Caracterización del dolor perineal postparto en puérperas

Introduccion : El dolor perineal posparto es un problema clinico frecuente, no abordado en profundidad en Colombia. Objetivo : Determinar la prevalencia, severidad y posibles factores asociados con el dolor perineal postparto en una muestra de mujeres en el Hospital La Victoria-Instituto Materno Infantil de Bogota.  Materiales y metodos : Estudio observacional prospectivo. Se evaluo el grado de dolor perineal percibido en 133 pacientes en posparto, mediante la escala analoga numerica de dolor, estando acostada, sentada, caminando y yendo al bano (miccion y/o defecacion), a las 12 y 48 horas postparto. Datos demograficos, del parto y recien nacido fueron tomados directamente de las historias clinicas. Resultados : Prevalencia global del dolor perineal moderado a severo 36-39,5% dependiendo de la actividad a las 12 horas del parto y entre 28-31,6% a las 48 horas. El dolor perineal se encontro asociado, en cualquiera de las actividades valoradas, con el uso de analgesia epidural durante el trabajo de parto, desgarro grado II o mayor, peso y perimetro cefalico del recien nacido. Se registra mejor efecto analgesico con dosis de acetaminofen de 3 g diarios o mas.  Conclusiones : El dolor perineal moderado a severo afecta a menos del 50% de las mujeres postparto vaginal; se asocia con la frecuencia y magnitud del trauma perineal. Los resultados sugieren la necesidad de profundizar en el estudio del manejo analgesico mas adecuado para estas pacientes. Abstract Introduction : Postpartum perineum pain is a common clinical problem, which is not addressed in detail in Colombia. Objective : To assess prevalence, magnitude and possible factors associated with postpartum perineum pain in a sample of women in the Hospital “La Victoria-Instituto Materno Infantil”, in Bogota. Materials and methods : A prospective observational study was performed where the degree of perineum pain perceived by 133 postpartum patients was evaluated by using numerical analog scale of pain when they were sitting down, lying, walking and going to the bathroom (urination and/or defecation), at 12 and 48 hours of postpartum . Demographic, birth and newborn data were taken directly from the medical records. Results : Overall prevalence of moderate to severe perineum pain 36 to 39.5% depending on the activity at 12 hours of delivery, and since 28 to 31.6% at 48 hours after it. Perineum pain was associated, during any of the activities assessed, with the use of epidural analgesia during labor, laceration of degree II or greater, birth weight and head circumference of the newborn. Better analgesic effect of acetaminophen doses as 3 g per day or more was registered. Conclusions: Moderate to severe perineum pain affects less than 50 % of women with vaginal postpartum. It is associated with the frequency and degree of perineum trauma. The results suggest the need for further study of the most appropriate analgesic doses for these patients.