Dor e alívio da dor relatada por puérperas no alojamento conjunto - quantificação e fatores associados

Abstract

Objetivos: Avaliar a prevalência de dor no puerpério imediato, fatores relacionados com a dor e com seu controle inadequado. Métodos: De outubro a dezembro de 2020, 351 puérperas foram consideradas elegíveis (bebês nasceram vivos ou natimortos com peso > 500 g e/ou idade gestacional > 22 semanas no HU/UFSC/EBSERH) para responder ao questionário do estudo, sendo excluídas 122 mulheres. Resultados: A média de dor relatada foi 5,34 e houve diferença (p < 0,001) entre as vias de parto. Cesariana apresentou associação com dor intensa referida (p = 0,006) e dor acima de oito pela EAV (p=0,02). Parto vaginal obteve associação com percepção de analgesia inadequada (p = 0,04). Dor intensa referida teve associação com dificuldades para o autocuidado (p<0,001) e do recém-nascido (p = 0,02), sensação de fraqueza (p < 0,001) e de desmaio (p = 0,02). Em ambas as vias de parto, o RN encaminhado à UTI (p=0,01) e a hemorragia pós-parto (p=0,002) apresentaram associação com dor intensa referida. No grupo parto vaginal, houve associação entre parto instrumental (p=0,04) e hemorragia pós-parto (p=0,01*) com dor intensa referida; e analgesia inadequada referida com encaminhamento do RN à UTI (p=0,003*). No grupo cesariana, houve associação entre dor intensa referida e encaminhamento do RN à UTI (p=0,01); e percepção de analgesia inadequada com ao menos um parto vaginal anterior (p=0,02*). Conclusões: O conhecimento dos fatores associados à dor no puerpério e da eficácia dos métodos de alívio permitem a elaboração de ações direcionadas para seu manejo.

Objectives: To assess the prevalence of pain in the immediate postpartum period, factors related to pain and inadequate control. Method: From October to December 2020, 351 postpartum women were considered eligible (baby births or stillbirths weighing > 500 g and/or gestational age > 22 weeks at HU/UFSC/EBSERH) to answer the study questionnaire, 122 women were excluded. Result: The mean reported pain was 5.34 and there was a difference (p < 0.001) between the modes of delivery. Cesarean section was associated with severe referred pain (p = 0.006) and pain above eight by visual analogue scale (p = 0.02). Vaginal delivery was associated with perception of inadequate analgesia (p = 0.04). Reported severe pain was associated with difficulties for self-care (p<0.001) and care of the newborn (p = 0.02), feeling of weakness (p < 0.001) and fainting (p = 0.02). In both modes of delivery, the newborn referred to the intensive care unit (p=0.01) and postpartum hemorrhage (p=0.002) were associated with severe referred pain. In the vaginal delivery group, there was an association between instrumental delivery (p=0.04) and postpartum hemorrhage (p=0.01*) with severe referred pain; and referred inadequate analgesia with referral of the newborn to the intensive care unit (p=0.003*). In the cesarean group, there was an association between referred severe pain and referral of the newborn to the intensive care unit (p=0.01); and perception of inadequate analgesia with at least one previous vaginal delivery (p=0.02*). Conclusions: Knowledge of factors associated with postpartum pain and the effectiveness of relief methods allow the development of actions aimed at its management.