Os paradigmas da episiotomia e a construção de novas visões baseada em evidências: uma revisão crítica da literatura

Abstract

The episiotomy was performed for decades, however, not based on scientific evidence and practical use remains controversial. Unfortunately, this procedure was applied in several women for decades, causing damage to the pelvic floor and several complications. Remains until today as the second most common procedure in obstetrics, aiming, prevent severe perineal damage in women undergoing vaginal delivery, as well as reduce the expulsion period. However, several well-controlled randomized trials have been published on the subject, providing level I evidence, countering these claims. This study reviewed the best available evidence in a systematic way, relevant to the supposed benefits perceived for episiotomy in the past, as well as its deleterious effects, moreover, were included studies comparing the performance of routine episiotomy to selective. It was noted, however, that episiotomy routine was previously considered by obstetricians a strategy for protecting the perineum and the pelvic floor birth injury of the fetus, but gradually it has been shown that this is an unnecessary procedure, damaging woman´s integrity physical and emotional.Besides not protect the pelvic floor, episiotomy increases the frequency of perineal pain, dyspareunia, blood loss, laceration of the anal sphincter, rectal injury and anal incontinence, without reducing the rates of urinary incontinence or improve neonatal outcome.Taking into account these results, there is no justification for the maintenance of episiotomy routinely, however, their frequency remains high in Brazil.With the advent of evidencebased medicine, obstetricians need to consider the risks of injury mother outweigh the possible benefits and adopt criteria for use this practice so selectively.Becomes necessary to break the paradigms that underlie the use of this practice, incorporating its application in an orderly manner, in order to promote a better quality obstetric care and thus more humanized.