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Episiotomia: resultados maternos e neonatais precoces do uso seletivo versus generalizado
Get PDFOverview and aims: Episiotomy is one of the most common procedures in Obstetrics, despite actual scientific evidence
does not support its routine practice.The aim of this study was to determine the impact of selective and routine practice of
episiotomy in early maternal and neonatal outcomes.
Study design:An observational, transversal, descriptive and analytic study was conducted in two public Hospitals in northern
Portugal, with different policies for the practice of episiotomy: selective practice (Hospital A) and routine practice
(Hospital B).
Population: A non-random sampling of convenience of the whole puerperal women whose deliveries was performed in
these hospitals during months of July and August 2011 was utilized. A total of 397 women was analyzed, 200 in selective
group and 197 in routine group.
Methods: Data was collected by consultation of medical records of the puerperal women. Comparison between hospitals
was performed with the chi-square test.
Results: The groups were similar for the obstetric history, demographic, biometric, pregnancy and labor characteristics.
However, gestational age, weight and head circumference of newborns as well as instrumentation rate were significantly
higher in selective group. Episiotomy was performed in 72.5% cases of selective group and in 88.8% of routine group
(p≤0.001).There wasless perinealsuturing (p=0.001) and a greater number of intact perineum in selective group (p≤0.001),
without differences in lacerations type or degree. The routine group presented more frequent early perineal complications
and higher pain levels in the first postpartum day (p≤0.001). No differences were found between groups in Apgar scores,
neonatal trauma and Neonatal Intensive Care Unit admissions number.
Conclusions: The selective use of episiotomy was associated with better early maternal outcomes, with no differences in
neonatal morbidity. Thus, the routine practice of episiotomy showed no benefit
Disfunção Temporomandibular no Contexto da Dor Orofacial
Get PDFA disfunção temporomandibular (DTM), é um termo colectivo que abrange uma série
de problemas clínicos que envolvem os músculos da mastigação, a ATM e estruturas
associadas. A DTM é uma causa comum de dor orofacial e a dor é o sintoma mais
comummente associado a DTM.
Desde meados do século passado até finais da sua década de 70, o tratamento da DTM
baseava-se numa prática mecanicista centrada na oclusão. Esta visão teve consequências
desagradáveis para os doentes, algumas delas graves, resultante de sobrediagnóstico e
sobretratamento. Os anos 90 foram de reflexão, tendo sido criados os critérios de
diagnóstico para pesquisa em DTM (RDC/TMD) e lançadas as bases dos pressupostos
em que se baseia a DTM na actualidade.
Com este trabalho de revisão pretendeu-se dar uma retrospectiva profunda e
epistemológica da DTM, tendo em conta o conhecimento actual sobre este tema, não só
no que respeita à etiologia e diagnóstico, mas também no que diz respeito ao tratamento
