Influencia de la tracción activa de hombros sobre los desgarros perineales y la adaptación neonatal en partos eutócicos

Abstract

Influence of active shoulder traction on perineal tears and neonatal adaptation in normal childbirth Among the new tendencies of natural and non-interventional delivery models, the fetal shoulder traction maneuver in normal childbirth is not routinely justified except on suspicion of shoulder dystocia. Objective: to relate perineal tears and neonatal adaptation in normal childbirth where shoulder traction is performed versus non-traction. Methodology: prospective cohort study in a sample of 211 normal childbirths followed by 3 months postpartum. Results: shoulder traction and tears showed a significant association (?2 (1) = 38.58, p <0.001). The percentage of deliveries with shoulder traction where tears were involved (98.3%) was significantly higher relative to deliveries without shoulder traction (64.7%). Apgar scores and the pH value of the umbilical cord were significantly lower in deliveries where shoulder pull was present (Apgar 1 min: t(209) = 4,65, p < 0,00. Apgar 5 min: t(209) = 2,26, p = 0.025. PH: t(180) = 2,338, p = 0,021). Patients with epidural anesthesia were 3.66 times more likely to have a tear than patients without anesthesia. Conclusions: the present thesis shows that active traction of fetal shoulders negatively influences, on the one hand, the perineal tears in terms of the number and severity of these, and, on the other hand, the neonatal adaptation to extrauterine life with lower scores in the pH values and the Apgar test. Epidural anesthesia is a risk factor for the onset of tears. Key words: hands on, hands off, perineal tear, shoulder traction, neonatal adaptation.