perineal injuries. In Catalonia there is an upward trend in the use of epidural analgesia in recent years, but its effect in healthy women is unknown. The type of birth and obstetric interventions women receive during labor are considered an important indicator of women's quality of life and these figures become an indispensable tool to plan and develop health policy. Despite its importance, there is no data on the effect of the use of epidural analgesia on severe perineal injuries and its effect on other obstetric outcomes, which makes it impossible to implement actions in this area. The main objective of the study is to obtain data regarding the use of epidural analgesia during childbirth in relation to severe perineal injuries and other obstetric outcomes in order to guide the implementation of policies aimed at improving perinatal outcomes. The specific objectives are to identify these results within our region based on data is generated from the MidconBirth study; to ascertain the effects of exposure time to EA in relation to instrumental deliveries; and finally, to devise a clinical trial protocol to test a digital tool for the use of heath care professionals and test whether it helps improve the management of normal birth care. This study concludes in three main results: a) provides, for the first time, data on the relationship of the use of epidural with severe perineal injuries during labor in our region; b) it shows a direct relationship between the time of exposure to epidural and birth mode; c) childbirth care offered in our region indicates that the Clinical Practice Guide for normal birth care is not properly implemented d) with the A-BIRTHPERFORM tool, compliance with clinical guidelines could be improved thus contributing to the improvement of perinatal outcomes and maternal satisfaction.