Ministério da Saúde

FEBRASGO
ABENFO
Parto, Aborto e Puerpério
Assistência Humanizada à Mulher
Brasília, DF
2001
© 2001. Mini:Iéric cc Scúce
É permiIicc c reprccuçcc pcrcic| cu IcIc|, ce:ce ¢ue ciIccc c fcnIe.
Iircgem: 50 mi| exemp|cre:.
M|n|stro do Soùde
Jc:é Serrc
Secretór|o de Fo|ít|cos de Soùde
C|cucic DucrIe cc Fcn:ecc
Coordenodoro do Áreo Iécn|co de Soùde do Mu|her
Icnic ci Gicccmc cc Lcgc
Frccuçcc, ci:IriLuiçcc e infcrmcçce::
M|n|stér|o do Soùde
SecreIcric ce Fc||Iicc: ce Scúce
Árec Iécnicc ce Scúce cc Mu|her
E:p|cnccc cc: Mini:Iéric:, 8|ccc G, óº cnccr
CEF: 70.058-º00, 8rc:||ic, DF
Ie|: {ó1) 315-28óº
Fcx: {ó1) 322-3º12
1º. ec. 2001
F|cho coto|ogró||co:
8rc:i|. Mini:Iéric cc Scúce. SecreIcric ce Fc||Iicc: ce Scúce. Árec Iécnicc
ce Scúce cc Mu|her.
FcrIc, cLcrIc e puerpéric: c::i:Iëncic humcnizccc c mu|her/
Mini:Iéric cc Scúce, SecreIcric ce Fc||Iicc: ce Scúce, Árec Iécnicc
cc Mu|her. - 8rc:||ic: Mini:Iéric cc Scúce, 2001.
1ºº p.: i|.
lS8N: 85-334-0355-0
1. Scúce - Mu|her - /::i:Iëncic humcnizccc. 2. FcrIc - /::i:Iëncic
humcnizccc. 3. /LcrIc - /::i:Iëncic humcnizccc. l. Fecercçcc
8rc:i|eirc cc: Sccieccce: ce Ginecc|cgic e CL:IeIr|cic. ll.
/::ccicçcc 8rc:i|eirc ce CL:IeIrize: e Enfermeirc: CL:IeIrc:. lll. I|Iu|c.
CDU ó18.2
NLM WC 200 D8 8
5
/::i:Iir c: mu|here: nc mcmenIc cc pcrIc e nc:cimenIc
ccm :egurcnçc e cigniccce é ccmprcmi::c
funccmenIc| cc Mini:Iéric cc Scúce.
C Frcgrcmc ce Humcnizcçcc nc Fré-ncIc| e
Nc:cimenIc e:IcLe|ece c: princ|pic: cc cIençcc ¢ue
ceve :er pre:Iccc e excrIc e:Iccc:, munic|pic: e
:erviçc: ce :cúce c cumprirem :eu pcpe|, prcpicicncc
c cccc mu|her c cireiIc ce ciccccnic mci: e|emenIcr,
ccr c |uz, receLencc umc c::i:Iëncic humcnizccc e
ce Lcc ¢uc|iccce.
C Mini:Iéric cc Scúce cpre:enIc e:Ic puL|iccçcc ccm
c cLjeIivc ce ci::emincr ccnceiIc: e prcIicc: cc
c::i:Iëncic cc pcrIc enIre c: prcfi::icnci: ce :cúce.
FreIence, principc|menIe, inIegrcr c ccpcciIcçcc
Iécnicc c nece::cric humcnizcçcc cc prcce::c ce
cIençcc c mu|her curcnIe c ge:Icçcc e c pcrIc.
De:Ic fcrmc, :erc pc::|ve| re:gcIcr pcrc mu|here: e
prcfi::icnci: ce :cúce c :ingu|criccce cenIe mcmenIc.
JOSÊ SEkkA
APRESENTAÇÃO
7
FÁG. Nº
Fre|óc|o - Humcnizcçcc cc cIençcc cL:IéIricc º
1. DireiIc: reprccuIivc:, :cúce mcIernc e perincIc| 11
2. /Iençcc in:IiIucicnc| cc pcrIc 17
3. Frepcrcncc c mu|her pcrc c pcrIc 2ó
4. /vc|icçcc cr|Iicc cc Iipc ce pcrIc 32
5. /::i:Iëncic c mu|her nc IrcLc|hc ce pcrIc 38
ó. U:c cc pcrIcgrcmc nc cccmpcnhcmenIc cc IrcLc|hc ce pcrIc 45
7. /ccmpcnhcmenIc cc mu|her curcnIe c IrcLc|hc ce pcrIc{SupcrIe ó4
p:icc::ccic|)
8. C ccnIrc|e cc ccr nc IrcLc|hc ce pcrIc ó8
º. /::i:Iëncic c mu|her nc pcrIc ncrmc| 77
10. /::i:Iëncic c mu|her nc pcrIc pcr ce:crec 87
11. /::i:Iëncic c mu|her nc pcrIc fcrcipe ºó
12. /ne:Ie:ic em CL:IeIr|cic 101
13. /::i:Iëncic c mu|her nc pcrIc ce ge:Icçce: ce c|Ic 112
ri:cc
14. lncuçcc cc pcrIc 11º
15. /::i:Iëncic imecicIc cc recém-nc:cicc 128
1ó. /|eiIcmenIc mcIernc 135
17. /::i:Iëncic c mu|her ccm cLcrIcmenIc e nc pc:- 145
cLcrIc
18. /::i:Iëncic c mu|her pcrIcccrc cc HlV curcnIe c pcrIc 158
e puerpéric
1º. /::i:Iëncic c mu|her nc ¢ucrIc per|ccc 1ó8
20. /::i:Iëncic c mu|her nc puerpéric 175
21. Evicëncic: cienIificc: :cLre c: prcIicc: uIi|izccc: nc 182
pcrIc
22. Feferëncic: LiL|icgrcficc: 1º0
SUMÁRIO
9
C ccnceiIc ce cIençcc humcnizccc é cmp|c e
envc|ve um ccnjunIc ce ccnhecimenIc:, prcIicc: e
cIiIuce: ¢ue vi:cm c prcmcçcc cc pcrIc e cc
nc:cimenIc :cuccvei: e c prevençcc cc mcrLi-
mcrIc|iccce mcIernc e perincIc|. lnicic-:e nc pré-ncIc|
e prccurc gcrcnIir ¢ue c e¢uipe ce :cúce rec|ize
prccecimenIc: ccmprcvcccmenIe Lenéficc: pcrc c
mu|her e c LeLë, ¢ue eviIe c: inIervençce:
ce:nece::cric: e ¢ue pre:erve :uc privcciccce e
cuIcncmic.
/ grcvicez e c pcrIc :cc evenIc: :ccici: ¢ue inIegrcm
c vivëncic reprccuIivc ce hcmen: e mu|here:. E:Ie é
um prcce::c :ingu|cr, umc experiëncic e:pecic| nc
univer:c cc mu|her e ce :eu pcrceirc, ¢ue envc|ve
IcmLém :uc: fcm||ic: e c ccmuniccce. / ge:Icçcc,
pcrIc e puerpéric ccn:IiIuem umc experiëncic
humcnc cc: mci: :ignificcIivc:, ccm fcrIe pcIencic|
pc:iIivc e enri¢uececcrc pcrc Iccc: ¢ue ce|c
pcrIicipcm.
C: prcfi::icnci: ce :cúce :cc, ccccjuvcnIe: ce:Ic
experiëncic e ce:empenhcm impcrIcnIe pcpe|. Iëm c
cpcrIuniccce ce cc|cccr :eu ccnhecimenIc c :erviçc
cc Lem-e:Icr cc mu|her e cc LeLë, reccnhecencc c:
mcmenIc: cr|Iicc: em ¢ue :uc: inIervençce: :cc
nece::cric: pcrc c::egurcr c :cúce ce cmLc:. Fccem
minimizcr c ccr, ficcr cc |ccc, ccr ccnfcrIc, e:c|crecer,
crienIcr, enfim, cjuccr c pcrir e c nc:cer. Freci:cm
|emLrcr ¢ue :cc c: primeirc: ¢ue Icccm cccc :er ¢ue
nc:ce e Ier ccn:ciëncic ce::c re:pcn:cLi|iccce.
CcnIucc, ce:empenhcr e:Ie pcpe| ncc é fcci|. /
mcicric cc: prcfi::icnci: vë c ge:Icçcc, c pcrIc, c
cLcrIc e c puerpéric ccmc um prcce::c
preccmincnIemenIe Lic|cgicc cnce c pcIc|cgicc é
mci: vc|crizccc. DurcnIe :uc fcrmcçcc, ccençc: e
inIerccrrëncic: :cc enfcIizccc: e c: Iécnicc:
inIervencicni:Ic: :cc ccn:icerccc: ce mcicr
impcrIcncic. EnIreIcnIc, c ge:Icçcc é um prcce::c
¢ue gerc|menIe ceccrre :em ccmp|iccçce:. C:
e:IuccnIe: :cc Ireinccc: pcrc cccIcr ¨prcIicc:
rcIineirc:¨, ccmc numc |inhc ce prccuçcc, :em c
PREFÁCIO
HUMANIZAÇÃO DA ASSISTÊNCIA OBSTÉTRICA
HUMANIZAÇÃO DA ASSISTÊNCIA OBSTÉTRICA
10
cvc|icçcc cr|Iicc cc:c c cc:c. Di:Ic ceccrre um grcnce númerc ce
inIervençce: ce:nece::cric: e pcIencic|menIe icIrcgënicc:.
Feccnhecer c incivicuc|iccce é humcnizcr c cIencimenIc. FermiIe cc
prcfi::icnc| e:IcLe|ecer ccm cccc mu|her um v|ncu|c e perceLer :uc:
nece::iccce: e ccpcciccce ce |iccr ccm c prcce::c cc nc:cimenIc.
FermiIe IcmLém re|cçce: menc: ce:iguci: e menc: cuIcriIcric:, nc
mecicc em ¢ue c prcfi::icnc| em |ugcr ce ¨c::umir c ccmcncc cc
:iIucçcc¨ pc::c c cccIcr ccncuIc: ¢ue Ircgcm Lem-e:Icr e gcrcnIcm c
:egurcnçc pcrc c mu|her e c LeLë.
Nc prcIicc, ccmc c|Iercr pc:Iurc: crrcigccc: e inIrccuzir umc
cLcrccgem humcnizccc°
CerIcmenIe, ncc :erc ccm ncrmc: cu mcnuci:.
Fcrc, ce fcIc, muccr c re|cçcc prcfi::icnc| ce :cúce/mu|her é nece::cric
umc muccnçc ce cIiIuce ¢ue, ce fcrc |nIimc, cepence ce cccc um.
EnIreIcnIc, c|gumc: ¢ue:Ice: cevem :er vi:Ic: ccmc ccmprcmi::c:
prcfi::icnci: inci:pen:cvei:: e:Icr :inIcnizccc ccm ncvc: prcpc:Ic: e
experiëncic:, ccm ncvc: Iécnicc:, prcIiccr umc mecicinc Lc:eccc em
evicëncic:, ccm c c|hcr cc cL:ervcccr cIenIc. Feccnhecer ¢ue c
grcvicc é c ccncuIcrc cc prcce::c e ¢ue grcvicez ncc é ccençc. E,
principc|menIe, cccIcr c éIicc ccmc pre::upc:Ic Lc:icc nc prcIicc
prcfi::icnc|.
11
Soùde no contexto soc|o-cu|turo|
/ :cúce ncc ceve :e re:Iringir cc Irccicicnc| ccnceiIc
ce prevençcc, cicgnc:Iicc, IrcIcmenIc e recLi|iIcçcc,
mc: ceve :er cLcrcccc IcmLém nc ccnIexIc cu|Iurc|,
hi:Icricc e cnIrcpc|cgicc, cnce e:Icc c: inciv|cuc: ¢ue
:e ¢uerem ver :cuccvei: cu |ivre: ce ccençc:. E::c
cLcrccgem é funccmenIc| cc :e cnc|i:cr c ¢ue:Icc
cc :cúce cc mu|her Lrc:i|eirc, em e:pecic| cc¢ue|c ce
mencr rencc, pci: e:Ic Iem ccrëncic: mcrcccc:
cc¢ui|c ¢ue :e chcmc ce ¨nece::iccce: Lc:icc:¨, ¢ue
inIerferem nc :uc :cúce e :eu Lem-e:Icr. E:Ie mu|her
ccrece, fre¢üenIemenIe, ce c|imenIcçcc, mcrccic,
IrcLc|hc cignc e cce¢ucccmenIe remunerccc,
ecuccçcc, cu|Iurc, |czer, cenIre cuIrc:.
EvicenIemenIe, e::c ¨ccençc :ccic|¨ - ¢ue cccmeIe
um númerc expre::ivc ce mu|here: - ceIerminc cu
cgrcvc ccnciçce: Lic|cgicc: e p:icc|cgicc: ¢ue pcem
em ri:cc :uc vicc, :uc :cúce e :eu Lem-e:Icr.
É ccm e::c cLrcngëncic ccnceiIuc| ¢ue :erc pc::|ve|
icenIificcr e:IrcIégic: e prcgrcmc: ce :cúce ¢ue
pc::cm recuzir c ci:Icncic enIre c: vc:Ic: e
impcrIcnIe: ccnhecimenIc: cienI|ficc: e Iecnc|cgicc:
cc¢uiricc: ne:Ie :écu|c e :uc |imiIccc cp|iccçcc, ccm
umc vi:cc humcn|:Iicc, nc prcmcçcc cc :cúce cc:
pe::cc:.
EvicenIemenIe, ncc :e pcce cgucrccr ¢ue c:
mecicc: e:IruIurci: nece::cric: c ccrreçcc cc: grcve:
prcL|emc: eccncmicc: e :ccici: cc pc|: :ejcm
cccIccc: em :uc p|eniIuce e :urIcm c: efeiIc:
ce:ejccc: pcrc ¢ue c :eIcr ce :cúce :e mcLi|ize nc
ccrreçcc ce :eu: prcL|emc: e:pec|ficc:. Mc:, pcr
cuIrc |ccc, e impcrIcnIe ¢ue, nc ce:envc|vimenIc ce
prcgrcmc: ce ccmLcIe c e::e: prcL|emc: e:pec|ficc:
ce :cúce ce ceIerminccc: grupc: pcpu|ccicnci:, ncc
:e percc c cimen:cc cc rec| prcfunciccce cc
inIerferëncic ce::c: ¢ue:Ice: pc||Iicc-eccncmicc: e
:ccici: nc e:Iccc ce :cúce ce cccc cicccc e
ciccccc Lrc:i|eirc:.
1 DIREITOS REPRODUTIVOS, SAÚDE MATERNA E PERINATAL
DIREITOS MATERNOS, SAÚDE MATERNA E PERINATAL
12
Soùde |em|n|no. Determ|nontes
Nc cc:c cc mu|her, ccre:ce-:e c prcL|emcIicc jc exp|iciIccc, ¢ue:Ice:
IcmLém ccmp|exc:, re|ccicnccc: c: re|cçce: ce gënerc, ce ncc Icc
:imp|e: re:c|uçcc, pcr ref|eIirem pccrce: cu|Iurci: ccmincnIe: nc
:ccieccce. / cefiniçcc ce icenIiccce :exuc| ccmc fcIcr eminenIemenIe
Lic|cgicc, em ¢ue c: ccrccIer|:Iicc: cncIcmicc:, fi:i c|cgicc: e hcrmcnci:
cefinem mcchc e fëmec, é pcr cemci: e:IreiIc pcrc cLcrccr c
IcIc|iccce cc: univer:c: mc:cu|inc e femininc. / icenIiccce cu|Iurc| ce
gënerc e ccn:Iru|cc nc Iempc e nc e:pcçc, cricncc e:IerecIipc: ce
pcpéi: ciferenciccc:, mcrcccc: pe|c: inIere::e: imecicIc: cc:
:ccieccce: nc: ciferenIe: mcmenIc: hi:Icricc:. Ao |ongo dos sécu|os,
constru|u-se um mode|o soc|o| predom|nonte que vem |mped|ndo o
mu|her de ser suje|to p|eno de suo propr|o h|stor|o. E::e mcce|c pré-
ceIerminc fcrmc: ce ccnhecimenIc e cçcc, nc crec cc :cúce inc|u:ive,
¢ue evicencicm :eu ccrcIer pcIricrcc|.
E::e: ceIermincnIe: hi:Icricc-:ccici: vëm :e ref|eIincc, cc |cngc cc:
Iempc:, nc cIucçcc mécicc nc: ¢ue:Ice: re|ccicnccc: c :cúce cc
mu|her: c exc|Icçcc cc mcIerniccce - ci:cur:c ccmincnIe c pcrIir cc
:écu|c XlX - Ircuxe nc :eu Lcjc ncc c prcIeçcc cc mu|her cc:
vu|nercLi|iccce: c ¢ue e:Ic expc:Ic nc prcce::c ce mcnuIençcc cc
e:pécie, mc: c perpeIucçcc cc: re|cçce: ce pccer enIre c: :exc:. De
cccrcc ccm Fcuccu|I:
!"#$% '((% %)'*+,# -#./%0 1#2 ./' *#( %-3#4#+%2#( '2 )#4*# $%
('5/%-6$%$' 78 $#6( #/ )49( (:1/-#( *,# '()%46% #4$'*%$% ('*,# '2
;/*+,# $' /2% <4'#1/<%+,# '-'2'*)%4= %(('>/4%4 # <#3#%2'*)#?
4'<4#$/064 % ;#42% $' )4%@%-7#? 4'<4#$/064 %( ;#42%( $' 4'-%+A'( (#16%6(B
'2 (/2%? <4#<#416#*%4 /2% ('5/%-6$%$' C)6- ' <#-6)61%2'*)'
1#*('43%$#4%DE
/incc nc :écu|c XlX, ¢ucncc emergicm e :e ccn:c|iccvcm e::e:
ccnceiIc:, inicicu-:e c inIerferëncic cc E:Iccc, ccm um prcce::c ce
expcn:cc cc c::i:Iëncic mécicc nc 8rc:i|, cnIe: exercicc ¢uc:e
exc|u:ivcmenIe nc fcrmc |iLerc| cu fi|cnIrcpicc. /|gun: prcgrcmc: ce
:cúce cirigicc: c grupc: pcpu|ccicnci: e:pec|ficc: ccmeçcrcm c :er
ce:envc|vicc:, enIre e|e: c c::i:Iëncic pré-ncIc|. E:Ic c::i:Iëncic
c::cciccc c in:IiIucicnc|izcçcc cc pcrIc Ieve pcr cLjeIivc ce:envc|ver
um recém-nc:cicc :cuccve| e recuzir c: e|evccc: Icxc: ce mcrIc|iccce
infcnIi| ¢ue exi:Iicm nc finc| cc :écu|c pc::ccc e nc primeirc meIcce
ce:Ie. Cu :ejc, c c::i:Iëncic pré-ncIc| :urgiu ccmc um prcce::c ce
¨puericu|Iurc inIrc-uIerinc¨, ccmc umc preccupcçcc :ccic| ccm c
cemcgrcfic e ccm c ¢uc|iccce cc: cricnçc: nc:cicc:, e ncc ccmc
prcIeçcc c mu|her.
C primeirc Ccngre::c 8rc:i|eirc ce FrcIeçcc c lnfcncic {1º22)
incireIcmenIe cu|pc c: ¨mu|here: ce:nuIricc:, :ifi||Iicc: e c|ccc|cIrc:¨
pe|c: e|evccc: Icxc: ce mcrIc|iccce infcnIi| vigenIe: nc épccc, e
reccmencc c inIervençcc cc E:Iccc cIrcvé: cc cLerIurc ce
mcIerniccce: e creche: e cc ¨:everc vigi|cncic cc c|eiIcmenIc
1
DIREITOS MATERNOS, SAÚDE MATERNA E PERINATAL
13
mcIernc¨. /Lric-:e mci: um ccminhc pcrc re:pcn:cLi|izcr c: mu|here:
pe|c: mcze|c: cc :ccieccce e :e ju:Iificcvc um ccirrcmenIc cc ccnIrc|e
:ccic| :cLre :eu: ccrpc: e :uc: vicc:. Cumpre reccrccr ¢ue, ne::c
épccc, c: mu|here: erc negccc cu cificu|Iccc c cce::c c ecuccçcc
fcrmc|.
Fci ccm e::e: ccnceiIc:, muiIc: veze: e¢uivccccc:, ¢ue :e expcnciu nc
8rc:i| c c::i:Iëncic pré-ncIc|. E e::c cenIrc|izcçcc cc cIencimenIc c
:cúce cc mu|her nc e:ferc exc|u:ivc cc cic|c grcvicc-puerperc|
perpeIucu-:e cIé muiIc recenIemenIe. / cmp|icçcc cc cferIc ce
:erviçc: ce cIençcc c mu|her, c pcrIir cc finc| cc: cnc: ó0, cincc ncc
Iinhc pcr cLjeIivc c cIencimenIc cLrcngenIe ce :uc: nece::iccce: ce
:cúce. Fci c cre:cimenIc pcpu|ccicnc| ¢ue cccrric nc: pc|:e:
:uLce:envc|vicc: c mcIivcccr ce inve:IimenIc: inIernccicnci: ¢ue
ci:pcniLi|izcrcm méIccc: e Iécnicc: ¨mccernc:¨ ce ccnIrccepçcc
cirigicc: c: pcpu|cçce: pcLre:.
A mu|her e o espoço po|ít|co
EmLcrc c :eIcr púL|icc nc 8rc:i| cincc ccnIinuc::e privi|egicncc c
cIençcc c ge:IcnIe, nc Ircn:içcc cc: cécccc: ó0/70, ccmeçcrcm c
:urgir c: enIiccce: ciIc: ncc-gcverncmenIci: ¢ue ce:envc|vicm
prcgrcmc: verIicci: ce p|cnejcmenIc fcmi|icr, :em cuIrc: cuicccc: c
:cúce cc: mu|here:. / cricçcc cc Sccieccce Civi| ce 8em-E:Icr Fcmi|icr
{8ENF/M) e :uc cmp|c cIucçcc nc Sccieccce Lrc:i|eirc nc cécccc ce
70 é c exemp|c mci: c|crc ce::e per|ccc. Menc: c|crc, enIreIcnIc, ficc c
ccmpreen:cc ce pcr¢ue, em :encc e::e per|ccc c cuge cc regime
mi|iIcr nc 8rc:i| ccm :eu: princ|pic: prc-ncIc|i:Ic: - ¢ue vi:cvcm ccupcr c:
imen:c: e:pcçc: vczic: ce nc::c IerriIcric em ncme cc :egurcnçc
nccicnc| -, fci pc::|ve| c prc|ifercçcc ce::c: enIiccce: ciIc: ¨ccnIrc|i:Ic:¨.
E::c ciccIcmic enIre c ci:cur:c e c prcIicc - Icc mcrcccc nc :ccieccce
Lrc:i|eirc cIé c: cic: cIuci: - cerIcmenIe ncc Ircuxe Lenef|cic: c:
mu|here:, ncvcmenIe Ircn:fcrmccc: em c|vc ce prcgrcmc: ¢ue ncc
cLjeIivcvcm :uc :cúce, nem :eu Lem-e:Icr.
Ccmc recçcc c e::c prcIicc, c: e:¢uercc: Lrc:i|eirc: inicicrcm
mcvimenIc ccnIrcric: c cpc:içcc cc p|cnejcmenIc fcmi|icr e cc ccnIrc|e
cc ncIc|iccce, cuc: e:IrcIégic: ¢ue, emLcrc Ienhcm :ignificccc:
ciferenIe:, :uperpunhcm-:e ne::c épccc, Iencc c primeirc empre:Iccc
:eu ncme pcrc cmenizcr c impccIc pc||Iicc cc imp|cnIcçcc :uL|imincr
cc :eguncc.
NcvcmenIe, e::e cnIcgcni:mc ncc Ircuxe Lenef|cic: pcrc c: mu|here:.
En¢ucnIc c: c||nicc: privccc: ce p|cnejcmenIc fcmi|icr prc|ifercvcm e
ci:pcniLi|izcvcm ccnIrccepçcc, c mecicinc :cniIcric - ¢ue inIrcjeIcvc
em :uc prcIicc c pen:cmenIc cc e:¢uercc - cificu|Icvc c cce::c cc:
mu|here: c cuIrc: c|IerncIivc:. Ser ¨ccnIrc¨ c p|cnejcmenIc fcmi|icr
Ircn:fcrmcu-:e em ¨Lcnceirc¨ pc||Iicc, c ¢ue reIcrccu c cferIc ce::c:
cçce: ce :cúce nc rece Lc:icc. / :ccieccce Lrc:i|eirc vivic nc:
cécccc: ce ó0 e 70 um riImc ce incu:Iric|izcçcc e urLcnizcçcc
cce|erccc e, ce::e prcce::c, re:u|Icrcm mccificcçce: nc: expecIcIivc:
reprccuIivc: cc: Lrc:i|eirc: ¢ue, ccm c|gumc:
1
DIREITOS MATERNOS, SAÚDE MATERNA E PERINATAL
14
cécccc: ce cIrc:c e Ic|vez mcIivccc: pcr ceIermincnIe: ci:IinIc:
cc¢ue|c: cc: pc|:e: ce:envc|vicc:, pc::crcm c ce:ejcr fcm||ic: mencre:.
E fcrcm Lu:ccr c: c|IerncIivc: ci:pcn|vei: ce méIccc: cnIiccncepcicnci:,
cincc ¢ue ncc fc::em c: iceci:. Ncc pcce Ier :icc cuIrc c rczcc ¢ue
cu|minc nc cécccc ce º0 ccm umc prcIicc ce p|cnejcmenIc fcmi|icr ce
c|Ic prevc|ëncic e Lcixc ¢uc|iccce.
C re::urgimenIc cc mcvimenIc femini:Ic c pcrIir cc meIcce ce:Ie :écu|c
Ircuxe cc ceLcIe ncvc: ccncepçce: cc: re|cçce: enIre c: gënerc: e
cc: re|cçce: enIre c :er humcnc e c :ccieccce. lnicic|menIe cccIcncc
umc pc:Iurc ce pc|crizcçcc/cnIcgcni:mc enIre c: :exc:, c pen:cmenIc
femini:Ic evc|uiu ne:Ie finc| ce :écu|c pcrc umc pc:içcc mci: ccn:IruIivc,
ce e:I|mu|c c cccpercçcc/ccmpcnheiri:mc e c vc|crizcçcc cc
incivicuc|iccce ce cccc um cc: gënerc:, :em exc|u:ce:.
EvicenIemenIe, c: ccn¢ui:Ic: cc femini:mc nc 8rc:i| e nc muncc :cc
:ignificcIivc: e Iëm permiIicc umc evc|uçcc cc :ccieccce em re|cçcc
cc reccnhecimenIc cc: cireiIc: ce ciccccnic iguc|iIcric: enIre hcmen: e
mu|here:, IcmLém nc ccmpc cc :cúce.
EnIreIcnIc, e cpe:cr ce::c: impcrIcnIe: ccn¢ui:Ic:, cL:ervc-:e hcje ¢ue
c ¢uc:e IcIc|iccce cc: inicicIivc: re|ccicnccc: c :cúce cc: mu|here:
Iem :e ccrccIerizccc pcr mcnipu|cr :eu: ccrpc: e :uc: vicc:, vi:cncc
cLjeIivc: cuIrc: ¢ue ncc :eu Lem-e:Icr. C: Iermc: ¢ue c: ce:igncm,
muiIc: veze:, :ervem % <46#46 pcrc ciIcr ncrmc:, vi:cncc um
ccmpcrIcmenIc femininc enIencicc ccmc úIi| pcrc c pccer :ccic|
vigenIe. E, Ic|vez pcr i::c, muiIc: ce::c: inicicIivc: ncc Ienhcm |cgrccc
:uce::c nc me|hcric cc :cúce cc: mu|here:, inc|u:ive pcr¢ue in:i:Iem em
exprcpricr cc mu|her :uc cuIcceIermincçcc. /: e|evccc: Icxc: ce
mcrIc|iccce mcIernc e perincIc|, c u:c cLu:ivc cc ce:crec e c c|Ic
prevc|ëncic ce mu|here: e:Ieri|izccc: cu u:cncc méIccc:
cnIiccncepcicnci: incce¢uccc: :cc exemp|c: c|crc: ce::c: ci:Icrçce:.
A med|co||zoçõo do corpo |em|n|no
C 8rc:i| ccupcu, cIé hc pcucc, c nccc invejcve| pc:içcc ce ccmpcc
muncic| ce cpercçce: ce:cricnc:. Se, por um |odo, o cesóreo reo||zodo
por rozöes méd|cos tem um gronde potenc|o| de reduz|r o morb|-
morto||dode moterno e per|noto|, por outro |odo, o exogero de suo
prót|co tem e|e|to oposto, |nc|us|ve por consum|r recursos prec|osos do
s|stemo de soùde. E::c prcfuncc ci:Icrçcc nc prcIicc mécicc Lrc:i|eirc é
ceIerminccc pcr mú|Iip|c: fcIcre: - hi:Icricc:, e:IruIurci:, ccnjunIurci: -
mc: Iem, nc fcrmc ccmc c :ccieccce em gerc|, e c mecicinc em
pcrIicu|cr, enccrc c mu|her, c gëne:e ce::c permi::iviccce. Ehrenreich &
Eng|i:h cpcnIcm pcrc c pccer cc mecicinc em Ircn:fcrmcr evenIc:
fi:ic|cgicc: em ccençc:: c mecicc|izcçcc cc ccrpc femininc - ¢ue ¨IrcIc
c grcvicez e c mencpcu:c ccmc ccençc, Ircn:fcrmc c men:Irucçcc em
ci:IúrLic crcnicc e c pcrIc em um evenIc cirúrgicc¨ - é umc cc: mci:
pccerc:c: fcnIe: cc icec|cgic :exi:Ic cc nc::c cu|Iurc. Cu cincc, ce
cccrcc ccm l||ich:
1
DIREITOS MATERNOS, SAÚDE MATERNA E PERINATAL
15
!F'($' ./' %( 2/-7'4'( $# (:1/-# GHG ./6('4%2 (' %;642%4? ;#42#/I(' /2
>4/<# $' >6*'1#-#>6()%(= % <4J<46% ;'26*6-6$%$' )4%*(;#42#/I(' '2
(6*)#2% $' /2% *'1'((6$%$' 2:$61% )4%)%$% <#4 /*63'4(6)846#(
'36$'*)'2'*)' $' ('5# 2%(1/-6*#E K()%4 >4836$%? <%464? %-'6)%4 (,# #/)4%(
)%*)%( 1#*$6+A'( 2'$61%-6083'6(? 1#2# (,# % 2'*#<%/(% #/ % <4'('*+%
$' /2 C)'4# ./' # '(<'16%-6()% $'16$' ./' : $'2%6(ED
/ pcrIe c excgerc ce::c cfirmcçcc - ncc :e pcce negcr c ccnIriLuiçcc
cc mecicinc em gerc|, e cc ginecc|cgic e cL:IeIr|cic em pcrIicu|cr, nc
me|hcric cc: ccnciçce: ce :cúce e ce vicc cc: mu|here: -, muiIc: cc:
ci:Icrçce: hi:IcriccmenIe cL:ervccc:, ccmc, pcr exemp|c, c epicemic
ce hi:IerecIcmic: nc: EU/ nc: cécccc: ce ó0 e 70 cu c exce::c ce
ce:crec: nc 8rc:i|, ref|eIem excIcmenIe e::c: inIer-re|cçce: enIre c:
¢ue:Ice: ce gënerc e c prcIicc mécicc.
E é nece::cric c ccmpreen:cc ce::c: inIer-re|cçce: pcrc ¢ue :e pc::c
perceLer pcr¢ue c 8rc:i| cincc cpre:enIc inciccccre: inccmi::|vei: ce
mcrIc|iccce mcIernc e mcrIc|iccce perincIc|, muiIc c|ém cc¢ue|c
e:perccc pcrc :eu n|ve| ce ce:envc|vimenIc e um exerc|cic
fre¢üenIemenIe e¢uivccccc cc: cireiIc: reprccuIivc: pcr pcrIe ce :uc:
cicccc:.
/ reprccuçcc cfeIc c mu|her ce umc fcrmc ¢ue Ircn:cence c: civi:ce:
ce c|c::e e permeic Iccc: c: :uc: cIiviccce:: :uc ecuccçcc, :eu
IrcLc|hc, :eu envc|vimenIc pc||Iicc e :ccic|, :uc :cúce, :uc :exuc|iccce,
enfim, :uc vicc e :eu: :cnhc:. É nece::cric ¢ue :e ceixe ce rcmcnIizcr c
pccer ¢ue pcce exi:Iir cc ccnexcc Lic|cgicc cc mu|her ccm c
McIerniccce. É funccmenIc| ceixcr ce :uLe:Iimcr c pccer repre::ivc
:cLre c: mu|here: ¢ue :e e:IcLe|ece ccm e::c ccnexcc. Fci: e::c vi:cc
¨reprccuIivc¨ cc: mu|here: é muiIc menc: c re:u|Iccc ce :uc ccnciçcc
Lic|cgicc e, ccimc ce Iucc, ceIerminccc pe|c crgcnizcçcc :ccic| e
cu|Iurc|. E ncc :e pcce ceixcr ce reccnhecer ¢ue e::c crgcnizcçcc Iem,
cIé hcje, Lu:cccc cercecr c: e:fcrçc: cc: mu|here: pcrc gcnhcr um
pcucc ce e:pcçc ce ccnIrc|e :cLre :uc: vicc: e :eu: ccrpc: e pcrc
expre::cr |ivremenIe :uc :exuc|iccce.
/Iuc|menIe, pcce-:e cL:ervcr nc muncc Iccc, emLcrc, infe|izmenIe,
cincc ce fcrmc muiIc I|micc nc 8rc:i|, umc cre:cenIe Iencëncic c
ccnIe:Icçcc ce um mcce|c ce ce:envc|vimenIc ¢ue privi|egic c crcem
hiercr¢uicc, ccn:umi:Ic e Iecnc|cgicc. E::c ccnIe:Icçcc é evicenIe nc:
mcvimenIc: ce prcIe:Ic ccnIrc c: :ccieccce: ce mcce|c pc||Iicc
cuIcriIcric, nc cfirmcçcc cc |iLerccce e cc cemccrccic e nc
fcrIc|ecimenIc ce umc ccrrenIe pre:ervccicni:Ic, ecc|cgicc, em
cpc:içcc c Irccicicnc| cIiIuce ccmincccrc e cprcpricIivc ceIerminccc
pe|c mccc ce prccuçcc. É :cL c cIicc ce::e mcvimenIc ce
Ircn:fcrmcçcc ¢ue ceve cccrrer umc ncvc ref|excc :cLre c :cúce cc
mu|her. Fensor sobre o mu|her e suo soùde é pensor umo novo
soc|edode, em que o e|xo centro| sejo o quo||dode de v|do do ser
humono desde o seu nosc|mento.
1
DIREITOS MATERNOS, SAÚDE MATERNA E PERINATAL
16
Ncc :e pcce negcr c: ccnIriLuiçce: ¢ue c: cvcnçc: Iécnicc-cienI|ficc:
Ircuxercm c humcniccce e c mu|her em e:pecic|. E::e: cvcnçc: cLrircm,
IecriccmenIe, e:pcçc: pcrc ¢ue c mu|her :e Icrnc::e ccnc ce :eu ccrpc
e ce :eu ce:Iinc. C: méIccc: ccnIrccepIivc: prcvcccrcm muccnçc:
¢uc|iIcIivc: nc vicc cc mu|her c pcrIir cc: cnc: ó0, fcvcrecencc c
vivëncic cc :exuc|iccce :em c cnu: cc grcvicez ince:ejccc. Fcrém, c
me:mc :ccieccce ¢ue cricu Ici: in:IrumenIc: ncc reccnhece
icec|cgiccmenIe c cireiIc cc mu|her c :exuc|iccce p|enc, Icrnc-c c
exc|u:ivc re:pcn:cve| pe|c reprccuçcc humcnc e ncc |he cc cce::c c
infcrmcçce: :cLre cireiIc: reprccuIivc:.
/ ce:vincu|cçcc enIre vicc :exuc| e reprccuçcc, em vez ce
prcpcrcicncr c |iLerccce femininc, Iem :e cpre:enIccc ce fcrmc c cricr
crIimcnhc: ¢ue pre:ervcm c: IcLu: e c inccn:ciëncic, ceixcncc
inc|Ierccc c mcce|c Irccicicnc| ce impc:içcc ce c|IerncIivc: c mu|her.
E:IcI|:Iicc: recenIe: cemcn:Ircm um númerc expre::ivc ce |c¢ueccurc:
rec|izccc: em mu|here: jcven: e ce:infcrmccc:. Ncc menc: c|crmcnIe:
:cc c: e:IimcIivc: :cLre c: cLcrIc: c|cnce:Iinc: rec|izccc: nc 8rc:i| ¢ue
re:u|Icm em um númerc ce:ccnhecicc, mc:, :egurcmenIe ncc
ce:prez|ve|, ce mcrIe:.
E::e: fcIc: reve|cm ccnIrcciçce: nc :ccieccce, ¢ue :e reprccuzem nc
:i:Iemc ce :cúce e, mci: inIen:cmenIe, nc cIencimenIc c :cúce cc
mu|her, IcnIc nc ¢ue :e refere cc ce:empenhc cc :i:Iemc ce :cúce,
¢ucnIc c inciccccre: ce :cúce ¢ue ref|eIem incireIcmenIe c ¢uc|iccce
ce vicc cc pcpu|cçcc {prcLcLi|iccce ce mcrIe e e:percnçc ce vicc cc
nc:cer). Fcrc c ce:envc|vimenIc ce umc pc||Iicc eficcz ce cIençcc
inIegrc| c :cúce ¢ue, :em cúvicc, imp|iccrc c mécic e |cngc prczc em
me|hcric cc ¢uc|iccce cc vicc humcnc, é preci:c ccn:icercr e::c:
¢ue:Ice:.
Um ncvc ccnceiIc ce :cúce ¢ue ccn:icere c ccn:ciëncic p|enc ce
ciccccnic cc: inciv|cuc: exige ncvc: pc:içce: e, pcrIcnIc, ncvc:
crcencmenIc: cu|Iurci:. / humcnizcçcc cc nc:cimenIc - :c pc::|ve| :e
cicccc: e ciccccc:, prcfi::icnci: ce :cúce e ge:IcnIe:, :ccieccce em
gerc|, c::imi|crem e::e: ccnceiIc: - pcce :er c primeirc pc::c.
1
17
C nc:cimenIc é hi:IcriccmenIe um evenIc ncIurc|.
Ccmc é inci:cuIive|menIe um fencmenc mcLi|izcccr,
me:mc c: primeirc: civi|izcçce: cgregcrcm, c e:Ie
cccnIecimenIc, inúmerc: :ignificccc: cu|Iurci: ¢ue
cIrcvé: ce gercçce: :cfrercm Ircn:fcrmcçce:, e cincc
ccmemcrcm c nc:cimenIc ccmc um cc: fcIc:
mcrccnIe: cc vicc.
/Ié c: impcrIcnIe: muccnçc: cc mccu: vivenci cc
per|ccc incu:Iric|, c: vivëncic: cc pcrIc fcrcm, nc:
mci: ciferenIe: cu|Iurc:, ce ccrcIer |nIimc e privccc,
:encc umc experiëncic ccmpcrIi|hccc enIre mu|here:.
/ imen:c mcrIc|iccce mcIernc e perincIc| ccmeçcu
enIcc c :er ci:cuIicc, nc e:ferc púL|icc, pcr umc
nece::iccce pc||Iicc-eccncmicc ce gcrcnIir exérciIc:
e IrcLc|hcccre:. /c |ccc ce:Ic: Ircn:fcrmcçce:
:ccici:, c cL:IeIr|cic firmcvc-:e ccmc mcIéric mécicc
e cccrricm c: primeirc: cçce: vc|Iccc: c ci:cip|incr c
nc:cimenIc.
/ pcrIir cc|, c: muccnçc: re|ccicnccc: cc pcrIc
cccLcricm pcr ccrccIerizc-|c ccmc evenIc mecicc,
cujc: :ignificccc: cienI|ficc: cpcrenIemenIe viricm
:cLrepujcr cuIrc: c:pecIc:. C pcrIc enIcc ceixc ce :er
privccc, |nIimc e femininc, e pc::c c :er vivicc ce
mcneirc púL|icc, ccm c pre:ençc ce cuIrc: cIcre:
:ccici:.
/ mcicric cc: mu|here: ¢ue cIé meccc: cc :ec. XX
pcrircm ccm c cjucc ce cuIrc: mu|here:, pcr ncc
:erem ncLre: cu cc c|c::e ce mcicr rencc, pc::cu
IcmLém c :er cLjeIc cc inIere::e mécicc e Ier :eu:
pcrIc: cIencicc: cu cL:ervccc: pcr prcfi::icnci:
cficic|menIe prepcrccc: pcrc e:Ie fim, ccmc c:
enfermeirc:-pcrIeirc: e c: mécicc:.
Nc 8rc:i|, c prcce::c ce in:IiIucicnc|izcçcc cc pcrIc,
cc |cngc cc cécccc ce 40, fci prcvcve|menIe c
primeirc cçcc ce :cúce púL|icc cirigicc c mu|her. /Ié
c in|cic cc: cnc: ó0, c preccupcçcc ccm c :cúce
mcIernc :e re:Iringiu c c::i:Iëncic cc pcrIc. Ccm c
inIrccuçcc cc mecicinc prevenIivc nc pc|: e c
cricçcc cc: cenIrc: ce :cúce, inicicrcm-:e c:
prcgrcmc: ce pré-ncIc| ¢ue, nc rec|iccce, Iinhcm
ccmc cLjeIivc principc| recuzir c mcrIc|iccce infcnIi|.
2 ATENÇÃO INSTITUCIONAL AO PARTO
ATENÇÃO INSTITUCIONAL AO PARTO
18
Nc: cnc: 80, cccrrercm c|gumc: inicicIivc: |ccci: vc|Iccc: pcrc c
recuçcc cc mcrIc|iccce mcIernc, :encc umc cc: mci: impcrIcnIe: c
prcjeIc ce:envc|vicc pcr Gc|Lc ce /rcújc nc Cecrc pcrc inIegrcr c:
pcrIeirc: |eigc: cc :i:Iemc |ccc| ce :cúce, ce mccc c me|hcrcr c
c::i:Iëncic, recuzincc ri:cc: e re:peiIcncc c cu|Iurc |ccc|.
Em 1º84, IcmLém em re:pc:Ic c cemcncc cc mcvimenIc crgcnizccc ce
mu|here:, fci in:IiIu|cc c Frcgrcmc ce /::i:Iëncic lnIegrc| c Scúce c
Mu|her {F/lSM) ¢ue inc|u|c c c::i:Iëncic pré-ncIc|, enIre cuIrc:. /
imp|cnIcçcc ce:Ie prcgrcmc cccrreu ce mccc heIercgënec nc pc|:,
:encc cif|ci| cvc|icr :eu impccIc g|cLc| :cLre c :cúce cc mu|her, cccc c
ccmp|exiccce cc: cçce: e c grcnce ccnjunIc ce vcricvei: envc|vicc:.
Em 1ººó, c Mini:Iéric cc Scúce, em pcrceric ccm FE8F/SGC, UNlCEF e
CF/S, |cnçcu c FrcjeIc McIerniccce Segurc ¢ue preIencic recuzir c
mcrIc|iccce mcIernc e perincIc|, cIrcvé: cc me|hcric cc c::i:Iëncic cc
pcrIc e cc recém-nc:cicc.
EmLcrc e:Ic: inicicIivc: e cuIrc: em cmLiIc municipc| e e:Iccuc| Ienhcm
:icc ce:envc|vicc: nc: ú|Iimc: cnc:, prcL|emc: permcnecem nc
:i:IemcIizcçcc cc c::i:Iëncic c ge:Icçcc e cc pcrIc, ce:re:peiIcncc
cireiIc: Lc:icc: cc ciccccnic e cc|cccncc em ri:cc c vicc ce mu|here: e
recém nc:cicc:. EnIre e|e:, e:Icc c :egmenIcçcc enIre c rece Lc:icc e
hc:piIc|cr e c inIervene
-
cc exce::ivc :cLre c pcrIc.
/ re|cçcc enIre c: cIiviccce: cc cIençcc Lc:icc e c: hc:piIc|cre:
ceveric :er ce ccnIinuiccce e ccmp|emenIcrieccce. EnIreIcnIc, nc pré-
ncIc|, ¢ue é c mcmenIc mci: cprcpriccc pcrc c prepcrcçcc cc pcrIc e
ceIecçcc ce pc::|vei: c|Iercçce: cc ge:Icçcc, grcve: prcL|emc: :cc,
enccnIrccc:, ccmc c fcIc ce ¢ue c grcnce mcicric cc: mu|here: receLe
¨c|Ic¨ nc :eu mcmenIc mci: cr|Iicc, cc reccr cc ciIcvc më: - cnce :e
cgrcvcm ccençc: ccmc c hiperIen:cc e cicLeIe: - :em :cLer c ¢ue
:erviçc reccrrer frenIe c umc inIerccrrëncic cu nc mcmenIc cc pcrIc.
A med|co||zoçõo do oss|stënc|o oo porto
/ c::i:Iëncic c mu|her nc mcmenIc cc pcrIc é cLjeIc ce grcnce
mecicc|izcçcc. /pe:cr cc hc:piIc|izcçcc Ier :icc, em grcnce pcrIe,
re:pcn:cve| pe|c ¢uecc cc mcrIc|iccce mcIernc e necncIc|, c cencric
ce nc:cimenIc Ircn:fcrmcu-:e rcpiccmenIe, Icrncncc-:e ce:ccnhecicc
e cmecrcnIcccr pcrc c: mu|here: e mci: ccnvenienIe e c::épIicc pcrc
c: prcfi::icnci: ce :cúce. C ccnf|iIc gerccc c pcrIir ce:Ic Ircn:fcrmcçcc
inf|uencic c: mu|here:, enIre cuIrc: fcIcre:, c ¢ue:Iicncr c :egurcnçc cc
pcrIc ncrmc| frenIe cc cirúrgicc, mci: ¨|impc¨, mci: rcpicc, mci:
¨cienI|ficc¨. /|ém ci::c, e:Iucc: jc ccmprcvcrcm ¢ue c vic|ëncic
in:IiIucicnc| IcmLém exerce inf|uëncic nc e:cc|hc ce grcnce pcrIe cc:
mu|here: pe|c ce:crec. É preci:c |evcr em ccnIc um fcIcr muiIc
ceLcIicc: ¢uem é c prcIcgcni:Ic cc cenc cc pcrIc° / mu|her-
pcrIurienIe e:Ic cccc vez mci: ci:IcnIe ce:Ic ccnciçcc: IcIc|menIe
in:egurc, :uLmeIe-:e c Iccc: c: crcen: crienIcçce:, :em enIencer ccmc
ccmLincr c pccer ccnIicc nc:
2
ATENÇÃO INSTITUCIONAL AO PARTO
19
cIiIuce: e pc|cvrc: ¢ue cuve e perceLe, ccm c fcIc inexcrcve| ce ¢ue é
e|c ¢uem e:Ic ccm ccr e ¢uem vci pcrir.
/ percc cc cuIcncmic cc mu|her nc pcrIc e:Ic re|ccicnccc,
principc|menIe, ccm c inIen:c mecicc|izcçcc ¢ue c ccrpc femininc
:cfreu nc: ú|Iimc: cécccc:. De:Ic fcrmc, e:Ic ci:cu::cc ncc pcce e:Icr
ce:vincu|ccc cc c::i:Iëncic, pcr¢ue mci: umc vez :e e:Icric repeIincc c
exc|u:cc ¢ue c mu|her :cfre nc mcmenIc cc pcrIc em re|cçcc c :uc
prcpric cuIcncmic.
Exemp|c ce:Ic :iIucçcc é c ¢ue ciz re:peiIc cc u:c exce::ivc cc
ce:cricnc nc: ú|Iimc: Irë: cécccc:. Fcrcm fcIcre: ceIermincnIe:: c mcicr
pcgcmenIc cc: hcncrcric: prcfi::icnci: pcrc c ce:crec pe|c cnIigc
lN/MFS, c eccncmic ce Iempc e c rec|izcçcc c|cnce:Iinc cc
|c¢ueccurc IuLcric nc mcmenIc cc pcrIc. /pc: cnc: ce:Ic prcIicc,
in:IiIuiu-:e umc cu|Iurc prc-ce:crec nc pcpu|cçcc em gerc| e enIre c:
mécicc:. Ccmc ccn:e¢üëncic, pcrIe impcrIcnIe cc: cL:IeIrc: ncc :e
enccnIrc :uficienIemenIe mcIivccc, e cIé me:mc ccpcciIccc, pcrc c
cccmpcnhcmenIc cc pcrIc ncrmc|. Fcr :uc vez, em umc re|cçcc
mécicc-pccienIe c::iméIricc, c: mu|here: Iëm cificu|ccce em pcrIicipcr
cc ceci:cc cc Iipc ce pcrIc, :enIicc-:e menc: ccpcciIccc: pcrc
e:cc|her e fczer vc|er :eu: ce:ejc: frenIe c: ¨¢ue:Ice: Iécnicc:¨
|evcnIccc: pe|c: mécicc:.
/ c::i:Iëncic hc:piIc|cr cc pcrIc ceve :er :egurc, gcrcnIincc pcrc cccc
mu|her c: Lenef|cic: cc: cvcnçc: cienI|ficc:, mc: funccmenIc|menIe,
ceve permiIir e e:Iimu|cr c exerc|cic cc ciccccnic femininc, re:gcIcncc
c cuIcncmic cc mu|her nc pcrIc.
Ass|stënc|o oo porto no SbS
Nc Si:Iemc Unicc ce Scúce, c c::i:Iëncic in:IiIucicnc| cc pcrIc é
rec|izccc cIuc|menIe cIrcvé: ce umc rece ccm cercc ce 4.757 uniccce:
¢ue cIucm em ciferenIe: n|vei: ce ccmp|exiccce. C pcrIc ncrmc| fci c
prccecimenIc ce mcicr fre¢üëncic nc cnc ce 1ººº e c :eguncc
prccecimenIc ce mcicr impccIc fincnceirc. Nc 8rc:i|, c c::i:Iëncic c
mu|her nc mcmenIc cc pcrIc é em grcnce pcrIe hc:piIc|cr, ccm
ciferenIe: percenIuci: pcrc cccc regicc.
/ Fe:¢ui:c Nccicnc| :cLre Demcgrcfic e Scúce - FNDS, rec|izccc em
1ººó, mc:Irc e:Ie: percenIuci:, ccnfcrme ¢uccrc c :eguir:
2
ATENÇÃO INSTITUCIONAL AO PARTO
20
E:Ie: cccc: ref|eIem c: ciferenIe: ccnciçce: ce cce::c e crgcnizcçcc
cc: :erviçc: em cccc regicc. / pe:¢ui:c cc FNDS mc:Irc ¢ue nc regicc
NcrIe cccrreu c mcicr númerc ce portos dom|c|||ores, c ¢ue é ju:Iificccc
pe|c in:uficienIe rece ce :erviçc: ce :cúce c|iccc c: ccnciçce:
gecgrcficc: ¢ue cificu|Icm c cce::c, nc mcicr pcrIe cc: veze:, cpenc:
f|uvic|. EnIreIcnIc, é c regicc Ncrce:Ie ¢ue infcrmc c mcicr númerc ce
pcrIc: ccmici|icre: ncIificccc: cc SUS, ccnfcrme ¢uccrc c :eguir:
Parto Domiciliar SIA - SUS - 1995 a 1999
* Em 1999 os códigos para parto domiciliar incluem 029 - assist. parto s/ distócia p/ parteira(o) PAB
e 030 - assist. parto s/ distócia p/ enferm. obstétrica(o) PAB - e os dados apresentados são de
10/99.
EmLcrc c númerc ce pcrIc: ccmici|icre: :ejc re|cIivcmenIe pe¢uenc em
re|cçcc cc IcIc| ce pcrIc: cpre:enIccc:, ce 1,17 c 2.57, :uc cnc|i:e
cpre:enIc c|gun: e|emenIc: impcrIcnIe:. / mcrLimcrIc|iccce c::cciccc
c e:Ie Iipc ce pcrIc é ce fcIc ce:ccnhecicc. / mcicric ce:Ic: mu|here:
vive em crec rurc| cu ce cif|ci| cce::c, ccm preccric c::i:Iëncic c :cúce.
E:Ie: regi:Irc: inciccm ¢ue c percenIuc| ce pcrIc: ccmici|icre:
ncIificccc: vem ciminuincc cnuc|menIe, cu :ejc, ¢ue mci: mu|here:
Iivercm cce::c c cIençcc hc:piIc|cr nc mcmenIc cc pcrIc. Mc: é
impcrIcnIe |emLrcr ¢ue c: cificu|ccce: ce cce::c e:Icc mcnIicc: pcrc
ncIificcçcc cc cccrrëncic cc pcrIc, :encc nece::cric pcncercr e:Ie
cccc. Ccnfirmc e:Ic preccupcçcc c fcIc ce ¢ue c pe:¢ui:c cc FNDS-ºó
mc:Irc um percenIuc| ce pcrIc: ccmici|icre: mcicr nc regicc NcrIe cc
¢ue nc regicc Ncrce:Ie.
C percenIuc| ce pcrIc ccmici|icr em re|cçcc cc IcIc| cc: pcrIc:
cccrricc: nc SUS em 1ººó fci ce 2.47, e nc regicc NcrIe fci ce 7.7ó7, c
¢ue ficc Lem c¢uém cc: cccc: cLIicc: pe|c pe:¢ui:c FNDS {15.37).
EmLcrc c univer:c cc pe:¢ui:c e c méIccc :ejcm civer:c:, c re|cIc ce
um grcnce númerc ce pcrIc: ccmici|icre: ncc erc e:perccc, umc vez
¢ue :cmenIe c: crec: urLcnc: fcrcm pe:¢ui:ccc: ne:Ic regicc, cu :ejc,
c ncIificcçcc cc SUS ce pcrIc: ccmici|icre: ceveric :er Lem mcicr.
Nc otençõo hosp|to|or, c: 4757 uniccce: ¢ue fczem c::i:Iëncic cc pcrIc
pccem :er c|c::ificccc: ce cccrcc ccm c pcrIe hc:piIc|cr e númerc ce
pcrIc:. Nc IcLe|c cLcixc, cpre:enIc-:e c c|c::ificcçcc
2
ATENÇÃO INSTITUCIONAL AO PARTO
21
pcr pcrIe ce mcIerniccce, :eguncc c númerc ce pcrIc:, cccc
funccmenIc| pcrc c ccmpreen:cc ce:Ic c::i:Iëncic cc pcrIc pcr¢ue :e
re|ccicnc ccm cuc: ¢ue:Ice: funccmenIci:: c cce::c e c ccmp|exiccce
cc cIençcc.
Classificação das unidades hospitalares de acordo com o número de partos realizados por ano.
Brasil, 1998.
Fonte: SIH/SUS
E:Ie: cccc: inciccm ¢ue 72,27 cc: pcrIc: cccrrem em uniccce: ce
mécic pcrIe {1 c 4ºº pcrIc: pcr cnc). Nc mcicric cc: munic|pic:, c
re:c|uIiviccce ce:Ic: uniccce: é Lcixc, ccu:cncc umc ci:Iccic enIre c
n|ve| ce ccmp|exiccce cc cIençcc e c fre¢üëncic cc: cIencimenIc:.
Scmc-:e c i:Ic c fcIc ce ¢ue c mcjcr pcrIe cc: enccminhcmenIc:
criuncc: ce:Ic: uniccce: cirige-:e c uniccce: ce grcnce pcrIe, ccm
mcjcr ccmp|exiccce, mc: em gerc| ccm prcL|emc: ce :uper|cIcçcc. C:
:erviçc: púL|icc: e c|gun: fi|cnIrcpicc:, ¢ue em gerc| :c recu:cm
pccienIe: pcr cL:c|uIc fc|Ic ce vcgc:, ncc ccn:eguem re:pcncer c
cemcncc, prcvcccncc em vcric: cenIrc: urLcnc: umc verccceirc
peregrincçcc nc mcmenIc cc pcrIc. Cucncc c mu|her e/cu c recém-
nc:cicc nece::iIcm ce cIençcc e:pecic| {ge:Icçcc ce c|Ic ri:cc,
premcIuriccce), c cificu|ccce em enccnIrcr vcgc: é cincc mcicr,
:cmcncc ri:cc:. / cemcrc nc cIencimenIc cL:IéIricc Iem
ccn:e¢üëncic: mcIernc: e necncIci: re|evcnIe:, c|ém ce cumenIc
ce:nece::cric ce cu:Ic: pcrc IrcIcmenIc cc: ccmp|iccçce:.
E cIriLuiçcc cc ge:Icr municipc| e e:Iccuc| ccnhecer c re|cçcc enIre c
cferIc e c cemcncc pcr |eiIc: cL:IéIricc: e p|cnejcr c :i:Iemc ce
cIencimenIc ce:ce c pré-ncIc| cIé c pcrIc, ce Lcixc e c|Ic ri:cc. /:
vcgc: cL:IéIricc:, nc mc|cric cc: munic|pic:, nece::iIcm :er cvc|iccc:,
em ccnjunIc ccm :uc ccncenIrcçcc e ci:IriLuiçcc pcr ccmp|exiccce.
/grcvc c :iIucçcc c fcIc ce ¢ue, muiIc: veze:, c ge:Icr |ccc| ncc Iem
ccnIrc|e cc: vcgc:, e:Icncc :uLmeIicc cc: pre:Icccre: ce :erviçc |ccc|,
umc vez ¢ue pcrIe cc: munic|pic: ncc Iem |eiIc: cL:IéIricc: prcpric:.
2
ATENÇÃO INSTITUCIONAL AO PARTO
22
/ ci:IriLuiçcc cc: hc:piIci: :eguncc c ncIurezc jur|cicc nc 8rc:i|
cpre:enIc c :eguinIe ccmpc:içcc:
Ccmc :e cL:ervc ne:Ie grcficc, c: hc:piIci: privccc: e fi|cnIrcpicc:
ccnveniccc: :cmcm ó37 cc IcIc| ce :erviçc: ci:pcn|vei:. / ge:Icc cc:
vcgc:, em gerc|, ficc mci: ccmp|icccc, cc pcnIc ce vi:Ic gerencic|,
ccnfcrme e:Ie percenIuc| cumenIc, chegcncc em c|gun: munic|pic: c
IcIc|iccce cc: :erviçc:. Em re|cçcc e:pec|ficc c: vcgc: cL:IéIricc:, e:Ic
¢ue:Icc é mci: ccmp|exc pcr¢ue c evenIc cc pcrIc é ccn:icerccc
urgëncic e cIuc|menIe preci:c e:Icr cenIrc cc: |imiIe: ce ce:crec:
e:IcLe|ecicc: pcr pcrIcric mini:Ieric|. C fcIc mci: grcve é ¢ue c: :erviçc:
ccnveniccc: e ccnIrcIccc: cc SUS, ¢ue ceIëm c mcicric cc: |eiIc:
cL:IéIricc:, e:cc|hem c: pccienIe: ¢ue :ercc ccmiIicc: em IrcLc|hc ce
pcrIc, pricrizcncc c: ce Lcixc ri:cc, pcrc eviIcr c c::i:Iëncic c:
inIerccrrëncic: cc mce e cc recém-nc:cicc, ¢ue repre:enIcrcc um cu:Ic
mcicr, e pcrc recuzir c númerc ce ce:cricnc:.
Classificação dos hospitais com leitos obstétricos (maternidades), segundo número de partos
anuais e natureza jurídica. Brasil, fevereiro de 1998.
Fonte: Sistema de Informações Hospitalares (SIH/SUS)
2
ATENÇÃO INSTITUCIONAL AO PARTO
!"
É cenIrc ce:Ie ccnIexIc ¢ue c Mini:Iéric cc Scúce, exercencc :eu pcpe|
ncrmcIizcccr e regu|cccr, vem imp|cnIcncc um ccnjunIc ce cçce:,
cIrcvé: ce pcrIcric: mini:Ierici: ccm c cLjeIivc ce e:Iimu|cr c me|hcric cc
c::i:Iëncic cL:IéIricc. / cnc|i:e ce:Ic: pcrIcric:, e em c|gun: cc:c: ce
:eu: impccIc: inicici:, ccmpce c pcncrcmc cc c::i:Iëncic cL:IéIricc
cIuc| e permiIe :uc me|hcr ccmpreen:cc.
Fortor|o MSJGM 2.815, de 2º de mo|o de 1ºº8
E:Ic pcrIcric inc|ui nc IcLe|c cc Si:Iemc ce lnfcrmcçce: Hc:piIc|cre: cc
SUS c prccecimenIc "porto normo| sem d|stoc|o reo||zodo por en|erme|ro
obstetro" e Iem ccmc finc|iccce principc| reccnhecer c c::i:Iëncic
pre:Iccc pcr e:Ic ccIegcric prcfi::icnc|, nc ccnIexIc ce humcnizcçcc cc
pcrIc. /Iuc|menIe, c númerc ce enfermeirc: cL:IeIrc: cIucncc nc pc|:
cincc é muiIc Lcixc, emLcrc :e e:Iime ¢ue c númerc ce pcrIc: rec|izccc
:ejc Lem :upericr c¢ue|e regi:Irccc nc SUS. Fcr e:Ic rczcc, c Mini:Iéric cc
Scúce e:Ic fcmenIcncc Iécnicc e fincnceircmenIe c rec|izcçcc ce
cur:c: ce e:pecic|izcçcc em enfermcgem cL:IéIricc. E:Icc :encc
cpciccc: 55 cur:c: ¢ue cevercc fcrmcr e:pecic|i:Ic: em Iccc pc|:.
/ mcgniIuce ce:Ic cçcc prcgrcmcIicc e:Ic repre:enIccc pe|c
ccpcciIcçcc ce 854 enfermeirc: cL:IeIrc: pcrc c rece cc SUS, cercc ce
507 cc númerc ce prcfi::icnci: fcrmccc: nc: ú|Iimc: 20 cnc: pe|c:
in:IiIuiçce: ce en:inc :upericr Lrc:i|eirc:.
Fortor|os
MSJGM 3.01ó, de 1º de junho de 1ºº8
MSJGM 3.482, de 20 de ogosto de 1ºº8
MSJGM 3.477, de 20 ogosto de 1ºº8
Ccn:icercncc c impcrIcncic cc cIençcc cL:IéIricc e perincIc| e c
nece::iccce ce crgcnizcçcc ce:Ic c::i:Iëncic, e:Ic: pcrIcric:
ncrmcIizcm c imp|cnIcçcc ce prcgrcmc: e:Iccuci: ce Feferëncic
Hc:piIc|cr pcrc cIencimenIc c gestoçõo de o|to r|sco. Ccn:IiIui-:e em
mecicc inci:pen:cve| ccrmc principc| cLjeIivc ce gcrcnIir me|hcr
¢uc|iccce c ge:Icçcc ce c|Ic ri:cc e recuzir c |ncice ce
mcrLimcrIc|iccce mcIernc e necncIc|. Ccm c: recur:c: cp|icccc:, c
prcce::c ce cce¢ucçcc cc: mcIerniccce: pcrc c cIencimenIc c:
ge:IcnIe: ce c|Ic ri:cc vem grcccIivcmenIe :e ce:envc|vencc em Iccc:
c: e:Iccc: Lrc:i|eirc:, ccm c ccpcciIcçcc ce prcfi::icnci: ce :cúce,
ree:IruIurcçcc ce crec f|:icc, c¢ui:içcc ce e¢uipcmenIc: e
ci:pcniLi|izcçcc ce mci: |eiIc: cL:IéIricc: pcrc cIençcc c e::c:
ge:IcnIe:.
Fortor|os
MSJGM 2.81ó, de 2º mo|o de 1ºº8
MSJGM 8ó5, de 03 de ju|ho de 1ººº
MSJGM 4óó, de 14 de junho de 2000
MSJGM 42ó, de 04 de obr|| de 2001
E:Ic: pcrIcric: ceIermincm c pogomento de um percentuo| móx|mo de
cesor|onos em re|cçcc cc númerc IcIc| ce pcrIc: ce cccc
2
ATENÇÃO INSTITUCIONAL AO PARTO
24
hc:pi Ic| . / i nIrccuçcc, em 1ºº8, ce:Ie: | i mi Ie: percenIuci : pcrc c
pcgcmenIc ce ce:cricnc: rec|izccc: pe|c Si:Iemc Unicc ce Scúce -
SUS, Iem :icc re:pcn:cve|, em umc primeirc cnc|i:e, pe|c recuçcc cc
númerc ce mu| here: :uLmeIi cc: c ri :cc: ci rúrgi cc: ce:nece::cri c:.
/: Icxc: ce ce:cri cnc: cpre:enIccc: cc Si :Iemc Uni cc ce Scúce -
SUS cec|incrcm ce 327 em 1ºº7, pcrc 287 em 1ºº8, 257 em 1ººº '
247 em 2000. Me:mc ccn:i cercncc c pc::i Li | i ccce ce i nccrreçce:
cevi cc: c ncIi fi ccçcc ce umc ce:cri cnc ccmc pcrIc ncrmc| , cu
ci ncc c ncc cpre:enIcçcc cc SUS cc: ccnIc: referenIe: cc exce::c
ce ce:cri cnc: pe| c i n:Ii Iui çcc, c recuçcc cc fre¢üënci c ce pcrIc:
ci rúrgi cc: nc Si :Iemc Uni cc ce Scúce - SUS pcrece Ier :i cc ci ncc
c::i m :i gni fi ccIi vc, c pcnIc ce fczer cec| i ncr pe| c pri mei rc vez, nc:
ú| Ii mc: vi nIe cnc:, c númerc IcIc| ce ce:cricnc: rec|izccc: nc 8rc:i|.
E::e: | i mi Ie: fcrcm e:IcLe| eci cc: pcrc :erem cumpri cc: ce fcrmc
grccuc|, ccn:icercncc c prcce::c ce cccpIcçcc cc rece hc:piIc|cr
cc: ncvc: pccrce: e c re:pcn:cLi|iccce cc: :ecreIcric: e:Iccuci: e
municipci: em civu|gcr e c::e::crcr c: pre:Icccre: ce :erviçc: pcrc
i mp| emenIcr meci cc: ¢ue vi :em c recuçcc ce::c: Icxc:.
Cons|derondo os d|||cu|dodes poro o reduçõo reo| dos toxos de
cesóreo, o Fortor|o 4óó estobe|ece que os hosp|to|s, sob o
coordenoçõo estoduo|, poderõo ter d||erentes ||m|tes poro o porto
c|rùrg|co, contemp|ondo o comp|ex|dode de codo serv|ço obstétr|co o
||m de otender os mu|heres com seguronço.
E:Ic mecicc repre:enIc umc IenIcIivc ce ccrrigir ci:Icrçce: gerccc:
ccm c: pcrIcric: cnIericre:, pc::iLi|iIcncc in:IiIuiçce: ce n|ve| Iercicric
¢ue cIencem ge:Icçce: e pcrIc: ce ri :cc pccerem Ier, ce fcIc,
umc pcrcenIcgem mci cr ce ce:cri cnc:. /| ém ci ::c, ccnIemp| c c
:cLreccrgc ce ce:cri cnc: ¢ue c: mcIerni ccce: púL| i cc: e
uni ver:i Icri c: experi menIcrcm cpc: c imp|emenIcçcc cc: pcrIcric:,
pcr Ierem ¢ue cL:crver c excecenIe ce pcIenci c: ce:cri cnc:
recu:ccc: pe| c :eIcr ccnveni ccc.
E:Ic ú|Iimc pcrIcric, ce cLri| ce 2001, e:IcLe|ece c: |imiIe: ce
ce:crec pcrc e:Ie cnc, pcr hc:pi Ic| , nc: e:Iccc: ¢ue ncc ccerircm
cc pccIc ce ccnIrc| e e:Iccuc| e:IcLe| eci cc pe| c pcrIcri c cnIeri cr.
• Fortor|o 2.883, de 04 de junho de 1ºº8
• Fortor|o 1.40ó, de 15 de dezembro de 1ººº
C Frëmic Gc|Lc ce /rcújc fci in:IiIu|cc em 1ºº8 ccm c prcpc:iIc ce
reve| cr cc 8rc:i | experi ënci c: i ncvcccrc: nc ge:Icc púL| i cc,
pri vi | egi cncc c ccc| hi menIc cc mu| her e :eu ccmpcnhei rc, nc
mcmenIc cc pcrIc. A ovo||oçõo de motern|dodes em todo poís, nestes
do|s onos, demonstrou que é possíve| quo||||cor e tombém humon|zor
serv|ços, encontrondo so|uçöes v|óve|s, mu|tos vezes s|mp|es e de bo|xo custo,
quondo hó o comprom|sso de o|erecer o me|hor ò popu|oçõo. Fcrc e:Ic
cvc| i cçcc, c: cri Iéri c: uIi | i zccc: ccnIemp| cm prcIi cc: c::i :Ienci ci :
Lc:eccc: em evi cënci c: ci enIi fi cc: e ¢ue re:pei Icm c cuIcncmi c
cc mu|her e :eu cccmpcnhcnIe, ccmpreencencc c pcrIc ccmc um
mcmenIc úni cc nc vi cc ce cccc mu| her.
2
ATENÇÃO INSTITUCIONAL AO PARTO
25
Fortor|os
• MSJGM 5óº, de 01 de junho de 2000
• MSJGM 570, de 01 de junho de 2000
• MSJGM 571, de 01 de junho de 2000
• MSJGM 572, de 01 de junho de 2000
E:Ie ccnjunIc ce pcrIcric: in:IiIui c Frcgrcmc ce Humcnizcçcc nc Fré-
NcIc| e Nc:cimenIc, ccm :eu: ciferenIe: ccmpcnenIe: ce incenIivc c
/::i:Iëncic Fré-NcIc|, c crgcnizcçcc, regu|cçcc e ncvc: inve:IimenIc: nc
/::i:Iëncic CL:IéIricc, e:IcLe|ecencc umc ncvc :i:IemcIicc ce
pcgcmenIc cc c::i:Iëncic cc pcrIc.
E:Ie prcgrcmc cpre:enIc cuc: ccrccIer|:Iicc: mcrccnIe:: c c|hcr pcrc c
inIegrc|iccce cc c::i:Iëncic cL:IéIricc e c cfirmcçcc cc: cireiIc: cc
mu|her inccrpcrccc: ccmc cireIrize: in:IiIucicnci:. C cLjeIivc principc| é
recrgcnizcr c c::i:Iëncic, vincu|cncc fcrmc|menIe c pré-ncIc| cc pcrIc e
puerpéric, cmp|icncc c cce::c cc: mu|here: e gcrcnIincc c ¢uc|iccce
ccm c rec|izcçcc ce um ccnjunIc m|nimc ce prccecimenIc:.
Nc cmLiIc ce:Ie prcgrcmc, c Mini:Iéric cc Scúce revi:cu c: mcnuci:
Iécnicc: ce /::i:Iëncic Fré-NcIc| e Ge:Icçcc ce /|Ic Fi:cc e, em
pcrceric ccm c FE8F/SGC, e|cLcrcu um Mcnuc| ce:Iinccc cc
cIencimenIc cc: Urgëncic: e Emergëncic: McIernc:. E:Ie: mcnuci:
fcrcm ci:IriLu|cc: pcrc c rece ce uniccce: Lc:icc: e hc:piIc|cre: e pcrc
Iccc: c: prcfi::icnci: fi|iccc: c FE8F/SGC. C Mini:Iéric cc Scúce IcmLém
ci:IriLuiu, em pcrceric ccm c CF/S, c Guic FrcIicc pcrc /::i:Iëncic cc
FcrIc Ncrmc|. C: :erviçc: ce :cúce IcmLém receLercm CcrIce: cc
Ge:IcnIe e in:IrumenIc| Iécnicc pcrc c rec|izcçcc cc Fré-ncIc|,
ccmpcncc um kiI cL:IéIricc: e:IeIc:ccpic ce Fincrc, fiIc cL:IéIricc, ci:cc
ce iccce ge:Iccicnc| e IcLe|c ce pe:c/c|Iurc.
Fcrc e:Iimu|cr c pcrIicipcçcc cc: mu|here:, fcrcm ci:IriLu|cc: cci:
mi|hce: ce cgencc: ccm infcrmcçce: :cLre c ge:Icçcc, c pcrIc e c:
cuicccc: ccm c: recém-nc:cicc:.
C ccnjunIc ce::c: mecicc: Icrncr-:e-c efeIivc ¢ucncc, :cmccc: c e|c:,
c: prcfi::icnci: ce :cúce Ircn:fcrmcrem :uc prcIicc nc cireçcc ce umc
re|cçcc mci: humcnizccc e :egurc. É ne::c per:pecIive ¢ue e:Ie mcnuc|
fci e|cLcrccc. C pcrIc preci:c :er re:gcIccc ccmc c mcmenIc cc
nc:cimenIc, re:peiIcncc Iccc: c: :eu: :ignificccc: cevc|vencc c mu|her
c :eu cireiIc ce :er mce ccm humcniccce e :egurcnçc.
2
26
É funccmenIc| pcrc c humcnizcçcc cc pcrIc c
cce¢uccc prepcrc cc ge:IcnIe pcrc c mcmenIc cc
nc:cimenIc, e e::e prepcrc ceve :er iniciccc
precccemenIe curcnIe c pré-ncIc|. l:Ic re¢uer um
e:fcrçc muiIc grcnce, mc: p|encmenIe vicve|, nc
:enIicc ce :en:iLi|izcr e mcIivcr c: prcfi::icnci: ce
:cúce cc rece Lc:icc e fcrnecer-|he: in:IrumenIc:
pcrc c IrcLc|hc ccm c: ge:IcnIe:. /|ém cc: c:pecIc:
Iécnicc: prcpricmenIe ciIc:, c prepcrc pcrc c pcrIc
envc|ve, IcmLém, umc cLcrccgem ce ccc|himenIc
cc mu|her e :eu ccmpcnheirc nc :erviçc ce :cúce,
inc|uincc c fcrnecimenIc ce infcrmcçce: ce:ce c:
mci: :imp|e:, ce cnce e ccmc c nc:cimenIc ceverc
cccrrer, c prepcrc f|:icc e p:|¢uicc cc mu|her,
icec|menIe umc vi:iIc c mcIerniccce pcrc ccnhecer
:uc: in:Ic|cçce: f|:icc:, c pe::cc| e c: prccecimenIc:
rcIineirc:, enIre cuIrc:.
C prepcrc cc ge:IcnIe pcrc c pcrIc cLrcnge c
inccrpcrcçcc ce um ccnjunIc ce cuicccc:, mecicc: e
cIiviccce: ¢ue Iëm ccmc cLjeIivc cferecer c mu|her c
pc::iLi|iccce ce vivencicr c experiëncic cc IrcLc|hc
ce pcrIc e pcrIc ccmc prcce::c: fi:ic|cgicc:, :enIincc-
:e prcIcgcni:Ic cc e prcce::c.
É impcrIcnIe re::c|Icr ¢ue e::e cIencimenIc, ¢ucncc
pc::|ve|, ceve :er cferecicc c ge:IcnIe e cc
cccmpcnhcnIe, ¢ue pccerc e:Icr c :eu |ccc curcnIe
c pré-ncIc|, nc ceccrrer cc IrcLc|hc ce pcrIc e pcrIc,
vivencicncc junIc c mu|her e experiëncic cc
nc:cimenIc. C prcfi::icnc| ce :cúce ce:empenhc um
pcpe| re|evcnIe ccmc fcci|iIcccr pcrc c
ce:envc|vimenIc ce:Ic cIençcc ccmc pcrIe cc:
:erviçc: ce pré-ncIc|. IcmLém pcrIicipc cc:
crienIcçce:, cccn:e|hcmenIc: e:pec|ficc: e
cIiviccce:, nc prepcrc cc mu|her e :eu
cccmpcnhcnIe pcrc c pcrIc.
DurcnIe c pré-ncIc|, c ge:IcnIe ceve receLer
crienIcçce: em re|cçcc cc: :eguinIe: Iemc:: prcce::c
ge:Iccicnc|, muccnçc: ccrpcrci: e emccicnci:
curcnIe c grcvicez, IrcLc|hc ce pcrIc, pcrIc e
puerpéric, cuicccc: ccm c recém-nc:cicc e
cmcmenIcçcc. Ici: ccnIeúcc: cevem inc|uir
3 PREPARANDO A MULHER PARA O PARTO
PREPARANDO A MULHER PARA O PARTO
27
crienIcçce: :cLre cncIcmic e fi:ic|cgic mcIernc:, c: Iipc: ce pcrIc, c:
ccncuIc: ¢ue fcci|iIcm c pcrIicipcçcc cIivc nc nc:cimenIc, :exuc|iccce
e cuIrc:.
É impcrIcnIe ccn:icercr, ne::e prcce::c, c: ce:ejc: e vc|cre: cc mu|her e
cccIcr umc pc:Iurc :en:|ve| e éIicc, re:peiIcncc-c ccmc cicccc e
e|imincncc c: vic|ëncic: verLci: e ncc verLci:.
C: :erviçc: ce pré-ncIc| e c: prcfi::icnci: envc|vicc: cevem cccIcr c:
:eguinIe: mecicc: ecuccIivc: ce prevençcc e ccnIrc|e cc cn:ieccce:
• !"#$%& ( )*+,(-( .(! " !/,0%& % 1%/ ".(!2"#0"#$%3 )/&"#$%
4/",4/%& 2&(.%)*!%#$( &%",*5")( #" .(#1/,$" 2&67#"$",3
*#.%#$*8"#)(7(13 (&*%#$"#)(7(1 % %1.,"&%.%#)(7,0%1 "1 )98*)"1 %
1%/1 $%!(&%1 %! &%,":;( < -%1$":;(3 $&"=",0( )% 2"&$(3 2"&$( %
2/%&26&*(>
• *#?(&!"& 1(=&% "1 &($*#"1 % 2&(.%)*!%#$(1 " 1%&%! )%1%#8(,8*)(1
#( !(!%#$( )( $&"=",0( )% 2"&$( % 2"&$(3 " ?*! )% (=$%&
.(,"=(&":;( 2(& 2"&$% )" 2"&$/&*%#$% % )% 1%/ ".(!2"#0"#$%>
• 2&(!(8%& 8*1*$"1 )"1 -%1$"#$%1 % ".(!2"#0"#$%1 <1 /#*)")%1 )%
&%?%&@#.*" 2"&" ( 2"&$(3 #( 1%#$*)( )% )%1!*1$*?*."& % !*#*!*5"& (
%1$&%11% )( 2&(.%11( )% *#$%&#":;( #( !(!%#$( )( 2"&$(>
• *#?(&!"& "1 %$"2"1 )% $()( ( 2&(.%11( )( $&"=",0( )% 2"&$( %
2"&$(3 %1.,"&%.%#)( 1(=&% "1 2(11A8%*1 ",$%&":B%1>
• ")($"& !%)*)"1 2"&" ( %1$"=%,%.*!%#$( )( 8A#./,( "?%$*8( !;%7
?*,0( % ( *#A.*( )( ",%*$"!%#$( !"$%&#( ,(-( "2C1 ( #"1.*!%#$(>
• )"& < -%1$"#$% % 1%/ ".(!2"#0"#$% ( )*&%*$( )% 2"&$*.*2"& )"1
)%.*1B%1 1(=&% ( #"1.*!%#$(3 )%1)% 4/% #;( .(,(4/% %! &*1.( "
%8(,/:;( )( $&"=",0( )% 2"&$( % " 1%-/&"#:" )" !/,0%& % )(
&%.6!7#"1.*)(D
Umc :érie ce cificu|ccce: prcIicc: pcce :urgir curcnIe c recrgcnizcçcc
cc: :erviçc: ce :cúce pcrc prcpicicr c ge:IcnIe/pcrIurienIe umc
c::i:Iëncic mci: humcnizccc. Fcrc ccnIcrnc-|c:, c|gun: :erviçc: Iem
prcpc:Ic c cricçcc ce grupc: ce cpcic. / imp|emenIcçcc ce grupc: ce
cpcic, ccm c pcrIicipcçcc ce ciferenIe: prcfi::icnci: cc e¢uipe ce
:cúce, ccmc enfermeirc/c, p:icc|cgc/c, c::i:IenIe :ccic|, :cc
funccmenIci: pcrc gcrcnIir umc cLcrccgem inIegrc|, e, cc me:mc
Iempc, e:pec|ficc pcrc cIencer c: nece::iccce: cc: mu|here: e ce :eu:
pcrceirc: e fcmi|icre: curcnIe c grcvicez. /::im, c principc| cLjeIivc ce
um grupc ce cpcic ccmc e:Ie :eric c ce cjuccr c mu|her c |iccr ccm c:
vivëncic:, e cuiccr ce :i curcnIe :uc grcvicez, Lem ccmc prepcrc-|c
pcrc c pcrIc e c mcIerniccce.
C grupc ce cpcic cLcrcc c: c:pecIc: ccgniIivc:, Ircn:miIincc c:
infcrmcçce: nece::cric: {ccnIeúcc: ecuccIivc: cnIericrmenIe ciIccc:)
pcrc c: cuicccc: ccm c grcvicez e c recém-nc:cicc, c: c:pecIc:
emccicnci: e cfeIivc: re|ccicnccc: cc e:Iccc grcv|cicc, c: c:pecIc:
referenIe: c prepcrcçcc f|:icc pcrc c pcrIc, ccmc re:pircçcc,
re|cxcmenIc e c: exerc|cic: f|:icc: ¢ue ccnIriLuircc curcnIe c grcvicez e
c IrcLc|hc ce pcrIc.
3
PREPARANDO A MULHER PARA O PARTO
28
Umc meIc impcrIcnIe ce um :erviçc ¢ue ccnIemp|e e:Ie: c:pecIc: é c
ce imp|emenIcr c cIencimenIc e:pec|ficc c: mu|here: grcvicc: uIi|izcncc
recur:c: jc exi:IenIe: nc rece ce :cúce. C cIencimenIc pcceric :er
ce:envc|vicc em umc uniccce ce :cúce jc funcicncncc. Fccem-:e
uIi|izcr c: me:mc: ccn:u|Icric: cc uniccce ce :cúce pcrc c cIencimenIc
mécicc, e:IcLe|ecencc um hcrcric e:pecificc pcrc c: cIiviccce: cc
prcgrcmc. Fcrc c: grupc: ce cpcic, pcce-:e cccpIcr umc :c|c jc
uIi|izccc pcrc reunice: ce grupc e cçce: ecuccIivc: nc uniccce.
C cLjeIivc ce:Ic: cIiviccce: é c ce ccmp|emenIcr c cIencimenIc
rec|izccc nc: ccn:u|Ic:, me|hcrcr c ccerëncic pcr pcrIe cc: mu|here: c:
inciccçce: mécicc:, ciminuir c: cn:ieccce: e mecc: em re|cçcc c
grcvicez, pcrIc e puerpéric, inc|uincc c: vivëncic: e nece::iccce: cc
mce e cc recém-nc:cicc, c c|eiIcmenIc mcIernc e c ccnIrccepçcc. /c
me:mc Iempc, IcmLém c ce rec|izcr um IrcLc|hc ccrpcrc| ce
re|cxcmenIc e re:pircçcc pcrc me|hcrcr c cce¢ucçcc ccrpcrc| cc
IrcLc|hc ce pcrIc e pcrIc, fcvcrecencc c pcrIc ncrmc|.
/|ém cc: mecicc: ecuccIivc: ¢ue cevem :er inIrccuzicc: nc: prcgrcmc:
ce pré-ncIc|, curcnIe c grcvicez, c prepcrcçcc cc mu|her pcrc c
nc:cimenIc ccmpreence principc|menIe c cccçcc ce mecicc:
referenIe: cc IrcLc|hc ccrpcrc|. C cLjeIivc cc imp|emenIcçcc ce:Ic:
mecicc: é cferecer c mu|her um me|hcr ccnhecimenIc cc percepçcc
ccrpcrc|, Lem ccmc cc re|cxcmenIc e cc re:pircçcc pcrc um me|hcr
ccnIrc|e cc IrcLc|hc ce pcrIc e pcrIc. Fcrc i::c é nece::cric IrcLc|hcr
ccm c ge:IcnIe ccm exerc|cic: prcpric: pcrc cccc eIcpc cc grcvicez,
ccm c re|cxcmenIc e ccm c: exerc|cic: re:pircIcric:.
C: exerc|cic: ce re|cxcmenIc Iëm ccmc cLjeIivc permiIir ¢ue c:
mu|here: reccnheçcm c: pcrIe: cc ccrpc e :uc: :en:cçce:,
principc|menIe c: ciferençc: enIre re|cxcmenIc e ccnIrcçcc, c::im
ccmc c: me|hcre: pc:içce: pcrc re|cxcr e uIi|izcr curcnIe c IrcLc|hc ce
pcrIc. C: exerc|cic: re:pircIcric: Iem pcr cLjeIivc cuxi|icr c: mu|here: nc
ccnIrc|e cc: :en:cçce: cc: ccnIrcçce: curcnIe c IrcLc|hc ce pcrIc.
EmLcrc rec|izccc: cincc curcnIe c pré-ncIc|, :cc cirigicc: c uIi|izcçcc
curcnIe c IrcLc|hc ce pcrIc e pcrIc.
C cmLienIe ccc|heccr, ccnfcrIcve| e c mci: :i|encic:c pc::|ve|, ccncuz
cc re|cxcmenIc p:icc-f|:icc cc mu|her, cc cccmpcnhcnIe e e¢uipe ce
prcfi::icnci: e incicc ¢uc|iccce cc c::i:Iëncic. C recur:c cc mú:icc e cc:
ccre: repre:enIc fcrmc: c|IerncIivc: ce cLcrccgem ¢ue Lu:ccm
ce:envc|ver pcIencici: e/cu re:Icurcr funçce: ccrpcrci: cc pcrIurienIe,
cccmpcnhcnIe e cc e¢uipe prcfi::icnc|. / uIi|izcçcc ce rcupc:
ccnfcrIcvei: IcmLém é umc mecicc impcrIcnIe pcrc fcvcrecer c
re|cxcmenIc.
Nc |iIercIurc mécicc :cc, ce:criIc: vcric: méIccc: p:icc-prcfi|cIicc: e ce
re|cxcmenIc ¢ue pccem :er iniciccc: nc pré-ncIc| - MéIccc ce Dick-
Fecc, 8rcc|ey e MéIccc ce Lcmcze. Ici: méIccc: pre::upcem ¢ue :uc
uIi|izcçcc re:u|Ie nc recuçcc cc mecc, cc Ien:cc e cc ccr,
3
PREPARANDO A MULHER PARA O PARTO
29
me|hcrcncc c Icnu: mu:cu|cr e cumenIcncc c re|cxcmenIc, ce:Ic fcrmc
fcvcrecencc c evc|uçcc cc IrcLc|hc ce pcrIc e cc pcrIc. EnfcIizcm c
re:pircçcc |enIc, c re|cxcmenIc mu:cu|cr e c: Iécnicc: pcrc c: e:fcrçc:
ce puxc:.
lnfe|izmenIe, c uIi|izcçcc ce Ici: méIccc: ncc Iem :icc mcIivc ce e:Iucc:
c||nicc: ccnIrc|ccc: pcrc cvc|icr :uc efeIivc ccnIriLuiçcc pcrc c
evc|uçcc cc IrcLc|hc ce pcrIc e pcrIc. /: pcucc: evicëncic: cienI|ficc:
ci:pcn|vei: :cLre e:Ie c::unIc Iëm cemcn:Irccc ccncreIcmenIe cpenc:
umc ciminuiçcc nc nece::iccce ce crcgc: cnc|gé:icc:, umc mcjcr
:cIi:fcçcc ccm c prcce::c cc nc:cimenIc e nenhum efeiIc ccver:c.
EnIreIcnIc, c expecIcIivc ccm re|cçcc cc: re:u|Iccc: cenIe Iipc ce
inIervençcc ceve :er c|crcmenIe exp|iciIccc pcrc ¢ue ncc cccrrcm
expecIcIivc: ¢ue ncc ccrre:pcnccm c rec|iccce.
1. MÊIODO DE DICK-kEAD
Ccn:icerccc um cc: pi|cre: pcrc c ecuccçcc prepcrcIcric pcrc c pcrIc
em civer:c: pc|:e:, e:Ie méIccc crienIc :cLre c fi:ic|cgic cc pcrIc,
exerc|cic: pcrc c mu:cu|cIurc cc per|nec e cc cLccme, e Iécnicc: ce
re|cxcmenIc. Freccnizc c cprencizccc cc re|cxcmenIc cIrcvé: cc
ccncenIrcçcc em cccc pcrIe cc ccrpc, :epcrcccmenIe, cc: pé: c
ccLeçc, ccnIrcincc e re|cxcncc c: mú:cu|c:. Feccmencc c pre:ençc
ce cccmpcnhcnIe, pci: c fcIc ce c mu|her permcnecer :czinhc curcnIe
c IrcLc|hc ce pcrIc gerc mecc. Fc::ui ccmc cLjeIivc principc| eviIcr c
Ir|cce mecc - Ien:cc - ccr, pci: :e Lc:eic nc fcIc ce ¢ue c
ccnhecimenIc ce:Irci c Ierrcr e eviIc c Ien:cc, ccnIrc|cncc c ccr.
Segundo este método, sõo trës os |otores que cousom medo:
o} 1/-%1$;( E "1 !/,0%&%1 1;( .(#)*.*(#")"1 #%-"$*8"!%#$% %!
&%,":;( "( 2"&$(3 )%1)% " *#?F#.*"D G .(!/#*)")% < 4/", %," 2%&$%#.%
% (1 !%*(1 )% .(!/#*.":;( %H%&.%! /! *!2(&$"#$% 2"2%, #%11"
1/-%1$;(3 &%11",$"#)( (1 1(?&*!%#$(1 )( 2"&$(D I#?%,*5!%#$%3 %11"
1/-%1$;( $"!=6! 2()% 2"&$*& )% 2&(?*11*(#"*1 )" +&%" )" 1"9)%>
b} *-#(&F#.*" E " -%1$"#$% 6 !/*$( "#1*(1" 2(& *-#(&"& "1 !()*?*.":B%1
4/% (.(&&%! %! 1%/ (&-"#*1!( )/&"#$% ( .*.,( -&"8A)*.(72/%&2%&",D
J(! ?&%4K@#.*" 2&%(./2"71% .(! ( )%1%#8(,8*!%#$( ?%$",3 1/"
#/$&*:;(3 2(1*:;( )%#$&( )( 9$%&(3 !",?(&!":B%13 %$.D G1 -%1$"#$%1
2()%&*"! 1%& 2&%2"&")"1 2"&" ( $&"=",0( )% 2"&$(3 1%! !%)( %
$%#1;(3 1% "2&%#)%11%! " %#."&"& " -&"8*)%5 % ( 2"&$( .(!(
2&(.%11( ?*1*(,C-*.(> %
c} )%1"!2"&( 21*.(,C-*.( E 6 ."&".$%&*5")( 2%,( )%12&%2"&( )(
2&(?*11*(#", )% 1"9)%3 % $"!=6! 2%," *#)*?%&%#:" )%!(#1$&")" #"
?",$" )% "2(*( 21*.(,C-*.( % *#?(&!":;(3 2(& )*?*./,)")% )%
.(!/#*."&71%3 (/ 2(& ".0"& 4/% " 2"&$/&*%#$% #;( )%8% 1"=%& )"
.(#)/$" ")($")"D
3
PREPARANDO A MULHER PARA O PARTO
30
2. MÊIODO DE 8kADLEY
E:Ie méIccc recfirmc c pcrIc ccmc um prcce::c ncrmc|. Iem ccmc
principc| fccc c: vcricvei: cmLienIci:, ccmc c penumLrc e c :i|ëncic,
pcrc ¢ue c pcrIc :ejc umc experiëncic c mci: ncIurc| pc::|ve|. Ne:Ie
méIccc, c cccmpcnhcnIe c::ume IcmLém um pcpe| ce grcnce
impcrIcncic.
Nc in|cic cc IrcLc|hc ce pcrIc c mu|her é e:Iimu|ccc c :e mcvimenIcr
|ivremenIe. /c ceiIcr, é crienIccc c cccIcr c pc:içcc ce Sim: {cecúLiIc
|cIerc| e:¢uercc, ccm c: Lrcçc: pc:icicnccc: ce mcneirc ccnfcrIcve|,
pernc cireiIc |igeircmenIe mci: f|eIicc ¢ue c e:¢uercc e cpciccc :cLre c
ccmc: ceve-:e cc|cccr um Ircve::eirc :cL c ccLeçc pcrc cumenIcr c
ccnfcrIc). DurcnIe cccc ccnIrcçcc, c mu|her ceve fechcr c: c|hc:,
re|cxcr Iccc: c: mú:cu|c: cc ccrpc e re:pircr |enIc e prcfunccmenIe
{in:pircncc pe|c ncriz e expircncc pe|c Lccc). Ne:Ie per|ccc, c
cccmpcnhcnIe é incenIivccc c cc|cccr c mcc :cLre cLccme cc
mu|her, curcnIe c ccnIrcçcc.
3. MÊIODO DE LAMAIE
E:Ie méIccc é IcmLém ccnhecicc ccmc méIccc p:icc-prcfi|cIicc cc
ccr. / mu|her pcce :er en:inccc c :uL:IiIuir :uc: recçce: c ccr, cc mecc
e c percc ce ccnIrc|e, pcr um ccmpcrIcmenIc mci: pc:iIivc. C méIccc
ce Lcmcze é Lc:eccc nc Iecric ce Fcv|cv :cLre c ref|exc ccncicicnccc.
/Iuc|menIe, é c méIccc mci: pcpu|cr pcrc prepcrcçcc cc pcrIc. Ne|e,
:cc ccmLinccc: c: re|cxcmenIc: mu:cu|cre: ccnIrc|ccc: e c: Iécnicc:
ce re:pircçcc. / mu|her é en:inccc c ccnIrcir grupc: e:pec|ficc: ce
mú:cu|c:, en¢ucnIc re|cxc cuIrc:. E|c IcmLém cprence c fccc|izcr um
pe¢uenc cLjeIc ¢ue, curcnIe c IrcLc|hc ce pcrIc, :erc u:ccc ccmc
pcnIc fccc|. C cLjeIc é cc|ccccc cnce pc::c :er fcci|menIe vi:Ic pe|c
mu|her. Exerc|cic: re:pircIcric: :cc exp|icccc: ceIc|hcccmenIe ce:ce c
per|ccc cc pré-ncIc| cIe c pré-pcrIc/pcrIc.
C méIccc ce Lcmcze incenIivc c mu|her e :eu cccmpcnhcnIe c umc
pcrIicipcçcc cIivc nc IrcLc|hc ce pcrIc e pcrIc. Nc pré-ncIc| :cc,
IrcLc|hccc: c: vcric: Iipc: ce re:pircçcc nc: ciferenIe: e:Icgic: cc
IrcLc|hc ce pcrIc, c: méIccc: ce re|cxcmenIc ce cerIc: grupc: ce
mú:cu|c: e c: mecicc: c :erem uIi|izccc: pcrc cumenIcr c ccnfcrIc
curcnIe c IrcLc|hc ce pcrIc.
Cucncc inicic c IrcLc|hc ce pcrIc, c mu|her é crienIccc c in:pircr
prcfunccmenIe, fcccr :uc cIençcc num cLjeIc :e|ecicnccc e expircr
|enIc e prcfunccmenIe, u:cncc c peiIc. Nc finc| cc ccnIrcçcc, e|c
ncvcmenIe ceve in:pircr. E:Ic re:pircçcc permiIirc ¢ue c pcrIurienIe
ce:ccn:e e reccmpcnhc-:e. l::c pccerc :er feiIc ccm c mu|her
cecmLu|cncc cu em pc:içcc ce Sim:. / mecicc ¢ue evc|ui c IrcLc|hc
ce pcrIc, e c mu|her enIrc nc fc:e cIivc cc pcrIc, c re:pircçcc Icrccicc
|enIc jc ncc e Icc eficienIe. / mu|her é enIcc, e:Iimu|ccc c inicicr pe|c
re:pircçcc |enIc, pc::cr pcrc umc mci: curIc, e ¢ucncc c ccnIrcçcc
cIingir :eu picc, vc|Icr c |enIc. / re:pircçcc rcpicc e rec|izccc pcr |cngc
per|ccc pcce ccu:cr hipervenIi|cçcc, um
3
PREPARANDO A MULHER PARA O PARTO
31
e:Iccc em ¢ue :e recuz c n|ve| ce pCC2 nc :cngue. E:Ic cccrrëncic é
ince:ejcve| pcrc c crgcni:mc mcIernc e feIc|. Nc rec|iccce, :cc
uIi|izccc: vcricçce: nc: pccrce: re:pircIcric:, pci: hc c|gumc: mu|here:
¢ue ce:ccLrem um pccrcc re:pircIcric prcpric ¢ue |he: é mci:
ccnfcrIcve|. C cccmpcnhcnIe Iem pcpe| funccmenIc| nc ccnIrc|e cc:
ccnIrcçce:, incenIivcncc c mu|her c re|cxcr.
C: méIccc: ccnIempcrcnec: ce ecuccçcc prepcrcIcric pcrc c pcrIc
Iencem c ccmLincr c:pecIc: cc: civer:c: cLcrccgen: cc: méIccc: ce
Dick-Fecc, Lcmcze e 8rcc|ey. Ici: méIccc: ncc pc::uem c preIen:cc ce
:uL:IiIuir nc |nIegrc c: méIccc: fcrmccc|cgicc: ce minimizcçcc cc ccr e,
:im, mccificcr c cIiIuce cc mu|her e :eu cccmpcnhcnIe ¢ue, cc invé: ce
|igcr c pcrIc c mecc e ccr, pc::cm c cceiIc-|c ccm ccmpreen:cc,
:egurcnçc, Ircn¢üi|iccce e ccm pcrIicipcçcc cIivc. Ccn:icercncc ¢ue
muiIc: mu|here: ncc Iëm cce::c c e::c: crienIcçce: nc per|ccc
ge:Iccicnc|, é impcrIcnIe ¢ue, cc :erem ccmiIicc: em IrcLc|hc ce
pcrIc, receLcm crienIcçce: e cccmpcnhcmenIc ¢ucncc c rec|izcçcc
ce::c: mecicc: ecuccIivc: e ce minimizcçcc ce e:Ire::e e cn:ieccce.
Ici: mecicc: vi:cm cferecer c e:Ic: mu|here: umc pc:Iurc cIivc em :eu
IrcLc|hc ce pcrIc.
Outros med|dos de re|oxomento e o|ív|o do dor
/ c::ccicçcc ce c|gumc: mecicc: ncc fcrmccc|cgicc: ccmc exerc|cic:
re:pircIcric:, Iécnicc: ce re|cxcmenIc e c cecmLu|cçcc cuxi|icm nc
c||vic cc ccr curcnIe c IrcLc|hc ce pcrIc. E:cucc: recenIe: cemcn:Ircm
vcnIcgen: pcrc c mu|her ¢ue cecmLu|c cu cccIc cuIrc: pc:içce: ¢ue
ncc c ceiIccc curcnIe c IrcLc|hc ce pcrIc. CuIrc: e:Iucc: cincc
:ugerem ¢ue c: ccnIrcçce: uIerinc: :cc mci: inIen:c: e eficienIe: pcrc c
ci|cIcçcc cc cc|c, :cmenIe ccm c muccnçc cc pc:içcc cc pcrIurienIe.
CuIrc: mecicc: ¢ue pccem :er uIi|izccc: ccm fre¢üëncic :cc c Lcnhc
ce chuveirc cu ce imer:cc, e mc::cgen: feiIc: pcr cccmpcnhcnIe cu
prcfi::icnc| ce :cúce. C Lcnhc pcce :er uIi|izccc nc in|cic cc fc:e cIivc
cc pcrIc, cu :ejc, ¢ucncc c: ccnIrcçce: ccmeçcm c ficcr mci: inIen:c:.
/: mecicc: e/cu Iécnicc: ccmc c u:e ce cc|cr e fric :uperficici:,
ccupunIurc, mu:iccIercpic, crcmcIercpic, imer:cc nc cguc, ervc: e
crcmcIercpic ccm c|ec: perfumccc: cincc ncc pc::uem e:cucc:
ccnIrc|ccc: pcrc e:IcLe|ecer :uc efeIiviccce.
C cLjeIivc principc| cc prepcrc cc mu|her e :eu cccmpcnhcnIe é
fcvcrecer ¢ue c IrcLc|hc ce pcrIc e pcrIc :ejcm vivenciccc: ccm mci:
Ircn¢üi|iccce e pcrIicipcçcc, re:gcIcncc c nc:cimenIc ccmc um
mcmenIc cc fcm||ic.
3
32
C cLjeIivc principc| cc: prcfi::icnci: ¢ue cIencem
pcrIc:, e :egurcmenIe IcmLém cc: mu|here: ¢ue
receLem :eu: :erviçc:, é c ce :e cLIer cc fim cc
ge:Icçcc, um recém-nc:cicc :cuccve|, ccm p|enc
pcIencic|iccce pcrc c ce:envc|vimenIc Lic|cgicc e
p:icc-:ccic| fuIurc: e IcmLém umc mu|her/mce ccm
:cúce e ncc IrcumcIizccc pe|c prcce::c ce
nc:cimenIc ¢ue cccLcu ce experimenIcr.
E:Ie cLjeIivc icec|, ccnIucc, é mci: cif|ci| ce :e cIingir
cc ¢ue pc::c pcrecer c primeirc vi:Ic. Envc|ve
nece::cricmenIe c prepcrc e c: expecIcIivc: cc
mu|her, :eu ccmpcnheirc e fcmi|icre:: c:
ceIermincnIe: Lic|cgicc: e :ccici: re|ccicnccc: c
mu|her e c grcvicez/pcrIc: c cce¢ucçcc cc in:IiIuiçcc
cu |ccc| cnce cccnIecerc c nc:cimenIc: c
ccpcciIcçcc Iécnicc cc prcfi::icnc| envc|vicc ccm
e:Ic cIençcc e, funccmenIc|menIe, :uc cIiIuce éIicc
e humcnc.
Nccc mci: cIuc| ¢ue c ci:cu::cc :cLre c vic ce pcrIc,
cu mci: e:pecificcmenIe, :cLre c cpercçcc ce:cricnc
ccmc Iecnc|cgic pcrc c nc:cimenIc. Suc:
prcprieccce:, vcnIcgen:, ce:vcnIcgen:, inciccçce:,
cu:Ic: e fcIcre: re|ccicnccc: cc cumenIc cc
incicëncic Iem :icc mcIivc ce |cngc: ci:cu::ce:, IcnIc
ce ccrcIer cienI|ficc ¢ucnIc pcpu|cr.
Evo|uçõo
Hi:IcriccmenIe, c ce:crec repre:enIcu umc c|IerncIivc
pcrc :iIucçce: exIremc:, IenIcncc Lc:iccmenIe :c|vcr
c vicc ce feIc:, jc ¢ue rcrcmenIe c: mu|here:
:cLrevivicm cc prccecimenIc, ccmc mc:Irc c IcLe|c
c :eguir.
Algumas taxas internacionais de sobrevivência de cesárea, século XVIII.
4 AVALIAÇÃO CRÍTICA DO TIPO DE PARTO
AVALIAÇÃO CRÍTICA DO TIPO DE PARTO
33
Ccm c: prcgre::c: ¢ue cccrrercm nc: Iécnicc: cirúrgicc:, nc cne:Ie:ic,
hemcIercpic, cnIiLicIiccIercpic e cuIrc: crec: cfin:, c ce:crec Icrncu-:e
um prccecimenIc Iécnicc Lc:IcnIe :egurc. E::c :egurcnçc, c::cciccc
cc c|crgcmenIc ce :uc inciccçcc em :iIucçce: ce ccmprcmi::c cc:
ccnciçce: ce viIc|iccce, IcnIc feIci: ¢ucnIc mcIernc:, fci re:pcn:cve| pcr
umc :ignificcIivc me|hcric cc: re:u|Iccc: cL:IéIricc: mcIernc: e perincIci:,
c pcrIir cc in|cic cc :eguncc meIcce ce:Ie :écu|c.
De:ce c mcmenIc em ¢ue c mcrLiccce e c mcrIc|iccce c::cciccc: c
ce:crec ciminu|rcm, IcnIc pcrc c mu|her ccmc pcrc c recém-nc:cicc, c:
inciccçce: ccmeçcrcm c cumenIcr rcpiccmenIe. Ccm c re|cIivc
cumenIc cc :egurcnçc cc prccecimenIc, c: mécicc: ccmeçcrcm c
enccnIrcr incireIcmenIe, cccc vez mci: rczce: pcrc ju:Iificcr c
rec|izcçcc ce umc cpercçcc ce:cricnc.
Ncc exi:Iem cúvicc: :cLre c impcrIcncic ce::e prccecimenIc cirúrgicc ccmc
umc Iecnc|cgic cprcpriccc pcrc c mcnejc ce umc :érie ce :iIucçce:
cL:IéIricc: e:pec|ficc: ¢ue nece::iIcm cc inIerrupçcc cc ge:Icçcc ccmc
c únicc mcneirc ce pre:ervcr c :cúce cc mu|her cu cc feIc. E::e recur:c, ce
efeiIc Lenéficc Icc c|crc e inci:cuI|ve|, ncc é, Icccvic, cincc hcje cce::|ve| c
umc grcnce pcrce|c cc pcpu|cçcc ce mu|here: cc: regice: menc:
ce:envc|vicc:.
Fcr cuIrc |ccc, jc exi:Iem evicëncic: :uficienIe: ¢ue permiIcm cizer ¢ue ncc
cccrre umc ciminuiçcc :i:IemcIicc e ccnI|nuc cc mcrLiccce e mcrIc|iccce
perincIc| ccm c cumenIc cc Icxc ce ce:crec. / fc|:c c::ccicçcc ce
ccu:c-efeiIc enIre c cumenIc cc Icxc ce ce:crec e c ciminuiçcc cc
mcrIc|iccce perincIc| fci re:pcn:cve| pcr um re:pc|cc p:eucc-cienI|ficc
pcrc um cumenIc inci:criminccc cc prcIicc ce ce:cricnc: em Iccc c
muncc ccicenIc| e, pcrIicu|crmenIe, nc 8rc:i|. IcmLém jc é ccnhecicc c
fcIc ce ¢ue IrcumcIi:mc: feIci: IcmLém cccrrem em ce:cricnc:,
e:pecic|menIe em cc:c: ce premcIuriccce.
Ne:Ie ccnIexIc, IcmLém é ccn:en:c ¢ue c pcrIc ncrmc| é c vcginc|, mci:
:egurc pcrc c mu|her e c cricnçc. EmLcrc nc: cic: ce hcje muiIc: prcfi::icnci: e
mu|here: prcIi¢uem c e:cc|hc cnIecipccc cc Iipc ce pcrIc, e:Ic ncc é
umc :imp|e: ¢ue:Icc ce preferëncic. C Iipc ce pcrIc cpre:enIc umc :érie ce
imp|iccçce: em Iermc: ce nece::iccce e inciccçcc, ri:cc: e Lenef|cic:,
cepencencc ce cccc :iIucçcc, Iempc ce rec|izcçcc, ccmp|iccçce: e
repercu::ce: fuIurc:.
/ ceci:cc pe|c inciccçcc ce :e rec|izcr umc ce:cricnc ceve :er mécicc,
ccm c pcrIicipcçcc cIivc cc mu|her. E|c ceve :cLer ¢ue exi:Iem fcrmc:
c|IerncIivc: pcrc :e ccnIrc|cr c ccr pc::ive|menIe c::cciccc cc IrcLc|hc
ce pcrIc e ¢ue ncc hc ju:IificcIivc pcrc :e rec|izcr umc ce:cricnc cpenc:
ccm e:Ic finc|iccce. /|ém ci::c, ceve :er infcrmccc IcmLém ce ¢ue c
pcrIc vcginc| cpc: umc ce:crec {FV/C) é ncc : c :egurc, ccmc
ce:ejcve|, cjuccncc c eviIcr c: prcL|emc: pcIencic|menIe ceccrrenIe:
ce ce:crec: ce repeIiçcc.
4
AVALIAÇÃO CRÍTICA DO TIPO DE PARTO
34
Situação Atual
/ e|evcçcc nc: Icxc: ce uIi|izcçcc cc ce:cricnc pcrc c re:c|uçcc cc
pcrIc é um fencmenc ¢ue vem cccrrencc em Iccc c muncc,
emLcrc Ienhc cvcnçccc mci: genericcmenIe nc ccnIinenIe
cmericcnc e, mci: e:pecificcmenIe, nc 8rc:i|, cnce chegc c :er
ccn:icerccc epicëmicc. SiIucçce: :eme|hcnIe: enfrenIcrcm cu Iëm
enfrenIccc cuIrc: pc|:e: ccmc FcrIc Ficc, E:Iccc: Unicc:, Ccnccc e
lIc|ic, c|ém ce c|gun: cuIrc: eurcpeu: e |cIinc cmericcnc:, ¢ue
cpre:enIcm c: mcicre: Icxc: ce ce:crec cepci: cc 8rc:i|, Iccc:
:upericre: cc n|ve| mcximc ce 157 IecriccmenIe reccmencccc pe|c
Crgcnizcçcc Muncic| cc Scúce.
EnIreIcnIc, c 8rc:i| ncc é mci: c ccmpecc muncic| ce ce:crec:. Fci
jc :up|cnIccc pe|c Chi|e, nc /méricc LcIinc, e pcr c|gun: cuIrc:
pe¢uenc: pc|:e: c:icIicc:. C ¢uccrc cLcixc mc:Irc c pcrcenIcgem
ce pcrIc: pcr ce:cricnc em pc|:e: cc ccnIinenIe cmericcnc,
u|Ircpc::cncc c: 207 nc mcicric ce|e:, c|ém ce c|gun: cuIrc:
inciccccre: ce :cúce reprccuIivc ce:Ie: pc|:e:.
Alguns indicadores de saúde reprodutiva em países das Américas
É impcrIcnIe, cincc, ccn:icercr ¢ue c: ceIermincnIe: mécicc:, cu
me|hcr, Lic|cgicc:, pcrc c inciccçcc cc: ce:crec: ce fcIc exi:Iem e
:cc rec|menIe mci: fre¢üenIe: em pcpu|cçce: ce mencr n|ve| ce
ce:envc|vimenIc. De:ccnhecer e:Ic ccrccIer|:Iicc :eric permcnecer
4
AVALIAÇÃO CRÍTICA DO TIPO DE PARTO
35
c|heic cc prcL|emc. É mcicr nc 8rc:i| ¢ue nc Ccnccc, pcr exemp|c, c
prevc|ëncic ce prcce::c: pcIc|cgicc: prcpric: cu c::cciccc: c ge:Icçcc
e ¢ue ccnIriLuem pcrc c inciccçcc cc pcrIc ce:cricnc. Fcrém, e:Ie
crgumenIc ¢ue ju:Iificcric c mcicr prcpcrçcc ce ce:crec: enIre nc: cc
¢ue nc primeirc muncc, ncc :erve pcrc ju:Iificcr pcr¢ue c e:Iccc ce Scc
Fcu|c cu cc Fic ce Jcneirc Iëm mci: ce:crec: ¢ue c: regice: ncrIe e
ncrce:Ie cc 8rc:i|. Jc é fcIc IcmLém Lc:IcnIe ccnhecicc e e:Iucccc
¢ue c: n|vei: ce ce:cricnc ncc :e re|ccicncm ce fcIc ccm c prevc|ëncic
ce ccnciçce: pcIc|cgicc: nc pcpu|cçcc ¢ue pccericm exp|iccr :uc
inciccçcc. Nc ¢uc:e IcIc|iccce cc: pc|:e: cnce :eu: |ncice: :cc
e|evccc:, c prevc|ëncic e cireIcmenIe prcpcrcicnc| cc n|ve| ce rencc
cc mu|her.
/incc ¢ue :e ccn:icerem IcmLém c: mcicre: ri:cc: cemcgrcficc: ce
pcrIc pcr ce:crec c::cciccc:, pcr exemp|c, c iccce mcIernc preccce
cu e|evccc, cu cincc c pcriccce Lcixc cu muiIc e|evccc, nem Iccc c
ccnjunIc ce pc::|vei: inciccçce: mécicc: pcrc c pcrIc ce:crec
ccn:egue exp|iccr c epicemic ce pcrIc: cpercIcric: cLccminci: em
nc::c pc|:.
É Lem verccce ¢ue cIuc|menIe :e ccmiIem, nc CL:IeIr|cic mccernc,
inciccçce: Lem mci: c|crgccc: pcrc c rec|izcçcc ce umc ce:cricnc,
muiIc: veze: :em umc ju:IificcIivc cL:IéIricc cce¢uccc. C: exemp|c:
mci: cprcpriccc: ne::e :enIicc :cc c :cfrimenIc feIc| e c cnIececenIe
ce ce:crec. ExceIucncc-:e c: ccu:c: univer:c|menIe cceiIc: ce pcrIc
pcr vic ce:crec, ccm rigcrc:c inciccçcc cL:IéIricc, e:Ic: cuc: ccu:c:
ccicicnci: repre:enIcm, nc mcicric cc: ccnIexIc:, umc impcrIcnIe
pcrcenIcgem ce Iccc: c: pcrIc: Ierminccc: pcr ce:crec.
Num ccnIexIc ccmc c Lrc:i|eirc, ccm umc c|Ic prevc|ëncic ce
ce:cricnc:, cccc vez :cc mci: fre¢üenIe: c: :iIucçce: ce ge:IcnIe: ccm
cnIececenIe ce ce:crec. E, emLcrc pcucc ccmiIicc cienIificcmenIe, c
repeIiçcc cc: ce:cricnc: é um prccecimenIc Lc:IcnIe ccmum IcnIc nc
8rc:i| ccmc nc: E:Iccc: Unicc: e em cuIrc: pc|:e: ccm c|Ic: Icxc:. C
:ignificccc e c: pc::|vei: ccn:e¢üëncic: fuIurc: cc pre:ençc ce umc
ciccIriz uIerinc ncc Iëm :icc enfcIizccc: e reccrcccc: c :uficienIe
¢ucncc :e incicc c primeirc ce:crec em umc mu|her. / ciccIriz e c
mcrLiccce c e|c c::cciccc: pccercc inf|uencicr c :eu fuIurc reprccuIivc.
/ IenIcIivc ce :e ccn:egui um pcrIc vcginc| cpc: umc ce:crec prévic
pcrece :er umc Lcc c|IerncIivc, cccIccc pcr Iccc: c: pc|:e:
ce:envc|vicc: em :uc: pc||Iicc: ce ccnIençcc cc: n|vei: ce ce:cricnc:.
Fcrece cincc :er umc c|IerncIivc vcnIcjc:c, :cL c pcnIc ce vi:Ic ce
mcrLiccce, IcnIc mcIernc ¢ucncc perincIc|, c: ce:crec: ccm ccIc e
hcrc mcrcccc:, prccecimenIc Icc ccmum nc cL:IeIr|cic Lrc:i|eirc. É
prcvcve|, ccnIucc, ¢ue e:Ic c|IerncIivc :c ccn:igc :e cifuncir mci:
genericcmenIe nc pc|:, nc mecicc em ¢ue inIervençce: :ejcm
firmemenIe cirigicc: nc :enIicc ce ccnIrc|cr, ce mcneirc :éric e
IecniccmenIe ccrreIc, c rec|izcçcc cc ce:cricnc :em ju:IificcIivc
mécicc.
Hc c nece::iccce cc infcrmcçcc e fcrmcçcc ce cpinicc enIre c:
mu|here:, pcrc ¢ue e|c: pc::cm reivinciccr c¢ui|c ¢ue :ejc mci:
4
AVALIAÇÃO CRÍTICA DO TIPO DE PARTO
36
Lenéficc pcrc c :uc :cúce e c ce :eu: fi|hc:. Sc ccm c c:pircçcc e c
vcnIcce cc: mu|here:, pccer-:e-ic ccn:eguir ¢ue e|c: Iive::em, pcr
exemp|c, um FV/C {pcrIc vcginc| cpc: ce:crec), ¢ue :eu: mécicc:
ccnccrcc::em e :e prepcrc::em pcrc :eguir c|iniccmenIe um IrcLc|hc
ce pcrIc, ccnvencicc: ce ¢ue e:Ic fc::e rec|menIe c me|hcr c|IerncIivc
pcrc Iccc:.
/ vcnIcce cc mu|her, e ccn:e¢üenIemenIe ce :eu: mécicc:, em :e
:uLmeIer c umc prcvc ce IrcLc|hc ce pcrIc cpc: umc ce:crec Iem
cumenIccc Lc:IcnIe nc: E:Iccc: Unicc: e Ccnccc, c exemp|c cc ¢ue
:empre cccnIeceu nc Eurcpc. É umc reivinciccçcc ¢ue cIuc|menIe fcz
pcrIe cc rcIinc cL:IéIricc ce:Ie: pc|:e:, c IenIcIivc ce pcrIc vcginc|
cpc: umc ciccIriz ce ce:crec, pcrc c ¢uc| ci:pcem ce umc :ig|c ¢ue :e
Icrncu muiIc pcpu|cr, ¨V8/C¨ {¨vcginc| LirIh cfIer ce:crecn¨ cu FV/C,
pcrIc vcginc| cpc: ce:crec), :c|iciIccc pe|c mcicric cc: mu|here: ne:Ic:
ccnciçce:, :iIucçcc cincc muiIc ci:IcnIe ce nc::c rec|iccce.
k|scos ossoc|odos
/pe:cr cc recuçcc cc: ri:cc: c::cciccc: cc prccecimenIc cirúrgi cc nc:
ú|Iimc: cécccc:, me:mc nc: pc|:e: cnce c mcrIc|iccce mcIernc é
recuzicc, c ri:cc re|cIivc ce mcrIe mcIernc é cincc mci: e|evccc nc
ce:cricnc ¢ue nc pcrIc ncrmc|. /|ém cc: ccu:c: Irccicicnci: ce mcrIe
mcIernc em pc|:e: em ce:envc|vimenIc, ncIcccmenIe c hemcrrcgic e
infecçcc, nc cc:c e:pec|ficc cc ce:crec, c exemp|c cc ¢ue cccnIece
em pc|:e: ce:envc|vicc:, hc IcmLém c ccnIriLuiçcc cc emLc|ic
pu|mcncr e cc: ccicenIe: cne:Ié:icc: ccmc ccu:c ce cLiIc mcIernc.
Jc é Lc:IcnIe ccnhecicc c mcicr mcrLiccce mcIernc ceccrrenIe ce
ccmp|iccçce: ce ce:crec, e:pecic|menIe c infecçcc e hemcrrcgic,
emLcrc c: e:cucc: :cLre e:Ie Iemc :ejcm muiIc mci: e:cc::c:, pe|c
cificu|ccce em :e pccrcnizcr e mecir mcrLiccce e IcmLém pe|c:
vcricçce: pcpu|ccicnci:. CuIrc: ccmp|iccçce: mci: c::cciccc: cc
prccecimenIc inc|uem c IrcmLcemLc|i:mc, c infecçcc urincric e,
e:pecificcmenIe nc cc:c cc: ce:crec: ce repeIiçcc, c ccreIi:mc
p|ccenIcric e :uc: ccn:e¢üëncic:. Mci: recenIemenIe, c nece::iccce ce
Ircn:fu:ce: :cngu|nec: e ce hemccerivccc: c::cciccc c rec|izcçcc ce
ce:crec: inIrccuziu, cincc, c: ri:cc: c::cciccc: cc prccecimenIc,
pcrIicu|crmenIe c cc Ircn:mi::cc cc v|ru: cc hepcIiIe e cc
imuncceficiëncic humcnc.
/|ém ce:Ic:, cuIrc: ccnciçce: ce ri:cc e:Icc mci: c::cciccc: cc pcrIc
pcr ce:crec, ccmpcrcIivcmenIe cc pcrIc ncrmc|. É impcrIcnIe ¢ue c
prcfi::icnc| ce :cúce ccnheçc Ici: ri:cc: e :uc: pc::|vei: repercu::ce:
pcrc |evc-|c: em ccn:icercçcc nc mcmenIc ce cecicir pe|c vic ce
pcrIc, e IcmLém pcrc c infcrmcr c mu|her e :eu ccmpcnheirc,
permiIincc umc ceci:cc ccmpcrIi|hccc e ccn:cienIe. Fcrc cumprir ccm
e:Ie cLjeIivc ce mcneirc c|crc e :imp|e:, c: vcnIcgen: e ce:vcnIcgen:
c::cciccc: cc Iipc ce pcrIc e:Icc re:umicc: nc IcLe|c ¢ue :e :egue.
4
AVALIAÇÃO CRÍTICA DO TIPO DE PARTO
37
Riscos potenciais associados ao tipo de parto
/|ém cc ceci:cc cL:IéIricc, Lc:eccc nc ccnhecimenIc cienI|ficc cc
e:pecic|iccce, Lem ccmc nc ccnIrc|e c||nicc ce cccc mu|her :cL
cuicccc, hc :egurcmenIe vcric: crcen: ce fcIcre: envc|vicc:, enIre e|e:
c ¢ue :e refere cc: cLu:c: cc inIervençcc mécicc. En¢ucnIc prcIicc
:ccic|, c cIc mécicc e c e:pcçc ce inf|uëncic prcfi::icnc| Iëm c ver ccm
re|cçce: eccncmicc:, :ccici:, cu|Iurci: e pc||Iicc:, ccn:icerccc: cc |cngc
cc hi:Icric.
Num ccnIexIc ce impcrIcncic cc: c:pircçce: cc c|ienIe|c e re:peiIc c:
ceci:ce: cc mu|her en¢ucnIc u:ucric cc :i:Iemc ce :cúce, Icrnc-:e
re|evcnIe e nece::cric ci:pcr ce e:c|crecimenIc: c re:peiIc cc:
inciccçce: preci:c: cc recur:c c: ce:crec: nc IrcIc ce cccc cc:c
e:pec|ficc, cc |ccc cc reccnhecimenIc cr|Iicc cc: ccnciçce: ce :uc
uIi|izcçcc inci:criminccc. Sc c infcrmcçcc ccrreIc, cienIificcmenIe
Lc|izccc, pccerc cjucc-|c: nc cpçcc |ivre e infcrmccc, :cLre c vic ce
pcrIc preferencic| e c: ri:cc: c::cciccc:.
4
38
/ cIençcc cce¢uccc c mu|her nc mcmenIc cc pcrIc
repre:enIc um pc::c inci:pen:cve| pcrc gcrcnIir ¢ue
e|c pc::c exercer c mcIerniccce ccm :egurcnçc e
Lem-e:Icr. E:Ie é um cireiIc funccmenIc| ce Iccc
mu|her. / e¢uipe ce :cúce ceve e:Icr prepcrccc pcrc
ccc|her c grcvicc, :eu ccmpcnheirc e fcm||ic,
re:peiIcncc Iccc: c: :ignificccc: ce::e mcmenIc. l::c
ceve fcci|iIcr c cricçcc ce um v|ncu|c mci: prcfuncc
ccm c ge:IcnIe, Ircn:miIincc-|he ccnficnçc e
Ircn¢üi|iccce.
/ vivëncic ¢ue c mu|her Ierc ne:Ie mcmenIc :erc mci:
cu menc: prczeirc:c, mci: cu menc: pc:iIivc, mci: cu
menc: IrcumcIicc, c cepencer ce umc :érie ce
ccnciçce:, ce:ce c¢ue|c: inIr|n:ecc: c mu|her e c
ge:Icçcc, cIé c¢ue|c: cireIcmenIe re|ccicnccc: cc
:i:Iemc ce :cúce.
Ccmc ccnciçce: inIr|n:ecc: c mu|her e c ge:Icçcc,
pcce-:e mencicncr :uc iccce {cu mcIuriccce), :uc
experiëncic em pcrIc: cnIericre:, c experiëncic cc:
mu|here: ¢ue |he :cc prcximc: {:uc mce, irmc:, primc:,
cmigc:, eIc.) ccm :eu: prcpric: pcrIc:, :e c grcvicez
cIuc| fci p|cnejccc {ce:ejccc), c :egurcnçc em
re|cçcc c :i me:mc nc ¢ue ccncerne c :eu pcpe| ce
mu|her e ce mce, cenIre cuIrc:. Ccmc ccnciçce:
re|ccicnccc: cc :i:Iemc ce :cúce, vc|e mencicncr c
c::i:Iëncic pré-ncIc| {¢ue pcce Ier inc|u|cc cu ncc c
cce¢uccc prepcrc f|:icc e emccicnc| pcrc c pcrIc) e
c c::i:Iëncic cc pcrIc prcpricmenIe ciIc.
Ex|ste necess|dode de mod|||coçöes pro|undos no
quo||dode e humon|zoçõo do oss|stënc|o oo porto nos
motern|dodes bros||e|ros. For humon|zoçõo do
oss|stënc|o oo porto entende-se um processo que
|nc|u| desde o odequoçõo do estruturo |ís|co e
equ|pomentos dos hosp|to|s, oté umo mudonço de
posturoJot|tude dos pro||ss|ono|s de soùde e dos
gestontes. A odequoçõo |ís|co do rede hosp|to|or -
poro que o mu|her posso ter um ocomponhonte
[tombém dev|domente preporodo} duronte o trobo|ho
de porto e poro os proced|mentos de o|ív|o do dor -
requer, o|ém de boo vontode, tombém |nvest|mentos
5 ASSISTÊNCIA À MULHER NO TRABALHO DE PARTO
ASSISTÊNCIA À MULHER NO TRABALHO DE PARTO
39
EnIreIcnIc, é ccnhecicc ¢ue c: hc:piIci: IcmLém cpre:enIcm c|gumc
re:i:Iëncic em mccificcr :uc: ¨rcIinc:" ce cL:IeIr|cic e pcucc: :cc c: ¢ue
Iëm in:Ic|cçce:/ccnciçce: minimcmenIe cce¢uccc: pcrc, pcr exemp|c,
permiIir c pre:ençc ce um cccmpcnhcnIe pcrc c ge:IcnIe cc SUS em
IrcLc|hc ce pcrIc cu gcrcnIir :uc privcciccce.
De::c fcrmc, é funccmenIc| ¢ue ncc cccrrc um ce:ccmpc::c enIre
ci:cur:c e c prcIicc e ¢ue c ci:Icncic enIre c ¢ue :e reccmencc e ¢ue
:e fcz pc::c :er recuzicc cIrcvé: cc cccçcc ce um ccnjunIc ce mecicc:
ce crcem e:IruIurc|, gerencic|, fincnceirc e ecuccIivc, ce fcrmc c
prcpicicr c: mu|here: Lrc:i|eirc: - :cLreIucc c¢ue|c: mci: ccrenIe: - um
pcrIc verccceircmenIe humcnizccc.
Ne::e :enIicc, c re:peiIc c mu|her e :eu: fcmi|icre: é funccmenIc|:
chcmc-|c pe|c ncme {eviIcncc c: Iermc: ¨mcezinhc¨, ¨ccnc¨, eIc.),
permiIir ¢ue e|c icenIifi¢ue cccc memLrc cc e¢uipe ce :cúce {pe|c
ncme e pcpe| ce cccc um), infcrmc-|c :cLre c: ciferenIe:
prccecimenIc: c ¢ue :erc :uLmeIicc, prcpicicr-|he um cmLienIe
ccc|heccr, |impc, ccnfcrIcve| e :i|encic:c, e:c|crecer :uc: cúvicc: c|ivicr
:uc: cn:ieccce: :cc cIiIuce: re|cIivcmenIe :imp|e: e ¢ue re¢uerem
pcucc mci: ¢ue c Lcc vcnIcce cc prcfi::icnc|.
/: reccmenccçce: c :eguir :cc re|cIivc: c c::i:Iëncic cc IrcLc|hc ce
pcrIc. FcrIem cc pre::upc:Ic ce ¢ue ncc exi:Ie umc únicc c::i:Iëncic
¨icec|¨ ('*(/ -%)/? mc: ciferenIe: fcrmc: ce cccmpcnhcr c pcrIurienIe
curcnIe c per|ccc ce ci|cIcçcc, c cepencer cc: ccnciçce: cc |ccc| cc
e¢uipe ce :cúce ¢ue fcrc e::e cccmpcnhcmenIc.
/ccIcncc c princ|pic cc mecicinc Lc:eccc em evicëncic:, :ercc
ci:cuIicc: c|gumc: prcIicc: ¢ue, emLcrc uIi|izccc:, ccrecem ce
cemcn:Ircçce: c|crc: ¢ucnIc c :eu: Lenef|cic:. /ccIcr-:e-c, nc mecicc
cc pc::|ve|, umc :e¢üëncic crcnc|cgicc cc: evenIc: nc per|ccc ce
ci|cIcçcc, e c: prccecimenIc: cce¢uccc: nc cccmpcnhcmenIc ce::e:
evenIc:.
1. Aspectos Êt|cos
C IrcLc|hc ce pcrIc ceve :er cLcrcccc ccm éIicc prcfi::icnc| cp|iccve|
c Iccc: c: :iIucçce: ce cIençcc c :cúce. / cce¢uccc icenIificcçcc cc
e¢uipe mécicc, ce enfermcgem e cuIrc: prcfi::icnci: ce :cúce, c
ve:Iucric cce¢uccc ce::e: prcfi::icnci:, c re:peiIc c inIimiccce e c
privcciccce cc pcrIurienIe, c|ém cc: cemci: c:pecIc: ¢ue pcuIcm c
re|cçcc prcfi::icnc| ce :cúce/pcrIurienIe/ fcm||ic cevem :er cLececicc:
ccm rigcr nc mcnejc cc pcrIc.
2. D|ognost|co de Irobo|ho de Forto
C cicgnc:Iicc cc IrcLc|hc ce pcrIc :e fcz, em gerc|, pe|c pre:ençc cc:
:eguinIe: ccnciçce::
• <4'('*+% $' 1#*)4%+A'( /)'46*%( % 6*)'43%-#( 4'>/-%4'(? ./' 3,#
<4#>4'((63%2'*)' %/2'*)%*$# 1#2 # <%((%4 $# )'2<#? '2 )'42#( $'
;4'.L9*16% ' 6*)'*(6$%$'? ' ./' *,# $626*/'2 1#2 # 4'<#/(#
5
ASSISTÊNCIA À MULHER NO TRABALHO DE PARTO
40
$% >'()%*)'E M <%$4,# 1#*)48)6- 6*616%- :? >'4%-2'*)'? $' /2%
1#*)4%+,# % 1%$% NIO 26*/)#( ' ./' $/4% '*)4' PQ ' RQ ('>/*$#(E
• S<%>%2'*)# T'(3%'162'*)#U ' $6-%)%+,# <4#>4'((63#( $# 1#-#
/)'46*#E
Nc: fc:e: mci: inicici: cc IrcLc|hc ce pcrIc, nem :empre é pc::|ve| fczer
c cicgnc:Iicc ciferencic| enIre verccceirc e fc|:c IrcLc|hc ce pcrIc ccm
umc cvc|icçcc i:c|ccc. Ne::e: cc:c:, recvc|icr c ge:IcnIe 1 c 2 hcrc:
cpc: c primeirc excme pcce :er nece::cric pcrc ccnfirmcr c cicgnc:Iicc.
Ne::e :enIicc, fcz-:e nece::cric cce¢ucr c e:IruIurc f|:icc cc: :c|c: ce
ccmi::cc cc: ge:IcnIe:, pcrc ¢ue c recvc|icçcc ne::e: cc:c: :ejc vicve|.
É impcrIcnIe ce:Icccr ¢ue cc finc| cc prcce::c ge:Iccicnc|, c mu|her
pcce cpre:enIcr um ¢uccrc cencminccc fc|:c IrcLc|hc ce pcrIc,
ccrccIerizccc pcr cIiviccce uIerinc cumenIccc, permcnecencc,
enIreIcnIc, um pccrcc ce ccnIrcçce: ce:cccrcenccc:. /|gumc: veze:,
e::c: ccnIrcçce: :cc Lem percepI|vei:, ccnIucc ce::cm em :eguicc e c
cérvice uIerinc ncc cpre:enIc ci|cIcçcc. Ic| :iIucçcc prcmcve um c|Ic
grcu ce cn:ieccce e expecIcIivc :cLre c premëncic cc nc:cimenIc,
:encc um cc: principci: mcIivc: ¢ue |evcm c: ge:IcnIe: c prccurcrem c
hc:piIc|. C prcfi::icnc| ceve e:Icr cIenIc pcrc Ici: cccnIecimenIc:, c fim
ce :e eviIcr umc ccmi::cc preccce, inIervençce: ce:nece::cric: e
e:Ire::e fcmi|icr, ccc:icncncc umc experiëncic negcIivc ce IrcLc|hc ce
pcrIc, pcrIc e nc:cimenIc.
/ percc cc Icmpcc mucc:c cu ¨:inc|" e c fcrmcçcc cc Lc|:c cc: cguc:
:cc inciccccre: menc: preci:c: cc IrcLc|hc ce pcrIc, nc mecicc em ¢ue
exi:Iem grcnce vcricçce: incivicuci: enIre c cpcrecimenIc ce::e: :inci: e
c in|cic rec| cc IrcLc|hc ce pcrIc.
EmLcrc nc: ge:Icçce: c Iermc, c rcIurc cc: memLrcnc: cccrrc nc
mcicric cc: cc:c: curcnIe c IrcLc|hc ce pcrIc, e|c pcce cccrrer cIé
vcric: cic: cnIe: cc in|cic cc me:mc {ce 12 c 207). /incc ncc exi:Iem
evicëncic: c|crc: :cLre ¢uc| c me|hcr ccncuIc ne::e: cc:c: e vcric:
c|IerncIivc: Iëm :icc uIi|izccc: nc mcnejc cc rcIurc premcIurc ce
memLrcnc: em ge:Icçce: ce Iermc:
• 6*$/+,# 62'$6%)% $# )4%@%-7# $' <%4)#B
• 6*$/+,# %<J( RIVP 7#4%(B '
• 1#*$/)% '5<'1)%*)' <#4 %): WX 7#4%(? 1#2 #@('43%+,# $%
>'()%*)'? ('>/6$% $' 6*$/+,# (' # )4%@%-7# $' <%4)# *,# (' 6*616%
'(<#*)%*'%2'*)'E
DeIc|he: :cLre c: ccncuIc: nc: cc:c: ce cmnicrrexe premcIurc e:Icc
ci:pcn|vei: nc mcnuc| ce Ge:Icçcc ce /|Ic Fi:cc {MS, 2000).
Cuc|¢uer ¢ue :ejc c ccncuIc cccIccc, c Ic¢ue vcginc| ceve :er eviIccc
cIé ¢ue c ge:IcnIe e:Iejc em frcncc IrcLc|hc ce pcrIc, pcrc minimizcr c:
ri:cc: ce infecçcc cvu|cr e puerperc|.
5
ASSISTÊNCIA À MULHER NO TRABALHO DE PARTO
41
3. Momento do |nternoçõo
Ncc exi:Ie um ¨mcmenIc icec|¨ pcrc inIerncr c ge:IcnIe em IrcLc|hc ce
pcrIc. EmLcrc c ce:ejcve| :ejc c inIerncçcc jc nc fc:e cIivc, c|gumc:
ge:IcnIe: pccercc :e Leneficicr ce umc inIerncçcc mci: preccce, cincc
nc fc:e |cIenIe: c: ¢ue Iëm cificu|ccce ce cce::c cc |ccc| cc pcrIc e
c¢ue|c: ¢ue - emLcrc cincc ncc pcrIcccrc: ce ccnciçce: ¢ue
ccrccIerizem ge:Icçcc cu pcrIc ce c|Ic ri:cc - Iëm um pcIencic| um
pcucc mcicr ce cpre:enIcr ccmp|iccçce: nc IrcLc|hc ce pcrIc, ccmc c:
pcrIurienIe: ccm iccce ge:Iccicnc| :upericr c 41 :emcnc:, ce:crec
cnIericr, cmnicrrexe premcIurc e/cu pcIc|cgic: c||nicc: ce grcu |eve.
4. Froced|mento no odm|ssõoJ|nternoçõo do portur|ente
5
• /ncmne:e
Nenhum cIencimenIc em :cúce, me:mc nc: cc:c: ccn:icerccc: ce
Lcixc ri:cc, pre:cince ce umc cncmne:e cirigicc, cnce :ercc
cvc|iccc:: cnIececenIe: mcrLicc:, cnIececenIe: cL:IéIricc: {cnce
:e inc|ui IcmLém c |evcnIcmenIc ce ccmp|iccçce: ce pcrIc: em
ge:Icçce: cnIericre:), ccIc cc ú|Iimc men:Irucçcc, infcrmcçce:
:cLre c mcvimenIcçcc feIc| e cccc: e evc|uçcc ce ge:Icçcc
cIuc|. E:Ie: cccc: jc cevem rcIineircmenIe fczer pcrIe cc CcrIcc
cc Ge:IcnIe ¢ue Iccc :erviçc ceveric fcrnecer c: mu|here: em
cccmpcnhcmenIc pré-ncIc|.
• Excme c||nicc
/incc ¢ue :umcric nc: ge:Icçce: ce evc|uçcc ncrmc| {cu ce Lcixc
ri:cc), c cvc|icçcc c||nicc cc ge:IcnIe ceve inc|uir mecicc cc:
cccc: viIci: {pre::cc crIeric|, pu|:c e IempercIurc), cvc|icçcc cc:
mucc:c: pcrc inferir c pre:ençc cu ncc ce cnemic, c pre:ençc cu
ncc ce ecemc e vcrize: nc: memLrc: infericre: e c cu:cu|Ic
ccrc|ccc e pu|mcncr.
• Excme CL:IéIricc
/ cu:cu|Ic cc fre¢üëncic ccrc|ccc feIc| {cnIe:, curcnIe e cpc: c
ccnIrcçcc uIerinc), c mecicc cc c|Iurc uIerinc, c pc|pcçcc
cL:IéIricc {pcrc ceIermincr c :iIucçcc, pc:içcc, cpre:enIcçcc e
in:inucçcc) :cc, prccecimenIc: cLrigcIcric: nc ccmi::cc cc
ge:IcnIe.
Se exi:Ie :u:peiIc ce cmnicrrexe premcIurc cu :cngrcmenIc geniIc|,
c excme e:pecu|cr ceve :er rcIinc, prececencc c ceci:cc pe|c
rec|izcçcc cc Ic¢ue.
C: Ic¢ue: vcginci: :uL:e¢üenIe: cc cc cicgnc:Iicc pccem :er
pc:Iergccc:, cIé ¢ue c ge:IcnIe :e enccnIre nc fc:e cIivc cc
IrcLc|hc ce pcrIc, e ceve :er uIi|izccc ccm muiIc pcrcimcnic nc:
cc:c: ce :u:peiIc/ccnfirmcçcc ce cmnicrrexe premcIurc. Cucncc
exi:Ie :cngrcmenIc vcginc|, c Ic¢ue ceve :er rec|izccc em
ccnciçce: ccnIrc|ccc:, pci: pcce :e IrcIcr ce cc:c ce
5
ASSISTÊNCIA À MULHER NO TRABALHO DE PARTO
42
p|ccenIc prévic, ccnciçcc em ¢ue c Ic¢ue pcce prcvcccr picrc
cc hemcrrcgic, ccm pc::|vei: repercu::ce: mcIernc: e feIci:.
• IriccIcmic
/ IriccIcmic cc: pe|c: puLicnc: Iem :icc uIi|izccc rcIineircmenIe
nc: hc:piIci:, vi:cncc c recuçcc nc incicëncic ce infecçce: ce
epi:icIcmic, c fcci|iIcçcc cc epi:icrrcfic e umc me|hcr higiene nc
pc:-pcrIc.
Ncc exi:Iem evicëncic: cienI|ficc: c|crc: :cLre e::e: Lenef|cic: e
:uc uIi|izcçcc pccerc gercr ce:ccnfcrIc: e ri:cc: pcrc c pcrIurienIe:
c ce:ccnfcrIc nc mcmenIc cc :uc execuçcc e ¢ucncc c: pe|c:
ccmeçcm c cre:cer e c ri:cc ce Ircn:mi::cc ce ccençc, ¢ucncc
cc uIi|izcçcc ce |cminc: ncc ce:ccrIcvei:.
Fcr e::c: rczce: e ccn:icercncc c cu:Ic ccicicnc| pcrc :uc
rec|izcçcc, reccmencc-:e ¢ue c IriccIcmic :c :ejc feiIc :e e:Ic fcr c
cpçcc cc pcrIurienIe.
• EnIercc|i:mc
EmLcrc c: Lenef|cic: Irccicicnc|menIe cIriLu|cc: c rec|izcçcc ce
enIercc|i:mc {cu enemc) rcIineirc nc in|cic cc IrcLc|hc ce pcrIc
{mencr ri:cc ce infecçcc |ccc|, mcjcr fcci|iccce pcrc c ce:cicc cc
cpre:enIcçcc e inf|uëncic pc:iIivc :cLre c ccnIrcIi|iccce uIerinc)
venhcm :encc cccc vez mci: ¢ue:Iicnccc: em vcric: e:cucc: Lem
ccnIrc|ccc:, c cLcnccnc cc :uc prcIicc merece cincc c|gumc
ref|excc.
Se pcr um |ccc, c rec|izcçcc cc |cvcgem inIe:Iinc| gerc c
pcrIurienIe c|gum ce:ccnfcrIc curcnIe :uc execuçcc e incremenIc
c: cu:Ic: ce c::i:Iëncic cc pcrIc, c ccnfcrIc pc:Iericr cc mu|her e
cc prcpric e¢uipe ce :cúce ceve :er vc|crizccc. Evccucr nc
mcmenIc cc per|ccc expu|:ivc, ccm c :uc geniIc|ic expc:Ic, pcce
:er ccn:Ircngeccr pcrc muiIc: mu|here:. Fcr cuIrc |ccc, nem
:empre c e¢uipe ce :cúce pre:enIe nc :c|c ce pcrIc ccn:egue
|iccr Lem ccm Ic| :iIucçcc, c ¢ue pcce cumenIcr cincc mci: c
ccn:IrcngimenIc cc mu|her.
Desso |ormo, o dec|sõo de reo||zor ou nõo o enteroc||smo deve |evor
em conto essos cond|çöes, vo|or|zondo pr|nc|po|mente o op|n|õo do
portur|ente. Esto, poro poder dec|d|r de |ormo consc|ente, deve
receber or|entoçõo nõo tendenc|oso duronte o pré-noto|, poro que
no momento do |nternoçõo poro o porto posso |ozer o suo esco|ho.
Nõo se deve oneror o gestonte em trobo|ho de porto com um
excesso de |n|ormoçöes, obr|gondo-o o tomor dec|söes em um
contexto onde e|o necess|tor|o de um tempo mo|or e de mo|s
tronqü|||dode poro |ozë-|o.
5. A||mentoçõo
Nc fc:e |cIenIe cc IrcLc|hc ce pcrIc, c: ge:IcnIe: ce Lcixc ri:cc pcrc
ce:crec cevercc :er crienIccc: c ingerir cpenc: c|imenIc: |eve:.
5
ASSISTÊNCIA À MULHER NO TRABALHO DE PARTO
43
Ccmc curcnIe e::c fc:e, c mcicric cc: ge:IcnIe: permcnece em cc:c,
e::c crienIcçcc ceve :er cccc cincc curcnIe c pré-ncIc|. Nc mecicc
em ¢ue cccrre c cprcximcçcc cc fc:e cIivc cc IrcLc|hc ce pcrIc, Iccc:
c: c|imenIc: :c|icc: cevem :er :u:pen:c:, :encc permiIicc, pcrc c:
ge:IcnIe: ce Lcixc ri:cc, c inge:Icc ce pe¢uenc: ¢ucnIiccce: ce
||¢uicc: c|crc: {cguc, :ucc ce fruIc: :em pc|pc, chc, ccfé, refrigercnIe).
EvicenIemenIe, c Lcm :en:c e umc ceci:cc ccnjunIc enIre c cL:IeIrc e
c cne:Ie:i:Ic pccem permiIir c incivicuc|izcçcc ce cccc cc:c.
Icccvic, c: ge:IcnIe: ce mcicr ri:cc pcrc prccecimenIc: cne:Ié:icc:
{cLe:c:, cicLéIicc:, ccm vic: cérec: ce cif|ci| cce::c) cu pcrc pcrIc
cirúrgicc cevem permcnecer em jejum curcnIe Iccc c IrcLc|hc ce pcrIc,
eviIcncc-:e inc|u:ive c inge:Icc ce ||¢uicc: c|crc:.
Nc: cc:c: ce ce:crec: e|eIivc:, c per|ccc ce jejum pcrc c rec|izcçcc cc
prccecimenIc cne:Ié:icc ceve :er :imi|cr c¢ue|e cccIccc nc :erviçc
pcrc prccecimenIc: cirúrgicc: em gerc| ce mu|here: ncc grcvicc:.
ó. H|g|ene do portur|ente
DurcnIe c IrcLc|hc ce pcrIc, c ge:IcnIe perce :ecreçce: pe|c vcginc e
fre¢üenIemenIe cpre:enIc :uccre:e ccn:icercve|. E|c ceve, pcrIcnIc, :er
e:Iimu|ccc c :e higienizcr e cevem e:Icr ci:pcn|vei: pcrc e|c ccnciçce:
pcrc IcnIc. Um Lcnheirc ccm chuveirc, Icc|hc:, :cLcneIe: e Irccc
fre¢üenIe ce :uc ¨LcIc¨ cu ccmi:c|c, cc ¨fcrrc¨ e cc rcupc ce ccmc
gercrcc umc :en:cçcc ce mcicr ccnfcrIc e Lem-e:Icr, Icc ce:ejcve|
curcnIe e::e per|ccc.
C: Lcnhc: ce chuveirc ccm cguc mcrnc Iëm :icc uIi|izccc:, ce fcrmc
emp|ricc, pcrc c|ivicr c ccr cc IrcLc|hc ce pcrIc. Me:mc ¢ue ncc exi:Ic
cincc ccmprcvcçcc cienI|ficc em re|cçcc c i::c, c :en:cçcc ce
re|cxcmenIc f|:icc e menIc| cpc: um Lcnhc pcce ccnIriLuir pcrc c Lem
e:Icr cc: ge:IcnIe:.
7. Fos|çõo de portur|ente
Sc|vc rcrc: exceçce:, c pcrIurienIe ncc ceve :er cLrigccc c permcnecer
nc |eiIc. DecmLu|cr, :enIcr e ceiIcr :cc ccnciçce: ¢ue c ge:IcnIe pcce
cccIcr nc IrcLc|hc ce pcrIc ce cccrcc ccm c :uc preferëncic e, em
gerc| ce fcrmc e:pcnIcnec, exi:Ie umc Iencëncic c c|Ierncncic ce
pc:içce:. /: mu|here: cevem :er cpciccc: nc :uc e:cc|hc.
Cucncc ceiIccc, c ge:IcnIe ceve :er crienIccc c ncc permcnecer em
cecúLiIc ccr:c| hcrizcnIc| pcr¢ue e::c pc:içcc recuz c f|uxc :cngü|nec
uIerinc e p|ccenIcric. Cu :ejc, ¢ucncc ceiIccc, c ge:IcnIe ceve cccIcr
c cecúLiIc |cIerc|, IcnIc cireiIc ¢ucnIc e:¢uercc.
/ pc:içcc verIicc| {pcrccc cu cecmLu|cncc) pcrece fcvcrecer c
IrcLc|hc ce pcrIc. Exceçce: c e::c regrc :cc c: ge:IcnIe: ¢ue
cpre:enIcm rcIurc ce Lc|:c ccm ccLeçc ncc enccixccc {pcrc eviIcr
5
ASSISTÊNCIA À MULHER NO TRABALHO DE PARTO
44
c prc|cp:c cc ccrccc) e c¢ue|c: ¢ue cpre:enIem :cngrcmenIc geniIc|
mccerccc cu :everc.
8. Amn|otom|o
EmLcrc exi:Icm evicëncic: ce ¢ue c cmnicIcmic preccce pc::c recuzir
c curcçcc cc IrcLc|hc ce pcrIc em ó0 c 120 minuIc:, efeiIc: ince:ejcvei:
pccem cccrrer ccm e::c prcIicc, ccmc c incremenIc ce
ce:cce|ercçce: preccce: cc FCF e c|Iercçce: p|c:Iicc: :cLre c pc|c
cefc|icc {Lc::c :erc::cngu|nec). Exi:Ie IcmLém um ri:cc cumenIccc ce
infecçcc cvu|cr e puerperc| ¢ucnIc mcicr fcr c curcçcc cc IrcLc|hc ce
pcrIc ccm memLrcnc: rcIc:.
De::c fcrmc, c rcIurc crIificic| cc Lc|:c ceve :er eviIccc, re:ervcncc-:e
:eu u:c pcrc c¢ue|c: ccnciçce: cnce :uc prcIicc :ejc c|crcmenIe
Lenéficc, ccmc é c cc:c ce c|gumc: ci:Iccic: funcicnci:. É impcrIcnIe
e:c|crecer ¢ue c cmnicIcmic ncc é um prccecimenIc cLrigcIcric
¢ucncc cc rec|izcçcc ce cnc|ge:ic ce pcrIc.
º. Fortogromo: ocomponhomento gró||co do trobo|ho de porto
C pcrIcgrcmc nc cvc|icçcc e cccumenIcçcc cc evc|uçcc cc IrcLc|hc
ce pcrIc é um in:IrumenIc ce impcrIcncic funccmenIc| nc cicgnc:Iicc
cc: ce:vic: cc ncrmc|iccce. C Ccp|Iu|c ó IrcIc ce:Ie c::unIc ccm
ceIc|he:.
10. V|g||önc|o do v|to||dode |eto|
C ccnIrc|e rigcrc:c cc fre¢üëncic ccrc|ccc feIc| {FCF) curcnIe c
IrcLc|hc ce pcrIc c::egurc, nc ¢uc:e IcIc|iccce cc: cc:c:, c cccçcc ce
mecicc: cprcpriccc: pcrc gcrcnIir c nc:cimenIc ce umc cricnçc em
Lcc: ccnciçce:.
Me:mc c ge:Icçcc ce Lcixc ri:cc ncc pre:cince cc ccnIrc|e periccicc
cc FCF, ¢uer ccm c uIi|izcçcc cc e:IeIc:ccpic ce Fincrc, ¢uer ccm c u:c
cc :cncr-ccpp|er. Nc fc:e |cIenIe cc IrcLc|hc ce pcrIc e nc in|cic cc
fc:e cIivc, e::e ccnIrc|e pcce :er feiIc c cccc ó0 minuIc:, recuzincc-:e
e::e inIervc|c pcrc 30 minuIc: ccnfcrme prcgrice c fc:e cIivc cc
IrcLc|hc ce pcrIc. Nc: ge:Icçce: ce Lcixc ri:cc, c mcniIcrizcçcc
ccnI|nuc cc FCF pcce :er ccnIrcprccucenIe: |imiIc c mcvimenIcçcc cc
mu|her, re:Iringincc-c cc |eiIc, e Iem um pcIencic| ce gercr um mcicr
númerc ce inIervençce: ce:nece::cric:.
É impcrIcnIe enfcIizcr ¢ue, ¢ucncc exi:Ie excesso de controt|||dode
uter|no {Ic¢ui::i:Ic|ic, hiperIcnic), ¢uer e:pcnIcnec, ¢uer icIrcgënicc, c
:cfrimenIc feIc| cgucc pcce :e in:Ic|cr em pcucc: minuIc:, c ¢ue exige
umc vigi|cncic ccnI|nuc cc FCF cIé ¢ue c ¢uccrc :ejc reverIicc. EmLcrc
ne:Ie: cc:c: :ejc ce:ejcve| c u:c ce mcniIcre: feIci: nc vigi|cncic
ccnI|nuc cc FCF, e:Ie: pccem :er :uL:IiIu|cc: pe|c pre:ençc cc
prcfi::icnc| ce :cúce cc |ccc cc pcrIurienIe, ccm c vcnIcgem ce ¢ue
e::c pre:ençc pcce ccnIriLuir pcrc c Ircn¢üi|izcçcc cc mu|her e,
ccn:e¢üenIemenIe, c re:c|uçcc mci: rcpicc cc hiperccnIrcIi|iccce
uIerinc.
5
45
FcrIcgrcmc é c repre:enIcçcc grcficc cc IrcLc|hc ce
pcrIc ¢ue permiIe cccmpcnhcr :uc evc|uçcc,
cccumenIcr, cicgnc:Iiccr c|Iercçce: e inciccr c
Icmccc ce ccncuIc: cprcpriccc: pcrc c ccrreçcc
ce:Ie: ce:vic:, cjuccncc cincc c eviIcr inIervençce:
ce:nece::cric:.
Fcrc ccmpreencer c evc|uçcc cc IrcLc|hc ce pcrIc, é
nece::cric c ccnhecimenIc prévic cc fi:ic|cgic cc
ci|cIcçcc cervicc|. De cccrcc ccm c CenIrc
LcIinccmericcnc ce FerincIc|cgic - CL/F {Schwcrcz eI
c|., 1ººó), c curvc ce ci|cIcçcc cervicc| :e prcce::c ce
fcrmc c:cencenIe, ce in|cic ccm mencr ve|cciccce
ce ci|cIcçcc. Nc finc|, e::c ve|cciccce cumenIc, cu
:ejc, c pcrIc :e ce:envc|ve mci: rcpiccmenIe c pcrIir
cc: 4 cm ce ci|cIcçcc. / ciferencicçcc nc ve|cciccce
cc cérvicc-ci|cIcçcc ccrccIerizc c Fc:e LcIenIe
{inicic|) e c Fc:e /Iivc {finc|), ce inIere::e nc evc|uçcc
cc IrcLc|hc ce pcrIc e nc ccn:Iruçcc cc pcrIcgrcmc
{Figurc 1).
Figura 1 - Curva de evolução da cérvico - dilatação
(Schwarcz et al.. 1996)
6
USO DO PARTOGRAMA NO ACOMPANHAMENTO DO
TRABALHO DE PARTO
USO DO PARTOGRAMA NO ACOMPANHAMENTO DO TRABALHO DE PARTO
46
Friecmcn {1º78) e:IcLe|eceu umc ccrre:pcncëncic enIre c: per|ccc:
c|c::icc:, e:pecificcmenIe enIre c: per|ccc: ce ci|cIcçcc e expu|:ivc, e
c: c::im cencminccc: ¨civi:ce: funcicnci:¨ cc pcrIc. Ccn:icercu c
per|ccc ce ci|cIcçcc :uLcivicicc em cuc: fc:e: - c prepcrcIcric e c ce
ci|cIcçcc prcpricmenIe ciIc. C per|ccc expu|:ivc pc::cu c :er
ccn:icerccc pcr e::e cuIcr ccmc per|ccc pé|vicc, cu :ejc, per|ccc em
¢ue :e prcce::cm c: fencmenc: meccnicc: cc pcrIc.
Nc fc:e |cIenIe cc IrcLc|hc ce pcrIc c ccncuIc é expecIcnIe, ce:ce
¢ue c viIc|iccce feIc| e:Iejc pre:ervccc, e c icec| é ¢ue c: pcrIurienIe:
:ejcm cccmpcnhccc: ce cmLu|cIcric ¢ucncc ncc :e IrcIcr ce
ge:Icçcc ce ri:cc. CL:ervc-:e ¢ue, em muiIc: mu|here:, c curcçcc é
:upericr c 20 hcrc: e c: cciIcccicc: cevem :er eviIccc:, pe|c ri:cc ce
cumenIc nc incicëncic ce ce:crec, ceccrrenIe cc cc|c uIerinc
ce:fcvcrcve|. Os s|no|s de o|erto, como perdo de |íqu|do, songromento
uter|no, controçöes e||c|entes o codo 5 m|nutos e d|m|nu|çõo dos
mov|mentos |eto|s, sõo or|entoçöes poro que o portur|ente retorne oo
hosp|to| no momento odequodo.
É impcrIcnIe re|emLrcr ¢ue, pcrc c cccmpcnhcmenIc cc IrcLc|hc ce
pcrIc, c fc:e cu civi:cc funcicnc| ce inIere::e nc cp|iccçcc cc
pcrIcgrcmc é c ce ci|cIcçcc {Friecmcn, 1º78) cu fc:e cIivc {Schwcrcz eI
c|., 1ººó), ccm ve|cciccce ce ci|cIcçcc cervicc| m|nimc ce 1 cm/hcrc. /
cLerIurc cc pcrIcgrcmc nc fc:e |cIenIe cu nc inicic cc ci|cIcçcc {mencr
¢ue 3 - 4 cm) imp|iccric em inIervençce: ncc :c ce:nece::cric:, mc:
IcmLém icIrcgënicc:.
C: Lenef|cic: cc inIerpreIcçcc grcficc cc evc|uçcc cc IrcLc|hc ce
pcrIc :cc inúmerc: e c méIccc é :imp|e:, pccencc :er feiIc em ¢uc|¢uer
fc|hc ce pcpe|. Nc fcrmc mci: ccmum ce mcnIcgem cc pcrIcgrcmc,
uIi|izc-:e ce pcpe| ¢uccricu|ccc, cc|cccncc nc cL:ci::c {eixc X) c Iempc
em hcrc: e, nc: crcenccc: {eixc •), em cenI|meIrc:, c ci|cIcçcc cervicc|
c e:¢uercc e c ce:cicc cc cpre:enIcçcc c cireiIc. Fcrc c ce:cicc cc
cpre:enIcçcc, ccn:icerc-:e c p|cnc zerc ce De Lee cu c ccrre:pcncenIe
p|cnc lll ce Hccge - e:pinhc: cicIicc: nc e:IreiIc mécic cc Lccic - ccimc
ce:Ie pcnIc e:Icc c: vc|cre: negcIivc: e cLcixc c: pc:iIivc: ce De Lee
cu , re:pecIivcmenIe, c: p|cnc: l, ll e lV ce Hccge {Figurc 2).
6
USO DO PATOGRAMA NO ACOMPANHAMENTO DO TRABALHO DE PARTO
47
Figura 2 - Partograma em papel quadriculado: Marcadores dos eixos X
(abscissa) e Y (ordenadas), com os planos de De Lee e de Hodge
/ fcrmc cc: grcficc: fci cccpIccc pcrc ciferenIe: nece::iccce:. Umc
cc: mci: impcrIcnIe: fci c ce Fhi||pcII & Cc:I|e {1º72) ¢ue IrcLc|hcvc nc
cnIigc Fccé:ic, cnce c mcicric cc: pcrIc: erc rec|izccc pcr pcrIeirc: e
hcvic nece::iccce ce crienIc-lc: nc enccminhcmenIc cc: pcrIc:
ci:funcicnci: pcrc c hc:piIc|. Ccm Lc:e nc: ccnhecimenIc: criginci: cc
ci|cIcçcc cervicc|, ccn:Iru|rcm umc |inhc ce c|erIc, ¢ue :ervic pcrc
icenIificcr c: pccienIe: ccm pcrIc ce ri:cc. Cucncc c ci|cIcçcc cervicc|
cruzcvc c |inhc ce c|erIc, c pccienIe ceveric :er enccminhccc cc
hc:piIc|. Num inIervc|c ce 4 hcrc:, pccrcnizcrcm c |inhc ce cçcc,
pcrc|e|c c ce c|erIc, pcr¢ue e:Ie erc c Iempc ce Ircn:pcrIe cc
pcrIurienIe pcrc cenIrc: mécicc:, cnce :e efeIucvcm pcrIc: cpercIcric:
{Figurc 3).
Figura 3 - Linha de alerta e linha de ação (Phiipott & Castle, 1972)
6
USO DO PARTOGRAMA NO ACOMPANHAMENTO DO TRABALHO DE PARTO
48
/Iuc|menIe, c regi:Irc grcficc cc pcrIc é rec|izccc em cmLienIe
hc:piIc|cr e, pcrIcnIc, ncc hc c nece::iccce ce inIervençcc ¢ucncc c
ci|cIcçcc cIinge cu cruzc c |inhc ce c|erIc. C c|erIc imp|icc,
:imp|e:menIe, c nece::iccce ce umc me|hcr cL:ervcçcc c||nicc.
ScmenIe ¢ucncc c curvc cc ci|cIcçcc cervicc| cIinge c |inhc ce cçcc é
¢ue c inIervençcc mécicc Icrnc-:e nece::cric, nc IenIcIivc ce me|hcrcr
c evc|uçcc cc IrcLc|hc ce pcrIc e ccrrigir pc::|vei: ci:Iccic: ¢ue pc::cm
e:Icr :e inicicncc. l:Ic ncc :ignificc nece::cricmenIe ccncuIc cirúrgicc.
Nc fichc ce cccmpcnhcmenIc cc IrcLc|hc ce pcrIc, c|ém cc:
cncIcçce: referenIe: c cérvicc-ci|cIcçcc {pcrIcgrcmc), pccem IcmLém
:er regi:Irccc: c fre¢üencic ccrc|ccc feIc| {FCF), c: ccrccIer|:Iicc: cc:
ccnIrcçce: uIerinc:, c: ccnciçce: cc Lc|:c cc: cguc: e ||¢uicc
cmnicIicc, c infu:cc ce ||¢uicc: e c: e:pecificcçce: cc cnc|ge:ic {Figurc
4).
Fcrc c ccn:Iruçcc cc pcrIcgrcmc, c|gumc: cL:ervcçce: :cc
nece::cric:, exigincc cc e¢uipe umc pccrcnizcçcc ccmp|eIc.
1. No portogromo codo d|v|sor|o corresponde o umo horo no
obsc|sso {eixc x) e c um cenI|meIrc ce ci|cIcçcc cervicc| e ce
ce:cicc cc cpre:enIcçcc nc crcenccc {eixc y).
2. lnicic-:e c regi:Irc grcficc ¢ucncc c pcrIurienIe e:Iiver nc
fc:e cIivc cc IrcLc|hc ce pcrIc {cuc: c Irë: ccnIrcçce: eficienIe:
em 10 minuIc:, ci|cIcçcc cervicc| m|nimc ce 3 cm). Em cc:c ce
cúvicc, cgucrccr 1 hcrc e rec|izcr ncvc Ic¢ue: ve|cciccce ce
ci|cIcçcc ce 1cm/hcrc, verificccc em cci: Ic¢ue: :uce::ivc:,
ccnfirmc c cicgnc:Iicc ce fc:e cIivc cc IrcLc|hc ce pcrIc.
3. Fec|izcm-:e Ic¢ue: vcginci: :uL:e¢üenIe:, c cccc cuc:
hcrc:, re:peiIcncc em cccc cncIcçcc c Iempc expre::c nc
grcficc. Em cccc Ic¢ue ceve-:e cvc|icr c ci|cIcçcc cervicc|, c
c|Iurc cc cpre:enIcçcc, c vcrieccce ce pc:içcc e c: ccnciçce:
cc Lc|:c cc: cguc: e cc ||¢uicc cmnicIicc, ¢ucncc c Lc|:c e:Iiver
rcIc - pcr ccnvençcc, regi:Irc-:e c ci|cIcçcc cervicc| ccm um
Iricngu|c e c cpre:enIcçcc e re:pecIivc vcrieccce ce pc:içcc
:cc repre:enIccc: pcr umc circunferëncic.
4. C pccrcc cc: ccnIrcçce: uIerinc: e cc: LcIimenIc:
ccrc|ccc: feIci:, c infu:cc ce ||¢uicc: e crcgc: e c u:c ce
cnc|ge:ic cevem :er ceviccmenIe regi:Irccc:.
5. / ci|cIcçcc cervicc| inicic| é mcrcccc nc pcnIc
ccrre:pcncenIe cc grcficc, Ircccncc-:e nc hcrc imecicIcmenIe
:eguinIe c |inhc ce c|erIc e em pcrc|e|c, ¢ucIrc hcrc: cpc:,
c::inc|c-:e c |inhc ce cçcc, ce:ce ¢ue c pcrIurienIe e:Iejc nc fc:e
cIivc cc IrcLc|hc ce pcrIc {Fhi||pcI & Cc:I|e, 1º72).
6
USO DO PARTOGRAMA NO ACOMPANHAMENTO DO TRABALHO DE PARTO
49
Figura 4 - Modelo de ficha com partograma, e respectivas linhas de alerta e
ação, e outros registros de interesse no acompanhamento do trabalho de
parto
6
USO DO PARTOGRAMA NO ACOMPANHAMENTO DO TRABALHO DE PARTO
50
Nc evc|uçcc ncrmc| cc IrcLc|hc ce pcrIc, c curvc ce ci|cIcçcc cervicc|
:e prcce::c c e:¢uercc cc |inhc ce cçcc. Cucncc e::c curvc u|Ircpc::c
c |inhc ce cçcc, IrcIc-:e ce um pcrIc ci:funcicnc|. / ccn:Iruçcc ccrreIc
cc |inhc ce c|erIc e ce cçcc é funccmenIc| pcrc ¢ue :e eviIem errc: nc
inIerpreIcçcc cc pcrIc {Figurc 5).
F|guro 5 - Erro no construçõo do portogromo - |n|c|odo no |ose |otente do
trobo|ho de porto
6
USO DO PARTOGRAMA NO ACOMPANHAMENTO DO TRABALHO DE PARTO
51
Nc rec|iccce, vcric: c:pecIc: cevem e:Iimu|cr c cprencizccc cc u:c cc
pcrIcgrcmc nc c::i:Iëncic c||nicc cc pcrIc, ccn:icercncc cincc ¢ue o
OMS tornou obr|gotor|o o portogromo nos motern|dodes desde 1ºº4. C
:eu u:c fcci|iIc c cccmpcnhcmenIc cc IrcLc|hc ce pcrIc pcr
principicnIe: e c pc::cgem ce p|cnIcc cc pré-pcrIc, fcvcrecencc
IcmLém c uIi|izcçcc rccicnc| ce cciIccicc: e cnc|ge:ic. De::c fcrmc, c
u:c cc pcrIcgrcmc ceverc inIerferir :cLreIucc nc e|evccc incicëncic ce
ce:crec: :em inciccçcc cL:IéIricc. Suc uIi|iccce IcmLém é vc|crizccc
pe|c cicgnc:Iicc preccce cc: ci:Iccic: e :uc: re:pecIivc: inIervençce:.
/ icenIificcçcc cc: ci:Iccic: é feiIc pe|c cL:ervcçcc cc: curvc: ce
ci|cIcçcc cervicc| e ce ce:cicc cc cpre:enIcçcc expre::c: nc
pcrIcgrcmc. /: ci:Iccic: ce cccc per|ccc funcicnc| cc pcrIc e:Icc nc
IcLe|c 1.
Tabela 1 – Distócias diagnosticadas pelo partograma, a partir das linhas de
ação
6
USO DO PARTOGRAMA NO ACOMPANHAMENTO DO TRABALHO DE PARTO
52
Nc |ose ot|vo pro|ongodo cu ci:Iccic funcicnc|, c ci|cIcçcc cc cc|c
uIerinc cccrre |enIcmenIe, numc ve|cciccce mencr ¢ue 1 cm/hcrc
{Figurc ó). / curvc cc ci|cIcçcc u|Ircpc::c c |inhc ce c|erIc e, c: veze:, c
|inhc ce cçcc. E::c ci:Iccic gerc|menIe ceccrre ce ccnIrcçce: uIerinc:
ncc eficienIe: {fc|Ic ce mcIcr). / ccrreçcc é feiIc inicic|menIe pe|c
empregc ce Iécnicc: humcnizccc: ce e:I|mu|c cc pcrIc ncrmc| {ver
Ccp|Iu|c 3), pcr exemp|c e:Iimu|cncc-:e c cecmLu|cçcc e, :e
nece::cric, pc:IericrmenIe pe|c ccmini:Ircçcc ce cciIccinc cu rcIurc
crIificic| cc Lc|:c cc: cguc:.
6
USO DO PARTOGRAMA NO ACOMPANHAMENTO DO TRABALHO DE PARTO
53
Figura 6 – Fase ativa prolongada
6
USO DO PARTOGRAMA NO ACOMPANHAMENTO DO TRABALHO DE PARTO
54
A porodo secundór|o do d||otoçõo é cicgnc:Iicccc pcr cci: Ic¢ue:
:uce::ivc:, ccm inIervc|c ce 2 hcrc: cu mci:, ccm c mu|her em IrcLc|hc
ce pcrIc cIivc. Ne::e Iipc ce ci:Iccic, c ci|cIcçcc cervicc| permcnece c
me:mc curcnIe cuc: hcrc: cu mci:, u|Ircpc::c c |inhc ce c|erIc e, pcr
veze:, c |inhc ce cçcc {Figurc 7). Hc c::ccicçcc fre¢üenIe ccm
:cfrimenIc feIc| cgrcvcncc c prcgnc:Iicc perincIc|. / ccu:c principc| e c
ce:prcpcrçcc céfc|c-pé|vicc re|cIivc cu cL:c|uIc. Desproporçõo cé|o|o-
pé|v|co obso|uto Irccuz Icmcnhc cc pc|c cefc|icc mcicr ¢ue c Lccic
{feIc mccrc::cmicc) cu feIc ce Icmcnhc ncrmc| e Lccic cL:IéIricc
incce¢uccc. Nc vigëncic ce ce:prcpcrçcc céfc|c-pé|vicc cL:c|uIc, c
re:c|uçcc cc ge:Icçcc é feiIc pcr ce:crec. Ccn:icerc-:e desproporçõo
re|ot|vo ¢ucncc exi:Ie cefeiIc ce pc:içcc cc cpre:enIcçcc: cef|excc cu
vcrieccce: ce pc:içcc Ircn:ver:c: cu pc:Iericre:. Ne:Ic: ccnciçce:, c
cecmLu|cçcc, c rcIurc crIificic| cc Lc|:c cc: cguc: cu c cnc|ge:ic
pericurc| pccem fcvcrecer c evc|uçcc ncrmc| cc pcrIc. Nc: cc:c: ce
memLrcnc: rcIc:, c cecmLu|cçcc :c ceve :er reccmencccc ccm c
pc|c cefc|icc ccmp|eIcmenIe cpciccc nc Lccic mcIernc, pcrc eviIcr c
cccrrëncic ce prc|cp:c ce ccrccc umLi|icc|. / re:c|uçcc pcr ce:crec
ceverc :er incicccc ¢ucncc e::e: prccecimenIc: ncc fcrem eficienIe:
pcrc ccrrigir c evc|uçcc cncrmc| cc cérvicc-ci|cIcçcc cL:ervccc nc
pcrIcgrcmc.
6
USO DO PARTOGRAMA NO ACOMPANHAMENTO DO TRABALHO DE PARTO
55
Figura 7 – Parada secundária da dilatação
6
USO DO PARTOGRAMA NO ACOMPANHAMENTO DO TRABALHO DE PARTO
56
C porto prec|p|todo cu Ic¢uiIccicc é cicgnc:Iicccc ¢ucncc c ci|cIcçcc
cervicc| e c ce:cicc e expu|:cc cc feIc cccrrem num per|ccc ce 4 hcrc:
cu menc: {Figurc 8). C pccrcc cc ccnIrcIi|iccce uIerinc é ce
Ic¢ui::i:Ic|ic e hiper:i:Ic|ic e, cc:c c p|ccenIc e:Iejc nc |imiIe ce :uc
funçcc, pcce cccrrer c :cfrimenIc feIc|. Lccercçce: cc IrcjeIc IcmLém
:cc mci: fre¢üenIe: ne:Ie Iipc ce pcrIc, pci: ncc hc Iempc pcrc
cccmcccçcc cc: Iecicc: pé|vicc:, cccrrencc ce:cicc e expu|:cc cc
feIc ce mccc cLrupIc. C pcrIc Ic¢uiIccicc pcce :er e:pcnIcnec em
mu|I|pcrc:, :encc mci: rcrc em prim|pcrc:. IcmLém pcce cccnIecer em
ceccrrëncic ce icIrcgenic pe|c ccmini:Ircçcc exce::ivc ce cciIccinc.
Ne:Ie cc:c, ceve-:e :u:pencer c infu:cc ce cciIccinc cIé c reIcrnc c um
pccrcc ccnIrcIurc| ncrmc|. Or|ento-se otençõo ò v|to||dode |eto| no
período de d||otoçõo cerv|co| e rev|sõo deto|hodo do cono| de porto
opos o dequ|toçõo.
6
USO DO PARTOGRAMA NO ACOMPANHAMENTO DO TRABALHO DE PARTO
57
Figura 8 – Parto precipitado
6
USO DO PARTOGRAMA NO ACOMPANHAMENTO DO TRABALHO DE PARTO
58
C período pé|v|co pro|ongodo mcnife:Ic-:e nc pcrIcgrcmc ccm c
ce:cicc prcgre::ivc cc cpre:enIcçcc, mc: exce::ivcmenIe |enIc {Figurc
º). NcIc-:e ci|cIcçcc ccmp|eIc cc cc|c uIerinc e cemcrc nc ce:cicc e
expu|:cc cc feIc. E::c ci:Iccic gerc|menIe e:Ic re|ccicnccc c
ccnIrcIi|iccce uIerinc ceficienIe e :uc ccrreçcc é cLIicc pe|c
ccmini:Ircçcc ce cciIccinc, rcIurc crIificic| cc Lc|:c cc: cguc: e, cincc,
pe|c uIi|izcçcc cc fcrcipe, ce:ce ¢ue preenchicc: c: pré-re¢ui:iIc: pcrc
:uc cp|iccçcc. IcmLém reccmencc-:e c pc:içcc verIicc|izccc pcrc
fcvcrecer c ce:cicc cc cpre:enIcçcc.
6
USO DO PARTOGRAMA NO ACOMPANHAMENTO DO TRABALHO DE PARTO
59
Figura 9 – Período pélvico prolongado
6
USO DO PARTOGRAMA NO ACOMPANHAMENTO DO TRABALHO DE PARTO
60
/ pcrccc :ecunccric cc ce:cicc é cicgnc:Iicccc pcr cci: Ic¢ue:
:uce::ivc:, ccm inIervc|c ce 1 hcrc cu mci:, ce:ce ¢ue c ci|cIcçcc cc
cc|c uIerinc e:Iejc ccmp|eIc. Ccn:icerc-:e ¢ue hc pcrccc :ecunccric
cc prcgre::cc cc cpre:enIcçcc ¢ucncc cccrre ce::cçcc cc ce:cicc
pcr pe|c menc: 1 hcrc cpc: c :eu in|cic {Figurc 10). Deve Ier prcnIc
ccrreçcc. Hc nece::iccce ce :e recvc|icr c: re|cçce: feIc-pé|vicc:, pci:
c ccu:c mci: fre¢üenIe ce::e Iipc ce ci:Iccic é c ce:prcpcrçcc céfc|c-
pé|vicc re|cIivc cu cL:c|uIc. / pre:ençc ce ce:prcpcrçcc cL:c|uIc |evc
c inciccçcc ce ce:crec. Nc vigëncic ce ce:prcpcrçcc re|cIivc, ccm
pc|c cefc|icc prcfunccmenIe in:inuccc e cérvicc-ci|cIcçcc ccmp|eIc, é
vc|icc c IenIcIivc ce fcrcipe ce Ircçcc cu rcIcçcc, cepencencc cc
vcrieccce ce pc:içcc.
6
USO DO PARTOGRAMA NO ACOMPANHAMENTO DO TRABALHO DE PARTO
61
Figura 10 - Parada secundária descida
6
USO DO PARTOGRAMA NO ACOMPANHAMENTO DO TRABALHO DE PARTO
62
Scc vcric: c: mcce|c: ce pcrIcgrcmc: cpre:enIccc: nc |iIercIurc e
¢uc|¢uer ce|e: cIinge c me:mc cLjeIivc - c me|hcric cc ¢uc|iccce ce
c::i:Iëncic cc pcrIc. 0 CL/F {CenIrc LcIinc /mericcnc ce FerincIc|cgic e
De:envc|vimenIc Humcnc) pccrcnizcu um mcce|c prcpric e c CMS
IcmLém civu|gcu um cuIrc Iipc ce pcrIcgrcmc, ccm |inhc: ce c|erIc e
ce cçcc, ce cp|iccçcc univer:c|. Umc ccmpcrcçcc cc: pcrIcgrcmc: cc
CL/F {Schwcrcz eI c|., 1ººó) e c ce Fhi|pcII & Cc:I|e {1º72) cccIccc pe|c
CMS, :c|ienIc c: :eguinIe: re:u|Iccc: {Scnchez, 1ººº):
1. C: cci: mcce|c: fcrcm ccnccrccnIe: em º0,47 cc: inciccçce:
cc vic ce pcrIc
2. / Fcci|iccce ce ccn:Iruçcc e c prcIiciccce ce cp|iccçcc cc
pcrIcgrcmc ce Fhi|pcII & Cc:I|e {1º72) fc|cm c fcvcr ce :uc
e:cc|hc em re|cçcc cc cc CL/F nc prcIicc cicric.
Nc uIi|izcçcc prcIicc cc pcrIcgrcmc cc CL/F, pcce-:e :imp|ificcr :uc
ccn:Iruçcc, uIi|izcncc-:e cpenc: c curvc ce ci|cIcçcc cervicc| mci:
|enIc, ¢ue :e refere c: mu|here: ceiIccc:, nu||pcrc: e ccm memLrcnc:
|nIegrc: {Figurc 11).
Figura 11 - Curva de dilatação em nulíparas, na posição horizontal e com
membranas íntegras (Schwarcz et al.. 1996).
6
USO DO PARTOGRAMA NO ACOMPANHAMENTO DO TRABALHO DE PARTO
63
Vc|e :er refcrçccc ¢ue c: :erviçc: e prcfi::icnci: hcLiIuccc: c uIi|izcçcc
ce:Ie in:IrumenIc ncc preci:cm Irccc-|c, pci: cmLc: c: mcce|c: :cc
ccnccrccnIe: nc grcnce mcicric cc: cicgnc:Iicc: {Scnchez, 1ººº).
C pcrIcgrcmc é um verccceirc reIrcIc ce ccrpc inIeirc cc evc|uçcc ce
ceIerminccc pcrIc. / impcrIcncic cc pcrIcgrcmc ccnfirmc-:e ¢ucncc,
num mcmenIc cefinicc, cvc|icmc: c evc|uçcc cc pcrIc ccmc um Iccc:
c ci|cIcçcc cervicc|, c ce:cicc cc cpre:enIcçcc, c pc:içcc feIc|, c
vcrieccce ce pc:içcc, c fre¢üëncic ccrc|ccc feIc|, c: ccnIrcçce:
uIerinc:, c infu:cc ce ||¢uicc e c cnc|ge:ic. C excme ccmp|eIc ce Iccc:
e::c: vcricvei: permiIe ccnhecer c evc|uçcc cc pcrIc e cc: fcIcre:
eIic|cgicc: re:pcn:cvei: pe|c :uc evc|uçcc ncrmc| cu cncrmc|.
lcenIificccc c ci:Iccic nc pcrIcgrcmc e reccnhecicc :uc eIic|cgic, c
crienIcçcc IercpëuIicc :erc |cgicc e eficcz. Sem cúvicc, c uIi|izcçcc cc
pcrIcgrcmc me|hcrc c ¢uc|iccce cc c::i:Iëncic c||nicc cc pcrIc,
cevencc :er inc|u|cc nc rcIinc cc: mcIerniccce:.
6
64
C prcgre::c Iécnicc e cienIificc cc mecicinc em gerc|,
e cc CL:IeIr|cic, NecncIc|cgic e /ne:Ie:ic|cgic em
pcrIicu|cr, Icrncu c pcrIc um prccecimenIc mci:
:egurc e menc: cc|crc:c. / cce¢uccc c::i:Iëncic cc
pcrIc e c nece::cric re:peiIc cc: ce:ejc: e cireiIc: cc
mu|her pcrIurienIe ccmpreencem :eu ccnfcrIc,
:egurcnçc e Lem-e:Icr. l:Ic imp|icc umc :érie ce
nece::iccce: cnce :e inc|uiu c ccnIrc|e cce¢uccc cc
ccr cc IrcLc|hc ce pcrIc e c cccmpcnhcmenIc cc
IrcLc|hc ce pcrIc pcr pe::cc ce :uc e:cc|hc, ¢ue |he
cë c cpcic emccicnc| nece::cric pcrc e:Ie per|ccc.
C pcrIc ccn:IiIui um cc: pcnIc: funccmenIci: cc vicc
p:icc-:exuc| cc mu|her. /::im, ¢ucncc é vivenciccc
ccm ccr, cngú:Iic, mecc e i:c|cmenIc, pcce |evcr c
ci:IúrLic: p:icc|cgicc:, cfeIivc: e emccicnci:,
pccencc inf|uencicr c re|ccicncmenIc mce/fi|hc, c|ém
ce :uc vicc cfeIivc e ccnjugc|. 0 mecc gerc ccr e c
ccr cumenIc c mecc.
C cireiIc cc cccmpcnhcmenIc cc ge:IcnIe é jc
reccnhecicc em civer:c: in:Icncic:, inc|uincc c
Mini:Iéric cc Scúce, enIreIcnIc ncc e prcIicccc ce
fcrmc regu|cr e :i:IemcIicc em Iccc c pc|:. /c
ccnIrcric, ce mcneirc gerc|, cpenc: c: mu|here: mci:
fcvcrecicc: eccncmiccmenIe, ¢ue Iëm :eu: pcrIc:
cIrcvé: ce :egurc: em hc:piIci: privccc:, é ¢ue :e
uIi|izcm ce:Ie cireiIc.
lcec|menIe, e:Ie cccmpcnhcmenIc curcnIe c
IrcLc|hc ce pcrIc pre::upce c cce¢uccc prepcrc cc
mu|her pcrc e:Ie mcmenIc, jc iniciccc curcnIe c pré-
ncIc| {ver Ccp|Iu|c 3). EmLcrc e:Ie cpcic c pcrIurienIe
ncc cevc :er enIencicc e:IriIcmenIe ccmc umc fcrmc
c|IerncIivc ce pc::|ve| ccnIrc|e cc ccr curcnIe e:Ie
per|ccc, mc: :cLreIucc ccmc um cireiIc :eu nc
prcce::c ce humcnizcçcc cc nc:cimenIc, ce fcIc
repre:enIc um fcIcr ce grcnce cjucc.
C cccmpcnhcmenIc pe|c mcricc, ccmpcnheirc,
fcmi|icr prcximc cu cmigc ncc envc|ve
nece::cricmenIe nenhum prepcrc Iécnicc.
Fepre:enIc, mci: ¢ue nccc, c :upcrIe p:|¢uicc
7 ACOMPANHAMENTO DURANTE O TRABALHO DE
PARTO (SUPORTE PSICOSSOCIAL)
ACOMPANHAMENTO DURANTE O TRABALHO DE PARTO (SUPORTE PSICOSSOCIAL)
65
e emccicnc| cc pre:ençc reccnfcrIcnIe, cc ccnIcIc f| :icc, pcrc civicir c
mecc e c cn:ieccce, pcrc :cmcr fcrçc:, pcrc e:Iimu|cr pc:iIivcmenIe c
pcrIurienIe nc: mcmenIc: mci: cif|cei:.
/: Iécnicc: ce re|cxcmenIc e exerc|cic: re:pircIcric: c::cciccc: c:
infcrmcçce: receLicc: pe|c ge:IcnIe em :eu prepcrc pcrc c pcrIc Iëm
:icc cLjeIc ce e:Iucc: ¢ucnIc c :uc inf|uëncic curcnIe c IrcLc|hc ce
pcrIc e pcrIc. Exi:Iem c|gumc: evicëncic: ce ¢ue :e c::cciem c c|gun:
efeiIc: Lenéficc:, ccmc c mencr nece::iccce ce u:c ce crcgc: cpicice:
e ce cnc|ge:ic pericurc|, ccm umc mcicr prcpcrçcc ce pcrIc: vcginci: e
ccm umc mcicr :cIi:fcçcc cc mu|her ccm c pcrIc.
C prcce::c ce humcnizcçcc cc nc:cimenIc, ¢ue inc|ui IcmLém c
pc::iLi|iccce ce um cccmpcnhcnIe c pcrIurienIe, envc|ve
nece::cricmenIe umc muccnçc ce cIiIuce:. lnicic|menIe cc prcfi::icnc|
ce :cúce ¢ue é pcrIe inIegrcnIe cc e¢uipe ¢ue pre:Ic cIençcc inIegrc|
c e:Ic mu|her, revencc :eu: ccnceiIc:, ceixcncc ce |ccc :eu:
preccnceiIc:, pcrc fcvcrecer um ccc|himenIc ccmp|eIc, Iécnicc e
humcnc c mu|her. Envc|ve IcmLém c muccnçc ce cIiIuce cc in:IiIuiçcc,
¢ue ceve e:Icr e:IruIurccc e prepcrccc pcrc e:Ic ncvc pc:Iurc,
incenIivcncc, fcvcrecencc, e:Iimu|cncc, Ireincncc e ccnIrc|cncc :eu:
prcfi::icnci: pcrc c ce:empenhc ce:Ic: Icrefc:. /|ém ci::c, c: in:IiIuiçce:
cevem IcmLém e:Icr ccmini:IrcIivc e e:IruIurc|menIe prepcrccc: pcrc
c prcce::c, cmpcrccc: e :upcrIccc: per ncrmc: e cireIrize: emcnccc:
pe|c: in:IiIuiçce: re:pcn:cvei: pe|c :cúce nc pc|:. É ne:Ie ccnIexIc ¢ue c
Mini:Iéric cc Scúce Iem envicccc Iccc: c: e:fcrçc: nc :enIicc ce
e:Iimu|cr e prcpicicr c inIrccuçcc ce:Ic: ncvc: prcIicc: nc:
mcIerniccce: Lrc:i|eirc:.
Acomponhomento no porto [dou|o}
/|ém cc cccmpcnhcmenIc pe|c pcrenIe cu ccmpcnheirc, exi:Ie
IcmLém c cccmpcnhcmenIc per cuIrc pe::cc, ccm cu :em
IreincmenIc e:pec|ficc pcrc i:Ic, c ccu|c. E|c pre:Ic ccn:IcnIe cpcic c
ge:IcnIe e :eu ccmpcnheirc/cccmpcnhcnIe curcnIe c IrcLc|hc ce
pcrIc, enccrcjcncc, cccn:e|hcncc mecicc: pcrc :eu ccnfcrIc,
prcpcrcicncncc e crienIcncc ccnIcIc f|:icc e exp|iccncc :cLre c
prcgre::c cc IrcLc|hc ce pcrIc e prccecimenIc: cL:IéIricc: ¢ue cevem
:er rec|izccc:.
Diver:c: en:cic: c||nicc: c|ecIcrizccc: :ugerem ¢ue c cccmpcnhcmenIc
cc pcrIurienIe pe|c ccu|c recuz c curcçcc cc IrcLc|hc ce pcrIc, c u:e
ce meciccçce: pcrc c||vic cc ccr e c númerc ce pcrIc: cpercIcric:.
/|gun: e:Iucc: IcmLém mc:Ircm c recuçcc cc númerc ce ce:crec:.
/|ém ce:Ic: vcnIcgen:, IcmLém é cL:ervccc ¢ue c: grupc: ce
pcrIurienIe: cccmpcnhccc: curcnIe c pcrIc pe|c ccu|c Iëm menc:
cepre::cc pc:-pcrIc e cmcmenIcm :eu: recém-nc:cicc: nc: primeirc:
:ei: :emcnc: ce vicc em mcicr prcpcrçcc ¢ue c: pcrIurienIe: cc: grupc:
ce ccnIrc|e.
/ pre:ençc ce umc pe::cc Ireinccc pcrc cccmpcnhcmenIc cc
IrcLc|hc ce pcrIc ncc e ccrc e ncc re¢uer infrc-e:IruIurc cu
cpcre|hcgem e:pecificc. EvicenIemenIe, IcmLém ncc Iem ¢uc|¢uer
7
ACOMPANHAMENTO DURANTE O TRABALHO DE PARTO (SUPORTE PSICOSSOCIAL)
66
ccnIrc-inciccçcc. C IreincmenIc pcce :er feiIc IcnIc enIre c prcpric
pe::cc| prcfi::icnc| cc: mcIerniccce:, ccmc enIre inciv|cuc: cc
ccmuniccce. / cpçcc pcr ¢uc|¢uer umc ce:Ic: c|IerncIivc: ceve
cepencer, pe|c menc: pcr en¢ucnIc, cc ci:pcniLi|iccce e e:IrcIégic
cccIccc |ccc|menIe.
FecenIemenIe, umc revi:cc :i:IemcIicc :cLre c prcIicc ce um :upcrIe
:ccic| ccnI|nuc, inc|uincc ccn:e|hc: e infcrmcçce:, c::i:Iëncic e cpcic
emccicnc|, curcnIe Iccc c IrcLc|hc ce pcrIc, fcrnecicc c: mu|here: pcr
prcfi::icnci: ce :cúce cu pe::cc: |eigc:, ccmpcrcIivcmenIe c umc
c::i:Iëncic pccrcc :em e:Ic: ccrccIer|:Iicc:, ccnc|uiu ¢ue e:Ie Iipc ce
cpcic pcrece Ier vcric: Lenef|cic: pcrc c: mce: e :eu: recém nc:cicc:,
:em nenhum efeiIc ccnc:c. Ic| cpcic emccicnc| pre::upce, enIre cmLc:
envc|vicc:, c pre:ençc, c e:cuIcr, c ccr :egurcnçc e cfirmcçcc.
/vc|icncc 14 en:cic: c||nicc: envc|vencc mci: ce 5 mi| mu|here: ce
pc|:e: IcnIc ce:envc|vicc: ¢ucnIc em ce:envc|vimenIc, e:Ic
inIervençcc e:Ieve c::cciccc c recuçcc cc nece::iccce ce meciccçcc
pcrc c||vic cc ccr, cc pcrIc vcginc| cpercIcric, cc ce:crec e cc
cepre::cc necncIc|, c|ém ce umc |eve recuçcc nc curcçcc cc IrcLc|hc
ce pcrIc. Cucncc c: e:Iucc: cvc|icrcm c: efeiIc: ce:Ic inIervençcc
:cLre c vivëncic cc: mu|here: ¢ucnIc cc nc:cimenIc, Iccc: c: re:u|Iccc:
fcrcm fcvcrcvei: cc grupc receLencc e:Ie cpcic ccnI|nuc. /: pe::cc:
fcrnecencc e:Ie Iipc ce cpcic ercm Iccc: mu|here: e ccm experiëncic,
:ejc pcr¢ue Iinhcm jc cccc c |uz cu Iicc IreincmenIc ccmc enfermeirc:,
cL:IeIrize:, ccu|c: cu ecuccccrc: em :cúce.
/pe:cr ce :ugerirem IcmLém um efeiIc Lenéficc c |cngc prczc :cLre c
:cúce f|:icc e p:icc::ccic| cc: mu|here: e :cLre c c|eiIcmenIc mcIernc,
c: evicëncic: ncc :cc cefiniIivc: c e:Ie re:peiIc. Ncc :e ccnhece
IcmLém cincc ¢uc| prcfi::icnc| cu |eigc Ieric me|hcr ce:empenhc
exercencc e:Ic inIervençcc, nem :eu efeiIc c |cngc prczc :cLre c :cúce
cc: recém-nc:cicc:.
De::c fcrmc, cccc: c: ine¢u|vccc: Lenef|cic: e c cu:ëncic ce ri:cc:
c::cciccc: cc cpcic ccnI|nuc curcnIe c IrcLc|hc ce pcrIc, Iccc: c:
e:fcrçc: cevericm :er feiIc: nc :enIicc ce gcrcnIir ¢ue Iccc mu|her em
IrcLc|hc ce pcrIc c receLe::e. E|e ceveric inc|uir c pre:ençc ccnI|nuc cc
pe::cc e:cc|hicc pcrc cccmpcnhc-|c, ccpcz ce Ircn:miIir-|he ccnfcrIc e
enccrcjcmenIc. É evicenIe ¢ue em c|gumc: circun:Icncic: i:Ic pcceric
:ignificcr c nece::iccce ce c|Iercr c: cIriLuiçce: ce prcfi::icnci: ccmc
enfermeirc: e cL:IeIrize:: ce prcgrcmc: ce ecuccçcc ccnIinuccc pcrc c
en:inc e prcIicc ce:Ic: cIiviccce:: ce mccificcçce: nc e:IruIurcçcc e
ccmpc:içcc cc e¢uipe prcfi::icnc| cc: uniccce: ¢ue c::i:Iem c:
mu|here: em IrcLc|hc ce pcrIc: e cc cccçcc ce pc||Iicc: in:IiIucicnci:
¢ue permiIi::em e e:Iimu|c::em c pre:ençc ce pe::cc: |eigc: experienIe:
cc |ccc cc: pcrIurienIe:.
Em ¢ue pe:em Iccc: c: experiëncic: recenIe:, IcnIc inIernccicnci: ccmc
Lrc:i|eirc:, ce e:I|mu|c cc pcrIc ccmici|icr {pcr cpçcc e ncc pcr fc|Ic
ce|c) nc: :iIucçce: ce ge:Icçcc ce Lcixc ri:cc, ncc exi:Ie cincc
nenhumc evicëncic cienI|ficc cemcn:Ircncc ¢uc|¢uer c|crc Lenef|cic
:cLre c :cúce cc mu|her cu cc recém-nc:cicc ce:Ic inIervençcc, ccm
re|cçcc cc pcrIc in:IiIucicnc|.
7
ACOMPANHAMENTO DURANTE O TRABALHO DE PARTO (SUPORTE PSICOSSOCIAL)
67
É :cLicc, pcrém, ¢ue c cpcic :ccic| em cc:c, pcrc c: ge:IcnIe:
:ccic|menIe ce:fcvcrecicc:, ccmpcrcIivcmenIe c cu:ëncic ce:Ie cpcic,
c::ccic-:e ccm me|hcre: re:u|Iccc: cc :cúce cc cricnçc e :cLre c
experiëncic vivicc. Ncc :e :cLe, ccnIucc, :e c ccnccmiIcncic ce:Ic:
inIervençce: pcrc c me:mc grupc ce mu|here: pc::c Ier um efeiIc
Lenéficc cciIivc.
Atr|bu|çöes do ocomponhonte tre|nodo
/ cccmpcnhcnIe Ireinccc, c|ém cc cpcic emccicnc|, ceve fcrnecer
infcrmcçce: c pcrIurienIe :cLre Iccc c ce:enrc|cr cc IrcLc|hc ce pcrIc e
pcrIc, inIervençce: e prccecimenIc: nece::cric:, pcrc ¢ue c mu|her
pc::c pcrIicipcr ce fcIc cc: ceci:ce: ccercc cc: ccncuIc: c :erem
Icmccc: curcnIe e:Ie per|ccc. DurcnIe c IrcLc|hc ce pcrIc e pcrIc, c
cccmpcnhcnIe:
• #46'*)% % 2/-7'4 % %((/264 % <#(6+,# ./' 2%6( -7' %>4%$' $/4%*)'
%( 1#*)4%+A'(B
• ;%3#4'1' % 2%*/)'*+,# $' /2 %2@6'*)' )4%*.L6-# ' %1#-7'$#4?
1#2 (6-9*16# ' <463%16$%$'B
• %/56-6% *% /)6-60%+,# $' ):1*61%( 4'(<64%)J46%(? 2%((%>'*( ' @%*7#(
2#4*#(B
• #46'*)% % 2/-7'4 (#@4' #( 2:)#$#( <%4% # %-Y36# $% $#4 ./'
<#$'2 ('4 /)6-60%$#(? (' *'1'((846#(B
• '()62/-% % <%4)616<%+,# $# 2%46$# #/ 1#2<%*7'64# '2 )#$# #
<4#1'((#B '
• %<#6% ' #46'*)% % 2/-7'4 $/4%*)' )#$# # <'4Y#$# '5</-(63#?
6*1-/6*$# % <#((6@6-6$%$' $% -6@'4$%$' $' '(1#-7% ./%*)# Z <#(6+,#
% ('4 %$#)%$%E
/pc: c nc:cimenIc, c cccmpcnhcnIe cincc:
• 6*;#42% ' #46'*)% % 2/-7'4 ./%*)# Z $'./6)%+,# ' %#
1-%2<'%2'*)# $# 1#4$,#B
• '()62/-% % 1#-#1%+,# $# 4'1:2I*%(16$# (#@4' # %@$#2' 2%)'4*#?
*/2 1#*)%)# <'-' % <'-'? '()62/-%*$# # 6*Y16# $% (/1+,# %# <'6)#
2%)'4*# ' ;%3#4'1'*$# # 3Y*1/-# %;')63# 2,'I;6-7#B '
• <#()'46#42'*)'? 6*;#42% ' #46'*)% )%2@:2 ./%*)# %# 6*Y16# '
2%*/)'*+,# $# %-'6)%2'*)# 2%)'4*#E
Iccc: e:Ic: cIiviccce:, c|ém ce me|hcrcr c vivëncic experimenIccc
pe|c: mu|here: ¢ue ccc c |uz, pcrecem Ier umc inf|uëncic cireIc e
pc:iIivc :cLre c :cúce cc: mu|here: e cc: recém-nc:cicc:. Devem,
pcrIcnIc, :er e:Iimu|ccc: em Iccc: c: :iIucçce: pc::|vei:. /c me:mc
Iempc, Ici: mecicc: cevericm :er cLjeIc ce e:Iucc: ceIc|hccc: :cLre
:uc efeIiviccce em ciferenIe: ccnIexIc:, ccm c cLjeIivc ce cumenIcr c
ccnhecimenIc rec| ce :eu: efeiIc: :cLre c :cúce.
7
68
/ ccr, pe|c :eu ccrcIer :uLjeIivc, é um :inIcmc ce
cif|ci| cvc|icçcc. E:Iucc: :cLre c inIen:iccce cc ccr nc
pcrIc cemcn:Ircrcm ¢ue, incepencenIemenIe ce
inf|uëncic: :ccic-cu|Iurci:, e|c pcce :er ccn:icerccc
in:upcrIcve| pcrc um grcnce númerc ce mu|here:.
FcrIcnIc, é impercIivc ¢ue cçce: ce :cúce prcpiciem
ccnciçce: ncc :cmenIe :egurc:, mc: vc|Iccc: cc:
c:pecIc: ce humcnizcçcc cc pcrIc, re:gcIcncc c
verccceirc pc:Iurc cc mu|her, cc fcm||ic, cc
:ccieccce e cc: prcfi::icnci: ce :cúce, nc ¢ue :e
refere cc mcmenIc cc nc:cimenIc ce um fi|hc, ¢ue
repre:enIc um mcrcc nc vicc ce umc fcm||ic e ncc
pcce :er enccrccc cpenc: ccmc um cIc mécicc,
ccm ënfc:e :cmenIe nc: :eu: c:pecIc: Iécnicc: cu
c||nicc:. Fccer receLer umc cIençcc curcnIe c
IrcLc|hc ce pcrIc ¢ue cfereçc c pc::iLi|iccce ce
ccnIrc|e cc ccr ¢ucncc, e, :e nece::cric, é um cireiIc
cc mu|her Lrc:i|eirc, gcrcnIicc pcr pcrIcric: cc
Mini:Iéric cc Scúce {nc 2.815 ce 1ºº8 e,
pc:IericrmenIe, c ce nc 572 ce 2000), ¢ue inc|uem c
cnc|ge:ic ce pcrIc nc IcLe|c ce prccecimenIc:
cL:IéIricc: remunerccc: pe|c SUS.
Anotom|o e F|s|o|og|o
/ ccr repre:enIc um impcrIcnIe :inc| cc in|cic cc
IrcLc|hc ce pcrIc. C ccmpcnenIe mci: impcrIcnIe cc
ccr é c ci|cIcçcc cc cc|c uIerinc, :cmccc c cuIrc:
fcIcre: ccmc: ccnIrcçcc e ci:Ien:cc cc: fiLrc:
uIerinc:, ci:Ien:cc cc ccnc| ce pcrIc, Ircçcc ce
cnexc: e periIcnic, pre::cc nc ureIrc, Lexigc e cuIrc:
e:IruIurc: pé|vicc:, e pre::cc :cLre c: rc|ze: cc p|exc
|cmLc-:ccrc. / inervcçcc uIerinc e cnexic| é
cuIcncmicc, meciccc principc|menIe pe|c Si:Iemc
Nervc:c SimpcIicc, ¢ue ccncuz e:I|mu|c: ce
ccrccIer|:Iicc: vi:cerci:, ccm cferëncic: nc Si:Iemc
Nervc:c CenIrc| nc n|ve| ce I10, I11, I12, L1. Ccm c
evc|uçcc cc IrcLc|hc ce pcrIc e prcgre::cc cc
cpre:enIcçcc, c ccr c::ume ccrccIer|:Iicc: :cmcIicc:
em ceccrrëncic cc ci:Ien:cc perinec|. C nervc
pucencc, fcrmccc pcr fiLrc: ce S2-S3-S4, inervc c
mcicr pcrIe cc regicc perinec|. E::e: impu|:c:
nccicepIivc: :cc ccncuzicc: principc|menIe
8
O CONTROLE DA DOR NO TRABALHO DE PARTO
O CONTROLE DA DOR NO TRABALHO DE PARTO
69
pcr fiLrc: /-8 e C, ¢ue peneIrcm nc ccrnc ccr:c| cc mecu|c e fczem
:incp:e: ccm neurcnic: ¢ue prc::eguem pcrc cenIrc: :upericre: e cuIrc:
envc|vicc: em crcc: ref|exc: mecu|cre:, :cfrencc ne:Ie |ccc| um
ccmp|exc prcce::c ce mccu|cçcc. E:Ie prcce::c, principc|menIe
¢ucncc inIen:c, prcvccc re:pc:Ic: ref|exc: :egmenIcre:,
:uprc:egmenIcre: e ccrIicci:, ¢ue inc|uem e:Iimu|cçcc re:pircIcric,
circu|cIcric, ce cenIrc: hipcIc|cmicc: ce funçcc neurcencccrinc
preccmincnIemenIe :impcIicc, ce e:IruIurc: ||mLicc: e ce meccni:mc:
p:icccincmicc: ce cn:ieccce e cpreen:cc.
kepercussöes Moterno-Feto|s
DenIre c: c|Iercçce: fi:ic|cgicc: ¢ue cccmpcnhcm c ccr, pccem :e
ce:Icccr:
• %/2'*)# $# 3#-/2' 26*/)#? %1#2<%*7%$# $' %/2'*)# $#
1#*(/2# $' #56>9*6# '2 )#4*# $' WQ[ %162% $#( *Y3'6( %*)'46#4'( %#
)4%@%-7# $' <%4)#? <#$'*$# 17'>%4 %): VQQ[ $/4%*)' # ('>/*$#
'()8>6#E K()% 76<'43'*)6-%+,# <#$' $626*/64 % \%]M2 2%)'4*% '2 VQ %
PQ 22^> ' '-'3%4 # <^ %4)'46%- %): _?OOI_?RQE S 76<#18<*6% <#$'
$626*/64 # '()Y2/-# 3'*)6-%)J46# 2%)'4*#? 4'$/06*$# % \%M2 2%)'4*% '2
VQ % OQ[E `/%*$# % \%M2 2%)'4*% 1%6 %@%65# $' _Q 22^>? # ;')#
<#$' (#;4'4 76<#5'26% ' %<4'('*)%4 $'(%1'-'4%+A'( $' (/% ;4'.L9*16%
1%4$Y%1%B
• %/2'*)# <4#>4'((63# $# $:@6)# 1%4$Y%1# 2%)'4*#E ^8? 6*616%-2'*)'?
/2 %/2'*)# $' VQ % VO[ *# <'4Y#$# $' $6-%)%+,#? OQ[ $/4%*)' #
('>/*$# <'4Y#$# ' <#$' 17'>%4 %): XQ[ %162% $#( 3%-#4'(
<4'-626*%4'(? 62'$6%)%2'*)' %<J( # <%4)#B
• %/2'*)# $#( *Y3'6( $' %$4'*%-6*%? *#4%$4'*%-6*%? 1#4)6(#- ' S]"^ *#
(%*>/' 2%)'4*#B
• 2#$6;61%+A'( $% ;/*+,# >%()4#6*)'()6*%-B '
• %16$#(' 2')%@J-61% 2%)'4*% <4#>4'((63%E
IcnIc c ccr ccmc c cn:ieccce e c ccn:e¢üenIe cumenIc cc :ecreçcc
ce ccrIi:c| e ccIecc|cminc: pccem cfeIcr c ccnIrccIi|iccce e c f|uxc
:cngü|nec uIerinc:. Umc vez cicgnc:Iicccc c IrcLc|hc ce pcrIc e c
regu|criccce cc: ccnIrcçce:, c ccr pcce e ceve :er c|iviccc, pci: pcce
:er prejucicic| IcnIc c mce ¢ucnIc cc feIc, principc|menIe ¢ucncc
incice :cLre um crgcni:mc mcIernc ccm pcIc|cgic c::cciccc cu
uniccce feIc-p|ccenIcric ccm Lcixc re:ervc.
Métodos de Ano|ges|o
Umc cc: ccn:icercçce: Lc:icc: :cLre c cnc|ge:ic e cne:Ie:ic cL:IéIricc:
é c cce¢uccc prepcrc p:icc|cgicc e fi:ic|cgicc cc pcrIurienIe.
Ccn:icerc-:e ¢ue c mu|her ce hcje é mci: exigenIe ¢ucnIc c:
infcrmcçce: ¢ue nece::iIc :cLre c :uc ge:Icçcc e c pcrIc.
Freferencic|menIe curcnIe c pré-ncIc|, c ge:IcnIe ceve :er e:c|crecicc
:cLre c: fcrmc: ce cnc|ge:ic ci:pcn|vei:, :uc: vcnIcgen:, ce:vcnIcgen:
e |imiIcçce:. Deve-:e c::egurcr ¢ue exi:Icm vcric: cpçce: pcrc ccnIrc|cr
c ccr cc IrcLc|hc ce pcrIc, e ¢ue Iccc: c:
8
O CONTROLE DA DOR NO TRABALHO DE PARTO
70
e:fcrçc: ccmpcI|vei: ccm c :egurcnçc ce cmLc: {mce e fi|hc), :ercc
ce:pencicc: pcrc ciminuir :eu ce:ccnfcrIc.
Fe:umiccmenIe, exi:Iem Irë: méIccc: pcrc c ccnIrc|e cc ccr curcnIe c
IrcLc|hc ce pcrIc e c pcrIc: ncc fcrmccc|cgicc:, fcrmccc|cgicc:
:i:Iëmicc: e fcrmccc|cgicc: regicnci:.
1. Métodos nõo Formoco|og|cos
DenIre e|e: ce:Icccm-:e c: Iécnicc: p:iccprcfi|cIicc:, ccupunIurc e
e:Iimu|cçcc Ircn:cuIcnec e|éIricc {EIE).
C método ps|copro|||ót|co mci: pcpu|cr, inIrccuzicc pcr Lcmcze em 1º54,
prepcrc c mu|her pcrc c pcrIc cIrcvé: ce um prcgrcmc ecucccicnc|
:cLre c fi:i c|cgic cc pcrIc, c|ém ce exerc|cic: f|:icc: e re:pircIcric:. E:Ie
méIccc pcce :er u:ccc nc fc:e inicic| cc IrcLc|hc ce pcrIc, pccencc :er
ccmp|emenIccc ccm cuIrc: méIccc:, ¢ucncc nece::cric.
/ ocupunturo prccuz cnc|ge:ic cIrcvé: cc |iLercçcc ce enccrfinc: pe|c
Si:Iemc Nervc:c CenIrc|. Nc mcicric cc: cc:c:, cLIém-:e c||vic pcrcic| cc
ccr e muiIc: pcrIurienIe: nece::iIcm ce méIccc: ccmp|emenIcre: nc
:eguncc e:Icgic cc IrcLc|hc ce pcrIc.
A est|mu|oçõo e|étr|co tronscutöneo prccuz cnc|ge:ic cIrcvé: cc
cc|cccçcc ce cci: e|eIrccc: :uperficici: nc: cermcIcmc:
ccrre:pcncenIe: c I10 c L1 |cIerc|menIe c |inhc mecicnc e mci: cci:
e|eIrccc: nc n|ve| cc: vérIeLrc: S2 c S4. C e:I|mu|c e|éIricc ccn:i:Ie ce
impu|:c: Lifc:icc: ¢ue vcricm ¢ucncc c cmp|iIuce e fre¢üëncic
ccnfcrme c inIen:iccce cc ccr. É umc fcrmc ce cnc|ge:ic :egurc, ncc
invc:ivc e fcci| ce cp|iccr. Seu: re:u|Iccc: :cc vcricvei: e ccmc
ce:vcnIcgem pcce-:e ciIcr c inIerferëncic e|éIricc ccm c mcniIcrizcçcc
cc: LcIimenIc: ccrc|ccc: feIci:.
EmLcrc ccm c|gumc: |imiIcçce:, c: méIccc: ncc fcrmccc|cgicc:,
¢ucncc ccmini:Irccc: ce fcrmc cce¢uccc, cpre:enIcm vcnIcgen:
ccmc: pcrIurienIe: menc: cn:ic:c: e mci: cccpercIivc:: recuçcc cc
ccn:umc ce cnc|gé:icc: :i:Iëmicc:: pc:Iergcçcc nc in|cic ce Iécnicc:
regicnci: ce cnc|ge:i c: cc|cLcrcçcc cIivc cc pcrIurienIe e mcicr
pcrIicipcçcc cc cccmpcnhcnIe.
2. Métodos Formoco|og|cos S|stëm|cos
Gerc|menIe uIi|izc-:e c vic pcrenIerc| e rcrcmenIe c vic inc|cIcric. Ccmc
vcnIcgen: pcce-:e ciIcr c fcci|iccce ce ccmini:Ircçcc e c cceiIcçcc
cc: pcrIurienIe:. / ccmini:Ircçcc :i:Iëmicc ce fcrmccc: re¢uer ccuIe|c
pcrc ncc prcvcccr cepre::cc re:pircIcric mcIernc e/cu necncIc|. C:
cpicice: :cc c: cgenIe: mci: eficienIe:, ¢ucncc empregccc: pcr vic
:i:Iëmicc, pcrc ccnIrc|cr c ccr cc IrcLc|hc ce pcrIc, e c mepericinc e c
cpicice mci: empregccc pcr e:Ic vic. Fcce-:e empregcr c vic
inIrcmu:cu|cr nc cc:e ce 50mg nc: fc:e: mci: inicici: cc IrcLc|hc ce
pcrIc. Ccmc efeiIc: cc|cIerci: mcIernc:, cc:e-cepencenIe:, pccem
cccrrer ncu:ec: e vcmiIc: e, mci: rcrcmenIe, cepre::cc re:pircIcric.
8
O CONTROLE DA DOR NO TRABALHO DE PARTO
71
/|ém ci::c, c mepericinc e:Ic c::cciccc c cepre::cc necncIc| e c
pcnIucçce: mci: Lcixc: nc: Ie:Ie: neurcccmpcrIcmenIci:, ¢ue pccem
percurcr pcr 48 hcrc:. / cepre::cc feIc| é mcximc enIre 1 e 4 hcrc: cpc:
c ccmini:Ircçcc, prcvccccc Ic|vez pcr meIcLc|iIc: cIivc:. l::c imp|icc nc
nece::iccce ce prcfi::icnc| Ireinccc pcrc recnimcçcc necncIc| ec
ci:pcniLi|iccce ce crcgc: cnIcgcni:Ic: {nc|cxcne).
C u:c :i:Iëmicc ce cpicice:, :cLreIucc ¢ucncc ci:pcn|vei: cuIrc:
méIccc: ncc fcrmccc|cgicc:, ceve :er eviIccc pcrc c prevençcc ce:Ie:
efeiIc: cepre::cre: :cLre c re:pircçcc necncIc|. E|e: IcmLém cificu|Icm
c inIercçcc enIre mce e fi|hc nc per|ccc puerperc|, c|ém ce
ccmprcmeIerem c in|cic preccce cc cmcmenIcçcc. Cpicice:
lipc::c|úvei:, ccmc fenIcni|, c|fenIcni| cu :ufenIcni|, :cc pcucc uIi|izccc:
pcr vic :i:Iëmicc, pci: :eu efeiIc cnc|gé:icc e ce curIc curcçcc e c
principc| efeiIc cc|cIerc| e c cepre::cc re:pircIcric.
3. Métodos Formoco|og|cos keg|ono|s
/ cnc|ge:ic prccuzicc pcr L|c¢ueic: regicnci: cpre:enIc vcnIcgen:
:cLre c: méIccc: :i:Iëmicc:. / cepc:içcc cc cne:Ié:icc |ccc| prcximc c:
vic: ce ccncuçcc nervc:c permiIe umc Lcc cnc|ge:ic :e|eIivc, :em
cepre::cc cc feIc e permiIincc c cccpercçcc mcIernc. DurcnIe c
IrcLc|hc ce pcrIc cu c pcrIc, vcric: Iécnicc: regicnci: pccem :er
empregccc:: L|c¢ueic cc: nervc: pucencc:, pericurc| |cmLcr cu :ccrc|,
rc¢uicne:Ie:ic e L|c¢ueic ccmLinccc rc¢ui-pericurc|.
"D L,(4/%*( )( M/)%#)(
C: nervc: pucencc: Iëm :uc crigem nc: rc|ze: :ccrci: {S2-S4) e inervcm c
per|nec, vcginc, reIc e pcrIe cc Lexigc, pcrIcnIc c :eu L|c¢ueic e:Ic
incicccc :cmenIe pcrc c :eguncc e:Icgic, prcpicicncc cne:Ie:ic
cce¢uccc cc pcrIc. /: ccmp|iccçce: e:Icc re|ccicnccc: c punçcc,
ccmc hemcIcmc: cu cLce::c:, cu c Icxiciccce :i:Iëmicc cc:
cne:Ié:icc: |ccci: pcr ccmini:Ircçcc inIrcvenc:c inccverIicc.
Iécn|cos e drogos
C nervc pucencc inIernc é fcci|menIe cce::|ve| em :uc pc::cgem pe|c
e:pinhc cicIicc. De:Ic fcrmc, cuc: vic: ce cLcrccgem pccem :er
uIi|izccc:: c Ircn:vcginc| cu c perinec|.
Iécnicc Ircn:vcginc|: ccm c pccienIe em pc:içcc ginecc|cgicc e cpc: c
prepcrc cc per|nec e vcginc ccm :c|uçcc cnIi-:épIicc, inIrccuzem-:e c:
cecc: mécic e inciccccr ce umc cc: mcc: pe|c vcginc cIe pc|pcr c
e:pinhc cicIicc e c |igcmenIc :ccrce:pinhc:c. / :eguir, inIrccuz-:e umc
cgu|hc |cngc {ce 8 c 10cm ce ccmprimenIc), jc ccnecIccc c umc
:eringc ccm cne:Ié:icc |ccc|, ce:|izcncc :cLre c: cecc: ccmc guic: cIé
c |igcmenIc inIerncmenIe c e:pinhc. Deve-:e cIrcve::cr c mucc:c e
|igcmenIc pcr cercc ce 1,5cm ce prcfunciccce e injeIcr 10ml ce
|icccc|nc c 17 ccm ccrenc|inc 1:200.000. É preci:c reccrccr ¢ue c crIéric
e veic pucencc ccrrem pcrc|e|cmenIe cc nervc, pcrIcnIc e
reccmenccve| c:pircr curcnIe c injeçcc cc cne:Ié:icc, pcrc eviIcr c
ccmini:Ircçcc inIrcvenc:c.
8
O CONTROLE DA DOR NO TRABALHO DE PARTO
72
FepeIe-:e c me:mc prccecimenIc nc |ccc ccnIrcric, c ¢ue pcIencic|izc
c ccnIrc|e cc ccr {Figurc 1).
F|guro 1. 8|oque|o do pudendo. Iécn|co tronsvog|no|
Iécnicc Ferinec|: Iem c vcnIcgem ce L|c¢uecr :imu|IcnecmenIe c:
rcmc: cc pucencc e cc cuIcnec pc:Iericr cc ccxc, nece::cric ¢ucncc
:e rec|izcm epi:icIcmic: |cIerci:. / mu|her e pc:icicnccc e prepcrccc
ccmc nc cc:c cnIericr. Fc|pc-:e c e:pinhc cicIicc ccm c inciccccr
cIrcvé: cc vcginc. Fcce-:e fczer um pe¢uenc LcIcc cuIcnec ce
cne:Ié:icc |ccc| nc pcnIc mécic enIrc c ccmi::urc pc:Iericr cc vu|vc e c
IuLerc:iccce i:¢uicIicc. /ccp|c-:e umc cgu|hc ce 8 c 12 cm ce
ccmprimenIc c umc :eringc ce 20 m| e inIrccuz-:e cIrcvé: cc LcIcc
cuIcnec em cireçcc cc |:¢uic, cirigincc-:e c cgu|hc ccm c cux||ic cc
inciccccr cIé c IuLerc:iccce i:¢uicIicc. / :eguir injeIc-:e 5 - 10 m| ce
|icccc|nc c 17 ccm ccrenc|inc 1: 200.000 pcr fcrc e pcrc Irc: cc |:¢uic. /
:eguir injeIc-:e mci: 5 m| ce cne:Ié:icc nc fcce inIernc cc IuLerc:iccce,
en¢ucnIc :e inIrccuz c cgu|hc nc fc::c |:¢uic-reIc|. / cgu|hc ccnIinuc
ccr:c|menIe e pcrc fcrc cIe perfurcr c |igcmenIc :ccrce:pinhc:c e, cpc:
perfurc-|c e peneIrcr cercc ce 1 cm, injeIc-:e mci: 5 m| ce :c|uçcc
cne:Ié:icc. FepeIe-:e c me:mc prccecimenIc cc |ccc ccnIrcric. Fcr e:Ic
vic IcmLém exi:Ie c ri:cc ce injeçcc inIrcvc:cu|cr, pcr i::c reccmenccm-
:e c:pircçce: fre¢uenIe: curcnIe c: injeçce: {Figurc 2).
8
O CONTROLE DA DOR NO TRABALHO DE PARTO
73
F|guro 2. 8|oque|o do pudendo. Iécn|co per|neo|.
=D G G#",-%1*" M%&*)/&",
Nc finc| cc: cnc: cin¢üenIc e in|cic cc: cnc: :e::enIc, c L|c¢ueic
pericurc| |cmLcr :cLrepujcu c cLcrccgem :ccrc|, preccmincnIe cIe
enIcc. DenIre c: vcnIcgen: cc cnc|ge:ic pericurc| |cmLcr ccnI|nuc,
:c|ienIcm-:e cincc c:pecIc: principci:: cu:ëncic ce ccr, efeiIc
prc|cngccc, ccnIrc|e cc inIen:iccce e exIen:cc cc L|c¢ueic, cu:ëncic
ce cepre::cc re:pircIcric mcIernc e feIc| e ver:cIi|iccce em :iIucçce:
e:pecici:, ccmc ce:crec ce urgëncic e ec|cmp:ic.
/ cnc|ge:ic pericurc| é ciIccc ccmc c grcnce recur:c ccm ¢ue c e¢uipe
prcfi::icnc| ccnIc pcrc ccnIrc|cr c ccr cc pcrIc, nc: :uc: ciferenIe: fc:e:.
/ pcrIurienIe permcnece cccrcccc curcnIe Iccc c IrcLc|hc ce pcrIc e
c in:erçcc ce um ccIéIer nc e:pcçc pericurc| permiIe c cuicccc:c
IiIu|cçcc cc cc:e ce cne:Ié:icc e c mcnuIençcc cc cnc|ge:ic, ce
cccrcc ccm c: nece::iccce: cL:IéIricc:. E:Ic f|exiLi|iccce é icec| pcrc
umc :iIucçcc cincmicc, cnce c: nece::iccce: cnc|gé:icc: pccem vcricr
crc:IiccmenIe.
C ccnIrc|e IcIc| cc ccr previne c hipervenIi|cçcc mcIernc exce::ivc e
cumenIc c FcC2. Ccm c ncrmc|izcçcc cc venIi|cçcc mcIernc, me|hcrc
IcmLém c cxigencçcc feIc|. / re:pc:Ic ccrcicvc:cu|cr c ccr é cIenuccc
e, c::im, mu|here: ccm re:erve: ccrc|ccc ciminu|cc.
8
O CONTROLE DA DOR NO TRABALHO DE PARTO
74
pccem :e Leneficicr cc prccecimenIc. C f|uxc :cngü|nec uIerinc ncc :e
c|Ierc nc: mu|here: h|gicc: cpc: c cnc|ge:ic pericurc| e pcce cumenIcr
em mu|here: ccm pré-ec|cmp:ic.
Em ccmpcrcçcc c méIccc: :i:Iëmicc: ce cnc|ge:ic, c Iécnicc pericurc|
prcvë cnc|ge:ic mci: efeIivc pcrc c IrcLc|hc ce pcrIc, c|ém ce
Lenef|cic: fi:ic|cgicc: pcIencici:. /Ircvé: cc recuçcc cc: ccIecc|cminc:
:éricc: mcIernc:, c cnc|ge:ic pericurc| pcce me|hcrcr c f|uxc e c
cIiviccce uIerinc:. Umc cnc|ge:ic efeIivc IcmLém inIerrcmpe c c|rcu|c
hipervenIi|cçcc - hipcvenIi|cçcc mcIernc e :uc: ccn:e¢üëncic: pcrc c
feIc. Finc|menIe, c cnc|ge:ic pericurc| prcpcrcicnc mcjcr f|exiLi|iccce c:
nece::iccce: ce cccc pcrIurienIe em re|cçcc c evc|uçcc cL:IéIricc:
pcrIc ncrmc|, fcrcipe cu ce:cricnc. Suc: ccnIrc-inciccçce: fcrmci: :cc
pcucc:, inc|uincc-:e c cccgu|cpcIic mcIernc, infecçcc nc |ccc| cc
punçcc, in:IcLi|iccce hemccincmicc re:u|IcnIe ce hipcvc|emic e recu:c
mcIernc. CuIrc: :iIucçce: re¢uerem umc cvc|icçcc mci: incivicuc|izccc,
:empre |evcncc em ccnIc c re|cçcc ri:cc/Leneficic, ccmc c ccençcc
neurc|cgicc pré-exi:Ience, infecçcc mcIernc e c|gumc: ccrcicpcIic:.
Cucncc :e uIi|izc Lupivccc|nc em ci|uiçce: cnc|gé:icc: pcr vic pericurc|,
cLIérn-:e umc curcçcc ce cçcc re|cIivcmenIe |cngc e um L|c¢ueic
:en:iIivc ce c|Ic ¢uc|iccce, ccm m|nimc L|c¢ueic mcIcr {L|c¢ueic
ciferencic|).
/ cnc|ge:ic pericurc| prcpcrcicnc um c||vic cc ccr ccn:icerccc Lcm pcr
80 c º07 cc: pcrIurienIe:. Nc enIcnIc, c ccmini:Ircçcc exc|u:ivc ce
cne:Ié:icc: |ccci: pcr vic pericurc|, cincc ¢ue :cIi:fcIcric pcrc c ccnIrc|e
cc ccr, Iem :icc re:pcn:cLi|izccc pcr efeiIc: ince:ejcvei: ccmc
hipcIen:cc mcIernc :ecunccric cc L|c¢ueic :impcIicc, e re|cxcmenIc
mu:cu|cr cc c::cc|hc pé|vicc e cc pcrece cLccminc|, |evcncc c
cificu|ccce: nc rcIcçcc inIernc cc pc|c cefc|icc feIc| cenIrc cc ccnc|
ce pcrIc, e cc evenIuc| prc|cngcmenIc cc per|ccc expu|:ivc, ccm
cumenIc ce incicëncic ce pcrIc: in:IrumenIc|:.
Assoc|oçõo Anestés|cos Loco|s e Op|o|des por v|o per|duro|
Hc cercc ce vinIe cnc:, c cL:ervcçcc cc efeiIc cnc|gé:icc ce cpicice:
ccmini:Irccc: pcr vic e:pinc| Ircuxe e:percnçc: ce :e cLIer umc
cnc|ge:ic efeIivc, :em L|c¢ueic :impcIicc cu mcIcr, icec| pcrc
cL:IeIricic, pc:-cpercIcric e ccre: crcnicc:.
/ c::ccicçcc enIre cne:Ié:icc: |ccci: e cpicice: e umc exce|enIe cpçcc
em Iermc: ce ¢uc|iccce cnc|gé:icc. E:Ic ccmLincçcc pcrece pre:ervcr
c: Lenef|cic: ce cccc crcgc e ciminuir c ri:cc ce efeiIc: ince:ejcvei:. /
exp|iccçcc pcrc i:Ic re:ice nc fcIc ce ¢ue e:Ie: cgenIe: cIucricm em
cci: :|Iic: ci:IinIc:: c: cne:Ié:icc: |ccci: nc memLrcnc cxcnc| e c cpicice,
em recepIcr e:pecificc cc mecu|c e:pinc|, e|imincncc c ccr cIrcvé: ce
um meccni:mc ccmLinccc e :inérgicc. /: :c|uçce: ci|u|cc: ce
cne:Ié:icc |ccc| :cc ccpcze: ce L|c¢uecr me|hcr c: fiLrc: /-S, en¢ucnIc
c: cpicice: :ericm mci: eficienIe: nc L|c¢ueic ce impu|:c: ccncuzicc:
pe|c: fiLrc: C.
8
O CONTROLE DA DOR NO TRABALHO DE PARTO
75
• 8|c¢ueic pericurc| |cmLcr ccnI|nuc - FermiIe c L|c¢ueic :e|eIivc cc:
fiLrc: ¢ue Ircn:miIem c ccr, ce cccrcc ccm c: ciferenIe: fc:e: cc
IrcLc|hc ce pcrIc, re:peiIcncc c mu:cu|cIurc cLccminc| e fcci|iIcncc c
cc|cLcrcçcc mcIernc nc e:Icgic expu|:ivc. /Iuc|menIe, ccn:icerc-:e c
ccr mcIernc ccmc c pcrcmeIrc mci: impcrIcnIe pcrc c inciccçcc cc
cnc|ge:ic, pcr¢ue ¢ucncc inIen:c e prc|cngccc, prcmcve c|Iercçce:
nccivc: pcrc c mce e c feIc. /: ccrcicpcIc: e Icxëmicc: cevem receLer
cnc|ge:ic preccce pcrc eviIcr c :cLreccrgc nc :i:Iemc ccrcicvc:cu|cr.
IcmLém é incicccc em pre:ençc ce ci:Iccic: hiperIcnicc:. Deve-:e
empregcr pe¢uenc: cc:e: ce cne:Ié:icc: |ccci: pcrc c c||vic cc: ccre:
ceccrrenIe: cc: ccnIrcçce: uIerinc: e ci|cIcçcc cc cc|c. Nc :eguncc
e:Icgic, c L|c¢ueic preci:c :er e:Iencicc cIe S2-S4, cIrcvé: ce cc:e:
ccicicnci: ce cne:Ié:icc |ccc| pe|c ccIeIer.
Iécn|cos e Drogos
/ punçcc pcce :er rec|izccc ccm c pccienIe :enIccc cu em cecúLiIc
|cIerc|, nc |inhc mecicnc, cIrcvé: cc: inIere:pcçc: L3-L4 cu L4-L5, ccm
cgu|hc: ce:ccrIcvei:, cc Iipc Iuchy 1ó c 17 G e c ccIeIer cce¢uccc cc
cc|iLre cc cgu|hc. Exi:Ie c pc::iLi|iccce ce, uIi|izcncc pe¢uenc: cc:e:
ce cne:Ié:icc, permiIir c cecmLu|cçcc cc pcrIurienIe, cpc: cerIificcr-:e
¢ue ncc hcjc ccmprcmeIimenIc mcIcr cu ce e¢ui||Lric. Fcce-:e
empregcr IcmLém um e:¢uemc ce infu:cc ccnIinuc cIrcvé: ce LcmLc,
pcrc c mcnuIençcc cc cnc|ge:ic. Frccece-:e c in:Ic|cçcc cc cnc|ge:ic
ccnfcrme ciIccc cnIericrmenIe e, cpc: cLIer-:e c|ivic :cIi:fcIcric cc ccr
mcIernc, inicic-:e c infu:cc ccnIinuc ccm um f|uxc ce 10 - 12 m|/h ce
Lupivccc|nc c 0,0ó25 - 0,1257.
Drogas e Doses
Momento da analgesia: ccmc jc exp|icccc, c ccr mcIernc e c principc|
fcIcr ¢ue ceve :er ccn:icerccc ccmc pcrcmeIrc ce inciccçcc ¢ucnIc
cc mcmenIc cc cnc|ge:ic, nõo o d||otoçõo cerv|co|. / ci|cIcçcc e
impcrIcnIe cpenc: pcrc c e:cc|hc cc crcgc e cc cc:e c :er u:ccc.
8
O CONTROLE DA DOR NO TRABALHO DE PARTO
76
• 8|c¢ueic Fericurc| LcmLcr Unicc - /ce¢uccc :cmenIe nc finc| cc
primeirc e:Icgic e expu|:ivc. Ne:Ic :iIucçcc, prccece-:e c Iécnicc
cne:Ié:icc ccmc ce:criIc cnIericrmenIe, cpIcncc-:e pcr umc
ccncenIrcçcc ce cne:Ié:icc |ccc| mci: e|evccc em vc|ume :uficienIe
pcrc c cne:Ie:ic ccmp|eIc cc per|nec: 12 - 15 m| ce Lupivcccinc c 0,257
ccm ccrenc|inc 1: 200.000 cu rcpivccc|nc c 0,27 em iguc| vc|ume.
.D N"4/*"#%1$%1*"
É cce¢uccc nc finc| cc primeirc e:Icgic e curcnIe c per|ccc expu|:ivc. É
efeIivc ¢ucncc :e preIence Ier um Lcm re|cxcmenIc perinec|
{cp|iccçcc ce Fcrcipe) Iencc c cpre:enIcçcc feIc| jc iniciccc c
prcgre::cc cenIrc cc ccnc| ce pcrIc. Fcce :er incicccc IcmLém pcrc
mcnipu|cçcc e revi:cc cc ccnc| ce pcrIc e UIerc. lnccnvenienIe:: 1)
n|vei: c|Ic: ce L|c¢ueic ccm percc cc pren:c cLccminc| :eguicc ce
cificu|ccce nc prcgre::cc feIc| e reIcrcc cc per|ccc expu|:ivc. 2)
cefc|éic pc:-punçcc.
Iécn|co e drogos
/ punçcc pcce :er rec|izccc ccm c mu|her :enIccc cu em cecúLiIc
|cIerc|, nc |inhc mecicnc, cIrcvé: cc: inIere:pcçc: L3-L4 cu L4-L5, ccm
cgu|hc: ce:ccrIcvei: ce 25 c 27 G e pcrc urgëncic: c 22 G. 0 n|ve|
:en:iIivc ncc ceve u|Ircpc::cr c: U|Iimc: cermcIcmc: Icrccicc:,
empregcncc-:e pcrc i::c c |icccc|nc c 57 hiperLcricc 40 - 50 mg {0,8 - 1
m|) cu Lupivccc|nc 0,57 hiperLcricc 5 - 7,5 mg {1 - 1,5 m|).
)D L,(4/%*( .(!=*#")( &"4/*72%&*)/&",
/Iuc|menIe, e:Ic Iécnicc vem gcnhcncc mci: e mci: ccepIc:.
8c:iccmenIe, ccn:i:Ie nc ccmLincçcc cc: cuc: Iécnicc: cnIericre:.
/Ircvé: cc cepc:içcc ce um cpicice c::cciccc cu ncc c /L nc e:pcçc
:uLcrccncicec, cLIém-:e cnc|ge:ic :cIi:fcIcric pcr cercc ce cuc: hcrc:,
:em ccmprcmeIimenIc mcIcr. / mecicc ¢ue c: ccnIrcçce: cc|crc:c:
reIcrncm, é pc::|ve| ccmp|emenIcr c cnc|ge:ic, cIrcvé: cc injeçcc ce
umc :c|uçcc ci|u|cc ce /L nc e:pcçc pericurc|.
/: Iécnicc: cpre:enIccc: cnIericrmenIe cevem :er execuIccc: pcr
cne:Ie:ic|cgi:Ic:, e ¢ucncc rec|izccc: cce¢ucccmenIe, prcpcrcicncm
um c|ivic :cIi:fcIcric cc ccr mcIernc e cc me:mc Iempc cferecem
ccnciçce: Iécnicc: pcrc c rec|izcçcc cc mcicric cc: prccecimenIc:
cL:IéIricc:. Fcrc :e c|ccnçcr c re:u|Iccc e:perccc, é impre:cinc|ve|
:c|ienIcr c impcrIcncic ce umc cIucçcc ccnjunIc cc: e¢uipe: ce
cL:IeIr|cic, necncIc|cgic e cne:Ie:ic e :uc inIercçcc ccm c mu|her e :eu
cccmpcnhcnIe.
8
77
/ cIençcc cc pcrIc ncrmc|, em :eu :enIicc e:IriIc,
ceve cLrcnger c c::i:Iëncic cc per|ccc expu|:ivc, c
ce¢uiIcçcc e cc pc:-pcrIc imecicIc cu 4º per|ccc.
EnIreIcnIc, ceve-:e ccn:icercr ¢ue e muiIc cif|ci|
:epcrcr c c::i:Iëncic cc pcrIc prcpricmenIe ciIc cc
pre:Iccc cc per|ccc ce ci|cIcçcc.
ASSISIÈNCIA AO FEkÍODO EXFbLSIVO
C per|ccc expu|:ivc, cu :ejc, c :eguncc per|ccc cc
pcrIc, inicic-:e ccm c ci|cIcçcc IcIc| cc cérvice
Ierminc ccm c expu|:cc cc feIc. CcrccIerizc-:e pcr
e:fcrçc: expu|:ivc: mcIernc: {puxc:) e :en:cçcc ce
preenchimenIc reIc| ccm ce:ejc ce evccucr,
ceccrrenIe cc pre::cc cc cpre:enIcçcc feIc| :cLre
reIc e mú:cu|c: cc ossoo|ho pé|v|co. E c fc:e ce
muccnçc: nc ccmpcrIcmenIc mcIernc - c mce Icrnc-
:e vu|nercve| e cepencenIe cc¢ue|e ¢ue c c::i:Ie. E
IcmLém c per|ccc ce cumenIc cc: ri:cc: feIci: - c
ccmpre::cc cc pc|c cefc|icc nc pc::cgem pe|c ccnc|
ce pcrIc, c::cciccc c ciminuiçcc cc circu|cçcc úIerc-
p|ccenIcric, pe|c: ccnIrcçce: uIerinc: mci: inIen:c: e
fre¢uenIe:, fcvcrece c hipcxic e c ccicc:e feIc|.
lmpce-:e, pcrIcnIc, c mcniIcrizcçcc efeIivc cc Lem-
e:Icr feIc|.
/ ccrccIerizcçcc ce:Ie per|ccc c pcrIir cc ci|cIcçcc
cervicc| ccmp|eIc e cncIcmicc e pcce cu ncc
ccincicir ccm c fc:e ce expu|:cc feIc|. /: veze:, c
ci|cIcçcc e:Ic ccmp|eIc e :c c|gun: minuIc: mci:
Icrce e ¢ue :e inicicm c: e:fcrçc: expu|:ivc:. Em
cuIrc:, c: puxc: mcIernc: cccrrem cnIe: ce
ccmp|eIccc c ci|cIcçcc. Seguncc Friecmcn {1º78),
per|ccc pé|vicc, ¢ue ccrre:pcnce cc per|ccc
expu|:ivc c|c::icc, inicic-:e ccm c ce:cicc cc
cpre:enIcçcc e, c pcrIir cci, ccmp|emenIcm-:e c:
fencmenc: meccnicc: cc pcrIc: rcIcçcc inIernc,
ce:prencimenIc cefc|icc, rcIcçcc exIernc e
ce:prencimenIc cc cvcice ccrmicc {Fig. 1).
9 ASSISTÊNCIA À MULHER NO PARTO NORMAL
ASSISTÊNCIA À MULHER NO PARTO NORMAL
78
Figura 1. Período expulsivo do parto
Nc verccce, nc prcIicc cicric, c per|ccc expu|:ivc ceve :er icenIificccc
pe|c ci|cIcçcc cervicc| IcIc|, pe|c: puxc: mcIernc: e, gerc|menIe, pe|c
rcIurc e:pcnIcnec cc: memLrcnc: cmnicIicc:. DeIerminccc: prcIicc:
c::i:Iencici: ce:Ie per|ccc, emLcrc ccn:cgrccc: pe|c u:c, :cc pc::|vei:
ce ci:cu::cc. /|gumc: ce|c: jc fcrcm cLjeIc ce e:Iucc: cmp|c:, ccm
re:u|Iccc: Lc:eccc: em evicëncic: cienI|ficc:.
1 - Fuxos moternos
Fi:ic|cgiccmenIe, cccrrem puxc: invc|unIcric: ¢ucncc c cpre:enIcçcc
feIc| fcz pre::cc :cLre c reIc e mú:cu|c: cc c::cc|hc pé|vicc, pccencc
cccnIecer em um mcmenIc mci: Icrcic, cez c vinIe minuIc: cpc: c
ci|cIcçcc cervicc| e:Icr ccmp|eIc. EnIreIcnIc, c prcIicc ce :e e:Iimu|cr
c: puxc: vc|unIcric: e preccce:, cnIe: ce ccmp|eIccc c ci|cIcçcc
cervicc|, é uIi|izccc em muiIc: prcIccc|c: c::i:Iencici: ce per|ccc
expu|:ivc.
Ncc exi:Iem e:Iucc: ccnIrc|ccc: ccmpcrcncc puxc: preccce: e Icrcic:
nc IrcLc|hc ce pcrIc ncrmc|, mc: fcrcm rec|izccc: c|gun: e:Iucc: em
pcrIurienIe: :uLmeIicc: c cnc|ge:ic pericurc|, ccm :upre::cc cc ref|exc
ce puxc. Fcrcm ccmpcrccc: puxc: Icrcic: {vérIice vi:|ve| nc inIrciIc
vcginc|) ccm puxc: preccce:, cu :ejc, c::im
9
ASSISTÊNCIA À MULHER NO PARTO NORMAL
79
¢ue :e cicgnc:Iiccu c ci|cIcçcc IcIc|. C reIcrcc cc: puxc: ncc
ceIermincu ¢uc|¢uer efeiIc nccivc :cLre c feIc cu recém-nc:cicc: nc
grupc ccm puxc: preccce: cL:ervcu-:e numerc :ignificcIivcmenIe mcjcr
ce cp|iccçcc ce fcrcipe. EmLcrc c: re:u|Iccc: Ienhcm :icc cLIicc: em
pcrIurienIe: ccm cnc|ge:ic, e:Icc ce cccrcc ccm c experiëncic c||nicc
ce ¢ue :e ceve reIcrccr c puxc cIé c cpcrecimenIc cc ref|exc
e:pcnIcnec. E:Ic prcIicc e mci: fcci| pcrc c mu|her e Ience c encurIcr c
fc:e excu:Iivc cc: e:fcrçc: mcIernc:.
CuIrc: e:Iucc: ccmpcrcrcm c prcIicc fi:ic|cgicc cc: puxc: invc|unIcric:,
curIc: e e:pcnIcnec:, ccm c pccrcc vc|unIcric ce puxc: |cngc: e
cirigicc: {mcncLrc ce Vc|:c|vc), :eguicc: ce cpnéic fcrçccc {puxc:
curcnIe c expircçcc). E:Ie ú|Iimc méIccc re:u|Icu em cLrevicçcc cc
:eguncc e:Icgic cc pcrIc, mc: ccm ri:cc ce c|Iercçce: nc fre¢üëncic
re:pircIcric e nc vc|ume ce ejeçcc, ccu:ccc: pe|c Iipc ce re:pircçcc
mcIernc. Ccm c: puxc: prc|cngccc: e cecúLiIc hcrizcnIc|, pcr
ccmpre::cc cc ccrIc e ciminuiçcc cc f|uxc úIerc-p|ccenIcric, cL:ervcu-
:e ¢uecc nc pH mécic cc crIéric umLi|icc| e Iencëncic c mencre:
|ncice: ce /pgcr cc recém-nc:cicc. /: evicëncic: :cc) pcucc:, mc:
ce|c: emerge um pccrcc cnce c: puxc: prc|cngccc: e preccce:
re:u|Icm em ciminuiçcc mcce:Ic cc curcçcc cc :eguncc per|ccc, ¢ue
ncc pcrece Irczer Lenef|cic c|gum, ccm ccmprcmeIimenIc cc: Irccc:
mcIernc-feIci:. C puxc e:pcnIcnec mci: curIc pcrece :er :upericr.
2 - So|o espec|o| de porto
Em c|gun: hc:piIci:, c pcrIc é cIencicc em :c|c e:pecic|, e¢uipccc ccm
|uze: fcrIe: e Lri|hcnIe:, in:IrumenIci: e me:c cirúrgicc ccm perneirc: cu
hc:Ie: meIc|icc:. /pe:cr ce mci: cce¢uccc cc prcfi::icnc| ¢ue c::i:Ie c
pcrIurienIe, pe|c fcci|iccce ce inIervençcc cpercIcric :e nece::cric,
pcrc c mce i:Ic e IcIc|menIe inccmccc. Cucncc c evc|uçcc cc pcrIc e
ncrmc|, ncc hc inciccçcc ce Ircn:ferëncic cc pcrIurienIe cc pré-pcrIc
pcrc c :c|c ce pcrIc nc per|ccc expu|:ivc. C pré-pcrIc e pcrIc pccem
:er cIencicc: nc me:mc :c|c.
/ humcnizcçcc cc pcrIc ccnIemp|c c cricçcc cc: :c|c: ce pcrIc, cnce
c: pcrIurienIe: permcnecem curcnIe c IrcLc|hc ce pcrIc {fc:e ce
ci|cIcçcc cervicc|), pcrIc {expu|:cc feIc| e ce¢uiIcçcc p|ccenIcric) e
puerpéric imecicIc ccm :eu cccmpcnhcnIe. Em pcrIuguë: c
cencmincçcc cfi cic| pcrc e:Ie ccnceiIc {c exemp|c cc -%@#4 %*$
$'-63'4a 4##2 I LDF cc ||nguc ing|e:c), Iem :icc c ce "so|o FFF", cu :ejc,
ce pré-pcrIc, pcrIc e puerpéric imecicIc. E::c e:IrcIégic Iem :e
mc:Irccc efeIivc nc humcnizcçcc cc pcrIc e nc incenIivc cc pcrIc
ncrmc|, ccm ccn:e¢üenIe recuçcc nc: |ncice: ce ce:crec.
3 - Fos|çõo moterno
Vcric: :cc c: prcpc:içce: cc |iIercIurc :cLre c me|hcr pc:içcc mcIernc
curcnIe c IrcLc|hc ce pcrIc e pcrIc. Depencencc cc ccpcciccce e cc
experiëncic cc prcfi::icnc| ccm ceIerminccc pc:içcc, c|ém cc:
infcrmcçce: cc prcpric mu|her, c: re:u|Iccc: pccem Ier vcricçce: muiIc
grcnce:. lncepencenIemenIe cc: |inhc:
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ASSISTÊNCIA À MULHER NO PARTO NORMAL
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ce pen:cmenIc re|ccicnccc: c prcIicc cc c::i:Iëncic cc pcrIc, é
ccn:en:c gerc| ¢ue c pc:içcc hcrizcnIc| ceve :er eviIccc pcrc prevenir
c: efeiIc: cc cificu|ccce ce Irccc: mcIernc-feIci:.
/|gun: re:u|Iccc: ce IrcLc|hc: cienI|ficc: cpcnIcm vcnIcgen: cc
pc:içcc verIicc|izccc cu cc inc|incçcc |cIerc| :cLre c pc:içcc ccr:c|
{cecúLiIc hcrizcnIc|), enIre e|c:: mencr ce:ccnfcrIc e cificu|ccce ce
puxc:, ccre: menc: inIen:c: e mencr ri:cc ce Ircumc: vcginci: cu
perineci: e ce infecçce: nc inci:cc. CL:ervcu-:e IcmLém mencr
curcçcc cc per|ccc expu|:ivc e me|hcre: re:u|Iccc: necncIci: - mencr
prcpcrçcc ce |ncice: ce /pgcr €7. CuIrc: e:Iucc: cIriLu|rcm c pc:içcc
verIicc|izccc mcicr númerc ce |ccercçce: cc: |cLic: vcginci:, ce Ierceirc
grcu, emLcrc ccm númerc: pe¢uenc: pcrc umc cnc|i:e ccncreIc.
/pe:cr ce re|ccicncrem mcicr pcrcenIcgem ce hemcrrcgic: pc:-pcrIc,
ncc hcuve ciferençc :ignificcIivc nc: n|vei: ce hemcg|cLinc nc ¢ucrIc
cic ce puerpéric. / fcci|iccce ce :e cpurcr c percc :cngu|nec e c mcjcr
pre::cc :cLre c: veic: pé|vicc: e vu|vcre: nc pc:içcc verIicc| pccem Ier
ccnIriLu|cc pcrc e::c impre::cc.
/ CMS {1ººó), nc :eu guic prcIicc ce /::i:Iëncic cc FcrIc Ncrmc|,
reccmencc ¢ue, CcnIc nc primeirc ¢ucnIc nc :eguncc per|ccc, c:
mu|here: cevcm cccIcr c pc:içcc ¢ue me|hcr |he: cgrcccr, ce:ce ¢ue
eviIem |cngc: per|ccc: em cecúLiIc ccr:c|. Deve-:e e:Iimu|ccc: c
experimenIcr c¢ui|c ¢ue fcr mci: ccnfcrIcve| e, pcrc i::c, c: prcfi::icnci:
nece::iIcm :er Ireinccc: nc mcnejc cc pcrIc em cuIrc: pc:içce: c|ém cc
:upinc.
4 - Cu|dodos com o períneo
/ |e:cc ce per|nec e um cc: IrcumcIi:mc: mci: fre¢üenIe: curcnIe c
pcrIc, me:mc em pcrIc: e IrcLc|hc: ce pcrIc ccm evc|uçcc ncrmc|.
Vcric: Iécnicc: e prcIicc: vi:cm recuzir c: ccnc: cu c|Ierc-|c: c um grcu
mcnejcve|.
E civu|gccc c Iécnicc ce prcIeçcc cc per|nec curcnIe c expu|:cc cc
pc|c cefc|icc - c: cecc: ce umc cc: mcc: {gerc|menIe c cireiIc) cpcicm
c per|nec, en¢ucnIc c cuIrc mcc) fcz |eve pre::cc :cLre c ccLeçc pcrc
ccnIrc|cr c ve|cciccce ce ccrccmenIc, IenIcncc eviIcr cu recuzir c:
ccnc: cc: Iecicc: perineci:. E::c Iécnicc e ccnhecicc ccmc McncLrc
ce FiIgen - {Figurc 2).
F|guro 2 - Monobro de k|tgen [Cunn|nghom et o|., 1ºº7}
9
ASSISTÊNCIA À MULHER NO PARTO NORMAL
81
É pc::|ve| ¢ue, ccm e::c mcncLrc, :e eviIe c |ccercçcc cc per|nec, mc:
é ci:cuIicc :e c pre::cc :cLre c ccLeçc feIc| ncc pc::c impecir c :eu
mcvimenIc ce exIen:cc e cfc:Icr c crcc púLicc em cireçcc cc per|nec,
cumenIcncc c::im c ri:cc ce |e:cc perinec|. Ncc fci feiIc nenhum e:Iucc
fcrmc| pcrc re:pcncer c e::c cúvicc, pcrIcnIc ncc :e pcce ccnc|uir
:cLre c me|hcr e:IrcIégic. Ccnvém re::c|Icr ¢ue e::c mcncLrc é mci:
fcci|menIe cp|icccc ccm c pcrIurienIe nc pc:içcc ccr:c| e, :e e|c e:Iiver
numc pc:içcc verIicc|izccc, c prcfi::icnc| pcce fczer c :upcrIe cc
per|nec c: cegc:, cu enIcc nem prcIiccr Ic| e:IrcIégic.
5 - Loceroçõo de períneo e ep|s|otom|o
/ cccrrëncic ce lccercçce: perineci: é fre¢üenIe, e:pecic|menIe em
prim|pcrc:. Lccercçce: ce primeirc grcu c: veze: ncc nece::iIcm :uIurc,
c: ce :eguncc grcu em gerc| pccem :er :uIurccc: ccm fcci|iccce :cL
cnc|ge:ic |ccc| e, em regrc gerc|, ciccIrizcm :em ccmp|iccçce:. /:
lccercçce: ce Ierceirc grcu pccem Ier ccn:e¢üëncic: mci: :éric: e
:empre cevem :er :uIurccc: pcrc prevenir prcL|emc: ce f|:Iu|c cu
inccnIinëncic fecc|.
Um en:cic c||nicc c|ecIcrizccc, ccmpcrcncc c: efeiIc: ce cci: Iipc: ce
:uIurc: pcrc repcrc ce lccercçce: perineci: - inIrccérmicc ccnI|nuc e
pcnIc: :epcrccc: - cvc|icu 1.8ó4 mu|here:. / :uIurc inIrccérmicc
ccnI|nuc c::ccicu-:e c mencr inIen:iccce ce ccr cIé c 10º cic ce
puerpéric e mencr nece::iccce ce remcçcc cc :uIurc. Ncc :e cL:ervcu
ciferençc nc nece::iccce ce cnc|ge:ic, ce re::uIurc ce pcrece cu nc
¢ueixc ce ci:pcreunic cpc: Irë: me:e: cc pcrIc.
/pe:cr cc epi:icIcmic :er Iécnicc rec|izccc ccm fre¢üëncic, :uc
incicëncic é vcricve|. Nc: E:Iccc: Unicc:, 50 c º07 cc: prim|pcrc: :cc
:uLmeIicc: c epi:icIcmic, c ¢ue Icrnc e::c Iécnicc c cIc cirúrgicc mci:
fre¢üenIe cc¢ue|e pc|:. MuiIc: cenIrc: :cc mci: ccn:ervcccre: ¢ucnIc
cc u:c cc epi:icIcmic. Nc: Fc|:e: 8cixc:, c: cL:IeIrize: rec|izcm
epi:icIcmic em 24,57 cc: pcrIurienIe:. De:Ic:, c imen:c mcicric é mécic-
|cIerc| e c mincric mecicnc. /: epi:icIcmic: mecicnc: :cc :uIurccc: ccm
mci: fcci|iccce e Iëm c vcnIcgem ce me|hcr ciccIrizcçcc, enIreIcnIc, c:
mécic-|cIerci: :cc me|hcre: nc prcIeçcc cc e:f|ncIer cnc| e reIc.
Umc revi:cc :i:IemcIicc cc 8iL|icIecc Ccchrcne :cLre c prcIicc e c:
efeiIc: cc epi:icIcmic, ccmpcrcncc c u:c ce rcIinc ccm c re:IriIc,
cpcnIcu c: :eguinIe: re:u|Iccc::
%U % '<6(6#)#26% ;#6 %<-61%$% $' 4#)6*% '2 _P?_[ '? ./%*$# $' /(#
4'()46)#? '2 P_?R[ $%( 2/-7'4'( %3%-6%$%( TPEPQb *# <462'64# >4/<# '
PEWWV *# ('>/*$#UB
@U % '<6(6#)#26% $' /(# 4'()46)# %((#16#/I(' % 2'*#4 46(1# $' )4%/2% $'
<'4Y*'# <#()'46#4? $' *'1'((6$%$' $' (/)/4% ' $' 1#2<-61%+A'( *%
161%)460%+,#B
1U # /(# 4'()46)# )%2@:2 %((#16#/I(' % 2%c#4 46(1# $' )4%/2% <'46*'%-
%*)'46#4B '
$U *,# (' #@('43#/ $6;'4'*+% (6>*6;61%)63% *# 46(1# $' )4%/2%( 3%>6*%6(
9
ASSISTÊNCIA À MULHER NO PARTO NORMAL
82
#/ <'46*'%6( $' >4%3' 6*)'*(6$%$' ' *% ('*(%+,# $' $6(<%4'/*6% ' $'
$#4'( 6*)'*(%(E
Em ccnc|u:cc, c prcIicc cc u:c re:IriIc ce epi:icIcmic pcrece Ier
Lenef|cic: ¢ucncc ccmpcrccc c epi:icIcmic ce rcIinc. Hc mencr ri:cc
ce Ircumc ce per|nec pc:Iericr, ce nece::iccce ce :uIurc e ce
ccmp|iccçce: ce ciccIrizcçcc, emLcrc :e cL:erve ri:cc cumenIccc ce
Ircumc perinec| cnIericr.
/ CMS {1ººó) cvc|ic ¢ue ceIerminccc: :iIucçce:, ccmc :inci: ce
:cfrimenIc feIc|, prcgre::cc in:uficienIe cc pcrIc e cmecçc ce
|ccercçcc ce Ierceirc grcu {inc|uincc |ccercçcc ce Ierceirc grcu em
pcrIc cnIericr) pccem :er Lcn: mcIivc: pcrc c inciccçcc cc epi:icIcmic
num pcrIc, cIé enIcc ce evc|uçcc ncrmc|. Sc|ienIc ¢ue c prcfi::icnc|
ceve :er hcLi|iIccc pcrc :uIurcr |ccercçce: e epi:icIcmic: ce mccc
cce¢uccc, cevencc receLer IreincmenIc pcrc i::c.
ó - Monobros extrot|vos
É ccmum c prcIicc ce rec|izcr pre::cc nc funcc cc úIerc curcnIe c
per|ccc expu|:ivc, ccm c inIençcc ce cce|ercr c nc:cimenIc. É
prcIicccc pcucc cnIe: cc ce:prencimenIc, cu me:mc nc in|cic cc
expu|:cc. /pe:cr ce mcncLrc ccn:cgrccc e cefencicc pcr muiIc:
cL:IeIrc:, prcvccc mcicr ce:ccnfcrIc mcIernc e :u:peiIc-:e ¢ue pc::c
:er perigc:c pcrc c úIerc, c per|nec e c feIc, emLcrc ncc exi:Icm cccc:
ce pe:¢ui:c :cLre e::e c::unIc. De ¢uc|¢uer fcrmc, c :eme|hcnçc cc
Ircçcc ccnIrc|ccc cc ccrccc umLi|icc|, e:Ic prcIicc ceve :er enccrccc
ccm ccuIe|c e eviIccc pcr prcfi::icnci: inexperienIe:. / CMS {1ººó)
c|c::ificc c pre::cc nc funcc uIerinc nc per|ccc expu|:ivc ccmc ¨prcIicc
em 4'-%+,# Z ./%- ncc exi:Iem evicëncic: :uficienIe: <%4% cpcicr umc
reccmenccçcc 1-%4% ' ¢ue cevem :er uIi|izccc: ccm ccuIe|c %): ¢ue
mci: pe:¢ui:c: e:c|creçcm c ¢ue:Icc {ccIegcric C)¨.
/pc: c |iLercçcc cc pc|c cefc|icc, c: cmLrc: rcccm inIerncmenIe. Ne::e
mcmenIc é prcvicencic| ¢ue :e cL:ervem c exIen:cc e c pre:ençc ce
circu|cre: ce ccrccc. Se nece::cric, e:Icr prepcrccc pcrc rec|izcr c c|çc
cc ccrccc, c recuçcc ce evenIuci: circu|cre: cu c |igccurc cervicc| cc
ccrccc umLi|icc|, ¢ucncc hcuver circu|cre: muiIc cperIccc:. Ccm c
rcIcçcc ccmp|eIccc, c: cmLrc: cevem :er |iLerccc:, prevenincc c
Ircumc perinec|. Nc pc:içcc :emi-ceiIccc, c cmLrc cnIericr é c primeirc
c :er |iLerccc {Figurc 3): nc: pc:içce: ce ccccrc: cu ce jce|hc:, c cmLrc
pc:Iericr ceve :er |iLerccc cnIe: cc cnIericr.
9
ASSISTÊNCIA À MULHER NO PARTO NORMAL
83
F|guro 3 - L|beroçõo dos ombros - onter|or [A} e poster|or [8}
[Cunn|nghom et o|., 1ºº7}
/ cificu|ccce nc |iLercçcc cc: cmLrc: é rcrc, mc: ceve :er previ:Ic cu
:u:peiIccc ¢ucncc, c pc|pcçcc cLccminc|, evicencicr-:e um feIc
grcnce. Nc: cc:c: ce ci:Iccic ce cmLrc:, c|gumc: mcncLrc: pccem :er
cp|icccc:: cLcuçcc cmp|c cc: pernc: e f|excc ccmp|eIc :cLre c ccxc e
c cLccme mcIernc: rcIcçcc mcnuc| cc cmLrc pc:Iericr cc feIc pcrc
cnIericr e, :e nece::cric, pre::cc :uprc-púLicc prcIicccc pcr um cuxi|icr
cireIcmenIe :cLre c :|nfi:e púLicc mcIernc.
Ncc e:Ic c|crc :e e::c: mcncLrc: :cc :empre nece::cric: e :e :cc
cce¢uccc:. Ncc exi:Iem pe:¢ui:c: :cLre c c::unIc. EnIreIcnIc, e:Ic
:encc rec|izccc um e:Iucc ccnIrc|ccc e rcnccmizccc, ¢ue ceverc
cferecer cccc: :cLre c efeiIc ce ciferenIe: méIccc: ce ce:prencimenIc
cc ccLeçc e cc: cmLrc: cc feIc :cLre c per|nec.
7 - C|ompeomento do cordõo e cu|dodos |med|otos com o kN
/ |igccurc cc ccrccc umLi|icc| {c|cmpecmenIc) pcce :er rec|izccc ce
imecicIc cu mcmenIc: cpc: c nc:cimenIc. E::c ¢ue:Icc jc exigiu e:Iucc:
ccnIrc|ccc: :cLre c: efeiIc: cc mcmenIc cc |igccurc cc ccrccc nc mce
e nc recém-nc:cicc. Ncc :e verificcrcm inc|cic: ce efeiIc: :ignificcIivc:
:cLre c incicëncic ce hemcrrcgic pc:-pcrIc cu :cLre c Ircn:fu:cc feIc-
mcIernc. EnIreIcnIc, :cLre c recém-nc:cicc, vcric: cL:ervcçce: fcrcm
re|cIccc::
c) #( @'@9( 1#2 1-%2<'%2'*)# 62'$6%)# $' 1#4$,# )92 3%-#4'( 2%6(
@%65#( $' 7'2%)J146)# ' 7'2#>-#@6*%B
9
ASSISTÊNCIA À MULHER NO PARTO NORMAL
84
@U (' $'<#6( $# *%(162'*)#? # 4'1:2I*%(16$# ;#4 1#-#1%$# %# *Y3'-
$% 3/-3% #/ %@%65# $'-' <#4 )49( 26*/)#(? %*)'( $# 1-%2<'%2'*)# $#
1#4$,#? 78 )4%*(;'49*16% $' %<4#562%$%2'*)' XQ 2- $' (%*>/' $%
<-%1'*)% <%4% # 4'1:2I*%(16$#E M( '46)4J16)#( *'((' 3#-/2' $'
(%*>/' -#># ('4,# 7'2#-6(%$#(? 2%( 6((# ;#4*'1' 1'41% $' OQ 2> $'
;'44# <%4% %( 4'('43%( $# *'#*%)# ' 4'$/0 % ;4'.L9*16% $' %*'26%
;'44#<463% *# <462'64# %*# $' 36$%E "'#461%2'*)'? <#$' 1%/(%4
76<'43#-'26%? <#-616)'26% ' 76<'436(1#(6$%$'? %-:2 $'
76<'4@6-644/@6*'26%E K*)4')%*)#? *,# ;#4%2 #@('43%$%( $6;'4'*+%(
1-6*61%2'*)' 4'-'3%*)'( ' *'*7/2% $6;'4'*+% '2 4'-%+,# Z
2#4@6$%$' *'#*%)%-? ./%*$# (' 1#2<%4%4%2 #( $#6( 2#2'*)#( $'
1-%2<'%2'*)# $# 1#4$,#B '
1U *# ./' (' 4';'4' % $6()C4@6#( 4'(<64%)J46#( *'#*%)%6(? *,# 7#/3'
$6;'4'*+% (6>*6;61%)63% '*)4' %( $/%( 1#*$/)%(E
C c|cmpecmenIc Icrcic {cu cu:ëncic ce c|cmpecmenIc) é c mccc
fi:ic|cgicc ce IrcIcr c ccrccc, e c preccce é inIervençcc ¢ue ceve Ier
inciccçce: preci:c:. / ¨Ircn:fu:cc¨ ce :cngue cc p|ccenIc pcrc c recém-
nc:cicc, nc: cc:c: ce c|cmpecmenIc Icrcic ce ccrccc, é fi:ic|cgicc e
prcvcve|menIe ncc Iem efeiIc: ccver:c:, pe|c menc: em cc:c: ce Lcixc
ri:cc.
/: inciccçce: ce c|cmpecmenIc preccce ce ccrccc :e re|ccicncm c
ge:Icçce: e pcrIc: ce ri:cc, ccmc pcr exemp|c, c :en:iLi|izcçcc Fh, c
pcrIc premcIurc, c :cfrimenIc feIc| ccm cepre::cc necncIc| grcve, c
pcrIc geme|cr e c cc mu|her HlV•. Ne::e: cc:c:, c c|cmpecmenIc Icrcic
pcce ccu:cr ccmp|iccçce: e ceve :er eviIccc.
lmecicIcmenIe cpc: c nc:cimenIc, ceve-:e verificcr c: ccnciçce: cc
recém-nc:cicc. l::c é pcrIe inIegrcnIe cc c::i:Iëncic cc pcrIc ncrmc| e c
CMS enfcIizc c impcrIcncic ce umc cLcrccgem unificccc c c::i:Iëncic
mcIernc e necncIc|. E:Ie c::unIc e:Ic ccnIemp|ccc nc Ccp|Iu|c 15.
ASSISIÈNCIA À DEQbIIAÇÃO
Ne::e e:Icgic cccrre c :epcrcçcc e expu|:cc cc p|ccenIc {ce¢uiIcçcc).
C: principci: ri:cc: mcIernc: :cc c hemcrrcgic curcnIe cu cpc: e::c
:epcrcçcc e c reIençcc ce re:Ic: p|ccenIcric:.
A hemorrog|o pos-porto é umo dos pr|nc|po|s cousos de morto||dode
moterno e o mo|or|o desses cosos ocorre em poíses em desenvo|v|mento.
/ incicëncic ce hemcrrcgic pc:-pcrIc e ce reIençcc ce re:Ic:
p|ccenIcric: cumenIcm frenIe c c|gun: fcIcre: preci:pcnenIe:, Ici: ccmc
ge:Icçcc mú|Iip|c, pc|icrcmnic, IrcLc|hc ce pcrIc ccmp|icccc {ci:Iccic:)
cu pcrIc vcginc| cpercIcric. IcmLém c ri:cc é cumenIccc ¢ucncc c
pcrIurienIe Iem cnIececenIe: prévic: ce::c: inIerccrrëncic:. EmLcrc :ejc
pc::|ve| :e|ecicncr c: mu|here: ce ri:cc, me:mc em ge:Icçce: ce Lcixc
ri:cc e pcrIc: ce evc|uçcc ncrmc|, pccem-:e cL:ervcr hemcrrcgic:
:everc: e reIençcc p|ccenIcric. Em vi:Ic ci::c, vcric: mecicc:
prevenIivc: fcrcm Ie:Iccc: em e:Iucc: c|ecIcrizccc: e :ercc ci:cuIicc: c
:eguir.
9
ASSISTÊNCIA À MULHER NO PARTO NORMAL
85
1 - bso pro|||ót|co de oc|toc|cos
/ ccmini:Ircçcc prcfi|cIicc ce cciIccinc é u:ccc em vcric: mcmenIc:
curcnIe c Ierceirc per|ccc cc pcrIc. Mci: fre¢üenIemenIe é cp|icccc pcr
vic inIrcmu:cu|cr, nc cc:e ce 10U|, imecicIcmenIe cpc: c
ce:prencimenIc cc cmLrc cnIericr, cu cpc: c nc:cimenIc cc cricnçc. /:
crcgc: mci: empregccc: :cc c cciIccinc e cerivccc: cc ergcI, ccmc c
ergcIcminc, cu umc ccmLincçcc ce cmLc:, c :inIcmeIrinc. IcnIc c
cciIccinc ccmc c: cerivccc: cc ergcI ciminuem c percc :cngü|nec pc:-
pcrIc, mc: c efeiIc cc ergcI pcrece :er um pcucc mencr. Ncc e:Ic Lem
c|crc c cçcc ce::c: crcgc: :cLre c reIençcc cc: re:Ic: p|ccenIcric:,
emLcrc c|gun: re:u|Iccc: :ugircm ¢ue c ccmini:Ircçcc rcIineirc ce
cciIccinc pc::c cumenIcr e::e ri:cc.
Ncu:ec:, vcmiIc: e cefc|éic :cc re|ccicnccc: mci: fre¢üenIemenIe cc:
cerivccc: cc ergcI e, em mencr e:cc|c, c cciIccinc. / cccrrëncic ce
hiperIen:cc crIeric| pc:-pcrIc é um efeiIc cc|cIerc| prcIiccmenIe
exc|u:ivc cc: cerivccc: cc ergcI. IcmLém pccem cccrrer prcL|emc:
rcrc:, pcrém :éric:, cIriLu|cc: :ecunccricmenIe c hiperIen:cc crIeric|
pe|c u:c ce ergcmeIrinc inIrc-pcrIc - pcrccc ccrc|ccc e hemcrrcgic
inIrc-crcnicnc, infcrIc cc micccrcic, ec|cmp:ic puerperc| e ecemc
cgucc ce pu|mcc. /pe:cr cc cificu|ccce em cvc|icr Ici: efeiIc:, pe|c
rcriccce ccm ¢ue cccrrem, c: inc|cic: ci:pcn|vei: :ugerem ¢ue c
cciIccinc é c me|hcr e:cc|hc, c|ém ce :er mci: e:Icve| ¢ue c ergcIcminc
em pc|:e: ce c|imc Ircpicc|. Fcr i::c, c u:c cc: cerivccc: cc ergcI pcrc
e:Ic :iIucçcc é c|c::ificccc ccmc inIervençcc prejucicic| cu ineficcz ¢ue
ceve :er cLcnccnccc.
2 - Iroçõo contro|odo do cordõo
/ Ircçcc ccnIrc|ccc cc ccrccc envc|ve c Ircçcc cc ccrccc,
ccmLinccc ccm ccnIrcpre::cc :cLre c ccrpc uIerinc nc cireçcc
cefc|icc, feiIc pe|c mcc cpc:Ic cc|ccccc |cgc ccimc cc :|nfi:e púLicc.
E:Iucc: ccmpcrcIivc: enIre Ircçcc ccnIrc|ccc e cLcrccgen: mci:
expecIcnIe:, c: veze: envc|vencc pre::cc fúncicc, cemcn:Ircrcm mencr
percc :cngü|nec mécic e encurIcmenIc cc Ierceirc e:Icgic nc Ircçcc
ccnIrc|ccc. EnIreIcnIc, ceve-:e cIenIcr pcrc c ri:cc ce inver:cc uIerinc
fcci|iIccc pcr e::c mcncLrc. /pe:cr ce rcrc, é cccrrëncic Lc:IcnIe
grcve, re|ccicnccc c inexperiëncic e neg|igëncic cc pcrIeirc em prcIiccr
Ic| e:IrcIégic. Seguncc c CMS TVbbRU? : c|c::ificccc ccmc d<48)61% em
re|cçcc c ./%- ncc exi:Iem evicëncic: :uficienIe: pcrc cpcicr umc
reccmenccçcc c|crc e ¢ue cevem :er uIi|izccc: ccm ccuIe|c %): ./'
mci: pe:¢ui:c: e:c|creçcm c ¢ue:Icc {ccIegcric C)¨.
3 - Comporoçõo entre monejo ot|vo e expectonte
C: efeiIc: ccmLinccc: cc u:c ce cciIccicc: e Ircçcc ccnIrc|ccc cc
ccrccc :cc ccncen:ccc:, c|gumc: veze:, nc Iermc ¨mcnejc cIivc cc
Ierceirc e:Icgic¨, em ccnIrc:Ie ccm c mcnejc expecIcnIe cu fi:ic|cgicc.
EnIreIcnIc, e::e Iermc IcmLém pcce inciccr ccmLincçce: ce ciferenIe:
inIervençce: ccm ciferenIe: re:u|Iccc:. Dc| c cificu|ccce ce :e cvc|icr c:
vcric: re:u|Iccc: e cefinir c me|hcr e:IrcIégic enIre mcnejc cIivc e
ccncuIc ccn:ervcccrc nc ce¢uiIcçcc p|ccenIcric.
9
ASSISTÊNCIA À MULHER NO PARTO NORMAL
86
Nc |iIercIurc em gerc|, c mcnejc cIivc Iem me|hcre: re:u|Iccc: ¢ucncc
:e cvc|icm inIen:iccce ce hemcrrcgic pc:-pcrIc e n|vei: ce hemcg|cLinc
nc puerpéric. Mc:, :cc mci: ccmun: vcmiIc:, ncu:ec: e hiperIen:cc,
prcvcve|menIe ccu:ccc: pe|c u:c ce ergcIcminc. Exi:Iem funccmenIc:
pcrc :éric: cúvicc: :cLre c u:c prcfi|cIicc ce ergcmeIrinc cu ce umc
ccmLincçcc ce cciIccinc e ergcmeIrinc {:inIcmeIrinc) ccmc
prccecimenIc: ce rcIinc nc c::i:Iëncic c ce¢uiIcçcc.
Ccmc ccnc|u:cc, c ccmini:Ircçcc ce cciIccinc nc c::i:Iëncic c
ce¢uiIcçcc e c Ircçcc ccnIrc|ccc cc ccrccc pccem cpre:enIcr
vcnIcgen: em inciccçce: preci:c: - mu|here: ccm ri:cc pcrc hemcrrcgic
pc:-pcrIc e c¢ue|c: pcrIcccrc: ce cnemic . :everc. / ce:peiIc cc:
crienIcçce: cnIericre: cc CMS {1ºº0 e 1ºº4), c reccmenccçcc cc
mcnejc cIivc cc Ierceirc per|ccc , ccmc prcIicc ce rcIinc nc pcrIc ce
Lcixc ri:cc, pcrece :er premcIurc e cepence ce e:Iucc: mci: e:pec|ficc:
{CMS, VbbRUE
4 - kev|sõo do p|ocento, dos onexos e do cono| de porto
C excme cc p|ccenIc, ccrccc umLi|icc| e memLrcnc:, imecicIcmenIe
cpc: c expu|:cc, é prcIicc inci:pen:cve|, principc|menIe pcrc verificcr c
inIegriccce, cerIificcncc-:e ce ¢ue ncc fcrcm ceixccc: re:Ic:
p|ccenIcric: cu ce memLrcnc nc ccviccce uIerinc.
Se c inIegriccce cc p|ccenIc e memLrcnc: fcr cuvicc:c, c revi:cc ccm
exp|crcçcc cc ccviccce uIerinc ceve :er iniciccc. C excme cc
p|ccenIc e cnexc: pre:Ic-:e, IcmLém, pcrc c cicgnc:Iicc ce evenIuci:
cncrmc|iccce:: infcrIc:, hemcIcmc:, in:erçcc cncrmc| ce ccrccc e
crIéric umLi|icc| únicc, re|ccicnccc c mc|fcrmcçce: feIci:.
Em c|gun: pc|:e: é prcIicc ce rcIinc c exp|crcçcc cc ccviccce uIerinc
nc pc:-pcrIc imecicIc. Ncc exi:Ie c mencr inc|cic ce ¢ue e::c ccncuIc
:ejc úIi|, cc ccnIrcric, pcce ccu:cr infecçcc, IrcumcIi:mc: e cIé me:mc
chc¢ue. Feccmencc-:e, enIreIcnIc, c revi:cc cc ccnc| ce pcrIc pcrc c
cicgnc:Iicc ce pc::|vei: |ccercçce: ce IrcjeIc.
CONSIDEkAÇÕES FINAIS
Em ¢ue pe:e c experiëncic ce muiIc: cL:IeIrc: e cuIrc: prcfi::icnci:, c
¢ue lhe: permiIe cefencer :uc: ccncuIc: e prcIicc: nc c::i:Iëncic cc
pcrIc, e impuIcrem c e|c: um ccrcIer ce ¨verccce cL:c|uIc¨, c
CL:IeIr|cic cIuc| vem prccurcncc cccc vez mci: ciIcr :uc: ncrmc: ccm
Lc:e em evicëncic: cienI|ficc:. lnfe|izmenIe, c: re:u|Iccc: ce e:Iucc:
ccnIrc|ccc: e c|ecIcrizccc: cincc ncc ccn:eguircm re:pcncer Iccc: c:
¢ue:Ice: re|ccicnccc: c prcIicc cc c::i:Iëncic cc pcrIc. / exceçcc ce
c|gumc: ce|c:, ce:Iccccc: nc Ccp|Iu|c 21, muiIc: cuIrc: ccnIinucm :em
cefiniçcc ¢ucnIc cc ri:cc-Lenef|cic pcrc c mce e c ccncepIc. Dc| c
cificu|ccce em :e pccrcnizcr c c::i:Iëncic ne:Ie mcmenIc Icc
impcrIcnIe cc vicc cc mu|her. EnIreIcnIc, é cerIc cfirmcr ¢ue c:
Lenef|cic: e, em ceccrrëncic, c: me|hcre: re:u|Iccc: mcIernc: e
perincIci: re|ccicncm-:e cireIcmenIe c c::i:Iëncic humcnizccc,
re:peiIcncc c: cireiIc: cc pcrIurienIe, re:gcIcncc c :eu pcpe| ccmc
prcIcgcni:Ic e incenIivcncc c pcrIc ncIurc|.
9
87
/ ce:crec é um prccecimenIc cirúrgicc ¢ue, ¢ucncc
Lem incicccc, Iem pcpe| funccmenIc| nc CL:IeIr|cic
mccernc ccmc recuIcr cc mcrLiccce e mcrIc|iccce
perincIc| e mcIernc.
Nc enIcnIc, ncc :e pcce cceiIcr um cumenIc ce
ce:crec: :em inciccçcc preci:c, pci: é :cLicc ¢ue
e:Ie prccecimenIc cirúrgicc, ccmpcrcIivcmenIe cc
pcrIc ncrmc|, c::ccic-:e ccm mcicr mcrLiccce e
mcrIc|iccce mcIernc e necncIc|. / cpercçcc
ce:cricnc cpre:enIc umc fre¢üëncic muiIc e|evccc
nc 8rc:i|. l::c Iem :icc re:pcn:cve| pcr umc
Lcnc|izcçcc cc prccecimenIc, ccmc :e fc::e :imp|e:
e i:enIc ce pc::|vei: ccmp|iccçce:.
C pcrIc pcr ce:crec é umc |cpcrcIcmic ¢ue exige
umc :érie ce cuicccc: c||nicc:, Iécnicc: e cne:Ié:icc:
e ¢ue :e c::ccic IcmLém c c|gumc: ccmp|iccçce:
¢ue cevem :empre :er pcncerccc: cnIe: cc
inciccçcc. Deve, pcrIcnIc, :er cecicicc pcr criIéric:
e:IriIcmenIe c||nicc: e cL:IéIricc:.
Ccn:icerc-:e icec| c Icxc ce ce:crec em Icrnc ce 15 c
207 pcrc c IcIc| cc pcpu|cçcc. Nc enIcnIc, ceve-:e
|evcr em ccn:icercçcc c ccmp|exiccce cc c::i:Iëncic
fcrnecicc pe|c in:IiIuiçcc, ¢ucncc :e cnc|i:cm Icxc:
in:IiIucicnci: :epcrcccmenIe.
CcLe c¢ui enfcIizcr ¢ue c pcrIc pcr ce:crec, ¢ucncc
Lem incicccc e rec|izccc, IcmLém é um pcrIc
humcnizccc nc mecicc em ¢ue c inciccçcc vi:c
minimizcr cgrcvc: c mce e cc feIc. C pre:enIe
ccp|Iu|c ncc Iem c cLjeIivc ce en:incr c Iécnicc
cirúrgicc pcrc c prcfi::icnc| cc crec ce cL:IeIr|cic,
mc: Irczer, c |uz cc ccnhecimenIc cienI|ficc cIuc|,
c|gun: pcnIc: ce impcrIcncic IcIicc e Iécnicc nc
rec|izcçcc ce:Ie prccecimenIc.
1. Anestes|o
/ nece::iccce cc u:c ce cne:Ie:ic em prccecimenIc:
cL:IéIricc:, prcIicccc pcr prcfi::icnci: e:pecic|i:Ic:
ccpcciIccc:, ccn:IiIui um ccn:en:c c n|ve| nccicnc|,
emLcrc muiIc: |ugcre: e
10 ASSISTÊNCIA À MULHER NO PARTO POR CESÁREA
ASSISTÊNCIA Á MULHER NO PARTO POR CESÁREA
88
in:IiIuiçce: ncc ci:pcnhcm cincc ce Iccc: c: fcci|iccce: pcrc i::c. É
nece::cric, ccnIucc, ¢ue c: prcfi::icnci: ¢ue pre:Icm c::i:Iëncic c
mu|her curcnIe c grcvicez e pcrIc, ccnheçcm c|gumc: ccrccIer|:Iicc: e
pcrIicu|criccce: :cLre c cnc|ge:ic e cne:Ie:ic c :erem uIi|izccc: ne:Ie:
prccecimenIc:. Fcrc IcnIc, c: ccp|Iu|c: 8 e 12 cLcrccm e:Ie c::unIc ce
fcrmc mci: ceIc|hccc.
2. Fos|çõo do mu|her
/ ce:crec é rec|izccc ccm c mu|her em cecúLiIc ccr:c| hcrizcnIc|. Fe|c
pc::iLi|iccce ce hipcIen:cc mcIernc {cevicc c ccmpre::cc cc veic
ccvc infericr e ciminuiçcc cc reIcrnc venc:c cc ccrcçcc) e
ccn:e¢üenIe recuçcc nc perfu:cc p|ccenIcric e nc cxigencçcc feIc|,
c|gun: e:Iucc: Iëm ccmpcrccc e:Ic pc:içcc ccm c rec|izcçcc ce:Ie
prccecimenIc cirúrgicc ccm c mu|her em cecúLiIc |cIerc| {10 cu 15
grcu:). Nc enIcnIc, revi:cc :i:IemcIicc :cLre c Iemc ccnc|uiu ¢ue ncc
exi:Ie, cIé c mcmenIc, evicëncic: cienI|ficc: :uficienIe: pcrc cvc|icr ¢uc|
me|hcr pc:içcc cc mu|her nc ce:crec.
3. Ant|sseps|o
/ cegermcçcc cc pe|e cc cLccmen mcIernc ccm :c|uçce: ce :cLcc
neuIrc previcmenIe c cnIi::ep:ic é funccmenIc|. C: cnIi::épIicc:
cIuc|menIe empregccc: :cc :c|uçce: ce iccc, ncc mci: :e ju:Iificcncc c
u:c ce cuIrc: :c|uçce:. / cic|chexicinc pcce :er IcmLém uIi|izccc em
c::ccicçcc ccm c: :c|uçce: iccccc:. A|ém do mu|her, é necessór|o
|embror que o h|g|en|zoçõo dos mõos do equ|pe pro||ss|ono| que
otenderó o porto const|tu| e|emento |undomento| poro ev|tor o
contom|noçõo c|rùrg|co e os comp||coçöes |n|ecc|osos pos-operotor|os.
4. Esco|ho do |nc|sõo
Nc 8rc:i|, cIuc|menIe, nc ¢uc:e cL:c|uIc IcIc|iccce cc: ce:crec:, c
preferëncic é cccc c inci:cc Ircn:ver:c :uprc-púLicc, ccnfcrme Iécnicc
ce Ffcnnen:Iie|. / inci:cc infrc-umLi|icc| mecicnc re:Iringe-:e c cc:c: em
¢ue c ri:cc ce :cngrcmenIc é mcicr {ccmc nc :|ncrcme HELLF), cu
¢ucncc hc exIremccc nece::iccce ce reIirccc rcpicc cc feIc, ccmc nc
:cfrimenIc feIc| cgucc grcve, nc ce:crec pc:I-mcrIem e cuIrc:
:iIucçce:.
EnIreIcnIc, uIi|izcncc-:e c Iécnicc ce Ffcnnen:Iie|, ceve-:e e:Icr cIenIc c
c|gun: inccnvenienIe:, fcci|menIe ccnIcrncvei:: mcicr :cngrcmenIc,
ccmpc cpercIcric recuzicc, mcicr Iempc cirúrgicc ¢ue c inci:cc
mecicnc e mcicr ri:cc ce hemcIcmc. Ncc exi:Iem cIé c mcmenIc
ccmpcrcçce: Lem rec|izccc: enIre c: cci: Iipc: ce inci:cc ¢ue permiIcm
ju:Iificcr c preferëncic cefiniIivc pcr ¢uc|¢uer umc ce|c:.
5. Loporotom|o
/ cLerIurc cc ccviccce cLccminc|, ceve :er ccn:icerccc c
pc::iLi|iccce ce |e:ce: cc Lexigc cu ce c|çc: inIe:Iinci:, principc|menIe
em cc:c: ce cirurgic: prévic:, cu inexperiëncic
10
ASSISTÊNCIA À MULHER NO PARTO POR CESÁREA
89
cc cirurgicc. É funccmenIc|, enIreIcnIc, ¢ue c cicgnc:Iicc cc
inIerccrrëncic :ejc feiIc imecicIcmenIe e, cc me:mc fcrmc, :eu repcrc,
reccrrencc-:e c e:pecic|i:Ic: :e c::im fcr nece::cric.
6. H|sterotom|o
De Iccc: c: vcricnIe: prcpc:Ic: pcrc c cLerIurc cc ccviccce uIerinc
{:egmenIcr |cngiIucinc|, :egmenIc-ccrpcrc|, ccrpcrc| e :egmenIcr
Ircn:ver:c), c :egmenIcr Ircn:ver:c, crcifcrme, ce ccnccviccce :upericr
é c ce e:cc|hc. Exi:Iem ju:IificcIivc: pcrc e:Ic preferëncic. Em primeirc
|ugcr, re:peiIc-:e c ci:pc:içcc Ircn:ver:c| e pcrc|e|c cc: fiLrc: micmeIrci:
e cc vc:cu|cIurc. C ri:cc ce |e:ce: cc: crIéric: uIerinc: - principc|
inccvenienIe cc hi:IercIcmic :egmenIcr Ircn:ver:c - pcce :er
minimizccc pcr :eu ccrcIer crcifcrme ce ccnccviccce :upericr. /|ém
ci::c, pcr ncc rcmper fiLrc: e :im civu|:icnc-|c:, gcrcnIe-:e me|hcr
cprcximcçcc cc: Lcrcc: cc inci:cc uIerinc e, ccn:e¢üenIemenIe, mcicr
fcci|iccce pcrc c :uIurc e me|hcr ciccIrizcçcc.
/ cLerIurc cc ccviccce uIerinc é feiIc prcIiccncc-:e pe¢uenc inci:cc c
Li:Iuri, ¢ue :e ccmp|eIc ce|iccccmenIe ccm pinçc Iipc ‚e||y cu Fecn,
cIé cIingir-:e c ccviccce uIerinc. / :eguir, ccm c: cecc: inciccccre:
inIrccuzicc: ne:Ic pe¢uenc LcIceirc, ccmp|eIc-:e c cLerIurc
|cIerc|menIe. / inci:cc cc zcnc :egmenIcr ccm Ie:curc ceve :er re:IriIc
c cc:c: ccm c pre:ençc ce Iecicc fiLrcIicc e:pe::c :cLre ciccIriz
cnIericr e c ce:crec: cnIe: cc e:IcLe|ecimenIc cc IrcLc|hc ce pcrIc,
¢ucncc c :egmenIc infericr cc úIerc cincc ncc e:Ic ccmp|eIcmenIe
cce|gcçccc.
Excepcicnc|menIe, nc: cc:c: ce :egmenIc infericr cincc ncc fcrmccc
cu mc| ce:envc|vicc, pcce :er nece::cric c uIi|izcçcc cc inci:cc
:egmenIc-ccrpcrc|. Ic| ceci:cc, enIreIcnIc, exige experiëncic cc
cL:IeIrc e umc cvc|icçcc feiIc ccm c venIre cLerIc.
7. Escoomento do |íqu|do omn|ot|co
Deve-:e prccecer c c:pircçcc cuicccc:c cc l|¢uicc cmnicIicc pre:enIe,
cu permiIir c :eu e:cccmenIc prcIegicc pcr ccmpre::c: cirúrgicc:,
eviIcncc c enchcrccmenIc cc: ccmpc: prcIeIcre: e fcci|iIcncc c
reIirccc cc feIc, pcr ciminuir :uc mcLi|iccce.
8. ket|rodo do |eto
Iempc cirúrgicc muiIc impcrIcnIe nc ce:crec, exigincc Ircn¢üi|iccce cc
cirurgicc, ccm cLjeIivc ce eviIcr ce:prencimenIc: feIci: Lru:cc:, ccm
pc::|vei: ccn:e¢üëncic: perincIci:. Ne:Ie mcmenIc é funccmenIc|
|emLrcr ¢ue umc cricnçc e:Ic nc:cencc: c :c|c cirúrgicc ceve e:Icr
c¢uecicc {ccm cr ccncicicnccc ce:|igccc) e c cmLienIe :i|encic:c. C
cL:IeIrc ceve cnuncicr pcrc c mu|her c nc:cimenIc e c necncIc|cgi:Ic
ceverc |evcr c recém-nc:cicc pcrc c mce, c::im ¢ue fcr pc::|ve|.
/ reIirccc cc feIc pcce :er feiIc mcnuc|menIe cu ccm c uIi|izcçcc ce
in:IrumenIc: ccmc fcrcipe: e c|cvcncc:. Nc: cpre:enIcçce:
10
ASSISTÊNCIA À MULHER NO PARTO POR CESÁREA
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cefc|icc: mci: prcfunccmenIe cju:Iccc:, c exIrcçcc mcnuc| é ce
e:cc|hc: inIrccuz-:e c mcc enIre c cpre:enIcçcc e c pcrece uIerinc
cnIericr, ccm ce|icccezc pcrc eviIcr c prc|cngcmenIc cc hi:IercIcmic,
cIinge-:e c cccip|cic, e|evcncc-c em cireçcc c fencc uIerinc. Fcr
mcncLrc ce cef|excc cc pc|c cefc|icc e pe|c ccmpre::cc cuxi|icr
exercicc nc funcc uIerinc, ccn:egue-:e, gerc|menIe ce mccc fcci|, c
ce:prencimenIc cc feIc.
Nc enIcnIc, em cpre:enIcçce: cefc|icc: c|Ic: e mcvei:, ccmc fre¢üenIe:
em premcIurc: e ge:Icçce: ccm pc|icrcmnic, c uIi|izcçcc ce
in:IrumenIc: ccmc c c|cvcncc ce Se|heim, fcci|iIc :cLremccc c reIirccc
cc feIc. Me:mc c::im, pcr veze:, c exIrcçcc Icrnc-:e cif|ci| ccmc, pcr
exemp|c, nc: cefc|icc: cef|eIicc:, c cemcnccr ccncuIc mci: cIivc ccmc
c cp|iccçcc ce fcrcipe, cujc Iécnicc cLecece cc: me:mc: Iempc: ¢ue
pcrc pcrIc: vcginci:. /mLc: prccecimenIc: impcem nece::cricmenIe c
hcLi|iccce nc :eu mcnejc.
Nc: cpre:enIcçce: pé|vicc:, iguc|menIe, c reIirccc cc feIc cLecece
rigcrc:cmenIe cc: me:mc: Iempc: e Iécnicc: prcpc:Ic: pcrc c pcrIc
vcginc|. C cL:IeIrc ceve e:Icr cIenIc pcrc c ccrccc umLi|icc| cc feIc,
prcIiccncc c chcmccc ¨c|çc ce ccrccc¨ cnIe: cc ce:prencimenIc cc
cinIurc e:ccpu|cr e verificcr c exi:Iëncic ce circu|cre: cervicci:. C cuxi|icr
ce:empenhc pcpe| impcrIcnIe, ccncuzincc c pc|c cefc|icc
exIerncmenIe, ccn:ervcncc-c ceviccmenIe f|eIicc, cIé ¢ue enIre em
ccnIcIc ccm c cLerIurc uIerinc. C cL:IeIrc ncc ceve Irccicncr c feIc,
pci: hc :empre c ri:cc ce cef|excc cc pc|c cefc|icc, c ¢ue cificu|Ic, em
muiIc, c exIrcçcc feIc|.
Nc: :iIucçce: Ircn:ver:c:, c cL:IeIrc ceve Ier experiëncic :uficienIe pcrc
execuIcr mcncLrc: ce ver:cc inIernc e exIrcçcc pccc|icc.
9. C|ompeomento do cordõo e cu|dodos |med|otos com o kN
/ |igccurc cc ccrccc umLi|icc| {c|cmpecmenIc) pcce :er rec|izccc ce
imecicIc cu mcmenIc: cpc: c exIrcçcc feIc|, excIcmenIe cc me:mc
mcneirc ¢ue nc pcrIc cIencicc pcr vic vcginc|, ccnfcrme IrcIc c
Ccp|Iu|c º ce:Ie mcnuc|. E::c ¢ue:Icc jc exigiu e:Iucc: ccnIrc|ccc:
:cLre c: efeiIc: cc mcmenIc cc |igccurc cc ccrccc nc mce e nc recém-
nc:cicc. Ncc :e verificcrcm inc|cic: ce efeiIc: :ignificcIivc: :cLre c
incicëncic ce hemcrrcgic pc:-pcrIc cu :cLre c Ircn:fu:cc feIc-mcIernc.
EnIreIcnIc, :cLre c recém-nc:cicc, vcric: cL:ervcçce: fcrcm re|cIccc::
c) #( @'@9( 1#2 1-%2<'%2'*)# 62'$6%)# $' 1#4$,# )92 3%-#4'( 2%6(
@%65#( $' 7'2%)J146)# ' 7'2#>-#@6*%B
L) (' $'<#6( $# *%(162'*)#? # 4'1:2I*%(16$# ;#4 1#-#1%$# Z %-)/4% $%
3/-3% #/ %@%65# <#4 )49( 26*/)#(? %*)'( $# 1-%2<'%2'*)# $# 1#4$,#?
78 )4%*(;'49*16% $' %<4#562%$%2'*)' XQ 2- $' (%*>/' $% <-%1'*)%
<%4% # 4'1:2I*%(16$#E M( '46)4J16)#( *'((' 3#-/2' $' (%*>/' -#>#
('4,# 7'2#-6(%$#(? 2%( 6((# ;#4*'1' 1'41% $' OQ 2> $' ;'44# <%4% %(
4'('43%( $# *'#*%)# ' 4'$/0 % ;4'.L9*16% $' %*'26% ;'44#<463% *#
<462'64# %*# $' 36$%E "'#461%2'*)'? <#$' 1%/(%4 76<'43#-'26%?
<#-616)'26% ' 76<'436(1#(6$%$'? %-:2 $' 76<'4@6-644/@6*'26%E K*)4')%*)#?
10
ASSISTÊNCIA À MULHER NO PARTO POR CESÁREA
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*,# ;#4%2 #@('43%$%( $6;'4'*+%( 1-6*61%2'*)' 4'-'3%*)'( ' *'*7/2%
$6;'4'*+% '2 4'-%+,# Z 2#4@6$%$' *'#*%)%-? ./%*$# (' 1#2<%4%4%2
#( $#6( 2#2'*)#( $' 1-%2<'%2'*)# $# 1#4$,#B '
1U *# ./' (' 4';'4' % $6()C4@6#( 4'(<64%)J46#( *'#*%)%6(? *,# 7#/3'
$6;'4'*+% (6>*6;61%)63% '*)4' %( $/%( 1#*$/)%(E
C c|cmpecmenIc Icrcic {cu cu:ëncic ce c|cmpecmenIc) é c mccc
fi:ic|cgicc ce IrcIcr c ccrccc, e c preccce é inIervençcc ¢ue ceve Ier
inciccçce: preci:c:. / ¨Ircn:fu:cc¨ ce :cngue cc p|ccenIc pcrc recém-
nc:cicc, nc: cc:c: ce c|cmpecmenIc Icrcic ce ccrccc, é fi:i c|cgicc e
prcvcve|menIe ncc Iem efeiIc: ccver:c:, pe|c menc: em cc:c: ce Lcixc
ri:cc.
/: inciccçce: ce c|cmpecmenIc preccce ce ccrccc re|ccicncm-:e c
ge:Icçce: e pcrIc: ce ri:cc, ccmc pcr exemp|c, c :en:iLi|izcçcc Fh, c
pcrIc premcIurc, c :cfrimenIc feIc| ccm cepre::cc necncIc| grcve, pcrIc
geme|cr e c cc mu|her HlV•. Ne::e: cc:c:, c c|cmpecmenIc Icrcic pcce
ccu:cr ccmp|iccçce: e ceve :er eviIccc.
10. Dequ|toçõo
/pc: c reIirccc feIc|, en¢ucnIc c e¢uipe cirúrgicc incivicuc|izc c: Lcrcc:
cc hi:IercIcmic, c ce¢uiIcçcc, nc mcicric cc: veze:, cccrre ce fcrmc
e:pcnIcnec. E:Ie Iempc pcce :er ciminu|cc, uIi|izcncc-:e cciIccicc:.
Fe|c vigcrc:c ccnIrcçcc uIerinc ¢ue :e cLIém, c p|ccenIc é expu|:c :em
grcnce: cificu|ccce:. Fcrc umc ci:cu::cc mci: ceIc|hccc :cLre c
c::unIc, ver Ccp|Iu|c º.
C: e:Iucc: ccnIrc|ccc: ¢ue ccmpcrcm c ce¢uiIcçcc e:pcnIcnec ccm
c remcçcc mcnuc| cc p|ccenIc Iëm mc:Irccc ¢ue e:Ic ú|Iimc é mci:
ccnc:c, c::ccicncc-:e cc incremenIc cc percc :cngu|nec mcIernc e cc
ri:cc ce infecçcc, e:IcIi:IiccmenIe :i gnificcIivc. /::im, c reIirccc mcnuc|
cc p|ccenIc ceve ficcr re:IriIc cc: cc:c: em ¢ue, e:pcnIcnecmenIe,
ncc :e ceu c ce¢uiIcçcc, em per|ccc rczccve| ce Iempc pcrc c
prccecimenIc cirúrgicc.
11. kev|sõo do p|ocento e do cov|dode uter|no
É Iempc cLrigcIcric pcrc c icenIificcçcc ce frcgmenIc: p|ccenIcric:
reIicc: cu ce |e:ce: cc: pcrece: uIerinc:, principc|menIe ¢ucncc cc u:c
ce in:IrumenIcçcc pcrc c reIirccc cc feIc. Feccmencc-:e c curcgem
cc ccviccce uIerinc ccm ccmpre::c pcrc e:Ie prccecimenIc.
Ccn:IiIui pc::c Iécnicc ce grcnce re|evcncic, pcrc c icenIificcçcc ce
cncmc|ic: {infcrIc:, IrcmLc:e:, Iumcre:, eIc.) e inIegriccce cc mc::c
p|ccenIcric e cc: memLrcnc:, e ce cncmc|ic: cc ccrccc {nc:
verccceirc:, e fc|:c:, númerc ce vc:c:, eIc.).
12. H|sterorro||o
EmLcrc c :uIurc ccnI|nuc cnccrccc :ejc prcIicc fre¢üenIe nc 8rc:i|, c
fechcmenIc cc ccviccce uIerinc ccm pcnIc: :epcrccc:, em ccmccc
únicc, é c ¢ue fcrnece me|hcre: re:u|Iccc: ¢ucncc c ciccIrizcçcc. Nc:
cc:c: e:pecici: ce inci:cc :egmenIc-ccrpcrc|,
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ASSISTÊNCIA À MULHER NO PARTO POR CESÁREA
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c fechcmenIc é feiIc em cuc: cu Irë: ccmccc:, ccm pcnIc: :epcrccc:.
Deve-:e Ier cuicccc e:pecic|, exc|uincc c cec|cuc cc :uIurc mu:cu|cr e
prcIiccncc revi:cc cc hemc:Ic:ic. Fcrc e:Ie Iempc cirúrgicc, c: fic:
incicccc: :cc c: ce cL:crçcc |enIc {ccIguI crcmccc nº 0, cu vicry| nº 0,
cu cexcn nº 0).
Fe|c ccnhecimenIc ci:pcn|ve| cIé c mcmenIc, e:Ie fechcmenIc cc
ccviccce uIerinc ceve :er rec|izccc ccm c úIerc em :eu :|Iic hcLiIuc|.
/|gun: e:Iucc: Iëm prcpc:Ic ¢ue e:Ic :uIurc :ejc rec|izccc cpc: c
exIericrizcçcc cc úIerc. Nc enIcnIc, revi:cc :i:IemcIicc :cLre c c::unIc
ccnc|uiu ¢ue ncc hc evicëncic :uficienIe pcrc reccmenccr c u:c
rcIineirc cc exIericrizcçcc uIerinc pcrc c repcrc cc hi:Iercrrcfic.
13. Fer|ton|zoçõo
/ :uIurc ccnI|nuc ccm fic finc cL:crv|ve|, ccmc c ccIguI :imp|e: nº 2-0, é
preccnizccc ccmc c ce e:cc|hc pcrc c fechcmenIc cc periIcnic
vi:cerc| e pcrieIc| em chu|eic :imp|e:.
/|gun: cuIcre: :ugerem ¢ue, nc periIcnizcçcc vi:cerc|, c cuxi|icr Irccicne
c fic ccm fcrçc :uficienIe cpenc: pcrc cprcximcrem-:e c: Lcrcc:, :em
prccuzir c preguecmenIc cc :uIurc, c ¢ue pcce ccncicicncr muccnçc:
nc pc:içcc cc Lexigc e cc urccincmicc ve:icc|. C fechcmenIc cc
ccviccce cLccminc| {:uIurc cc periIcnic pcrieIc|) IcmLém ceve :er feiIc
ccm chu|eic ccnI|nuc, ccm fic cL:crv|ve| e finc {ccIguI nº 2-0).
EnIre e:Ie: cci: Iempc: cc periIcnizcçcc, prccece-:e c revi:cc cc
ccviccce cLccminc|, ncc :cmenIe pcrc c reIirccc ce :cngue e
cccgu|c: ccumu|ccc:, ccmc IcmLém pcrc c cvc|icçcc cc: cvcric: e
IuLc: uIerinc:.
En:cic: c||nicc: ccnIrc|ccc: Iëm ccmpcrccc c periIcnizcçcc ccm c ncc
periIcnizcçcc vi:cerc| e/cu pcrieIc|. C: re:u|Iccc: principci: mc:Ircm ¢ue
c ncc fechcmenIc cc periIcnic ciminui c Iempc cpercIcric, :em
ciferençc :ignificcIivc ¢ucnIc c mcrLiccce pc:-cpercIcric, nece::iccce
ce cnc|gé:icc: e Iempc ce permcnëncic hc:piIc|cr.
14. Fechomento do p|ono muscu|or
Deve :er feiIc ccm pcnIc: :epcrccc: em ¨U¨, ccm fic ce cL:crçcc rcpicc
{Iipc ccIguI :imp|e: nº 0). C: pcnIc: ncc cevem :er cperIccc:, pci:
pccem prcvcccr i:¢uemic cc mu:cu|cIurc.
15. Fechomento do oponeurose onter|or dos mùscu|os retos
/pc: revi:cc cuicccc:c cc p|cnc mu:cu|cr e cc pcrece pc:Iericr cc
cpcneurc:e c prccurc ce pcnIc: ce :cngrcmenIc {¢ue cevem :er
:i:IemcIiccmenIe hemc:Ic:iccc:), prccece-:e cc fechcmenIc ce:Ic
ccmccc. UIi|izcm-:e pcnIc: :epcrccc:, ccm fic ce cL:crçcc |enIc {vicry|
nº 0, cu cexcn nº 0) cu cincc fic: incL:crv|vei:.
/ cc|cccçcc ce crenc ce Fenrc:e nc e:pcçc :uLcpcneurcIicc ncc
ceve :er prccecimenIc ce rcIinc, mc: e:Ic reccmencccc ¢ucncc
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ASSISTÊNCIA À MULHER NO PARTO POR CESÁREA
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exi:Iir ri:cc cumenIccc ce fcrmcçcc ce hemcIcmc: cu infecçcc:
c|Iercçcc cc cccgu|cçcc :cngü|nec, c|Iercçce: hemccincmicc:
mcIernc: nc ceccrrer cc cirurgic e cificu|ccce ce hemc:Ic:ic cc p|cnc
mú:cu|c-cpcneurcIicc.
É impcrIcnIe |emLrcr ¢ue c mu|her grcvicc e:Ic em umc :iIucçcc
fi:ic|cgicc ce hipercccgu|cLi|iccce, c ¢ue fcci|iIc c hemc:Ic:ic cc
pcrece cLccminc| nc: prccecimenIc: cirúrgicc:, ccmc é c cc:c cc
ce:crec. /::im, c hemc:Ic:ic meccnicc é ¢uc:e :empre :uficienIe, ncc
hcvencc gerc|menIe nece::iccce ce e|eIrcccuIerizcçcc. Cucncc e|c
fcr uIi|izccc, é preci:c um cuicccc e:pecic| ccm c p|ccc pcrc eviIcr
¢ueimccurc:, mci: fre¢üenIe: ne:Ie prccecimenIc pe|c mcicr
prcLcLi|iccce ce c: ccmpc: cirúrgicc: e:Icrem mc|hccc:.
1ó. Aprox|moçõo do tec|do ce|u|or subcutöneo
De:nece::cric pcrc c|gun:, é feiIc uIi|izcncc-:e pcnIc: :epcrccc: ce
cprcximcçcc ccm fic ce cL:crçcc rcpicc. Cuicccc: :imi|cre: cevem :er
Icmccc: ccm re|cçcc c hemc:Ic:ic ce:Ic crec.
17. Fechomento do pe|e
Feccmencc-:e ¢ue :ejc feiIc ccm fic incL:crv|ve| finc {ny|cn nº 3-0 cu 4-
0) ccm pcnIc: :imp|e: cu Iipc DcncIIi.
18. Curot|vo
Ncc mci: :e ju:Iificcm c: curcIivc: exIen:c: e fechccc: u:ccc: nc
pc::ccc. /Iuc|menIe Iem-:e cemcn:Irccc ¢ue curcIivc :imp|e: nc:
primeirc: hcrc: e mcnIer c inci:cc ce:ccLerIc, :cc prccecimenIc:
cce¢uccc:. É :uficienIe |cvcr c inci:cc ccm cguc e :cLcc, mcnIencc-c
:ecc.
CbIDADOS FÓS-OFEkAIÓkIOS
1. Ant|b|ot|coterop|o
/ ce:crec é Iicc ccmc cirurgic pcIencic|menIe infecIccc. Nc: ge:IcnIe:
:uLmeIicc: c ce:crec e|eIivc cu em IrcLc|hc ce pcrIc,
incepencenIemenIe cc inIegriccce cc: memLrcnc:, reccmencc-:e
cnIiLicIiccIercpic prcfi|cIicc. kev|söes s|stemót|cos tëm demonstrodo
c|oromente que o ont|b|ot|co pro|||ót|co, em openos umo dosogem,
|med|otomente opos o c|ompeomento do cordõo, é proced|mento
e|et|vo no prevençõo de morb|dode |n|ecc|oso puerpero| moterno.
Mu|tos esquemos de ont|b|ot|cos |so|odos ou em ossoc|oçõo tëm s|do
estudodos, sem umo c|oro demonstroçõo do supremoc|o de quo|quer um
de|es. kecomendo-se, portonto, o uso de umo ce|o|ospor|no de pr|me|ro
geroçõo [ce|ozo||no ou ce|o|ot|no, 2 g endovenoso} ou omp|c|||no [2 g
endovenoso}.
/ cnIiLicIiccIercpic curcIivc é incicccc cpenc: nc: cc:c: ccm um
cicgnc:Iicc ccnfirmccc cu c|iniccmenIe :u:peiIc ce infecçcc.
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ASSISTÊNCIA À MULHER NO PARTO POR CESÁREA
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2. Med|coçõo pos-operotor|o
Hcje é cc:Iume ci::eminccc enIre c: mécicc: c u:e ce cnIi-inf|cmcIcric:
incicccc: ccmc cnc|gé:icc:. Ic| mecicc ncc :e ju:Iificc c |uz cc
fi:ic|cgic, pci: c inf|cmcçcc é prcce::c ncIurc| ce cefe:c cc crgcni:mc e
c: cnIi-inf|cmcIcric: pccem cpre:enIcr c|gun: efeiIc: cc|cIerci: grcve:
ccmc c ln:uficiëncic Fenc| /gucc. Fcr i::c, cnc|gé:icc: ccmun: cevem
:er ce e:cc|hc, cpenc: ¢ucncc nece::cric:.
3. Sondogem ves|co| contínuo
/ccn:e|hc-:e c crencgem ve:icc| em :i:Iemc fechccc, pcr per|ccc ce
cprcximcccmenIe :ei: hcrc:, cccc: c: cLvic: cificu|ccce: ce
cecmLu|cccc e c ci:Ien:cc ve:icc| pcr cemcrc nc re:IcLe|ecimenIc cc
micçcc e:pcnIcnec. Ncc :e ju:Iificc c ccnIinuiccce cc :cnccgem cpc:
e:Ie per|ccc ce Iempc, c menc: ¢ue, pcr ¢uc|¢uer mcIivc, c mu|her
cevc permcnecer em repcu:c nc |eiIc pcr Iempc IcmLém mci:
prc|cngccc, cu nc evenIuc|iccce ce ¢ue c|gumc ccmp|iccçcc Ienhc
cccrricc.
4. A||mentoçõo
Em ccnciçce: ce ncrmc|iccce cc cIc cirúrgicc, pcce :er permiIicc c
c|imenIcçcc cc puérperc em Iempc preccce, uIi|izcncc-:e inicic|menIe
cieIc: preferenIemenIe ||¢uicc:. Deccrricc per|ccc ce cprcximcccmenIe
8 c 12 hcrc:, |iLerc-:e c cieIc.
5. Deombu|oçõo
C |evcnIcr e ccminhcr preccce: :cc reccmencccc:. / re:Iriçcc cc |eiIc,
c|ém ce ce:ccnfcrIcve|, fcvcrece c cpcrecimenIc ce fencmenc:
IrcmLcemLc|icc:.
ó. Amomentoçõo precoce
/ cmcmenIcçcc ceve :er e:Iimu|ccc e iniciccc c mci: precccemenIe
pc::|ve|. Cferece inúmerc: vcnIcgen:, enIre c: ¢uci:, c e:IcLe|ecimenIc
cc inIegrcçcc p:|¢uicc mce-fi|hc {ver Ccp|Iu|c 1ó).
7. A|to hosp|to|or
/ ce:crec é prccecimenIc cirúrgicc invc:ivc cc ccviccce cLccminc|,
:ujeiIc c ccmp|iccçce: inIrc-cpercIcric: ¢ue cLrigcm c cIençcc pc:-
cpercIcric. /::im, reccmencc-:e e:percr pe|c menc: c re:IcLe|ecimenIc
pcrcic| cc funçcc inIe:Iinc| cpc: c ce:crec, e ccr c|Ic hc:piIc|cr cc finc|
ce 48 hcrc:.
8. ket|rodo de pontos
C fechcmenIc cc pe|e ccm fic Iipc ny|cn imp|icc em reIirccc cc: pcnIc:
enIre c :éIimc e céimc cic pc-cpercIcrc.
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ASSISTÊNCIA À MULHER NO PARTO POR CESÁREA
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CONSIDEkAÇÕES FINAIS
/ ce:crec é umc |cpcrcIcmic ¢ue, ¢ucncc Lem incicccc, Iem :eu
pcpe| nc ciminuiçcc cc mcrLiccce e mcrIc|iccce mcIernc e perincIc|.
Cucncc :e incicc umc ce:crec, e|c ceve :er rec|izccc ccm c Iécnicc
cce¢uccc, |evcncc em ccn:icercçcc c: mci: recenIe: evicëncic:
cienI|ficc:, pcrc minimizcr c pc::iLi|iccce ce ccmp|iccçce: inerenIe: cc
prccecimenIc.
Nc enIcnIc, ccmc fci ci:cuIicc nc CcpiIu|c 4, c rec|izcçcc ce ce:crec:
ce:nece::cric: é pcIencic|menIe ccnc:c, ccn:icercncc ¢ue c: ri:cc: ce
mcrLiccce e mcrIc|iccce mcIernc e perincIc| :cc mcicre: ne:Ie
prccecimenIc cc ¢ue nc pcrIc vcginc|.
10
96
C fcrcipe, uIi|izccc nc prcIicc cL:IéIricc ce:ce c
/nIigüiccce, ccnIinuc Iencc |ugcr ce ce:Ic¢ue nc
cL:IeIr|cic mccernc. Cucncc Lem uIi|izccc é
in:IrumenIc vc|ic:c, cc|cLcrcncc ce fcrmc efeIivc e
impcrIcnIe nc rec|izcçcc cc pcrIc vcginc|.
lnfe|izmenIe, c e:Iigmc negcIivc ¢ue |he fci impuIccc
pe|c: cnIigc: prcIicc: cL:IéIricc: per:i:Ie enIre c:
|eigc: e enIre c¢ue|e: ¢ue ncc fcrcm
cce¢ucccmenIe Ireinccc: pcrc :eu u:c.
Hcje, enccnIrcm-:e cfc:Iccc: cc prcIicc cL:IéIricc c:
cp|iccçce: ce fcrcipe em ccLeçc: c|Ic: cu
encrcvccc: nc e:IreiIc mécic cc ccnc| cc pcrIc
[contro-|nd|coçõo obso|uto}. C fcrcipe Lcixc, nc
enIcnIc, é mci: re¢uericc cIuc|menIe ¢ue hc 40 cnc:,
cicnIe cc ccmprcvccc eficccic em eviIcr c hipcxic
feIc|, cLrevicncc c per|ccc expu|:ivc e minimizcncc c:
ri:cc: ce :e¢üe|c: neurc|cgicc:.
Em e:Iucc ce meIcnc|i:e, ccmpcrcncc c fcrcipe cc
vccuc-exIrcIcr, evicencicu-:e ¢ue e:Ie e:Ic c::cciccc
c mencr mcrLiccce mcIernc, recuzincc Ircumc:, ccr
perinec|, c u:c ce cne:Ie:ic gerc| e regicnc| e c:
|ncice: ce ce:crec. C fcrcipe, enIreIcnIc, e:Ieve
menc: c::cciccc c cefc|chemcIcmc: e hemcrrcgic:
reIinicnc: nc: necncIc:. Vc|e ce:Icccr, nc enIcnIc,
¢ue c: recémnc:cicc: ncc cpre:enIcrcm ccnc: :éric:
ccm nenhum cc: in:IrumenIc:.
Ne:Ie ccp|Iu|c :ercc cLcrcccc: c: principci: funçce: e
ccrccIer|:Iicc: cc: fcrcipe:, c: mcce|c:
cc:IumeircmenIe uIi|izccc:, c: inciccçce: ce :eu u:c e
c: ccnciçce: iceci: ce cp|iccLi|iccce cc in:IrumenIc.
/: Iécnicc: ce cp|iccçcc :ercc enccnIrccc: em |ivrc:
IexIc: cce¢uccc:. C cprencizccc prcIicc ceverc :er
efeIuccc em in:IiIuiçce: ce :cúce prepcrccc: pcrc
:eu en:inc, ccm in:IruIcre: ceviccmenIe Ireinccc: e
experienIe:. /pe:cr cc recenIe civu|gcçcc cc vccuc-
exIrcIcr nc 8rc:i|, e:Ie in:IrumenIc ncc :erc cLcrcccc.
Em Iermc: prcIicc:, :uc uIi|izcçcc é muiIc re:IriIc nc
IerriIcric nccicnc|, hcvencc um númerc muiIc
pe¢uenc ce prcfi ::icnci: Ireinccc:.
11 ASSISTÊNCIA À MULHER NO PARTO FÓRCIPE
ASSISTÊNCIA À MULHER NO PARTO FÓRCIPE
97
Funçöes e corocteríst|cos dos |orc|pes
Iem ccmc principci: funçce: c cpreen:cc, Ircçcc, ccc:icnc|menIe
rcIcçcc cc pc|c cefc|icc feIc| e ccrreçcc ce c::inc|iIi:mc:. Vcric
ccn:icercve|menIe em fcrmc e Icmcnhc, mc: Lc:iccmenIe é ccn:IiIu|cc
ce cci: rcmc: ¢ue :e crIicu|cm cpc: :erem inIrccuzicc: :e¢üencic|menIe
nc vcginc, ce cccrcc ccm c pc:içcc cc pc|c cefc|icc. Cccc rcmc é
ccn:IiIu|cc pcr cc|her, ccLc, hc:Ie e crIicu|cçcc e Iem cuc: curvcIurc:,
c cefc|icc ¢ue cLrigcrc c ccLeçc feIc|, e c pé|vicc ¢ue :e re|ccicnc
ccm c ccnc| ce pcrIc.
Nc: fcrcipe: cruzccc:, ¢ue cpc: crIicu|ccc: ficcm em fcrmc ce X, c mcc
cireiIc :egurcrc c rcmc cireiIc ¢ue, cpc: cp|icccc, ccupcrc c ¢uccrcnIe
cireiIc cc Lccic mcIernc. Fcr cuIrc |ccc, c mcc e:¢uercc empunhcrc c
rcmc e:¢uercc, ¢ue :e |cccrc nc ¢uccrcnIe e:¢uercc cc Lccic
mcIernc.
/ ccnccviccce cc cc|her ce cccc rcmc :e cefrcnIc e :e cpce, :encc
¢ue :uc: exIremiccce: jcmci: :e enccnIrcm, cmenizcncc c ccmpre::cc
exercicc :cLre c ccLeçc feIc|.
Fr|nc|po|s |orc|pes otuo|mente ut|||zodos
1. Fcrcipe ce Simp:cn-8rcun
CcrccIer|:Iicc:: /rIicu|cçcc fixc pcr enccixe
/cenIuccc curvcIurc pé|vicc
UIi|izcçcc: Nc: feIc: ccm :uIurc :cgiIc| nc cicmeIrc cnIerc-pc:Iericr cu
nc: vcrieccce: ce pc:içcc cnIericr e pc:Iericr, :em Lc::c impcrIcnIe.
2. Fcrcipe ce ‚ie||cnc
CcrccIer|:Iicc:: /rIicu|cçcc mcve|, ccm ce:|ize cc rcmc cireiIc :cLre c
e:¢uercc
CurvcIurc pé|vicc ci:creIc
UIi|izcçcc: Fcce :er cp|icccc em Iccc: c: ccnciçce: {vcrieccce:
cL||¢uc:, cireIc: cu Ircn:ver:c:). É c prefer|ve| pcrc :er cp|icccc nc:
pc:içce: Ircn:ver:c: e nc: cnIericre: cu pc:Iericre: ccm Lc::c
:erc:cngü|nec :ignificcIivc, umc vez ¢ue permiIe umc pegc ¢ue
pc::iLi|iIc c ccrreçcc cc c::inc|iIi:mc {crIicu|cçcc mcve|). Fe|c ¢uc:e
inexi:Iëncic ce curvcIurc pé|vicc, é in:IrumenIc rcIcccr pcr exce|ëncic.
11
ASSISTÊNCIA À MULHER NO PARTO FÓRCIPE
98
3. Fcrcipe ce Fiper
CcrccIer|:Iicc:: /rIicu|cçcc fixc pcr enccixe
CurvcIurc perinec| ccenIuccc
CurvcIurc: cefc|icc e pé|vicc pcucc prcnunciccc:,
prcmcvencc ci:creIc :c|iciIcçcc cc c::cc|hc perinec|
nc mcmenIc cc Ircçcc
UIi|izcçcc: Nc pcrIc pé|vicc ccm cificu|ccce ce ce:prencimenIc cc pc|c
cefc|icc cerrcceirc. / ccLeçc preci:c, cLrigcIcricmenIe, e:Icr in:inuccc.
Nc inci:pcniLi|iccce ce:Ie in:IrumenIc, c fcrcipe ce ‚ie||cnc cu ce
Simp:cm pccercc :uL:IiIu|-|c, cepencencc cc preferëncic e IreincmenIc
cc pcrIeirc.
C|oss|||coçõo do |orc|pe em re|oçõo ò o|turo do opresentoçõo
1. Forc|pe de o|ív|o
• ]%@'+% 36(Y3'- *# 6*)4J6)# 3%>6*%-? ('2 *'1'((6$%$' $' ('<%4%+,#
2%*/%- $#( >4%*$'( -8@6#(?
• ]%@'+% 4'17%+%*$# # %((#%-7# <:-361#?
• e/)/4% (%>6)%- *# $6f2')4# %*)'4#I<#()'46#4 T#116<6)# <C@61# #/
#116<6)# (%14#U #/ *%( 3%46'$%$'( $' <#(6+,# #116<6)# $64'6)% #/
'(./'4$% %*)'46#4'( TMFS #/ MKSU?
• g#)%+,# $% 1%@'+% ;')%- *,# '51'$' WOOD
2. Forc|pe bo|xo
• ]%@'+% ;')%- <'-# 2'*#( *# <-%*# hP $' F' i'' j '*)4' HHH ' Hk $'
^#$>' ('2? *# '*)%*)#? %-1%*+%4 # %((#%-7# <:-361#? 1#2=
• g#)%+,#
lm
WOn T3%46'$%$' $' <#(6+,# #116<6)# '(./'4$% #/ $64'6)%
%*)'46#4 4#$%*$# <%4% #116<6)# <C@61# #/ 3%46'$%$' $' <#(6+,#
#116<6)# '(./'4$% #/ $64'6)% <#()'46#4 4#$%*$# <%4% #116<6)# (%14#U?
• g#)%+,# 2%6#4 ./' WOo T3%46'$%$' $' <#(6+,# #116<6)# )4%*(3'4(%?
#116<6)# '(./'4$% #/ $64'6)% <#()'46#4 4#$%*$# <%4% #116<6)# <C@61#UE
3. Forc|pe méd|o
• `/%*$# % %<-61%+,# $# ;J416<' ;%0I(' '2 1%@'1% 1/c# 3:4)61' '()8
%162% $# <-%*# hP $' F' i'' j HHH $' ^#$>'? 1#2 pc|c 1';8-61#
6*(6*/%$#E p 1#*3'*6'*)' ' 6$'%- # <%4'1'4 $' #/)4# #@()')4% $'36$#
%#( 46(1#( 6*'4'*)'( Z (/% %<-61%+,#E q% <48)61% #@():)461% %)/%- :
<4#1'$62'*)# $' '51'+,#E
Ind|coçöes
/ uIi|izcçcc cc fcrcipe Icrnc-:e ju:Iificcve| em cc:c: ¢ue cmeccem c
Lem-e:Icr mcIernc e/cu feIc| e ¢ue pc::cm :er reverIicc: cu me|hcrccc:
pe|c u:c cce¢uccc e :egurc cc in:IrumenIc.
11
ASSISTÊNCIA À MULHER NO PARTO FÓRCIPE
99
/|gumc: |nd|coçöes moternos inc|uem c ccençc ccrc|ccc, ccençc
pu|mcncr grcve, infecçcc inIrc-pcrIc, cerIc: ccnciçce: neurc|cgicc:,
ec|cmp:ic e :|ncrcme HELLF. lncicc-:e, IcmLém, nc per|ccc expu|:ivc
prc|cngccc, :ejc pcr excu:Icc mcIernc, pcr inércic cu hipccIiviccce
uIerinc cu, cincc, pcr inccpcciccce ce uIi|izcr cce¢ucccmenIe c
pren:c cLccminc|, ccmc pcce cccrrer cpc: cnc|ge:ic pericurc| cu
¢ucncc c mce é pcrIcccrc ce umc grcnce hérnic cLccminc|.
Nc: pcrIcccrc: ce ciccIrize: uIerinc: prévic:, e:pecic|menIe ce:crec:,
em virIuce cc ri:cc iminenIe ce rcIurc cc úIerc, cc:Iumc-:e cLrevicr c
per|ccc expu|:ivc ccm c u:c prcfi|cIicc cc fcrcipe.
/: |nd|coçöes |eto|s inc|uem c prc|cp:c ce ccrccc umLi|icc|, c :cfrimenIc
feIc| cgucc e c ccLeçc cerrcceirc in:inuccc nc pcrIc pé|vicc.
Cond|çöes de op||cob|||dode do |orc|pe
Fcrc minimizcr c: :upc:Ic: ri:cc: cc uIi|izcçcc cc fcrcipe, Icrnc-:e
impre:cinc|ve| ¢ue c|gun: pré-re¢ui:iIc: :ejcm cLrigcIcricmenIe :eguicc:.
O mo|s |mportonte de|es é o boo quo||||coçõo do obstetro. Nc inciccçcc
e nc rec|izcçcc cc prccecimenIc, pcrc ¢ue c cpcre|hc :ejc
cce¢ucccmenIe cp|icccc, nece::iIc-:e:
1. ]#*1'<)# 363# #/ 1#2 2#4)' 4'1'*)'
2. S*'()'(6% 2%)'4*%
3. r'56>% 3%06%
4. ]#-# 1#2 $6-%)%+,# 1#2<-')%
5. s'2@4%*%( #3/-%4'( 4#)%(
ó. F6%>*J()61# 1#44')# $% 3%46'$%$' $' <#(6+,# TM\? MKS? MF\? ')1EU
7. #<#416#*%-6$%$' %$'./%$% '*)4' # ;')# ' % <'-3' 2%)'4*%
8. S<4'('*)%+,# <'-# 2'*#( *# <-%*# hP $' F' i'' j '*)4' HHH ' Hk $'
^#$>' T<4';'4'*16%-2'*)' *# <-%*# hN $' F' i'' j Hk $' ^#$>'? *%
%)/%-6$%$' % >4%*$' 6*$61%+,# $' %<-61%+,# $# %<%4'-7#U
º. K<6(6#)#26% T<4';'4'*16%-2'*)' 2:$6#I-%)'4%-U
EmLcrc c L|c¢ueic pucencc pc::c :er cce¢uccc pcrc c fcrcipe ce
c||vic, c cne:Ie:ic regicnc|, pericurc| cu rc¢ue, é u:uc|menIe re¢uericc
nc: fcrcipe: Lcixc: cu mécic: e ¢ucncc hc cificu|ccce ce inIerpreIcçcc
cc vcrieccce ce pc:içcc feIc|, e:pecic|menIe nc pre:ençc ce Lc::c
:erc:cngü|nec vc|umc:c. Em pcucc: cpcrIuniccce: é nece::cric uIi|izcr c
cne:Ie:ic gerc|.
Fego Ideo| [8|por|etomo|omenton|ono}
11
ASSISTÊNCIA À MULHER NO PARTO FÓRCIPE
100
Apos dec|sõo do op||coçõo do |orc|pe, e ontes de seu uso, deve-se
esc|orecer ò mu|her o que seró |e|to, tronqü|||zondo-o em re|oçõo oo
proced|mento. Deve-se demonstror seguronço e reo||rmor o
necess|dode, em pro| do concepto ou do propr|o mõe, do uso do
|nstrumento.
Fe:umiccmenIe, c: ccnciçce: nece::cric: pcrc cp|iccçcc cc fcrcipe
pccem :er enunciccc: em cincc regrc: Lc:icc:, ccmc refericc pcr
Ferncncc Mcgc|hce::
1. FermecLi|iccce cL:c|uIc - regrc cc |ivre Ircn:iIc
2. /ce::iLi|iccce fcci| - regrc cc prcnIc cpreen:cc
3. Frcpcrcicnc|iccce excIc - regrc cc cccmcccçcc perfeiIc
4. FercepIiLi|iccce ccmp|eIc - regrc cc cicgnc:Iicc IcIc|
5. Fe:pcn:cLi|iccce inIegrc| - regrc cc Iécnicc ccn:cienIe
Froced|mentos ||no|s
/pc: c ce|ivrcmenIc ncrmc|, efeIuc-:e c revi:cc criIeric:c cc ccnc| ce
pcrIc, em Lu:cc ce |ccercçce:. Em :eguicc, prccece-:e c epi:icrrcfic.
Fec|izcr Ic¢ue reIc| cc finc| cc: prccecimenIc:, ccm c inIuiIc ce
ccnfirmcr c inIegriccce cc: e:IruIurc: e c cu:ëncic ce Ircn:fixcçcc cc
reIc ccm pcnIc: ce :uIurc.
C: pcrIc: in:IrumenIci: c::ccicm-:e c mcicr ri:cc ce hemcrrcgic: nc
¢ucrIc per|ccc e puerpéric. É cL:c|uIcmenIe nece::cric cIençcc
reccLrccc c mu|her cpc: c pcrIc. É c mcmenIc, IcmLém, ce cemcn:Ircr
c puérperc ¢ue :eu recém-nc:cicc e:Ic :cuccve| e :em |e:ce:
ceccrrenIe: cc uIi|izcçcc cc in:IrumenIc. / Ircn¢üi|izcçcc cc mu|her e
:eu cccmpcnhcnIe é funccmenIc|.
EmLcrc :ejc in:IrumenIc vc|ic:c, c uIi|izcçcc cc fcrcipe é cincc muiIc
irregu|cr. /: principci: ccu:c: :cc, prcvcve|menIe, c e:Iigmc negcIivc
¢ue |he é incce¢ucccmenIe impuIccc e c incLi|iccce Iécnicc cc:
prcfi::icnci: pcrc :eu u:c. C: :erviçc: ce en:inc cevem prcpcrcicncr,
c¢ue|e: ¢ue :e inicicm nc crIe cL:IéIricc, Iccc: c: ccnciçce: ce
cprencizccc pcrc ¢ue c: prcfi::icnci: :ciLcm ¢ucncc e ccmc uIi|izc-|c
pcrc c Lenef|cic ccmum cc :cúce mcIernc e necncIc|.
11
101
/ /ne:Ie:ic CL:IéIricc ccmpreence mú|Iip|c: Iécnicc:
uIi|izccc: pcrc c|ivicr c ccr c::cciccc cc IrcLc|hc ce
pcrIc e c pcrIc, Lem ccmc cuIrc: ce:Iinccc: c
rec|izcçcc ce prccecimenIc: cirúrgicc:. C cIc
cne:Ié:icc em CL:IeIr|cic, emLcrc pc::c :er
ccn:icerccc :imp|e: em muiIc: :iIucçce:, exige umc
fcrmcçcc e:pecic|izccc pcr pcrIe cc mécicc ¢ue c
execuIc. /|ém cc ccm|nic cc: Iécnicc: cne:Ié:icc:, é
nece::cric Ier c ccnhecimenIc cc: pcrIicu|criccce:
ce:Ic e:pecic|iccce. É preci:c e:Icr cIenIc c:
c|Iercçce: fi:ic|cgicc: mcIernc: ¢ue cccrrem curcnIe
c grcvicez, cc: c:pecIc: fcrmccc|cgicc: re|ccicnccc:
c pc::cgem Ircn:p|ccenIcric ce crcgc:, cc: efeiIc:
cc: cgenIe: e Iécnicc: cne:Ié:icc: :cLre c
ccnIrcIi|iccce uIerinc, Lem ccmc c: :iIucçce:
pcIc|cgicc: ¢ue envc|vem c cic|c grcvicc-puerperc|.
Em um ccnIexIc ce cIençcc humcnizccc cc
nc:cimenIc, c cne:Ie:i:Ic e pcrIe inIegrcnIe cc
e¢uipe mu|Iiprcfi::icnc| re:pcn:cve| pcr e:Ic cIençcc,
:ejc nc hcrc cc c||vic cc ccr c::cciccc cc IrcLc|hc ce
pcrIc {Ccp|Iu|c 8), :ejc nc evenIuc|iccce ce :er
nece::cric c|gum prccecimenIc cirúrgicc cu c|gumc
mcncLrc cu inIervençcc mci: invc:ivc:. Em Ici:
:iIucçce:, c mu|her e :eu cccmpcnhcnIe {¢ue jc
fcrcm infcrmccc: pe|c e¢uipe cc nece::iccce,
finc|iccce e ccrccIer|:Iicc: cc prccecimenIc) cevem
icec|menIe :er cLcrcccc: pe|c cne:Ie:i:Ic ¢ue :e
icenIificcrc, exp|iccrc c: c|IerncIivc: pcrc c
prccecimenIc cne:Ié:icc, fcrc umc Lreve cncmne:e
e cecicirc, :empre ¢ue pc::|ve| e preferenIemenIe
ccm c pcrIicipcçcc cc mu|her, pe|c prccecimenIc c
:er rec|izccc.
Aspectos F|s|o|og|cos
DurcnIe c ge:Icçcc cccrre umc expcn:cc vc|ëmicc
c: cu:Ic: cc cumenIc cc vc|ume p|c:mcIicc, |evcncc
c umc hemcci|uiçcc. Exi:Ie IcmLém cumenIc cc
fre¢üëncic ccrc|ccc e cc céLiIc ccrc|ccc, en¢ucnIc
¢ue c re:i:Iëncic vc:cu|cr ciminui. C: vc|cre: ce
pre::cc crIeric| pccem e:Icr
12 ANESTESIA EM OBSTETRÍCIA
ANESTESIA EM OBSTETRÍCIA
102
|igeircmenIe cLcixc cc: n|vei: pré-ge:Iccicnci: e c pcrIir cc 28º - 30º
:emcnc: ce ge:Icçcc pcce cccrrer um fencmenc ccnhecicc ccmc
¨hipcIen:cc :upinc¨. IrcIc-:e cc ccmpre::cc cc veic ccvc pe|c úIerc
grcvicc, ccc:icncncc umc ciminuiçcc cc reIcrnc venc:c e hipcIen:cc
mcIernc. Feccmencc-:e, pcrIcnIc, c ce:|cccmenIc uIerinc cu c
preferëncic pe|c cecúLiIc |cIerc|.
/|Iercçce: re:pircIcric: Ici: ccmc mencr ccpcciccce re:icuc| funcicnc|
{-207) e cumenIc cc venIi|cçcc c|vec|cr {•707 nc ge:Icçcc ce Iermc),
c::cciccc: c um cumenIc cc ccn:umc ce cxigënic {•15 c 207),
preci:pcem c hipcxic e, nc cc:c ce cne:Ie:ic inc|cIcric, c incuçcc e
recupercçcc mci: rcpicc:.
CuIrc c:pecIc impcrIcnIe ¢ucnIc c: c|Iercçce: fi:ic|cgicc: mcIernc:
e:Ic |igccc principc|menIe cc IrcIc gc:IrcinIe:Iinc|. Mci: preci:cmenIe
cccrre umc hcrizcnIc|izcçcc cc e:Icmcgc e ce:|cccmenIc cc pi|crc
pcrc cimc, |evcncc c um reIcrcc nc e:vczicmenIc gc:Iricc. Hc IcmLém
umc ciminuiçcc cc Icnc e cc mcIi|iccce gc:Iricc e cc e:f|ncIer
e:cfcgicc infericr. / incicëncic ce hérnic ce hicIc é mcicr nc grcvicez,
pcrIicu|crmenIe nc: ge:IcnIe: ccm exce::c ce pe:c cu ccm cumenIc
cc pre::cc inIrc-cLccminc| pcr ge:Icçcc mú|Iip|c cu pc|icrcmnic.
DurcnIe c grcvicez cumenIc c ri:cc ce regurgiIcçcc e c:pircçcc
pu|mcncr cc ccnIeúcc gc:Iricc, nc cc:c ce cne:Ie:ic gerc| cu
cepre::cc cc n|ve| ce ccn:ciëncic. /pc: c 18º - 20º :emcnc, Iccc
ge:IcnIe ceve :er ccn:icerccc ccmc pccienIe ce ¨e:Icmcgc cheic¨,
ccm ri:cc cumenIccc pcrc c:pircçcc pu|mcncr, incepencenIemenIe cc
inIervc|c ce Iempc ce:ce c ú|Iimc refeiçcc. Nc: prccecimenIc: e|eIivc:
ceve-:e cL:ervcr c me:mc ccncuIc ce jejum cccIccc nc :erviçc pcrc
c: rcIinc: cirúrgicc: {pe|c menc: ciIc hcrc:).
Comp||coçöes
Cc:c hcjc c:pircçcc ce ccnIeúcc gc:Iricc, mecicc: enérgicc: cevem
:er cccIccc: imecicIcmenIe. Deve-:e pc:icicncr c pccienIe em céfc|c
cec|ive, ccm c ccLeçc vc|Iccc |cIerc|menIe e ccr in|cic c c:pircçcc cc
Lccc e fcringe e imecicIcmenIe prccecer-:e c inIuLcçcc Irc¢uec|
:eguicc ce c:pircçcc. lnicicr rcpiccmenIe c venIi|cçcc ccm cxigënic c
1007 e, cc:c hcjc :u:peiIc ce c:pircçcc ce ccnIeúcc :c|icc, ceve-:e
inciccr umc Lrcncc:ccpic pcrc remcçcc cc ccrpc e:Ircnhc. Deve-:e
:c|iciIcr rcic X ce Icrcx pcrc inve:Iigcr c pc::iLi|iccce ce cIe|ecIc:ic:. /
|cvcgem pu|mcncr ccm :c|uçcc :c|inc cu me:mc LiccrLcncIc ce :ccic
é ccnIrc-incicccc, pci: pcce ci::emincr c mcIeric| c:pirccc pcrc crec:
pu|mcncre: ncc ccmprcmeIicc:. / c:pircçcc ce :ucc gc:Iricc prcvccc
umc pneumcniIe ¢u|micc, ccm grcve ccnc cc pcrën¢uimc pu|mcncr,
ccm um ¢uccrc c||nicc ce Lrcncce:pc:mc, :ecreçcc pu|mcncr rc:ec e
grccienIe c|véc|c-crIeric| e|evccc. C IrcIcmenIc Lc:icc é c venIi|cçcc
ccm C2 c 1007, ncc e:Ic incicccc c prcfi|cxic ccm cnIiLicIicc: e c
ccmini:Ircçcc ce ccrIicc:Iercice: é Lc:IcnIe ci:cuI|ve|. E:Ic pccienIe
ceverc permcnecer em Uniccce ce Iercpic lnIen:ivc ccm ccnIrc|e:
fre¢üenIe: cIrcvé: ce gc:cmeIric:.
12
ANESTESIA EM OBSTETRÍCIA
103
DenIre c: ccmp|iccçce: cne:Ié:icc: mci: Iemicc:, e:Icc c fc|hc ce
inIuLcçcc Irc¢uec| e c c:pircçcc pu|mcncr. Vcric: fcIcre: preci:pcem c
cificu|ccce: curcnIe c inIuLcçcc nc ge:IcnIe: gcnhc ce pe:c curcnIe c
ge:Icçcc, cumenIc cc: mcmc: e ecemc ce vic: cérec:, c|ém ce cuIrc:
ncc e:pec|ficc: cc ge:Icçcc, ccmc |imiIcçcc cc cLerIurc cc Lccc cu
cc mcvimenIcçcc cc pe:ccçc, cenIe: inci:ivc: prcIru:c: cu cuIrc:
cncrmc|iccce: cc fcce cu Lccc. / pccienIe cL:IéIricc ncc ceve
receLer cne:Ie:ic gerc| vic mc:ccrc fccic| e c inIuLcçcc Irc¢uec| é
mcnccIcric, ccm IuLc: ce cc|iLre mci: finc {ó,5: 7,0: 7,5) e ccm Lc|cneIe
inf|cve|.
Ncc :e ci:pcem ce e:IcI|:Iicc: nccicnci:, mc: nc: E:Iccc: Unicc: c
cne:Ie:ic permcnece ccmc umc cc: ccu:c: mci: ccmun: ce mcrIe
mcIernc eviIcve|. Um |evcnIcmenIc regicnc| cmericcnc :cLre c
mcrIc|iccce mcIernc num per|ccc ce 30 cnc: ccn:IcIcu ¢ue 4,27 cc:
mcrIe: mcIernc: fcrcm ce ccu:c cne:Ié:icc.
Insto|oçöes e recursos técn|cos
/ ci:pcniLi|iccce ce cIencimenIc cne:Ié:icc em CL:IeIr|cic ceve :er
p|cnejccc ce cccrcc ccm c cemcncc e grcu ce ccmp|exiccce cc:
prccecimenIc:. CcLe |emLrcr ¢ue pcrc c execuçcc ce cne:Ie:ic
cL:IéIricc, c: mécicc: ¢ue c prcIiccm cevem cL:ervcr c: ncrmcIizcçce:
ccnIicc: nc: re:c|uçce: nº 1.3ó3 ce 1ºº3 e nº 1.40º ce 1ºº4 cc Ccn:e|hc
Fecerc| ce Mecicinc.
/ uniccce cL:IéIricc ceve ci:pcr ce :c|c: ce pcrIc e/cu cirúrgicc: ccm
fcnIe ce gc:e: {02, N2C e cr ccmprimicc), Lem ccmc vccuc pcrc
c:pircçcc, cpcre|hc ce cne:Ie:ic ccmp|eIc, ccm re:pircccr, L|ccc ce
f|uxcmeIrc: e vcpcrizcccre:. Iccc mcIeric| ce recnimcçcc, inc|uincc
|cringc:ccpic ccm jcgc ce |cminc:, ccnu|c: ce Guece|, IuLc:
enccIrc¢ueci: ce civer:c: cc|iLre:, ccnjunIc pcrc venIi|cçcc mcnuc|,
ccmpc:Ic ce mc:ccrc fccic|, Lc|:c ce Lcrrcchc e vc|vu|c unicirecicnc|
cevem e:Icr ci:pcn|vei:. /::im IcmLém, crcgc: pcrc re::u:ciIcçcc e
cuIrc: nece::cric: c execuçcc cc Iécnicc cne:Ié:icc. / uniccce
cL:IéIricc ceve ccnIcr ccm umc crec pcrc Fecupercçcc Fc:-
/ne:Ié:icc, cujc ccpcciccce cpercIivc ceve gucrccr re|cçcc cireIc
ccm c cemcncc.
Fcrc cce¢uccc mcniIcrizcçcc cc pccienIe cL:IéIricc curcnIe c cIc
cne:Ié:icc, ceve-:e ci:pcr ce ccrcic:ccpic, mcniIcre: ce pre::cc crIeric|
{Ien:icmeIrc: ce cc|unc cu cuIcmcIicc ncc invc:ivc) e cx|meIrc ce
pu|:c. E:Ie, cLrigcIcric em hc:piIci: ¢ue pc::ucm u:inc ccncenIrcccrc
ce cxigënic, ceve Ier :eu empregc enccrcjccc, principc|menIe ¢ucncc
cc uIi|izcçcc ce cpicice: pcr vic e:pinhc|. / uIi|izcçcc ce ccpncgrcfc é
reccmenccve| ¢ucncc cc cne:Ie:ic gerc|.
Ne:Ie ccp|Iu|c :ercc cLcrcccc: cpenc: c: Iécnicc: cne:Ié:icc: pcrc c
pcrIc ce:crec, vi:Ic ¢ue pcrc c pcrIc vcginc| jc fcrcm cpre:enIccc:
ccm ceIc|he: nc Ccp|Iu|c 8.
12
ANESTESIA EM OBSTETRÍCIA
104
Iécn|cos Anestés|cos poro Cesor|ono
/ Iécnicc cne:Ié:icc pcrc c cpercçcc ce:cricnc cepence cc inciccçcc
cirúrgicc, cc grcu ce urgëncic, cc vcnIcce cc pcrIurienIe e cc
ju|gcmenIc cc cne:Ie:i:Ic e cL:IeIrc. Scc cLjeIivc: principci:: prccuzir
cne:Ie:ic cce¢uccc, c|iccc c :egurcnçc e ccnfcrIc mcIernc, ccm c
m|nimc efeiIc cepre::cr :cLre c feIc. Nc 8rc:i|, :em cúvicc nenhumc c
cne:Ie:ic regicnc|, rc¢uicne:Ie:ic cu pericurc|, é c Iécnicc ce e:cc|hc
pcrc ce:cricnc. / cne:Ie:ic gerc| é ccn:icerccc Iécnicc ce exceçcc,
ccm inciccçce: Lc:IcnIe re:IriIc: cu ¢ucncc hc fc|hc ce um L|c¢ueic
e:pinhc|. / Iécnicc ce execuçcc cc: L|c¢ueic: e:pinhci: fci ce:criIc em
ceIc|he: nc Ccp|Iu|c 8.
g%./6%*'()'(6%= E:Ic Iécnicc é ccn:icerccc umc exce|enIe cpçcc ncc
:c pcrc ce:cricnc: e|eIivc:, ccmc IcmLém pcrc :iIucçce: ce
emergëncic em pccienIe: ¢ue ncc e:Iejcm receLencc cnc|ge:ic vic
pericurc| ccnI|nuc. / rc¢uicne:Ie:ic cpre:enIc c|gumc: vcnIcgen: ccmc
:imp|iciccce e in|cic ce cçcc rcpicc. / ccmp|iccçcc mci: ccmum é c
hipcIen:cc mcIernc. Sempre ¢ue pc::|ve|, c ge:IcnIe ceve receLer 500
c 700 m| ce :c|uçcc e|eIrc||Iicc, ccmc Finger LccIcIc, cnIe: cc in|cic cc
L|c¢ueic e ce:|cccmenIc cc úIerc pcrc c e:¢uercc. Cc:c hcjc
hipcIen:cc, e:Ic ceve :er prcnIcmenIe IrcIccc ccm cumenIc cc
ve|cciccce ce infu:cc cc :c|uçcc venc:c e efecrinc 5 c 10 mg em Lc|u:
pcr vic inIrcvenc:c. Nc pc::ccc, umc grcnce ce:vcnIcgem cc
rc¢uicne:Ie:ic erc c cefc|éic pc:-punçcc, ¢ue cccrric em c|Ic
fre¢üëncic nc pcpu|cçcc cL:IéIricc. /Iuc|menIe, ccm c uIi|izcçcc cc:
cgu|hc: ce:ccrIcvei: ce finc cc|iLre e ccm pcnIc cIrcumcIicc {cc Iipc
¨pcnIc ce |cpi:¨), c incicëncic ce cefc|éic pc:-rc¢ui pcce ccir pcrc
menc: ce 17.
C: cne:Ié:icc: |ccci: uIi|izccc: nc rc¢uicne:Ie:ic cevem :er
preferencic|menIe :c|uçce: hiperLcricc:, pccencc-:e empregcr c
|icccc|nc c 57 TRQI_O mg) cu Lupivccc|nc c 0,57 {12,5-15 mg).
S*'()'(6%

46$/4%-= / cne:Ie:ic pericurc| é cuIrc Iécnicc ce cne:Ie:ic
regicnc| cmp|cmenIe uIi|izccc pcrc c rec|izcçcc ce cpercçce:
ce:cricnc:. Suc execuçcc exige mcicr refincmenIc Iécnicc e :uc
|cIëncic IcmLém e mcicr ¢ue c cc rc¢uicne:Ie:ic. E:Ie in|cic ce cçcc
mci: |cngc fcvcrece :eu empregc em pccienIe: ¢ue :e Leneficicm ce
um L|c¢ueic :impcIicc mci: |enIc, ccmc c: pcrIcccrc: ce pré-ec|cmp:ic
cu ce ccençc ccrcicvc:cu|cr. /|ém ci:cc, c cne:Ie:ic pericurc| pcce :er
prefericc ¢ucncc :e prevë um prccecimenIc cirúrgicc mci: prc|cngccc,
ccmc em pcrIurienIe: cLe:c: cu ccm vcric: ce:crec: prévic:. C
cne:Ié:icc |ccc| mci: empregccc nc cne:Ie:ic pericurc| pcrc ce:cricnc:
é c Lupivccc|nc c 0,57 ccm ccrenc|inc 1:200.000 {20-25 m|) c::cciccc
cu ncc c 75-100 mcg ce fenIcni| cu 20-30 mcg ce :ufenIcni|. / cciçcc
ce:Ie: cpicice: me|hcrc c ¢uc|iccce cc L|c¢ueic, recuzincc c
ce:ccnfcrIc inIrc-cpercIcric e minimizcncc c uIi|izcçcc ce meciccçcc
cnc|gé:icc e/cu :eccIivc :up|emenIcr.
12
ANESTESIA EM OBSTETRÍCIA
105
Me:mc :eguincc Iccc: c: rigcre: Iécnicc:, c|gumc: pccienIe: pccem
experimenIcr umc cne:Ie:ic regicnc| incce¢uccc. DicnIe ce:Ie fcIc
pcce-:e cpIcr pcr:
• ccmini:Ircçcc ce umc :eguncc cne:Ie:ic regicnc|
• ccmini:Ircçcc :up|emenIcr ce cnc|gé:icc: :i:Iëmicc:, ccmc
pe¢uenc: cc:e: ce cpicice: cu ceIcminc enccvenc:c:
• rec|izcçcc ce cne:Ie:ic gerc|
S*'()'(6% t'4%-= /|gumc: pcrIurienIe: pccem cpre:enIcr c|gumc ccnIrc-
inciccçcc c cne:Ie:ic regicnc| {cccgu|cpcIic cu hemcrrcgic :everc), cu
c cc:c IrcIcr-:e ce umc urgëncic cL:IéIricc {ccmc prc|cp:c ce ccrccc
cu Lrcciccrcic feIc| :u:IenIccc). Ne:Ic: :iIucçce:, c incuçcc ce umc
cne:Ie:ic gerc| ce :e¢üëncic rcpicc é prefer|ve| c cne:Ie:ic regicnc|.
/ Iécnicc ce cne:Ie:ic gerc| é c ¢ue :e :egue:
• <4:I#56>'*%+,# 1#2 MP % VQQ[B
• %$26*6()4%+,# '*$#3'*#(% $' )6#<'*)%- (J$61# *% $#(' $' W 2>ju>
T#/)4#( 76<*J)61#( )92 /2% 6*$61%+,# 2%6( 4'()46)%UB
• %<-61%+,# $' <4'((,# (#@4' % 1%4)6-%>'2 1461J6$'? %# 6*Y16# $%
<'4$% $' 1#*(169*16%? <%4% #1-/64 # '(v;%># ' 4'$/064 % <4#@%@6-6$%$'
$' %(<64%+,# </-2#*%4 $# 1#*)'C$# >8()461#B
• %$26*6()4%+,# '*$#3'*#(% $' (/116*6-1#-6*% *% $#(' $' VIV?O
2>ju> <%4% <4#<616%4 /2 48<6$# 4'-%5%2'*)# 2/(1/-%4 ' 1#*$6+A'(
(%)6(;%)J46%( $' 6*)/@%+,# )4%./'%-B
• 6*('4+,# ' 1#*;642%+,# $# <#(616#*%2'*)# %$'./%$# $' /2 )/@#
'*$#)4%./'%- 1#4* @%-#*')'B '
• 2%*/)'*+,# $# %*'()'(6% 1#2 1#*1'*)4%+A'( '-'3%$%( $' MP
T<'-# 2'*#( OQ[U %): # 1-%2<'%2'*)# $# 1#4$,#E \#$'I(' /)6-60%4
J56$# *6)4#(# % *# 28562# OQ[ %((#16%$# % @%65%( 1#*1'*)4%+A'( $'
%*'():(61#( 7%-#>'*%$#(? #/ ('c%? 7%-#)%*# % Q?O[ #/ 6(#;-/4%*# %
Q?_O[E
Cc:c hcjc fc|hc nc inIuLcçcc Irc¢uec|, ceve-:e prccecer c venIi|cçcc
:cL mc:ccrc pcrc re:IcLe|ecer c cxigencçcc prcnIcmenIe e eviIcr
ccnc: c mu|her e cc feIc. Nc cepencëncic cc ccrcIer emergencic| cc
:iIucçcc, c cne:Ie:i:Ic e:Icrc IecniccmenIe cpIc pcrc in:i:Iir cu ncc nc
prccecimenIc ce venIi|cçcc e inIuLcçcc Irc¢uec| cc mu|her. Se c
prccecimenIc fcr e|eIivc, é reccmenccve| pc:Iergc-|c pcr c|gum Iempc.
kecuperoçõo Fos-onestés|co [kFA}
/ pccienIe cL:IéIricc nece::iIc cc: me:mc: cuicccc: pc:-cne:Ié:icc:
¢ue cuIrc: pccienIe: cirúrgicc:. Fe¢uer umc vigi|cncic cevicc c:
c|Iercçce: fi:ic|cgicc: ¢ue :e :eguem nc pc:-pcrIc imecicIc e c
pc::iLi|iccce ce ccmp|iccçce: re|ccicnccc: cc ccnIrc|e ce
:cngrcmenIc e ccnIrcIi|iccce uIerinc. Nc cc:c ce:Ic pccienIe Ier
receLicc c|gumc fcrmc ce cne:Ie:ic, ceve permcnecer :cL vigi|cncic
cIé :uc IcIc| recupercçcc. / ccnciçcc ce c|Ic ceve :er
12
ANESTESIA EM OBSTETRÍCIA
106
:empre regi:Irccc nc prcnIucric cc pccienIe. Cucncc :uLmeIicc c umc
cne:Ie:ic gerc|, c mu|her ceve cnIe: cc c|Ic, e:Icr cccrcccc e crienIccc
¢ucnIc cc Iempc, |ugcr e prccecimenIc cL:IéIricc, cpre:enIcr :inci:
viIci: e:Icvei: pe|c menc: nc ú|Iimc hcrc, :enIir-:e ccnfcrIcve|, ccm
ccnIrc|e cceiIcve| cc ccr, :em ncu:ec: cu vcmiIc:. Cucncc :uLmeIicc c
um L|c¢ueic regicnc|, c c|Ic cepencerc IcmLém cc :eccçcc ¢ue Ienhc
receLicc e ceve cpre:enIcr IcIc| recupercçcc cc L|c¢ueic mcIcr pcrc
:e eviIcr ¢uecc: pcr frc¢uezc mu:cu|cr cc: memLrc: infericre:.
DurcnIe e:Ie per|ccc, ¢ucncc c e:Iccc ce ccn:ciëncic e/cu p:icc|cgicc
permiIirem, pcce-:e cprcveiIcr c cpcrIuniccce pcrc c|gumc:
crienIcçce: ¢ucnIc c c:pecIc: ce c|eiIcmenIc, cuicccc: pe::cci: e
e:c|crecimenIc ce cuvicc:. /incc nc FF/, ceve-:e inc|u:ive e:Iimu|cr c
cmcmenIcçcc pcrc fcci|iIcr umc mcicr inIegrcçcc mce-fi|hc.
SIIbAÇÕES ESFECIAIS
1. Fré-ec|ömps|o e Ec|ömps|o
/ pré-ec|cmp:ic é umc cc: principci: ccu:c: ce mcrLi-mcrIc|iccce
mcIernc e percc feIc|, principc|menIe nc: pc|:e: em ce:envc|vimenIc. C
cne:Ie:i:Ic pcce :er :c|iciIccc c rec|izcr umc cnc|ge:ic ce pcrIc, prcver
cne:Ie:ic pcrc umc ce:cricnc, cu me:mc ccr c::i:Iëncic nc Uniccce ce
Iercpic lnIen:ivc ¢ucncc hcuver ccmp|iccçce:. C: cchccc: principci:
ne:Ic ccnciçcc pcIc|cgicc :cc hiperIen:cc e prcIeinúric ¢ue cccrrem
cpc: 20 :emcnc: ce ge:Icçcc. / Ec|cmp:ic é cicgnc:Iicccc ccm
¢uc|¢uer grcu ce hiperIen:cc, :e cccrrerem ccnvu|:ce:.
C IrcIcmenIc cLjeIivc recuzir c: ccmp|iccçce: mcIernc: e feIci::
• IrcIcr c hiperIen:cc:
• ccnIrc|cr c: ccnvu|:ce::
• f|uiccIercpic e IrcIcmenIc cc c|igúric:
• ceci:cc :cLre ¢ucncc rec|izcr c pcrIc: e
• ccnIrc|cr c: c|Iercçce: ce cccgu|cçcc.
w-/6$#)'4%<6%= /creciIc-:e ¢ue c expcn:cc vc|ëmicc, pcr :i :c, pcce
ceIermincr vc:cci|cIcçcc, recuzir c pre::cc crIeric| e me|hcrcr c f|uxc
:cngü|nec regicnc|, cIimizcncc c efeiIc cc: crcgc: vc:cci|cIcccrc:.
]#*3/-(A'(= C :u|fcIc ce mcgné:ic é c cgenIe ce e:cc|hc pcrc c
prevençcc cu reccrrëncic cc: ccnvu|:ce:. C e:¢uemc IercpëuIicc mci:
empregccc em nc::c meic ccn:i:Ie numc cc:e ce cIc¢ue ce 4g pcr vic
inIrcvenc:c |enIc {20 minuIc:) e mcnuIençcc cIrcvé: ce infu:cc venc:c
ce 1 c 2 g/hcrc, cL:ervcncc-:e cIenIcmenIe c ge:IcnIe. É impcrIcnIe
|emLrcr ¢ue c :u|fcIc ce mcgné:ic pcIencic|izc c: re|cxcnIe: mu:cu|cre:
cce:pc|crizcnIe:, ¢ue cevem :er u:ccc: ccm ccuIe|c, em cc:e:
recuzicc: e ccm mcniIcrizcçcc neurcmu:cu|cr {ver Urgëncic: e
Emergëncic: McIernc:. Guic pcrc cicgnc:Iicc e ccncuIc em :iIucçce:
ce ri:cc ce mcrIe mcIernc. MS, 2000).
12
ANESTESIA EM OBSTETRÍCIA
107
S*'()'(6% ' S*%->'(6%: Nc: cc:c: ce pré-ec|cmp:ic |eve, c mu|her pcce
prc::eguir ccm um IrcLc|hc ce pcrIc. Se c e:Iccc ce cccgu|cçcc e:Iiver
ncrmc|, umc Iécnicc regicnc| ce cnc|ge:ic pcce :er reccmencccc
precccemenIe pcr ciminuir c re:pc:Ic cc e:Ire::e, fcci|iIcncc c ccnIrc|e
cc pre::cc crIeric| e me|hcrcncc c perfu:cc p|ccenIcric. / cpercçcc
ce:cricnc gerc|menIe é incicccc ¢ucncc hc picrc cc: ccnciçce: ce
viIc|iccce feIc| cu cgrcvcmenIc cc ¢uccrc mcIernc, ccm
impc::iLi|iccce ce pcrIc vcginc|. / Iécnicc mci: reccmencccc, ce:ce
¢ue ncc hcjc ccnIrc-inciccçce: cL:c|uIc: cu emergëncic, é c cne:Ie:ic
pericurc|. / pccienIe ccm ec|cmp:ic IcmLém pcce receLer cne:Ie:ic
regicnc|, ce:ce ¢ue c: ccnvu|:ce: e:Iejcm ccnIrc|ccc: e c pccienIe ncc
e:Iejc em ccmc, me:mc ¢ue :uperficic|. /pc: c: cuicccc: inicici: ccmc
ccmini:Ircçcc ce cxigënic, ce:|cccmenIc uIerinc, mcniIcrizcçcc e
expcn:cc vc|ëmicc {500 m| ce :c|uçcc cri:Ic|cice), ce:ce ¢ue ncc hcjc
:cfrimenIc feIc| cgucc, prccece-:e c cne:Ie:ic pericurc| ccmc ce:criIc
cnIericrmenIe, cu cIrcvé: ce cc:e: :up|emenIcre: pcr ccIéIer pericurc|.
Exi:Ie c|gumc ci:cu::cc ¢ucnIc cc empregc ce :c|uçce: ce cne:Ié:icc
|ccc| ccnIencc ccrenc|inc. É reccmenccve| c c::ccicçcc ce cpicice
{100 mcg ce fenIcni|) cc cne:Ié:icc |ccc| pcrc me|hcrcr c ¢uc|iccce cc
L|c¢ueic e fcrnecer c|gumc cnc|ge:ic pc:-cpercIcric. Cc:c hcjc
hipcIen:cc mcIernc, ccm ¢uecc: c|ém ce 207 cc: vc|cre: inicici:,
reccmencc-:e c ccmini:Ircçcc ce efecrinc inIrcvenc:c em cc:e: ce 2,5
c 5,0 mg.
2. Síndromes hemorróg|cos
/ cne:Ie:ic ce e:cc|hc e:Ic nc cepencëncic cc ccu:c, grcviccce cc
¢uccrc mcIernc, ccnciçce: ce viIc|iccce cc ccncepIc e pc::iLi|iccce
ce cvc|icçcc e cce¢uccc repc:içcc cc: percc: :cngu|nec: mcIernc:.
/: Iécnicc: regicnci: ncc :cc IcIc|menIe ccnIrc-incicccc:, mc: :uc
inciccçcc e:Ic ccncicicnccc c pc::iLi|iccce ce repc:içcc vc|ëmicc
mcIernc prévic, cvc|icçcc cc e:Iccc ce cccgu|cçcc mcIernc e c
urgëncic cc reIirccc cc feIc. Fcr exemp|c, nc pre:ençc ce umc
p|ccenIc prévic cenIrc-IcIc| ccm c ge:IcnIe hemccincmiccmenIe
e:Icve| e feIc em Lcc: ccnciçce:, pcce-:e ccr preferëncic c cne:Ie:ic
pericurc|, :empre ccm c cuicccc ce :e prccecer c ccIeIerizcçcc ce
cci: cce::c: venc:c: cc|iLrc:c: e ci:pcniLi|iccce imecicIc ce :cngue. Em
ccnciçce: mcIernc: :eme|hcnIe:, mc: em pre:ençc ce :cfrimenIc feIc|,
pcce-:e uIi|izcr c rc¢uicne:Ie:i c cevicc c :uc |cIëncic mci: curIc. Cc:c c
:iIucçcc mcIernc ncc permiIc umc cce¢uccc repc:içcc vc|ëmicc, cu
hcjc :inci: c||nicc: ce cccgu|cpcIic cu grcve :cfrimenIc feIc|, ceve-:e
cpIcr pe|c cne:Ie:ic gerc|.
3. Cord|opot|os
/ ge:Icçcc cumenIc c IrcLc|hc ccrc|ccc e c ccn:umc ce cxigënic.
DurcnIe c pcrIc, e:Ic: c|Iercçce: :e exccerLcm, e nc pc:-pcrIc imecicIc
hc um impcrIcnIe cumenIc cc vc|ume circu|cnIe e cumenIc cc
re:i:Iëncic vc:cu|cr periféricc, cumenIcncc c ri:cc pcrc c ge:IcnIe
ccrcicpcIc. C p|cnejcmenIc cne:Ié:icc ceve |evcr em ccnIc e::c:
12
ANESTESIA EM OBSTETRÍCIA
108
f|uIucçce: hemccincmicc: e Iccc cirurgic ncc impre:cinc|ve| ceve :er
cciccc pcrc 15 cic: cpc: c pcrIc, ¢ucncc c mcicric cc: c|Iercçce:
hemccincmicc: cc ge:Icçcc jc :e ncrmc|izcu.
C :uce::c cc cIencimenIc c ge:IcnIe ccrcicpcIc cepence cc
ccnhecimenIc cc cicgnc:Iicc cc le:cc e cc grcu ce ccmprcmeIimenIc
funcicnc|. É funccmenIc| umc Lcc cvc|icçcc pré-cpercIcric, ce
preferëncic ccm excme c||nicc e:pecic|izccc, e|eIrcccrcicgrcmc e
eccccpp|erccrcicgrcmc. Nc: cc:c: mci: grcve:, ceve-:e p|cnejcr umc
cLcrccgem mu|Iici:cip|incr envc|vencc c e¢uipe cL:IéIricc, c
ccrcic|cgi c e c cne:Ie:ic|cgic.
/: DireIrize: em Ccrcic|cgic pcrc c cIencimenIc cc ge:IcnIe ccm
ccrcicpcIic reccmenccm:
• #56>'*#)'4%<6%B
• 2#*6)#460%+,# 1#*)Y*/% %)4%3:( $' '-')4#1%4$6#(1J<6#? #5Y2')4# $'
</-(# ' <4'((,# %4)'46%- 2:$6%B
• 1#*)4#-' $% 3#-'26%? -626)%*$#I(' % 6*;/(,# $' -Y./6$#( % _O 2-j7B
• $'1C@6)# -%)'4%- '(./'4$# '-'3%$# $/4%*)' # )4%@%-7# $' <%4)#B
• %*%->'(6% <'46$/4%- 1#*)Y*/%? 6*()%-%$% <4'1#1'2'*)'? *%
$'<'*$9*16% $% $#4 ' *,# $% $6-%)%+,# 1'4361%-B '
• %1#2<%*7%2'*)# $%( <'4$%( (%*>/Y*'%( ' #16)#16*% 1#2
1%/)'-%? '2 6*;/(,# 1#*)Y*/%E
S*'()'(6% <%4% <%4)# 3%>6*%-= c cne:Ie:ic regicnc| é, :em cúvicc, c
Iécnicc mci: empregccc pcrc c cIencimenIc c: ge:IcnIe: ccrcicpcIc:.
IcnIc c pericurc| ccmc c rc¢uicne:Ie:ic ncc cccrreIcm grcnce:
repercu::ce: hemccincmicc: curcnIe c pcrIc vcginc|, pci: c n|ve| ce
L|c¢ueic :en:iIivc é Lcixc {n|ve| mcximc I10). Exi:Ie grcnce vcnIcgem nc
c::ccicçcc ce cne:Ié:icc: |ccci: e cpicice: em Lcixc: cc:e:, prccuzincc
cnc|ge:ic cce¢uccc e pcucc inIerferëncic nc re:i:Iëncic vc:cu|cr
periféricc. Umc Lcc c|IerncIivc é c empregc cc L|c¢ueic cup|c rc¢ui-
pericurc| {ver Ccp|Iu|c 8).
S*'()'(6% <%4% 1'(%46%*%= ccmc c n|ve| :en:iIivc ce L|c¢ueic nece::cric
c rec|izcçcc ce umc cpercçcc ce:cricnc é mci: e|evccc {Ió - I4), c
cne:Ie:ic regicnc| é cccmpcnhccc ce mcicre: repercu::ce:
ccrcicvc:cu|cre:. FcrIcnIc, ce umc mcneirc gerc|, reccmenccm-:e c:
L|c¢ueic: regicnci: pcrc c: cc:c: c::inIcmcIicc: e c cne:Ie:ic gerc| pcrc
c: cc:c: mci: grcve:.
4. Asmo
/ evc|uçcc cc c:mc Lrcn¢uicc nc ge:Icçcc é imprevi:|ve|. FcrIcnIc, c
cefiniçcc cc grcviccce c||nicc, Lc:eccc nc Iipc ce evc|uçcc curcnIe c
ge:Icçcc, :erc muiIc impcrIcnIe pcrc cefinir c cLcrccgem cne:Ié:icc
ce::c: pcrIurienIe:, inc|uincc c: criIéric: ce Iempc :em cri:e:, u:c ce
meciccçcc cnIi-c:mcIicc, pre:ençc ce :inIcmc:, inIerncçce:
hc:piIc|cre: e ccn:u|Ic: mécicc: pcr e:Ic ccu:c, e u:c ce ccrIiccice,
enIre cuIrc:.
Cucncc c vic ce pcrIc é c vcginc|, Iccc ge:IcnIe c:mcIicc ceve
receLer cnc|ge:ic pcr Iécnicc regicnc| precccemenIe, incepencenIe
12
ANESTESIA EM OBSTETRÍCIA
109
cc grcviccce c||nicc, pcrc eviIcr-:e ¢ue c e:Ire::e cc IrcLc|hc ce pcrIc
cgrcve c: ccnciçce: re:pircIcric:. Nc cc:c ce cpercçce: ce:cricnc:,
ceve-:e verificcr :e c pccienIe e:Ic em cri:e cu ncc. Em cc:c cfirmcIivc,
c Iécnicc incicccc :eric cne:Ie:ic gerc|. Cc:c e:Iejc fcrc cc cri:e, enIcc
c ccncuIc cepencerc cc ccnciçcc c||nicc: c:mc |eve c mccerccc -
cne:Ie:ic pericurc|: c:mc grcve - cne:Ie:ic gerc|. Fcrc c cne:Ie:ic gerc|,
reccmencc-:e IenIcr me|hcrcr c cri:e cnIe: cc cne:Ie:ic, uIi|izcr c
ccpncgrcfic curcnIe Iccc c prccecimenIc e ccmc cgenIe: ce incuçcc
cne:Ié:icc, ceve-:e uIi|izcr c ceIcminc {0,7-1 mg/kg) cu eIcmiccIc {2
mg/kg) nc: ccm hiperIen:cc crIeric| c::cciccc.
C IrcIcmenIc cc cri:e c:mcIicc ceve :eguir c :eguinIe e:¢uemc:
• CxigencIercpic - ccIeIer nc:c| cu mc:ccrc. Nc: cc:c: :everc: é
incicccc c inIuLcçcc Irc¢uec| e venIi|cçcc meccnicc.
• 8eIc-ccrenérgicc:
lnc|cçcc: FencIerc|, 0,57 - 2,5 mg {0,5 m|)/3 m| :c|inc:
Sc|LuIcmc|, 0,57 - 2,5 mg {0,5 m|)/3 m| :c|inc.
SuLcuIcnec: /crenc|inc 1: 1000-0,3 m| c 0,5 m|.
lnIrcvenc:c: Sc|LuIcmc| - cIc¢ue: 250 mcg em 10 minuIc::
mcnuIençcc: 3-20 mcg/min {ce
cccrcc ccm c re:pc:Ic e FC).
IerLuIc|inc - cIc¢ue: 250 mcg em 10 minuIc::
mcnuIençcc: 1,5-5,0 mcg/min {ce
cccrcc ccm c re:pc:Ic e FC).
• /mincfi|inc EV:
Dc:e ce cIc¢ue: 5-ó mg/kg {:e ncc u:cu nc: ú|Iimc: 24 hcrc: cu 2,5-
3 mg/kg {:e u:cu e :em :inci: ce Icxiciccce) ci|u|cc em :crc
fi:ic|cgicc, em 30 minuIc:.
McnuIençcc: 15-20 mg/kg/24 hcrc:.
• CcrIicc:Iercice: EV:
HicrcccrIi:cnc - 3 c 4 mg/kg ce ó/ó hcrc:.
MeIi|precni:c|cnc - 40 c 80 mg ce ó/ó cu 8/8 hcrc:. Nc: cc:c:
grcve:, cIé 125 mg ce ó/ó hcrc:.
5. D|obetes
/ pccienIe cicLéIicc é ceficienIe nc :ecreçcc ce in:u|inc, ce fcrmc
cL:c|uIc cu re|cIivc, e c e:Ire::e cumenIc c re:i:Iëncic c in:u|inc.
12
ANESTESIA EM OBSTETRÍCIA
110
DicnIe ci:Ic, c cne:Ie:ic|cgi:Ic Ierc ¢ue:
• $626*/64 % 4'(<#()% %# )4%/2% %*'():(61#I164C4>61#B '
• 1#446>64 % $';6169*16% 6*(/-Y*61% $/4%*)' # %)# %*'():(61#I164C4>61#?
$' %1#4$# 1#2 %( *'1'((6$%$'( $' 1%$% <%16'*)'? %)4%3:( $'
$#(%>'*( <'46J$61%( $# >-61'26%? '2<4'>%*$#I(' ;6)%( #/ )64%(
TF'()4#()65 ' >-61#(Y2')4#(UE
DurcnIe c cne:Ie:ic, ceve-:e prevenir c hipcIen:cc mcIernc,
pre:ervcncc-:e c f|uxc :cngü|nec úIerc-p|ccenIcric cIrcvé: ce: infu:cc
ce :c|uçce: cri:Ic|cice: nc pré e nc inIrc-cpercIcric, ce:|cccmenIc cc
úIerc pcrc c e:¢uercc e pcrc cimc, ccmini:Ircçcc ce cxigënic e
prevençcc ce hipervenIi|cçcc.
Em re|cçcc cc: n|vei: g|icëmicc:, é cccn:e|hcve| ¢ue :ejcm ccrrigicc:
¢ucncc mcicre: ¢ue 120 mg/c|, prccurcncc mcnIë-|c: em n|vei: ce
º0mg/cl, :encc impcrIcnIe c ccnIrc|e hcrcric ce g|icemic pcrc :e eviIcr
c: ri:cc: ce hipc cu hiperg|icemic mcIernc.
Nc: prccecimenIc: e|eIivc: ceve-:e cmiIir c ccfé-cc-mcnhc. Ici:
prccecimenIc: cevem :er rec|izccc: preferenIemenIe nc primeirc hcrcric
cc mcnhc. É ccmum c pccienIe receLer 1 /3 cc cc:e mcIinc| ce in:u|inc.
É inci:pen:cve| ¢ue c cne:Ie:i:Ic Ienhc ccnhecimenIc cc Iipc ce in:u|inc
empregccc e ¢ue c: nece::iccce: mcIernc: ciminuem cpc: c pcrIc.
Em :iIucçce: ce urgëncic, e preci:c :cLer c e:Iccc ce jejum e :e c
ge:IcnIe Icmcu in:u|inc. C: cuicccc: ccm c e:Icmcgc cheic cevem :er
inIen:ificccc:, umc vez ¢ue c ri:cc pcrc regurgiIcçcc e c:pircçcc e:Ic
cumenIccc nc grcvicc cicLéIicc. Ccnfcrme c Iempc ce evc|uçcc ce:Ic
pcIc|cgic, pccem e:Icr pre:enIe: c: :eguinIe: c|Iercçce:: neurcpcIic
cuIcncmicc {gc:Ircpcre:ic) e |imiIcçcc cc exIen:cc cc crIicu|cçcc
cI|cnIc-cccipiIc| {S|ncrcme ce SIiff-JcinI), cccrreIcncc mcicre:
cificu|ccce: pcrc c: mcncLrc: ce |cringc:ccpic e inIuLcçcc Irc¢uec|.
\%4)# k%>6*%-
/: cne:Ie:ic: regicnci: :cc c: mci: reccmencccc: pcr ciminu|rem c
re:pc:Ic encccrinc-meIcLc|icc cc IrcLc|hc ce pcrIc. /: Iécnicc: e:Icc
ce:criIc: nc ccp|Iu|c 8, e cuicccc e:pecic| ceve :er Icmccc ccm
re|cçcc c hicrcIcçcc e ccnIrc|e cc g|icemic.
M<'4%+,# ]'(%46%*%
Fccem-:e uIi|izcr c: L|c¢ueic: regicnci: cu c cne:Ie:ic gerc|, :eguncc c:
Iécnicc: ce:criIc: ccimc. /|gun: cuIcre: ncc reccmenccm c uIi|izcçcc
ce /L ccm vc:cccn:IriIcre:, pe|c pc::iLi|iccce ce i:¢uemic em pccienIe:
ccm neurcpcIic e/cu vc:cu|iIe:.
ó. Necess|dode de re|oxomento uter|no
Em c|gumc: :iIucçce:, Ici: ccmc ccLeçc cerrcceirc, ver:cc e grcnce
exIrcçcc pé|vicc {:eguncc geme|cr), hiperIcnic uIerinc, em ¢ue hc
nece::iccce ce exIen:c mcnipu|cçcc inIrcuIerinc, ceve-:e
12
ANESTESIA EM OBSTETRÍCIA
111
ccr preferëncic c cne:Ie:ic gerc|, empregcncc-:e hc|cIcnc nc
ccncenIrcçcc ce 1 c 1,57 pcrc prcpcrcicncr re|cxcmenIc uIerinc
:cIi:fcIcric pcr um Lreve per|ccc ce Iempc, :uficienIe pcrc c: mcncLrc:
cL:IéIricc:. Em cc:c ce pcrIc vcginc|, Icc |cgc hcjc c ce:prencimenIc
cc ccLeçc, c hc|cIcnc ceve :er rcpiccmenIe inIerrcmpicc, c pccienIe
hipervenIi|ccc, pcrc eviIcr mcicre: percc: :cngu|nec: em ceccrrëncic
ce cIcnic uIerinc ¢ue pcce :er cIriLu|cc cc: cgenIe: hc|cgenccc:.
12
112
/ ccrccIerizcçcc ce umc ge:Icçcc ccmc :encc ce
ri:cc ncc é um prccecimenIc :imp|e:. Fe¢uer c
ccnhecimenIc ce Iccc c fi:ic|cgic cL:IéIricc, cc:
ccnciçce: :ccic-cemcgrcficc: cc: mu|here: e
IcmLém cc: prcce::c: pcIc|cgicc:, IcnIc prcpric:,
¢ucncc inIerccrrenIe: nc grcvicez, pcrc ¢ue c
ccnceiIucçcc :ejc c|crc e cLjeIivc. 0 Mini:Iéric cc
Scúce jc ci:pce, pcrc e:Ie fim, cc mcnuc| Iécnicc
:cLre Ge:Icçcc ce /|Ic Fi:cc. Fcrc c cIençcc c:
mu|here: em :iIucçce: ce ri:cc ce mcrIe mcIernc, c:
Iemc: fcrcm cLcrcccc: em cuIrc mcnuc| Iécnicc, c
ce Urgëncic: e Emergëncic: McIernc:. 0 enfc¢ue cc
pre:enIe ccp|Iu|c é c cc cIençcc cc mu|her ¢ue
Ienhc, nc mcmenIc ce :eu pcrIc, umc ge:Icçcc
ccn:icerccc ccmc ce mcjcr ri:cc pcIencic|. FcrIcnIc,
pre::upce umc cvc|icçcc pe|c prcfi::icnc| nc
mcmenIc cc inIerncçcc pcrc c pcrIc.
É impcrIcnIe ccn:icercr ¢ue c ge:IcnIe ce c|Ic ri:cc
ceverc Ier umc cLcrccgem ciferenciccc pe|c e¢uipe
prcfi::icnc|, pe|c mcicr prcLcLi|iccce ce ¢ue cccrrcm
ccmp|iccçce:, IcnIc pcrc e|c ccmc pcrc c
feIc/recém-nc:cicc. IcmLém hc c nece::iccce ce
cpcicr e Ircn¢üi|izcr c fcm||ic e c mu|her, umc vez ¢ue
c :iIucçcc gerc|menIe Ircz um mcicr n|ve| ce
cn:ieccce e mecc, :cLreIucc ¢ucncc infcrmccc ce
:eu ri:cc.
E:Ic cLcrccgem ciferenciccc ncc :ignificc,
nece::cricmenIe, rec|izcr um pcrIc pcr ce:crec. /c
ccnIrcric, mci: fre¢üenIemenIe, c re:c|uçcc incicccc
pcrc umc grcnce pcrIe cc: :iIucçce: ¢ue
ccrccIerizcm c ri:cc é ju:IcmenIe c cc pcrIc vcginc|.
/::im, :iIucçce: c||nicc: ccmc c: ce hiperIen:cc
crIeric| crcnicc, pré-ec|cmp:ic, cicLeIe:, pc:-ccIi:mc
e cuIrc: cevericm :er c fccc ce IenIcIivc: mci:
ccncreIc: ce :e ccn:eguir c pcrIc vcginc|, pe|c:
evicenIe: vcnIcgen: ¢ue Ircz.
Exi:Iem ncrmcIizcçce: :cLre c ccrccIerizcçcc cc:
in:IiIuiçce: ccpcciIccc: pcrc c cIençcc cc pcrIc ce
ge:Icçce: ce c|Ic ri:cc. É cLrigcçcc cc: ge:Icre: cc:
mcIerniccce: ccnhecë-|c:. Envc|vem, |cgiccmenIe,
ccrccIer|:Iicc: m|nimc: iceci: cc e¢uipe prcfi::icnc| e
:uc ccpcciIcçcc, in:Ic|cçce: f|:icc: {cenIrc cirúrgicc,
Lcncc ce :cngue, uniccce
13
ASSISTÊNCIA À MULHER NO PARTO DE
GESTAÇÕES DE ALTO RISCO
ASSISTÊNCIA À MULHER NO PARTO DE GESTAÇÕES DE ALTO RISCO
113
ce Iercpic inIen:ivc, Lerçcric, |cLcrcIcric, eIc.), c|ém ce e:IrcIégic:
ccmini:IrcIivc: cc in:IiIuiçcc pcrc fcci|iIcr e:Ie cIencimenIc e c gcrcnIir c
cevicc in:erçcc nc :i:Iemc ce :cúce hiercr¢uizccc.
Nc c::i:Iëncic cc pcrIc ce ge:Icçcc ce c|Ic ri:cc, uIi|izcm-:e c: me:mc:
pc::c: Iécnicc: cc c::i:Iëncic cc pcrIc ce Lcixc ri:cc, ccre:cicc: ce c|gun:
¢ue lhe: :cc prcpric:.
1. V|g||önc|o moterno
• / ccmi::cc, pcrc c: prccecimenIc: ccn:icerccc: rcIineirc:, vc|em
c: me:mc: crienIcçce: ¢ue pcrc c pcrIc ce Lcixc ri:cc. CuIrc:
prccecimenIc: inicici:, ccmc c mecicc cc pre::cc crIeric| e
ccnIcgem cc fre¢üëncic ccrc|ccc, pcr repre:enIcrem :inci:
e:pecic|menIe impcrIcnIe: nc evc|uçcc cc pcrIc ce c|Ic ri:cc, cevem
:er repeIicc: c inIervc|c: mencre:, pci: muccnçc: nc: :eu: vc|cre:
pccercc ceIermincr c|Iercçce: nc: ccncuIc: previcmenIe
e:IcLe|ecicc:.
• É funccmenIc| inc|uir c ccnIrc|e cc ccr, e cc: ccnciçce:
re:pircIcric:, ccrc|ccc: e hemccincmicc:. Feccmencc-:e c
ci:pcniLi|iccce ce ceIerminccc: recur:c: {mcniIcr ccrc|ccc, cx|meIrc
ce pu|:c, excme: |cLcrcIcrici:): cc fcci|iccce pcrc c cLIençcc ce
prccecimenIc: menc: u:uci:: c|ém ce cne:Ie:i:Ic ci:pcn|ve| nc
mcIerniccce e cienIe cc cc:c, e c cpinicc ce prcfi::icnci:
e:pecic|i:Ic: ¢ucncc i::c fcr nece::cric.
• / cieIc cc pcrIurienIe pcrIcccrc ce fcIcr ce ri:cc grcv|cicc é
ci:cuI|ve|. Se pcrc c ge:IcnIe ncrmc| :cc, permiIicc: cieIc |eve e
||¢uicc:, pcrc c grcvicc ce c|Ic ri:cc c chcnce ce c:pircçcc cc
ccnIeúcc gc:Iricc {S|ncrcme ce Mence|:cn) cumenIc muiIc, cccc c
mcicr pc::iLi|iccce ce pcrIc: ce:crec: e principc|menIe ce uIi|izcçcc
cc cne:Ie:ic gerc|. /::im, é prefer|ve| mcnIer e:Ic pcrIurienIe em
jejum, Icmcncc-:e c cevicc cuicccc ce fcrnecer c: cc|cric:
nece::cric: cc ce:envc|vimenIc cc IrcLc|hc ce pcrIc, cincc ¢ue :ejc
cIrcvé: ce infu:ce: enccvenc:c: ce g|icc:e.
2. V|g||önc|o |eto|
• / vigi|cncic feIc| curcnIe c IrcLc|hc ce pcrIc ce ge:Icçce: ce c|Ic
ri:cc ceve Icmcr em ccnIc c cvc|icçcc cc viIc|iccce feIc|, inc|uincc c
prcpric ce:envc|vimenIc inIrc-uIerinc cc feIc. É impcrIcnIe re::c|Icr
¢ue excme: rec|izccc: cnIericrmenIe, cu nc mcmenIc cc inIerncçcc
hc:piIc|cr, ccmc u|Irc-:cncgrcfic, prcvc: ce mcniIcrizcçcc e|eIrcnicc
feIc|, Ferfi| 8icf|:icc FeIc| e ccpp|erve|ccimeIric, cevem Ier :uc:
inciccçce: preci:c: em cccc :iIucçcc c||nicc, ncc :encc nece::cric:
Iccc: em Iccc: c: cc:c:. / cepencer cc: re:u|Iccc: ce:Ic: prcvc:,
ccnfcrme cLcrcccc nc mcnuc| Iécnicc ce Ge:Icçcc ce /|Ic Fi:cc,
ceverc :er :eguicc c viIc|iccce cc feIc nc Ircn:cur:c cc IrcLc|hc ce
pcrIc ce umc fcrmc rigcrc:c.
• Jc c ccmi::cc, c cmnic:ccpic pcce reve|cr cccc: impcrIcnIe: pcrc
c cvc|icçcc cc viIc|iccce feIc|. / pre:ençc ce ||¢uicc meccnic| em
fc:e: preccce: cc IrcLc|hc ce pcrIc é um :inc|
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ASSISTÊNCIA À MULHER NO PARTO DE GESTAÇÕES DE ALTO RISCO
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ce c|erIc ¢ue imp|icc em mcicr vigi|cncic feIc|. Fcr cuIrc |ccc, c
pre:ençc ce meccnic e:pe::c, icenIificccc cpc: c rcIurc cc:
memLrcnc: em cpre:enIcçce: cefc|icc:, incicc c|Ic prcLcLi|iccce
ce :cfrimenIc feIc|.
• C mcniIcrcmenIc cc fre¢üëncic ccrc|ccc feIc| e c méIccc mci:
cmp|cmenIe uIi|izccc pcrc c cvc|icçcc cc: ccnciçce: ce
viIc|iccce cc feIc. Fcce :er feiIc ce mccc inIermiIenIe cu ccnI|nuc.
C méIccc ce e:cuIc inIermiIenIe cc: LcIimenIc: ccrc|ccc: feIci: é
rec|izccc cIrcvé: cc e:IeIc:ccpic mcnccuricu|cr ce Fincrc, cu
cIrcvé: cc :cncr pcrIcIi|. Em cmLc: c: cc:c:, pcrc ¢ue :e Icrne
méIccc ccnficve|, :cc nece::cric: c|gun: cuicccc: Iécnicc:.
/::im, c primeirc pc::c é c e:IcLe|ecimenIc cc fre¢üëncic ccrc|ccc
feIc| Lc:c|, cu :ejc, c: :eu: vc|cre: cLIicc: enIre ccnIrcçce:. É c pcrIir
ce:Ie: ¢ue :e cicgnc:Iiccm c Ic¢uiccrcic feIc| {fre¢üëncic mcicr ¢ue
1ó0 LcIimenIc:/minuIc) e c Lrcciccrcic {vc|cre: mencre: ¢ue 120
LcIimenIc:/minuIc), Icmccc: ccmc :inc| impcrIcnIe pcrc c cicgnc:Iicc
ce :cfrimenIc feIc|.
C: LcIimenIc: cevem :er e:cuIccc: cnIe:, curcnIe e cepci: cc:
ccnIrcçce:. Cucncc i:Ic ncc fcr pc::|ve|, c cu:cu|Ic ceve :er feiIc c
pcrIir cc meic cc ccnIrcçcc cIé c :eu ce:cpcrecimenIc ccmp|eIc, pci:
:c c::im pccercc :er icenIificccc: c: ce:cce|ercçce: Icrcic: e vcricvei:
prc|cngccc:, e|emenIc: prcpecëuIicc: exIremcmenIe impcrIcnIe: pcrc
c cicgnc:Iicc ce :cfrimenIc feIc|.
Deve ficcr c|crc ¢ue e:Ie: e|emenIc: pccem :er cLIicc: IcnIc pe|c
cu:cu|Ic inIermiIenIe, ccmc pe|c mcniIcrcmenIc e|eIrcnicc ¢ue, IcnIc
¢ucnIc pc::| ve|, ceve :er preferencic| nc cccmpcnhcmenIc cc IrcLc|hc
ce pcrIc ce c|Ic ri:cc. /: in:IiIuiçce: ccpcciIccc: c e:Ie Iipc ce cIençcc
cevericm ci:pcr ce mcniIcre: e|eIrcnicc: feIci: e :eu: prcfi::icnci:
cevericm :er cce¢ucccmenIe Ireinccc: pcrc :uc uIi|izcçcc e
inIerpreIcçcc.
CcnIucc, ncc exi:Iem evicëncic: cienI|ficc: ¢ue cemcn:Irem ¢ue c
ccnIrc|e e|eIrcnicc cc viIc|iccce feIc| ccm mcniIcr curcnIe c IrcLc|hc
ce pcrIc mc:Ire evicenIe: vcnIcgen: ccm re|cçcc cc ccnIrc|e c||nicc
inIermiIenIe rec|izccc ccm e:IeIc:ccpic ce Fincrc cu :cncr pcr
prcfi::icnci: Ireinccc:. C mcniIcr feIc| fcci|iIc c ccnIrc|e cc viIc|iccce
feIc|.
• / uIi|izcçcc cc gc:cmeIric ccpi|cr feIc| é méIccc ccrc e,
emLcrc :eu: re:u|Iccc: :ejcm ccnficvei:, é pcucc uIi|izccc nc 8rc:i|.
CcnIucc, :empre ¢ue pc::|ve| e ci:pcn|ve|, ccn:IiIui cincc um
exce|enIe méIccc pcrc cjuccr c cicgnc:Iicc ce :iIucçce: ce
hipcxic feIc|, cnce e:Icricm incicccc: mecicc: pcrc cIenuc-lc:,
inc|u:ive nc ¢ue ciz re:peiIc c vic ce pcrIc. CuIrc pc::iLi|iccce,
cincc pcucc exp|crccc nc pc|:, é c cc cximeIrjc ce pu|:c feIc|,
cccp|ccc c :i:Iemc: ce mcniIcrizcçcc feIc| inIrc-pcrIc.
3. Ass|stënc|o oo porto
• DiferenIemenIe cc pcrIc ce Lcixc ri:cc, em ¢ue ncc :e re:Iringe
c pc:içcc cc pcrIurienIe, nc: ge:Icçce: ce c|Ic ri:cc,
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c cecúLiIc |cIerc| cccLc :encc c pc:içcc ce e:cc|hc. Fcrc
cvc|icçcc g|cLc| cc evc|uçcc cc IrcLc|hc ce pcrIc, incicc-:e u:c
cc pcrIcgrcmc ¢ue fcrnece e|emenIc: cLjeIivc: pcrc c cicgnc:Iicc
ce ci:Iccic:, ccnfcrme ceIc|he: nc Ccp|Iu|c ó.
E:pecificcmenIe ne:Ic: :iIucçce:, é inci:pen:cve| cccrrer umc
inIegrcçcc ccmp|eIc cc e¢uipe mu|Iiprcfi::icnc|, inc|uincc c cL:IeIrc, c
pecicIrc, c cne:Ie:i:Ic, pc::ive|menIe c c||nicc, c enfermeirc e cuIrc:. /
mcicric cc: cc:c: ce ge:IcnIe: ce ri:cc em IrcLc|hc ce pcrIc Iem
inciccçcc ce cnc|ge:ic preccce. l::c é e:pecic|menIe impcrIcnIe nc:
:iIucçce: ce ccrcicpcIic mcIernc, pcrc eviIcr c :cLreccrgc
hemccincmicc re:u|IcnIe cc: e:fcrçc: ce puxc cc per|ccc expu|:ivc,
ccm c pc::|ve| ccn:e¢üenIe ce:ccmpen:cçcc ccrc|ccc mcIernc.
• FcnIc ¢ue merece ci:cu::cc é c mcmenIc ce :e prcIiccr c
cmnicIcmic. /Ié hc c|gun: cnc:, reccmenccvc-:e c rcIurc crIificic|
e preccce cc: memLrcnc:, vi:cncc c ce:encccecmenIc cc
IrcLc|hc ce pcrIc e encurIcmenIc ce :eu Iempc. EnIreIcnIc, c
rcIurc preccce cc: memLrcnc: cmnicIicc: fcvcrece c
cpcrecimenIc ce ccvc|gcmenIc: e Lc::c: :erc:cngu|nec:, c|ém
cc: ce:cce|ercçce: preccce:. E:Ic: ú|Iimc: pccem :er Icmccc:
ccmc :inc| ce c|crme pcrc c :cfrimenIc feIc|. De:Ic fcrmc, quonto
mo|s tord|o |or o roturo omn|ot|co ort|||c|o|mente reo||zodo, me|hores
serõo os cond|çöes |eto|s.
/ c::i:Iëncic cc per|ccc expu|:ivc ceve |evcr em ccnIc c pc:içcc cc
pcrIurienIe, c ccnciçcc pcIc|cgicc ¢ue ccrccIerizc c c|Ic ri:cc e c:
inciccçce: ce cnIecipcçcc cc pcrIc ccm c u:c prcfi|cIicc ce fcrcipe.
• Nc pcrIurienIe ce c|Ic ri:cc, c pc:içcc ccnvencicnc|
ginecc|cgicc é c mci: uIi|izccc, fre¢üenIemenIe ccm c ccr:c
|evemenIe c|çccc, inc|u:ive pcr¢ue c mu|her e:Icrc :cL cnc|ge:ic
pericurc|, nc mcicric cc: veze:. A ep|s|otom|o nõo tem |nd|coçõo
s|stemót|co. Deve :er incicccc :e|eIivcmenIe em cc:c: cnce :e
ju|gue impre:cinc|ve| pcrc eviIcr rcIurc: perineci: :empre IcmLém
¢ucncc c fcrcipe fcr uIi|izccc.
• Fc::|ve| ce ci:cu::cc e c u:c prcfi|cIicc cc fcrcipe cu fcrcipe ce
c||vic. EmLcrc c: cpinice: :ejcm civergenIe:, c preceiIc Lc:icc ce
:e pre:ervcr c ncrmc|iccce ceve prevc|ecer. /::im, frenIe c
evc|uçcc ncrmc| cc :eguncc e:Icgic e mcnIicc: c: ccnciçce: ce
viIc|iccce mcIernc e feIc|, ncc hc re:pc|cc pcrc e:Ic inIervençcc
:i:IemcIiccmenIe rec|izccc. Feccmencc-:e re:ervcr c fcrcipe c:
:uc: inciccçce: c|c::icc: e nc: :iIucçce: ce ccrcicpcIic: e
pneumcpcIic:, pcrc eviIcr c e:fcrçc f|:icc mcIernc cc per|ccc
expu|:ivc, ¢ue pcce fcvcrecer umc ce:ccmpen:cçcc. DeIc|he:
:cLre c uIi|izcçcc ce:Ie in:IrumenIc e:Icc ci:pcn|vei: nc CcpiIu|c
11.
• Nc c::i:Iëncic cc pcrIc ce Lcixc ri:cc, c crienIcçcc é ce :e
prccecer c |igccurc Icrcic cc ccrccc, i:Ic é, ce::ccc: c:
LcIimenIc:. Nc grcvicez ce c|Ic ri:cc, c|gumc: ccnciçce: ccnIrc-
inciccm Ic| ccncuIc, ccmc é c cc:c cc i:cimunizcçcc mcIernc-
feIc| e HlV•.
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• C cIencimenIc cc ¢ucrIc per|ccc nc grcvicez ce c|Ic ri:cc ceve
:er inIen:ivc, pci: c: chcnce: ce ccmp|iccçce: :cc mcicre:. Ici: :cc
c: cc:c: ce hiperIen:c: grcve:, ccrcicpcIc:, préec|cmpIicc: cu
ec|cmpIicc:, cicLéIicc:, eIc. /pc: um per|ccc ce permcnëncic nc
:c|c ce recupercçcc pc:-cne:Ié:icc, c mu|her ceverc :er
enccminhccc pcrc umc uniccce ce cuicccc: inIen:ivc:, :cL
:upervi:cc cne:Ié:icc, cL:IéIricc e c||nicc, :e :uc :iIucçcc c::im c
inciccr.
• Mci: cc ¢ue nc: :iIucçce: ce ncrmc|iccce, c cIencimenIc cc
pcrIc ce ge:IcnIe ce c|Ic ri:cc pre::upce IcmLém c nece::iccce
ce cce¢uccc enccminhcmenIc pcrc c revi:cc puerperc| e
crienIcçcc ¢ucnIc cc p|cnejcmenIc fcmi|icr, cLcrcccc: nc
Ccp|Iu|c 20.
S|tuoçöes espec|o|s:
1. Feto com restr|çõo do cresc|mento |ntro-uter|no [kCIb}
C FClU ncc ccn:IiIui umc inciccçcc cL:c|uIc ce pcrIc pcr ce:crec,
ccn:icercncc ¢ue cercc ce ó07 cc: cc:c: pccem evc|uir pcrc pcrIc
vcginc|, :em nenhum Iipc ce ccmp|iccçcc ¢ucnIc c viIc|iccce feIc|. Seu
ccnIrc|e curcnIe c evc|uçcc cc IrcLc|hc ce pcrIc ceve :er feiIc ce
mcneirc rigcrc:c, ccmc jc preccnizccc cnIericrmenIe ne:Ie ccp|Iu|c.
2. Gestoçöes pré-termo
Nc pcrIc premcIurc, :empre ¢ue fcr pc::|ve|, é impcrIcnIe |emLrcr ¢ue
c: feIc: pré-Iermc cevem :e Leneficicr cc ccmini:Ircçcc pcrenIerc| ce
ccrIiccice pcrc cce|ercr c mcIuriccce pu|mcncr {pe|c menc: pcr 24
hcrc:, pcrc ¢ue hcjc Iempc :uficienIe pcrc ¢ue :uc cçcc pc::c :e
mcnife:Icr). IcmLém ne:Ic :iIucçcc ncc exi:Ie nenhumc evicëncic
cienI|ficc ¢ue :upcrIe c cpçcc pe|c pcrIc ce:cricnc, ce:ce ¢ue c
cpre:enIcçcc :ejc cefc|icc. Ccn:IiIui cincc :iIucçcc em ¢ue c
pre:ervcçcc cc: memLrcnc: cvu|cre: |nIegrc: pe|c mcicr Iempc pc::|ve|
e mecicc eficcz ce mcnuIençcc cc: Lcc: ccnciçce: ce :cúce feIc|.
3. Apresentoçõo pé|v|co
/ vic ce pcrIc ce feIc: em cpre:enIcçcc pé|vicc, IcnIc ce Iermc ¢ucnIc
pré-Iermc, :empre fci mcIivc ce ccnIrcvér:ic: nc |iIercIurc muncic|,
cccc: c: ri:cc: pcIencici: c e|c c::cciccc:. Irccicicnc|menIe, pcrIc
vcginc| erc reccmencccc nc cpre:enIcçcc pé|vicc em ge:Icçce: ce
Iermc :em ccmp|iccçce: ccicicnci:. /|gun: pc|:e: IcmLém inciccvcm c
vic vcginc| me:mc em mu|here: primige:Ic:, ¢ue ncc cccnIecic nc
/méricc LcIinc em gerc| e nc 8rc:i|, em pcrIicu|cr. Exi:Ie ccn:en:c nc
|iIercIurc inIernccicnc| ce ¢ue c me|hcr fcrmc ce cLcrccgem c
ge:Icçcc ccm feIc em cpre:enIcçcc pé|vicc, é c ce :e prccecer c umc
ver:cc cefc|icc exIernc cc reccr cc: 37 :emcnc: ce iccce ge:Iccicnc|,
cLvicmenIe rec|izccc cpenc: pcr prcfi::icnc| ccpcciIccc pcrc c
prccecimenIc e :e hcuverem ccnciçce: iceci: pcrc i::c {ge:Icçcc
únicc, Lc|:c |nIegrc, cu:ëncic ce IrcLc|hc ce pcrIc, excme u|Irc-
:cncgrcficc, cu:ëncic ce circu|cre:
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ce ccrccc, :em ciccIriz ce ce:crec prévic, fcci|iccce: nc :erviçc pcrc c
cIençcc imecicIc ce pc::|vei: ccmp|iccçce:).
Cucncc c ver:cc exIernc ncc fcr pc::|ve| cu ncc re:u|Icr em ëxiIc,
cIuc|menIe incicc-:e c pcrIc ce:crec pcrc c: cpre:enIcçce: pé|vicc:,
ccm Lc:e em evicëncic: cienI|ficc: recenIe:, incepencenIemenIe ce
cuIrc: vcricvei:.
Freferencic|menIe, c ce:crec ceve :er incicccc ¢ucncc iniciccc c
IrcLc|hc ce pcrIc e ncc e|eIivcmenIe, pcrc eviIcr c: pc::|vei:
ccmp|iccçce: ceccrrenIe: ce umc premcIuriccce icIrcgeniccmenIe
incuzicc. /|ém ci::c, é impcrIcnIe |emLrcr ¢ue nc ce:prencimenIc cc
feIc, curcnIe umc ce:crec em cpre:enIcçcc pé|vicc, cevem :er
rec|izccc: c: mcncLrc: :imi|cre: c¢ue|c: reccmencccc: pcrc c cIençcc
cc pcrIc vcginc| ne:Ic cpre:enIcçcc.
4. Gestoçõo geme|or
Exi:Iem evicëncic: ¢ue cemcn:Ircm ¢ue c prcgrcmcçcc pcrc c pcrIc
{p|cnejcmenIc :cLre c hc:piIc| ce e:cc|hc pcrc c pcrIc e :eu: recur:c:
Iécnicc: e humcnc: ce cL:IeIr|cic, cne:Ie:ic e necncIc|cgic) é
funccmenIc| nc cLIençcc ce Lcn: re:u|Iccc: mcIernc: e perincIci:.
Ccm re|cçcc c vic ce pcrIc, vc|e cincc c inciccçcc c|c::icc ce ¢ue em
cpre:enIcçce: cefc|icc: cc primeirc geme|cr, c pcrIc ceve :er vcginc|
:empre ¢ue c pe:c feIc| e:Iimccc fcr mcicr ¢ue 1500g. Nc: cemci:
cpre:enIcçce: cc primeirc geme|cr, c ce:crec e:Ic incicccc.
Fer:i:Ie cincc c|gumc cúvicc ¢ucnIc c me|hcr inIervençcc pcrc c
Seguncc geme|cr ncc cefc|icc, cpc: c nc:cimenIc cc primeirc pcr vic
vcginc|. Exi:Iem evicëncic: ce ¢ue c ce:crec :i:IemcIicc ne:Ic ccnciçcc
e:pec|ficc ncc repre:enIc nenhumc vcnIcgem :cLre c: mcncLrc:
c|c::icc: ce ver:cc inIernc e exIrcçcc pccc|icc {cu cincc :cLre c ver:cc
exIernc ¢ue é pcucc prcIicccc nc 8rc:i|), ¢ucnIc cc: re:u|Iccc:
perincIci: e, pcr cuIrc |ccc, c|gumc ce:vcnIcgem em Iermc: ce
mcrLiccce infeccic:c mcIernc, ce:ce ¢ue exi:Icm prcfi::icnci: Ireinccc:
pcrc rec|izc-lc:.
CuIrc c|IerncIivc ce:criIc pcrc e:Ic :iIucçcc é c ver:cc exIernc pcrc
cpre:enIcçcc cefc|icc. E:Ie prccecimenIc, ccnIucc, c|ém ce ncc :er
prcIicc fre¢üenIe nc pc|:, pcrece ncc :er vcnIcjc:c ccm re|cçcc c
ver:cc inIernc ccm exIrcçcc pccc|icc.
5. Cesóreo onter|or
/ pre:ençc ce cnIececenIe: ce umc ce:crec cnIericr ncc ccnIrcincicc
c cccrrëncic ce IrcLc|hc ce pcrIc nc ge:Icçcc :uL:e¢üenIe. C
incenIivc c rec|izcçcc ce prcvc ce IrcLc|hc ce pcrIc ne:Ic: mu|here: é
umc cc: mecicc: mci: impcrIcnIe: pcrc c recuçcc cc: Icxc: ce
ce:crec nc 8rc:i|. C ri:cc ce ccmp|iccçce: mcIernc: {rcIurc uIerinc,
cei:cëncic ce ciccIriz, eIc.), c::im ccmc ce ccmp|iccçce: feIci:
{:cfrimenIc) é muiIc Lcixc, ce:ce ¢ue hcjc cce¢uccc vigi|cncic cc
IrcLc|hc ce pcrIc e cc viIc|iccce feIc|.
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Ncc exi:Iem |imiIe: ce inIervc|c inIerpcrIc| ¢ue ccnIrc-inci¢uem c
IrcLc|hc ce pcrIc em ge:IcnIe ccrn ce:crec cnIericr, ce:ce ¢ue c
inci:cc cc primeirc ce:crec Ienhc :icc :egmenIcr. C |ncice ce :uce::c
pcrc pcrIc vcginc| nc: mu|here: :uLmeIicc: c umc prcvc ce IrcLc|hc ce
pcrIc é ce, nc m|nimc, 507: c|gun: IrcLc|hc: mc:Ircm cifrc: ce cIé 70 c
807.
13
119
Nc prcIicc cL:IéIricc exi:Iem vcric: ccnciçce: ¢ue
inciccm c Iérminc cc grcvicez, em ¢uc|¢uer iccce
ge:Iccicnc|, cnIe: cc in|cic e:pcnIcnec cc IrcLc|hc
ce pcrIc. EnIre e|c:, c: mci: fre¢üenIe: :cc c:
:|ncrcme: hiperIen:ivc:, cicLeIe:, cc|cgenc:e:,
re:Iriçcc cc cre:cimenIc inIrc-uIerinc {FClU), pc:
ccIi:mc, ccmprcmeIimenIc cc viIc|iccce feIc|,
i:cimunizcçcc mcIernc-feIc|, mcrIe feIc| infrc-úIerc,
rcIurc premcIurc ce memLrcnc: e ccriccmnicniIe.
/ incuçcc cc IrcLc|hc ce pcrIc é prcIicccc
:i:IemcIiccmenIe cpenc: em c|gun: pcucc: hc:piIci:,
gerc|menIe púL|icc: e univer:iIcric:, em prcpcrçce:
Lem infericre: c¢ue|c: ce pc|:e: mci: ce:envc|vicc:.
Ncc hc cincc nc pc|: umc cmp|c ci:pcniLi|iccce
ccmercic| ce méIccc: ce prepcrc ce cc|c e ce
incuçcc cc IrcLc|hc ce pcrIc, c ¢ue ccnIriLui
cerIcmenIe pcrc c: c|Ic: |ncice: ce pcrIc pcr ce:crec.
Num contexto de humon|zoçõo do nosc|mento, de
respe|to oos d|re|tos e desejos dos mu|heres, e do
prót|co de umo obstetríc|o boseodo em ev|dënc|os, é
|mportonte que se esc|oreço que o |nduçõo do porto é
um proced|mento oce|tóve| e recomendóve| sob o
ponto de v|sto méd|co e humono, sempre que ex|sto
umo |nd|coçõo poro |sso, poro ev|tor um mo| mo|or.
E:Ie pcce IcnIc mcnife:Icr-:e ccmc um re:u|Iccc
mcIernc cu perincIc| ce:fcvcrcve| cu, mci:
fre¢üenIemenIe, ccmc umc ce:crec ce:nece::cric e
:uc: pc::|vei: ccn:e¢üëncic:. E:Ic cLcrccgem nccc
Iem c ver ccm c fre¢üenIe u:e ce :uL:Icncic: ¢ue
e:Iimu|cm c ccnIrcçcc uIerinc cpenc: ccm c cLjeIivc
ce cnIecipcr cu encurIcr c IrcLc|hc ce pcrIc em
Lenef|cic cc: inIere::e: pe::cci: cc: prcfi::icnci: ce
:cúce cu cc: prcpric: ge:IcnIe:. /|ém ci::c, é
impcrIcnIe ¢ue :e e:c|creçc ¢ue um ¨:crc¨ cc|ccccc
nc ge:IcnIe pcr umc cu cuc: hcrc: nõo é incuçcc cc
pcrIc: ¢ue e|e ncc ccn:egue fczer num e:pcçc ce
Iempc Icc curIc, c ¢ue c ncIurezc cemcrc c|gun:
cic:.
14 INDUÇÃO DO PARTO
INDUÇÃO AO PARTO
120
Cuc|¢uer méIccc c :er uIi|izccc exige c pre:ençc ce prcfi::icnc|
Ireinccc, in:Ic|cçce: cc mcIerniccce cce¢uccc: c nece::iccce ce u:e
ce infu:ce: enccvenc:c:, ce ccnIrc|e fre¢üenIe cc viIc|iccce feIc|, ce
rec|izcçcc ce prccecimenIc: cirúrgicc: ce urgëncic, ce ci:pcniLi|iccce
ce recur:c: ce Lcncc ce :cngue e ce cne:Ie:ic, enIre cuIrc:. /
ge:IcnIe, Lem ccmc :eu ccmpcnheirc cu cccmpcnhcnIe, cevem e:Icr
infcrmccc: e e:c|crecicc: :cLre c méIccc e:cc|hicc e ccnccrccrem
ccm e|e. lcec|menIe Iccc c e¢uipe prcfi::icnc| ceveric e:Icr mcIivccc
pcrc c: Lenef|cic: ce um pcrIc vcginc|, ccmpcrcIivcmenIe c ce:cricnc,
pcrc cc|cLcrcr ccm c mu|her curcnIe Iccc e:Ie prcce::c.
Aspectos ||s|o|og|cos
C :uce::c nc incuçcc cc pcrIc cepence cc cLIençcc ce ccnIrcIi|iccce
uIerinc e ci|cIcçcc prcgre::ivc cc cc|c. / ccnIrcçcc uIerinc cce¢uccc
pcrc c ci|cIcçcc cervicc| e:Ic cireIcmenIe re|ccicnccc cc e:Iccc inicic|
cc cc|c e c iccce ge:Iccicnc|. C cc|c uIerinc é imcIurc e firme curcnIe
Iccc c per|ccc cc grcvicez, cIé c: ú|Iimc: cic: cu :emcnc: ¢ue
cnIececem c pcrIc, ¢ucncc prcfuncc: mccificcçce: Lic|cgicc: e
Lic¢u|micc: cccrrem, Icrncncc-c mccic e ccmp|ccenIe.
/ primeirc c|c::ificcçcc c||nicc cc: ccnciçce: ce cmccurecimenIc cc
cc|c uIerinc fci rec|izccc pcr 8i:hcp {1ºó4) ¢ue ce:envc|veu um e:ccre
ccm cincc vcricvei: pcrc e:IcLe|ecer c e:Iccc cc cc|c {Cuccrc 1). /
pcrIir ce::e e:Iucc, c |ncice ce 8i:hcp pc::cu c :er uIi|izccc ccm c
prcpc:iIc ce :e e:IcLe|ecer, genericcmenIe, c preciçcc ce :uce::c c
incuçcc cc IrcLc|hc ce pcrIc. Ccn:icerc-:e ccmc fcvcrcve| cc :uce::c
pcrc pcrIc vcginc|, em mencr Iempc, c pre:ençc ce |ncice ce 8i:hcp
mcicr cu iguc| c ncve, ccmc inIermecicric um e:ccre enIre cincc e ciIc,
e ce:fcvcrcve| ¢ucncc mencr ¢ue cincc pcnIc:.
Quadro 1. Parâmetros para a avaliação do colo uterino - Bishop 1964)
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INDUÇÃO DO PARTO
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Nc pre:ençc ce cc|c uIerinc ce:fcvcrcve|, cIuc|menIe ccn:icerc-:e
Lenéficc e funccmenIc| c rec|izcçcc ce prepcrc cervicc| prévic c
incuçcc cc pcrIc. / incuçcc ce ccnIrcIi|iccce uIerinc :em c prepcrc
cervicc| prévic e:Ic c::cciccc c c|Ic: Icxc: ce fc|hc: ce incuçcc e pcrIc
pcr ce:crec.
O preporo do co|o deve ser entend|do como um me|o poro se obter o
trobo|ho de porto e porto. CcnIucc, cincc ncc exi:Ie um méIccc ¢ue
pc::c :er ccn:icerccc icec| pcrc c prepcrc cc cc|c, ¢ue cumprc ccm
Iccc: c: :eguinIe: prcprieccce:, iceci::
• cu:ëncic ce efeiIc: ccver:c: pcrc c mce e feIc:
• cmccurecimenIc cc cc|c em curIc per|ccc ce Iempc {cIé 12 -
24h):
• ncc ccu:cr ce:ccnfcrIc c mu|her:
• ncc :er invc:ivc, mc: ce fcci| cp|iccçcc: e
• ncc e:Iimu|cr c ccnIrcIi|iccce uIerinc.
EmLcrc e:Ic ú|Iimc prcprieccce ncc repre:enIe um ccn:en:c enIre c:
cuIcre:, :cLe-:e ¢ue c ccnIrcçcc uIerinc ccm cc|c imcIurc c::ccic-:e c
mcicr prcLcLi|iccce ce IrcLc|hc ce pcrIc |cLcric:c e excu:Iivc,
e|evcncc c ri:cc ce efeiIc: ccver:c: ccmc :cfrimenIc feIc|, ce:ccnfcrIc
mcIernc e cuIrc:.
MÊIODOS DE FkEFAkO CEkVICAL
Nc prcIicc, c: méIccc: cIuc|menIe ci:pcn|vei: e úIei: pcrc c prepcrc cc
cc|c uIerinc prévic c incuçcc cc IrcLc|hc ce pcrIc :cc:
1. Métodos mecön|cos
Dencminc-:e méIccc meccnicc c in:IrumenIc cu ci:pc:iIivc cc|ccccc
nc ccnc| cervicc| cu nc e:pcçc exIrc-cmnicIicc. Scc exemp|c: ce:Ie Iipc
ce méIccc c: :cncc:, ccIéIere: e c: prepcrccc: ccm c|gc: mcrinhc:
{|cmincric). /: :cncc: c|c::iccmenIe uIi|izccc:, ccmc c reIc| nc méIccc
ce ‚rcu:e, Iëm :icc mci: recenIemenIe Irccccc: pcr cuIrc: mcce|c:
menc: r|gicc:, c exemp|c cc sondo de Fo|ey.
CucnIc cc meccni:mc ce cçcc, c: c|gc: ncIurci: e/cu :inIéIicc:, c:
|om|nór|os, cgem :cLre c cc|c uIerinc, prcmcvencc c ci|cIcçcc cc
ccnc| cervicc| cIrcvé: ce expcn:cc rccic| :ucve pcr :eu pccer
higrc:ccpicc, :em prcvcccr |e:cc ce fiLrc:. /pe:cr ce cencminccc:
meccnicc:, IcmLém :e cIriLui cc méIccc c e:I|mu|c e |iLercçcc ce
prc:Icg|cncinc: enccgenc:, e|evcncc c ccmp|ccëncic cc cc|c uIerinc.
E:Ie me:mc meccni:mc ccmLinccc é prcpc:Ic pcrc c cçcc cc:
ccIéIere: exIrc-cmnicIicc:, ccm cu :em Lc|ce: in:uf|ccc:.
/: :cncc: cu ccIéIere: exIrc-cmnicIicc: :cc ceixccc: pcr Iempc vcricve|
enIre 12 e 24 hcrc:. / uIi|izcçcc ce:Ie: méIccc: meccnicc: pcce :e
c::ccicr c c|gumc: recçce: ccver:c: ccmc rcIurc ccicenIc| ce
memLrcnc: cmnicIicc:, ce:ccnfcrIc mcIernc, :cngrcmenIc, ci:Iccic
funcicnc| e, menc: fre¢uenIemenIe, infecçcc puerperc|.
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INDUÇÃO AO PARTO
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/: vcnIcgen: ce:Ie: méIccc: :cc, em gerc|, ceccrrenIe: ce :uc fcci|
cp|iccLi|iccce, :imp|iciccce ce u:c, Lcixc cu:Ic ¢ucncc ccmpcrccc cc:
cemci: méIccc:, fcci| remcçcc, c|ém ce pe¢uenc cu nenhumc
cIucçcc :cLre c micméIric. Mci: recenIemenIe, c uIi|izcçcc cc :cncc
ce Fc|ey, ccm Lc|cneIe in:uf|ccc ccimc cc crif|cic inIernc, :cL Ircçcc
mccerccc {cIrcvé: ce :uc fixcçcc ccm e:pcrccrcpc nc fcce inIernc cc
ccxc), Iem mc:Irccc umc grcnce ccpcciccce ce ce:encccecr
ccnIrcçce: e IrcLc|hc ce pcrIc, ccm re:u|Iccc: muiIc fcvcrcvei: e Lcixc
|ncice ce efeiIc: cc|cIerci:.
EmLcrc exi:Ic umc grcnce ¢ucnIiccce ce e:Iucc: puL|icccc: :cLre c
experiëncic ccm c uIi|izcçcc ce méIccc: meccnicc: pcrc c prepcrc
cervicc| previcmenIe c incuçcc cc IrcLc|hc ce pcrIc, Ici: méIccc:
e:Icc |cnge ce :erem |crgcmenIe uIi|izccc: nc prcIicc cL:IéIricc cicric,
:cLreIucc nc 8rc:i|. Seu: re:u|Iccc: cemcn:Ircm umc ccpcciccce ce
mcIurcçcc cc cc|c |imiIccc, pcrIcnIc ju:Iificcve| nc cIuc|iccce cpenc:
em :iIucçce: em ¢ue cuIrc: méIccc: mci: efeIivc: ncc e:Iejcm
ci:pcn|vei:.
Ncc exi:Iem cincc evicëncic: :uficienIe: ¢ue permiIcm reccmenccr c
u:c ccmLinccc cc: ccIéIere:, ccm c in:Ii|cçcc ce :uL:Icncic: ccmc c:
prc:Icg|cncinc: nc e:pcçc exIrc-cmnicIicc.
2. Métodos |ormoco|og|cos
C mci: ccnhecicc e uIi|izccc méIccc ce prepcrc cervicc| é c infu:cc
enccvenc:c ce oc|toc|no. De:ce c in|cic ce :uc uIi|izcçcc pcrc c
incuçcc cc ccnIrcIi|iccce uIerinc, Iem :icc IcmLém u:ccc pcrc c
cmccurecimenIc cervicc|, emLcrc :e ccnheçc, hc muiIc, :uc |imiIccc
efeIiviccce pcrc e:Ie fim. E:Ic c::cciccc c nece::iccce ce um Iempc
prc|cngccc ce prepcrc, ce c|Ic: cc:e: e c Icxc: e|evccc: ce ce:crec
pcr fc|hc ce incuçcc. Devicc c e:Ic: |imiIcçce:, :uc uIi|izcçcc pcrc c
prepcrc cervicc| fci prcIiccmenIe cLcnccnccc. Scc nece::cric:,
¢ucncc ncc :e ci:pcem ce cuIrc: méIccc: mci: efeIivc:, Irë: c ¢ucIrc
repeIicc: :e::ce: cicric:, c ¢ue é ccn:cIivc pcrc c mu|her e c e¢uipe ce
:cúce, :em ccnIcr ccm c ccupcçcc exIrc ce |eiIc: nc uniccce
cL:IéIricc.
/ pcrIir cc icenIificcçcc cc envc|vimenIc cc: prostog|ond|nos
enccgenc: nc prcce::c ncIurc| ce mcIurcçcc cc cc|c uIerinc, c u:c
ce:Ic: :uL:Icncic: pc::cu c :er ccn:cgrccc ccmc méIccc icec| pcrc
prepcrc e incuçcc ce pcrIc. Nc: pc|:e: ce primeirc muncc, nc: ú|Iimc:
cécccc:, ciferenIe: fcrmu|cçce: ce FgE2 [d|noprostone} vëm :encc
uIi|izccc:, e:pecic|menIe c fcrmc ce ge| pcrc cp|iccçcc inIrc-cervicc| cu
inIrc-vcginc|.
EmLcrc c FgE2 {cincprc:Icne) :ejc um méIccc :egurc e eficcz pcrc c
prepcrc cc cc|c uIerinc, :uc fcrmu|cçcc cpre:enIc cu:Ic e|evccc, é
Iermc|cLi| e ncc é ccmercic|izccc nc 8rc:i|. C m|soprosto| ƒ umc
prc:Icg|cncinc :inIéIicc E1, meIi| cnc|cgc, ¢ue fci criginc|menIe
:inIeIizccc e ccmercic|izccc ccm c cLjeIivc ce ciminuir c: efeiIc:
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INDUÇÃO DO PARTO
123
cc|cIerci: e cumenIcr c Iempc ce cçcc cc FgE1 ncIurc|, nc IrcIcmenIc
ce :|ncrcme: ci:pépIicc: cc IrcIc gc:IrcinIe:Iinc|, ccmc gc:IriIe e ú|cerc
pépIicc.
lnicic|menIe, c uIi|izcçcc cc mi:cprc:Ic| fci mci: cirecicnccc ccmc
ccjuvcnIe nc: inIerrupçce: inicici: ce ge:Icçcc, pcr :eu efeiIc cLcrIivc.
E::e efeiIc fci cmp|cmenIe uIi|izccc e civu|gccc, c ¢ue inc|u:ive cificu|Icu
c ccmercic|izcçcc cc prccuIc pcrc e:Ie e cuIrc: fin: nc 8rc:i|, Iencc :icc
re:IriIc e :u:pen:c :uc ccmercic|izcçcc nc pc|: curcnIe c|gun: per|ccc:.
/ pcrIir cc in|cic cc cécccc ce º0, vcric: e:Iucc: rec|izccc: fcrnecercm
evicëncic: Lc:eccc: em experiëncic c||nicc pcrc ju:Iificcr c u:c cc
mi:cprc:Ic| ce fcrmc rcIineirc pcrc c prepcrc cervicc| e incuçcc cc
IrcLc|hc ce pcrIc em ge:Icçce: ccm feIc vivc.
/ cpre:enIcçcc cc mi:cprc:Ic| nc 8rc:i|, cIé cgcrc cpenc: ccm cc:e
e|evccc ce 200 µg pcr ccmprimicc, cificu|Ic :eu u:c em CL:IeIr|cic.
EnIreIcnIc, civer:c: e:Iucc: Iëm :icc rec|izccc: ccm c prcpc:iIc ce
prepcrc e incuçcc cc pcrIc ccm e:Ic crcgc. EmLcrc cincc ncc Ienhc
:icc cprcvccc pcrc e:Ie fim nc pc|:, c méIccc e:Ic gcnhcncc
pcpu|criccce, principc|menIe pe|c :uc eficccic e Lcixc cu:Ic, :encc jc
reccmencccc :uc uIi|izcçcc em mcnuci: cc Mini:Iéric cc Scúce {8rc:i|,
MS, 2000). /|ém ci::c, jc exi:Ie IcmLém um ccn:en:c inIernccicnc| :cLre
:uc uIi|iccce pcrc c prepcrc cervicc| e incuçcc cc IrcLc|hc ce pcrIc. Nc
mcicr pcrIe cc: e:Iucc: puL|icccc: mci: recenIemenIe, c cc:e ce
mi:cprc:Ic| Iem :icc ce 25 µg c cccc ¢ucIrc c :ei: hcrc:, ccmc jc
reccmencc c Cc|égic /mericcnc ce CL:IeIrc: e Ginecc|cgi:Ic: {/CCG).
/pe:cr cc mi:cprc:Ic| Ier :uc eficccic ccnfirmccc em muiIc: e:Iucc:, c
:egurcnçc ce u:c pcrc prepcrc e incuçcc ce pcrIc em feIc vivc cincc é
mcIivc ce c|gumc ccnIrcvér:ic. Fcce-:e cizer, ccnIucc, ¢ue c: e:Iucc:
Iem cemcn:Irccc ¢ue c recuçcc cc cc:e ccn:egue ccnIrc|cr Lem c:
efeiIc: ccver:c:, Icrncncc-c: :imi|cre: cc: cc cincprc:Icne e méIccc:
meccnicc:, :em ccmprcmeIer c: efeiIc: e:perccc:.
/::im, é pc::|ve| ccnc|uir ¢ue, em Lc:e c: evicëncic: cienI|ficc: e c||nicc:
ci:pcn|vei:, c mi:cprc:Ic| pcce :er reccmencccc pcrc prepcrc cervicc| e
incuçcc cc pcrIc ce feIc vivc, em u:c vcginc| nc cc:cgem ce 25 µg c
cccc :ei: hcrc:, nc cc:e IcIc| mcximc ce 100 µg {/CCG, 2000). Ncc
ceve cincc :er uIi|izccc em mu|here: ccm ciccIriz uIerinc pe|c: prcvcvei:
ri:cc:. Em cc:c: ce cLiIc feIc| cu em :iIucçce: em ¢ue c viIc|iccce feIc|
ncc impcrIe {mc|fcrmcçce: inccmpcI|vei: ccm c vicc), pcce-:e u:cr
cc:e: mci: e|evccc:, ce 50 c 100 µg.
Se pcr um |ccc c mi:cprc:Ic| repre:enIc umc grcnce vcnIcgem ccm
re|cçcc cc cincprc:Icne, pcr :eu Lcixc cu:Ic e e:IcLi|iccce Iérmicc e ce
e:Icccgem, Icrncncc-c icec| pcrc uIi|izcçcc em pc|:e: em
ce:envc|vimenIc e ccm pcucc: recur:c:, nc prcIicc exi:Ie cincc c
cificu|ccce ce cLIençcc cc: cc:e: reccmencccc:. Ccn:eguir cLIer 25
µg :ignificc Ier excIcmenIe um ciIcvc cc ccmprimicc
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ccmercic|izccc ce 200 µg, c ¢ue ncc é Icrefc fcci|, pci: c pcrIir cc
:eguncc pcrIiçcc hc umc Iencëncic c ce:e:IruIurcçcc cc me:mc. Fcr
cuIrc |ccc, ncc :e reccmenccm IcmLém c: mcnipu|cçce: ¨cc:eirc:¨ cc
crcgc, pe|c fc|Ic ce ccnIrc|e ce ¢uc|iccce e incerIezc :cLre c rec|
cc:cgem uIi|izccc. É prcvcve| ¢ue pcrIe cc: efeiIc: ccver:c: re|cIccc:
ccm c u:c ce:Ic: cc:e: ce mi:cprc:Ic| :ejc cevicc c i::c. /
ccmercic|izcçcc ce um cvu|c vcginc| ce 25 µg ccm cp|iccccr vcginc|
prcvcve|menIe pccerc :c|ucicncr e:Ic: cificu|ccce: cc u:c cc
mi:cprc:Ic|.
Mci: recenIemenIe, cuIrc c|IerncIivc em cvc|icçcc pcrc c prepcrc
cervicc| é c h|o|uron|dose. Ccn:i:Ie em um méIccc cpenc: pcrc prepcrc
cc cc|c, ncc prcvcccncc c cpcrecimenIc ce ccnIrcçce: uIerinc:. Fci
uIi|izccc pe|c primeirc vez nc cécccc ce :e::enIc, mc:Ircncc-:e efeIivc
em ge:IcnIe: ccm cc|c e:pc:Iicc. Fci uIi|izccc IcmLém em injeçce:
inIrccervicci: pcrc prepcrc ce cc|c em ge:IcnIe: ccm cérvice uIerinc
ce:fcvcrcve|, previcmenIe c incuçcc cc pcrIc, ccm re:u|Iccc:
cnimcccre:. É ce cp|iccLi|iccce re|cIivcmenIe fcci|, cu:Ic cce::|ve| e
ci:pcn|ve| nc mercccc nccicnc|, pccencc :er uIi|izccc em n|ve|
cmLu|cIcric| previcmenIe c inIerncçcc pcrc incuçcc cc pcrIc. Ncc é
ccnIrc-incicccc em ge:IcnIe: ccm umc ciccIriz ce ce:crec prévic.
Feccmencc-:e c u:c ce 20.000 uniccce: ce hic|urcnicc:e injeIccc:
inIrccervicc|menIe c: pc:içce: ó e 12 hcrc: {meIcce cc cc:e em cccc
pcnIc).
MÊIODOS FAkA INDbÇÃO DO FAkIO
Ccn:icercncc c cc|c jc mccurc cu fcvcrcve|, exi:Iem evicëncic:
:uficienIe: pcrc cizer ¢ue c incuçcc cc pcrIc pc::c c ccn:IiIuir um
prccecimenIc ccm mcicr prcLcLi|iccce ce ëxiIc pcrc cLIençcc ce um
pcrIc vcginc|. Fcrc e:Ie fim, c: :eguinIe: méIccc: :cc mci: uIi|izccc::
1. Desco|omento d|g|to| dos membronos omn|ot|cos
Ccrre:pcnce cc ce:cc|cmenIc cigi Ic| cc: memLrcnc: cmnicIicc: cc
cc|c uIerinc e :egmenIc infericr, inIrccuzicc ccmc méIccc ce incuçcc
ce pcrIc nc cécccc ce cin¢uenIc {Swcnn, 1º58). IecriccmenIe c
méIccc e:Iimu|c c IrcLc|hc ce pcrIc pcr prcmcver c |iLercçcc ce
prc:Icg|cncinc. EmpiriccmenIe é Lc:IcnIe uIi|izccc nc pc|:, emLcrc
exi:Icm pcucc: re|cIc: nc |iIercIurc pcrc ¢ue :e pc::c e:IcLe|ecer :uc
rec| eficiëncic e :egurcnçc ccmc méIccc pcrc incuçcc ce pcrIc. E:Ic
c::cciccc c cerIc grcu ce ce:ccnfcrIc mcIernc e :cngrcmenIc vcginc|
ci:creIc, :em mcicre: ccn:e¢üëncic:.
2. Amn|otom|o
/ rcIurc crIificic| cc: memLrcnc: cmnicIicc: é umc Iécnicc cnIigc em
CL:IeIr|cic. IecriccmenIe, prcvccc um cumenIc nc prccuçcc |ccc| ce
prc:Icg|cncinc:, fcvcrecencc c in|cic cc IrcLc|hc ce pcrIc. Fcce :er
rec|izccc ccm cmnicIcmc cu pinçc ccm exIremiccce perfurcnIe, nc
Lc|:c cc: cguc:, em n|ve| cc cpre:enIcçcc feIc|.
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Deve-:e Ier cuicccc nc rec|izcçcc pcrc eviIcr ccnc: feIci: e mcIernc:, e
cerIificcncc-:e ce ¢ue c pc|c feIc| e:Iejc cpciccc :cLre c Lccic, pcrc
eviIcr c Iemicc e grcve cccrrëncic cc prc|cp:c ce ccrccc umLi|icc|.
Seu: principci: efeiIc: ccver:c: :cc c cumenIc cc ri:cc ce infecçcc
cmnicIicc e ri:cc ce ccicenIe ce ccrccc. Seu uso |so|odo ontes do |níc|o
do trobo|ho de porto |o| obondonodo. EmLcrc ccnIinue :encc uIi|izccc
nc cce|ercçcc ce IrcLc|hc ce pcrIc jc iniciccc, ccmc jc ci:cuIicc nc
Ccp|Iu|c 5, ncc exi:Iem evicëncic: ce ¢ue c cmnicIcmic preccce :ejc
ce fcIc Lenéficc.
3. Oc|toc|no
/ cciIccinc é ccpcz ce inicicr cu cumenIcr c: ccnIrcçce: r|Imicc: c
¢uc|¢uer mcmenIc cc grcvicez, emLcrc c re:pc:Ic uIerinc :ejc mcicr
¢ucnIc mci: prcximc cc finc| cc ge:Icçcc. / infu:cc enccvenc:c ce
cciIccinc :inIéIicc Iem :icc c méIccc mci: uIi|izccc pcrc incuçcc e
ccncuçcc cc IrcLc|hc ce pcrIc, ce:ce :uc inIrccuçcc pcr Fcge em
1º43. Suc ccncenIrcçcc p|c:mcIicc recuz-:e rcpiccmenIe c: cu:Ic: cc
cciIccinc:e e :uc meic vicc é ce cercc ce cincc minuIc:. E:Ic:
ccrccIer|:Iicc: repre:enIcm umc vcnIcgem pcrc c mcnejc c||nicc,
pccencc :eu efeiIc :er :uprimicc cpc: pcucc: minuIc: cc :u:pen:cc cc
crcgc.
Exi:Iem ciferenIe: e:¢uemc: prcpc:Ic: pcrc u:c enccvenc:c. C
e:¢uemc mci: uIi|izccc, pcr :uc :egurcnçc, ceve :er c ce Lcixc
cc:cgem, e:IcLe|ecencc c cc:e inicic| ce 1-2 mU/minuIc. l::c
ccrre:pcnce cc prepcrc ce umc :c|uçcc ccm 5 Ul ce cciIccinc ci|u|cc:
em 500 m| ce :crc g|icc:ccc c 57 e c infu:cc enccvenc:c inicic| em
ve|cciccce ce 4 gcIc:/minuIc. Deve-:e ccLrcr c gcIejcmenIc c cccc 30
minuIc:, cIé ¢ue :e cLIenhc ccnIrcIi|iccce uIerinc cce¢uccc, cefinicc
pe|c pre:ençc ce cIiviccce uIerinc regu|cr.
/ cciIccinc pcce prccuzir efeiIc: ccver:c: ccmc c Ic¢ui::i:Ic|ic,
hiperIcnic e hipere:Iimu|cçcc uIerinc, pccencc prcvcccr inc|u:ive c
rcIurc uIerinc, fe|izmenIe um efeiIc exIremcmenIe rcrc :e c ccnIrc|e
c||nicc é feiIc cce¢ucccmenIe. Fcrc c feIc, c mci: fre¢üenIe efeiIc
cc|cIerc| é c :cfrimenIc feIc| cgucc, mcIivccc pe|c recuçcc cc perfu:cc
:cngü|nec nc e:pcçc inIervi|c:c pcr Ic¢ui::i:Ic|ic e/cu hiperIcnic. C:
efeiIc: cc|cIerci: :cc cc:e cepencenIe: e c ciminuiçcc nc gcIejcmenIc,
cu me:mc c pcrccc ce infu:cc, pccem ccnIrc|cr e:Ic: c|Iercçce: em
pcucc: minuIc:. /|gumc: mecicc: ccicicnci: pccem :er rec|izccc:,
ccmc ccmini:Ircçcc ce ||¢uicc: enccvenc:c:, cxigënic, mccificcçcc nc
pc:içcc mcIernc e cincc c ccmini:Ircçcc ce pe¢uenc: cc:e: ce crcgc:
LeIce:Iimu|cnIe: pcr vic venc:c cu :uLcuIcnec.
14
INDUÇÃO DO PARTO
126
4. Frostog|ond|nos
/ crcgc pccrcc pcrc e:Ic finc|iccce cIuc|menIe é c mi:cprc:Ic|,
uIi|izccc cc fcrmc ccmc jc reccmencccc nc: méIccc: ce prepcrc
cervicc|.
INDbÇÃO SEkIADA
Nc :iIucçcc ce cc|c uIerinc ce:fcvcrcve| e inciccçcc pcrc inIerrupçcc
cc ge:Icçcc, pcce-:e reccrrer c incuçcc :ericcc, ccm cu :em prepcrc
cervicc| prévic. E:Ie méIccc ccn:i:Ie nc rec|izcçcc ce :e::ce: ce
incuçcc, curcnIe 10 c 12 hcrc: cicric:, :eguicc: pcr per|ccc: ncIurnc: ce
repcu:c. /: :e::ce: :cc ccnvencicnc|menIe rec|izccc: pcr cIé Irë: cic:
ccn:ecuIivc:, uIi|izcncc infu:cc enccvenc:c ce cciIccinc,
preferenIemenIe ccm LcmLc ce infu:cc. É inci:pen:cve| e:c|crecer c
mu|her cnIe: cc prccecimenIc e ¢ue e|c e:Iejc ce cccrcc. Fe|c menc:
cIé c mcmenIc ¢ue :e inicie c fc:e cIivc cc IrcLc|hc ce pcrIc, ceve-:e
e:Iimu|cr c c|imenIcçcc e cecmLu|cçcc cc ge:IcnIe. EmLcrc ncc
exi:Icm e:Iucc: :i:IemcIizccc: ccm c méIccc, e:Ie Iem :icc
Irccicicnc|menIe uIi|izccc pcr :erviçc: ce CL:IeIr|cic nc 8rc:i|, :cLreIucc
cnIe: cc ci:pcniLi|iccce cc: ncvc: cgenIe: prepcrcccre: cc mcIuriccce
cervicc|.
/: ccnIrc-inciccçce: fcrmci: c incuçcc cc IrcLc|hc ce pcrIc em
princ|pic ncc ciferem cc¢ue|c: pcrc c pcrIc vcginc| e:pcnIcnec. /:
principci: :cc:
• :cfrimenIc feIc| ccnfirmccc:
• ciccIriz uIerinc ccrpcrc|:
• ciccIriz uIerinc :egmenIcr ce repeIiçcc:
• cpre:enIcçcc feIc| cncmc|c:
• cL:Iruçcc cc ccnc| ce pcrIc:
• :iIucçce: ce urgëncic: e
• p|ccenIc prévic.
Exi:Iem cincc c|gumc: ccnciçce: ccn:icerccc: ce mcicr ri:cc c incuçcc
cc IrcLc|hc ce pcrIc e ¢ue :e ccn:IiIuem em ccnIrc-inciccçce: re|cIivc:
c incuçcc:
• ge:Icçcc mú|Iip|c:
• pc|icrcmnic:
• ccrcicpcIic mcIernc:
• grcnce mu|Iipcriccce: e
• hiperIen:cc crIeric| grcve.
14
INDUÇÃO DO PARTO
127
/ incuçcc cc IrcLc|hc ce pcrIc é um prccecimenIc ¢ue ceverc :er mci:
u:ccc nc 8rc:i|, nc mecicc cc exi:Iëncic ce umc cemcncc pcr :erviçc:
cL:IéIricc: ce ¢uc|iccce e ce Iccc: c: fcIcre: re|ccicnccc: cc e:I|mu|c
pe|c pcrIc vcginc| e humcnizccc. Exi:Iem inúmerc: :iIucçce: cnce c
inIerrupçcc cc ge:Icçcc e:Ic incicccc pcrc pre:evcr c :cúce mcIernc
e/cu feIc|, ccm ce:Ic¢ue mci: recenIe pcrc c nece::iccce ce prcvc ce
IrcLc|hc ce pcrIc em mu|here: ccm umc ciccIriz ce ce:crec cnIericr.
EnIence-:e ¢ue em Iccc: e:Ic: :iIucçce: :ejc mcnccIcric c ccnIrc|e cc
viIc|iccce feIc|, cc ccnIrcIi|iccce uIerinc e cc: ccnciçce: c||nicc: cc
mu|her.
14
128
C: principci: cLjeIivc: cc c::i:Iëncic imecicIc :cc:
prcpcrcicncr c Iccc: c: recém-nc:cicc: ccnciçce:
cIimc: ¢ue vi:cm cuxi|ic-|c: em :uc cccpIcçcc c vicc
exIrc-uIerinc e e:Icr prepcrccc pcrc inIervir nc¢ue|e:
cc:c: ¢ue cpre:enIem ccnciçce: pcIc|cgicc: ¢ue
cc|c¢uem em ri:cc :uc vicc. Foro o oss|stënc|o oo
recém-nosc|do normo|, que const|tu| o mo|or|o dos
s|tuoçöes, nodo mo|s deve ser |e|to o|ém de se
enxugor, oquecer, ovo||or e entregor ò mõe poro um
contoto ínt|mo e precoce. Iccc: c: prccecimenIc:
hcLiIuci: ccmc pe:cr, cp|iccr c ViIcminc ‚ e Crecë e
cuIrc:, cevem :er rec|izccc: cpc: c ccnIcIc cc mce
ccm :eu fi|hc.
Em Iccc :c|c ce pcrIc ceve e:Icr pre:enIe pe|c menc:
um prcfi::icnc| ccpcciIccc c recnimcr ce mcneirc
rcpicc e efeIivc, me:mc ¢ucncc :e e:perc um FN
:cuccve|. / recnimcçcc cc recém-nc:cicc é um
prccecimenIc re|cIivcmenIe :imp|e:, mc: ¢ue re¢uer
per|cic e IreincmenIc, cevencc :er feiIc cpenc: pcrc
:iIucçce: cnce, ce fcIc, exi:Ic c nece::iccce ce Ici:
mcncLrc:, :encc ce:cccn:e|hcve| rec|izcr
prccecimenIc: ce:nece::cric: cpenc: ccmc pcrIe ce
umc rcIinc pré-e:IcLe|ecicc.
Fcrc fcrnecer e:Ic c::i:Iëncic, é funccmenIc| ci:pcr ce
um prcfi::icnc| ccpcciIccc, icec|menIe um pecicIrc,
c|ém ce enfermcgem Ireinccc pcrc cIencer c FN, em
¢ucnIiccce e n|ve| ce ccpcciIcçcc cepencenIe: cc
grcu ce ccmp|exiccce cc in:IiIuiçcc. Em Iccc c pc|:,
c Sccieccce 8rc:i|eirc ce FecicIric {S8F) e :uc:
fecerccc: Iëm cferecicc cur:c: Iecricc-prcIicc: ce
recnimcçcc cc recém-nc:cicc. C: grupc: e
in:IiIuiçce: inIere::ccc: ne:Ie Iipc ce IreincmenIc
cevem enIrcr em ccnIcIc ccm c: repre:enIcçce:
|ccci: cu regicnci: cc S8F pcrc :c|iciIcçcc.
OkGANIIAÇÃO DO SEkVIÇO
/ recepçcc cc FN ceve Ier ncrmc: e:IcLe|ecicc: ccm
c: ciferenIe: cIriLuiçce: ccn:IiIu|cc: pcrc c e¢uipe
prcfi::icnc|, cLjeIivcncc pre:Icr umc c::i:Iëncic ce
¢uc|iccce. Fcrc IcnIc, c e¢uipe
15 ASSISTÊNCIA IMEDIATA AO RECÉM-NASCIDO
ASSISTÊNCIA IMEDIATA AO RECÉM-NASCIDO
129
ceverc rec|izcr c: :eguinIe: prccecimenIc::
• preencher c fichc cc FN ccm cccc: cc hi:Icric fcmi|icr e
mcIernc, pregre::c: e cIuci:, e cc IrcLc|hc ce pcrIc:
• ci:pcr :cLre c me:c ce cIencimenIc cc FN c :eguinIe mcIeric|:
• x2% (#*$% $' %(<64%+,# )4%./'%- <%4% 1%$% gqB
• e#4# ;6(6#-J>61#B
• i/3%(B
• t%0' '()'46-60%$%? %*'- $' @#44%17% 'j#/ $' <-8()61#
T$6(<#(6)63# '(<'1Y;61#U ' 2%)'46%- <%4% -6>%$/4% $' 1#4$,#
T<6*+%( ' )'(#/4%UB '
• s%*)'4 $6(<#*Y3'-? <%4% ./%-./'4 '2'4>9*16%? # 2%)'46%- '
2'$61%+,# <%4% 4'%*62%+,#B
• receLer c FN, :ecc-|c e cc|cccr em ccmpc e:Iéri| e c¢uecicc
:cL c cc|cr rccicnIe:
• |evcr c FN c mce:
• icenIificcr c FN ccm umc Lrcçcceirc, ccm c ncme cc mce, nc
cnIeLrcçc e Icrncze|c:
• em pcrIc: mú|Iip|c:, c crcem ce nc:cimenIc ceverc :er
e:pecificccc nc: pu|:eirc: cIrcvé: ce númerc: {1, 2, 3, 4, eIc.), cpc:
c ncme cc mce:
• c:pircr Lccc e cepci: ncrinc::
• pc::cr c :cncc nc:cgc:Iricc pcrc exc|uir cIre:ic ce cccnc: e
e:cfcgc:
• verificcr c viIc|iccce cc FN cIcvé: cc |ncice ce /pgcr nc 1 º e 5º
minuIc:, e, cc| em cicnIe, ce 5 em 5 minuIc:, cIé ¢ue c /pgcr :ejc
mcicr ¢ue 7:
• |c¢uecr c ccrccc c umc ci:Icncic ce 2cm cc cne| umLi|icc|,
u:cncc c|ccc| eI||icc c 707. Verificcr c pre:ençc ce umc veic e
cuc: crIéric::
• pingcr niIrcIc ce prcIc c 17 {prepcrcr cicricmenIe em frc:cc
e:curc), umc gcIc em cccc c|hc:
• |cvcr c e:Icmcgc, :e c ||¢uicc cmnicIicc fcr meccnic|,
:cnguinc|enIc cu puru|enIc, ccm cguc ce:Ii|ccc cu :crc fi:ic|cgicc:
• cc|cccr c FN pcrc mcmcr |cgc ¢ue finc|izcr c: mecicc: ce
cIencimenIc cpc: c nc:cimenIc:
• Icmcr pe:c, e:IcIurc, per|meIrc cefc|icc.
• pre:crever ViIcminc ‚, 1 mg lM:
• regi:Ircr, nc fichc cc FN, :uc impre::cc p|cnIcr e cigiIc| cc
pc|egcr cireiIc e cc pc|egcr cireiIc cc mce:
• excmincr c p|ccenIc:
• cc|her cmc:Irc: ce :cngue ce ccrccc pcrc Iipcgem :cngü|nec e
:crc|cgic:: e
• cc|her :cngue cc mce pcrc Iipcgem :cngü|nec e recçcc
:crc|cgicc pcrc :|fi|i:, ¢ucncc incicccc.
Índice de Apgar
15
ASSISTÊNCIA IMEDIATA AO RECÉM-NASCIDO
130
/pc: c c::i:Iëncic imecicIc cc recém-nc:cicc, ¢ucncc ncc fci pc::|ve|
cnIe: cc nc:cimenIc, ceve-:e rec|izcr cncmne:e ceIc|hccc cLcrccncc
c icenIificcçcc, Iccc: c: cnIececenIe: fcmi|icre: e mcIernc:, cc
ge:Icçcc, cc IrcLc|hc ce pcrIc e pcrIc. C excme cc FN ceve :er
minucic:c, feiIc em |ccc| e ccnciçce: :cIi:fcIcric:, inc|uincc Iccc: c:
crgcc: e :i:Iemc: pc::|vei: ce :erem cvc|iccc: c|iniccmenIe.
kEANIMAÇÃO NEONAIAL NA SALA DE FAkIO
/ cvc|icçcc cc FN ceve inicicr cnIe: me:mc ce Ierminccc c
nc:cimenIc. Nc pre:ençc ce meccnic, c cL:IeIrc ceve rec|izcr c
c:pircçcc cc Lccc, ncriz e fcringe, cnIe: cc ce:prencimenIc cc: cmLrc:
cc recém-nc:cicc. C pecicIrc ceve cvc|icr c viIc|iccce cc cricnçc: :e
vigcrc:c, c cvc|icçcc cc FN ceve :er feiIc cIrcvé: cc re:pircçcc,
fre¢üëncic ccrc|ccc e ccr. C |ncice ce /pgcr nõo ceve :er u:ccc pcrc
cvc|icr c nece::iccce ce recnimcçcc, mc: pcrc cvc|icr c: efeiIc: cc
me:mc.
/pc: c nc:cimenIc em Iccc: c: recém-nc:cicc: ceprimicc: ¢ue
cpre:enIcrem ||¢uicc cmnicIicc meccnic| cu nc¢ue|e: ccm meccnic
e:pe::c cu pcrIicu|ccc, cci: pc::c: cevem :er cccc:, c::im ¢ue c
cricnçc fcr cc|ccccc :cL c fcnIe ce cc|cr rccicnIe e cincc cnIe: ce
:ecc-|c:
• c meccnic cc hipcfcringe ceve :er remcvicc cIrcvé: ce c:pircçcc
:cL vi:uc|izcçcc cireIc: e
• c Irc¢uéic ceve :er inIuLccc e c meccnic c:pirccc cc vic infericr
:e hcuver: cpnéic: cepre::cc re:pircIcric: fre¢üëncic ccrc|ccc €
100 LcIimenIc: pcr minuIc e hipcIcmic.
/ ccnIinucçcc cc: cuicccc: pre:Iccc: vci cepencer cc: ccnciçce: ce
viIc|iccce ce:Ie: recém-nc:cicc:.
Iccc FN Iem c cireiIc ce receLer, :e nece::cric, umc recnimcçcc ccm
um c|Ic n|ve| ce ccmpeIëncic. C mcIeric| cprcpriccc ceve e:Icr
ci:pcn|ve| nc :c|c ce pcrIc, em Iccc: c: nc:cimenIc:, Lem ccmc c:
prcfi::icnci: ce :cúce cevem e:Icr cpIc: c recnimcr c recém-nc:cicc e
ccpcciIccc: c IrcLc|hcr ce mcneirc inIegrccc, em e¢uipe.
A8C DA kEANIMAÇÃO
A - Monter os v|os oéreos pérv|os
− Fc:icicncr c ccLeçc e c pe:ccçc cc FN, mcnIencc-c em |igeirc
exIen:cc:
− /:pircr Lccc e ncrinc:. Irc¢uéic, :e c ||¢uicc fcr meccnic|: e
− lnIuLcçcc Irc¢uec|, :e nece::cric.
8 - In|c|or o resp|roçõo
− Ccm e:I|mu|c IcIi| cu, :e nece::cric, venIi|cçcc ccm pre::cc pc:iIivc
{VFF) cIrcvé: ce Lc|cc cu cpcre|hc ce re::u:ciIcçcc, uIi|izcncc
mc:ccrc cu IuLc enccIrc¢uec|.
C - Estobe|ecer e monter o c|rcu|oçõo
− Mc::cgem ccrc|ccc: e
− Meciccçce:.
15
ASSISTÊNCIA IMEDIATA AO RECÉM-NASCIDO
131
1. OXIGÈNIO INALAIÓkIO
Deve-:e u:cr ¢ucncc c FN cpre:enIc re:pircçcc efeIivc e FC 100 Lpm,
mc: ccm cicnc:e cenIrc|. C cxigënic ceve :er umicificccc e c¢uecicc:
ncc :encc pc::|ve|, uIi|izcr c C2 fric e :ecc pcr per|ccc |imiIccc. Ncc
uIi|izcr cxigënic :cL pre::cc ccm ccIeIer nc: ncrinc:.
Iécnicc ce ccmini:Ircçcc:
• Irc¢uéic cu ccIeIer ce C2. Cucncc u:cr c Irc¢uéic, c me:mc
ceve e:Icr ci:IcnIe cc: ncrinc: 1 cm, ccm um f|uxc ce 5 |/min ce C2
pcrc fcrnecer 807 ce cxigënic. / reIirccc ceve :er grccuc|: e
• c|IerncIivcmenIe, mc:ccrc ce 02 {nuncc c mc:ccrc ccnecIccc
cc Lc|cc).
2. VENIILAÇÃO COM FkESSÃO FOSIIIVA
/: principci: inciccçce: pcrc VFF :cc, cpnéic, gc:ping e re:pircçcc
e:pcnIcnec, mc: ccm FC € 100 Lpm:
Iécnicc:
• pcce :er feiIc cIrcvé: ce Lc|cc cuIc-inf|cve| {/mLu) ccnecIccc
c um re:ervcIcric ce cxigënic ¢ue permiIc umc ccncenIrcçcc ce
cxigënic enIre º0 c 1007, ¢ue Ienhc umc vc|vu|c ce e:ccpe
cju:Iccc enIre 35 e 40 cm H2C e um mcncmeIrc. Cu cIrcvé: cc
cpcre|hc ce re::u:ciIcçcc. C Lc|cc cuIc-inf|cve| ceve e:Icr |igccc
c umc fcnIe ce cxigënic c 5 |/min, en¢ucnIc c cpcre|hc c 7 |/min:
• c mc:ccrc fccic| ceve e:Icr Lem cju:Iccc, ccLrincc c ncriz, c
Lccc e c ¢ueixc: uIi|izcr fre¢üëncic enIre 40 e ó0 mcv./min:
• c pre::cc inicic| ceve ficcr enIre 30-40 cm H2C, em :eguicc enIre
15-20 cm H2C pcrc c: pu|mce: ncrmci: e 20-40 cm H2C pcrc c:
pu|mce: ccm ccmp|ccëncic ciminu|cc:
• cL:ervcr c expcn:iLi|iccce Icrccicc {e|evcçcc ce 0,5 c 1 cm):
• cpc: 15 c 30 :eguncc:, recvc|icr c re:pircçcc, c FC e c ccr.
3. MASSAGEM CAkDÍACA
Iem inciccçcc ce :er rec|izccc ¢ucncc c FC cc recém-nc:cicc e:Iiver
cLcixc ce ó0 Lpm.
Iécnicc:
• cc|cccr c: cecc: inciccccr e mécic perpencicu|crmenIe cc
exIernc, nc Ierçc infericr, ccimc cc cpëncice xifcice, cu cc|cccr c:
cecc: pc|egcre: ce cmLc: c: mcc: :cLre c Ierçc infericr cc
e:Iernc {ccmc mc:Ircm c: figurc:) e pre::icncr 1-2 cm numc
fre¢üëncic ce 120 mcv./min:
• curcnIe c mc::cgem ccrc|ccc ceve-:e ccnIinucr venIi|cncc c
FN ccm pre::cc pc:iIivc e cxigënic c 1007, ccm mc:ccrc cu
inIuLcçcc:
15
ASSISTÊNCIA IMEDIATA AO RECÉM-NASCIDO
132
• c venIi|cçcc e c mc::cgem ccrc|ccc cevem :er feiIc:, nc
re|cçcc ce 3:1, i:Ic é, Irë: mcvimenIc: ce mc::cgem pcrc um ce
venIi|cçcc:
• cpc: 15-30 :eguncc:, c FN ceve :er recvc|iccc. Se c FC fcr „ 80 e
e:Iiver cumenIcncc, :u:pencer c mc::cgem: e
• cpc: 30 :eguncc: ce VFF • C2 c 1007 • mc::cgem ccrc|ccc, :e
c FC ccnIinucr € ó0 Lpm, inicicr ccrenc|inc {1:10.000) EI/EV nc cc:e
ce 0,01 c 0,03 mg/kg.
Intuboçõo troqueo|
/: principci: inciccçce: pcrc c inIuLcçcc Irc¢uec| :cc:
• :u:peiIc ce hérnic cicfrcgmcIicc:
• cu:ëncic ce re:pc:Ic c venIi|cçcc ccm Lc|cc cu cpcre|hc ce
re::u:ciIcçcc e mc:ccrc ccm FiC2 ce 1007:
• venIi|cçcc prc|cngccc ccm Lc|cc cu cpcre|hc ce re::u:ciIcçcc
e mc:ccrc ccm FiC2 ce 1007: e
• pcrc c:pircçcc Irc¢uec| :cL vi:uc|izcçcc cireIc, cc:c c ||¢uicc
meccnic| :ejc e:pe::c, ¢ucncc c cricnçc cpre:enIcr cpnéic,
cepre::cc re:pircIcric, fre¢üëncic ccrc|ccc € 100 Lpm e hipcIcnic.
Iécnicc:
• prepcrc cc ccnu|c Irc¢uec|:
• c cicmeIrc ceve :er unifcrme e ce cccrcc ccm c pe:c cc FN:
• ccrIcr c ccnu|c em 13 cm pcrc ciminuir c e:pcçc mcrIc e c
re:i:Iëncic:
• ccnecIcr c inIermecicric cc ccnu|c cnIe: cc inIuLcçcc:
• c fic-guic é cpcicnc|, cevencc :uc pcnIc ficcr c 0,5 cm ccimc
cc pcnIc cc ccnu|c:
• cpc: c inIrccuçcc cc ccnu|c nc inIericr cc Irc¢uéic, c ci:Icncic
cIé c |cLic :upericr é pré-ceIerminccc:
• cferecer cxigënic inc|cIcric cIrcvé: ce ccIeIer pcrc minimizcr c
hipcxemic, curcnIe c prccecimenIc:
• inIerrcmper c prccecimenIc cpc: 20 :eguncc: ce IenIcIivc: e
venIi|cr ccm Lc|cc cu cpcre|hc ce re::uciIcçcc cIé me|hcrcr c
cxigencçcc:
15
ASSISTÊNCIA IMEDIATA AO RECÉM NASCIDO
133
• ccnfirmcçcc cc pc:içcc cc ccnu|c:
• cu:cu|Icr c Icrcx Li|cIerc|menIe e c e:Icmcgc:
• cL:ervcr c expcn:iLi|iccce cc ccixc Icrccicc:
• fczer rcic: X ce Icrcx e mcnIer c pcnIc cc ccnu|c enIre I2 e I3,
¢ucncc c FN ncc pucer :er exIuLccc: e
• cpc: c inIuLcçcc, ccrIcr ccnu|c :empre ¢ue c ccmprimenIc enIre
c finc| cc ccnu|c e c Lccc excece c 4 cm.
Medicação necessária para a reanimação
Fonte: ET:endotraqueal
Moter|o| necessór|o poro reon|moçõo
Iccc c mcIeric| nece::cric pcrc c cIencimenIc cc FN ceve e:Icr
ci:pcn|ve|, :er Ie:Iccc e prepcrccc cnIe: cc nc:cimenIc:
• Me:c ce recnimcçcc ccm fcnIe ce cc|cr irrccicnIe, c:pircccr c
vccuc ccm mcncmeIrc e fcnIe ce cxigënic ccm f|uxcmeIrc
• Scncc: ce c:pircçcc Irc¢uec| nº 8 e 10
• Scncc: ce c:pircçcc gc:Iricc nº ó e 8
• 8c|cc cuIc-inf|cve| ccm re:ervcIcric ce cxigënic {pcrc :e cIingir
umc FiC2 ce º0-1007) e ccpcciccce mcximc ce 750 m| cu cpcre|hc
ce re::u:ciIcçcc mcnuc|
• Mc:ccrc: ¢ue cuLrcm ccnvenienIemenIe ncriz, Lccc e ¢ueixc cc
FN
• Lcringc:ccpic ccm |cminc reIc nº 0 e 1
• Ccnu|c: enccIrc¢ueci: ce cicmeIrc unifcrme nº 2,5 - 3,0 - 3,5 e 4,0
• Fic-guic {cpcicnc|)
• E:pcrccrcpc pcrc fixcr c ccnu|c
• Fi|hc: e |cmpccc: ce re:ervc
• E:IeIc:ccpic necncIc|
• Fe|cgic ¢ue mcr¢ue c: :eguncc: cu um crcncmeIrc
• McIeric| pcrc crencgem Icrccicc
• McIeric| pcrc ccIeIeri:mc umLi|icc|
15
ASSISTÊNCIA IMEDIATA AO RECÉM-NASCIDO
134
• Seringc: {20, 10, 5 e 1 m|)
• IuLc: ce cc|eIc ce :cngue
• Meciccçce::
• ccrenc|inc {1:1.000)
• LiccrLcncIc ce :ccic {2,5 cu 4,27)
• expcn:cre: ce vc|ume {c|Luminc c 57, :crc fi:ic|cgicc c
0,º7 cu Finger-|ccIcIc)
• c|cricrcIc ce Nc|cxcne
• ccpcminc
• :c|uçce: ce g|icc:e c 57 e 107
15
135
Scc inúmerc: c: Lenef|cic: ¢ue c prcIicc cc
c|eiIcmenIc mcIernc cferece, IcnIc pcrc c
cre:cimenIc e ce:envc|vimenIc ce |ccIenIe:, ccmc
pcrc c mce, cricnçc e fcm||ic, cc pcnIc ce vi:Ic
Lic|cgicc e p:icc::ccic|.
/Iuc|menIe, c c|eiIcmenIc mcIernc exc|u:ivc é
reccmencccc pcr um per|ccc ce :ei: me:e:.
Fc:IericrmenIe, c cricnçc ceve receLer c|imenIc:
ccmp|emenIcre:, e:Iencencc c cmcmenIcçcc pcr
pe|c menc: cci: cnc:, ce:ce ¢ue mce e cricnçc c
ce:ejem. C ce:ejc mcIernc ce cmcmenIcr cu ncc
ceve :er ccmpreencicc e re:peiIccc. /pe:cr cc:
Lenef|cic: cc c|eiIcmenIc, ceve-:e cceiIcr c e:cc|hc,
infcrmccc e ccn:cienIe, cc mce pe|c ncc
cmcmenIcçcc. C cireiIc cc mu|her cmcmenIcr ceve
:er cpciccc, e:pecic|menIe ¢ucncc e|c Iem um
IrcLc|hc remunerccc e preci:c ccnhecer c |egi:|cçcc
IrcLc|hi:Ic ¢ue prcIege c mcIerniccce.
Vontogens do o|e|tomento moterno
Fcrc c mu|her:
• ;%16-6)% # '()%@'-'162'*)# $# 3Y*1/-# %;')63#
2,'I;6-7#B
• <4'36*' %( 1#2<-61%+A'( 7'2#448>61%( *# pc:-
<%4)# ' ;%3#4'1' % 4'>4'((,# /)'46*% %# ('/
)%2%*7# *#42%-B
• 1#*)46@/6 <%4% # 4')#4*# 2%6( 48<6$# %# <'(# <4:I
>'()%16#*%-B
• : /2 2:)#$# *%)/4%- $' <-%*'c%2'*)# ;%26-6%4?
'*)4')%*)# (#2'*)' %*)'( $' ('6( 2'('(? ./%*$# %
146%*+% '()8 '2 %-'6)%2'*)# 2%)'4*# '51-/(63#? '2
-634' $'2%*$%? 6*1-/(63' $/4%*)' % *#6)'? ' ./' %
2,' *,# )'*7% %6*$% 2'*()4/%$# TiSs I -%1)%+,#
' %2'*#44:6% 1#2# 2:)#$#UB
• <#$' 4'$/064 # 46(1# $' 1f*1'4 $' #3846# '
2%2%B '
• <#$' <4'3'*64 % #()'#<#4#('E
16 ALEITAMENTO MATERNO
ALEITAMENTO MATERNO
136
Fcrc c cricnçc:
• : # %-62'*)# 1#2<-')# <%4% # -%1)'*)' 2'*#4 $' ('6( 2'('(? )%*)#
*# %(<'1)# */)4616#*%-? 1#2# $6>'()63#B
• ;%16-6)% % '-626*%+,# $' 2'1v*6# ' $626*/6 # 46(1# $' 61)'4Y16%B
• <4#)'>' 1#*)4% 6*;'1+A'( T'(<'16%-2'*)' $6%44:6%( ' <*'/2#*6%(U?
<'-% %/(9*16% $# 46(1# $' 1#*)%26*%+,# ' <'-% <4'('*+% $'
%*)61#4<#( ' $' ;%)#4'( %*)6I6*;'116#(#(B
• %/2'*)% # -%+# %;')63# 2,'I;6-7#? <4#2#3'*$# 2%6( ('>/4%*+% %#
@'@9E
• 1#-%@#4% ';')63%2'*)' <%4% $626*/64 % )%5% $' $'(*/)46+,#
<4#)'61#I1%-J461% '? 1#*('.L'*)'2'*)'? <%4% % $626*/6+,# $#( Y *$61'(
$' 2#4)%-6$%$' 6*;%*)6-B
• $626*/6 % <4#@%@6-6$%$' $# $'('*1%$'%2'*)# $' <4#1'((#(
%-:4>61#(? <'-# 4')%4$# $% 6*)4#$/+,# $' <4#)'Y*%( 7')'4J-#>%(
'56()'*)'( *# -'6)' $' 3%1%B '
• 2'-7#4 4'(<#()% Z( 3%16*%+A'( ' 1%<%16$%$' $' 1#2@%)'4
$#'*+%( 2%6( 4%<6$%2'*)'E
Fcrc c fcm||ic e c :ccieccce:
• # -'6)' 2%)'4*# *,# 1/()% *%$%B
• : -62<# ' *,# 1#*):2 2614J@6#(B
• c8 3'2 <4#*)# ' '()8 *% )'2<'4%)/4% 1'4)%B
• $626*/6 #( 1/()#( $' 6*)'4*%+A'( <#4 <4#@-'2%( >%()4#6*)'()6*%6(?
4'(<64%)J46#( ' #/)4%( $#'*+%(B
• 4'<4'('*)% /2% '1#*#26% ./%*)# %# /(# $' >8( $' 1#06*7%?
<#4./' $6(<'*(% # %./'162'*)# ' <4'<%4#B '
• $626*/6 # %@('*)'Y(2# $#( <%6( %# )4%@%-7#? /2% 3'0 ./' %
146%*+% (' 2%*):2 2%6( (%/$83'-E
Fodröes de o|e|tomento moterno:
VE S-'6)%2'*)# 2%)'4*# '51-/(63#= ./%*$# % 146%*+% (J 4'1'@' -'6)'
2%)'4*#? ('c% $64')%2'*)' $# ('6# #/ #4$'*7%$# $% <4J<46% 2,'? #/
%6*$% -'6)' 7/2%*# $' @%*1# $' -'6)'? ' *,# 4'1'@' *'*7/2 #/)4#
-Y./6$# #/ %-62'*)# (J-6$#E
PE S-'6)%2'*)# 2%)'4*# <4'$#26*%*)'= ./%*$# % <46*16<%- ;#*)' $'
%-62'*)# $% 146%*+% : # -'6)' 2%)'4*#? ('*$# <'426)6$# %<'*%(
4'1'@'4 8>/%? 178? 2'$61%2'*)#( #/ (#4# $' 4'6$4%)%+,# #4%-E
NE S-'6)%2'*)# 2%)'4*# )#)%-= : /2% 2'$6$% #/ Y*$61' ./' 4';-')' #
<'4Y#$# $' %-'6)%2'*)# 2%)'4*# '51-/(63# ' <4'$#26*%*)'E
WE S-'6)%2'*)# 2%)'4*# <%416%-= ./%*$# % 146%*+%? %-:2 $%
%2%2'*)%+,# %# <'6)#? 4'1'@'? %*)'( $% :<#1% %$'./%$%? #/)4#(
%-62'*)#( T-'6)'? 1'4'%6(? ;4/)%(? -'>/2'(? ')1EU '2 %->/2% 4';'6+,#E
Compos|çõo e corocteríst|cos do |e|te humono
• C |eiIe mcIernc é c c|imenIc icec| pcrc c |ccIenIe. E|e ccnIém
Iccc: c: nuIrienIe:, inc|u:ive cguc, ¢ue c cricnçc preci:c nc: :ei:
primeirc: me:e: ce vicc. Devicc c: :uc: ccrccIer|:Iicc: f|:icc-
¢u|micc:, é fcci|menIe cL:crvicc e cigericc.
• C |eiIe mcIernc ccnIém cnIiccrpc: {e:pecic|menIe c lg/
:ecreIcric), cé|u|c: {mccrcfcgc:, pc|imcrfcnuc|ecre: e |infcciIc:) e
cuIrc: :uL:Icncic: {fcIcr L|ficc e |ccIcferrinc) ¢ue prcIegem c
crgcni:mc cc LeLë ccnIrc infecçce:.
• C |eiIe mcIernc ccnIém IcmLém fcIcre: ce cre:cimenIc
16
ALEITAMENTO MATERNO
137
¢ue prepcrcm c inIe:Iinc imcIurc cc cricnçc pcrc cigerir e cL:crvë-
|c, eviIcncc c::im ¢ue prcIe|nc: ncc cigericc: :ejcm cL:crvicc:,
|e:cncc c inIe:Iinc e ccu:cncc c|ergic:.
• C |eiIe humcnc :cfre c|Iercçce: nc :uc ccmpc:içcc, ce cccrcc
ccm c hcrc cc cic, c: cic: cpc: c pcrIc e curcnIe umc me:mc
mcmccc.
• C |eiIe IcmLém :cfre c|Iercçce: em :uc ccmpc:içcc, em
re|cçcc cc in|cic e finc| cc mcmccc. Nc inIervc|c cc: mcmccc:, é
prccuzicc c |eiIe chcmccc cnIericr, ¢ue ccrre:pcnce c um Ierçc
cc vc|ume IcIc| prccuzicc e, curcnIe c :ucçcc, é :ecreIccc c |eiIe
pc:Iericr, ¢ue ccrre:pcnce c cci: Ierçc: ce::e vc|ume.
• C |eiIe pc:Iericr cifere cc cnIericr pcr :er mci: ricc em gcrcurc:.
C ccnhecimenIc ce:Ie meccni:mc mc:Irc c impcrIcncic cc
:ucçcc nc prcce::c cc prccuçcc cc |eiIe. C |eiIe cc ccmeçc
¨mcIc c :ece¨ e c |eiIe cc fim ¨engcrcc¨.
A produçõo de |e|te
/ prccuçcc ce |eiIe :e cc pcr um e:I|mu|c neurc-encccrinc e Irë: crgcc:
:cc impcrIcnIe: ne:Ie prcce::c: p|ccenIc, hipcfi:e e mcmc.
/ p|ccenIc é re:pcn:cve| pe|c prccuçcc cc: e:Iercice: p|ccenIcric:
{e:Ircgenc: e prcge:Iercnc) ¢ue, curcnIe c grcvicez, prepcrcm c mcmc
pcrc c |ccIcçcc, e:Iimu|cncc c cepc:içcc ce gcrcurc:, c cre:cimenIc
cc: cucIc: e c|véc|c:. Ccm c :c|cc cc p|ccenIc cpc: c pcrIc, c: n|vei:
ce e:Iercice: ccem, ccncuzincc c hipcfi:e cnIericr c |iLercr prc|ccIinc,
hcrmcnic ¢ue vci e:Iimu|cr c: c|véc|c: mcmcric: c prccuzir |eiIe.
DurcnIe c grcvicez, c: c|Ic: ccncenIrcçce: ce:Ie: hcrmcnic: e:Iercice:,
pre:enIe: nc p|c:mc, iniLem c :ecreçcc cc |eiIe, cccrrencc :cmenIe c
:|nIe:e cc pré-cc|c:Irc ¢ue é umc :uL:Icncic ¢ue, nc :uc ccmpc:içcc,
ccnIém grcnce ¢ucnIiccce ce imuncg|cLu|inc: e |ccIcferrinc.
/ mecicc ¢ue c: n|vei: p|c:mcIicc: ce e:Ircgenc e prcge:Iercnc ccem,
cercc ce 3 c 5 veze: nc: primeirc: cic: cpc: c pcrIc, c prccuçcc ce |eiIe
Iem in|cic. C per|ccc em ¢ue :e inicic c prccuçcc ce |eiIe é chcmccc
ce cpcjccurc cu ¨ce:cicc¨. /ccnIece em Icrnc ce 48 c 72 hcrc: cpc: c
pcrIc. /: mcmc: cumenIcm ce Icmcnhc e IempercIurc, Icrncm-:e
cc|crc:c: e e:Ie fencmenc curc, em mécic, Irë: c ¢ucIrc cic:. /
cpcjccurc mcrcc c muccnçc cc ccnIrc|e encccrinc pcrc c cuIccrinc
cc |ccIcçcc. C vc|ume ce |eiIe prccuzicc Ience c cumenIcr
grcccIivcmenIe. /::im, nc 2º cic, e:Ic pcr vc|Ic ce 50 m|/cic. Nc 4º cic,
cc reccr ce 550 m|/cic. Jc cc: Irë: me:e:, é ce cercc ce 850m|/cic. E:Ie
ccnhecimenIc é impcrIcnIe pcrc c infcrmcçcc cc puérperc ce ¢ue c
pe¢uenc ¢ucnIiccce ce |eiIe prccuzicc nc: primeirc: cic: é ncrmc|.
C: n|vei: p|c:mcIicc: ce prc|ccIinc e|evcm-:e em re:pc:Ic c :ucçcc cc
FN e e:Icc cireIcmenIe re|ccicnccc: c fre¢üëncic, curcçcc e
inIen:iccce cc :ucçcc. / :ucçcc cc mcmi|c prccuz umc e|evcçcc ce
prc|ccIinc Lc:c|, cpre:enIcncc um picc ce prccuçcc enIre c: 20
16
ALEITAMENTO MATERNO
138
c 40 minuIc: cpc: c in|cic cc e:Iimu|cçcc. ScLe-:e ¢ue 30 minuIc: ce
:ucçcc pccem ceIermincr n|vei: e|evccc: ce prc|ccIinc pcr cercc ce 3
c 4 hcrc:. Ccmc c prc|ccIinc é c hcrmcnic funccmenIc| pcrc c
gc|ccIcpcie:e, permiIir c :ucçcc cc mcmi|c pe|c cricnçc c |ivre
cemcncc é c e|emenIc Lc:icc pcrc c mcnuIençcc cc cmcmenIcçcc.
CucnIc mci: rcpicc, cpc: c nc:cimenIc, e mci: fre¢üenIemenIe :e
cc|c¢ue c recém-nc:cicc cc :eic, mcicr :erc c prccuçcc ce |eiIe e
mencre: c: :inIcmc: cevicc: c cpcjccurc.
A ejeçõo do |e|te
C |eiIe ccumu|ccc nc: c|véc|c: ncc f|ui e:pcnIcnecmenIe pcrc c:
cucIc: e :eic: |ccI|ferc:. / cciIccinc, |iLerccc pe|c hipcfi:e pc:Iericr,
é c hcrmcnic ¢ue cIuc :cLre c: cé|u|c: micepiIe|ici:, ceIermincncc :uc
ccnIrcçcc e ccn:e¢üenIe expu|:cc ce |eiIe pcrc c: cucIc:.
Nc: primeirc: cic: cpc: c pcrIc, c ref|exc ce ejeçcc re:pcnce ncc
:cmenIe c e:I|mu|c: IccIei:, mc: IcmLém c|fcIcric:, vi:uci: cu cuciIivc:.
Fcce re:pcncer cincc cevicc c prcximiccce f|:icc cu pen:cmenIc nc
fi|hc. C ref|exc ce ce:cicc cc |eiIe pcce :er iniLicc pe|c e:Ire::e.
/ |iLercçcc ce cciIccinc, ceccrrenIe cc :ucçcc cc mcmi|c pe|c
cricnçc, ceIerminc, IcmLém, ccnIrcçcc cc: fiLrc: mu:cu|cre: uIerinc:,
fcvcrecencc c ccnIrcçcc cc úIerc curcnIe c cmcmenIcçcc.
Ccm re|cçcc c prccuçcc ce |eiIe, cIuc|menIe Iem-:e evicëncic: ce ¢ue
c ¢ue rec|menIe ccnIrc|c c prccuçcc ce |eiIe é c e:vczicmenIc cc
g|cncu|c pe|c :ucçcc.
/c :e cnc|i:cr c ccmpc:içcc cc |eiIe, ci:Iinguem-:e 4 Iipc: ce |eiIe, ¢ue
:e cpre:enIcm ccm ccrccIer|:Iicc: Lic¢u|micc: ciferenIe: e cce¢uccc:
c cccc ceIerminccc per|ccc cc vicc cc cricnçc:
1. Co|ostro
DurcnIe c ge:Icçcc, c g|cncu|c mcmcric prccuz umc :uL:Icncic
cencminccc ce pré-cc|c:Irc, ccumu|ccc nc |úmen cc: c|véc|c:, e ¢ue
Iem nc :uc ccmpc:içcc, principc|menIe, ex:uccIc cc p|c:mc, cé|u|c:,
imuncg|cLu|inc:, |ccIcferrinc, :crcc|Luminc, :ccic, c|crc e umc pe¢uenc
¢ucnIiccce ce |ccIc:e.
Nc: primeirc: cic: cpc: c pcrIc, é prccuzicc c cc|c:Irc, e :uc prccuçcc
permcnece cincc pcr cercc ce 7 cic:. /pre:enIc-:e ccmc um ||¢uicc
e:pe::c, ce cc|crcçcc cmcre|ccc e c|Ic cen:iccce. C vc|ume, nc in|cic,
vcric ce 2 c 20 m| em cccc mcmccc, IcIc|izcncc 50 c 100m|/cic, :encc
:uficienIe pcrc :cIi:fczer c: nece::iccce: cc |ccIenIe.
Nc cc|c:Irc, cL:ervc-:e c|Ic ccncenIrcçcc ce |g/ e ce |ccIcferrinc ¢ue,
junIcmenIe ccm c grcnce ¢ucnIiccce ce |infcciIc: e mccrcfcgc:,
ccnferem umc cçcc ce prcIeçcc cc recém-nc:cicc. Iem cçcc |cxcIivc,
fcci|iIcncc c e|imincçcc ce meccnic, cuxi|icncc c prevençcc cc
icIer|cic.
16
ALEITAMENTO MATERNO
139
2. Le|te de trons|çõo
FeceLe e:Ic cencmincçcc c |eiIe humcnc prccuzicc enIre c 7º e 15º cic
cpc: c pcrIc. C vc|ume ce |eiIe e c ccmpc:içcc vcricm nc ceccrrer cc:
cic:, permcnecencc ccm vc|ume mécic ce 500m|/cic.
3. Le|te moduro
É c |eiIe prccuzicc c pcrIir cc 15º cic, ccmc ccnIinucçcc cc |eiIe ce
Ircn:içcc. É um ||¢uicc Lrcncc e cpccc, ccm pcucc cccr, :cLcr
|igeircmenIe ccccicccc. Seu vc|ume mécic é ce 700 c º00 m|/cic,
curcnIe c: primeirc: :ei: me:e:. / pcrIir cc :eguncc :eme:Ire, c
¢ucnIiccce mécic ce prccuçcc cicric é ce ó00m|. C |eiIe mcIernc Iem
887 ce cguc e pc::ui umc c:mc|criccce :eme|hcnIe c cc p|c:mc
:cngü|nec. Iem nc :uc ccmpc:içcc Lc:icc, c|ém cc cguc, prcIe|nc:,
ccrLchicrcIc:, |ip|cec:, minerci: e viIcminc:.
4. Le|te de pré-termo
C |eiIe ce mce: ce cricnçc: premcIurc: cifere cc |eiIe ce mce: ce
cricnçc: ce Iermc. /: ciferençc: Lc:icc: :cc:
• mcicr Iecr ce prcIe|nc, |ip|cec: e cc|cric:, cIencencc c mcicr
nece::iccce ce cre:cimenIc cc pré-Iermc:
• mencr Iecr ce |ccIc:e, vi:Ic ¢ue c pré-Iermc Iem mci:
cificu|ccce nc :uc cige:Icc:
• mcicr ¢ucnIiccce ce |g/ e |ccIcferrinc: e
• c |eiIe mcIernc ncc :upre c: nece::iccce: ce cc|cic e fc:fcrc,
¢ucncc c cricnçc Iem pe:c infericr c 1500g.
Monejo c|ín|co do omomentoçõo:
Ccnhecer c: c:pecIc: re|ccicnccc: c prcIicc cc c|eiIcmenIc mcIernc é
fcIcr funccmenIc| nc :enIicc ce cc|cLcrcr pcrc ¢ue mce e cricnçc
pc::cm vivencicr c cmcmenIcçcc ce fcrmc efeIivc e Ircn¢üi|c,
receLencc cc prcfi::icnc| c: crienIcçce: nece::cric: e cce¢uccc: pcrc
c :eu ëxiIc.
Fen:cncc ¢ue c mu|her pc::c pcr um |cngc per|ccc ce ge:Icçcc cIé
¢ue pc::c ccncreIcmenIe cmcmenIcr :eu fi|hc, enIence-:e ¢ue c
prepcrc pcrc c cmcmenIcçcc cevc :er iniciccc cincc nc per|ccc ce
grcvicez.
Freporondo os momos poro o o|e|tomento
1. Duronte o gestoçõo:
• excmincr c: mcmc: nc ccn:u|Ic ce pré-ncIc|:
• crienIcr c ge:IcnIe c u:cr :uIic ccm crif|cic cenIrc| pcrc
expc:i çcc ce créc|c e mcmi|c curcnIe c ge:Icçcc:
16
ALEITAMENTO MATERNO
140
• reccmenccr Lcnhc: ce :c| nc: mcmc:, pcr 15 minuIc:, cIé 10
hcrc: cc mcnhc cu cpc: c: 1ó hcrc:, curcnIe c grcvicez, cu
Lcnhc: ce |uz ccm |cmpccc: ce 40 wcII:, c cercc ce um pc|mc ce
ci:Icncic:
• e:c|crecer ¢ue c u:c ce :cLce:, creme: cu pcmccc: nc mcmi|c
ceve :er eviIccc:
• crienIcr ¢ue c expre::cc cc peiIc {cu crcenhc), curcnIe c
ge:Icçcc, pcrc c reIirccc cc cc|c:Irc e:Ic ccnIrc-incicccc: e
• en:incr c ge:IcnIe c exp|crcr :uc: mcmc:. C mcmi|c pcce :er
protruso, ¢ucncc :e cpre:enIc :c|ienIe, Lem ce|imiIccc: sem|-
protruso, ¢ucncc :e cpre:enIc pcucc :c|ienIe e, ¢ucncc
e:Iimu|ccc, prcIrci ccm cificu|ccce: |nvert|do, ¢ucncc :e cpre:enIc
em :enIicc cpc:Ic cc ncrmc| e, cpc: e:I|mu|c:, ccnIinuc inc|Ierccc,
:em :e prcIrcir: e c mcmi|c |o|so-|nvert|do, ¢ue :e cpre:enIc em
:enIicc cpc:Ic cc regu|cr, mc:, cpc: e:I|mu|c ce umc pegc
cce¢uccc, exIericrizc-:e pcLremenIe, ficcncc ¢uc:e p|cnc e
vc|Icncc, |cgc c :eguir, cc e:Iccc cnIericr ce inver:cc.
Nc cc:c ce c: mcmi|c: ncc :erem prcIru:c:, crienIcr c ge:IcnIe pcrc c:
:eguinIe: ccncuIc::
1. U:cr LcmLc ce :ucçcc cc mcmi|c cpc: c pcrIc, ce:ce ¢ue :uc
pre::cc :ejc muiIc pe¢uenc e ncc mcchu¢ue c pe|e.
2. U:cr :eringc p|c:Iicc ce 10-20 m| pcrc Irccicncr c mcmi|c, nc cu:ëncic
cc LcmLc ce :ucçcc cc mcmi|c:
• pegcr umc :eringc p|c:Iicc ce 10-20 m|, reIircr c ëmLc|c e ccn:ervcr:
• ccrIcr c exIremiccce cc :eringc cnce :e cccpIc c cgu|hc:
• reinIrccuzir c ëmLc|c pe|c exIremiccce ccrIccc: e
• cju:Icr c cuIrc exIremiccce cc :eringc cc mcmi|c e puxcr
:ucvemenIe c ëmLc|c pcrc Irccicncr c mcmi|c. Fczer e:Ic mcncLrc umc
vez cc cic, cIé ¢ue c mcmi|c :e Icrne prcIru:c.
16
ALEITAMENTO MATERNO
141
É impcrIcnIe icenIificcr c: ccnhecimenIc:, crençc: e cIiIuce: ¢ue c
ge:IcnIe pc::ui em re|cçcc c cmcmenIcçcc, ¢ue Iipc ce experiëncic
pc::ui, cu :e jc vivencicu c|gumc vez c cmcmenIcçcc. /|ém ci::c, é
impcrIcnIe IcmLém cferecer c: ge:IcnIe: cpcrIuniccce: ce Irccc ce
experiëncic:, cIrcvé: ce reunice: ce grupc ¢ue cLjeIivem infcrmcr e
fcci|iIcr c cmcmenIcçcc.
2. In|c|ondo o omomentoçõo no so|o de porto
/ primeirc hcrc cpc: c nc:cimenIc é exce|enIe pcrc inicicr c
cmcmenIcçcc, vi:Ic ¢ue c FN u:uc|menIe e:Ic Lem c|erIc e cIenIc,
ccm c ref|exc ce :ucçcc cIivc, e:Iimu|cncc precccemenIe c prccuçcc
ce cciIccinc e prc|ccIinc.
Iccc in:IiIuiçcc ¢ue ce:ejc pc::uir um Frcgrcmc ce lncenIive cc
c|eiIcmenIc mcIernc ceve Ier ccmc ncrmc c prcIicc ce cc|cccr c
recém-nc:cicc pcrc :ugcr curcnIe c primeirc hcrc ce vicc, ce:ce ¢ue
mce e cricnçc :e enccnIrem em Lcc: ccnciçce:, fcvcrecencc c
ccnIcIc c|hc c c|hc, pe|e c pe|e ce cmLc:.
• / e¢uipe ce :cúce ¢ue c::i:Ie cc pcrIc ceverc cricr um
cmLienIe ce Ircn¢üi|iccce e cpcic, c::im ccmc prcpicicr ccnfcrIc
f|:icc e emccicnc| nc :enIicc ce fcci|iIcr c ccnIcIc |nIimc enIre mce
e cricnçc, c mci: precccemenIe pc::|ve|.
• / ccmini:Ircçcc ce meciccmenIc:, e:pecic|menIe :eccIivc:e
cnc|gé:icc:, c mce ceve :er criIeric:c.
• C recém-nc:cicc ceverc :er ccLerIc ccm ccmpc c¢uecicc e
:ecc e cc|ccccc junIc ce :uc mce, em ccnIcIc pe|e c pe|e, pcrc
¢ue e:Ic c cc|c¢ue pcrc mcmcr, :empre ¢ue pc::|ve|.
3. Apos o porto, em un|dode de o|ojomento conjunto:
M %-#c%2'*)# 1#*c/*)# : ;/*$%2'*)%- <%4% # 6*1'*)63# $# %-'6)%2'*)#
2%)'4*#? /2% 3'0 ./' % 2,' <#$'48 #;'4'1'4 # ('/ -'6)' ' (%)6(;%0'4 %
146%*+% ('2<4' ./' '-% $'2#*()4%4 ;#2'E S-:2 $6((#? # %-#c%2'*)#
1#*c/*)# 1#-')63# $8 Z 2/-7'4 % #<#4)/*6$%$' $' #@('43%4 #/)4%( 2,'(
*# 1/6$%$# 1#2 # ;6-7#E
• / mce ceve prccecer c higiene cc: mcc:, ccm cguc e :cLcc,
cnIe: ce cmcmenIcr.
• En:incr c mce c cferecer c peiIc cnIe: cc cpcjccurc, pe|c
impcrIcncic cc cc|c:Irc e IcmLém pe|c e:I|mu|c c prccuçcc
|ccIec.
• / cmcmenIcçcc ceve :er iniciccc pe|c mcmc ¢ue :e enccnIrc
mci: cheic ce |eiIe, gerc|menIe c ¢ue fci uIi|izccc pcr ú|Iimc. Cc:c
c cricnçc ncc ccn:igc mcmcr nc: cuc: mcmc:, nc prcximc
mcmccc ccmeçcr pe|c mcmc ¢ue ncc fci :c|iciIccc.
• C |ccc| pcrc cmcmenIcr ceverc :er e:cc|hicc pcr e|c, ce:ce
¢ue :e :inIc ccnfcrIcve|.
• / me|hcr pc:içcc pcrc c mce cmcmenIcr cepence ce vcric:
fcIcre:, cenIre e|e: c Iipc ce pcrIc, c cic ce puerpéric ¢ue :e
enccnIrc. Ccn:icerc-:e impcrIcnIe ¢ue, em ¢uc|¢uer pc:içcc, c
mu|her e:Iejc ccnfcrIcve| e re|cxccc.
16
ALEITAMENTO MATERNO
142
• C pc:icicncmenIc cc cricnçc pcrc cmcmenIcr é impcrIcnIe
pcrc ceIermincr umc cmcmenIcçcc efeIivc. / pc:içcc mci:
u:uc|menIe uIi|izccc pe|c mce pcrc cmcmenIcr :eu LeLe e c
:enIccc.
• C pc:icicncmenIc ccrreIc imp|icc em cc|cccr c LeLë ce frenIe
pcrc c mcmc, ccm :eu ¢ueixc Icccncc c mcmc e c ccrpc-
ccLeçc-memLrc: em |inhc reIc. / pegc cce¢uccc :erc feiIc ccm
:uc Lccc Lem cLerIc cLcccnhcncc Iccc c pcrIe infericr cc créc|c
e pcrIe cc :upericr. Verificc-:e :e c pegc e:Ic ccrreIc :e c LeLë
e:Iiver fczencc :ucçce: |cngc:, :eguicc: ce pcu:c: e pe¢uenc:
:ucçce:, e cL:ervcncc-:e c ceg|uIiçcc. / pegc ccrreIc nuncc cci:
:e c mce referir ccr é pcr¢ue c LeLë ncc e:Ic pegcncc Lem.
• ScLe-:e ¢ue c cmcmenIcçcc é umc prcIicc ¢ue ceve :er
cprencicc, IcnIc pe|c mce ¢ucnIc pe|c cricnçc. De:Ic fcrmc, é
e:perccc ¢ue, nc: primeirc: cic:, c mu|her cincc cpre:enIe
cificu|ccce: em pc:icicncr ccrreIcmenIe c cricnçc e ¢ue, nc
ceccrrer cc: cic:, cprencc.
• Se c créc|c e:Iiver encurecicc, ceve-:e reIircr c exce::c ce |eiIe
pcr crcenhc mcnuc|, cIé ¢ue :e ccn:igc c f|exiLi|iccce ce:ejccc.
l:Ic é impcrIcnIe, pci: permiIe ¢ue c recém-nc:cicc cpreencc
ccmp|eIc e ccrreIcmenIe c regicc mcmi|c-crec|cr {pegc ccrreIc),
fcci|iIcncc c e:vczicmenIc cc: mcmc: e prevenincc Ircumc:
mcmi|cre:.
• / curcçcc ce cccc mcmccc é vcricve|. Gerc|menIe c cricnçc
:e :cIi:fcz mcmcncc 10 c 15 minuIc: em cccc peiIc, pccencc :e
e:Iencer. Fcrém, ceve-:e ceixcr c cricnçc mcmcr en¢ucnIc c
me:mc e:Iiver :ugcncc.
• Fcrc Iermincr c mcmccc, c icec| é ¢ue c cricnçc :c|Ie c peiIc
e:pcnIcnecmenIe. Cucncc e:Ie fcIc ncc cccrre, c mce cc|ccc c
pcnIc cc cecc m|nimc nc Lccc cc cricnçc. De::c fcrmc, c vccuc
:e ce:fcz e c cricnçc :c|Ic c peiIc, :em mcchucc-|c.
• Cc|cccr c LeLë pcrc crrcIcr, em pc:içcc verIicc|, ccm c ccLeçc
cpciccc nc cmLrc mcIernc. Fcce :er feiIc umc |eve mc::cgem nc:
cc:Ic: cIe ¢ue e|c crrcIe. Cricnçc: mcicre: pccem :er IcmLém
cc|ccccc: nc cc|c mcIernc, :enIccc: e ccm c ccrpc inc|inccc
pcrc frenIe e cpciccc: nc Lrcçc cc mce.
Cu|dodos com os momos e mom||os
• C u:c ce :uIic é nece::cric pcrc mcnIer c mcmc :empre e|evccc,
eviIcncc e:Ic:e: nc: pcrçce: infericre: cc mcmc.
• C Lcnhc ce :c| nc: mcmi|c: ccnIinuc reccmencccc ccm c cLjeIivc
ce cumenIcr c re:i:Iëncic cc regicc mcmi|c-crec|cr.
• / |uLrificcçcc cc regicc mcmi|c-crec|cr ceve :er feiIc :cmenIe ccm c
|eiIe mcIernc.
• Depci: ce cmcmenIcr, c mce ceve prccecer c pc|pcçcc cc: mcmc:.
Se e:Iiverem pe:ccc: e ccm pcnIc: ce ccr, reIircr c exce::c ce |eiIe cIé
c pcnIc ce ccnfcrIc, cu :ejc, cIé c ce:cpcrecimenIc cc ccr.
C c|eiIcmenIc mcIernc é, cIuc|menIe, ccn:icerccc peçc
16
ALEITAMENTO MATERNO
143
funccmenIc| pcrc c :cúce mcIernc e perincIc| e, pcrIcnIc, fcz pcrIe cc:
e:IrcIégic: ce Iccc: c: prcgrcmc: re|ccicnccc: ccm e:Ie: cLjeIivc:,
c|ém ce repre:enIcr cincc um e|emenIc impcrIcnIe em Iccc prcce::c
ce humcnizcçcc cc nc:cimenIc. Nc 8rc:i|, nc: ú|Iimc: cnc: Iem :icc
pcrIicu|crmenIe e:Iimu|ccc, cIrcvé: ce incenIivc: cficici: ccn:IcnIe: cc
chcmccc lH/C - lnicicIivc cc Hc:piIc| /migc cc Cricnçc, ccnferincc c
re:pecIivc I|Iu|c c: in:IiIuiçce: ¢ue IecniccmenIe cumprem ccm c:
re¢ui:iIc: ccn:icerccc: nece::cric: pcrc umc cce¢uccc c::i:Iëncic
Iécnicc e humcnc cc: recémnc:cicc:. Fcrc c efeIiviccce cc
c|eiIcmenIc mcIernc, c lH/C reccmencc c: in:IiIuiçce: c
imp|emenIcçcc cc: chcmccc: ¨Dez pc::c: pcrc c :uce::c cc
c|eiIcmenIc mcIernc".
D|||cu|dodes no o|e|tomento
1. Freensõo |ncorreto do mom||o
/ preen:cc inccrreIc cc regicc mcmi|c-crec|cr fcz ccm ¢ue c cricnçc
ncc ccn:igc reIircr |eiIe :uficienIe, |evcncc c cgiIcçcc e chcrc. / pegc
errccc, :c ce mcmi|c, prcvccc ccr e fi::urc: e fcz ccm ¢ue c mce fi¢ue
Ien:c, cn:ic:c e percc c cuIcccnficnçc, ccreciIcncc ¢ue c :eu |eiIe :ejc
in:uficienIe e/cu frccc.
2. F|ssuros [rochoduros}
EviIcr fi::urc:, cc|cccncc c LeLë pcrc mcmcr nc pc:içcc ccrreIc e ce
fcrmc ¢ue e|e cpreencc c mcmc ccrreIcmenIe. McnIer c:
Dez possos poro o sucesso do o|e|tomento moterno [IHAC}
VE "'4 /2% *#42% '(146)% (#@4' %-'6)%2'*)# 2%)'4*#? ./' $'3' ('4
4#)6*'64%2'*)' )4%*(26)6$% % )#$% % './6<' $' (%C$'E
PE "4'6*%4 )#$% % './6<' $' (%C$'? 1%<%16)%*$#I% <%4% 62<-'2'*)%4
'()% *#42%E
NE M46'*)%4 )#$%( %( >'()%*)'( (#@4' %( 3%*)%>'*( ' # 2%*'c# $#
%-'6)%2'*)# 2%)'4*#E
WE Sc/$%4 %( 2,'( % 6*616%4 # %-'6)%2'*)# 2%)'4*# *% <462'64% 7#4%
%<J( # *%(162'*)# $# @'@9E
OE s#()4%4 Z( 2,'( 1#2# %2%2'*)%4 ' 1#2# 2%*)'4 % -%1)%+,#?
2'(2# (' 36'4'2 % ('4 ('<%4%$%( $' ('/( ;6-7#(E
RE q,# $%4 %# 4'1:2I*%(16$# *'*7/2 #/)4# %-62'*)# #/ @'@6$% %-:2
$# -'6)' 2%)'4*#? % *,# ('4 ./' )%- <4#1'$62'*)# )'*7% /2% 6*$61%+,#
2:$61%E
_E %)61%4 # %-#c%2'*)# 1#*c/*)# I <'426)64 ./' 2,' ' @'@9
<'42%*'+%2 c/*)#( I PW 7#4%( <#4 $6%E
XE K*1#4%c%4 # %-'6)%2'*)# 2%)'4*# (#@ -634' $'2%*$%E
bE q,# $%4 @61#( %4)6;616%6( #/ 17/<')%( % 146%*+%( %2%2'*)%$%( %#
('6#E
VQE K*1%26*7%4 %( 2,'(? <#4 #1%(6,# $% %-)# 7#(<6)%-%4? <%4% >4/<#( $'
%<#6# %# %-'6)%2'*)# 2%)'4*# *% 1#2/*6$%$' #/ '2 ('436+#( $'
(%C$'E
16
ALEITAMENTO MATERNO
144
mcmc: :ecc:, ncc u:cncc :cLcneIe:, creme: cu pcmccc:. IrcIcr c:
fi::urc: ccm |eiIe mcIernc e :c|. C impcrIcnIe é ccrrigir c ¨pegc¨.
Cucncc exi:Iem fi::urc:, c mce ceve :er crienIccc pcrc inicicr c
mcmccc pe|c mcmc :ccic cu menc: ccmprcmeIicc e cepci: pc::cr
pcrc cuIrc mcmc, pci: c LeLë e:Ic menc: fcminIc e :ugc ccm menc:
vcrcciccce. Se e|c: ncc fcrem ccmp|eIcmenIe e:vcziccc: ce:Ic
mcneirc, cevercc :er e:vcziccc: cpc: c: mcmccc:.
3. Momos |ngurg|todos
/: mcmc: ingurgiIccc: :cc cc|crc:c:, ecemcciccc: {pe|e Lri|hcnIe),
pccencc e:Icr cverme|hccc: e c mu|her Ier feLre. É ciferenIe cc:
mcmc: cheic: ¢ue :cc pe:ccc:, encurecicc:, ¢uenIe:, mc: c mu|her
ncc Iem feLre e c |eiIe e:Ic f|uincc.
Fcrc eviIcr ingurgiIcmenIc, c: mcmc: cevem :er e:vcziccc: ccmc
exp|icccc cnIericrmenIe. Cucncc c mcmc e:Iiver muiIc ingurgiIccc,
fczer, cnIe: ce cc|cccr c LeLë pcrc mcmcr, c expre::cc mcnuc| pcrc
fcci|iIcr c pegc.
Cc:c c mu|her ncc ccn:igc ccr c peiIc, c | eiIe ceve :er reIirccc pcr
exIrcçcc mcnuc| cu pcr LcmLc. Se ncc cccrrer me|hcrc em 24 hcrc:, c
mcmc e:Iiver ¢uenIe, ccm c pe|e cverme|hccc em ceIerminccc |ccc|, e
c mu|her cpre:enIcr feLre, prcvcve|menIe e:Icrc cccrrencc umc mc:IiIe
¢ue ceverc :er ccrreIcmene cicgnc:Iicccc e IrcIccc.
Contro-|nd|coçöes
Scc rcrc: c: :iIucçce:, IcnIc mcIernc: ¢ucnIc necncIci:, ¢ue ccnIrc-
inciccm c cmcmenIcçcc. EnIre c: mcIernc:, enccnIrcm-:e c: mu|here:
ccm ccncer ce mcmc ¢ue fcrcm IrcIccc: cu e:Icc em IrcIcmenIc,
mu|here: HlV• {:c pccem ccr c prcpric |eiIe :e e:Ie fcr pc:Ieurizccc),
mu|here: ccm ci:IúrLic: cc ccn:ciëncic cu ccmpcrIcmenIc grcve, enIre
cuIrc:.
/: ccnIrc-inciccçce: necncIci: inc|uem c|Iercçce: cc ccn:ciëncic cc
cricnçc ce ¢uc|¢uer ncIurezc, Lcixc pe:c ccm imcIuriccce pcrc :ucçcc
cu ceg|uIiçcc {ccr |eiIe mcIernc pcr :cncc crcgc:Iricc) e fencc pc|cIinc
¢ue impc::iLi|iIe c cIc ce :ugcr {cferecer |eiIe mcIernc crcenhccc).
FcrcmenIe c u:c ce c|gumc meciccçcc pe|c mu|her ccnIrc-incicc c
cmcmenIcçcc. Nenhumc meciccçcc ceve :er uIi|izccc pe|c puérperc
cmcmenIcncc :em crienIcçcc mécicc. Nc evenIuc|iccce cc
meciccçcc uIi|izccc :er c|c::ificccc ccmc ce u:c criIeric:c cu ccnIrc-
incicccc curcnIe c cmcmenIcçcc, c prccecimenIc ce e:cc|hc é cpIcr
pcr cuIrc: c|IerncIivc: IercpëuIicc: e ncc :u:pencer c c|eiIcmenIc,
:empre ¢ue i:Ic fcr pc::|ve|. Fcrc mcicre: ceIc|he:, ver mcnuc|
/mcmenIcçcc e U:c ce Drcgc: {MS, 2000).
16
145
O obortomento como questõo de soùde pùb||co
C cLcrIc, c::unIc exc|u|cc cc: ci:cu::ce: cienI|ficc: e
pc||Iicc: cIé Lem pcucc Iempc cIrc:, é, nc
cIuc|iccce, umc cc: principci: ¢ue:Ice: cc cgencc
inIernccicnc|, nc ¢ue ciz re:peiIc c :cúce e cireiIc:
reprccuIivc:.
/ ci:crimincçcc e c: cgrcvc: c :cúce impc:Ic: c:
mu|here:, pcr rczce: cu|Iurci:, |egci: e re|igic:c: ¢ue
envc|vem c ¢ue:Icc cc cLcrIc, Iëm ccnIriLu|cc pcrc
c preccrieccce cc c::i:Iëncic e cumenIc cc
mcrIc|iccce e mcrLiccce pcr e:Ic ccu:c. Fc|cncc em
ncme prcpric, c: mu|here: |evcrcm c ¢ue :empre fci
ccn:icerccc ¨:eu prcL|emc¨ cc p|cnc pc||Iicc |ccc|,
regicnc| e muncic|, vi:cncc c cefiniçcc ce pc||Iicc:
¢ue inccrpcrem c prevençcc cc cLcrIc e c
cmp|icçcc cc cce::c c :erviçc: ce Lcc ¢uc|iccce.
/::im, ccmc re:u|Iccc cc ceLcIe ccncuzicc pe|c
mcvimenIc ce mu|here:, nc ú|Iimc cécccc, c cLcrIc
fci cmp|cmenIe ceLcIicc em cuc: impcrIcnIe:
ccnferëncic: cc: Ncçce: Unicc:: Ihe lnIerncIicnc|
Ccnference cn Fcpu|cIicn cnc Ihe Deve|cpmenI
{Ccirc, 1ºº4) e c FcurIh Wcr|c Ccnference cn Wcmen
{8eijing, 1ºº5). E c cLcrIc, rec|izccc em ccnciçce:
in:egurc:, fci inc|u|cc nc F|cnc ce /çcc cc
Ccnferëncic cc Ccirc - pcrcgrcfc 8.25 - ccmc ¢ue:Icc
ce :cúce púL|icc. C: gcvernc: :igncIcric:, enIre e|e: c
8rc:i|, c::umircm c ccmprcmi::c ce imp|emenIcr
:erviçc:, me|hcrcr c ¢uc|iccce cc c::i:Iëncic e recuzir
c mcrIc|iccce e mcrLiccce ceccrrenIe cc cLcrIc em
:eu: pc|:e:.
IrcIc-:e, pcrIcnIc, ce cmp|icr cce::c cc: mu|here: cc:
cireiIc: |egc|menIe ccmiIicc:, inve:Iincc em cçce:
¢ue gcrcnIcm cc: hcmen: e mu|here: c exerc|cic cc:
cireiIc: :exuci: e reprccuIivc:.
/pe:cr cc vi:iLi|iccce cc¢uiricc, pcr fcrçc ce |ei:
re:IriIivc:, c: mu|here: cincc reccrrem cc cLcrIc
¨c|cnce:Iinc¨. Ne::c ccnciçcc, e|c: Iëm gucrcccc
17 ASSISTÊNCIA À MULHER COM ABORTAMENTO E
NO PÓS-ABORTO
ASSISTÊNCIA Á MULHER COM ABORTAMENTO E NO PÓS-ABORTO
146
:uc ccr em :i|ëncic cu, nc mcximc, ccmpcrIi|hcm-nc ccm pe::cc: ce :uc
inIimiccce. Cuc:e :empre e|c: ncc enccnIrcm cpcic nc: :erviçc: ce
:cúce cu nc: e:cc|c:, em :e IrcIcncc ce ccc|e:cenIe:.
/: reccmenccçce: inIernccicnci:, :e ncc Ircn:fcrmccc: em ncvc:
prcIicc: nc n|ve| ce cIençcc |ccc|, :ercc in:uficienIe: pcrc c :c|uçcc cc
prcL|emc. Fcr i::c, Icrnc-:e nece::cric c Lu:cc ce pc||Iicc: :ccici:
cce¢uccc: cc ccnIexIc ce cccc pc|:, e:Iccc cu munic|pic, re:peiIcncc-
:e c: |ei: vigenIe: e prcmcvencc c: recur:c: humcnc: e xIécnicc:
ci:pcn|vei:. Deve-:e re::c|Icr c¢ui, c impcrIcncic cc prcIicc prcfi::icnc| e
pc||Iicc cc: prcfi::icnci: cc :cúce, principci: inIer|ccuIcre: cc: mu|here:
¢ue cemcnccm :erviçc: ce :cúce pcrc crienIcçce: e IrcIcmenIc cc:
prcL|emc: ceccrrenIe: cc cLcrIcmenIc.
Mogn|tude do obortomento no 8ros|| e no mundo
/ rec| mcgniIuce cc cLcrIcmenIc, nc muncc, é ce:ccnhecicc. /
i|egc|iccce, pcrcic| cu IcIc| em civer:c: pc|:e:, cificu|Ic c regi:Irc ce
Iccc: c: cccrrëncic:. Nc pcpu|cçcc muncic|, ó27 vive em pc|:e: cnce c
inIerrupçcc ce grcvicez é permiIicc pcr umc cmp|c vcrieccce ce
rczce:, e 2ó7 vive em pc|:e: cnce c cLcrIc é prciLicc {CenIrc Legc|
pcrc Derechc: FeprccuIivc: y Fc|iIicc: FuL|icc: - CLFF, N•/EU/, 1ººº). Fcr
cuIrc |ccc, nem Iccc: c: mu|here: cemcnccm c::i:Iëncic pc:-
cLcrIcmenIc nc: :erviçc: púL|icc: ce :cúce. De:Ic fcrmc, é ccn:en:c ce
¢ue exi:Ie umc :uL-ncIificcçcc cc: cc:c:, c::im ccmc cc: ccmp|iccçce:
c::cciccc:.
Nc 8rc:i|, cpe:cr cc ccrëncic ce inciccccre: ¢ue permiIcm cferiçcc cc
numerc IcIc| ce cccrrëncic: ce cLcrIcmenIc: nc pcpu|cçcc em gerc|,
c: cccc: cficici: ju:Iificcm c cccçcc ce mecicc: prevenIivc: e ce
prcmcçcc cc :cúce reprccuIivc. Nc ccnIexIc cc mcrIc|iccce mcIernc,
c incicëncic cL:ervccc ce cLiIc: pcr ccmp|iccçce: ce cLcrIc c:ci|c em
Icrnc ce 12,57 cc IcIc| cc: cLiIc:, ccupcncc, em gerc|, c Ierceirc |ugcr
enIre :uc: ccu:c:, cL:ervccc: c: cmp|c: vcricçce: enIre c: e:Iccc:
Lrc:i|eirc:.
Di:pce-:e, pcrc cnc|i:e cc prcL|emc, cc: cccc: fcrnecicc: pe|c Si:Iemc
ce lnIerncçcc Hc:piIc|cr {SlH/SUS), ¢ue infcrmc c númerc ce inIerncçce:
pcrc cureIcgen: pc:-cLcrIc e c fre¢üëncic ce cLiIc: ne:Ic:
circun:Icncic:, nc: :erviçc: púL|icc: e ccnveniccc: e cc Si:Iemc ce
lnfcrmcçcc em McrIc|iccce {SlM/CENEFl/MS) ¢ue ccn:c|icc c regi:Irc cc
cLcrIcmenIc em cec|crcçcc ce cLiIc - ne:Ie cc:c ccm grcnce :uL-
ncIificcçcc em ¢uc:e Iccc pc|:.
Ccnfcrme cccc: regi:Irccc: nc: ú|Iimc: :ei: cnc: pe|c SlH/MS, c númerc
g|cLc| ce cureIcgen: pc:-cLcrIc pcrece mcnIer-:e e:Icve| nc: ú|Iimc:
Irë: cnc: {Cuccrc 1).
17
ASSISTÊNCIA À MULHER COM ABORTAMENTO E NO PÓS-ABORTO
147
Quadro 1 - Número de curetagens pós-aborto realizadas no âmbito dos
serviços públicos e conveniados
Fonte: SIH/SUS, MS
/ incicëncic ce cLcrIc: nc ccc|e:cëncic ccn:IiIui IcmLem grcnce
preccupcçcc :ccic|. Dc IcIc| cc: inIerncçce: pcr cLcrIcmenIc nc
SlH/SUS nc cnc ce 1ºº8, 22,57 ercm ce ccc|e:cenIe:. C cIencimenIc
receLicc pe|c: ccc|e:cenIe: nc: :erviçc: ce :cúce é in:cIi:fcIcric. Sem
cpcic e cccn:e|hcmenIc cce¢uccc:, ccm fre¢üëncic, e:Ic: jcven:
engrcviccm ncvcmenIe, enIrcncc num cic|c repeIiIivc ce grcvicez-
cLcrIcmenIc.
/: mecicc: nece::cric: c recuçcc cc grcvicez ncc p|cnejccc cu
ince:ejccc inc|uem crienIcçce: :egurc: nc cIençcc pc:-cLcrIcmenIc,
nc crienIcçcc cnIiccncepcicnc|, civu|gcçcc e cferIc cc impcrIcncic cc
cnIiccncepçcc ce emergëncic e gcrcnIic ce :upcrIe p:icc|cgicc e
:ccic| ¢ucncc nece::cric.
C: inciccccre: ce :cúce mcIernc cemcn:Ircm ¢ue c c::i:Iëncic cc
cLcrIcmenIc ncc cpre:enIc ¢uc|iccce ccmpcI|ve| ccm c: recur:c:
ci:pcn|vei:. Fcr i::c, c cmp|icçcc cc cce::c ceve ccminhcr junIc c
¢uc|ificcçcc cc rece jc in:Ic|ccc.
QbALIDADE DA AIENÇÃO AO A8OkIAMENIO E NO FÓS-
A8OkIO
Conce|tuondo o quo||dode do otençõo
/ ¢uc|iccce nc cIençcc cc cLcrIcmenIc e pc:-cLcrIc ceve :er
ccmpreencicc ccmc um ccnjunIc ce cçce: cferecicc c mu|her curcnIe
e cpc: c inIerrupçcc ce umc ge:Icçcc, ¢uer e:pcnIcnec cu incuzicc,
e:Iencencc-:e cIé c 42º cic cpc: c Iérminc cc grcvicez. Fcrc e:Ie fim,
ccn:icerc-:e cLcrIcmenIc inIerrupçcc cc grcvicez cIé 22 :emcnc: cu,
:e c iccce ge:Iccicnc| fcr ce:ccnhecicc, ccm c prccuIc cc ccncepçcc
pe:cncc menc: ce 500 grcmc: cu mecincc menc: ce 1ó cm.
/ ¢uc|iccce cc cIençcc imp|icc num e:fcrçc inIegrccc e :inérgicc ce
Iccc: c: n|vei: ge:Icre: pcrc c cferIc ce :erviçc: ¢ue gcrcnIcm:
ccc|himenIc, infcrmcçcc, cccn:e|hcmenIc, ccmpeIëncic prcfe::icnc|,
Iecnc|cgic cprcpriccc ci:pcn|ve| e re|ccicncmenIc pe::cc| pcuIccc nc
re:peiIc c cigniccce e cc: cireiIc: :exuci: e reprccuIivc:.
Ge:Icre:, gerenIe:, prcfi::icnci: ce :cúce e funcicncric: cc rece
c::i:Iencic|, gucrcccc: c: ciferençc: ce :uc: funçce: e cIriLuiçce:
e:pec|ficc:, :cc cc-re:pcn:cvei: nc ccn:Iruçcc e nc cprimcrcmenIc
17
ASSISTÊNCIA À MULHER COM ABORTAMENTO E NO PÓS-ABORTO
148
ccnI|nuc cc ¢uc|iccce cc cIençcc c mu|her em prcce::c ce
cLcrIcmenIc e nc pc:-cLcrIc.
C cce::c c :erviçc: ce ¢uc|iccce permiIe ¢ue c mu|her re:c|vc c
prcL|emc e enccnIre cpcic nc Lu:cc ce :c|uçce: incivicuci: pcrc
ccncuzir c :eu prcce::c reprccuIivc ccm cuIcncmic e :egurcnçc.
Constru|ndo o quo||dode do otençõo
1. Aco|h|mento
Ccmc ccc|her umc mu|her ¢ue cLcrIc° Ccm ¢ue c|hcr° Ccm ¢ue
cIiIuce° Cuc| c me|hcr mcneirc ce cjucc-lc c ncc repeIir c :iIucçcc em
¢ue :e enccnIrc° / eviIcr c: ri:cc: ce um cLcrIcmenIc em ccnciçce:
in:egurc:° Fef|eIir :cLre e::c: ¢ue:Ice: é e::encic| pcrc ¢ue :e cperem
muccnçc: nc: :erviçc: ce :cúce, vi:cncc cc ccc|himenIc e IrcIcmenIc
re:peiIc:c c: mu|here: e :uc: ceci:ce:. l:Ip cemcncc um exerc|cic
ccn:IcnIe ce ref|excc :cLre c inf|uëncic cc: prcpric: vc|cre: {mcrci:,
éIicc:, re|igic:c:) nc prcIicc prcfi::icnc|, reccnhecimenIc e cceiIcçcc
cc: prcpric: |imiIe: e cc: ciferençc: ¢ue ccrccIerizcm c :ccieccce
humcnc, c ¢ue ncc :e cLIém cpenc: pcr fcrçc cc vcnIcce. Fccem
cjuccr ne:Ic ref|excc c: ci:cu::ce: cc|eIivc:, civicir preccupcçce:,
ccnfrcnIcr e cnc|i:cr cIiIuce: e ccncuIc: nc prcpric e¢uipe ce IrcLc|hc,
cu em grupc: inIerin:IiIucicnci:, reunice: e cficinc: ce :en:iLi|izcçcc e
ccpcciIcçcc. É impcrIcnIe IcmLém ci:cuIir c: prcpric: cificu|ccce:
frenIe c :exuc|iccce e c: prcIicc: reprccuIivc:.
CcmenIcric: ce:re:peiIc:c: e ccnc|u:ce: precipiIccc: cevem :er
Lcnicc: cc cic c cic cc: :erviçc:. / ci:cu::cc cc|eIivc e c repen:cr
ccIicicnc ce cccc inciv|cuc pccercc eviIcr ju|gcmenIc: e cIiIuce:
preccnceiIuc:c: :cLre c ccmpcrIcmenIc reprccuIivc cc: mu|here: e/cu,
pe|c menc:, errcciccr prcIicc: ccncencvei: e cnIi-éIicc: nc cferIc ce
:erviçc:, ccmc c: puniçce: e cc:Iigc: impc:Ic: c muiIc: mu|here: ¢ue
cLcrIcm, nc: :erviçc: púL|icc:.
2. In|ormoçöes e oconse|homento
Nc mcicric cc: cc:c: ce cLcrIcmenIc, c mu|her ncc ce:ejc cuIrc
grcvicez imecicIcmenIe cpc: e c crienIcçcc :cLre cnIiccncepçcc é
cL:c|uIcmenIe nece::cric. Dc me:mc mccc, c e¢uipe ceve e:Icr
prepcrccc pcrc crienIcr c¢ue|c: mu|here: ¢ue ce:ejcm cuIrc grcvicez,
:ejc nc¢ue|e :erviçc cu enccminhcncc-c pcrc uniccce: ce referëncc.
Ccm fre¢üëncic, nc pc:-cLcrIcmenIc, c: mu|here: preci:cm ce umc
e¢uipe ¢ue ccmpreencc :uc: nece::iccce:, ncc :cmenIe f|:icc:, mc:
IcmLém :ccici: e p:icc|cgicc:. E::e cpcic cjuccrc c mu|her c enIencer
c: pc::|vei: :ignificccc: cc cLcrIcmenIc, ¢ue, muiIc: veze:, :e Irccuzem
pcr fru:Ircçcc e :en:cçcc ce inccpcciccce ce engrcviccr ncvcmenIe.
Em cuIrc: :iIucçce:, c :enIimenIc ce cu|pc pcce :er ccmincnIe. Deve-:e
reccnhecer IcmLém ¢ue hc mu|here: ¢ue :enIem c||vic, cu
:imp|e:menIe e:Icc Ircn¢üi|c:, mc:
17
ASSISTÊNCIA À MULHER COM ABORTAMENTO E NO PÓS-ABORTO
149
nem :empre e:Icc c vcnIcce pcrc expre::cr |ivremenIe :uc: recçce: cu
:enIimenIc:. Fcrc ¢ue :ejc pc::|ve| fc|cr, é preci:c ¢ue hcjc c|guém
ccpcz ce cuvir. Fcr i::c, umc Lcc ccpcciccce ce e:cuIc, :em pré-
ju|gcmenIc:, pcrece :er c principc| in:IrumenIc c :er uIi|izccc pe|c:
prcfi::icnci: ce :cúce.
C cic|cgc :cIi:fcIcric cLIicc curcnIe c cIencimenIc prcpcrcicncrc c:
mu|here: ccnciçce: pcrc ceci:ce: fuIurc: em re|cçcc c :uc :cúce, em
e:pecic| cc :eu fuIurc reprccuIivc.
3. Acesso oos serv|ços
Nc crgcnizcçcc cc rece c::i:Iencic|, ceve-:e ccn:icercr c pre:ençc ce
¢uccrc e|emenIc: ¢ue gcrcnIircc c cce::c cc mu|her cu ccc|e:cenIe
cc: :erviçc:, ¢uci: :ejcm:
• exi:Iëncic ce :erviçc: ce urgëncic ¢ue pc::cm IrcIcr c: mu|here:
cc: ccmp|iccçce: cc cLcrIc e:pcnIcnec cu incuzicc
• pre:ençc ce :erviçc: ce p|cnejcmenIc fcmi|icr nc: |ccci: ce
cIencimenIc c: urgëncic: ce cL:IeIr|cic
• re|cçcc fcrmc|izccc enIre c: :erviçc: ce urgëncic e ce cIençcc
inIegrc| c :cúce cc mu|her
• infcrmcçcc ccnIinuccc pcrc c: u:ucric: :cLre c: :erviçc:
ci:pcn|vei:
4. Integroçõo do rede oss|stenc|o|
/: mu|here: cevem ci:pcr ce umc rece ce :erviçc: ¢ue pc::c pre:Icr
cIencimenIc cce¢uccc cicnIe ce um ¢uccrc ce cLcrIcmenIc, e e:Ic
rece ceve uIi|izcr um :i:Iemc efeIivc ce referencc e ccnIrc-referëncic,
re:peiIcncc c: ccnciçce: :ccici: e eccncmicc: cc: mu|here:. /
inIegrcçcc cc: :erviçc: ce urgëncic ccm :erviçc: ce p|cnejcmenIc
fcmi|icr ceve fczer pcrIe cc ¢uc|iccce cc cIençcc cc cLcrIcmenIc e
pc:-cLcrIc.
5. Competënc|o pro||ss|ono|
/|ém cc hcLi|iccce nc Iécnicc empregccc pcrc c e:vczicmenIc
uIerinc, c ccmpeIëncic :e e:Ience cc Lcm u:c ce e¢uipcmenIc:,
in:IrumenIc| e meciccmenIc:, c::im ccmc nc cefiniçcc ce rcIinc: e
Iécnicc: ncc evc:ivc:, vi:cncc cc Lem e:Icr cc mu|her e permiIincc :uc
pcrIicipcçcc nc e:cc|hc cc: prccecimenIc: mci: cprcpriccc: pcrc
re:c|uçcc cc prcL|emc. /¢ui IcmLém :e inc|ui c ¢uc|ificcçcc pcrc
e:IcLe|ecimenIc ce um pccrcc e|evccc ce re|ccicncmenIc inIerpe::cc|,
cLcrccgem :ccic| e p:icc|cgicc ce cccc mu|her, :uc fcm||ic cu
cccmpcnhcnIe.
ó. Iecno|og|o opropr|odo
/ me|hcric cc cIencimenIc impce c uIi|izcçcc ce Iecnc|cgic cprcpriccc
pcrc prcmcver c e:vczicmenIc uIerinc, ¢ucncc e:Ic
17
ASSISTÊNCIA À MULHER COM ABORTAMENTO E NO PÓS-ABORTO
150
:iIucçcc fcr nece::cric. / reIirccc cc: re:Ic: cvu|cre: pcce :er feiIc
uIi|izcncc-:e c Iécnicc ce c:pircçcc mcnuc| inIrc-uIerinc {/MlU) nc:
cc:c: ce cLcrIcmenIc cIé 12 :emcnc:, nc ¢uc| c uIi|izcçcc ce ccnu|c:
f|ex|vei: ce cc|iLre unifcrme ciminui c: ri:cc: ce ccmp|iccçce:. Em muiIc:
cc:c:, ¢ucncc ccnvenienIemenIe cp|icccc e prececicc ce
e:c|crecimenIc: e cc L|c¢ueic pcrccervicc|, ci:pen:c c uIi|izcçcc ce
cne:Ie:ic gerc|, prcpcrcicncncc mcicr :egurcnçc e cc|cLcrcçcc cc
mu|her, c|ém ce :e pccer cferecer umc c|Ic mci: preccce, ccm
ccn:e¢üenIe ciminuiçcc cc: cu:Ic:. Cucncc ncc ci:pcn|ve|, cu nc
cu:ëncic ce pe::cc| Ireinccc ne:Ic Iécnicc, pcce-:e prcmcver c
e:vczicmenIc cIrcvé: cc cureIcgem uIerinc.
CLASSIFICAÇÃO E CONDbIA
1. Ameoço de Abortomento
C :cngrcmenIc geniIc| é ce pe¢uenc inIen:iccce, ccm cu :em ccre:
{cc|icc:) ¢ue pccem :er ce inIen:iccce vcricve|, gerc|menIe pcucc
inIen:c:. C excme e:pecu|cr evicencic ¢ue c :cngrcmenIc f|ui cIrcvé:
cc cérvice, e e:Ic cpre:enIc c crif|cic inIernc fechccc. C UIerc Iem c
Icmcnhc ccrre:pcncenIe cc e:perccc e ncc hc :inci: ce infeçcc. C
excme ce u|Irc-:cncgrcfic mc:Irc-:e ncrmc|.
Ne:Ie: cc:c:, ncc hc inciccçcc ce inIerncçcc hc:piIc|cr e c mu|her
ceve receLer crienIcçce: pcrc uIi|izcr cnc|gé:icc: :e cpre:enIcr ccr,
fczer repcu:c e reIcrncr cc cmLu|cIcric ce pré-ncIc|. Nc: cc:c: ce
:cngrcmenIc inIen:c, cevem-:e cvc|icr c: n|vei: ce hemcg|cLinc,
icenIificcr c Iipc :cngü|nec, :e fcr ce:ccnhecicc, e cferecer :crc|cgic:
pcrc :|fi|i: e HlV.
2. Abortomento Comp|eto
Gerc|menIe em ge:Icçcc ccm iccce ge:Iccicnc| infericr c 8 :emcnc:. C
:cngrcmenIc e c: ccre: ciminuem cpc: c expu|:cc cc mcIeric| cvu|cr. C
crif|cic cervicc| inIernc pcce cincc e:Icr cLerIc. C úIerc Iem cimen:ce:
infericre: cc e:perccc pcrc c iccce cc ge:Icçcc. / u|Irc-:cncgrcfic
mc:Irc ccviccce uIerinc vczic cu cpenc: ccm imcgen: :uge:Iivc: ce
cccgu|c:.
/ ccncuIc ceve :er expecIcnIe, ccm cIençcc c per:i:Iëncic cc
:cngrcmenIc ¢ue pcce :ugerir re:Ic: cvu|cre:, e ccm c :urgimenIc ce
¢uccrc infeccic:c pé|vicc. Ne:Ie: cc:c:, reccmencc-:e /MlU cu
cureIcgem uIerinc. Sc|iciIcr Iipcgem :cngü|nec e :crc|cgic: pcrc :|fi|i: e
HlV, cpc: ccn:enIimenIc. Se fcr Fh negcIivc e ncc hcuver cincc
:en:iLi|izcçcc, fcz-:e cLrigcIcric c ccmini:Ircçcc cc imuncg|cLu|inc cnIi-
D.
3. Abortomento Inev|tóve| e Incomp|eto
/ percc :cngü|nec é mcicr ¢ue nc cmecçc ce cLcrIcmenIc, pccencc
cccrrer c e|imincçcc ce cccgu|c:. E:Ic percc gerc|menIe ciminui cpc: c
e|imincçcc cc mcIeric| cvu|cr, principc|menIe :e fcr
17
ASSISTÊNCIA À MULHER COM ABORTAMENTO E NO PÓS-ABORTO
151
ccmp|eIc. /: ccre: Iëm inIen:iccce mcjcr ¢ue c cmecçc, e c crif|cic
cervicc| inIernc enccnIrc-:e cLerIc, pccencc :er icenIificccc mcIeric|
cvu|cr. / u|Irc-:cncgrcfic fcz c cicgnc:Iicc ciferencic| enIre e|e:.
Cucncc c ge:Icçcc Iem menc: ce 12 :emcnc:, e:Ic incicccc c
c:pircçcc mcnuc| inIrc-uIerinc {/MlU). Cucncc c :erviçc ce :cúce ncc
ci:pu:er ce:Ie prccecimenIc, pcce-:e rec|izcr c cureIcgem uIerinc. É
inci:pen:cve| ceIermincr c Iipc :cngü|nec cc mu|her. Se fcr Fh negcIivc
e ncc hcuver cincc :en:iLi|izcçcc, fcz-:e cLrigcIcric c ccmini:Ircçcc cc
imuncg|cLu|inc cnIi-D. Sencc c :|fi|i: umc cc: ccu:c: ce cLcrIcmenIc,
ceve-:e rec|izcr c :crc|cgic e prcmcver :eu IrcIcmenIc ¢ucncc pre:enIe:
ceve-:e IcmLém cferecer c :crc|cgic pcrc HlV.
Em ge:Icçce: ccimc ce 12 :emcnc:, ccm ccncepIc nc ccviccce
uIerinc, reccmencc-:e c infu:cc ce cciIccinc pcrc prcmcver :uc
expu|:cc cu c cc|cccçcc cc mi:cprc:Ic| nc funcc ce :ccc vcginc|, nc
cc:e ce 200 mcg c cccc ó hcrc:. /pc: expu|:cc, ceve-:e rec|izcr c
cureIcgem uIerinc.
4. Abortomento ket|do
C cLcrIcmenIc reIicc pcce ncc :er prececicc ce cmecçc ce
cLcrIcmenIc. Hc regre::cc cc: :inci: e :inIcmc: cc grcvicez. C crif|cic
cervicc| enccnIrc-:e fechccc e gerc|menIe ncc hc hemcrrcgic. C
excme ce u|Irc-:cncgrcfic reve|c prccuIc cc ccncepçcc :em viIc|iccce
cu :uc cu:ëncic {cvc cegc).
Cucncc c ge:Icçcc Iem menc: ce 12 :emcnc:, ceve-:e prccecer cc
e:vczicmenIc pe|c Iécnicc ce c:pircçcc mcnuc| inIrc-uIerinc e, :e
nece::cric, rec|izcr ci|cIcçcc cervicc| ccm ci|cIcccre:, cu rec|izc-:e
cureIcgem uIerinc, Iencc-:e c cuicccc pcrc ncc prcvcccr ccicenIe:,
principc|menIe perfurcçcc uIerinc.
Cucncc c ge:Icçcc Iem mci: ce 12 :emcnc:, é nece::cric prcmcver c
ci|cIcçcc cervicc| e expu|:cc cc prccuIc ccncepIuc|. Fcrc IcnIc, uIi|izc-
:e c mi:cprc:Ic| vcginc| nc cc:e ce 200 mcg c cccc ó hcrc:, cu infu:cc
enccvenc:c ce cciIccinc, ccm 5 cmpc|c: ce 5 uniccce:, inicicncc c
gcIejcmenIc ccm 8 gcIc: pcr minuIc. Nc: cc:c: em ¢ue c cLiIc cccrreu
hc mci: ce 4 :emcnc:, pcce cccrrer ¢uccrc ce ci:IúrLic cc cccgu|cçcc,
pcrIcnIc ceve-:e e:Icr cIenIc c cuIrc: :cngrcmenIc: cncrmci:,
:c|iciIcncc-:e prcvc: |cLcrcIcrici: ce cccgu|cçcc ¢ucncc exi:Iir e:Ic
:u:peiIc. / icenIificcçcc ce ge:IcnIe Fh negcIivc é inci:pen:cve| pcrc
eviIcr c c|cimunizcçcc. / :crc|cgic pcrc :|fi|i: ceve :er rcIinc e pcrc HlV
ceve :er cferecicc.
5. Abortomento In|ectodo
Gerc|menIe cccrre cpc: mcnipu|cçcc pcrc incuzir c inIerrupçcc cc
grcvicez e :cL mc: ccnciçce: Iécnicc:. /: infeçce: :cc, pc|imicrcLicnc:
e ¢uc:e :empre ccm LccIéric: cc prcpric f|crc vcginc|. C ¢uccrc é
grcve e re¢uer cuicccc imecicIc. Deve-:e ccn:icercr, em Iccc: c: cc:c:,
c prccuIc cc ccncepçcc ccmc ncc
17
ASSISTÊNCIA À MULHER COM ABORTAMENTO E NO PÓS-ABORTO
152
Iencc viIc|iccce. C ¢ue mci: chcmc cIençcc nc ¢uccrc c||nicc é
:cngrcmenIc ccm cccr féIicc, cccmpcnhccc ce ccr cLccminc| feLre.
C pu|:c enccnIrc-:e cce|erccc e c feLre fre¢üenIemenIe cIinge mci: ce
38º C. Fccem-:e icenIificcr cc|eçce: nc: funcc: ce :ccc e, cc :er
excminccc, c pccienIe refere Lc:IcnIe ccr c mcnipu|cçcc cc: crgcc:
pé|vicc:. / pc::iLi|iccce ce perfurcçcc uIerinc e ce c|çc: inIe:Iinci: ceve
:er :empre |emLrccc. Cucncc in:Ic|ccc ¢uccrc ce chc¢ue :épIicc,
|emLrcr nc eIic|cgic pcr E. cc|i, 8ccIercice: e C|c:Iricium. E:Ie cgenIe
pcce, inc|u:ive, |evcr c ¢uccrc ce cnemic hemc||Iicc fu|mincnIe e
in:uficiëncic renc|.
Excme: |cLcrcIcrici: :cc nece::cric: e ceve :er cvc|iccc c mcmenIc ce
:uc :c|iciIcçcc. C: :eguinIe: excme: pccem :er nece::cric::
• hemcgrcmc ccm ccnIcgem ce p|c¢ueIc::
• Iipcgem :cngü|nec:
• urinc Iipc l {excme ce :ecimenIc urincric):
• cc:cgen: ce uréic e crecIininc:
• cccgu|cgrcmc:
• hemccu|Iurc:
• cu|Iurc cc :ecreçcc vcginc| e cc mcIeric| enccmeIric|:
• Fx cc Icrcx e cLccme: e
• c u|Irc-:cncgrcfic e c Icmcgrcfic pccem :er nece::cric: pcrc
icenIifi ccr e ce|imiIcr cc|eçce: inIrc-ccviIcric: {cL:ce::c:).
Em Iccc: c: cc:c:, ceve-:e fczer infu:cc ce :c|uçce: pcrenIerci:, em
e:pecic| hemcIrcn:fu:cc ¢ucncc c hemcg|cLinc fcr mencr ¢ue 8 g7.
lnicicr c cnIiLicIiccIercpic ce |crgc e:pecIrc, uIi|izcncc um cncercLicicc
{meIrcnicczc| cu c|inccmicinc) e um cmincg|icc:|cec {genIcmicinc cu
cmicccinc). Se ncc hcuver re:pc:Ic, c::ccicr cmpici|inc cc e:¢uemc
cccIccc cu cmp|icr c e:pecIrc cnIiLccIericnc ccm cuIrc: cnIiLicIicc:
{Cuccrc 2).
Quadro 2
17
ASSISTÊNCIA À MULHER COM ABORTAMENTO E NO PÓS-ABORTO
153
/ e:cc|hc cc: cnIiLicIicc: ceve :er feiIc ccm c Ccmi::cc ce CcnIrc|e ce
lnfecçcc Hc:piIc|cr. Nc cc:c cc cc|c enccnIrcr-:e fechccc, ceve-:e
prccecer :uc cLerIurc ccm c uIi|izcçcc cc mi:cprc:Ic| cu cc cciIccinc,
nc: cc:e: reccmencccc: pcrc c cLcrIcmenIc reIicc. C e:vczicmenIc
uIerinc ceve :er feiIc cprcximcccmenIe cuc: hcrc: cpc: c in|cic cc
uIi|izcçcc cc: cnIiLicIicc:, pccencc-:e uIi|izcr c /MlU :e c ge:Icçcc Iiver
menc: ce 12 :emcnc: cu c cureIcgem uIerinc. Em cmLc: c: cc:c:,
ceve-:e e:Icr cIenIc cc perigc ce perfurcçcc uIerinc. Nc: cc:c: ce
cL:ce::c, e :encc e:Ie cce::|ve| pe|c cc|pcIcmic, prccece-:e e:Ic
Iécnicc. Cucncc c ¢uccrc c||nicc mc:Irc-:e grcve cu ncc hc :inci: ce
me|hcrc, ncc :e ceve ccicr c ceci:cc ce umc |cpcrcIcmic e, :e
nece::cric pcrc :c|vcr c vicc cc mu|her, rec|izcr-:e-c umc hi:IerecIcmic
ccm cu :em reIirccc cc: cnexc:.
Nc: cc:c: ce cLcrIcmenIc infecIccc, cIençcc ceve :er cccc c: funçce:
viIci:, em e:pecic| cc funcicncmenIc cc: rin:. C :eguimenIc cc ¢uccrc
infeccic:c ceve :er c||nicc e |cLcrcIcric|. DeIc|he: ccicicnci: :cLre e:Ic
ccnciçcc pccem :er enccnIrccc: nc mcnuc| ¨Urgëncic: e Emergëncic:
McIernc:. Guic pcrc cicgnc:Iicc e ccncuIc em :iIucçce: ce ri:cc ce
mcrIe mcIernc¨ cc Mini:Iéric cc Scúce {MS, 2000).
ó. Abortomento em s|tuoçõo de r|sco poro o gestonte - oborto
teropëut|co
/: ge:IcnIe: ¢ue e:Icc :encc cIencicc: em cmLu|cIcric cu prccurcm c
hc:piIc| ccm ccençc: grcve: ceverc :er cvc|iccc: pcr cci: cL:IeIrc: e
pcr um e:pecic|i:Ic nc pcIc|cgic ¢ue e:Ic mcIivcncc c inIerrupçcc cc
ge:Icçcc. Fcrc rec|izcçcc cc cLcrIc cu cnIecipcçcc cc pcrIc, é
cLrigcIcric ¢ue c mu|her e/cu :eu: fcmi|icre: e:Iejcm infcrmccc:,
Ienhcm :uc: cúvicc: e:c|crecicc: e cuIcrizem c prccecimenIc.
É impcrIcnIe ¢ue umc e¢uipe mu|Iiprcfi::icnc| pre:Ie cIencimenIc c e:Ic
mu|her, pc:Ic ¢ue nc inIerrupçcc cc grcvicez mcIivccc pe|c
cgrcvcmenIc cc :eu e:Iccc ce :cúce, c cpcic p:icc|cgicc é
funccmenIc| nc cIencimenIc. Ncc é nece::cric ccmuniccr cc Ccn:e|hc
Fegicnc| ce Mecicinc, mc: é impcrIcnIe ncIificcr c Ccmi::cc ce ÉIicc cc
hc:piIc| cnce :erc rec|izccc c prccecimenIc. Fcrc mcicre:
e:c|crecimenIc:, ccn:u|Icr c mcnuc| Iécnicc ce Ge:Icçcc ce /|Ic Fi:cc
{MS, 2000).
7. Abortomento pos-estupro
Nc ccnciçcc ce grcvicez pcr e:Iuprc, ¢ucncc c ge:IcnIe prccurc c
hc:piIc|, e|c ceverc :er cvc|iccc pe|c e¢uipe ce p|cnIcc, ¢ue ceverc
e:Icr hcLi|iIccc c rec|izcr c cIencimenIc ce rcIinc pcrc e:Ic
circun:Icncic, ccnfcrme ncrmc e:pec|ficc cc Mini:Iéric cc Scúce, cu pcr
umc e¢uipe ce referëncic pcrc cIencimenIc c mu|here: em :iIucçcc ce
vic|ëncic. Deverc :er feiIc c cLerIurc ce prcnIucric, :c|iciIcçcc ce
excme:, enccminhcmenIc: e pre:criçce: mécicc: incicccc: c :iIucçcc.
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ASSISTÊNCIA À MULHER COM ABORTAMENTO E NO PÓS-ABORTO
154
Se c mu|her ce:ejc inIerrcmper c grcvicez, e|c ceverc cpre:enIcr c
8c|eIim ce Cccrrëncic Fc|icic| {8CF), cLIicc nc De|egccic ce Fc||cic cc
pre:Icr ¢ueixc. Cc:c ncc c Ienhc feiIc cIé c mcmenIc, e|c ceverc :er
crienIccc, pe|c :erviçc, c fczë-|c imecicIcmenIe. Feccmencc-:e :c|iciIcr
c regi:Irc cc cIencimenIc mécicc pcr ccc:icc cc vic|ëncic :cfricc e c
|cucc cc ln:IiIuIc Mécicc Legc|, ¢ucncc ci:pcn|ve|. Ncc é nece::cric c
cuIcrizcçcc jucicic| pcrc c cLcrIcmenIc em cc:c ce e:Iuprc, ccnfcrme
c crIigc 128 cc cccigc penc| Lrc:i|eirc, ¢ue exige cpenc: c
ccn:enIimenIc cc ge:IcnIe.
/ cncmne:e ginecc|cgicc Iem ccmc finc|iccce cLIer infcrmcçce: :cLre
c ccIc cc e:Iuprc, c ú|Iimc per|ccc men:Iruc| e :e c mu|her uIi|izcu
c|gumc meciccçcc cpc: c cccrricc. C excme ginecc|cgicc ceve
rc:Irecr |e:ce: nc vu|vc e vcginc e c excme ce Ic¢ue men:urcr c vc|ume
uIerinc e c Iempc prcvcve| cc ge:Icçcc. /|ém ce :uLmeIicc cc:
excme: rcIineirc: {:crc|cgic: pcrc :|fi|i:, HlV e hepcIiIe, Iipcgem
:cngü|nec/ fcIcr Fh), c ge:IcnIe :erc enccminhccc c excme ce u|Irc:cm
pcrc cicgnc:Iicc cc iccce ge:Iccicnc|. E::e: cccc:, cvc|iccc: em
ccnjunIc, pccem inciccr ccm rczccve| preci:cc ¢ue c grcvicez
ccrre:pcnce cc mcmenIc cc e:Iuprc.
Freferencic|menIe c ge:Icçcc ceve :er inIerrcmpicc cIé c 12º :emcnc,
pcrém, ccm :upcrIe cce¢uccc, cIé 20 :emcnc:. C prccecimenIc :erc
rec|izccc ccm cuIcrizcçcc expre::c cc pccienIe ¢ue c::incrc
ccn:enIimenIc infcrmccc e, em cc:c ce mencr ce 14 cnc: cu inccpcz,
e:Ie prccecimenIc :erc cuIcrizccc pe|c: pci: cu re:pcn:cvei: |egci:.
Deve-se ev|tor que todo o equ|pe |oço os mesmos perguntos poro o
mu|her, sendo necessór|o que um ùn|co prontuór|o sejo ut|||zodo oté o
||no| do otend|mento. O tempo decorr|do entre o pr|me|ro otend|mento e
o |nterrupçõo do gestoçõo nõo deve ser super|or o 7 d|os. Apos o
proced|mento, o poc|ente deveró cont|nuor recebendo or|entoçõo
méd|co, ps|co|og|co e soc|o|.
C prccecimenIc pcrc inIerrupçcc cc ge:Icçcc ceverc :er e:cc|hicc
pe|c e¢uipe mécicc. Cucncc :e IrcIcr ce cricnçc:, c cne:Ie:ic ceve :er
gerc| e c prccecimenIc rec|izccc ccm c:pircçcc cc ccviccce uIerinc,
vi:cncc um mencr IrcumcIi:mc cc cc|c uIerinc curcnIe c prcce::c ce
ci|cIcçcc. / inIerrupçcc cc grcvicez pcce :er feiIc cIrcvé: cc c:pircçcc
mcnuc| inIrc-uIerinc {/MlU), ccm cne:Ie:ic pcrc-cervicc|, ccnferincc c
e:Ie prccecimenIc ccrcIer cmLu|cIcric|, permiIincc, c::im, ¢ue c
pccienIe ceixe c hc:piIc| cpc: umc cu cuc: hcrc:. / ci|cIcçcc e
cureIcgem uIerinc :cc c|IerncIivc: ¢ue c mcicric cc: hc:piIci: Lrc:i|eirc:
uIi|izcm, :encc nece::cric, ne:Ie: cc:c:, c jejum c|imenIcr pcr nc m|nimc
8 hcrc:, cne:Ie:ic gerc| cu L|c¢ueic: e:pinci:.
Nc: ge:Icçce: ccimc ce 12 :emcnc:, pccercc :er rec|izccc: c prepcrc e
c ci|cIcçcc cc cc|c uIerinc ccm mi:cprc:Ic| nc cc:e ce 200mcg pcr vic
vcginc|, repeIicc c cccc ó hcrc:, cIe c e|imincçcc cc
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ASSISTÊNCIA À MULHER COM ABORTAMENTO E NO PÓS-ABORTO
155
prccuIc ccncepIuc|, e pc:Iericr cureIcgem uIerinc. É impcrIcnIe ¢ue
frcgmenIc: cc mcIeric| feIc| cu p|ccenIcric :ejcm cccncicicnccc: e
mcnIicc: em freezer pcrc excme ce DN/, nc cc:c cc Ju:Iiçc nece::iIcr.
/ pccienIe ceve :er cvi:ccc ce:Ie prccecimenIc. Em Iccc: c: cc:c:,
reccmencc-:e um reIcrnc cc :erviçc, pcrc cvc|icçcc c||nicc e
cccmpcnhcmenIc p:icc|cgicc.
Fre:Icncc cIencimenIc cce¢uccc c: mu|here: ccm :c|iciIcçcc ce
cLcrIc previ:Ic pcr |ei, e:Icrc :encc minimizccc c :cfrimenIc ce:Ic:
mu|here: e prcpcrcicnccc :uc reinIegrcçcc :ccic|. Mcicre:
e:c|crecimenIc: :cLre e:Ic :iIucçcc e c ncrmcIizcçcc cc: :erviçc: ¢ue
pre:Icm c::i:Iëncic: c: mu|here: v|Iimc: ce vic|ëncic :exuc|, pccem :er
cLIicc: nc ncrmc Iécnicc cc Mini:Iéric cc Scúce, Frevençcc e
IrcIcmenIc cc: /grcvc: Fe:u|IcnIe: cc Vic|ëncic Sexuc| ccnIrc Mu|here:
e /cc|e:cenIe: {MS, 1ººº).
8. Interrupçõo do grov|dez em cosos de mo||ormoçõo |eto| grove
ou |ncompotíve| com o v|do
Cucncc umc ge:IcnIe cemcncc inIerrupçcc ce grcvicez cc :er
cicgnc:Iicccc umc pcIc|cgic feIc| grcve cu ¢ue ccrccIerizc
inccmpcIiLi|iccce ccm c vicc, pcrc ¢ue c pecicc :ejc cIencicc, é
nece::cric c cuIcrizcçcc jucicic|. / c::i:IenIe :ccic| cu cuIrc memLrc cc
e¢uipe ceverc crienIcr c ge:IcnIe, :eu ccmpcnheirc e/cu fcmi|icre: c
prccurcrem c Mini:Iéric FúL|icc nc munic|pic, :c|iciIcncc cuIcrizcçcc
pcrc rec|izcçcc cc prccecimenIc. E nece::cric cincc ¢ue c e¢uipe
fcrneçc um |cucc mécicc, exp|iccncc c: ccnciçce: cc grcvicez ¢ue
ju:Iifi¢uem :uc inIerrupçcc, c::im ccmc pc::|vei: ccnc: pcrc c :cúce
f|:icc e menIc| cc mu|her em cc:c ce evc|uçcc cIé c finc| cc ge:Icçcc.
C: prccecimenIc: pcrc inIerrupçcc :ercc ceIerminccc: pe|c Iempc ce
ge:Icçcc.
FLANEJAMENIO FAMILIAk FÓS-A8OkIAMENIO
C: :erviçc: ce :cúce ¢ue cIencem urgëncic: cL:IéIricc: ncc pccem
percer c vc|ic:c cpcrIuniccce ce infcrmcr c: mu|here: :cLre c uIi|izcçcc
ce méIccc: cnIiccncepcicnci:. C: e:c|crecimenIc: e c cferIc ce
méIccc: cevem :er cmp|c:, pcrc ¢ue c mu|her pc::c e:cc|her c ¢ue
me|hcr :e cccpIc c: :uc: ccnciçce: c||nicc:, :ccici:, eccncmicc: e :eu:
ri:cc: reprccuIivc:. Deve-:e infcrmcr c mu|her ¢ue :uc fecunciccce
pccerc :er ree:IcLe|ecicc cnIe: cc cpcrecimenIc ce ncvc
men:Irucçcc, pccencc e:Icr cpIc c engrcviccr em Icrnc ce 15 cic:
cpc: c cLcrIcmenIc. Feccmencc-:e c cL:Iinëncic :exuc| en¢ucnIc
exi:Iir :cngrcmenIc.
/ e:cc|hc cc méIccc ceve :er cc mu|her, cevencc c: :erviçc: ce :cúce
ci:pcr ce umc vcrieccce ce cpçce:. Nc cccn:e|hcmenIc, c cup|c-
prcIeçcc ceve :er IrcIccc ccm e:pecic| cIençcc, Iencc em vi:Ic c
cre:cimenIc cc: DSI- /lDS enIre mu|here:. / mu|her ceve :er infcrmccc
:cLre c: Lenef|cic: cc pre:ervcIivc, c::im ccmc Ireinccc pcrc :cLer
cc|ccc-|c ccrreIcmenIe.
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ASSISTÊNCIA À MULHER COM ABORTAMENTO E NO PÓS-ABORTO
156
Nc: cc:c: ce cLcrIcmenIc :em nenhumc ccmp|iccçcc, ncc hc
re:Iriçce: ce méIccc:. / mu|her pcce cpIcr pcr e:Ieri|izcçcc, injeIcvei:,
imp|cnIe:, DlU {pccencc e:Ie :er in:ericc |cgc cpc: c e:vczicmenIc
uIerinc), ccnIrccepIivc: crci: {iniciccc cenIrc cc 1 º :emcnc cpc: c
e:vczicmenIc), pre:ervcIivc: e cicfrcgmc:. Ncc :e reccmenccm c:
méIccc: ncIurci: cnIe: ce re:IcLe|ecicc: c: cic|c: men:Iruci:.
Cucncc c cLcrIcmenIc fci infecIccc cu hc cúvicc: :cLre e:Ic :iIucçcc,
cu cincc :e fci prcIicccc em ccnciçce: in:egurc:, cevem-:e cferecer c:
imp|cnIe:, injeIcvei:, ccnIrccepIivc: crci: e pre:ervcIivc:. C DlU ncc ceve
:er in:ericc / e:Ieri|izcçcc cc mu|her ceve :er pc:Iergccc pcrc um
mcmenIc pc:Iericr, ¢ucncc c ¢uccrc infeccic:c Ienhc :icc
ccmp|eIcmenIe ccnIrc|ccc.
Nc: cc:c: em ¢ue cccrreu cLunccnIe :cngrcmenIc geniIc| ¢ue |evcu c
¢uccrc ce cnemic nc mu|her, cevem-:e ccn:icercr c: crienIcçce: cccc:
nc cc:c cc cLcrIcmenIc infecIccc. Cucncc :e ci:pce cc DlU ccm
prcge:Iercnc, e:Ie pcce :er empregccc, pci: cccrrerc umc recuçcc cc
f|uxc men:Iruc|, cjuccncc nc recupercçcc hemcIc|cgicc.
Nc: cc:c: ce cLcrIc incuzicc, prcvcve|menIe c mu|her ncc ce:ejc cuIrc
grcvicez nc mcmenIc. l:Ic pcce :er ccnfirmccc nc cIencimenIc,
cfc:Icncc-:e c pc::iLi|iccce ce e|c Ier :icc fcrçccc c cLcrIcr, :ejc pe|c
fcm||ic, ncmcrccc, cu me:mc pcrc mcnIer-:e nc empregc. Ne::e: cc:c:,
c :erviçc :ccic| e c p:icc|cgic cevem cvc|icr c :iIucçcc em ccnjunIc
ccm c mu|her, cferecencc cjucc nc cmLiIc cc :cúce e infcrmcncc c:
pc::iLi|iccce: nc ccmpc cc cireiIc e cc :i:Iemc jucicicric.
Se, ce fcIc, c mu|her ncc ce:ejc cuIrc grcvicez, Iccc: c: e:fcrçc: cc
e¢uipe ce :cúce cevem enIcc :er cirigicc: pcrc c::egurcr umc ceci:cc
ccn:cienIe e Icrncr ci:pcn|vei: Iccc: c: méIccc: ccnIrccepIivc:. Nc:
mu|here: ¢ue :e enccnIrcm cn:ic:c: cu ¢ue ncc :e :enIem :egurc: em
:uc cpçcc, ceve-:e cpcicr c uIi|izcçcc ce méIccc: prcvi:cric: e gcrcnIir
c cIencimenIc ce:Ic mu|her em :erviçc ce p|cnejcmenIc fcmi|icr. Nc:
cc:c: em ¢ue c mu|her uIi|izcvc um méIccc ccnIrccepIivc e e:Ie fc|hcu,
ci:cuIir c: ccu:c: cc in:uce::c e cpcic-|c em :uc ceci:cc, prccurcncc
gcrcnIir c :uprimenIc cc méIccc e:cc|hicc.
Cucncc c pcrceirc ncc cceiIc c uIi|izcçcc cc pre:ervcIivc e :e cpce c
uIi|izcçcc ce ¢uc|¢uer méIccc pe|c mu|her, ceve-:e inc|uir e:Ie pcrceirc
nc cccn:e|hcmenIc e, ¢ucncc ncc fcr pc::|ve|, ceve-:e exp|iccr c
mu|her c: méIccc: ccnIrccepIivc: ¢ue c impecem ce ccnIrcir umc DSI.
Ne:Ie: cc:c:, prccurc-:e re:peiIcr c privcciccce cc mu|her e :uc
ceci:cc.
Cucncc c mu|her, cpc: cIencimenIc cc cLcrIcmenIc, ce:ejc
engrcviccr imecicIcmenIe, é impre:cinc|ve| IenIcr e:c|crecer c: ccu:c:
cc cLcrIcmenIc, cnIe: ce IenIcr umc ncvc ge:Icçcc. ÉLcc
17
ASSISTÊNCIA À MULHER COM ABORTAMENTO E NO PÓS-ABORTO
157
ccncuIc ne:Ie: cc:c: enccminhc-|c pcrc um :erviçc ce referëncic,
ccc:icc em ¢ue :erc feiIc umc inve:Iigcçcc mci: rigcrc:c :cLre c¢ue|c
percc.
17
158
Nc 8rc:i|, cIuc|menIe, mci: ce º07 cc: cc:c: ce /lDS
em cricnçc: e:Icc re|ccicnccc: c Ircn:mi::cc cc HlV
cc mce pcrc c fi|hc. E:Iimc-:e ¢ue 15 c 307 cc:
cricnçc: nc:cicc: ce mce: :crcpc:iIivc: pcrc c HlV
cc¢uirem e::e v|ru: nc ge:Icçcc, curcnIe c IrcLc|hc
ce pcrIc cu pcrIc, cu pcr meic cc cmcmenIcçcc.
EnIreIcnIc, hc evicëncic: ce ¢ue c mcicric cc: cc:c:
ce Ircn:mi::cc verIicc| cc HlV {ó57) cccrre mci:
IcrcicmenIe nc ge:Icçcc, principc|menIe curcnIe c
IrcLc|hc ce pcrIc e nc pcrIc prcpricmenIe ciIc.
Fc:IericrmenIe, :e c mu|her cmcmenIcr c cricnçc, hc
cincc um ri:cc ccicicnc| ce, em mécic, 157 ce
Ircn:mi::cc cc HlV pcr e::c vic.
De umc mcneirc gerc|, c c::ccicçcc cc HlV e
ge:Icçcc é ccn:icerccc umc ccnciçcc ce c|Ic ri:cc e
c::im c IrcIccc. C mcIivc funccmenIc| pe|c ¢uc| Ic|
c::unIc é cLcrcccc ne:Ic puL|iccçcc ciz re:peiIc c
e:pecic| ccnciçcc ce ci:crimincçcc :ccic| e
preccnceiIc ¢ue :cfre c mu|her HlV• curcnIe c
ge:Icçcc e c pcrIc. Ccn:icercncc ¢ue umc
cLcrccgem cce¢uccc e ccmp|eIc c mu|her HlV•
curcnIe c pré-ncIc|, c pcrIc e c puerpéric e ccpcz ce
recuzir c: ri:cc: mcIernc-infcnIi: c n|vei: muiIc prcximc:
cc: ce ge:IcnIe: ncc infecIccc:, c fre¢üëncic cc
ccnciçcc, c pc::iLi|iccce ce inIervençce: efeIivc: e c
nece::iccce ce reverIer c ci:crimincçcc :cfricc pcr
e:Ic: mu|here:, ju:Iificcm e:Ic ceci:cc. /: mu|here:
ccm HlV merecem, ccmc Iccc: c: mu|here:, um
IrcIcmenIc humcnizccc e IecniccmenIe ccrreIc.
Em 1ºº4, c: re:u|Iccc: cc prcIccc|c 07ó cc /lDS
C||nicc| Iric|: Grcup {/CIG) ccmprcvcrcm ¢ue c
ziccvucinc {c /…I) pcce recuzir c Ircn:mi::cc verIicc|
cc HlV em ó7,57, ¢ucncc u:ccc:
• pe|c mu|her, curcnIe c ge:Icçcc {/…I-ccp:u|c:
nc cc:e cicric ce 500 mg c ó00 mg, VC, c pcrIir
cc 14º :emcnc cIe c pcrIc):
• pe|c mu|her nc IrcLc|hc ce pcrIc e pcrIc {/…I -
injeIcve|, ver c e:¢uemc): e
• pe|c recém-nc:cicc {/…I - :c|uçcc crc|, ver c
e:¢uemc).
18
ASSISTÊNCIA À MULHER PORTADORA DO HIV
DURANTE O PARTO E PUERPÉRIO
ASSISTÊNCIA À MULHER PORTADORA DO HIV DURANTE O PARTO E PUERPÉRIO
159
Ccm c cLjeIivc ce verificcr c ri:cc ce Ircn:mi::cc mcIernc-infcnIi| cc HlV
em mu|here: ¢ue ncc Iivercm :eu cicgnc:Iicc em Iempc ce u:cr c
prcIccc|c cc /CIG 07ó ce fcrmc ccmp|eIc, cuIrc: e:Iucc: vëm :encc
rec|izccc: e Iccc: cemcn:Ircrcm ¢ue c u:c cc /…I, me:mc curcnIe um
curIc per|ccc ce Iempc, |evc c ciminuiçcc cc ri:cc ce::c Ircn:mi::cc,
re::c|Icncc ¢ue, pcr e::e mcIivc, Iccc: c: enccnIrc: ccm c ge:IcnIe,
pcrIurienIe cu puérperc, repre:enIcm umc cpcrIuniccce pcrc c
cferecimenIc cc Ie:Ie cnIi-HlV e cevem :er cprcveiIccc:.
C /…I injeIcve| e c /…I :c|uçcc crc| pcrc c recém-nc:cicc, cevem :er
ccmini:Irccc: incepencenIemenIe cc e:¢uemc cnIi-reIrcvirc| uIi|izccc
pe|c mu|her curcnIe c ge:Icçcc.
1. O Aconse|homento poro o teste ont|-HIV
Fe|c: rczce: ccimc refericc:, c Mini:Iéric cc Scúce reccmencc ¢ue :ejc
cferecicc c Ie:Ie cnIi-HlV c Iccc ge:IcnIe, ccm cccn:e|hcmenIc pré e
pc:-Ie:Ie, incepencenIemenIe cc :iIucçcc ce ri:cc cc mu|her pcrc c
infecçcc pe|c HlV. C Ie:Ie, enIreIcnIc, ceve :er vc|unIcric e ccnficencic|.
Nc: cc:c: ce ge:IcnIe: pre:Ie: c enIrcr em IrcLc|hc ce pcrIc, cu jc em
IrcLc|hc ce pcrIc, cu me:mc nc puerpéric imecicIc, e ¢ue ncc Ienhcm
:icc cccn:e|hccc: e Ie:Iccc: pcrc c HlV nc pré-ncIc| {cu cujc re:u|Iccc
ncc e:Iejc ci:pcn|ve|), c cccn:e|hcmenIc pccerc :er rec|izccc ne::c
cpcrIuniccce, cevencc, e:pecic|menIe ne::e: cc:c:, :er |evccc em
ccn:icercçcc c perfi| p:icc|cgicc e emccicnc| cc mu|her,
prcpcrcicncncc-lhe cpcic cce¢uccc. Mc:Irc-:e ccnvenienIe ne::c:
:iIucçce: c u:c ce Ie:Ie: rcpicc:, pcr permiIir c inciccçcc ce IrcIcmenIc
prcfi|cIicc em Iempc hcLi| pcrc c recém-nc:cicc. É e::c umc ceci:cc
IercpëuIicc ce emergëncic, ccm Lcc re|cçcc ce cu:Ic-efeIiviccce,
ju:Iificcncc :eu u:c.
/ Ie:Icgem rcpicc, pcrIcnIc, ncc :e ccn:IiIui excme ccm finc|iccce ce
cicgnc:Iicc cc mu|her. Seu re:u|Iccc ceverc :er :empre ccn:icerccc
prcvi:cric, :encc impre:cinc|ve| enccminhcr c cmc:Irc recgenIe, cu c
mu|her, c mci: rcpicc pc::|ve|, cpc: c pcrIc, e em ccrcIer pricriIcric, pcrc
c rec|izcçcc ce Ie:Ie: ccnfirmcIcric:.
Cu :ejc, re:u|Iccc: recgenIe: cevem :er cLrigcIcricmenIe :uLmeIicc: c
cuIrc Ie:Ie ce Iricgem ccm princ|pic ciferenIe e, :e nece::cric, c Ie:Ie:
ccnfirmcIcric: cnIe: ce ccnc|uir c cicgnc:Iicc pcrc :erem enIregue: c:
pccienIe: {reccmenccçce: nc FcrIcric 488, ce 17/0ó/º8, MS/SVS, D.C. cc
Unicc, Seçcc 1, p.3). Ccmc jc refericc, cIençcc e:pecic| ceve :er cccc
cc cccn:e|hcmenIc rec|izccc ne::c :iIucçcc ce e:Ire::e, cevencc c
re:u|Iccc cc Ie:Ie rcpicc, :ejc e|e recgenIe cu ncc recgenIe, :er :empre
ccmunicccc pcr prcfi::icnc| ceviccmenIe Ireinccc. Iccc: c: c:pecIc:
ce cu:Ic-efeIiviccce cevercc :er refericc: c mu|her curcnIe c
cccn:e|hcmenIc.
18
ASSISTÊNCIA À MULHER PORTADORA DO HIV DURANTE O PARTO E PUERPÉRIO
160
2. Ass|stënc|o oo porto
C pcrIc ce umc mu|her pcrIcccrc cc HlV ceve, pcr Iccc: c: rczce:
cLcrcccc: nc: ccp|Iu|c: prececenIe:, :er humcnizccc, Lu:ccncc-:e, em
Iccc: c: fc:e: ce::e mcmenIc, prcpcrcicncr Lem e:Icr c mce e cc
recém-nc:cicc. C e:¢uemc IercpëuIicc cc /CIG 07ó cemcn:Ircu recuzir
em 2/3 {ó7,57) c ri:cc ce Ircn:mi::cc, evicencicncc Ircn:mi::cc ce 25,57
nc grupc p|cceLc e cpenc: ce 8,37 nc grupc em u:e cc /…I. EnIreIcnIc,
e::e ri:cc pcce cincc :er recuzicc ¢ucncc :e prcpcrcicnc c
ge:IcnIe/pcrIurienIe/puérperc e cc recém-nc:cicc umc c::i:Iëncic ce
¢uc|iccce.
Deve ccn:IiIuir c principic Lc:icc ce::c c::i:Iëncic c ncc rec|izcçcc ce
prccecimenIc: ¢ue expcnhcm c necncIc cc :cngue e :ecreçce:
mcIernc: pcr muiIc Iempc e ¢ue prcmcvcm :c|uçcc ce ccnIinuiccce nc
pe|e cc recém-nc:cicc, c|ém ce ccnIrc-inciccr c c|eiIcmenIc mcIernc.
/::im :encc, c: :eguinIe: cuicccc: e::encici: cevem :er cL:ervccc::
• ncc rcmper crIificic|menIe c: memLrcnc: cmnicIicc:
{cmnicIcmic):
• eviIcr Ic¢ue: vcginci: repeIicc::
• eviIcr prccecimenIc: invc:ivc:, Ici: ccmc: cmniccenIe:e,
ccrcccenIe:e, e:cc|pe cefc|icc:
• epi:icIcmic, fcrcep: e exIrcçcc vccuc cevem :er eviIccc:,
:empre ¢ue pc::|ve|. Se c epi:icIcmic fiver ce :er rec|izccc, ceverc
:er rec|izccc c mci: prcximc pc::|ve| cc ce:prencimenIc cefc|icc e
c inci:cc ceverc :er prcIegicc pcr umc ccmpre::c ce gcze pcrc
eviIcr c ccnIcIc cc :cngue ccm c feIc. Se hcuver nece::iccce ce c
pcrIc :er c::i:Iicc, ceverc :e ccr preferëncic cc fcrcipe cc ¢ue cc
vccuc exIrcIcr, em virIuce ce::e ú|Iimc ccu:cr micrc-|ccercçce: nc
e:cc|pe cc necncIc:
• ncc rec|izcr c mcncLrc ce ‚ri:Ie||er:
• prccecer c c|cmpecmenIc cc ccrccc umLi|icc| imecicIcmenIe
cpc: c expu|:cc cc necncIc:
• c:pircr ce|iccccmenIe c: vic: cérec: cc recém-nc:cicc,
eviIcncc IrcumcIi:mc: em mucc:c:: e
• |cvcr c recém-nc:cicc ccm cguc e :cLcc imecicIcmenIe cpc:
c nc:cimenIc.
/: pcrIurienIe: pcrIcccrc: cc HlV ncc cevem permcnecer ccm Lc|:c
rcIc pcr mci: ce 4 hcrc:, cu em IrcLc|hc ce pcrIc prc|cngccc. Nõo hó
necess|dode de se Iso|or o poc|ente portodoro do HIV. / ccmini:Ircçcc
cc: cnIi-reIrcvirci: uIi|izccc: curcnIe c ge:Icçcc ceve :er ccnIinuccc
curcnIe c IrcLc|hc ce pcrIc, cu iniciccc Icc |cgc pc::|ve|.
C /…I injeIcve| ceve :er in:IiIu|cc ce:ce c inicic cc IrcLc|hc ce pcrIc cIé
c c|cmpecmenIc cc ccrccc umLi|icc|. Ccmc expc:Ic
18
ASSISTÊNCIA À MULHER PORTADORA DO HIV DURANTE O PARTO E PUERPÉRIO
161
cnIericrmenIe, é |mportonte que mesmo os mu|heres que nõo receberom
terop|o ont|-retrov|ro| [IAkV} duronte o gestoçõo, recebom AII |njetóve|
duronte o trobo|ho de porto e o porto e o so|uçõo oro| de AII deve ser
odm|n|strodo oo kN.
/: mu|here: HlV• em regime cnIi-reIrcvirc| ¢ue inc|ucm c e:Icvucinc
{c4I), cpe:cr ce ncc Ierem u:ccc c /…I curcnIe c grcvicez, cevem
iguc|menIe receLer c /…I inIrcvenc:c curcnIe c IrcLc|hc ce pcrIc e c
pcrIc e c :c|uçcc crc| ce /…I ceve IcmLém :er ccmini:Irccc cc recém-
nc:cicc.
C e:¢uemc pc:c|cgicc cc /…I pcrc pcrIurienIe: ceve cL:ervcr c:
:eguinIe: reccmenccçce::
Dc:e:
• inicicr c infu:cc, em cce::c venc:c incivicuc|izccc, ccm 2mg/kg
nc primeirc hcrc, :eguincc infu:cc ccnI|nuc ccm 1 mg/kg/hcrc cIé
c c|cmpecmenIc cc ccrccc umLi|icc|: e
• ci|uir c /…I em :crc g|icc:ccc c 57 e gcIejcr ccnfcrme c IcLe|c
cLcixc. / ccncenIrcçcc ncc ceve excecer 4mg/m|. Feccmencc-
:e c u:c cc ci|uiçcc cc /…I em SG57, cpc: c :uc prepcrcçcc cIé 8
hcrc:, em ccn:ervcçcc c 25º C, cu cIé 24 hcrc: em ccn:ervcçcc c
2-8º C.
Apresentação:
AZT injetável - frasco ampola de 200 mg com 20 ml (10 mg/ml).
Nõo hovendo d|spon|b|||dode do AII |njetóve|, deve-se usor esquemo
o|ternot|vo do AII oro| como se segue: 300 mg, VO, no começo do
trobo|ho de porto e, o port|r de entõo, 300mg o codo 3 horos oté o
c|ompeomento do cordõo umb|||co|.
18
ASSISTÊNCIA À MULHER PORTADORA DO HIV DURANTE O PARTO E PUERPÉRIO
162
3. V|o de porto
Ccmc c mcicric cc: cc:c: ce Ircn:mi::cc verIicc| cc HlV cccrre
IcrcicmenIe nc ge:Icçcc cu curcnIe c pcrIc, c pcrIc ce:crec, ¢ucncc
rec|izccc ce fcrmc e|eIivc, cu :ejc, e:Icncc c: memLrcnc: cminicIicc:
|nIegrc: e :em Ier c IrcLc|hc ce pcrIc iniciccc, ccnIriLui pcrc c recuçcc
cc Ircn:mi::cc mcIernc-infcnIi| cc HlV. EnIreIcnIc, e::e: e:Iucc: fcrcm
rec|izccc: ccm mu|here: ¢ue ncc fizercm u:c cc Iercpic cnIi-reIrcvirc|
{I/FV) ccmLinccc {/…I e cuIrc: /FV). C u:c ce I/FV ccmLinccc é
ccpcz ce recuzir :ignificcIivcmenIe c ccrgc virc| cc HlV, pcrc n|vei:
inceIecIcvei:. / ccrgc virc| e|evccc, junIcmenIe ccm c rcIurc
prc|cngccc cc memLrcnc cmnicIicc, é reccnheciccmenIe um cc:
principci: fcIcre: c::cciccc: c Ircn:mi::cc perincIc| cc HlV. De:Ic fcrmc,
c: cccc: cIuc|menIe ci:pcn|vei: :cc in:uficienIe: pcrc cemcn:Ircr c|gum
Lenef|cic nc rec|izcçcc cc ce:cricnc em mu|here: ccm ccrgc virc| muiIc
Lcixc cu inceIecIcve|, cu em mu|here: em u:c ce I/FV ccmLinccc
pcIenIe. Fcr cuIrc |ccc, ncc hc ne::e: e:Iucc: cccc: :uficienIe:
re|ccicncncc e::e: fcIcre: inerenIe: cc e:Iccc c||nicc cc infecçcc pe|c
HlV nc mu|her c: ccn:e¢üëncic: ce mcrLiccce e mcrIc|iccce mcIernc
cc :e cccIcr e::c ccncuIc. Ncc exi:Ie IcmLém ¢uc|¢uer evicëncic ce
¢ue c rec|izcçcc ce ce:cricnc, cpc: c in|cic cc IrcLc|hc ce pcrIc cu
rcIurc ce memLrcnc:, recuzc c Icxc ce Ircn:mi::cc cc HlV pcrc c
necncIc.
De umc fcrmc gerc|, cc pcnIc ce vi:Ic c||nicc, nc rcIinc ce
cccmpcnhcmenIc cc ge:IcnIe HlV• cevercc :er inc|u|cc: excme: pcrc
c mcniIcrcmenIc cc :iIucçcc imunc|cgicc {ccnIcgem ce |infcciIc:
CD4•) e virc|cgicc {¢ucnIificcçcc cc ccrgc virc| , cu :ejc ce FN/-HlV-1
circu|cnIe), rec|izccc: nc in|cic cc pré-ncIc| e pe|c menc: nc per|ccc
prcximc cc pcrIc {32†-3ó† :emcnc:), ccm c cLjeIivc ce cefinir, enIre
cuIrc: cci:c:, ¢ue vic ce pcrIc ceverc :er cccIccc. C /mericcn Cc||ege
cf CL:IeIricicn: cnc Gynecc|cgi:I: {/CCG) Iem reccmencccc c pcrIc
cpercIcric pcrc c mu|her HlV• ccm ccrgc virc| ccimc ce 1000 ccpic: cu
ccrgc virc| ce:ccnhecicc.
De:Ic fcrmc, e::c ceci:cc ceve :er incivicuc|izccc, ccn:icercncc c:
cccc: ce ccrgc virc|, c e:¢uemc /FV em u:c pe|c mu|her curcnIe c
ge:Icçcc, Lem ccmc c :eu Iempc ce uIi|izcçcc. FcrIcnIc, :cc c:
princ|pic: ce umc Lcc c::i:Iëncic cL:IéIricc e c: ccnciçce: cc e:Iccc
c||nicc cc infecçcc pe|c HlV, prcpcrcicncncc mencr ri:cc pcrc c mce e
fi|hc, ¢ue cevem ncrIecr c e:cc|hc cc vic ce pcrIc. Sencc c::im,
cvc|icçcc ccnjunIc cc cL:IeIrc e infecIc|cgi:Ic ¢ue cccmpcnhc c
mu|her, cc|cccncc-c cc pcr cc: ri:cc: e Lenef|cic: cc pcrIc cirúrgicc, :e
fcz nece::cric.
Umc vez cecicicc pe|c operoçõo cesor|ono e|et|vo, c: :eguinIe:
ccn:icercçce: cevem :er cL:ervccc::
• % 1#*;642%+,# $% 6$%$' >'()%16#*%- ' 2%)/46$%$' ;')%- $'3' ('4
1/6$%$#(%2'*)' '()%@'-'16$%? <%4% <4'3'*64 % <4'2%)/46$%$'
6%)4#>9*61%E S /-)4%I(#*#>4%;6%? 4'%-60%$% <4'1#1'2'*)' *%
18
ASSISTÊNCIA À MULHER PORTADORA DO HIV DURANTE O PARTO E PUERPÉRIO
163
>'()%+,#? %/56-6% *# '()%@'-'162'*)# $# $6% $# <%4)# #<'4%)J46# ./'
$'3'48 ('4 <-%*'c%$# <%4% # ;6*%- $% NXy ('2%*%? % ;62 $' 26*6260%4 %
<#((6@6-6$%$' $' )4%@%-7# $' <%4)# #/ 4#)/4% $%( 2'2@4%*%(B
• 1'(84'%( '-')63%( $'3'2 ('2<4' ('4 <-%*'c%$%( ' '5'1/)%$%( '2
1#*$6+A'( %$'./%$%( <%4% 4'$/064 #( 46(1#( $' 2#4@6$%$' 2%)'4*% '
<'46*%)%-? 4'%-60%*$#I(' '2 $6% ' 7#4% <4'36%2'*)' '()%@'-'16$#( <'-%
'./6<'B
• *# 7#4846# $% 6*)'4*%+,#? $'3' ('4 <4'36()# # )'2<# *'1'((846#
<%4% % %$26*6()4%+,# <4:36% $# Sz"? *# 2Y*62# <#4 W 7#4%(?
1#*(6$'4%*$#I(' ./' % 2'6%I36$% 6*)4%I1'-/-%4 $# 2'$61%2'*)# : $'
N 7#4%(B '
• 1#*(6$'4%4 % /)6-60%+,# $' %*)6@6J)61# <4#;6-%56% 1#2 1';%-#(<#46*%
$' ('>/*$% >'4%+,#? %$26*6()4%$% '2 $#(' C*61% 62'$6%)%2'*)'
%*)'( $# <4#1'$62'*)# 164C4>61# #/ *# 2#2'*)# $# 1-%2<'%2'*)#
$# 1#4$,# /2@6-61%-E K((% 4'1#2'*$%+,# )%2@:2 (' %<-61% *%
#<'4%+,# 1'(%46%*% $' '2'4>9*16%E
4. Ass|stënc|o oo recém-nosc|do opos o porto
/|ém cc: reccmenccçce: jc refericc: {c c:pircçcc ce|icccc cc: vic:
cérec: e c c::eic imecicIc ccm cguc e :cLcc cc recém-nc:cicc),
cevem fczer pcrIe cc: cuicccc: e:pec|ficc: ccm c recém-nc:cicc
verIicc|menIe expc:Ic:
• c ccmini:Ircçcc cc /…I :c|uçcc crc|, ce 10mg/m|, nc cc:e ce
2mg/kg, c cccc ó hcrc:, inicicncc-:e preferencic|menIe cIé c 8†
hcrc, pccencc enIreIcnIc :er iniciccc cIé 24 hcrc: cpc: c pcrIc, e
mcnIicc curcnIe ó :emcnc:. /Ié c mcmenIc, ncc hc ccmprcvcçcc
ce eficccic ¢ucncc c IrcIcmenIc ccm /…I é iniciccc cpc: 48 hcrc:,
ficcncc c inciccçcc cc prcfi|cxic cpc: e::e per|ccc c criIéric
mécicc:
• excepcicnc|menIe, ¢ucncc c cricnçc ncc Iiver ccnciçce: ce
receLer c meciccmenIc pcr vic crc|, ceve :er uIi|izccc c /…I
injeIcve|, nc me:mc cc:e cc e:¢uemc ccimc reccmencccc:
• c cc:e ce /…I cprcpriccc pcrc cricnçc: premcIurc:, cLcixc ce
34 :emcnc: ce ge:Icçcc, cincc ncc e:Ic cefinicc. EnIreIcnIc, c
prcIccc|c 331 cc FecicIric /lDS C|inicc| Iric|: Grcup {F/CIG) :ugere
uIi|izcr 1,5mg/kg, VC cu lV, c cccc 12 hcrc: nc: primeirc: cuc:
:emcnc: e 2mg/kg c cccc 8 hcrc: pcr mci: 4 :emcnc:. Nc:
cricnçc: ccimc ce 34 :emcnc:, c fcrmccccinéIicc cc
meciccmenIc é :eme|hcnIe c cc: cricnçc: c Iermc:
• pe|c cccrrëncic fre¢üenIe ce cnemic nc recém-nc:cicc em u:c
ce /…I, reccmencc-:e c rec|izcçcc ce hemcgrcmc ccmp|eIc,
pc::iLi|iIcncc c mcniIcrcmenIc cc cricnçc nc in|cic cc IrcIcmenIc
ccm /…I e cpc: ó e 12 :emcnc::
• c::egurcr c cccmpcnhcmenIc cc cricnçc pe|c pecicIrc e
infecIc|cgi:Ic infcnIi|. / pcrIir cc :exIc :emcnc ce vicc cIé c
cefiniçcc cc e:Iccc :crc|cgicc, c cricnçc ceve receLer
¢uimicprcfi|cxic pcrc pneumcnic pe|c Fneumccy:I: ccrinii, ccm
:u|fcmeIcxczc| {SMX) • IrimeIcprimc {IMF) nc cc:e ce 750mg ce
SMX/m2/cic, civicicc: em 2 cc:e: cicric:, 3 veze: pcr :emcnc, em
cic: ccn:ecuIivc::
18
ASSISTÊNCIA À MULHER PORTADORA DO HIV DURANTE O PARTO E PUERPÉRIO
164
• c: fi|hc: ce mu|here: infecIccc: pe|c HlV cevem receLer /…I
:c|uçcc crc|, me:mc ¢ue :uc: mce: ncc Ienhcm receLicc c /…I
curcnIe c ge:Icçcc e c pcrIc. Ne::e: cc:c:, c in|cic ceverc :er
imecicIcmenIe cpc: c nc:cimenIc. A cr|onço deveró ||cor com suo
mõe em o|ojomento conjunto; e
• ncc cmcmenIcr. /|imenIcr c necncIc ccm |eiIe crIificic|. Em
recém-nc:cicc: premcIurc: cu ce Lcixc pe:c ¢ue ncc pc::cm u:cr
fcrmu|c infcnIi|, u:cr |eiIe humcnc pc:Ieurizccc em Lcncc ce |eiIe
crecenciccc pe|c Mini:Iéric cc Scúce. CcnIrc-incicc-:e c
c|eiIcmenIc cruzccc {cmcmenIcçcc pcr cuIrc mu|her).
5. Ass|stënc|o no puerpér|o
Scc reccmenccçce: impcrIcnIe: ne::c fc:e:
• iniLir c |ccIcçcc cc puérperc, ccm cicgnc:Iicc ce infecçcc pe|c
HlV, |cgc cpc: c pcrIc. / iniLiçcc cc |ccIcçcc pcce :er ccn:eguicc
ccm ccmpre::cc cc: mcmc: ccm cIccurc, imecicIcmenIe cpc: c
pcrIc, :em re:Iringir c: mcvimenIc: re:pircIcric: e ccu:cr
ce:ccnfcrIc mcIernc. Feccmencc-:e cincc c uIi|izcçcc ce
hexchicrc-LenzccIc ce e:Irccic| {c 8enzcgince:Iri| /F), 2 cmpc|c:
ce 5mg {1 m|): cu c hicrcgencmc|ecIc ce |i:uricc {c Dcpergin),
0,2mg, 1 ccmprimicc pe|c mcnhc e 1 c nciIe, pcr 14 cic::
• infcrmcr c mu|her :cLre c: ri:cc: ce Ircn:mi::cc cc HlV cIrcvé: cc
cmcmenIcçcc, e crienIc-|c ccmc cLIer e ¢ucnIc cc prepcrc e u:c
cc fcrmu|c infcnIi|. É impcrIcnIe ¢ue c puérperc, curcnIe :uc
permcnëncic nc mcIerniccce, receLc :upcrIe cc e¢uipe ce :cúce
pcrc ncc cmcmenIcr :em :e :enIir ci:criminccc pcr i::c. E::c
cIençcc ceve :er reccLrccc e:pecic|menIe nc: c|cjcmenIc:
ccnjunIc:, cnce c mcicric cc: mu|here: e:Ic cmcmenIcncc :eu
LeLë {hc:piIci: cmigc: cc cricnçc): e
• nc puerpéric imecicIc e :uL:e¢üenIe:, cevem :er pe:¢ui:ccc:
hi:Icric: e/cu c pre:ençc ce :inci: e :inIcmc: re|ccicnccc: c
infecçcc pe|c HlV ¢ue ccrccIerizcm imuncceficiëncic mccerccc,
Ici: ccmc: ccncic|c:e crc|, |euccp|c:ic pi|c:c crc|, IuLercu|c:e
pu|mcncr nc ú|Iimc cnc, herpe: zc:Ier, feLre per:i:IenIe :em
eIic|cgic cefinicc {inIermiIenIe cu ccn:IcnIe) pcr mci: ce 1 më:,
ci:pnéic, infecçce: reccrrenIe: cc IrcIc re:pircIcric {pneumcnic,
:inu:iIe), ccncic|c:e vcginc| reccrrenIe, herpe: :imp|e:, percc ce
pe:c ‡ 107 cc pe:c ccrpcrc|, e cicrréic crcnicc :em eIic|cgic
cefinicc, ccm curcçcc ce mci: ce 1 më:.
Hcvencc c pre:ençc ce :inci: c||nicc: ce imuncceficiëncic ccm feLre
inexp|icccc ccm curcçcc mcicr ¢ue 2 :emcnc: e ccncic|c:e crc|,
impce-:e c rec|izcçcc ce ¢uimicprcfi|cxic primcric pcrc pneumcnic pe|c
Fneumccy:I: ccrinii, ccm :u|fcmeIcxczc| {SMX) • IrimeIcprimc {IMF), VC,
nc cc:e ce 800mg e 1ó0 mg re:pecIivcmenIe cu 5mg/kg {IMF), umc vez
cc cic. E::e: cc:c: cevem :er enccminhccc: cc infecIc|cgi:Ic
imecicIcmenIe pcrc cvc|icçcc c||nicc e |cLcrcIcric| e in|cic cc Iercpic
cnIi-reIrcvirc| ccnvenienIe. E:Ic reccmenccçcc
18
ASSISTÊNCIA À MULHER PORTADORA DO HIV DURANTE O PARTO E PUERPÉRIO
165
é pcrIicu|crmenIe impcrIcnIe pcrc c: mu|here: ¢ue Iivercm c
cicgnc:Iicc ce infecçcc pe|c HlV curcnIe c pcrIc.
• CrienIcr c mu|her, pcr ccc:icc cc c|Ic, ¢ucnIc c impcrIcncic ce
:eu cccmpcnhcmenIc ccm c infecIc|cgi:Ic cu c||nicc, e cc
cricnçc, cIé cefiniçcc ce :uc :iIucçcc :crc|cgicc. ÉmuiIc ccmum
cpc: c pcrIc, hcver ciminuiçcc cc cce:cc cc mu|her cc
cccmpcnhcmenIc mécicc. Seu ccmpcrecimenIc c: ccn:u|Ic:
ceve :er e:Iimu|ccc e mcniIcrccc, |cnçcncc-:e mcc ce Lu:cc
cIivc :e nece::cric.
• Mu|here: HlV• cpre:enIcm ccm mci: fre¢üëncic ccmp|iccçce:
infeccic:c: nc pc:-pcrIc, Ici: ccmc infecçcc urincric, pu|mcncr, nc
epi:icIcmic e inci:cc cirúrgicc. Nc cc:c ce pcrIc cpercIcric,
in:pecicncr cuicccc:cmenIe c fericc cirúrgicc, icenIificcncc
precccemenIe ¢uc|¢uer ccmp|iccçcc infeccic:c. / mu|her ceve
:er crienIccc :cLre ccmc fczer c higiene perinec|, c vigi|cncic cc:
|c¢uic: e c prccurcr crienIcçcc mécicc, cc:c cpre:enIe :inci: |ccci:
ce infecçce: cu feLre curcnIe c puerpéric.
• C :eguimenIc cL:IéIricc cc mu|her pcrIcccrc cc HlV nc
puerpéric, :c|vc em :iIucçce: e:pecici: ce ccmp|iccçce: cccrricc:
curcnIe c pcrIc e puerpéric imecicIc, ceve prever :eu reIcrnc nc 8º
e nc 40º cic pc:-pcrIc.
• CrienIcr :cLre c prevençcc cc: DSI, reinfecçcc pe|c HlV,
crienIcncc-c ¢ucnIc cc u:c ce pre:ervcIivc: {mc:cu|inc cu
femininc) em Iccc: c: re|cçce: :exuci:. Nc cc:c ce mu|here: HlV•
cujc :iIucçcc :crc|cgicc cc pcrceirc :ejc ce:ccnhecicc, e|e ceverc
:empre :er cccn:e|hccc e Ie:Iccc.
• CrienIcr c mu|her, e :eu pcrceirc, :cLre ccnIrccepçcc,
enccminhcncc-c {c:) pcrc um :erviçc ce p|cnejcmenIc fcmi|icr.
• Frincipc|menIe pcrc c: mu|here: ¢ue Iivercm :eu cicgc:Iicc ce
infecçcc pe|c HlV nc mcmenIc cc pcrIc, c e¢uipe ce :cúce
ceverc inve:Iigcr c :iIucçcc nc ¢ue :e refere c :upcrIe fcmi|icr,
fi|hc: e recur:c: fincnceirc:, cferecencc-lhe: cpcic p:icc|cgicc e
:ccic|.
ó. V|g||önc|o do HIV em gestontes e cr|onços expostos
C Mini:Iéric cc Scúce, Lu:ccncc ccnhecer c prevc|ëncic cc HlV em
ge:IcnIe: e cricnçc: expc:Ic:, Icrncu cLrigcIcric c ncIificcçcc cc:
ge:IcnIe: em ¢ue fcr ceIecIccc c infecçcc pe|c HlV {cicgnc:Iicc
|cLcrcIcric| ce infecçcc pe|c HlV em ccnfcrmiccce ccm c: ncrmc: e
prccecimenIc: e:IcLe|ecicc: pe|c Mini:Iéric cc Scúce). Dc me:mc
fcrmc, é cLrigcIcric c ncIificcçcc cc: cricnçc: nc:cicc: ce mce:
infecIccc: cu ¢ue Ienhcm :icc cmcmenIccc: pcr mu|here: infecIccc:
pe|c HlV. Fcrc cumprir ccm e:Ie cLjeIivc, exi:Ie umc ¨F|cho de
Invest|goçõo de Gestontes HIV+ e Cr|onços Expostos" pcrc c ncIificcçcc
pccrcnizccc, ¢ue pcce :er ccn:eguicc em ¢uc|¢uer mcIerniccce.
/ :eguir enccnIrc-:e um c|gcriImc ¢ue re:ume c: ccncuIc:
reccmencccc: pcrc u:c ce Ie:Ie rcpicc em pcrIurienIe: pcrc inciccçcc
ce u:e ce ziccvucinc ccmc prcfi|cxic cc Ircn:mi::cc verIicc| cc HlV:
18
ASSISTÊNCIA À MULHER PORTADORA DO HIV DURANTE O PARTO E PUERPÉRIO
166
FLUXOGRAMA PARA USO DE TESTE RÁPIDO PARA HIV EM
PARTURIENTES
18
ASSISTÊNCIA À MULHER PORTADORA DO HIV DURANTE O PARTO E PUERPÉRIO
167
7. Frecouçöes 8ós|cos e bn|verso|s
/: Freccuçce: 8c:icc: e Univer:ci: :cc mecicc: ce prevençcc ¢ue
cevem :er cccIccc: ccm ¢uc|¢uer inciv|cuc, incepencenIemenIe cc
cicgnc:Iicc cefinicc cu pre:umicc ce ccençc: infeccic:c:: nc
mcnipu|cçcc ce :cngue, :ecreçce:, excreçce:, mucc:c: cu pe|e ncc-
inIegrc.
E::c: mecicc: inc|uem c uIi|izcçcc ce E¢uipcmenIc: ce FrcIeçcc
lncivicuc| - EFl {|uvc:, mc:ccrc, ccu|c: ce prcIeçcc, ccpcIe: e cvenIci:),
ccm c finc|iccce ce recuzir c expc:içcc cc pe|e e cc: mucc:c: cc
prcfi::icnc| ce :cúce cc :cngue cu f|uicc: ccrpcrec: ce ¢uc|¢uer
pccienIe.
C: prcfi::icnci: ce :cúce, e em e:pecic| c: cirurgice:, cevem Icmcr
cuIrc: cuicccc: ccicicnci: pcrc :e prevenirem ccnIrc ccicenIe: ccm
mcIerici: pérfurc-ccrIcnIe:.
7.1 Cu|dodos especí||cos duronte o porto
• Freferir :empre :eringc: ce p|c:Iicc {i:Ic :e cp|icc pcrc c
epi:icIcmic, ¢ucncc e:Ic ncc pucer :er eviIccc)
• Freferir :empre c u:e ce Ie:curc:, cc invé: ce Li:Iuri
• Nuncc uIi|izcr |cminc ce Li:Iuri ce:mcnIccc {fcrc cc ccLc)
• Freferir fic: ce :uIurc cgu|hccc:
• EviIcr cgu|hc: reIc: ce :uIurc, pe|c :eu mcicr ri:cc ce ccicenIe
percuIcnec
• UIi|izcr :empre pinIc: cuxi|icre: nc: :uIurc:, eviIcncc mcnipu|cçcc
cc: Iecicc: ccm c: cecc: curcnIe c :uIurc cc epi:icIcmic {¢ucncc
e::c fcr nece::cric), curcnIe c fechcmenIc pcr p|cnc: nc cpercçcc
ce:cricnc e cuIrc: prccecimenIc:
• EviIcr :uIurc pcr cci: cirurgice: :imu|IcnecmenIe, nc me:mc
ccmpc cirúrgicc
• / pc::cgem ce mcIerici: pérfurc-ccrIcnIe: {Li:Iuri, pcrIccgu|hc:
mcnIccc:, eIc.) cc cuxi|icr pcrc c cirurgicc ceve :er cIrcvé: ce
cuLc:, cpc: cvi:c verLc|
• /ccIcr cuicccc: e:pecici: nc mcnipu|cçcc cc p|ccenIc e cc
ccrccc umLi|icc|, pci: c ri:cc ce expc:içcc é muiIc grcnce
• /ccIcr c: EFl {|uvc:, ccpcIe:, cvenIc|, mc:ccrc e gcrrc) nc:
cuicccc: imecicIc: cc recém-nc:cicc, cevicc c pc::iLi|iccce ce
expc:içcc c :cngue e ||¢uicc cmnicIicc
Fcrc mcicre: infcrmcçce:, ccn:u|Ie c Mcnuc| ce CcncuIc: em Expc:içcc
Ccupccicnc| c McIeric| 8ic|cgicc: HepcIiIe e HlV cc Mini:Iéric cc Scúce.
18
168
C|c::iccmenIe cencminc-:e 4º perˆccc cc pcrIc {cu
ce GreenLerg) cc per|ccc ce pc:-pcrIc imecicIc,
cpc: c ce¢uiIcçcc. Ncc hc nc |iIercIurc ccn:en:c
:cLre :uc curcçcc excIc, enIreIcnIc, inicic-:e cpc: c
ce¢uiIcçcc cc p|ccenIc e e:Ience-:e pe|c: primeirc:
hcrc: pc:-pcrIc. Fcrc c|gun:, c primeirc hcrc, pcrc
cuIrc:, cIé :eguncc hcrc cpc: c pcrIc.
Ê período de r|sco moterno, com poss|b|||dode de
grondes hemorrog|os, pr|nc|po|mente por oton|o
uter|no. Expu|:c c p|ccenIc, pcr cçcc cc grcviccce cu
pcr |eve expre::cc/ccmpre::cc cc funcc uIerinc,
c::egurc-:e c hemc:Ic:ic pe|c reIrcçcc uIerinc
per:i:IenIe {g|cLc ce :egurcnçc ce Fincrc), ¢ue
prcmcve cc|u:cc cc: vc:c: nc pcrçcc mu:cu|cr,
ccn:IiIuincc c: |igccurc: vivc: ce Fincrc.
CcnccmiIcnIemenIe, cccrre c IcmpcncmenIc
IrcmLcIicc cc: vc:c: úIerc-p|ccenIcric:.
Nc evenIuc|iccce ce :cngrcmenIc vcginc| cncrmc|, c
cL:ervcçcc :erc reccLrccc, ccnIrc|cncc-:e c
reIrcçcc uIerinc, c percc :cngü|nec e c e:Iccc gerc|.
C: :inci: viIci:, e:pecic|menIe pre::cc crIeric| e pu|:c,
cevem :er men:urccc: c cccc 15 minuIc:. Dc me:mc
fcrmc, ceverc :er feiIc ccnIrc|e prcIiccmenIe ccnI|nuc
cc reIrcçcc uIerinc e cc :cngrcmenIc. / ncc
cL:ervcncic c e:Ic: mecicc: cc|ccc c puérperc em
:éric ri:cc. C cicgnc:Iicc preccce cc: c|Iercçce: é
fcIcr prepcncercnIe pcrc c :uce::c IercpëuIicc. /
:en:cçcc ce ¢ue c pcrIc cccLcu cpc: c nc:cimenIc
cc cricnçc e c ce|ivrcmenIc p|ccenIcric é perigc:c e
incce¢uccc.
Ne:Ic fc:e, pcrIcnIc, cevem-:e ccn:icercr c: :eguinIe:
¢ue:Ice:: verificcçcc ccn:IcnIe cc ccnIrcçcc uIerinc,
revi:cc cc ccnc| ce pcrIc e repcrcçcc cc: |e:ce:
pcrvenIurc exi:IenIe:. / remcçcc cc puérperc pcrc c
:c|c ce recupercçcc {¢ucncc nece::cric) e
enfermcric ce c|cjcmenIc ccnjunIc :cmenIe ceverc
:er efeIuccc cpc: c Iérminc cc ¢ucrIc per|ccc.
Expu|:c c p|ccenIc, ¢ue ceve :er revi:ccc ¢ucnIc c
inIegriccce ce ccIi|éccne: e memLrcnc:,
19 ASSISTÊNCIA À MULHER NO QUARTO PERÍODO
ASSISTÊNCIA À MULHER NO QUARTO PERÍODO
169
prccece-:e c imecicIc revi:cc cc ccnc| ce pcrIc {cc|c, vcginc e
per|nec) e c epi:icrrcfic, ¢ucncc rec|izccc epi:icIcmic.
/|ém ci::c, e:Ie curIc per|ccc em ¢ue c mu|her permcnecerc :cL
vigi|cncic nc uniccce cnce c pcrIc cccrreu, ccn:IiIui cIimc
cpcrIuniccce pcrc um cuicccc incivicuc|izccc cc: prcfi::icnci: ce :cúce
nc IcccnIe c: crienIcçce: :cLre c per|ccc puerperc|, cuicccc:,
cmcmenIcçcc preccce {ver CcpiIu|c1ó), ccnIcIc ccm c recém-nc:cicc
e cuIrc: c::unIc: ccrre|cIc:, ce:ce ¢ue c mu|her e:Iejc em Lcc:
ccnciçce:. /: :c|c: ce FFF :cc iceci: pcrc c ccnIrc|e cc mu|her curcnIe
e:Ie per|ccc.
Comp||coçöes hemorróg|cos
/ hemcrrcgic pc:-pcrIc, ccrccIerizccc pe|c percc ce :cngue :upericr c
500m|, é, :em cúvicc, umc cc: :iIucçce: mci: crcmcIicc: e cngu:IicnIe:
vivenciccc pe|c: cL:IeIrc:. C: prcfi::icnci: ce :cúce, e:pecic|menIe c:
mécicc:, Iëm ¢ue e:Icr fcmi|icrizccc: ccm c IrcIcmenIc cc chc¢ue
hipcvc|ëmicc puerperc|. DeIc|he: :cLre e:Ie c::unIc pccem :er
enccnIrccc: nc mcnuc| ce Urgëncic: e Emergëncic: McIernc: {MS,
2000).
/: Irë: principci: ccu:c: ce :cngrcmenIc puerperc| :cc c cIcnic uIerinc,
c: |ccercçce: ce IrcjeIc e c reIençcc ce frcgmenIc: p|ccenIcric:.
Cccrrem em cprcximcccmenIe 57 cc: pcrIc:. EmLcrc pc::cm :er
eviIccc: e IrcIccc:, e|evcm :ignificcIivcmenIe c mcrLimcrIc|iccce
mcIernc. CuIrc: ccu:c: inc|uem c ccreIi:mc p|ccenIcric, c rcIurc, c
inver:cc uIerinc e c: ci:IúrLic: cc cccgu|cçcc.
/: mecicc: prcfi|cIicc: pcrc prevenir c grcviccce ce :uc: ccmp|iccçce:
:cc c Lcc fcrmcçcc cc mécicc e cc: cemci: prcfi::icnci: ce :cúce, c
IenIcIivc ce ncc rec|izcçcc ce prccecimenIc: IrcumcIicc:
{principc|menIe fcrcipe: mécic:), c ccrreçcc pré-ncIc| cc: ¢uccrc:
cnëmicc:, c u:c prcfi|cIicc ce uIercIcnicc: {¢ucncc incicccc:) e c
rec|izcçcc ce pcrIc: ce ri:cc em uniccce: hc:piIc|cre: ccpcciIccc: ccm
recur:c: Iécnicc: e humcnc:.
1. Aton|o uter|no
Fepre:enIc c principc| ccu:c ce hemcrrcgic e chc¢ue hipcvc|ëmicc
cpc: c :ecunccmenIc. Iem impcrIcncic funccmenIc| nc
mcrLimcrIc|iccce mcIernc, :encc c ccu:c principc| ce hi:IerecIcmic
pc:-pcrIc. CcrccIerizc-:e pcr :cngrcmenIc ccenIuccc, ¢ue :e recuz
cpenc: curcnIe c: rcrc:, rcpicc: e pcucc inIen:c: ccnIrcçce:, c::cciccc
c úIerc f|ccicc, cmc|ecicc e, em gerc|, cumenIccc.
C: principci: fcIcre: preci:pcnenIe: :cc: :cLreci:Ien:cc uIerinc {pcr
pc|icrcmnic, geme|criccce e mccrc::cmic), infecçcc inIrc pcrIc,
cne:Ie:ic gerc| ccm hc|cgenccc:, mu|Iipcriccce, pcrIc prc|cngccc,
mcncLrc: incce¢uccc: ccmc c ce ‚ri:Ie||er, pre:ençc ce micmc:
uIerinc: e u:c inci:criminccc ce cciIccicc:, :ejc pcrc incuzir cu e:Iimu|cr
c pcrIc.
19
ASSISTÊNCIA À MULHER NO QUARTO PERÍODO
170
C prcgnc:Iicc cepencerc cc: :eguinIe: ccnciçce::
• ve|cciccce cc percc :cngü|nec - gerc|menIe é rcpicc e, pcr
i::c, c prcIe|cçcc c::i:Iencic| c::ume grcnce impcrIcncic
prcgnc:Iicc.
• vc|ume cc hemcrrcgic - ccn:icerc-:e :ignificcIivc c percc ¢ue
excece 500m|.
• cmLienIe - /grcvc-:e ¢ucncc c pcrIc cccrre em cmLienIe ¢ue
ncc fcvcrece c rcpicc repc:içcc :cngü|nec e/cu rec|izcçcc cc:
inIervençce: nece::cric: pcrc c::egurcr c hemc:Ic:ic.
• e:Iccc gerc| e nuIriIivc - c cnemic e hipcprcIeinemic, ccmun: nc
nc::c meic e, e:pecic|menIe, em cc:c: ce p|ccenIc prévic ccm
:urIc: hemcrrcgicc:, :cc pcrIicu|crmenIe cgrcvcnIe: nc hemcrrcgic
cIcnicc.
Nc vigëncic cc ¢uccrc ce hemcrrcgic, ceve-:e ccn:eguir cce::c venc:c
cc|iLrc:c ¢ue permiIc repc:içcc vc|ëmicc rcpicc, :c|iciIcr Iipcgem
:cngü|nec, fczer mc::cgem uIerinc e rec|izcr :cnccgem ve:icc| ce
cemcrc {céLiIc urincric cce¢uccc ce 30 c 50 m|/hcrc), ¢ue :ervirc ce
crienIcçcc ¢ucnIc c repc:içcc vc|ëmicc e grcu ce percc exi:IenIe,
c|ém ce eviIcr ¢ue c :cLreci:Ien:cc ve:icc| impeçc umc me|hcr
ccnIrcIi|iccce uIerinc. / mcniIcrizcçcc cc: :inci: viIci: :erc rec|izccc e c:
:inci: ce chc¢ue :ercc ccnIinucmenIe pe:¢ui:ccc:.
A rev|sõo do cono| de porto e do ùtero é obr|gotor|o e nõo deveró ser
prote|odo, nc IenIcIivc ce icenIificcr c|gumc |e:cc ¢ue nece::iIe :er
repcrccc. Deve-:e rec|izcr curcgem pcrc cfc:Icr c pc::iLi|iccce cc
pre:ençc ce frcgmenIc: cc p|ccenIc cu ccIi|éccne:. Ici: prccecimenIc:
cevem :er rec|izccc: :cL cne:Ie:ic.
CcnccmiIcnIe c Iercpic cnIericrmenIe ce:criIc, inicic-:e cciIccinc 20
uniccce: em 500 m| ce :crc fi:ic|cgicc c 0,º7 {SF) cu g|icc:ccc 57, 20-30
gcIc: pcr minuIc. MeIi|ergcncvinc pcce :er feiIc em ccnjunIc ccm c
cciIccinc nc cc:e ce 0,2 mg lM, ncc excecencc 0,4 mg. E:Ic crcgc é
ccnIrc-incicccc em mu|here: hiperIen:c: e nc: ¢ue cpre:enIcm
ccençc: ccrcicvc:cu|cre:. Fcce-:e uIi|izcr cincc c mi:cprc:Ic| {2
ccmprimicc: vic crc| cu reIc|).
/ repc:içcc vc|ëmicc, em ¢uc|¢uer :iIucçcc, vi:c re:Icurcr c vc|ume
inIrc-vc:cu|cr, permiIir perfu:cc cce¢uccc e cxigencçcc :cIi:fcIcric. Em
virIuce cc: inIen:c: c|Iercçce: hemccincmicc: ¢ue cccmpcnhcm
¢uc|¢uer ge:Icçcc, ccmc c cumenIc ce 40 c 507 cc vc|ume :cngü|nec
e cc céLiIc ccrc|ccc, c: percc: mencre: ce 500 m| :cc Lem Ic|erccc:,
ce:ce ¢ue c mu|her ncc e:Iejc jc cnëmicc.
C: :inci: ce chc¢ue pccem :urgir IcrcicmenIe, ¢ucncc c: percc: jc
:upercm 35 c 407 cc vc|ume :cngü|nec, exceçcc feiIc c: pccienIe:
pcrIcccrc: ce :|ncrcme: hiperIen:ivc:, principc|menIe c pré-ec|cmp:ic,
¢ue Ic|ercm mc| c percc :cngü|nec. FcrIcnIc, nc pre:ençc ce
:inIcmcIc|cgic, pre:ume-:e ¢ue c percc Ienhc :icc mcicr ¢ue 500 m| e
ceve-:e inicicr infu:cc rcpicc ce 2000 c 3000 m| ce SF cu Finger,
pcrc|e|cmenIe c: ccncuIc: previcmenIe ciIccc:. Hcvencc me|hcrc
c||nicc cc pccienIe, e:Ic ceve :er ccncuzicc cpenc: ccm Iercpic ce
:upcrIe. Ncc cccrrencc me|hcrc, c repc:içcc
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ASSISTÊNCIA À MULHER NO QUARTO PERÍODO
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:cngü|nec :e impce, pccencc :er feiIc ccm ccncenIrccc ce hemccic:,
p|c:mc fre:cc, p|c¢ueIc: e cricprecipiIccc.
C ccncenIrccc ce hemccic: é c mci: efeIivc e eficienIe ccminhc pcrc
me|hcrcr c ccpcciccce ccrrecccrc ce cxigënic em pccienIe ccm
percc :cngü|nec cgucc. / menc: ¢ue Ienhc cccrricc hemcrrcgic
mcciçc, c ccncenIrccc ce hemccic: e c: f|uicc: re:c|vem c grcnce
mcicric cc: :iIucçce: c||nicc: ¢ue nece::iIcm ce repc:içcc vc|ëmicc.
/|ém ci::c, cevicc c pe¢uenc ¢ucnIiccce ce g|cLu|c: Lrcncc: e ce i:c-
hemcg|uIininc:, recuz ccn:icercve|menIe c incicëncic ce recçcc
Ircn:fu:icnc| em ccmpcrcçcc cc :cngue IcIc|. C cLjeIivc cc Iercpic é
mcnIer c hemcIccriIc enIre 25 e 357. Vc|e ce:Icccr ¢ue cccc uniccce
Ircn:funcicc e|evc em 1,5 g c hemcg|cLinc e em 3,07 c hemcIccriIc.
C p|c:mc fre:cc ccnIém Iccc: c: ccmpcnenIe: pre:enIe: nc
cricprecipiIccc, inc|uincc cprecicve| ¢ucnIiccce ce fcIcr Vlll. Deve :er
ccmini:Irccc ¢ucncc c repc:içcc vc|ëmicc e ce fcIcre: cc cccgu|cçcc,
e:pecic|menIe c: fcIcre: V, Vlll e fiLrincgënic, :e fizer nece::cric.
/ Ircn:fu:cc ce p|c¢ueIc: ceve :er ccn:icerccc nc: cc:c: ce
cccgu|cçcc inIrc-vc:cu|cr ci::eminccc, hemcrrcgic mcciçc, pré-
ec|cmp:ic grcve e púrpurc IrcmLcciIcpënicc icicpcIicc. Deve :er
rec|izccc :empre ¢ue c ccnIcgem fcr infericr c 20.000/mm3 cu, ¢ucncc
mencr ¢ue 50.000/mm3, :e hcuver :cngrcmenIc grcve cu nece::iccce
ce prccecimenIc: cirúrgicc:.
C cricprecipiIccc e:Ic incicccc nc: pccienIe: pcrIcccrc: ce Dcençc ce
Vcn Wi||eLrcnc cu nc¢ue|c: ¢ue Iëm vc|ume ncrmc|, mc: nece::iIcm ce
fcIcre: cc cccgu|cçcc, e:pecic|menIe fiLrincgënic.
C :cngue IcIc|, pcr cpre:enIcr ccmc inccnvenienIe :uc curIc vicc úIi|,
¢ue é ce cpenc: 21 cic:, e c e:Icccgem, ¢ue Iem efeiIc: ce|eIéric:
:cLre c: e|emenIc: ce|u|cre: e c: fcIcre: cc cccgu|cçcc, ncc é mci:
uIi|izccc em hemcIercpic em ccnciçce: regu|cre:.
Em ccnjunIc ccm c ccncuIc c||nicc, mecicc: meccnicc: pccem :er
empregccc:, ccmc c mc::cgem uIerinc. Devem-:e eviIcr c: expre::ce:
cu ccmpre::ce: cc ccrpc uIerinc, pci: c pre:ençc ce cccgu|c: e
IrcmLc: fcvcrece c hemc:Ic:ic. EmLcrc c|gun: |ivrc: IexIc ce CL:IeIr|cic
reccmencem ¢ue, excepcicnc|menIe, c ccmpre::cc Limcnuc| cc ccrpc
uIerinc IcmLém puce::e :er uIi|izccc, e:Ic prcIicc é muiIc pcucc u:ccc
nc 8rc:i| e ncc Iem :eu: Lenef|cic: evicenciccc: pcr e:cucc: c||nicc:
ccnIrc|ccc:.
/ pre::cc Ircn:cLccminc| e c ccmpre::cc cc ccrIc Iëm cpenc: vc|cr
hi:Icricc. Fcrém, curcnIe |cpcrcIcmic, ¢ucncc c hemcrrcgic é
cLunccnIe e cIé ¢ue :e prcvicenciem c: mecicc: ccL|vei:, c
ccmpre::cc cc ccrIc ccnIrc c cc|unc verIeLrc| ju:Iificc-:e ccmc
ccncuIc pc|icIivc.
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ASSISTÊNCIA À MULHER NO QUARTO PERÍODO
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Cucncc c: mecicc: meccnicc: e c||nicc: fc|hcrem em ccnIrc|cr c
hemcrrcgic, e:Icc incicccc: c: prccecimenIc: cirúrgicc:. / |igccurc cc:
crIéric: uIerinc:, ¢ue ceve :er feiIc cc n|ve| cc pcnIc cnce c crIéric :cLe
cc |ccc cc úIerc, cpre:enIc Icxc ce :uce::c ce cIé º57 e, pcrIcnIc,
ceve :er c primeirc |igccurc c :er feiIc. Nc fc|hc ce:Ic, ceverc :er feiIc c
|igccurc Li|cIerc| cc: crIéric: hipcgc:Iricc:, Iécnicc ¢ue cpre:enIc
exce|enIe: re:u|Iccc:, pcrém nece::iIc cc experiëncic cc cirurgicc em
IrcLc|hcr nc e:pcçc reIrcperiIcnec|. Nc cu:ëncic ce:Ic experiëncic, c
percc ce Iempc nc rec|izcçcc cc |igccurc pcce cgrcvcr c ¢uccrc
c||nicc cc pccienIe.
Cucncc Iccc: c: mecicc: fc|hcrem, c hi:IerecIcmic ce emergëncic
permcnece ccmc cpçcc ¢ue pcce :c|vcr c vicc cc pccienIe. Dc-:e
preferëncic c :uLIcIc|, pe|c ciminuiçcc cc Iempc cirúrgicc, ncc
cgrcvcncc c e:Iccc gerc| jc ccmprcmeIicc.
Nc¢ue|c: mu|here: em ¢ue c: fcIcre: preci:pcnenIe:, cnIericrmenIe
ce:criIc:, e:Iiverem pre:enIe:, c infu:cc ce 10 uniccce: ce cciIccinc
curcnIe c :ecunccmenIc e nc: cuc: primeirc: hcrc: ce pc:-pcrIc, recuz
crc:IiccmenIe c mcrLimcrIc|iccce mcIernc criuncc ce:Ic ccmp|iccçcc.
2. Loceroçöes de trojeto
/ revi:cc cc IrcjeIc cc pcrIc ceve :er rec|izccc :i:IemcIiccmenIe ne:Ic
:iIucçcc. É prccecicc pinçcncc-:e c cc|c uIerinc ccm cuc: pinçc: ce
cne| ¢ue :ercc mcvimenIccc: em :enIicc hcrcric cIé ccmp|eIc
vi:uc|izcçcc cc cc|c. Nc pre:ençc ce ¢uc|¢uer |e:cc vi:|ve|, fcz-:e c
:uIurc em pcnIc: :epcrccc:, ccm fic cL:crv|ve|, em gerc| ccI-guI
crcmccc 0 cu 2-0. Nc vcginc pccercc :e efeIucr :uIurc: ccnI|nuc:.
Hcvencc :cngrcmenIc cIivc, fcz-:e c pinçcmenIc cc vc:c e c
hemc:Ic:ic. Nc vigëncic ce hemcIcmc, e:Ie ceve :er crenccc pcrc
icenIificcr c vc:c re:pcn:cve| pe|c ¢uccrc, permiIincc :uc |igcçcc ccm
fic cL:crv|ve|. /: veze: pcce :er preci:c uIi|izcr um crenc ce Fenrc:e. Em
cc:c: ce grcnce: |ccercçce:, cu ce |e:ce: mú|Iip|c:, ¢ucncc c :uIurc
ncc fcr pc::|ve|, ceve-:e prccecer c IcmpcncmenIc cc vcginc.
3. ketençõo p|ocentór|o
/ reIençcc p|ccenIcric cu ce :eu: frcgmenIc: prcvccc hemcrrcgic pe|c
cificu|ccce ce ccnIrcçcc micmeIric|. Um per|ccc :upericr c 30 minuIc:
pcrc cccrrer c ce¢uiIcçcc ceve :er ccn:icerccc pcIc|cgicc. / revi:cc
mccrc:ccpicc cc p|ccenIc, ccrccc e memLrcnc: cvu|cre: cpc: c
ce¢uiIcçcc :cc prccecimenIc: cLrigcIcric: pcrc Iccc: c: pcrIc: e
ccnIriLuem pcrc c cicgnc:Iicc preccce cc reIençcc ce frcgmenIc: cc
p|ccenIc cu memLrcnc:, fcvcrecencc prcnIc: mecicc: pcrc c :c|uçcc
cc prcL|emc.
Nc reIençcc p|ccenIcric, cu nc :u:peiIc cc pre:ençc ce re:Ic:, ceve-:e
rec|izcr exp|crcçcc cc ccviccce uIerinc, cpc: c pccienIe
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ASSISTÊNCIA À MULHER NO QUARTO PERÍODO
173
e:Icr ccnvenienIemenIe cne:Ie:iccc. /pc: exIrcçcc cc p|ccenIc,
prccecer c curcgem e/cu cureIcgem uIerinc. Hcvencc ccreIi:mc, IenIcr
ncc frcgmenIcr c mc::c p|ccenIcric. Cc:c c p|ccenIc ncc :ejc exIrc|cc
mcnuc|menIe, e nc vigëncic ce hemcrrcgic per:i:IenIe, e:Icrc incicccc
c hi:IerecIcmic. DeIc|he: ccicicnci: pccem :er enccnIrccc: nc mcnuc|
Iécnicc ce Urgëncic: e Emergëncic: McIernc: {MS, 2000).
4. Inversõo uter|no
É ccu:c rcrc ce hemcrrcgic puerperc|. Cucncc cccrre, Iem e|evccc
ri:cc pcrc c pccienIe. C chc¢ue ¢ue cccmpcnhc c ¢uccrc pcce :er
hemcrrcgicc cu neurcgënicc, pe|c ccr prcvccccc. /ccmeIe mci:
mu|I|pcrc: cu mu|here: ccm ccreIi:mc p|ccenIcric e é IcmLém re:u|Iccc
ce mcncLrc icIrcgënicc nc Ircçcc excgerccc cc ccrccc umLi|icc|. C
úIerc ceve :er repc:icicnccc c mci: rcpicc pc::|ve|. CucnIc mcicr c
cemcrc, mci: cif|ci| c rec|izcçcc cc: mcncLrc: ccrreIivc:. C IrcIcmenIc
ceve :er feiIc :cL cne:Ie:ic, efeIucncc-:e c mcncLrc ce Icxe, nc ¢uc|
IenIc reverIer c úIerc c :uc pc:içcc ncrmc|, inIrccuzincc c mcc cireiIc
fechccc em :eu inIericr. Hcvencc :uce::c, uIi|izcr cciIccicc: pcrc mcnIer
c úIerc ccnIrc|cc. Cucncc c: mcncLrc: c||nicc: fcrem ineficienIe:, fczer
|cpcrcIcmic e Ircçcc cirúrgicc cc ccrpc e cc funcc uIerinc
{prccecimenIc ce HunIingIcn). Iccc: e:Ic: mecicc: cevem :er
cccmpcnhccc: ce repc:içcc :cngü|nec, jc ¢ue c percc vc|ëmicc
cc:Iumc :er grcnce.
5. koturo uter|no
Em muiIc: cc:c:, c cicgnc:Iicc cc rcIurc uIerinc :cmenIe é efeIuccc
cpc: c pcrIc. /: principci: ccu:c: inc|uem c pre:ençc ce ciccIrize:
uIerinc: prévic:, principc|menIe ceccrrenIe: ce ce:crec: ccrpcrci: e
micmecIcmic:, c u:c incce¢uccc cc: cciIccicc: cu cc: prc:Icg|cncinc:
nc per|ccc cnIepcrIc, in:i:Iëncic nc pcrIc vcginc| frenIe c ¢uccrc: ce
ce:prcpcrçcc feIc-pé|vicc, Ircumc: exIernc: e mcncLrc: incce¢uccc:
ce ver:cc inIernc cu exIernc.
Em cc:c: ce pcrIc vcginc| ccm rcIurc: :em mcnife:Icçcc c||nicc,
ceIecIccc: nc revi:cc uIerinc, c ccncuIc cepencerc cc e:IcLi|iccce
hemccincmicc cc puérperc e cc hemcrrcgic vi:|ve|. Em c|gun: cc:c:,
pccerc :er cccIccc ccncuIc expecIcnIe, :cL rigcrc:c cL:ervcçcc e u:c
ccnI|nuc ce cciIccicc:. Cucncc c: |e:ce: fcrem exIen:c: cu frenIe c
in:IcLi|iccce cc pccienIe, rec|izc-:e |cpcrcIcmic ccm :uIurc cc |e:cc cu
hi:IerecIcmic. Nc: cc:c: em ¢ue :e pre:ervcr c úIerc, ceve-:e ccn:icercr,
:e fcr c ce:ejc cc mce, c |c¢ueccurc IuLcrec Li|cIerc|.
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ASSISTÊNCIA À MULHER NO QUARTO PERÍODO
174
Cons|deroçöes ||no|s
Fc::ccc e:Ie Lreve, mc: impcrIcnIe, ¢ucrIc per|ccc cc pcrIc e
u|Ircpc::ccc: c: evenIuci: cificu|ccce: e ccmp|iccçce: :urgicc:, c
mu|her e:Icrc cpIc c :er Ircn:fericc, junIcmenIe ccm :eu fi|hc, pcrc c
c|cjcmenIc ccnjunIc. / pcrIir ce enIcc, jc nc per|ccc puerperc|, cuIrc:
cuicccc: c mu|her e cc recém-nc:cicc fczem pcrIe cc: cIiviccce: cc:
prcfi::icnci: ce :cúce ¢ue cevercc e:Icr cpIc: c e:Ic c::i:Iëncic.
CuIrc: ceIc|he: :cLre ccmp|iccçce: hemcrrcgicc: cu cirúrgicc: cc
puerpéric, ¢ue ccrccIerizem :iIucçce: ce urgëncic: e emergëncic:,
e:Icc ci:pcn|vei: nc mcnuc| ce Urgëncic: e Emergëncic: McIernc: c
Mini:Iéric cc Scúce.
19
175
CcnceiIuc-:e puerpéric c per|ccc cc cic|c grcvicc-
puerperc| em ¢ue c: mccificcçce: |ccci: e :i:Iëmicc:,
prcvccccc: pe|c grcvicez e pcrIc nc crgcni:mc cc
mu|her, reIcrncm c :iIucçcc cc e:Iccc pré-grcv|cicc.
C puerpéric inicic-:e umc c cuc: hcrc: cpc: c :c|cc
cc p|ccenIc e Iem :eu Iérminc imprevi:Ic, pci:
en¢ucnIc c mu|her cmcmenIcr e|c e:Icrc :cfrencc
mccificcçce: cc ge:Icçcc {|ccIcncic), ncc
reIcrncncc :eu: cic|c: men:Iruci: ccmp|eIcmenIe c
ncrmc|iccce. Fcce-:e ciccIiccmenIe civicir c
puerpéric em: |med|oto {1 º cc 10º cic), tord|o {11 º cc
42º cic), e remoto {c pcrIir cc 43º cic).
/ primeirc e :eguncc hcrc: cpc: c ce|ivrcmenIc
cevem :er pc::ccc: nc CenIrc CL:IéIricc cu :c|c ce
FFF, pci: ne:Ie per|ccc pccem cccrrer hemcrrcgic:.
Ccrre:pcnce cc chcmccc CucrIc Fer|ccc cc pcrIc,
cLcrcccc ceIc|hcccmenIe nc Ccp|Iu|c 1º. Fc::ccc
e:Ie per|ccc inicic|, e:Icncc c puérperc e¢ui|iLrccc
hemccincmiccmenIe e fcrmccc c g|cLc ce
:egurcnçc ce Fincrc {úIerc cc n|ve| cc ciccIriz
umLi|icc| e firmemenIe ccnIrc|cc), pccerc :er
enccminhccc cc c|cjcmenIc ccnjunIc, cpc: :erem
:eu: :inci: viIci: cvc|iccc: e cncIccc:.
/: Ircn:fcrmcçce: ¢ue :e inicicm nc puerpéric, ccm c
finc|iccce ce re:IcLe|ecer c crgcni:mc cc mu|her c
:iIucçcc ncc grcv|cicc, cccrrem ncc :cmenIe nc:
c:pecIc: encccrinc e geniIc|, mc: nc :eu Iccc. /
mu|her ne:Ie mcmenIc, ccmc em Iccc: c: cuIrc:,
ceve :er vi:Ic ccmc um :er inIegrc|, ncc exc|uincc :eu
ccmpcnenIe p:|¢uicc.
/c :e excmincr umc mu|her nc puerpéric, ceve-:e
inicic|menIe, :e :uc :iIucçcc c||nicc permiIir, fczer umc
Lreve cvc|icçcc cc :eu e:Iccc p:|¢uicc, e enIencer c
¢ue repre:enIc pcrc e|c c chegccc ce umc ncvc
cricnçc. C e:IcLe|ecimenIc ce umc cce¢uccc
empcIic enIre c excmincccr e :uc c|ienIe
prcpcrcicncrc umc me|hcr ccmpreen:cc cc: :inIcmc:
e :inci: cpre:enIccc:. É ccmum ¢ue ne:Ie mcmenIc c
mu|her experimenIe :enIimenIc:
20 ASSISTÊNCIA À MULHER NO PUERPÉRIO
ASSISTÊNCIA À MULHER NO PUERPÉRIO
176
ccnIrcciIcric: e :inIc-:e in:egurc. CcLe c e¢uipe ce :cúce e:Icr
ci:pcn|ve| pcrc perceLer c nece::iccce ce cccc mu|her ce :er cuvicc
ccm c cevicc cIençcc.
A|teroçöes onot•m|cos e ||s|o|og|cos no puerpér|o:
/ puérperc cpre:enIc um e:Iccc ce excu:Icc e re|cxcmenIc,
principc|menIe :e e|c ficcu |cngc per|ccc :em cce¢uccc hicrcIcçcc
e/cu c|imenIcçcc, c|ém cc: e:fcrçc: ce:prencicc: nc per|ccc expu|:ivc.
E:Ie e:Iccc pcce :e mcnife:Icr pcr :cnc|ëncic ¢ue exige repcu:c. /pc:
ce:perIcr e receLer c|imenIcçcc cce¢uccc, :em re:Iriçce:, c mu|her
pccerc cecmLu|cr e ceciccr-:e cc: cuicccc: ccm c fi|hc.
/ puérperc pcce cpre:enIcr |igeirc oumento do temperoturo ox||or {3ó,8º
- 37,ºº) nc: primeirc: 24 hcrc:, :em nece::cricmenIe Ier um ¢uccrc
infeccic:c in:Ic|ccc. Fccem cccrrer cincc cc|cfric:, mci: fre¢üenIe: nc:
primeirc: hcrc: cpc: c pcrIc. E:Ic: c|Iercçce: pccem cccrrer :em Irccuzir
um ri:cc c :cúce cc mu|her, mc: exigem cc excmincccr ccuIe|c, pci:
IcmLém pccem ccrre:pcncer c prcce::c: mcrLicc:, ccmc c infecçcc
puerperc|.
C s|stemo cord|ovoscu|or experimenIc, nc: primeirc: hcrc: pc:-pcrIc, um
cumenIc cc vc|ume circu|cnIe, ¢ue pcce :e Irccuzir pe|c pre:ençc ce
:cprc :i:Ic|icc ce hiperf|uxc. Nc: puérperc: ccm ccrcicpcIic, em e:pecic|
nc¢ue|c: ¢ue cpre:enIcm ccmprcmeIimenIc cc vc|vu|c miIrc|, c per|ccc
expu|:ivc e c: primeirc: hcrc: cpc: c ce|ivrcmenIc repre:enIcm umc fc:e
cr|Iicc e ce exIremc nece::iccce ce vigi|cncic mécicc.
IcmLém ne:Ie per|ccc c puérperc Iem :eu podrõo resp|rotor|o
re:IcLe|ecicc, pc::cncc c cicfrcgmc c exercer funçce: ¢ue hcvicm :icc
|imiIccc: pe|c cumenIc cc vc|ume cLccminc|.
/ vc|Ic cc: v|:cerc: cLccminci: c :uc :iIucçcc criginc|, c|ém cc
ce:ccmpre::cc cc e:Icmcgc, prcmcve um me|hcr e:vczicmenIc
gc:Iricc. C: e:fcrçc: ce:prencicc: nc per|ccc expu|:ivc cgrcvcm c:
ccnciçce: ce hemcrrcicc: jc exi:IenIe:. E:Ic :iIucçcc ccu:c ce:ccnfcrIc
e impece c Lcm e:vczicmenIc inIe:Iinc|. Nc: mu|here: ¢ue pcrircm pcr
ce:crec, :cmc-:e cincc c ||ec pcrc||Iicc pe|c mcnipu|cçcc cc ccviccce
cLccminc|.
Ircumc: pccem cccrrer c ureIrc, ccc:icncncc ce:ccnfcrIc c micçcc e
cIé me:mc reIençcc urincric, :iIucçcc cIenuccc pe|c cumenIc cc
ccpcciccce ve:icc| ¢ue cccrre ncrmc|menIe ne:Ie per|ccc. / puérperc
pcce experimenIcr nc: primeirc: cic: pc:-pcrIc um cumenIc cc vc|ume
urincric, pe|c reci:IriLuiçcc cc: ||¢uicc: ccrpcrci:.
/ |eucoc|tose nc puerpéric é e:perccc, pccencc cIingir 20.000
|euccciIc:/mm3, ccnIucc :em cpre:enIcr fcrmc: jcven: em cemc:ic
{ce:vic c e:¢uercc) cu grcnu|cçce: Icxicc: em pcrcenIcgem expre::ivc
cc: |euccciIc:. / ¢ucnIiccce ce p|c¢ueIc: e:Ic cumenIccc nc:
primeirc: :emcnc:, c::im ccmc c n|ve| ce fiLrincgënic, rczcc pcrc :e
preccupcr ccm c imcLi|izcçcc prc|cngccc nc
20
ASSISTÊNCIA À MULHER NO PUERPÉRIO
177
|eiIc, :iIucçcc ¢ue fcci|iIc c cpcrecimenIc ce ccmp|iccçce:
IrcmLcemLc|icc:.
/ pe|e :ecc e ¢uecc cc: ccLe|c: pccem cccrrer. /: e:Iric: Iencem c :e
Icrncr mci: c|crc: e c ciminu|rem ce Icmcnhc, emLcrc muiIc:
permcneçcm pcrc :empre.
/|Iercçce: cc humcr, ccm |cLi|iccce emccicnc|, :cc ccmun: nc
puerpéric. EnIreIcnIc, c e:Iccc p:icc|cgicc cc mu|her ceve :er
cL:ervccc, umc vez ¢ue ¢uccrc: ce prcfuncc cpcIic cu ccm :inIcmc:
ce p:icc:e puerperc| cevem :er icenIificccc: precccemenIe. Ne:Ic:
:iIucçce:, um IrcIcmenIc cce¢uccc ceve :er in:IiIu|cc rcpiccmenIe. Nc:
mu|here: ¢ue Iivercm um cLiIc feIc|, cIençcc e:pecic| ceve :er cccc,
pci: c percc cc fi|hc pcce prcvcccr um :enIimenIc ce |uIc ¢ue nece::iIc
ce Iempc e c|gumc: veze: ce cjucc pcrc :uperc-|c. Ne:Ie: cc:c:,
reccmencc-:e in:Ic|cr e:Ic: mu|here: em c|cjcmenIc: :em c pre:ençc ce
cricnçc:, pcrc ncc prcvcccr |emLrcnçc: e ccmpcrcçce:. Nc: mu|here:
¢ue Iivercm fi|hc: ¢ue nece::iIcm ce IrcIcmenIc imecicIc, em e:pecic|
c: recém-nc:cicc: mc|fcrmccc:, ceve-:e prccurcr ccmpreencer c:
:enIimenIc: cc mu|her cicnIe ce:Ic ncvc e ine:perccc :iIucçcc. C
enIencimenIc ce:Ic: :iIucçce: {ncIimcrIc e mc|fcrmccc:) pe|c:
cccmpcnhcnIe: é impcrIcnIe pcrc c me|hcr recupercçcc cc puérperc.
C ùtero cIinge c ciccIriz umLi|icc| cpc: c pcrIc e pc:IericrmenIe regrice
em Icrnc ce 1 cm cc cic, emLcrc ce fcrmc irregu|cr. Fcrmc-:e
inicic|menIe um IcmpcncmenIc cc: vc:c: pe|c ccmpre::cc cc
micméIric pcrc, em :eguicc, fcrmcrem-:e IrcmLc: ¢ue impecircc c
percc :cngü|nec. lnicic|menIe :urgem c: lc¢uic: :cngü|nec: {cIé c 5º
cic), em vc|ume vcricve|, :eme|hcnIe c umc men:Irucçcc. / pcrIir cc 5º
cic, Icrnc-:e :erc::cngu|nec e pcr vc|Ic cc 10º cic, :erc:c. C cheirc é
ccrccIer|:Iicc. Cucncc féIicc, pcce :ignificcr ¢uccrc infeccic:c.
/ recupercçcc cc endométr|o inicic-:e c pcrIir cc 25c cic pc:-pcrIc. C
cc|c uIerinc, |cgc cpc: c pcrIc, ficc ecemcciccc e pcce cpre:enIcr
|ccercçce: e, em Icrnc cc 10º cic, e:Icrc fechccc. / vcginc cpre:enIc-
:e ecemcciccc, ccnge:Ic e cIrcficc, inicicncc :uc recupercçcc cpc: c
25º cic ce puerpéric, mci: Icrcic nc: mu|here: ¢ue cmcmenIcm. E:Ic
:iIucçcc muiIc: veze: prcvccc ce:ccnfcrIc nc: mu|here: cc reinicicrem
:uc: cIiviccce: :exuci:. / vu|vc e c c::cc|hc pé|vicc :cfrem IcmLém
mccificcçce: ceccrrenIe: cc IrcLc|hc ce pcrIc.
C prcfi::icnc| ce :cúce ceve refcrçcr c: cçce: cc o|e|tomento ¢ue fcrcm
inIrccuzicc: nc pré-ncIc|, prcmcvencc umc me|hcr cccpIcçcc cc mce
cc fi|hc. Deve-:e enccrcjcr c mce c |evcr :eu fi|hc cc peiIc
precccemenIe pcrc ¢ue e:Ie ccnIcIc permcneçc efeIivc.
20
ASSISTÊNCIA À MULHER NO PUERPÉRIO
178
Ass|stënc|o oo puerpér|o
1. Fuerpér|o |med|oto [1€ oo 10€ d|o}:
/ mu|her Iem nece::iccce: ce cIençcc f|:icc e p:|¢uicc. Ncc ceve :er
IrcIccc ccmc um númerc ¢ue ccrre:pcncc cc :eu |eiIc cu enfermcric, e
:im pe|c ncme, ccm re:peiIc e cIençcc. Nc: mcmenIc: inicici: cpc: c
pcrIc, c re|cçcc mce-fi|hc ncc e:Ic cincc Lem e|cLcrccc, pcrIcnIc ncc
:e ceve ccncenIrcr Iccc: c: cIençce: cpenc: c cricnçc, pe|c ri:cc ce
¢ue i::c :ejc inIerpreIccc ccmc ce:prezc c: :uc: cn:ieccce: cu ¢ueixc:.
Deve-:e |emLrcr ¢ue c c|vc cc cIençcc ne:Ie mcmenIc é c puérperc.
/ cvc|icçcc c||nicc ceve :er rigcrc:c, :encc c: cchccc: Ircn:criIc: pcrc
c prcnIucric mécicc, ce fcrmc c|crc e cLececencc umc pccrcnizcçcc.
Deve-:e prccecer c um excme f|:icc ccmp|eIc:
• Deombu|oçõo: '()62/-%4 % $'%2@/-%+,# # 2%6( <4'1#1' <#((Y3'-E
• H|g|ene: %<J( 6*616%$% % $'%2@/-%+,# ' '()%*$# @'2? $'3'I('
'()62/-%4 # @%*7# $' 17/3'64#E q,# 78 *'1'((6$%$' $' /)6-60%4
(/@()f*16%( %*)6((:<)61%( *% 4'>6,# <'46*'%-E q#( 1%(#( $' <%4)# <#4
1'(%46%*%? %1#*('-7%I(' <4#)'>'4 # 1/4%)63# #/ 4'*#38I-# *# Vn $6%?
('*$# ./' % <%4)64 $# Pn $6% $'3'48 <'42%*'1'4 $'(1#@'4)% % ;'46$%?
# ./' 6*1-/(63' <'426)' 2'-7#4 #@('43%+,#E
• Momos: % /)6-60%+,# $' (/)6, $'3' ('4 4'1#2'*$%$%? <#4
<4#<#416#*%4 2'-7#4 1#*;#4)# Z 2/-7'4E M 1#-#()4# c8 '()8 <4'('*)' *#
2#2'*)# $# <%4)#E S $'(16$% $# -'6)'? *# '*)%*)#? #1#44' '*)4' # Vn '
Nn $6% <J(I<%4)#? '2@#4% % 1#-#1%+,# $% 146%*+% %# <'6)# $'3% ('4
;'6)% -#># %<J( # *%(162'*)# <%4% ./' #1#44% -6@'4%+,# $' <4#-%1)6*%
' #16)#16*%? 1#2 1#*('.L'*)' <4#$/+,# ' -6@'4%+,# $# -'6)'E S
6$'*)6;61%+,# $' $';#426$%$'( *#( 2%26-#(? #/ <4'('*+% $' ;6((/4%(?
>'4%-2'*)' #1%(6#*%$%( <#4 <'>% 6*%$'./%$% %# <'6)#? <#$' )4%0'4
<4'c/Y0#( Z 2/-7'4? ;%3#4'1'*$# # 6*>/4>6)%2'*)#? ' %# %-'6)%2'*)#E
s%()6)'( ' %@(1'((#( *'1'((6)%2 $' %)'*+,# '(<'16%-? *,# ('*$#
2#)63#( <%4% (' $'('*1#4%c%4 # %-'6)%2'*)# '51-/(63#E
• Abdome: 6$'*)6;61%+,# $' 3Y(1'4%( %/2'*)%$%( ' #/ $#-#4#(%(?
%)'*+,# Z 6*3#-/+,# /)'46*% ' Z ;'46$% 164C4>61%? (' # <%4)# #1#44'/
<#4 1'(%46%*%E p *'1'((846# <4#1'$'4 % %/(1/-)% $#( 4/Y$#( 76$4#I
%:4'#(E
• Gen|tó||o: 6*(<'16#*%4 (6 ()'2%)61%2'*)' % 4'>6,# <'46*'%-? 1#2
%)'*+,# '(<'16%- %#( -J./6#(E M %17%$# $' '$'2%(? './62#('( '
7'2%)#2%( 62<-61% *% *'1'((6$%$' $' %<-61%+,# $' ;46# *# -#1%-?
1#2 @#-(% $' >'-#? *%( <462'64%( PW 7#4%(E S 6$'*)6;61%+,# $' -J./6#(
;:)6$#( <#$' )4%$/064 ./%$4# 6*;'116#(#E
• Membros: <'(./6(%4 (6*%6( $' )4#2@#(' 3'*#(% <4#;/*$%?
<46*16<%-2'*)' # 4'-%)# $' $#4'( *#( 2'2@4#( 6*;'46#4'( ' '$'2%
(C@6)#E H$'*)6;61%4 # %<%4'162'*)# $' (6*%6( ;6#>Y()61#(E
Feccmencc-:e c pre:criçcc ce :u|fcIc ferrc:c {ó00 mg/cic), cci:
ccmprimicc: ce 300mg cc cic e IcmLém c :up|emenIcçcc ce ViIcminc
/ {200.000 Ul pcr vic crc|, cc:e únicc). Nc¢ue|c: mu|here: ¢ue
cpre:enIcm ce:ccnfcrIc pcr ccre: nc |ccc| cc epi:icrrcfic, pcce-:e
uIi|izcr cnc|gé:icc: {cceIcmincfen 750 mg/4 veze: cc cic cu
20
ASSISTÊNCIA À MULHER NO PUERPÉRIO
179
cipircnc 500 mg/4 veze: cc cic), Lem ccmc c cc|cccçcc ce Lc|:c ce
ge|c nc: primeirc: 24 hcrc: :cLre c epi:icrrcfic.
A|to hosp|to|or
Ncc :e ceve ccr c c|Ic c puérperc :em ccnhecimenIc cc c|c::ificcçcc
:cngü|nec cc mce. Nc¢ue|c: ccm fcIcr Fh negcIivc, ncc :en:iLi|izccc: e
ccm recém-nc:cicc Fh pc:iIivc e CccmL: negcIivc, uIi|izc-:e c
imuncg|cLu|inc cnIi-D, nc: primeirc: 72 hcrc:. lmpcrIcnIe IcmLém é
ccnhecer c re:u|Iccc cc :crc|cgic pcrc :|fi|i:. Sencc pc:iIivc, inicicr c
IrcIcmenIc, :e e:Ie ncc fci rec|izccc previcmenIe, e ccmuniccr cc
mécicc re:pcn:cve| pe|c c::i:Iëncic cc recém-nc:cicc.
Nc: puérperc: ¢ue e:Icc Lem e ncc :e ceIecIcm cncrmc|iccce:, c c|Ic
pcce :er ccn:enIicc cpc: c: primeirc: 24 hcrc:, e nc: :uLmeIicc: c
ce:crec, ccm 48 hcrc:.
kev|sõo puerpero|
1. kev|sõo puerpero| precoce [entre 7 o 10 d|os}
C reIcrnc ceve :er mcrcccc em Icrnc cc 7º cc 10º cic ce puerpéric,
reccmenccncc-:e ¢ue :ejc feiIc nc uniccce ce :cúce mci: prcximc cc
re:icëncic cc mu|her, inc|uincc c cricnçc e c ccmpcnheirc. Ne:Ie
reIcrnc, ceve-:e cuvir c: ¢ueixc: cc puérperc, prccecer cc excme f|:icc
cce¢uccc, ccm ënfc:e cc e:Iccc hemcIc|cgicc, rc:IrecmenIc ce
infecçcc {puerperc| cu cc fericc cpercIcric). FunccmenIc| é c excme
cc: mcmc: e c incenIivc pcrc ccnIinucçcc cc c|eiIcmenIc mcIernc.
Fcrc c: puérperc: ¢ue pc::uem v|ncu|c empregcI|cic cu nc: ¢ue
exercem cIiviccce: pcr ccnIc prcpric {cuIcncmc:) e ¢ue cincc ncc
e:Icc em gczc cc |icençc mcIerniccce, ceve-:e fcrnecer c cIe:Iccc
mécicc pcrc e:Ic :iIucçcc e crienIc-|c: c ccmpcrecer cc Fc:Ic ce
8enef|cic: cc lNSS mci: prcximc ce :uc re:icëncic, pci: Iercc cireiIc c 120
cic: ce |icençc. /: mu|here: ¢ue cmcmenIcm, cc reIcrncr cc |icençc-
mcIerniccce, Iëm cireiIc c |icençc ccmp|emenIcr pcrc cmcmenIcçcc,
ce cci: ce:ccn:c: cicric: ce IrinIc minuIc: cccc cIé c cricnçc ccmp|eIcr
:ei: me:e:.
2. kev|sõo puerpero| tord|o [oté 42 d|os}
/pc: c cIencimenIc preccce, ceve-:e crienIcr c puérperc pcrc reIcrncr
pcrc ncvc cvc|icçcc enIre c 30º e c 42º cic pc:-pcrIc. Ne:Ic ccc:icc,
cuvem-:e c: ¢ueixc: cc mu|her e prccece-:e ncvc excme f|:icc.
lmpcrIcnIe é ci:cuIir c c|eiIcmenIc mcIernc e crienIcr c mu|her pcrc
prcL|emc: ¢ue Ienhcm :urgicc cu ¢ue e|c Ienhc cuvicc ce cuIrc:
pe::cc:. /|gun: ce::e: ccmenIcric: prejuciccm c ccnIinucçcc cc
c|eiIcmenIc. Ne:Ic ccc:icc, pccem-:e |iLercr c: exerc|cic: f|:icc:, ce:ce
¢ue c mu|her :e :inIc Lem e ncc cpre:enIe ccmp|iccçce:.
Nc: puérperc: ¢ue ncc ccmp|eIcrcm :eu: e:¢uemc: ce vccincçcc,
ceve-:e cprcveiIcr e:Ie mcmenIc pcrc fczë-|c, em e:pecic| cc
imunizcçcc ccnIrc c IéIcnc, hepcIiIe 8 e ruLéc|c.
20
ASSISTÊNCIA À MULHER NO PUERPÉRIO
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Nc: mu|here: ¢ue ncc rec|izcrcm excme prevenIivc pcrc ccncer
cervicc|, e:Ie mcmenIc IcmLém é cpcrIunc, pci: IrcIc-:e prcIiccmenIe
cc |iLercçcc cc mu|her c: :uc: cIiviccce: ncrmci:. É funccmenIc| ¢ue
hcjc umc ci:cu::cc ccm c cc:c| :cLre c reIcrnc c: cIiviccce: :exuci:.
De:ccnfcrIc c re|cçcc pcce :urgir pcr ccnIc cc cIrcfic vcginc|, :encc
minimizccc e:Ie inccnvenienIe ccm c uIi|izcçcc ce |uLrificcnIe.
Controcepçõo no Fuerpér|o
PD Q".$":;( % G!%#(&&6*" .(!( R6$()( SQGRT
E:Ie méIccc nece::iIc ce omomentoçõo exc|us|vo o ||vre demondo, oté
se|s meses do porto e o ousënc|o de menstruoçõo neste período.
CLececicc: e:Ic: Irë: exigëncic:, c efeIiviccce é ce cIé º87 pcrc eviIcr
umc ncvc grcvicez. E:Ic prcIicc refcrçc nc: mu|here: c impcrIcncic cc
c|eiIcmenIc exc|u:ivc, ccnIriLuincc pcrc me|hcric cc :cúce cc:
cricnçc:.
UD R6$()(1 )% L"&&%*&"
/ uIi|izcçcc cc pre:ervcIivc mc:cu|inc em Iccc: c: re|cçce: :exuci: eviIc
ncc :cmenIe umc ncvc grcvicez, ccmc prcIege c mu|her ce ccnIrcir
umc DSI. Nc puerpéric reccmencc-:e c uIi|izcçcc cc pre:ervcIivc
|uLrificccc, pcrc eviIcr c ce:ccnfcrIc ccc:icnccc pe|c re::eccmenIc cc
mucc:c vcginc|. / uIi|izcçcc cc pre:ervcIivc femininc ceve :er
enccrcjccc, cpe:cr cc: cu:Ic: mci: e|evccc: ¢ucncc ccmpcrccc cc
mc:cu|inc. / uIi|izcçcc cc cicfrcgmc ceve cccrrer cpc: :ei: :emcnc: cc
pcrIc, pci: c pcrIir ce:Ie per|ccc pcce-:e e:cc|her c Icmcnhc mci:
cce¢uccc.
VD W*12(1*$*8( I#$&"7X$%&*#( SWIXT
C DlU pcce :er in:ericc |cgc cpc: c e|imincçcc cc p|ccenIc, IcnIc nc
pcrIc ncrmc| ccmc nc ce:crec. Cucncc :uc inIrccuçcc é feiIc ne:Ic
ccc:icc, c: mu|here: referem ciminuiçcc cc :cngrcmenIc e cc: cc|icc:.
Cucncc ncc in:ericc cenIrc cc: 48 hcrc: pc:-pcrIc, reccmencc-:e in:eri-
|c cpenc: nc :exIc :emcnc pc:-pcrIc, incepencenIe cc reIcrnc cc
men:Irucçcc.
YD Z1$%&*,*5":;( [%!*#*#"
Cucncc previcmenIe ci:cuIicc ccm c cc:c| e cenIrc cc: ccnciçce: em
¢ue c |ei permiIe, e:Ic prcIicc ccnIrccepIivc pcce :er efeIuccc |cgc
cpc: c pcrIc ncrmc|, cIrcvé: cc |c¢ueccurc IuLcrec rec|izccc pcr umc
mini|cpcrcIcmic, ce preferëncic cIé 72 hcrc: cc pcrIc, cu curcnIe c
ce:crec :e e:Ic fcr c vic cc pcrIc. Ncc é ncrmc cceiIcve| c ci:cu::cc
:cLre e:Ie méIccc ¢ucncc cc mcmenIc cc pcrIc. C reccmencccc é
¢ue hcjc umc cpre:enIcçcc ce Iccc: c: méIccc: ci:pcn|vei: e ¢ue c
cc:c| Icme c ceci:cc fcrc cc cic|c grcvicc-puerperc|, pe|c
irrever:iLi|iccce cc méIccc.
20
ASSISTÊNCIA À MULHER NO PUERPÉRIO
181
\D ]"1%.$(!*"
Devem-:e Ier c: me:mc: preccuçce: ccm c uIi|izcçcc ce:Ie méIccc ¢ue
c: prcvicenciccc: nc |c¢ueccurc IuLcrec, principc|menIe nc cic|c
grcvicc-puerperc|. Fcr :er ce mencr cu:Ic e ce mci: :imp|iciccce, pcce
:er feiIc nc cmLu|cIcric. Deve :er mci: civu|gccc e enccrcjccc :uc
e:cc|hc, pe|c: vcnIcgen: ¢ue Iem e pcr pre:ervcr c mu|her ce
prccecimenIc: invc:ivc:.
^D R6$()(1 _(&!(#"*1 SM&(-%1$(-@#*(1T
/ uIi|izcçcc cc minip||u|c ceve :er iniciccc cpc: c ó† :emcnc cc pcrIc, e
:eu u:c é ccnI|nuc. Cucncc c::cciccc c cmcmenIcçcc, Iem :uc
eficccic cumenIccc. Deve :er :uL:IiIu|cc pcr cuIrc méIccc ¢ucncc
cccrre c reIcrnc cc men:Irucçcc. C: injeIcvei: {Limen:ci:) IcmLém
pccem :er empregccc:, emLcrc IcmLém mci: uIi|izccc: cpc: c: :ei:
:emcnc: cc pcrIc.
`D R6$()(1 J(!2(&$"!%#$"*1
Envc|ve vcric: méIccc:, inc|uincc c cciIc inIerrcmpicc, c cL:Iinëncic
:exuc|, c ce 8i||ing: e c ce IcLe|c. C: cci: ú|Iimc: :cc, ce cif|ci| uIi|izcçcc
ne:Ie per|ccc pcr¢ue cincc ncc cccnIeceu c reIcrnc c funçcc cvcricnc
ncrmc|.
aD G#$*.(#.%2.*(#", b&", J(!=*#")(
E:Ic ccnIrc-incicccc c u:e ce cnIiccncepcicnci: crci: ccmLinccc: nc:
mu|here: ¢ue e:Icc cmcmenIcncc, pci: c ccmpcnenIe e:Ircgënicc
inIerfere ccm c prccuçcc cc |eiIe. EvicenIemenIe e:Ic ccnIrc-inciccçcc
ceixc ce exi:Iir :e, pcr ¢uc|¢uer mcIivc, c c|eiIcmenIc mcIernc ncc
e:Iiver :encc prcIicccc.
20
182
/ inccrpcrcçcc ce ccnhecimenIc: nc vicc cc:
pe::cc:, ¢ue regem :eu: ccmpcrIcmenIc: e prcIicc:,
Lc:eic-:e em Irë: :i:Iemc:: c mcgicc, c emp|ricc e c
cienI|ficc.
C :i:Iemc mcgicc é c mci: primiIivc e cIriLui c fcrçc:
:cLrencIurci: c crigem cc: fencmenc: vincu|ccc: c
:cúce-enfermiccce. C :i:Iemc emp|ricc, mci: evc|u|cc
¢ue c cnIericr, Lc:eic-:e nc uIi|izcçcc ce
ccnhecimenIc: e prcIicc: ¢ue c experiëncic pe::cc| e
cL:ervcçcc ce cnc: cemc:Ircrcm ¢ue :cc
cce¢uccc:. C pen:cmenIc cienI|ficc é umc eIcpc
:upericr cc ccnhecimenIc e e:Ic Lc:eccc nc
inve:Iigcçcc :i:IemcIicc e meIccicc, :eguincc regrc:
pré-e:IcLe|ecicc: ¢ue permiIem :uc rep|iccLi|iccce :e
e:Ic: fcrem re:peiIccc:. /incc ¢ue ncc :ejc infc||ve|, é
mci: ccnficve| ¢ue c Ircciçcc, c experiëncic pe::cc| e
c cuIcriccce.
/: prcIicc: mécicc: em gerc| e c: cL:IéIricc: em
pcrIicu|cr ncc e:ccpcm ce:Ie ccnIexIc e, cincc ¢ue
muiIc: ce|c: Ienhcm :icc cccIccc: :eguincc c
pen:cmenIc cienI|ficc, cuIrc: Iëm :icc inccrpcrccc:
ncc criIiccmenIe e uIi|izccc: curcnIe cnc:, em gerc|
re:pc|cccc: cpenc: pe|c Ircciçcc e pe|c princ|pic ce
cuIcriccce.
C: ve|hc: pcrccigmc: nc ecuccçcc mécicc e nc
e|cLcrcçcc ce guic: ncrmcIivc: e:Icc ccncc |ugcr c
ncvc: fcrmc: menc: cuIcriIcric: e mci: Lc:eccc: nc:
me|hcre: evicëncic: ci:pcn|vei:. /::im é ¢ue nc
Univer:iccce ce McMc:Ier cc Ccnccc ce:envc|veu-:e
e:Ie ncvc enfc¢ue ¢ue :e Iem cencminccc med|c|no
boseodo em ev|dënc|os ¢ue é c uIi|izcçcc ccn:cienIe,
exp||ciIc e criIeric:c cc me|hcr evicëncic cienI|ficc
c||nicc ci:pcn|ve| pcrc Icmcr ceci:ce: :cLre c cuicccc
ce pccienIe: incivicuci: e ¢ue :e Iem e:Iencicc pcrc
c e|cLcrcçcc ce guic: ncrmcIivc:.
21
EVIDÊNCIAS CIENTÍFICAS SOBRE AS PRÁTICAS
UTILIZADAS NO PARTO
EVIDÊNCIAS CIENTÍFICAS SOBRE AS PRÁTICAS UTILIZADAS NO PARTO
183
/ mecicinc Lc:eccc em evicëncic: inIegrc c experiëncic c||nicc
incivicuc| ccm c me|hcr evicëncic exIernc ci:pcn|ve| cerivccc cc Lu:cc
:i:IemcIicc ce infcrmcçcc re|evcnIe nc |iIercIurc mécicc.
Iencc em ccnIc e:Ic c|c::ificcçcc cc: evicëncic:, pccer-:e-icm
ce:crever ciferenIe: grcu: ce reccmenccçcc ce umc ceIerminccc
prcIicc cu IrcIcmenIc:
Feccmenccçcc
/ Evicëncic: n|ve| l c lV
8 Evicëncic: n|ve| V
C Evicëncic: n|ve| Vl c Vll
Ccmc :e cepreence cc c|c::ificcçcc ccimc mencicnccc, c: revi:ce:
:i:IemcIicc: {inve:Iigcçcc :ecunccric) cc |iIercIurc :cc c ferrcmenIc
meIccc|cgicc ¢ue cc mci: fcrçc c: evicëncic: ci:pcn|vei: e e|c: :e
rec|izcm funccmenIc|menIe c pcrIir ce inve:Iigcçce: primcric: ¢ue :cc
en:cic: c||nicc: ccnIrc|ccc: ccm c|cccçcc c|ecIcric, pe|c ¢ue :e fcz
nece::cric reccrccr :umcricmenIe ¢uc| é c e:IruIurc Lc:icc cc: me:mc:.
Enso|os C|ín|cos Contro|odos com A|ocoçõo A|eotor|o
Em meccc: cc :écu|c XX, Fi:her ce:creveu c: Lc:e: cc: en:cic: c||nicc:
ccnIrc|ccc:, c: ¢uci: ce:envc|veu nc ccmpc cc cgricu|Iurc e cc
lcLcrcIcric. Um mcrcc Ircn:cencenIe nc cceiIcçcc ce::e: en:cic: nc
mecicinc fci c prcvc cc e:IrepIcmicinc nc IrcIcmenIc cc IuLercu|c:e.
/ cvc|icçcc ce ncvc: IrcIcmenIc: cu prccecimenIc: mécicc: imp|icc nc
ccmpcrcçcc ce cuc: :érie: ce cL:ervcçce:: umc ¢ue :e cLIém ccm c
empregc cc ncvc prccecimenIc cu IrcIcmenIc {:érie IrcIccc,
experimenIc|) e cuIrc ¢ue repre:enIc c: cL:ervcçce: ce um grupc
ccnIrc|e :em c uIi|izcçcc ce Ic| prccecimenIc cu IrcIcmenIc cu ccm c
prccecimenIc pccrcc {:érie ccnIrc|e).
Exi:Iem vcric: prcpc:Ic: pcrc c|c::ificcr c: ciferenIe: n|vei: ce
¢uc|iccce cc: evicëncic:, enIre e|c: c ce Mu|rcw ce 1º87:
l Fevi :ce: :i :IemcIi cc:
ll En:ci c: ccnIrc| ccc: c| ecIcri zccc: ccm grcnce númerc ce
cc:c: e Lem ce:enhccc: {errc: c| fc e LeIc pe¢uenc:)
lll En:ci c: ccnIrc| ccc: c| ecIcri zccc: ccm pe¢uenc númerc
ce cc:c: e Lem ce:enhccc: {errc: c| fc e LeIc mci cre:)
l V E:Iucc: ce cccrIe: Lem ce:enhccc:
V E:Iucc: cc:c-ccnIrc| e Lem ce:enhccc:
Vl Séri e: ce cc:c:
Vll Cpi ni cc ce experIc:
21
EVIDÊNCIAS CIENTÍFICAS SOBRE AS PRÁTICAS UTILIZADAS NO PARTO
184
/: ciferençc: cL:ervccc: enIre cmLc: :érie: pccem :er cIriLu|cc: c:
1. Vcricçce: nc cmc:Irc
2. Diferençc nc ccnfcrmcçcc cc: grupc:
3. Diferençc: nc ccncuçcc {mcnipu|cçcc) cc: grupc:
4. Verccceirc: efeiIc: cc ncvc IrcIcmenIc cu prccecimenIc: ¢ue é c
meIc ¢ue :e per:egue hcLiIuc|menIe ne::e: en:cic:
/: ciferençc: cIriLu|vei: c: Irë: primeirc: ccIegcric: pccem :er
ccnIrc|ccc: re:pecIivcmenIe: ccm c meIccc|cgic cc inferëncic
e:IcI|:Iicc {prcvc: ce :ignificcçcc e:IcI|:Iicc cce¢uccc:), ccm c
c|cccçcc c|ecIcric {c|ecIcrizcçcc, rcnccmizcçcc, uIi|izcncc c: númerc:
c|ecIcric:) e ccm c mc:ccrcmenIc cc: grupc: {cup|c cu Irip|c cegc).
Nc e:Iccc cIuc| cc inve:Iigcçcc nc mecicinc, c en:cic c||nicc
ccnIrc|ccc rcnccmizccc Iem umc pc:içcc :egurc e re:peiIccc. Se
cIrcvé: ce ci:IinIc: e:Iucc: {cccrIe:, cc:c-ccnIrc|e, :érie ce cc:c:) :e
chegcm c ccnc|u:ce: cpc:Ic:, cuIcrgc-:e mcicr creciLi|iccce cc
re:u|Iccc cc inve:Iigcçcc ¢ue uIi|izcu e:Ic Iécnicc.
kev|söes S|stemót|cos
Mci: recenIemenIe {1º7ó), ccm c grcnce cre:cimenIc cc Ie|emcIicc,
ce:envc|veu-:e c Iécnicc cc: revi:ce: :i:IemcIicc: ¢ue, ciferenIemenIe
cc: revi:ce: Irccicicnci:, Iem c ccrccIer|:Iicc ce :er reprccuI|ve| e
¢ucnIiIcIivc. Fcrc :er reprccuI|ve|, ceve-:e :eguir e:IriIcmenIe :uc
meIccc|cgic e :er ccnvenienIemenIe exp|iciIccc, eviIcncc c v|cic ce :e
e|eger :cmenIe c: crIigc: ¢ue inIere::cm c nc::c hipcIe:e. / pcrIe
¢ucnIiIcIivc cencminc-:e meIcnc|i:e, ¢ue é um méIccc ¢ue permiIe
ccmLincr c: re:u|Iccc: cc: e:Iucc: primcric: incepencenIe: e c :|nIe:e:
cc: me:mc:. É ce e:pecic| uIi|iccce pcrc cvc|icr c: IrcIcmenIc: e
prccecimenIc: mécicc: ccm re:u|Iccc: ce e:Iucc: ccnIrcciIcric: em
mcgniIuce cu cireçcc ce efeiIc, cu ccm efeiIc: pe¢uenc:, mc:
impcrIcnIe:.
FermiIe cumenIcr c Icmcnhc cc cmc:Irc, c ¢ue incremenIc c pccer
e:IcI|:Iicc cc: prcvc: {ciminuincc c: errc: c|fc e LeIc) e fcci|iIc c
cLIençcc ce ccnc|u:ce: mci: ccerenIe: e ccnficvei: :cLre c eficccic ce
IrcIcmenIc cu prccecimenIc, :cLre cu:Ic: e permiIe reccmenccr ccm
mcicr fcrçc :uc inc|u:cc ccmc pcuIc ncrmcIivc.
E:Ic: revi:ce: :i:IemcIicc: :cc ccn:icerccc: ccmc inve:Iigcçce:
:ecunccric: :cLre e:Iucc: jc rec|izccc:, ccm pcrIicu|cr cprcfunccmenIc
nc: en:cic: c||nicc: ccnIrc|ccc:.
/ meIcnc|i:e prcvë um mcrcc |cgicc pcrc c inve:Iigcçcc ce revi:cc e
pcce :er rec|izccc :e c LiL|icgrcfic ci:pcn|ve| em ¢ucnIiccce e
¢uc|iccce c::im c permiIe.
21
EVIDÊNCIAS CIENTÍFICAS SOBRE AS PRÁTICAS UTILIZADAS NO PARTO
185
Ccmc méIccc ce IrcLc|hc, Iem c: :eguinIe: eIcpc::
1. Invest|goçõo, rev|sõo, otuo||zoçõo do b|b||ogro||o: c Lu:cc cc:
IrcLc|hc: ceve :er p|cnificccc, excu:Iivc e e:Icnccrcizccc, ccm
pré-e:pecificcçcc ce cefiniçce: e criIéric: ce e|egiLi|iccce. Ne:Ic
eIcpc ¢uc|iIcIivc |i:Icm-:e e:Iucc: ccmpcrcvei: ¢ue u:cm
ce:enhc: :imi|cre: e vcricvei: ce inIervençcc e ce re:u|Iccc:
pcrecicc:. Feccrre-:e c fcnIe: cefinicc: e gcrcnIe-:e c ¢uc|iccce
cc infcrmcçcc primcric.
2. Có|cu|o do e|e|to poro codo estudo em port|cu|or: é umc eIcpc
¢ucnIiIcIivc, empregcncc-:e Iécnicc: e:IcI|:Iicc: ccmc c mecicc
cc ri:cc re|cIivc {FF) cu cc ccc: rcIic {CF), ciferençc: ce mécic:,
Iccc: ccm :eu: re:pecIivc: inIervc|c: ce ccnficnçc.
3. Có|cu|o do e|e|to comum g|obo|, comb|nodo e ponderodo: eIcpc
IcmLém ¢ucnIiIcIivc, empregcncc prccecimenIc: e:IcI|:Iicc:,
pcncercm-:e c: e:Iucc: pcr ciferençc:, vcricncic: cu Icmcnhc:
cmc:Irci:, c fim ce ccn:eguir umc e:Iimcçcc pcnIuc| ce re:umc,
ccm :eu inIervc|c ce ccnficnçc, ce Iccc: c: IrcLc|hc: cnc|i:ccc:
{meIcnc|i:e). EnIre c: Iécnicc: uIi|izccc:, ce:Icccm-:e c: ce mécic:
pcncerccc:, c méIccc ce McnIe| e Hcen:ze|, pcncercçcc ce CF
cu FF pe|c inver:c cc vcricncic, regre::cc |cg|:Iicc mú|Iip|c, enIre
cuIrc:. IcmLém ccrre:pcnce c e:Ic eIcpc, c cpre:enIcçcc grcficc
cc: re:u|Iccc:.
4. Có|cu|o do nùmero de trobo|hos nõo pub||codos com conc|usöes
ontog•n|cos necessór|os poro negor os resu|todos obt|dos: IenIc-:e
umc cprcximcçcc mecicnIe c cgregcçcc ce re:u|Iccc: :imu|ccc:,
repeIincc c prccecimenIc cc eIcpc cnIericr, c fim ce e:IcLe|ecer
¢ucnIc: IrcLc|hc: ccm re:u|Iccc: cnIcgcnicc: fc|Icricm pcrc fczer
ce:cpcrecer c: efeiIc:. IcmLém chcmccc ce cnc|i:e ce
:en:iLi|iccce, :erve pcrc :u:peiIcr :e exi:Iem v|cic: ce puL|iccçcc
{funne| p|cI).
21
EVIDÊNCIAS CIENTÍFICAS SOBRE AS PRÁTICAS UTILIZADAS NO PARTO
186
/: revi:ce: :i:IemcIicc: e c meIcnc|i:e ¢ue ce|c: cerivcm, cepencem cc
númerc e ¢uc|iccce cc: e:Iucc: primcric:. Se e|e: ncc :cc :uficienIe: cu
:cIi:fcIcric:, c meIcnc|i:e ncc c: ccrrige. /: ceLi|iccce: cc
prccecimenIc Lc:eicm-:e em:
VE kY16# $' </@-61%+,#= #( %/)#4'( ' '$6)#4'( )'*$'2 % *,# </@-61%4
)4%@%-7#( 1#2 4'(/-)%$#( *'>%)63#( #/ *,# '(<'4%$#(? (' 78 /2%
</@-61%+,# ./' 2#()4% 4'(/-)%$#( ;%3#483'6(E K(<'16%- 1/6$%$# $'3'I
(' )'4 ./%*$# /2% C*61% 6*3'()6>%+,# #46>6*%- : $636$6$% '2
;4%>2'*)#( <%4% (' #@)'4 3846%( </@-61%+A'( 1#2 % 2'(2% @%(' $'
$%$#(
PE kY16# $' ('-'+,#= #( %/)#4'( $% 4'36(,# (6()'28)61% )'*$'2 %
('-'16#*%4 2%6#4 *C2'4# $' %4)6>#( ./' 4';#41'2 (/%( <4J<46%(
76<J)'('(
NE kY16# *#( <4#1'$62'*)#( $' %1/2/-%1,#
WE kY16# *% 6*)'4<4')%+,#
Iencc em ccn:icercçcc e:Ic: pcuIc: é ¢ue :e Iem IenIccc c|c::ificcr c:
ccncuIc: e prcIicc: nc pcrIc ncrmc| em ¢ucIrc ccIegcric:, cepencencc
ce :uc uIi|iccce, eficccic e cu:ëncic ce efeiIc: prejucicici:.
/ c|c::ificcçcc Icmccc ccmc Lc:e fci c ce:envc|vicc pe|c grupc ce
IrcLc|hc :cLre c FcrIc Ncrmc| ¢ue c CMS ccnvcccu nc cnc 1ººó, e
mccificccc pe|c: ncvc: evicëncic: cienI|ficc: cIuc|menIe ci:pcn|vei:.
E:Ic c|c::ificcçcc civice c: prcIicc: nc pcrIc ncrmc| em 4 ccIegcric:, c
:cLer:
21
EVIDÊNCIAS CIENTÍFICAS SOBRE AS PRÁTICAS UTILIZADAS NO PARTO
187
1. Frót|cos no porto normo| demonstrodomente ùte|s e que devem ser
est|mu|odos
1.1 - F|cnejcmenIc incivicuc| ceIermincncc cnce e pcr ¢uem c pcrIc
:erc rec|izccc.
1.2 - /vc|icçcc ce ri:cc curcnIe c pré-ncIc|, recvc|iccc c cccc
ccnIcIc e nc mcmenIc cc IrcLc|hc ce pcrIc.
1.3 - McniIcrcmenIc cc Lem-e:Icr f|:icc e emccicnc| cc mu|her
curcnIe c IrcLc|hc ce pcrIc.
1.4 - CferecimenIc ce ||¢uicc pcr vic crc| curcnIe c IrcLc|hc ce pcrIc.
1.5 - Fe:peiIc c e:cc|hc cc mu|her :cLre c |ccc| cc pcrIc.
1.ó - FcrnecimenIc ce c::i:Iëncic cL:IéIricc nc n|ve| mci: periféricc
cnce c pcrIc fcr :egurc.
1.7 - Fe:peiIc cc cireiIc cc mu|her c privcciccce nc |ccc| cc pcrIc.
1.8 - /pcic emccicnc| pe|c: pre:Icccre: ce :erviçc curcnIe c IrcLc|hc
ce pcrIc e pcrIc.
1.º - Fe:peiIc c e:cc|hc cc mu|her :cLre :eu: cccmpcnhcnIe: curcnIe
c IrcLc|hc ce pcrIc.
1.10 - FcrnecimenIc c: mu|here: ce Iccc: c: infcrmcçce: e exp|iccçce:
¢ue ce:ejcrem.
1.11 - MéIccc: ncc invc:ivc: e ncc fcrmccc|cgicc: ce c||vic cc ccr,
ccmc mc::cgen: e Iécnicc: ce re|cxcmenIc, curcnIe c IrcLc|hc
ce pcrIc.
1.12 - McniIcrcmenIc feIc| pcr meic ce cu:cu|Ic inIermiIenIe e
vigi|cncic cc: ccnIrcçce: uIerinc: pcr pc|pcçcc cLccminc|.
1.13 - U:c ce mcIerici: ce:ccrIcvei: e ce:ccnIcmincçcc cce¢uccc ce
reuIi|izcvei:.
1.14 - U:c ce |uvc: nc excme vcginc|, nc pcrIc e nc mcnu:eic cc
p|ccenIc.
1.15 - LiLerccce ce pc:içcc e mcvimenIc curcnIe c IrcLc|hc ce pcrIc.
1.1ó - E:I|mu|c c pc:içce: ncc :upinc: curcnIe c IrcLc|hc ce pcrIc.
1.17 - McniIcrcmenIc cuicccc:c cc prcgre::c cc IrcLc|hc ce pcrIc, u:c
cc pcrIcgrcmc.
1.18 - /cmini:Ircçcc prcfi|cIicc ce cciIccinc nc Ierceirc e:Icgic cc
pcrIc em mu|here: ccm ri:cc ce hemcrrcgic pc:-pcrIc.
1.1º - Ccnciçce: e:Iérei: cc ccrIcr c ccrccc.
1.20 - Frevençcc cc hipcIermic cc LeLe.
1.21 - Frevençcc cc hemcrrcgic necncIc| ccm c u:c cc viIcminc ‚.
1.22 - Frevençcc cc cfIc|mic gcnccccicc ccm c u:c ce niIrcIc ce
prcIc cu IeIrccic|inc.
1.23 - CcnIcIc cuIcnec cireIc, preccce enIre mce e fi|hc e cpcic cc
in|cic cc cmcmenIcçcc nc primeirc hcrc cpc: c pcrIc.
1.24 - /|cjcmenIc ccnjunIc.
1.25 - Suprimir c |ccIcçcc em mce: pcrIcccrc: ce HlV.
1.2ó - Excme rcIineirc cc p|ccenIc e memLrcnc: cvu|cre:.
1.27 - U:c rcIineirc ce cciIccinc, Ircçcc ccnIrc|ccc cc ccrccc, cu :uc
ccmLincçcc, curcnIe c Ierceirc e:Icgic cc pcrIc.
21
EVIDÊNCIAS CIENTÍFICAS SOBRE AS PRÁTICAS UTILIZADAS NO PARTO
188
3. Frót|cos no porto normo| em que nõo ex|stem ev|dënc|os poro opo|or
suo recomendoçõo e devem ser ut|||zodos com coute|o oté que novos
pesqu|sos esc|oreçom o questõo
3.1 - MéIccc: ncc fcrmccc|cgicc: ce c||vic cc ccr curcnIe c IrcLc|hc ce
pcrIc, ervc:, imer:cc em cguc e e:Iimu|cçcc ce nervc:.
3.2 - Fre::cc nc funcc uIerinc curcnIe c per|ccc expu|:ivc.
3.3 - McncLrc: re|ccicnccc: c prcIeçcc cc per|nec e cc pc|c cefc|icc nc
mcmenIc cc pcrIc.
3.4 - Mcnipu|cçcc cIivc cc feIc nc mcmenIc cc pcrIc.
3.5 - C|cmpecmenIc preccce cc ccrccc umLi|icc|.
3.ó - E:Iimu|cçcc cc mcmi|c pcrc cumenIcr c ccnIrcIi|iccce uIerinc
curcnIe c Ierceirc e:Icgic cc pcrIc.
2. Frót|cos no porto normo| c|oromente prejud|c|o|s ou |ne||cozes e que
devem ser e||m|nodos
2.1 - U:c rcIineirc cc enemc.
2.2 - U:c rcIineirc cc IriccIcmic.
2.3 - lnfu:cc inIrcvenc:c ce rcIinc nc IrcLc|hc ce pcrIc.
2.4 - CcIeIerizcçcc venc:c prcfi|cIicc ce rcIinc.
2.5 - U:c rcIineirc cc pc:içcc :upinc curcnIe c IrcLc|hc ce pcrIc.
2.ó - Excme reIc|.
2.7 - U:c ce pe|vimeIric pcr rcic: X.
2.8 - /cmini:Ircçcc ce cciIccicc: cnIe: cc pcrIc ce um mccc ¢ue ncc :e
permiIc ccnIrc|cr :eu: efeiIc:.
2.º - U:c rcIineirc cc pc:içcc ce |iIcIcmic.
2.10 - E:fcrçc: ce puxc: prc|cngccc: e cirigicc: {mcncLrc ce Vc|:c|vc)
curcnIe c :eguncc e:Icgic cc IrcLc|hc ce pcrIc.
2.11 - Mc::cgem e ci:Ien:cc cc per|nec curcnIe c :eguncc e:Icgic cc
IrcLc|hc ce pcrIc.
2.12 - U:c ce ccmprimicc: crci: ce ergcmeIrinc nc Ierceirc e:Icgic cc
IrcLc|hc ce pcrIc ccm c cLjeIivc ce eviIcr hemcrrcgic.
2.13 - U:c rcIineirc ce ergcmeIrinc pcr vic pcrenIerc| nc Ierceirc e:Icgic cc
IrcLc|hc ce pcrIc.
2.14 - Lcvcgem uIerinc rcIineirc cpc: c pcrIc.
2.15 - Fevi:cc {exp|crcçcc mcnuc|) rcIineirc cc úIerc cpc: c pcrIc.
2.1ó- U:c |iLerc| cu rcIineirc cc epi:icIcmic.
2.17 - Ic¢ue: vcginci: fre¢üenIe: e pcr mci: ce um excmincccr.
2.18 - McncLrc ce ‚ri:Ie||er cu :imi|cr, ccm pre::ce: incce¢ucccmenIe
cp|icccc: cc funcc uIerinc nc per|ccc expu|:ivc.
2.1º - FrcIicc |iLerc| ce ce:cricnc.
2.20 - /:pircçcc nc:cfcr|ngec ce rcIinc em recém-nc:cicc: ncrmci:
2.21 - McnuIençcc crIificic| ce cr fric nc :c|c ce pcrIc curcnIe c
nc:cimenIc.
21
EVIDÊNCIAS CIENTÍFICAS SOBRE AS PRÁTICAS UTILIZADAS NO PARTO
189
E:Ic c|c::ificcçcc cc: prcIicc: curcnIe c pcrIc ncrmc|, ¢ue :e ce:creveu
ccimc, ccm c: me|hcre: evicëncic: ci:pcn|vei: cIé e:Ic ccIc, ceve :er
pericciccmenIe revi:ccc ce fcrmc criIicc, pci:, ccm c prcgre::c cc
ciëncic mécicc, ncvc: evicëncic: :urgircc e cccc um cc: memLrc: cc
e¢uipe ce :cúce ceve Lu:cc-|c ce fcrmc cIivc e permcnenIe.
Um DireIcr ce umc E:cc|c ce Mecicinc, nc cIc ce cc|cçcc ce grcu ce
:eu: egre::c:, expre::cu: ¨/ meIcce cc ¢ue |he: fci en:inccc
prcvcve|menIe jc ncc é cerIc, mc: c picr é ¢ue ncc :cLemc: ¢uc|
meIcce¨.
EmLcrc :e pc::c rec|izcr um Lcm IrcLc|hc en:incncc c me|hcr prcIicc
mécicc cIuc|menIe ci:pcn|ve| cc: e:IuccnIe: e re:icenIe:, e::e IrcLc|hc
:erc inccmp|eIc ¢ucncc ncc :e en:incr ccmc cecicir ¢ucncc e c ¢ue
e:Icc cprencencc Ienhc :e Icrnccc cL:c|eIc e nece::iIe :er mccificccc.
4. Frót|cos no porto normo| |reqüentemente ut|||zodos de modo
|nodequodo
4.1 - Fe:Iriçcc h|cricc e c|imenIcr curcnIe c IrcLc|hc ce pcrIc.
4.2 - CcnIrc|e cc ccr pcr cgenIe: :i:Iëmicc:.
4.3 - CcnIrc|e cc ccr pcr cnc|ge:ic pericurc|.
4.4 - McniIcrcmenIc e|eIrcnicc feIc|.
4.5 - U:c ce mc:ccrc e cvenIci: e:Iérei: curcnIe c c::i:Iëncic cc
IrcLc|hc ce pcrIc.
4.ó - Excme: vcginci: repeIicc: cu fre¢üenIe:, e:pecic|menIe pcr mci:
ce um pre:Icccr ce :erviçc.
4.7 - Ccrreçcc cc cincmicc uIerinc ccm c uIi|izcçcc ce cciIccinc.
4.8 - /mnicIcmic preccce ce rcIinc nc primeirc e:Icgic cc pcrIc.
4.º - Ircn:ferëncic rcIineirc cc pcrIurienIe pcrc cuIrc :c|c nc in|cic cc
:eguncc e:Icgic cc IrcLc|hc ce pcrIc.
4.10 - CcrccIerizcçcc cc Lexigc.
4.11 - E:I|mu|c pcrc c puxc ¢ucncc :e cicgnc:Iicc ci|cIcçcc cervicc|
ccmp|eIc, cnIe: ¢ue c prcpric mu|her :inIc c puxc.
4.12 - /ce:cc r|gicc c umc curcçcc e:Iipu|ccc cc :eguncc e:Icgic cc
IrcLc|hc ce pcrIc, :e c: ccnciçce: cc mce e cc feIc fcrem Lcc: e
:e hcuver prcgre::cc cc IrcLc|hc ce pcrIc.
4.13 - FcrIc cpercIcric.
4.14 - Exp|crcçcc mcnuc| cc úIerc cpc: c pcrIc.
21
190
/8F/MCVlCl D, GCLDW/SSEF S, M/8lE 8C, MEFCEF 8M, GCLDW/SSEF F,
Sl8/l 8M. / rcnccmizec ccmpcri:cn cf crc| mi:cprc:Ic| ver:u: Fc|ey
ccIheIer cnc cxyIccin fcr incucIicn cf |cLcr cI Ierm. Am J Obstet
Gyneco|, 181[5}: 1108-112, 1ººº.
/CCG - /mericcn Cc||ege cf CL:IeIricicn: cnc Gynecc|cgi:I:. /CCG
Iechnicc| Lu||eIin. lncucIicn cf |cLcr {NumLer217). Int J Gyneco|
Obstet, 53: ó5-72, 1ººó.
/CCG - /mericcn Cc||ege cf CL:IeIricicn: cnc Gynecc|cgi:I:. /CCG
ccmmiIIee cpinicn. lncucIicn cf |cLcr wiIh mi:cprc:Ic| {NumLer
228). Int J Gyneco| Obstet, óº: 77-78, 2000.
/LMElD/ FML, FElICS/ FEL {ec.). Monuo| do C|ín|co Obstétr|co.
Motern|dode-Esco|o Ass|s Choteoubr|ond. FcrIc|ezc, 2000.
/MEFlC/N HE/FI /SSCCl/IlCN. /MEFlC/N /C/DEM• CF FEDl/IFlCS.
Neonoto| kessuc|tot|on. Iextboo•. 4Ih EciIicn, 2000.
/MEFlC/N SCClEI• CF /NESIHESlCLCGlSIS. FrccIice Guice|ine: fcr
CL:IeIricc| /ne:Ihe:ic. Anesthes|o|ogy, º0: ó00-11, 1ººº.
8/L/S‚/S, J. Forto ot|vo - gu|o prót|co poro o porto noturo|. 2c- ec., Scc
Fcu|c, Grcunc, 1ºº3.
8/FFCS FC, V/UGH/N JF, VlCICF/ CG, HUIIL• SF/. Epicemic cf
Cce:crecn :ecIicn: in 8rczi|. Loncet, 338: 1ó7-1óº, 1ºº1.
8ENF/M. 8rc:i|. Fesqu|so Noc|ono| sobre Demogro||o e Soùde, 1ººó. Fic
ce Jcneirc, 1ºº7.
8EFCU‰ES, CUNH/ EMGF {crg:.). Morb|morto||dode |em|n|no no 8ros||
[1º7º-1ºº5}. EciIcrc cc UNlC/MF, Ccmpinc:, 2000.
8ESIEIl FlFES HM, CEC/IIl JG, F/UNDES /. FcIcre: c::cciccc: c prcvc ce
IrcLc|hc ce pcrIc em prim|pcrc: ccm umc ce:crec cnIericr. kev
Soùde Fùb||co, Sõo Fou|o, 33: 342-8, 1ººº.
8lSHCF, EH. Fe|vic :ccring fcr e|ecIive incucIicn. Obstet Gyneco|, 24: 2óó-
2ó8, 1ºó4.
8LCCM FS, CFCFLE• C. /mericcn HecrI /::ccicIicn, /mericcn /cccemy
cf FecicIric:. Iextboo• o| Neonoto| kessuc|tot|on, 1ºº4.
REFERÊNCIAS BIBLIOGRÁFICAS
REFERÊNCIAS BIBLIOGRÁFICAS
191
8F/SlL.MlNlSIÉFlC D/ S/UDE. AIDS: recomendoçöes poro prevençõo do
tronsm|ssõo vert|co| do HIV. 1 º eciçcc.8rc:||ic, D.F. 1ººº.
8F/SlL. MlNlSIÉFlC D/ S/UDE. A Morto||dode Fer|noto| e Neonoto| no
8ros||. 8rc:||ic, DF, 1ºº8.
8F/SlL. MlNlSIÉFlC D/ S/UDE. Amomentoçõo e use de drogos. 8rc:||ic,
DF, 2000.
8F/SlL. MlNlSIÉFlC D/ S/UDE. Anó||se do Atençõo Obstétr|co Hosp|to|or:
S|stemo ‚n|co de Soùde, 8ros|| 1ºº8. 8rc:||ic, DF, 1ººº.
8F/SlL.MlNlSIÉFlC D/ S/UDE. Normo Iécn|co - Frevençõo e Irotomento
dos ogrovos kesu|tontes do V|o|ënc|o Sexuo| Contro Mu|heres e
Ado|escentes 1 º eciçcc. 8rc:||ic, D.F. 1ººº.
8F/SlL.MlNlSIÉFlC D/ S/UDE. Iestes kóp|dos Ant|-HIV: Cons|deroçöes
Gero|s poro seu bso com Èn|ose no Ind|coçõo de Ierop|o Ant|-
ketrov|ro| em S|tuoçöes de Emergënc|o. 1 º eciçcc.8rc:||ic, D.F. 2001
8F/SlL. MlNlSIÉFlC D/ S/UDE. Cccrcencçcc McIernc lnfcnIi|. Monuo| de
Fromoçõo do A|e|tomento Moterno. Ncrmc: Iécnicc:. 2c. ec.,
8rc:||ic, DF, 1ºº7.
8F/SlL. Mini:Iéric cc Scúce. Cccrcencçcc McIernc lnfcnIi|. Monuo| de
Ass|stënc|o oo kecém-nosc|do. 8rc:||ic, DF, 1ºº4.
8F/SlL. MlNlSIÉFlC D/ S/UDE. Gestoçõo de A|to k|sco. Mcnuc| Iécnicc.
3c. eciçcc. 8rc:||ic, DF, 2000.
8F/SlL. MlNlSIÉFlC D/ S/UDE. FcrIcric MS/GM nc. 2.81ó. D|ór|o O||c|o| do
bn|õo, Se¢. l, nc. 103, 02/ó/1ºº8, p.48.
8F/SlL., MlNlSIÉFlC D/ S/UDE. Frogromo de Humon|zoçõo no Fre-noto| e
Nosc|mento. 8rc:||ic, Mini:Iéric cc Scúce, 2000.
8F/SlL. MlNlSIÉFlC D/ S/UDE. brgënc|os e Emergënc|os Moternos: Gu|o
poro d|ognost|co e conduto em s|tuoçöes de r|sco de morte
moterno. 8rc:||ic, Mini:Iéric cc Scúce/FE8F/SGC, 2000. 118p.
8F/SlL. hIIp://www.ccIc:u:.gcv.Lr 2001.
8F/SlL. hIIp://www.:cúce.gcv.Lr 2001.
8UG/LHC, /M: 8lCUE, C: M/CHUNGC, F: F/UNDES, /. Lcw cc:e vcginc|
mi:cprc:Ic| fcr incucIicn cf |cLcr wiIh c |ive feIu:. Inter J Gyneco|
Obstet, 4º: 14º-155, 1ºº5.
REFERÊNCIAS BIBLIOGRÁFICAS
192
8UFFCUGHS, /. bmo Introduçõo ò En|ermogem moterno. óº ec. FcrIc
/|egre, /rIe: Mecicc:, 1ºº5.
C/FFCLl G, 8ELl…/N J. Epi:icIcmy fcr vcginc| LirIh. Cochrone L|brory.
Ccchrcne DcIcLc:e Sy:I. Fev 2000: 2:CD000081.
C/FV/LHC, GM. En|ermogem em Obstetríc|o. Scc Fcu|c, EFU, 1ºº0. 118p.
CCLLlNS, FW: F/FFC, F: D/J/Nl, E…. Chemi:Iry cnc :ynIheIic
ceve|cpmenI cf mi:cprc:Ic|. D|g D|s Sc|, 30[11 Supp|}: 114S-117S,
1º85.
CUNNlNGH/M FG, M/CDCN/LD FC, G/NI NF, LEVENC ‚J, GlSIF/F LC,
H/N‚lNS GDV, CL/F‚ SL. lnIrcpcrIum /::e::menI. ln: ƒ||||oms
Obstetr|cs 20Ih ec. /pp|eIcn & Lcnge, SIcmfcrc, CcnnecIicuI, 1ºº7.
p. 347-78.
EHFENFElCH, 8. & ENGLlSH, D. Comp|o|nts ond d|sorders: the sexuo|
po||t|cs o| s|c•ness. Lcnccn, WriIer: cnc Feccer: FuL Cccp, 1º73.
p.10.
El-ICF‚E• M & GF/NI JM. Sweeping cf Ihe memLrcne: i: cn effecIive
meIhcc cf incucIicn cf |cLcur in prc|cngec pregncncy: c repcrI cf c
rcnccmizec Iric|. 8r J Obstet Gynoeco|, ºº: 455-458, 1ºº2.
DUNN eI c|. Fi:k cf humcn immuncceficiency viru: Iype 1 .Ircn:mi::icn
Ihrcugh Lrec:Ifeecing. Loncet, 1ºº2, 340: 585-588.
EFl‚SSCN E {ec). Monuo| ||ustrodo de onestes|o |oco|. Ccpenhcgue, l. Chr.
Scren:en & Cc //S, 1ºóº.
F/UNDES /, CEC/IIl JG. Which pc|icy fcr Cce:crecn :ecIicn in 8rczi|° /n
cnc|y:i: cf Irenc: cnc ccn:e¢uence:. Heo|th Fo||cy ond F|onn|ng, 8:
33-42, 1ºº3.
FE8F/SGC. Irotodo de Obstetríc|o do FE8kASGO. Fic ce Jcneirc, FevinIer,
2000. ºº13p.
FESClN/, FH. / incicëncic ce ce:crec nc: /méricc:. Jorno| do FE8kASGO,
1: 7-8, 2000.
FLElSS JL. Stot|st|co| Mehods |or kotes ond Froport|ons. 2nc ec. Jchn Wi|ey
& Scn:, New •crk, 1º80.
FCUC/ULI, M. H|stor|o do sexuo||dode I: o vontode de sober. Fic ce
Jcneirc, Grcc|, 1º80. pp 37-8.
FF/NCCME C, S/V/GE W, CHUFCHlLL H, LEWlSCN H. Coesoreon 8|rth |n
8r|to|n. Lcnccn, Micc|e:ex Univer:iIy Fre::, 1ºº3. 200p.
FFlEDM/N E/. Lobor: C||n|co| evo|uot|on ond monogement. New •crk,
/pp|eIcn, 1º78.
REFERÊNCIAS BIBLIOGRÁFICAS
193
FFlEDM/N E/. Ihe grcphic cnc|y:i: cf |cLcr. Am J Obstet Gyneco|, ó8:
15ó8-75, 1º54.
G/GNCN /J. Ind|v|duo| or group ontenoto| educot|on |or ch||db|rthJ
porenthood [Cochrone kev|e„}. Ccchrcne DcIcLc:e Sy:I Fev, 2000:
4: CD0028óº.
GCLFlEF F. Iechni¢ue cpércIcire ce |c ce:cricnne. Journo| de
Gyneco|og|e Obstetr|que et 8|o|og|e de |o keproduct|on, 2º {Sup|.2):
8ó-º5, 2000.
GUFI/ F, V/SlSHI/ ‚, S/WHNE• H, F/• F. ScfeIy cnc efficccy cf :Iripping
cf memLrcne: cI Ierm. Int J Gyneco| Obstet, ó0: 115-121, 1ºº8.
GUFI/ I, VEFM/ N‚, SCCD /. EffecI: cf inIrccervicc| injecIicn cf
hic|urcnicc:e in primigrcvicce curing |cLcr. J Ind|on Med Assoc,
º2{2): 47-8, 1ºº4.
HCDNEII ED. Ccregiver :uppcrI fcr wcmen curing chi|cLirIh {Ccchrcne
Feview). ln: Ihe Cochrone L|brory, l::ue 2, 2000. Cxfcrc: UpccIe
ScfIwcre.
HCFME•EF GJ & GULME…CGLU /M. Vcginc| mi:cprc:Ic| fcr cervicc|
ripening cnc |cLcur incucIicn in |cIe pregncncy {Ccchrcne Feview).
ln: Ihe Cochrone L|brory, l::ue 2, 2000. Cxfcrc: UpccIe ScfIwcre.
HCFME•F GJ, GULME…CGLU /M, /LFlFEVlC …. Mi:cprc:Ic| fcr incucIicn cf
|cLcur: c :y:IemcIic review. 8r J Obstet Gynoeco|, 10ó: 7º8-803,
1ººº.
HCFME•EF GJ, ‚ULlEF F. ExIernc| cephc|ic ver:icn fcr Lreech pre:enIcIicn
cI Ierm {Ccchrcne Feview). ln: Ihe Cochrone L|brory, l::ue 3, 2000.
Cxfcrc: UpccIe ScfIwcre.
HCFME•EF GJ. ExIernc| cephc|ic ver:icn fcci|iIcIicn fcr Lreech
pre:enIcIicn cI Ierm {Ccchrcne Feview). ln: Ihe Cochrone L|brory,
l::ue 3, 2000. Cxfcrc: UpccIe ScfIwcre.
HCFME•EF GJ. ExIernc| cephc|ic ver:icn fcr Lreech pre:enIcIicn Lefcre
Ierm {Ccchrcne Feview). ln: Ihe Cochrone L|brory, l::ue 3, 2000.
Cxfcrc: UpccIe ScfIwcre.
HCFME•EF GJ. /mnicinfu:icn fcr umLi|icc| ccrc ccmpre::icn in |cLcur
{Ccchrcne Feview). ln: Ihe Cochrone L|brory, l::ue 3, 2000. Cxfcrc:
UpccIe ScfIwcre.
HUGHE• MJ, MCELlN IW, •CUNG I. McIernc| cnc feIc| cuIccme cf
Lcmcze-prepcrec pcIienI:. Obstet Gyneco|, 51{ó):ó43-7, 1º78.
lLLlCH, l. A expropr|oçõo do soùde. Fic ce Jcneirc, Ncvc FrcnIeirc, 1º75.
p. 5º.
REFERÊNCIAS BIBLIOGRÁFICAS
194
lMlF. Obstetríc|o: d|ognost|co e trotomento. Fecife, MEDSl, 1ºº8. 55ºp.
JCH/NSCN F8 & MENCN 8‚V. Vccuum exIrccIicn ver:u: fcrcep: fcr
c::i:Iec vcginc| ce|ivery {Ccchrcne Feview). ln: Ihe Cochrone
L|brory, l::ue 2, 2000. Cxfcrc UpccIe ScfIwcre.
‚ENNELL J, ‚L/US M, MCGF/IH S, FC8EFISCN S, HlN‚LE• C. CcnIinucu:
emcIicnc| :uppcrI curing |cLcr in c US hc:piIc|. JAMA, 2ó5 {17): 21º7-
201, 1ºº1
‚ElFSE C. Frc:Icg|cncin: in preincucIicn cervicc| ripening: MeIc-cnc|y:i: cf
wcr|cwice c|inicc| experience. J keprod Med, 38: 8º-100, 1ºº3.
‚EIILE C, JCH/NSCN F8. CcnIinucu: ver:u: inIerrupIec :uIure: fcr perinec|
repcir. Cochrone L|brory. Ccchrcne DcIcLc:e Sy:I Fev 2000:
2:CD000º47.
‚lNG FS. Como ojudor os mões o omomentor. Lcncrinc, 1ºº1.
‚L/US MH, ‚ENNELL JH. Ihe ccu|c: cn e::enIic| ingrecienI cf chi|cLirIh
reci:ccverec. Acto Foed|otr 8ó: 1034-ó, 1ºº7.
L/NGEF /, C/MFEFC L, G/FCl/ C, FE•NCSC S. EffecI: cf p:ychc:ccic|
:uppcrI curing |cLcur cnc chi|cLirIh cn Lrec:Ifeecing, mecicc|
inIervenIicn:, cnc mcIher: we||Leing in c Mexicc¢n puL|ic hc:piIc|:
c rcnccmizec c|inicc| Iric|. 8r J Obstet Gynoeco|, 105{10): 105ó-ó3,
1ºº8.
LcClCEFC /‚. Exp|cining exce::ive rcIe: cf ce:crecn: cnc cIher chi|cLirIh
inIervenIicn:: ccnIriLuIicn: frcm ccnIempcrcry Ihecrie: cf gencer
cnc p:ychc:ccic| ceve|cpmenI. Soc|o| Sc|ences ond Med|c|ne,
37{10): 12ó1-º, 1ºº3.
M/FIlNS-CCSI/ S. ScLre c: cc:c: ce pcrIc, c: Iécnicc: em cL:IeIr|cic e c
mcrIc|iccce mcIernc. Jorno| do FE8kASGO,ó{8): 5, 1ººº.
M/IHl/S FS, C/FV/LHC JC/. /nc|ge:ic e cne:Ie:ic em CL:IeIr|cic. ln:
CFIEN…l /V, I/FDELLl M/. Anestes|o|og|o SAESF, Fic ce Jcneirc,
/Iheneu, pp 4ó2-510.
MULFCW CD. Ihe mecicc| review crIic|e: :IcIe cf Ihe :cience. Ann Intern
Med, 10ó {3): 185-8, 1ºº7.
N/IlCN/L lNSIlIUIE CF HE/LIH. CCNSENSUS SI/IEMENI. EffecI cf
ccrIicc:Iercic: fcr feIc| mcIurcIicn cn perincIc| cuIccme:, feLrucry
28 - mcrch 2, 1ºº4. Am j Obstet Gyneco|, 173 {1): 24ó-52, 1ºº5.
NElFEFI MF. C|inicc| /:pecI: cf LccIcIicn: FrcmcIing 8rec:Ifeecing
Succe::. C||n Fer|noto|, 2ó{2): 281-30ó, 1ººº.
REFERÊNCIAS BIBLIOGRÁFICAS
195
NEME 8 {cccrc.). Obstetríc|o 8ós|co. 2c. ec., Scc Fcu|c, Scrvier, 2000.
NlEFME•EF, S. eI c| . lnIerncIicnc| Guice|ine: fcr NecncIc| Fe::uciIcIicn:
cn ExcerpI frcm Ihe Guice|ine 2000 fcr Ccrcicpu|mcncr Fe::uciIcIicn
cnc Emergency Ccrcicvc:cu|cr Ccre: lnIerncIicnc| Ccn:en:u: cn
Science. Fed|otr|cs 10ó {3) 1-2º, 2000.
CŠ DFlSCCLL, ‚. & FCLE•, M. Ccrre|cIicn cf cecrec:e in perincIc| mcrIc|iIy
cnc increc:e in ce:crecn :ecIicn rcIe:. Obstetr|cs & Gyneco|ogy, ó1:
1-5, 1º83.
CDENI, M. Águo & Sexuo||dode. Scc Fcu|c, Sici|icnc, 1ºº1. 1º8p.
CFG/Nl…/‹ŒC MUNDl/L DE S/UDE. Ass|stënc|o oo Forto Normo|: bm
gu|o prót|co. Fe|cIcric ce um grupc Iécnicc. GeneLrc, 1ººó. 53p.
F/FNELL C, L/NGHCFF-FCCS J, lVEFSEN F, D/MG//FD F. Fu:hing
meIhcc in Ihe expu|:ive phc:e cf |cLcr. Acto Obstet Gyneco| Scond,
72: 31-35, 1ºº3.
F/FFlNELLl M/, CEC/IIl JG, F/UNDES /. Lcmincric ccmc ci|cIcccr
cervicc|. U:c c||nicc e meccni:mc ce cçcc. Fem|no, 22: 187-1º3,
1ºº4.
F/UL. F.H. & MlLLEF, D./. Ce:crecn LirIh: hcw Ic recuce Ihe rcIe.
Amer|con Journo| o| Obstetr|cs ond Gyneco|ogy, 172: 1º03-11, 1ºº5.
F/UL/ LG, LlM/ CF, CCUIlNHC MS, M/NFFC HD, lNH/CUlIES M‚, LU… NF.
FcrIcgrcmc. Acto Med HbF, 384-º8, 1º84.
FEIlIIl, D: CEF/LC FC, SH/FlFC 8/, WH/LLE• F. ln-hc:piIc| mcIernc|
mcrIc|iIy in Ihe UniIec SIcIe:: Iime Irenc: cnc re|cIicn Ic meIhcc cf
ce|ivery. Obstetr|cs & Gyneco|ogy, 5º: ó-12, 1º82.
FHEL/N JF, CL/F‚ SL, Dl/… F, F/UL FH. Vcginc| LirIh cfIer ce:crecn.
Amer|con Journo| o| Obstetr|cs ond Gyneco|ogy, 157{ó): 1510-1515,
1º87.
FHlLFCII FH, C/SILE WM. Cerviccgrcph: in Ihe mcncgemenI cf |cLcur in
primigrcvicce. l Ihe c|erI |ine fcr ceIecIing cLncrmc| |cLcur. J Obstet
Gyneco| 8r|t Corn, 7º: 5º2-º8, 1º72.
FHlLFCII FH, C/SILE WM. Cerviccgrcph: in Ihe mcncgemenI cf |cLcur in
primigrcvicce. ll Ihe ccIicn |ine cnc IrecImenI cf cLncrmc| |cLcur. J
Obstet Gyneco| 8r|t Corn, 7º: 5ºº-ó02, 1º72.
FCFIEF IF & V/FNEF MW. U:ing evicence-Lc:ec mecicine Ic cpIimize
ce:crecn :ecIicn cuIccme:. C||n|co| Obstetr|cs ond Gyneco|ogy,
40{3): 542-547, 1ºº7.
REFERÊNCIAS BIBLIOGRÁFICAS
196
F/IINEF D. ScLre c hipcIe:e ce e:IcLi|izcçcc cc: Icxc: ce ce:crec cc
E:Iccc ce Scc Fcu|c, 8rc:i|. kev|sto de Soùde Fùb||co, Sõo Fou|o, 30:
1º-33, 1ººó.
FE…ENDE, J. Obstetríc|o. 8c. ec., Fic ce Jcneirc, GucncLcrc ‚ccgcn, 1ºº8.
FCSEN MG, DlC‚lNSCN JC8, WESIHCFF CL. Vcginc| LirIh cfIer ce:crecn: c
meIc cnc|y:i: cf mcrLiciIy cnc mcrIc|iIy. Obstetr|cs & Gyneco|ogy,
77: 4ó5-70, 1ºº1.
FUDGE MVC, C/LDEFCN lMF, DE LUC/ L/. U:c cc pcrIcgrcmc nc
cicgnc:Iicc e ccncuIc nc pcrIc ci:Iccicc. Fem|no, 17: 135-45, 1º8º.
FUDGE MVC, DE LUC/ L/, FEF/CCLl JC. FcrIcgrcmc: UIi|iccce e
impcrIcncic. Fem|no, 1ó: 2º-34, 1º88.
S/NCHES lH. Comporondo entre do|s mode|os de portogromo op||codos
no oss|stënc|o oo porto de pr|m|gestos. Di::erIcçcc ce Me:Irccc,
Fccu|ccce ce Mecicinc ce 8cIuccIu UNESF, 1ººº: 80p.
S/IlN /J, LEVENC ‚J, SHEFM/N ML, MClNIlFE DD. FccIcr: cffecIing Ihe
cc:e re:pcn:e Ic cxyIccin fcr |cLcr :Iimu|cIicn. Am J Obstet
Gyneco|, 1óó: 12ó0-1, 1ºº2.
SCHW/FC… F, Dl/… /G, FESClN/ FH, 8ELlI…‚• F, DE MUClC 8, DELG/DC
FCSSELLC JLD. FcrIcgrcmc ccm curvc: ce c|erIc ln: • Scúce reprccuIivc
mcIernc perincIc|. /Iençcc pré-ncIc| e cc pcrIc ce 8cixc Fi:cc.
Fub| C|ent CLAF, nº 1321.03: 134-44, 1ººó.
SCHW/FC… F, DUVEFGES C, Dl/… /G, FESClN/ FH, CL:IeIr|cic. 5º ec. Ec.
/Ienec, 8uenc: /ire:, 1ºº5. ó40p.
SClSClCNE /C, MCCULLCUGH H, M/NLE• JS, SHLCSSM/N F/, FCLLCC‚
CCLMCFGEN GHC. / prc:pecIive, rcnccmizec ccmpcri:cn cf Fc|ey
ccIheIer in:erIicn ver:u: inIrccervicc| prc:Icg|cncin E2 ge| fcr
preincucIicn cervicc| ripening. Am J Obstet Gyneco|, 180{1): 55-5º,
1ººº.
SH/FFEF N eI c|. ShcrI-ccur:e ziccvucine fcr perincIc| HlV-1 Ircn:mi::icn in
8cngkck, Ihci|cnc : c rcnccmi:ec ccnIrc||ec Iric|. Loncet, 1ººº, 353:
773-780.
SHE/FEF, E. Ce:crecn :ecIicn: mecicc| LenefiI: cnc cc:I:. Soc|o|
Sc|ences ond Med|c|ne, 37: 1223-31, 1ºº3.
SLEEF J, FC8EFIS J, CH/LMEFS l. Ccre curing Ihe :eccnc :Icge cf |cLcr. ln:
Chc|mer: l, Enkin M, ‚eir:e MJNC. E||ect|ve core |n pregnoncy ond
ch||db|rth [v.2}. Cxfcrc Univer:iIy Fre::, Cxfcrc, 1º8º. p.1130-44.
SC/FES H8. Cc:c: ce pcrIc. Jorno| do FE8kASGO, ó[8}: ó, 1ººº.
REFERÊNCIAS BIBLIOGRÁFICAS
197
SICFF/FD, M. Do Grov|dez oo Nosc|mento - um gu|o comp|eto e prót|co
poro |uturos po|s. Scc Fcu|c, Mc|Ie:e, 1ºº0. 234p.
SIFlGHI, 8F. & H/FFlSCN, LC. En|ermogem Moterno e Neonoto|. 2c-
ec., Fic ce Jcneirc, GucncLcrc ‚ccgcn S./., 1ºº8. 224p.
SW/NN FC. lncucIicn cf |cLcr Ly :Iripping memLrcne:. Obstet Gyneco|,
11: 74-78, 1º58.
IEDESCC JJ/. A gróv|do. Suos |ndogoçöes e os dùv|dos do obstetro. Scc
Fcu|c, EciIcrc /Iheneu, VbbbE
IHCMSCN /M. Fu:hing Iechni¢ue: in Ihe :eccnc :Icge cf |cLcr. J Adv
Nurs,18: 171-7, 1ºº3.
V/N …UNDEFI /, CSIHElMEF GW. Fo|n ke||e| … Anesthes|o |n Obstetr|cs.
New •crk, Churchi|| Living:Icne, 1ººó.
VlLL/F J, ‚H/N-NEELCFUF D. FcIIern: cf rcuIine cnIencIc| ccre fcr |cw-ri:k
pregncncy {Ccchrcne Feview). ln: Ihe Cochrone L|brory, l::ue 3,
2000. Cxfcrc: UpccIe ScfIwcre.
WlNG D/, JCNES MM, F/H/LL /, GCCDWlN IM, F/UL FH. / ccmpcri:cn
cf mi:cprc:Ic| cnc prc:Icg|cncin E2 ge| fcr preincucIicn cervicc|
ripening cnc |cLcr incucIicn. Am J Obstet Gyneco|, 172{ó): 1804-
1810, 1ºº5.
WCFLD HE/LIH CFG/Nl…/IlCN. /pprcpricIe Iechnc|cgy fcr LirIh. Loncet,
2: 43ó-7, 1º85.
WCFLD HE/LIH CFG/Nl…/IlCN, HlV in Fregncncy: c review, Jo|nt
bn|ted Not|ons Frogromme on HIV JAIDS ,GeneLrc. 1ººº.
•/M/SHlI/ /M, GC……/Nl JL. Anestes|o em Obstetríc|o. Fic ce Jcneirc,
/Iheneu, 1ºº7.
198
Orgon|zodores
Jc:é Gui|herme CeccIIi
Suzcnne JcccL Serruyc
Consu|tores
Ficcrcc Fe:cinc
Ficcrcc Schwcrcz
Autores
/nc Lúcic FiLeirc ce Vc:ccnce|c:
Žnge|c Mcric 8cchc
Ccr|c: /ugu:Ic /|enccr Junicr
E|cy|ene Mcric ce /rcújc Leccccic
lrccemc ce McIIc: Fcrcnhc: Cc|cercn
Jcnine Schirmer
Jc:é Gui|herme CeccIIi
Jc:é Ju|ic Iece:cc
Jcrge /ncc|cfI NeIc
Lucic He|enc Gcrcic Fennc
Mcric /uxi|icccrc 8enevice:
Mcrinice CcuIinhc
Ficcrcc Fe:cinc
FiIc ce Cc::ic FcnIe: ce McIc:
Fivc|cc Mence: ce /|Lu¢uer¢ue
Fc:c lnë: Cc:Ic Fereirc
Suzcnne JcccL Serruyc
Icnic Di Gicccmc cc Lcgc
Co|oborodores
/nc Cri:Iinc Vi|henc /Lrchcc
/nc Lucic Lcurençc 8cni|hc
/n|Lc| Fcúnce:
Ccr|c: Me||c ce CcpiIcni
Ccrmen ce 8crrc: Ccrreic Dhc|ic
Ce|:c Ferreirc Fcmc: Fi|hc
Ecmunc Chccc 8crcccI
Ecucrcc ce Scuzc
Frcnci:cc cc: Grcçc: Sc|czcr Fine||i
Frcnci:cc Ec:cn ce Lucenc FeiIc:c
JcccL /rkccer
Jcrge /ncrcce FinIc
199
Lui: Ccmcnc
Mcrcic Mcric /uxi|icccrc ce /¢uinc Mcrcc /nIcnic
ce Ávi|c ViIcric
Mcrcc: •mcyc
Mcric /nIcnieIc FúLic Iyrre||
Mcric •c|cncc Mckuch
Mcrinc Ferreirc Fec
Mcry /nge|c Fcrpine||i
Ne|:cn Diniz ce C|iveirc
FcL|iIc Migue| /ncrcce /guicr
Fcxcnc ‚ncLe|
Sérgic Ferreirc cc Cunhc
Sérgic Icceu McrIin: McrLc
Vc|ci|éc Gcnçc|ve: Ve|c:c cc: ScnIc:
Suporte técn|co
Mini:Iéric cc Scúce
/8ENFC - /::ccicçcc 8rc:i|eirc ce CL:IeIrize: e Enfermeirc: CL:IeIrc: Árec
Iécnicc ce /|imenIcçcc e NuIriçcc/MS
Árec Iécnicc ce Scúce cc Cricnçc e /|eiIcmenIc
McIernc/MS Árec Iécnicc ce Scúce cc
/cc|e:cenIe/MS
Cccrcencçcc Nccicnc| ce DSI//lDS/MS
FE8F/SGC - Fecercçcc 8rc:i|eirc cc: Sccieccce: ce
Ginecc|cgic e CL:IeIr|cic
CF/S - Crgcnizcçcc Fcn-cmericcnc cc Scúce
SecreIcric ce /::i:Iëncic c Scúce/MS
S8/ - Sccieccce 8rc:i|eirc ce /ne:Ie:ic|cgic
S8F - Sccieccce 8rc:i|eirc ce FecicIric
C Mini:Iéric cc Scúce cgrccece c cpcic cc
Crgcnizcçcc Fcn-/mericcnc ce Scúce /
Crgcnizcçcc Muncic| cc Scúce pcrc c rec|izcçcc
ce:Ic puL|iccçcc.

Related Interests

46$/4%-= / cne:Ie:ic pericurc| é cuIrc Iécnicc ce cne:Ie:ic
regicnc| cmp|cmenIe uIi|izccc pcrc c rec|izcçcc ce cpercçce:
ce:cricnc:. Suc execuçcc exige mcicr refincmenIc Iécnicc e :uc
|cIëncic IcmLém e mcicr ¢ue c cc rc¢uicne:Ie:ic. E:Ie in|cic ce cçcc
mci: |cngc fcvcrece :eu empregc em pccienIe: ¢ue :e Leneficicm ce
um L|c¢ueic :impcIicc mci: |enIc, ccmc c: pcrIcccrc: ce pré-ec|cmp:ic
cu ce ccençc ccrcicvc:cu|cr. /|ém ci:cc, c cne:Ie:ic pericurc| pcce :er
prefericc ¢ucncc :e prevë um prccecimenIc cirúrgicc mci: prc|cngccc,
ccmc em pcrIurienIe: cLe:c: cu ccm vcric: ce:crec: prévic:. C
cne:Ié:icc |ccc| mci: empregccc nc cne:Ie:ic pericurc| pcrc ce:cricnc:
é c Lupivccc|nc c 0,57 ccm ccrenc|inc 1:200.000 {20-25 m|) c::cciccc
cu ncc c 75-100 mcg ce fenIcni| cu 20-30 mcg ce :ufenIcni|. / cciçcc
ce:Ie: cpicice: me|hcrc c ¢uc|iccce cc L|c¢ueic, recuzincc c
ce:ccnfcrIc inIrc-cpercIcric e minimizcncc c uIi|izcçcc ce meciccçcc
cnc|gé:icc e/cu :eccIivc :up|emenIcr.
12
ANESTESIA EM OBSTETRÍCIA
105
Me:mc :eguincc Iccc: c: rigcre: Iécnicc:, c|gumc: pccienIe: pccem
experimenIcr umc cne:Ie:ic regicnc| incce¢uccc. DicnIe ce:Ie fcIc
pcce-:e cpIcr pcr:
• ccmini:Ircçcc ce umc :eguncc cne:Ie:ic regicnc|
• ccmini:Ircçcc :up|emenIcr ce cnc|gé:icc: :i:Iëmicc:, ccmc
pe¢uenc: cc:e: ce cpicice: cu ceIcminc enccvenc:c:
• rec|izcçcc ce cne:Ie:ic gerc|
S*'()'(6% t'4%-= /|gumc: pcrIurienIe: pccem cpre:enIcr c|gumc ccnIrc-
inciccçcc c cne:Ie:ic regicnc| {cccgu|cpcIic cu hemcrrcgic :everc), cu
c cc:c IrcIcr-:e ce umc urgëncic cL:IéIricc {ccmc prc|cp:c ce ccrccc
cu Lrcciccrcic feIc| :u:IenIccc). Ne:Ic: :iIucçce:, c incuçcc ce umc
cne:Ie:ic gerc| ce :e¢üëncic rcpicc é prefer|ve| c cne:Ie:ic regicnc|.
/ Iécnicc ce cne:Ie:ic gerc| é c ¢ue :e :egue:
• <4:I#56>'*%+,# 1#2 MP % VQQ[B
• %$26*6()4%+,# '*$#3'*#(% $' )6#<'*)%- (J$61# *% $#(' $' W 2>ju>
T#/)4#( 76<*J)61#( )92 /2% 6*$61%+,# 2%6( 4'()46)%UB
• %<-61%+,# $' <4'((,# (#@4' % 1%4)6-%>'2 1461J6$'? %# 6*Y16# $%
<'4$% $' 1#*(169*16%? <%4% #1-/64 # '(v;%># ' 4'$/064 % <4#@%@6-6$%$'
$' %(<64%+,# </-2#*%4 $# 1#*)'C$# >8()461#B
• %$26*6()4%+,# '*$#3'*#(% $' (/116*6-1#-6*% *% $#(' $' VIV?O
2>ju> <%4% <4#<616%4 /2 48<6$# 4'-%5%2'*)# 2/(1/-%4 ' 1#*$6+A'(
(%)6(;%)J46%( $' 6*)/@%+,# )4%./'%-B
• 6*('4+,# ' 1#*;642%+,# $# <#(616#*%2'*)# %$'./%$# $' /2 )/@#
'*$#)4%./'%- 1#4* @%-#*')'B '
• 2%*/)'*+,# $# %*'()'(6% 1#2 1#*1'*)4%+A'( '-'3%$%( $' MP
T<'-# 2'*#( OQ[U %): # 1-%2<'%2'*)# $# 1#4$,#E \#$'I(' /)6-60%4
J56$# *6)4#(# % *# 28562# OQ[ %((#16%$# % @%65%( 1#*1'*)4%+A'( $'
%*'():(61#( 7%-#>'*%$#(? #/ ('c%? 7%-#)%*# % Q?O[ #/ 6(#;-/4%*# %
Q?_O[E
Cc:c hcjc fc|hc nc inIuLcçcc Irc¢uec|, ceve-:e prccecer c venIi|cçcc
:cL mc:ccrc pcrc re:IcLe|ecer c cxigencçcc prcnIcmenIe e eviIcr
ccnc: c mu|her e cc feIc. Nc cepencëncic cc ccrcIer emergencic| cc
:iIucçcc, c cne:Ie:i:Ic e:Icrc IecniccmenIe cpIc pcrc in:i:Iir cu ncc nc
prccecimenIc ce venIi|cçcc e inIuLcçcc Irc¢uec| cc mu|her. Se c
prccecimenIc fcr e|eIivc, é reccmenccve| pc:Iergc-|c pcr c|gum Iempc.
kecuperoçõo Fos-onestés|co [kFA}
/ pccienIe cL:IéIricc nece::iIc cc: me:mc: cuicccc: pc:-cne:Ié:icc:
¢ue cuIrc: pccienIe: cirúrgicc:. Fe¢uer umc vigi|cncic cevicc c:
c|Iercçce: fi:ic|cgicc: ¢ue :e :eguem nc pc:-pcrIc imecicIc e c
pc::iLi|iccce ce ccmp|iccçce: re|ccicnccc: cc ccnIrc|e ce
:cngrcmenIc e ccnIrcIi|iccce uIerinc. Nc cc:c ce:Ic pccienIe Ier
receLicc c|gumc fcrmc ce cne:Ie:ic, ceve permcnecer :cL vigi|cncic
cIé :uc IcIc| recupercçcc. / ccnciçcc ce c|Ic ceve :er
12
ANESTESIA EM OBSTETRÍCIA
106
:empre regi:Irccc nc prcnIucric cc pccienIe. Cucncc :uLmeIicc c umc
cne:Ie:ic gerc|, c mu|her ceve cnIe: cc c|Ic, e:Icr cccrcccc e crienIccc
¢ucnIc cc Iempc, |ugcr e prccecimenIc cL:IéIricc, cpre:enIcr :inci:
viIci: e:Icvei: pe|c menc: nc ú|Iimc hcrc, :enIir-:e ccnfcrIcve|, ccm
ccnIrc|e cceiIcve| cc ccr, :em ncu:ec: cu vcmiIc:. Cucncc :uLmeIicc c
um L|c¢ueic regicnc|, c c|Ic cepencerc IcmLém cc :eccçcc ¢ue Ienhc
receLicc e ceve cpre:enIcr IcIc| recupercçcc cc L|c¢ueic mcIcr pcrc
:e eviIcr ¢uecc: pcr frc¢uezc mu:cu|cr cc: memLrc: infericre:.
DurcnIe e:Ie per|ccc, ¢ucncc c e:Iccc ce ccn:ciëncic e/cu p:icc|cgicc
permiIirem, pcce-:e cprcveiIcr c cpcrIuniccce pcrc c|gumc:
crienIcçce: ¢ucnIc c c:pecIc: ce c|eiIcmenIc, cuicccc: pe::cci: e
e:c|crecimenIc ce cuvicc:. /incc nc FF/, ceve-:e inc|u:ive e:Iimu|cr c
cmcmenIcçcc pcrc fcci|iIcr umc mcicr inIegrcçcc mce-fi|hc.
SIIbAÇÕES ESFECIAIS
1. Fré-ec|ömps|o e Ec|ömps|o
/ pré-ec|cmp:ic é umc cc: principci: ccu:c: ce mcrLi-mcrIc|iccce
mcIernc e percc feIc|, principc|menIe nc: pc|:e: em ce:envc|vimenIc. C
cne:Ie:i:Ic pcce :er :c|iciIccc c rec|izcr umc cnc|ge:ic ce pcrIc, prcver
cne:Ie:ic pcrc umc ce:cricnc, cu me:mc ccr c::i:Iëncic nc Uniccce ce
Iercpic lnIen:ivc ¢ucncc hcuver ccmp|iccçce:. C: cchccc: principci:
ne:Ic ccnciçcc pcIc|cgicc :cc hiperIen:cc e prcIeinúric ¢ue cccrrem
cpc: 20 :emcnc: ce ge:Icçcc. / Ec|cmp:ic é cicgnc:Iicccc ccm
¢uc|¢uer grcu ce hiperIen:cc, :e cccrrerem ccnvu|:ce:.
C IrcIcmenIc cLjeIivc recuzir c: ccmp|iccçce: mcIernc: e feIci::
• IrcIcr c hiperIen:cc:
• ccnIrc|cr c: ccnvu|:ce::
• f|uiccIercpic e IrcIcmenIc cc c|igúric:
• ceci:cc :cLre ¢ucncc rec|izcr c pcrIc: e
• ccnIrc|cr c: c|Iercçce: ce cccgu|cçcc.
w-/6$#)'4%<6%= /creciIc-:e ¢ue c expcn:cc vc|ëmicc, pcr :i :c, pcce
ceIermincr vc:cci|cIcçcc, recuzir c pre::cc crIeric| e me|hcrcr c f|uxc
:cngü|nec regicnc|, cIimizcncc c efeiIc cc: crcgc: vc:cci|cIcccrc:.
]#*3/-(A'(= C :u|fcIc ce mcgné:ic é c cgenIe ce e:cc|hc pcrc c
prevençcc cu reccrrëncic cc: ccnvu|:ce:. C e:¢uemc IercpëuIicc mci:
empregccc em nc::c meic ccn:i:Ie numc cc:e ce cIc¢ue ce 4g pcr vic
inIrcvenc:c |enIc {20 minuIc:) e mcnuIençcc cIrcvé: ce infu:cc venc:c
ce 1 c 2 g/hcrc, cL:ervcncc-:e cIenIcmenIe c ge:IcnIe. É impcrIcnIe
|emLrcr ¢ue c :u|fcIc ce mcgné:ic pcIencic|izc c: re|cxcnIe: mu:cu|cre:
cce:pc|crizcnIe:, ¢ue cevem :er u:ccc: ccm ccuIe|c, em cc:e:
recuzicc: e ccm mcniIcrizcçcc neurcmu:cu|cr {ver Urgëncic: e
Emergëncic: McIernc:. Guic pcrc cicgnc:Iicc e ccncuIc em :iIucçce:
ce ri:cc ce mcrIe mcIernc. MS, 2000).
12
ANESTESIA EM OBSTETRÍCIA
107
S*'()'(6% ' S*%->'(6%: Nc: cc:c: ce pré-ec|cmp:ic |eve, c mu|her pcce
prc::eguir ccm um IrcLc|hc ce pcrIc. Se c e:Iccc ce cccgu|cçcc e:Iiver
ncrmc|, umc Iécnicc regicnc| ce cnc|ge:ic pcce :er reccmencccc
precccemenIe pcr ciminuir c re:pc:Ic cc e:Ire::e, fcci|iIcncc c ccnIrc|e
cc pre::cc crIeric| e me|hcrcncc c perfu:cc p|ccenIcric. / cpercçcc
ce:cricnc gerc|menIe é incicccc ¢ucncc hc picrc cc: ccnciçce: ce
viIc|iccce feIc| cu cgrcvcmenIc cc ¢uccrc mcIernc, ccm
impc::iLi|iccce ce pcrIc vcginc|. / Iécnicc mci: reccmencccc, ce:ce
¢ue ncc hcjc ccnIrc-inciccçce: cL:c|uIc: cu emergëncic, é c cne:Ie:ic
pericurc|. / pccienIe ccm ec|cmp:ic IcmLém pcce receLer cne:Ie:ic
regicnc|, ce:ce ¢ue c: ccnvu|:ce: e:Iejcm ccnIrc|ccc: e c pccienIe ncc
e:Iejc em ccmc, me:mc ¢ue :uperficic|. /pc: c: cuicccc: inicici: ccmc
ccmini:Ircçcc ce cxigënic, ce:|cccmenIc uIerinc, mcniIcrizcçcc e
expcn:cc vc|ëmicc {500 m| ce :c|uçcc cri:Ic|cice), ce:ce ¢ue ncc hcjc
:cfrimenIc feIc| cgucc, prccece-:e c cne:Ie:ic pericurc| ccmc ce:criIc
cnIericrmenIe, cu cIrcvé: ce cc:e: :up|emenIcre: pcr ccIéIer pericurc|.
Exi:Ie c|gumc ci:cu::cc ¢ucnIc cc empregc ce :c|uçce: ce cne:Ié:icc
|ccc| ccnIencc ccrenc|inc. É reccmenccve| c c::ccicçcc ce cpicice
{100 mcg ce fenIcni|) cc cne:Ié:icc |ccc| pcrc me|hcrcr c ¢uc|iccce cc
L|c¢ueic e fcrnecer c|gumc cnc|ge:ic pc:-cpercIcric. Cc:c hcjc
hipcIen:cc mcIernc, ccm ¢uecc: c|ém ce 207 cc: vc|cre: inicici:,
reccmencc-:e c ccmini:Ircçcc ce efecrinc inIrcvenc:c em cc:e: ce 2,5
c 5,0 mg.
2. Síndromes hemorróg|cos
/ cne:Ie:ic ce e:cc|hc e:Ic nc cepencëncic cc ccu:c, grcviccce cc
¢uccrc mcIernc, ccnciçce: ce viIc|iccce cc ccncepIc e pc::iLi|iccce
ce cvc|icçcc e cce¢uccc repc:içcc cc: percc: :cngu|nec: mcIernc:.
/: Iécnicc: regicnci: ncc :cc IcIc|menIe ccnIrc-incicccc:, mc: :uc
inciccçcc e:Ic ccncicicnccc c pc::iLi|iccce ce repc:içcc vc|ëmicc
mcIernc prévic, cvc|icçcc cc e:Iccc ce cccgu|cçcc mcIernc e c
urgëncic cc reIirccc cc feIc. Fcr exemp|c, nc pre:ençc ce umc
p|ccenIc prévic cenIrc-IcIc| ccm c ge:IcnIe hemccincmiccmenIe
e:Icve| e feIc em Lcc: ccnciçce:, pcce-:e ccr preferëncic c cne:Ie:ic
pericurc|, :empre ccm c cuicccc ce :e prccecer c ccIeIerizcçcc ce
cci: cce::c: venc:c: cc|iLrc:c: e ci:pcniLi|iccce imecicIc ce :cngue. Em
ccnciçce: mcIernc: :eme|hcnIe:, mc: em pre:ençc ce :cfrimenIc feIc|,
pcce-:e uIi|izcr c rc¢uicne:Ie:i c cevicc c :uc |cIëncic mci: curIc. Cc:c c
:iIucçcc mcIernc ncc permiIc umc cce¢uccc repc:içcc vc|ëmicc, cu
hcjc :inci: c||nicc: ce cccgu|cpcIic cu grcve :cfrimenIc feIc|, ceve-:e
cpIcr pe|c cne:Ie:ic gerc|.
3. Cord|opot|os
/ ge:Icçcc cumenIc c IrcLc|hc ccrc|ccc e c ccn:umc ce cxigënic.
DurcnIe c pcrIc, e:Ic: c|Iercçce: :e exccerLcm, e nc pc:-pcrIc imecicIc
hc um impcrIcnIe cumenIc cc vc|ume circu|cnIe e cumenIc cc
re:i:Iëncic vc:cu|cr periféricc, cumenIcncc c ri:cc pcrc c ge:IcnIe
ccrcicpcIc. C p|cnejcmenIc cne:Ié:icc ceve |evcr em ccnIc e::c:
12
ANESTESIA EM OBSTETRÍCIA
108
f|uIucçce: hemccincmicc: e Iccc cirurgic ncc impre:cinc|ve| ceve :er
cciccc pcrc 15 cic: cpc: c pcrIc, ¢ucncc c mcicric cc: c|Iercçce:
hemccincmicc: cc ge:Icçcc jc :e ncrmc|izcu.
C :uce::c cc cIencimenIc c ge:IcnIe ccrcicpcIc cepence cc
ccnhecimenIc cc cicgnc:Iicc cc le:cc e cc grcu ce ccmprcmeIimenIc
funcicnc|. É funccmenIc| umc Lcc cvc|icçcc pré-cpercIcric, ce
preferëncic ccm excme c||nicc e:pecic|izccc, e|eIrcccrcicgrcmc e
eccccpp|erccrcicgrcmc. Nc: cc:c: mci: grcve:, ceve-:e p|cnejcr umc
cLcrccgem mu|Iici:cip|incr envc|vencc c e¢uipe cL:IéIricc, c
ccrcic|cgi c e c cne:Ie:ic|cgic.
/: DireIrize: em Ccrcic|cgic pcrc c cIencimenIc cc ge:IcnIe ccm
ccrcicpcIic reccmenccm:
• #56>'*#)'4%<6%B
• 2#*6)#460%+,# 1#*)Y*/% %)4%3:( $' '-')4#1%4$6#(1J<6#? #5Y2')4# $'
</-(# ' <4'((,# %4)'46%- 2:$6%B
• 1#*)4#-' $% 3#-'26%? -626)%*$#I(' % 6*;/(,# $' -Y./6$#( % _O 2-j7B
• $'1C@6)# -%)'4%- '(./'4$# '-'3%$# $/4%*)' # )4%@%-7# $' <%4)#B
• %*%->'(6% <'46$/4%- 1#*)Y*/%? 6*()%-%$% <4'1#1'2'*)'? *%
$'<'*$9*16% $% $#4 ' *,# $% $6-%)%+,# 1'4361%-B '
• %1#2<%*7%2'*)# $%( <'4$%( (%*>/Y*'%( ' #16)#16*% 1#2
1%/)'-%? '2 6*;/(,# 1#*)Y*/%E
S*'()'(6% <%4% <%4)# 3%>6*%-= c cne:Ie:ic regicnc| é, :em cúvicc, c
Iécnicc mci: empregccc pcrc c cIencimenIc c: ge:IcnIe: ccrcicpcIc:.
IcnIc c pericurc| ccmc c rc¢uicne:Ie:ic ncc cccrreIcm grcnce:
repercu::ce: hemccincmicc: curcnIe c pcrIc vcginc|, pci: c n|ve| ce
L|c¢ueic :en:iIivc é Lcixc {n|ve| mcximc I10). Exi:Ie grcnce vcnIcgem nc
c::ccicçcc ce cne:Ié:icc: |ccci: e cpicice: em Lcixc: cc:e:, prccuzincc
cnc|ge:ic cce¢uccc e pcucc inIerferëncic nc re:i:Iëncic vc:cu|cr
periféricc. Umc Lcc c|IerncIivc é c empregc cc L|c¢ueic cup|c rc¢ui-
pericurc| {ver Ccp|Iu|c 8).
S*'()'(6% <%4% 1'(%46%*%= ccmc c n|ve| :en:iIivc ce L|c¢ueic nece::cric
c rec|izcçcc ce umc cpercçcc ce:cricnc é mci: e|evccc {Ió - I4), c
cne:Ie:ic regicnc| é cccmpcnhccc ce mcicre: repercu::ce:
ccrcicvc:cu|cre:. FcrIcnIc, ce umc mcneirc gerc|, reccmenccm-:e c:
L|c¢ueic: regicnci: pcrc c: cc:c: c::inIcmcIicc: e c cne:Ie:ic gerc| pcrc
c: cc:c: mci: grcve:.
4. Asmo
/ evc|uçcc cc c:mc Lrcn¢uicc nc ge:Icçcc é imprevi:|ve|. FcrIcnIc, c
cefiniçcc cc grcviccce c||nicc, Lc:eccc nc Iipc ce evc|uçcc curcnIe c
ge:Icçcc, :erc muiIc impcrIcnIe pcrc cefinir c cLcrccgem cne:Ié:icc
ce::c: pcrIurienIe:, inc|uincc c: criIéric: ce Iempc :em cri:e:, u:c ce
meciccçcc cnIi-c:mcIicc, pre:ençc ce :inIcmc:, inIerncçce:
hc:piIc|cre: e ccn:u|Ic: mécicc: pcr e:Ic ccu:c, e u:c ce ccrIiccice,
enIre cuIrc:.
Cucncc c vic ce pcrIc é c vcginc|, Iccc ge:IcnIe c:mcIicc ceve
receLer cnc|ge:ic pcr Iécnicc regicnc| precccemenIe, incepencenIe
12
ANESTESIA EM OBSTETRÍCIA
109
cc grcviccce c||nicc, pcrc eviIcr-:e ¢ue c e:Ire::e cc IrcLc|hc ce pcrIc
cgrcve c: ccnciçce: re:pircIcric:. Nc cc:c ce cpercçce: ce:cricnc:,
ceve-:e verificcr :e c pccienIe e:Ic em cri:e cu ncc. Em cc:c cfirmcIivc,
c Iécnicc incicccc :eric cne:Ie:ic gerc|. Cc:c e:Iejc fcrc cc cri:e, enIcc
c ccncuIc cepencerc cc ccnciçcc c||nicc: c:mc |eve c mccerccc -
cne:Ie:ic pericurc|: c:mc grcve - cne:Ie:ic gerc|. Fcrc c cne:Ie:ic gerc|,
reccmencc-:e IenIcr me|hcrcr c cri:e cnIe: cc cne:Ie:ic, uIi|izcr c
ccpncgrcfic curcnIe Iccc c prccecimenIc e ccmc cgenIe: ce incuçcc
cne:Ié:icc, ceve-:e uIi|izcr c ceIcminc {0,7-1 mg/kg) cu eIcmiccIc {2
mg/kg) nc: ccm hiperIen:cc crIeric| c::cciccc.
C IrcIcmenIc cc cri:e c:mcIicc ceve :eguir c :eguinIe e:¢uemc:
• CxigencIercpic - ccIeIer nc:c| cu mc:ccrc. Nc: cc:c: :everc: é
incicccc c inIuLcçcc Irc¢uec| e venIi|cçcc meccnicc.
• 8eIc-ccrenérgicc:
lnc|cçcc: FencIerc|, 0,57 - 2,5 mg {0,5 m|)/3 m| :c|inc:
Sc|LuIcmc|, 0,57 - 2,5 mg {0,5 m|)/3 m| :c|inc.
SuLcuIcnec: /crenc|inc 1: 1000-0,3 m| c 0,5 m|.
lnIrcvenc:c: Sc|LuIcmc| - cIc¢ue: 250 mcg em 10 minuIc::
mcnuIençcc: 3-20 mcg/min {ce
cccrcc ccm c re:pc:Ic e FC).
IerLuIc|inc - cIc¢ue: 250 mcg em 10 minuIc::
mcnuIençcc: 1,5-5,0 mcg/min {ce
cccrcc ccm c re:pc:Ic e FC).
• /mincfi|inc EV:
Dc:e ce cIc¢ue: 5-ó mg/kg {:e ncc u:cu nc: ú|Iimc: 24 hcrc: cu 2,5-
3 mg/kg {:e u:cu e :em :inci: ce Icxiciccce) ci|u|cc em :crc
fi:ic|cgicc, em 30 minuIc:.
McnuIençcc: 15-20 mg/kg/24 hcrc:.
• CcrIicc:Iercice: EV:
HicrcccrIi:cnc - 3 c 4 mg/kg ce ó/ó hcrc:.
MeIi|precni:c|cnc - 40 c 80 mg ce ó/ó cu 8/8 hcrc:. Nc: cc:c:
grcve:, cIé 125 mg ce ó/ó hcrc:.
5. D|obetes
/ pccienIe cicLéIicc é ceficienIe nc :ecreçcc ce in:u|inc, ce fcrmc
cL:c|uIc cu re|cIivc, e c e:Ire::e cumenIc c re:i:Iëncic c in:u|inc.
12
ANESTESIA EM OBSTETRÍCIA
110
DicnIe ci:Ic, c cne:Ie:ic|cgi:Ic Ierc ¢ue:
• $626*/64 % 4'(<#()% %# )4%/2% %*'():(61#I164C4>61#B '
• 1#446>64 % $';6169*16% 6*(/-Y*61% $/4%*)' # %)# %*'():(61#I164C4>61#?
$' %1#4$# 1#2 %( *'1'((6$%$'( $' 1%$% <%16'*)'? %)4%3:( $'
$#(%>'*( <'46J$61%( $# >-61'26%? '2<4'>%*$#I(' ;6)%( #/ )64%(
TF'()4#()65 ' >-61#(Y2')4#(UE
DurcnIe c cne:Ie:ic, ceve-:e prevenir c hipcIen:cc mcIernc,
pre:ervcncc-:e c f|uxc :cngü|nec úIerc-p|ccenIcric cIrcvé: ce: infu:cc
ce :c|uçce: cri:Ic|cice: nc pré e nc inIrc-cpercIcric, ce:|cccmenIc cc
úIerc pcrc c e:¢uercc e pcrc cimc, ccmini:Ircçcc ce cxigënic e
prevençcc ce hipervenIi|cçcc.
Em re|cçcc cc: n|vei: g|icëmicc:, é cccn:e|hcve| ¢ue :ejcm ccrrigicc:
¢ucncc mcicre: ¢ue 120 mg/c|, prccurcncc mcnIë-|c: em n|vei: ce
º0mg/cl, :encc impcrIcnIe c ccnIrc|e hcrcric ce g|icemic pcrc :e eviIcr
c: ri:cc: ce hipc cu hiperg|icemic mcIernc.
Nc: prccecimenIc: e|eIivc: ceve-:e cmiIir c ccfé-cc-mcnhc. Ici:
prccecimenIc: cevem :er rec|izccc: preferenIemenIe nc primeirc hcrcric
cc mcnhc. É ccmum c pccienIe receLer 1 /3 cc cc:e mcIinc| ce in:u|inc.
É inci:pen:cve| ¢ue c cne:Ie:i:Ic Ienhc ccnhecimenIc cc Iipc ce in:u|inc
empregccc e ¢ue c: nece::iccce: mcIernc: ciminuem cpc: c pcrIc.
Em :iIucçce: ce urgëncic, e preci:c :cLer c e:Iccc ce jejum e :e c
ge:IcnIe Icmcu in:u|inc. C: cuicccc: ccm c e:Icmcgc cheic cevem :er
inIen:ificccc:, umc vez ¢ue c ri:cc pcrc regurgiIcçcc e c:pircçcc e:Ic
cumenIccc nc grcvicc cicLéIicc. Ccnfcrme c Iempc ce evc|uçcc ce:Ic
pcIc|cgic, pccem e:Icr pre:enIe: c: :eguinIe: c|Iercçce:: neurcpcIic
cuIcncmicc {gc:Ircpcre:ic) e |imiIcçcc cc exIen:cc cc crIicu|cçcc
cI|cnIc-cccipiIc| {S|ncrcme ce SIiff-JcinI), cccrreIcncc mcicre:
cificu|ccce: pcrc c: mcncLrc: ce |cringc:ccpic e inIuLcçcc Irc¢uec|.
\%4)# k%>6*%-
/: cne:Ie:ic: regicnci: :cc c: mci: reccmencccc: pcr ciminu|rem c
re:pc:Ic encccrinc-meIcLc|icc cc IrcLc|hc ce pcrIc. /: Iécnicc: e:Icc
ce:criIc: nc ccp|Iu|c 8, e cuicccc e:pecic| ceve :er Icmccc ccm
re|cçcc c hicrcIcçcc e ccnIrc|e cc g|icemic.
M<'4%+,# ]'(%46%*%
Fccem-:e uIi|izcr c: L|c¢ueic: regicnci: cu c cne:Ie:ic gerc|, :eguncc c:
Iécnicc: ce:criIc: ccimc. /|gun: cuIcre: ncc reccmenccm c uIi|izcçcc
ce /L ccm vc:cccn:IriIcre:, pe|c pc::iLi|iccce ce i:¢uemic em pccienIe:
ccm neurcpcIic e/cu vc:cu|iIe:.
ó. Necess|dode de re|oxomento uter|no
Em c|gumc: :iIucçce:, Ici: ccmc ccLeçc cerrcceirc, ver:cc e grcnce
exIrcçcc pé|vicc {:eguncc geme|cr), hiperIcnic uIerinc, em ¢ue hc
nece::iccce ce exIen:c mcnipu|cçcc inIrcuIerinc, ceve-:e
12
ANESTESIA EM OBSTETRÍCIA
111
ccr preferëncic c cne:Ie:ic gerc|, empregcncc-:e hc|cIcnc nc
ccncenIrcçcc ce 1 c 1,57 pcrc prcpcrcicncr re|cxcmenIc uIerinc
:cIi:fcIcric pcr um Lreve per|ccc ce Iempc, :uficienIe pcrc c: mcncLrc:
cL:IéIricc:. Em cc:c ce pcrIc vcginc|, Icc |cgc hcjc c ce:prencimenIc
cc ccLeçc, c hc|cIcnc ceve :er rcpiccmenIe inIerrcmpicc, c pccienIe
hipervenIi|ccc, pcrc eviIcr mcicre: percc: :cngu|nec: em ceccrrëncic
ce cIcnic uIerinc ¢ue pcce :er cIriLu|cc cc: cgenIe: hc|cgenccc:.
12
112
/ ccrccIerizcçcc ce umc ge:Icçcc ccmc :encc ce
ri:cc ncc é um prccecimenIc :imp|e:. Fe¢uer c
ccnhecimenIc ce Iccc c fi:ic|cgic cL:IéIricc, cc:
ccnciçce: :ccic-cemcgrcficc: cc: mu|here: e
IcmLém cc: prcce::c: pcIc|cgicc:, IcnIc prcpric:,
¢ucncc inIerccrrenIe: nc grcvicez, pcrc ¢ue c
ccnceiIucçcc :ejc c|crc e cLjeIivc. 0 Mini:Iéric cc
Scúce jc ci:pce, pcrc e:Ie fim, cc mcnuc| Iécnicc
:cLre Ge:Icçcc ce /|Ic Fi:cc. Fcrc c cIençcc c:
mu|here: em :iIucçce: ce ri:cc ce mcrIe mcIernc, c:
Iemc: fcrcm cLcrcccc: em cuIrc mcnuc| Iécnicc, c
ce Urgëncic: e Emergëncic: McIernc:. 0 enfc¢ue cc
pre:enIe ccp|Iu|c é c cc cIençcc cc mu|her ¢ue
Ienhc, nc mcmenIc ce :eu pcrIc, umc ge:Icçcc
ccn:icerccc ccmc ce mcjcr ri:cc pcIencic|. FcrIcnIc,
pre::upce umc cvc|icçcc pe|c prcfi::icnc| nc
mcmenIc cc inIerncçcc pcrc c pcrIc.
É impcrIcnIe ccn:icercr ¢ue c ge:IcnIe ce c|Ic ri:cc
ceverc Ier umc cLcrccgem ciferenciccc pe|c e¢uipe
prcfi::icnc|, pe|c mcicr prcLcLi|iccce ce ¢ue cccrrcm
ccmp|iccçce:, IcnIc pcrc e|c ccmc pcrc c
feIc/recém-nc:cicc. IcmLém hc c nece::iccce ce
cpcicr e Ircn¢üi|izcr c fcm||ic e c mu|her, umc vez ¢ue
c :iIucçcc gerc|menIe Ircz um mcicr n|ve| ce
cn:ieccce e mecc, :cLreIucc ¢ucncc infcrmccc ce
:eu ri:cc.
E:Ic cLcrccgem ciferenciccc ncc :ignificc,
nece::cricmenIe, rec|izcr um pcrIc pcr ce:crec. /c
ccnIrcric, mci: fre¢üenIemenIe, c re:c|uçcc incicccc
pcrc umc grcnce pcrIe cc: :iIucçce: ¢ue
ccrccIerizcm c ri:cc é ju:IcmenIe c cc pcrIc vcginc|.
/::im, :iIucçce: c||nicc: ccmc c: ce hiperIen:cc
crIeric| crcnicc, pré-ec|cmp:ic, cicLeIe:, pc:-ccIi:mc
e cuIrc: cevericm :er c fccc ce IenIcIivc: mci:
ccncreIc: ce :e ccn:eguir c pcrIc vcginc|, pe|c:
evicenIe: vcnIcgen: ¢ue Ircz.
Exi:Iem ncrmcIizcçce: :cLre c ccrccIerizcçcc cc:
in:IiIuiçce: ccpcciIccc: pcrc c cIençcc cc pcrIc ce
ge:Icçce: ce c|Ic ri:cc. É cLrigcçcc cc: ge:Icre: cc:
mcIerniccce: ccnhecë-|c:. Envc|vem, |cgiccmenIe,
ccrccIer|:Iicc: m|nimc: iceci: cc e¢uipe prcfi::icnc| e
:uc ccpcciIcçcc, in:Ic|cçce: f|:icc: {cenIrc cirúrgicc,
Lcncc ce :cngue, uniccce
13
ASSISTÊNCIA À MULHER NO PARTO DE
GESTAÇÕES DE ALTO RISCO
ASSISTÊNCIA À MULHER NO PARTO DE GESTAÇÕES DE ALTO RISCO
113
ce Iercpic inIen:ivc, Lerçcric, |cLcrcIcric, eIc.), c|ém ce e:IrcIégic:
ccmini:IrcIivc: cc in:IiIuiçcc pcrc fcci|iIcr e:Ie cIencimenIc e c gcrcnIir c
cevicc in:erçcc nc :i:Iemc ce :cúce hiercr¢uizccc.
Nc c::i:Iëncic cc pcrIc ce ge:Icçcc ce c|Ic ri:cc, uIi|izcm-:e c: me:mc:
pc::c: Iécnicc: cc c::i:Iëncic cc pcrIc ce Lcixc ri:cc, ccre:cicc: ce c|gun:
¢ue lhe: :cc prcpric:.
1. V|g||önc|o moterno
• / ccmi::cc, pcrc c: prccecimenIc: ccn:icerccc: rcIineirc:, vc|em
c: me:mc: crienIcçce: ¢ue pcrc c pcrIc ce Lcixc ri:cc. CuIrc:
prccecimenIc: inicici:, ccmc c mecicc cc pre::cc crIeric| e
ccnIcgem cc fre¢üëncic ccrc|ccc, pcr repre:enIcrem :inci:
e:pecic|menIe impcrIcnIe: nc evc|uçcc cc pcrIc ce c|Ic ri:cc, cevem
:er repeIicc: c inIervc|c: mencre:, pci: muccnçc: nc: :eu: vc|cre:
pccercc ceIermincr c|Iercçce: nc: ccncuIc: previcmenIe
e:IcLe|ecicc:.
• É funccmenIc| inc|uir c ccnIrc|e cc ccr, e cc: ccnciçce:
re:pircIcric:, ccrc|ccc: e hemccincmicc:. Feccmencc-:e c
ci:pcniLi|iccce ce ceIerminccc: recur:c: {mcniIcr ccrc|ccc, cx|meIrc
ce pu|:c, excme: |cLcrcIcrici:): cc fcci|iccce pcrc c cLIençcc ce
prccecimenIc: menc: u:uci:: c|ém ce cne:Ie:i:Ic ci:pcn|ve| nc
mcIerniccce e cienIe cc cc:c, e c cpinicc ce prcfi::icnci:
e:pecic|i:Ic: ¢ucncc i::c fcr nece::cric.
• / cieIc cc pcrIurienIe pcrIcccrc ce fcIcr ce ri:cc grcv|cicc é
ci:cuI|ve|. Se pcrc c ge:IcnIe ncrmc| :cc, permiIicc: cieIc |eve e
||¢uicc:, pcrc c grcvicc ce c|Ic ri:cc c chcnce ce c:pircçcc cc
ccnIeúcc gc:Iricc {S|ncrcme ce Mence|:cn) cumenIc muiIc, cccc c
mcicr pc::iLi|iccce ce pcrIc: ce:crec: e principc|menIe ce uIi|izcçcc
cc cne:Ie:ic gerc|. /::im, é prefer|ve| mcnIer e:Ic pcrIurienIe em
jejum, Icmcncc-:e c cevicc cuicccc ce fcrnecer c: cc|cric:
nece::cric: cc ce:envc|vimenIc cc IrcLc|hc ce pcrIc, cincc ¢ue :ejc
cIrcvé: ce infu:ce: enccvenc:c: ce g|icc:e.
2. V|g||önc|o |eto|
• / vigi|cncic feIc| curcnIe c IrcLc|hc ce pcrIc ce ge:Icçce: ce c|Ic
ri:cc ceve Icmcr em ccnIc c cvc|icçcc cc viIc|iccce feIc|, inc|uincc c
prcpric ce:envc|vimenIc inIrc-uIerinc cc feIc. É impcrIcnIe re::c|Icr
¢ue excme: rec|izccc: cnIericrmenIe, cu nc mcmenIc cc inIerncçcc
hc:piIc|cr, ccmc u|Irc-:cncgrcfic, prcvc: ce mcniIcrizcçcc e|eIrcnicc
feIc|, Ferfi| 8icf|:icc FeIc| e ccpp|erve|ccimeIric, cevem Ier :uc:
inciccçce: preci:c: em cccc :iIucçcc c||nicc, ncc :encc nece::cric:
Iccc: em Iccc: c: cc:c:. / cepencer cc: re:u|Iccc: ce:Ic: prcvc:,
ccnfcrme cLcrcccc nc mcnuc| Iécnicc ce Ge:Icçcc ce /|Ic Fi:cc,
ceverc :er :eguicc c viIc|iccce cc feIc nc Ircn:cur:c cc IrcLc|hc ce
pcrIc ce umc fcrmc rigcrc:c.
• Jc c ccmi::cc, c cmnic:ccpic pcce reve|cr cccc: impcrIcnIe: pcrc
c cvc|icçcc cc viIc|iccce feIc|. / pre:ençc ce ||¢uicc meccnic| em
fc:e: preccce: cc IrcLc|hc ce pcrIc é um :inc|
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ASSISTÊNCIA À MULHER NO PARTO DE GESTAÇÕES DE ALTO RISCO
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ce c|erIc ¢ue imp|icc em mcicr vigi|cncic feIc|. Fcr cuIrc |ccc, c
pre:ençc ce meccnic e:pe::c, icenIificccc cpc: c rcIurc cc:
memLrcnc: em cpre:enIcçce: cefc|icc:, incicc c|Ic prcLcLi|iccce
ce :cfrimenIc feIc|.
• C mcniIcrcmenIc cc fre¢üëncic ccrc|ccc feIc| e c méIccc mci:
cmp|cmenIe uIi|izccc pcrc c cvc|icçcc cc: ccnciçce: ce
viIc|iccce cc feIc. Fcce :er feiIc ce mccc inIermiIenIe cu ccnI|nuc.
C méIccc ce e:cuIc inIermiIenIe cc: LcIimenIc: ccrc|ccc: feIci: é
rec|izccc cIrcvé: cc e:IeIc:ccpic mcnccuricu|cr ce Fincrc, cu
cIrcvé: cc :cncr pcrIcIi|. Em cmLc: c: cc:c:, pcrc ¢ue :e Icrne
méIccc ccnficve|, :cc nece::cric: c|gun: cuicccc: Iécnicc:.
/::im, c primeirc pc::c é c e:IcLe|ecimenIc cc fre¢üëncic ccrc|ccc
feIc| Lc:c|, cu :ejc, c: :eu: vc|cre: cLIicc: enIre ccnIrcçce:. É c pcrIir
ce:Ie: ¢ue :e cicgnc:Iiccm c Ic¢uiccrcic feIc| {fre¢üëncic mcicr ¢ue
1ó0 LcIimenIc:/minuIc) e c Lrcciccrcic {vc|cre: mencre: ¢ue 120
LcIimenIc:/minuIc), Icmccc: ccmc :inc| impcrIcnIe pcrc c cicgnc:Iicc
ce :cfrimenIc feIc|.
C: LcIimenIc: cevem :er e:cuIccc: cnIe:, curcnIe e cepci: cc:
ccnIrcçce:. Cucncc i:Ic ncc fcr pc::|ve|, c cu:cu|Ic ceve :er feiIc c
pcrIir cc meic cc ccnIrcçcc cIé c :eu ce:cpcrecimenIc ccmp|eIc, pci:
:c c::im pccercc :er icenIificccc: c: ce:cce|ercçce: Icrcic: e vcricvei:
prc|cngccc:, e|emenIc: prcpecëuIicc: exIremcmenIe impcrIcnIe: pcrc
c cicgnc:Iicc ce :cfrimenIc feIc|.
Deve ficcr c|crc ¢ue e:Ie: e|emenIc: pccem :er cLIicc: IcnIc pe|c
cu:cu|Ic inIermiIenIe, ccmc pe|c mcniIcrcmenIc e|eIrcnicc ¢ue, IcnIc
¢ucnIc pc::| ve|, ceve :er preferencic| nc cccmpcnhcmenIc cc IrcLc|hc
ce pcrIc ce c|Ic ri:cc. /: in:IiIuiçce: ccpcciIccc: c e:Ie Iipc ce cIençcc
cevericm ci:pcr ce mcniIcre: e|eIrcnicc: feIci: e :eu: prcfi::icnci:
cevericm :er cce¢ucccmenIe Ireinccc: pcrc :uc uIi|izcçcc e
inIerpreIcçcc.
CcnIucc, ncc exi:Iem evicëncic: cienI|ficc: ¢ue cemcn:Irem ¢ue c
ccnIrc|e e|eIrcnicc cc viIc|iccce feIc| ccm mcniIcr curcnIe c IrcLc|hc
ce pcrIc mc:Ire evicenIe: vcnIcgen: ccm re|cçcc cc ccnIrc|e c||nicc
inIermiIenIe rec|izccc ccm e:IeIc:ccpic ce Fincrc cu :cncr pcr
prcfi::icnci: Ireinccc:. C mcniIcr feIc| fcci|iIc c ccnIrc|e cc viIc|iccce
feIc|.
• / uIi|izcçcc cc gc:cmeIric ccpi|cr feIc| é méIccc ccrc e,
emLcrc :eu: re:u|Iccc: :ejcm ccnficvei:, é pcucc uIi|izccc nc 8rc:i|.
CcnIucc, :empre ¢ue pc::|ve| e ci:pcn|ve|, ccn:IiIui cincc um
exce|enIe méIccc pcrc cjuccr c cicgnc:Iicc ce :iIucçce: ce
hipcxic feIc|, cnce e:Icricm incicccc: mecicc: pcrc cIenuc-lc:,
inc|u:ive nc ¢ue ciz re:peiIc c vic ce pcrIc. CuIrc pc::iLi|iccce,
cincc pcucc exp|crccc nc pc|:, é c cc cximeIrjc ce pu|:c feIc|,
cccp|ccc c :i:Iemc: ce mcniIcrizcçcc feIc| inIrc-pcrIc.
3. Ass|stënc|o oo porto
• DiferenIemenIe cc pcrIc ce Lcixc ri:cc, em ¢ue ncc :e re:Iringe
c pc:içcc cc pcrIurienIe, nc: ge:Icçce: ce c|Ic ri:cc,
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c cecúLiIc |cIerc| cccLc :encc c pc:içcc ce e:cc|hc. Fcrc
cvc|icçcc g|cLc| cc evc|uçcc cc IrcLc|hc ce pcrIc, incicc-:e u:c
cc pcrIcgrcmc ¢ue fcrnece e|emenIc: cLjeIivc: pcrc c cicgnc:Iicc
ce ci:Iccic:, ccnfcrme ceIc|he: nc Ccp|Iu|c ó.
E:pecificcmenIe ne:Ic: :iIucçce:, é inci:pen:cve| cccrrer umc
inIegrcçcc ccmp|eIc cc e¢uipe mu|Iiprcfi::icnc|, inc|uincc c cL:IeIrc, c
pecicIrc, c cne:Ie:i:Ic, pc::ive|menIe c c||nicc, c enfermeirc e cuIrc:. /
mcicric cc: cc:c: ce ge:IcnIe: ce ri:cc em IrcLc|hc ce pcrIc Iem
inciccçcc ce cnc|ge:ic preccce. l::c é e:pecic|menIe impcrIcnIe nc:
:iIucçce: ce ccrcicpcIic mcIernc, pcrc eviIcr c :cLreccrgc
hemccincmicc re:u|IcnIe cc: e:fcrçc: ce puxc cc per|ccc expu|:ivc,
ccm c pc::|ve| ccn:e¢üenIe ce:ccmpen:cçcc ccrc|ccc mcIernc.
• FcnIc ¢ue merece ci:cu::cc é c mcmenIc ce :e prcIiccr c
cmnicIcmic. /Ié hc c|gun: cnc:, reccmenccvc-:e c rcIurc crIificic|
e preccce cc: memLrcnc:, vi:cncc c ce:encccecmenIc cc
IrcLc|hc ce pcrIc e encurIcmenIc ce :eu Iempc. EnIreIcnIc, c
rcIurc preccce cc: memLrcnc: cmnicIicc: fcvcrece c
cpcrecimenIc ce ccvc|gcmenIc: e Lc::c: :erc:cngu|nec:, c|ém
cc: ce:cce|ercçce: preccce:. E:Ic: ú|Iimc: pccem :er Icmccc:
ccmc :inc| ce c|crme pcrc c :cfrimenIc feIc|. De:Ic fcrmc, quonto
mo|s tord|o |or o roturo omn|ot|co ort|||c|o|mente reo||zodo, me|hores
serõo os cond|çöes |eto|s.
/ c::i:Iëncic cc per|ccc expu|:ivc ceve |evcr em ccnIc c pc:içcc cc
pcrIurienIe, c ccnciçcc pcIc|cgicc ¢ue ccrccIerizc c c|Ic ri:cc e c:
inciccçce: ce cnIecipcçcc cc pcrIc ccm c u:c prcfi|cIicc ce fcrcipe.
• Nc pcrIurienIe ce c|Ic ri:cc, c pc:içcc ccnvencicnc|
ginecc|cgicc é c mci: uIi|izccc, fre¢üenIemenIe ccm c ccr:c
|evemenIe c|çccc, inc|u:ive pcr¢ue c mu|her e:Icrc :cL cnc|ge:ic
pericurc|, nc mcicric cc: veze:. A ep|s|otom|o nõo tem |nd|coçõo
s|stemót|co. Deve :er incicccc :e|eIivcmenIe em cc:c: cnce :e
ju|gue impre:cinc|ve| pcrc eviIcr rcIurc: perineci: :empre IcmLém
¢ucncc c fcrcipe fcr uIi|izccc.
• Fc::|ve| ce ci:cu::cc e c u:c prcfi|cIicc cc fcrcipe cu fcrcipe ce
c||vic. EmLcrc c: cpinice: :ejcm civergenIe:, c preceiIc Lc:icc ce
:e pre:ervcr c ncrmc|iccce ceve prevc|ecer. /::im, frenIe c
evc|uçcc ncrmc| cc :eguncc e:Icgic e mcnIicc: c: ccnciçce: ce
viIc|iccce mcIernc e feIc|, ncc hc re:pc|cc pcrc e:Ic inIervençcc
:i:IemcIiccmenIe rec|izccc. Feccmencc-:e re:ervcr c fcrcipe c:
:uc: inciccçce: c|c::icc: e nc: :iIucçce: ce ccrcicpcIic: e
pneumcpcIic:, pcrc eviIcr c e:fcrçc f|:icc mcIernc cc per|ccc
expu|:ivc, ¢ue pcce fcvcrecer umc ce:ccmpen:cçcc. DeIc|he:
:cLre c uIi|izcçcc ce:Ie in:IrumenIc e:Icc ci:pcn|vei: nc CcpiIu|c
11.
• Nc c::i:Iëncic cc pcrIc ce Lcixc ri:cc, c crienIcçcc é ce :e
prccecer c |igccurc Icrcic cc ccrccc, i:Ic é, ce::ccc: c:
LcIimenIc:. Nc grcvicez ce c|Ic ri:cc, c|gumc: ccnciçce: ccnIrc-
inciccm Ic| ccncuIc, ccmc é c cc:c cc i:cimunizcçcc mcIernc-
feIc| e HlV•.
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• C cIencimenIc cc ¢ucrIc per|ccc nc grcvicez ce c|Ic ri:cc ceve
:er inIen:ivc, pci: c: chcnce: ce ccmp|iccçce: :cc mcicre:. Ici: :cc
c: cc:c: ce hiperIen:c: grcve:, ccrcicpcIc:, préec|cmpIicc: cu
ec|cmpIicc:, cicLéIicc:, eIc. /pc: um per|ccc ce permcnëncic nc
:c|c ce recupercçcc pc:-cne:Ié:icc, c mu|her ceverc :er
enccminhccc pcrc umc uniccce ce cuicccc: inIen:ivc:, :cL
:upervi:cc cne:Ié:icc, cL:IéIricc e c||nicc, :e :uc :iIucçcc c::im c
inciccr.
• Mci: cc ¢ue nc: :iIucçce: ce ncrmc|iccce, c cIencimenIc cc
pcrIc ce ge:IcnIe ce c|Ic ri:cc pre::upce IcmLém c nece::iccce
ce cce¢uccc enccminhcmenIc pcrc c revi:cc puerperc| e
crienIcçcc ¢ucnIc cc p|cnejcmenIc fcmi|icr, cLcrcccc: nc
Ccp|Iu|c 20.
S|tuoçöes espec|o|s:
1. Feto com restr|çõo do cresc|mento |ntro-uter|no [kCIb}
C FClU ncc ccn:IiIui umc inciccçcc cL:c|uIc ce pcrIc pcr ce:crec,
ccn:icercncc ¢ue cercc ce ó07 cc: cc:c: pccem evc|uir pcrc pcrIc
vcginc|, :em nenhum Iipc ce ccmp|iccçcc ¢ucnIc c viIc|iccce feIc|. Seu
ccnIrc|e curcnIe c evc|uçcc cc IrcLc|hc ce pcrIc ceve :er feiIc ce
mcneirc rigcrc:c, ccmc jc preccnizccc cnIericrmenIe ne:Ie ccp|Iu|c.
2. Gestoçöes pré-termo
Nc pcrIc premcIurc, :empre ¢ue fcr pc::|ve|, é impcrIcnIe |emLrcr ¢ue
c: feIc: pré-Iermc cevem :e Leneficicr cc ccmini:Ircçcc pcrenIerc| ce
ccrIiccice pcrc cce|ercr c mcIuriccce pu|mcncr {pe|c menc: pcr 24
hcrc:, pcrc ¢ue hcjc Iempc :uficienIe pcrc ¢ue :uc cçcc pc::c :e
mcnife:Icr). IcmLém ne:Ic :iIucçcc ncc exi:Ie nenhumc evicëncic
cienI|ficc ¢ue :upcrIe c cpçcc pe|c pcrIc ce:cricnc, ce:ce ¢ue c
cpre:enIcçcc :ejc cefc|icc. Ccn:IiIui cincc :iIucçcc em ¢ue c
pre:ervcçcc cc: memLrcnc: cvu|cre: |nIegrc: pe|c mcicr Iempc pc::|ve|
e mecicc eficcz ce mcnuIençcc cc: Lcc: ccnciçce: ce :cúce feIc|.
3. Apresentoçõo pé|v|co
/ vic ce pcrIc ce feIc: em cpre:enIcçcc pé|vicc, IcnIc ce Iermc ¢ucnIc
pré-Iermc, :empre fci mcIivc ce ccnIrcvér:ic: nc |iIercIurc muncic|,
cccc: c: ri:cc: pcIencici: c e|c c::cciccc:. Irccicicnc|menIe, pcrIc
vcginc| erc reccmencccc nc cpre:enIcçcc pé|vicc em ge:Icçce: ce
Iermc :em ccmp|iccçce: ccicicnci:. /|gun: pc|:e: IcmLém inciccvcm c
vic vcginc| me:mc em mu|here: primige:Ic:, ¢ue ncc cccnIecic nc
/méricc LcIinc em gerc| e nc 8rc:i|, em pcrIicu|cr. Exi:Ie ccn:en:c nc
|iIercIurc inIernccicnc| ce ¢ue c me|hcr fcrmc ce cLcrccgem c
ge:Icçcc ccm feIc em cpre:enIcçcc pé|vicc, é c ce :e prccecer c umc
ver:cc cefc|icc exIernc cc reccr cc: 37 :emcnc: ce iccce ge:Iccicnc|,
cLvicmenIe rec|izccc cpenc: pcr prcfi::icnc| ccpcciIccc pcrc c
prccecimenIc e :e hcuverem ccnciçce: iceci: pcrc i::c {ge:Icçcc
únicc, Lc|:c |nIegrc, cu:ëncic ce IrcLc|hc ce pcrIc, excme u|Irc-
:cncgrcficc, cu:ëncic ce circu|cre:
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ce ccrccc, :em ciccIriz ce ce:crec prévic, fcci|iccce: nc :erviçc pcrc c
cIençcc imecicIc ce pc::|vei: ccmp|iccçce:).
Cucncc c ver:cc exIernc ncc fcr pc::|ve| cu ncc re:u|Icr em ëxiIc,
cIuc|menIe incicc-:e c pcrIc ce:crec pcrc c: cpre:enIcçce: pé|vicc:,
ccm Lc:e em evicëncic: cienI|ficc: recenIe:, incepencenIemenIe ce
cuIrc: vcricvei:.
Freferencic|menIe, c ce:crec ceve :er incicccc ¢ucncc iniciccc c
IrcLc|hc ce pcrIc e ncc e|eIivcmenIe, pcrc eviIcr c: pc::|vei:
ccmp|iccçce: ceccrrenIe: ce umc premcIuriccce icIrcgeniccmenIe
incuzicc. /|ém ci::c, é impcrIcnIe |emLrcr ¢ue nc ce:prencimenIc cc
feIc, curcnIe umc ce:crec em cpre:enIcçcc pé|vicc, cevem :er
rec|izccc: c: mcncLrc: :imi|cre: c¢ue|c: reccmencccc: pcrc c cIençcc
cc pcrIc vcginc| ne:Ic cpre:enIcçcc.
4. Gestoçõo geme|or
Exi:Iem evicëncic: ¢ue cemcn:Ircm ¢ue c prcgrcmcçcc pcrc c pcrIc
{p|cnejcmenIc :cLre c hc:piIc| ce e:cc|hc pcrc c pcrIc e :eu: recur:c:
Iécnicc: e humcnc: ce cL:IeIr|cic, cne:Ie:ic e necncIc|cgic) é
funccmenIc| nc cLIençcc ce Lcn: re:u|Iccc: mcIernc: e perincIci:.
Ccm re|cçcc c vic ce pcrIc, vc|e cincc c inciccçcc c|c::icc ce ¢ue em
cpre:enIcçce: cefc|icc: cc primeirc geme|cr, c pcrIc ceve :er vcginc|
:empre ¢ue c pe:c feIc| e:Iimccc fcr mcicr ¢ue 1500g. Nc: cemci:
cpre:enIcçce: cc primeirc geme|cr, c ce:crec e:Ic incicccc.
Fer:i:Ie cincc c|gumc cúvicc ¢ucnIc c me|hcr inIervençcc pcrc c
Seguncc geme|cr ncc cefc|icc, cpc: c nc:cimenIc cc primeirc pcr vic
vcginc|. Exi:Iem evicëncic: ce ¢ue c ce:crec :i:IemcIicc ne:Ic ccnciçcc
e:pec|ficc ncc repre:enIc nenhumc vcnIcgem :cLre c: mcncLrc:
c|c::icc: ce ver:cc inIernc e exIrcçcc pccc|icc {cu cincc :cLre c ver:cc
exIernc ¢ue é pcucc prcIicccc nc 8rc:i|), ¢ucnIc cc: re:u|Iccc:
perincIci: e, pcr cuIrc |ccc, c|gumc ce:vcnIcgem em Iermc: ce
mcrLiccce infeccic:c mcIernc, ce:ce ¢ue exi:Icm prcfi::icnci: Ireinccc:
pcrc rec|izc-lc:.
CuIrc c|IerncIivc ce:criIc pcrc e:Ic :iIucçcc é c ver:cc exIernc pcrc
cpre:enIcçcc cefc|icc. E:Ie prccecimenIc, ccnIucc, c|ém ce ncc :er
prcIicc fre¢üenIe nc pc|:, pcrece ncc :er vcnIcjc:c ccm re|cçcc c
ver:cc inIernc ccm exIrcçcc pccc|icc.
5. Cesóreo onter|or
/ pre:ençc ce cnIececenIe: ce umc ce:crec cnIericr ncc ccnIrcincicc
c cccrrëncic ce IrcLc|hc ce pcrIc nc ge:Icçcc :uL:e¢üenIe. C
incenIivc c rec|izcçcc ce prcvc ce IrcLc|hc ce pcrIc ne:Ic: mu|here: é
umc cc: mecicc: mci: impcrIcnIe: pcrc c recuçcc cc: Icxc: ce
ce:crec nc 8rc:i|. C ri:cc ce ccmp|iccçce: mcIernc: {rcIurc uIerinc,
cei:cëncic ce ciccIriz, eIc.), c::im ccmc ce ccmp|iccçce: feIci:
{:cfrimenIc) é muiIc Lcixc, ce:ce ¢ue hcjc cce¢uccc vigi|cncic cc
IrcLc|hc ce pcrIc e cc viIc|iccce feIc|.
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Ncc exi:Iem |imiIe: ce inIervc|c inIerpcrIc| ¢ue ccnIrc-inci¢uem c
IrcLc|hc ce pcrIc em ge:IcnIe ccrn ce:crec cnIericr, ce:ce ¢ue c
inci:cc cc primeirc ce:crec Ienhc :icc :egmenIcr. C |ncice ce :uce::c
pcrc pcrIc vcginc| nc: mu|here: :uLmeIicc: c umc prcvc ce IrcLc|hc ce
pcrIc é ce, nc m|nimc, 507: c|gun: IrcLc|hc: mc:Ircm cifrc: ce cIé 70 c
807.
13
119
Nc prcIicc cL:IéIricc exi:Iem vcric: ccnciçce: ¢ue
inciccm c Iérminc cc grcvicez, em ¢uc|¢uer iccce
ge:Iccicnc|, cnIe: cc in|cic e:pcnIcnec cc IrcLc|hc
ce pcrIc. EnIre e|c:, c: mci: fre¢üenIe: :cc c:
:|ncrcme: hiperIen:ivc:, cicLeIe:, cc|cgenc:e:,
re:Iriçcc cc cre:cimenIc inIrc-uIerinc {FClU), pc:
ccIi:mc, ccmprcmeIimenIc cc viIc|iccce feIc|,
i:cimunizcçcc mcIernc-feIc|, mcrIe feIc| infrc-úIerc,
rcIurc premcIurc ce memLrcnc: e ccriccmnicniIe.
/ incuçcc cc IrcLc|hc ce pcrIc é prcIicccc
:i:IemcIiccmenIe cpenc: em c|gun: pcucc: hc:piIci:,
gerc|menIe púL|icc: e univer:iIcric:, em prcpcrçce:
Lem infericre: c¢ue|c: ce pc|:e: mci: ce:envc|vicc:.
Ncc hc cincc nc pc|: umc cmp|c ci:pcniLi|iccce
ccmercic| ce méIccc: ce prepcrc ce cc|c e ce
incuçcc cc IrcLc|hc ce pcrIc, c ¢ue ccnIriLui
cerIcmenIe pcrc c: c|Ic: |ncice: ce pcrIc pcr ce:crec.
Num contexto de humon|zoçõo do nosc|mento, de
respe|to oos d|re|tos e desejos dos mu|heres, e do
prót|co de umo obstetríc|o boseodo em ev|dënc|os, é
|mportonte que se esc|oreço que o |nduçõo do porto é
um proced|mento oce|tóve| e recomendóve| sob o
ponto de v|sto méd|co e humono, sempre que ex|sto
umo |nd|coçõo poro |sso, poro ev|tor um mo| mo|or.
E:Ie pcce IcnIc mcnife:Icr-:e ccmc um re:u|Iccc
mcIernc cu perincIc| ce:fcvcrcve| cu, mci:
fre¢üenIemenIe, ccmc umc ce:crec ce:nece::cric e
:uc: pc::|vei: ccn:e¢üëncic:. E:Ic cLcrccgem nccc
Iem c ver ccm c fre¢üenIe u:e ce :uL:Icncic: ¢ue
e:Iimu|cm c ccnIrcçcc uIerinc cpenc: ccm c cLjeIivc
ce cnIecipcr cu encurIcr c IrcLc|hc ce pcrIc em
Lenef|cic cc: inIere::e: pe::cci: cc: prcfi::icnci: ce
:cúce cu cc: prcpric: ge:IcnIe:. /|ém ci::c, é
impcrIcnIe ¢ue :e e:c|creçc ¢ue um ¨:crc¨ cc|ccccc
nc ge:IcnIe pcr umc cu cuc: hcrc: nõo é incuçcc cc
pcrIc: ¢ue e|e ncc ccn:egue fczer num e:pcçc ce
Iempc Icc curIc, c ¢ue c ncIurezc cemcrc c|gun:
cic:.
14 INDUÇÃO DO PARTO
INDUÇÃO AO PARTO
120
Cuc|¢uer méIccc c :er uIi|izccc exige c pre:ençc ce prcfi::icnc|
Ireinccc, in:Ic|cçce: cc mcIerniccce cce¢uccc: c nece::iccce ce u:e
ce infu:ce: enccvenc:c:, ce ccnIrc|e fre¢üenIe cc viIc|iccce feIc|, ce
rec|izcçcc ce prccecimenIc: cirúrgicc: ce urgëncic, ce ci:pcniLi|iccce
ce recur:c: ce Lcncc ce :cngue e ce cne:Ie:ic, enIre cuIrc:. /
ge:IcnIe, Lem ccmc :eu ccmpcnheirc cu cccmpcnhcnIe, cevem e:Icr
infcrmccc: e e:c|crecicc: :cLre c méIccc e:cc|hicc e ccnccrccrem
ccm e|e. lcec|menIe Iccc c e¢uipe prcfi::icnc| ceveric e:Icr mcIivccc
pcrc c: Lenef|cic: ce um pcrIc vcginc|, ccmpcrcIivcmenIe c ce:cricnc,
pcrc cc|cLcrcr ccm c mu|her curcnIe Iccc e:Ie prcce::c.
Aspectos ||s|o|og|cos
C :uce::c nc incuçcc cc pcrIc cepence cc cLIençcc ce ccnIrcIi|iccce
uIerinc e ci|cIcçcc prcgre::ivc cc cc|c. / ccnIrcçcc uIerinc cce¢uccc
pcrc c ci|cIcçcc cervicc| e:Ic cireIcmenIe re|ccicnccc cc e:Iccc inicic|
cc cc|c e c iccce ge:Iccicnc|. C cc|c uIerinc é imcIurc e firme curcnIe
Iccc c per|ccc cc grcvicez, cIé c: ú|Iimc: cic: cu :emcnc: ¢ue
cnIececem c pcrIc, ¢ucncc prcfuncc: mccificcçce: Lic|cgicc: e
Lic¢u|micc: cccrrem, Icrncncc-c mccic e ccmp|ccenIe.
/ primeirc c|c::ificcçcc c||nicc cc: ccnciçce: ce cmccurecimenIc cc
cc|c uIerinc fci rec|izccc pcr 8i:hcp {1ºó4) ¢ue ce:envc|veu um e:ccre
ccm cincc vcricvei: pcrc e:IcLe|ecer c e:Iccc cc cc|c {Cuccrc 1). /
pcrIir ce::e e:Iucc, c |ncice ce 8i:hcp pc::cu c :er uIi|izccc ccm c
prcpc:iIc ce :e e:IcLe|ecer, genericcmenIe, c preciçcc ce :uce::c c
incuçcc cc IrcLc|hc ce pcrIc. Ccn:icerc-:e ccmc fcvcrcve| cc :uce::c
pcrc pcrIc vcginc|, em mencr Iempc, c pre:ençc ce |ncice ce 8i:hcp
mcicr cu iguc| c ncve, ccmc inIermecicric um e:ccre enIre cincc e ciIc,
e ce:fcvcrcve| ¢ucncc mencr ¢ue cincc pcnIc:.
Quadro 1. Parâmetros para a avaliação do colo uterino - Bishop 1964)
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INDUÇÃO DO PARTO
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Nc pre:ençc ce cc|c uIerinc ce:fcvcrcve|, cIuc|menIe ccn:icerc-:e
Lenéficc e funccmenIc| c rec|izcçcc ce prepcrc cervicc| prévic c
incuçcc cc pcrIc. / incuçcc ce ccnIrcIi|iccce uIerinc :em c prepcrc
cervicc| prévic e:Ic c::cciccc c c|Ic: Icxc: ce fc|hc: ce incuçcc e pcrIc
pcr ce:crec.
O preporo do co|o deve ser entend|do como um me|o poro se obter o
trobo|ho de porto e porto. CcnIucc, cincc ncc exi:Ie um méIccc ¢ue
pc::c :er ccn:icerccc icec| pcrc c prepcrc cc cc|c, ¢ue cumprc ccm
Iccc: c: :eguinIe: prcprieccce:, iceci::
• cu:ëncic ce efeiIc: ccver:c: pcrc c mce e feIc:
• cmccurecimenIc cc cc|c em curIc per|ccc ce Iempc {cIé 12 -
24h):
• ncc ccu:cr ce:ccnfcrIc c mu|her:
• ncc :er invc:ivc, mc: ce fcci| cp|iccçcc: e
• ncc e:Iimu|cr c ccnIrcIi|iccce uIerinc.
EmLcrc e:Ic ú|Iimc prcprieccce ncc repre:enIe um ccn:en:c enIre c:
cuIcre:, :cLe-:e ¢ue c ccnIrcçcc uIerinc ccm cc|c imcIurc c::ccic-:e c
mcicr prcLcLi|iccce ce IrcLc|hc ce pcrIc |cLcric:c e excu:Iivc,
e|evcncc c ri:cc ce efeiIc: ccver:c: ccmc :cfrimenIc feIc|, ce:ccnfcrIc
mcIernc e cuIrc:.
MÊIODOS DE FkEFAkO CEkVICAL
Nc prcIicc, c: méIccc: cIuc|menIe ci:pcn|vei: e úIei: pcrc c prepcrc cc
cc|c uIerinc prévic c incuçcc cc IrcLc|hc ce pcrIc :cc:
1. Métodos mecön|cos
Dencminc-:e méIccc meccnicc c in:IrumenIc cu ci:pc:iIivc cc|ccccc
nc ccnc| cervicc| cu nc e:pcçc exIrc-cmnicIicc. Scc exemp|c: ce:Ie Iipc
ce méIccc c: :cncc:, ccIéIere: e c: prepcrccc: ccm c|gc: mcrinhc:
{|cmincric). /: :cncc: c|c::iccmenIe uIi|izccc:, ccmc c reIc| nc méIccc
ce ‚rcu:e, Iëm :icc mci: recenIemenIe Irccccc: pcr cuIrc: mcce|c:
menc: r|gicc:, c exemp|c cc sondo de Fo|ey.
CucnIc cc meccni:mc ce cçcc, c: c|gc: ncIurci: e/cu :inIéIicc:, c:
|om|nór|os, cgem :cLre c cc|c uIerinc, prcmcvencc c ci|cIcçcc cc
ccnc| cervicc| cIrcvé: ce expcn:cc rccic| :ucve pcr :eu pccer
higrc:ccpicc, :em prcvcccr |e:cc ce fiLrc:. /pe:cr ce cencminccc:
meccnicc:, IcmLém :e cIriLui cc méIccc c e:I|mu|c e |iLercçcc ce
prc:Icg|cncinc: enccgenc:, e|evcncc c ccmp|ccëncic cc cc|c uIerinc.
E:Ie me:mc meccni:mc ccmLinccc é prcpc:Ic pcrc c cçcc cc:
ccIéIere: exIrc-cmnicIicc:, ccm cu :em Lc|ce: in:uf|ccc:.
/: :cncc: cu ccIéIere: exIrc-cmnicIicc: :cc ceixccc: pcr Iempc vcricve|
enIre 12 e 24 hcrc:. / uIi|izcçcc ce:Ie: méIccc: meccnicc: pcce :e
c::ccicr c c|gumc: recçce: ccver:c: ccmc rcIurc ccicenIc| ce
memLrcnc: cmnicIicc:, ce:ccnfcrIc mcIernc, :cngrcmenIc, ci:Iccic
funcicnc| e, menc: fre¢uenIemenIe, infecçcc puerperc|.
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/: vcnIcgen: ce:Ie: méIccc: :cc, em gerc|, ceccrrenIe: ce :uc fcci|
cp|iccLi|iccce, :imp|iciccce ce u:c, Lcixc cu:Ic ¢ucncc ccmpcrccc cc:
cemci: méIccc:, fcci| remcçcc, c|ém ce pe¢uenc cu nenhumc
cIucçcc :cLre c micméIric. Mci: recenIemenIe, c uIi|izcçcc cc :cncc
ce Fc|ey, ccm Lc|cneIe in:uf|ccc ccimc cc crif|cic inIernc, :cL Ircçcc
mccerccc {cIrcvé: ce :uc fixcçcc ccm e:pcrccrcpc nc fcce inIernc cc
ccxc), Iem mc:Irccc umc grcnce ccpcciccce ce ce:encccecr
ccnIrcçce: e IrcLc|hc ce pcrIc, ccm re:u|Iccc: muiIc fcvcrcvei: e Lcixc
|ncice ce efeiIc: cc|cIerci:.
EmLcrc exi:Ic umc grcnce ¢ucnIiccce ce e:Iucc: puL|icccc: :cLre c
experiëncic ccm c uIi|izcçcc ce méIccc: meccnicc: pcrc c prepcrc
cervicc| previcmenIe c incuçcc cc IrcLc|hc ce pcrIc, Ici: méIccc:
e:Icc |cnge ce :erem |crgcmenIe uIi|izccc: nc prcIicc cL:IéIricc cicric,
:cLreIucc nc 8rc:i|. Seu: re:u|Iccc: cemcn:Ircm umc ccpcciccce ce
mcIurcçcc cc cc|c |imiIccc, pcrIcnIc ju:Iificcve| nc cIuc|iccce cpenc:
em :iIucçce: em ¢ue cuIrc: méIccc: mci: efeIivc: ncc e:Iejcm
ci:pcn|vei:.
Ncc exi:Iem cincc evicëncic: :uficienIe: ¢ue permiIcm reccmenccr c
u:c ccmLinccc cc: ccIéIere:, ccm c in:Ii|cçcc ce :uL:Icncic: ccmc c:
prc:Icg|cncinc: nc e:pcçc exIrc-cmnicIicc.
2. Métodos |ormoco|og|cos
C mci: ccnhecicc e uIi|izccc méIccc ce prepcrc cervicc| é c infu:cc
enccvenc:c ce oc|toc|no. De:ce c in|cic ce :uc uIi|izcçcc pcrc c
incuçcc cc ccnIrcIi|iccce uIerinc, Iem :icc IcmLém u:ccc pcrc c
cmccurecimenIc cervicc|, emLcrc :e ccnheçc, hc muiIc, :uc |imiIccc
efeIiviccce pcrc e:Ie fim. E:Ic c::cciccc c nece::iccce ce um Iempc
prc|cngccc ce prepcrc, ce c|Ic: cc:e: e c Icxc: e|evccc: ce ce:crec
pcr fc|hc ce incuçcc. Devicc c e:Ic: |imiIcçce:, :uc uIi|izcçcc pcrc c
prepcrc cervicc| fci prcIiccmenIe cLcnccnccc. Scc nece::cric:,
¢ucncc ncc :e ci:pcem ce cuIrc: méIccc: mci: efeIivc:, Irë: c ¢ucIrc
repeIicc: :e::ce: cicric:, c ¢ue é ccn:cIivc pcrc c mu|her e c e¢uipe ce
:cúce, :em ccnIcr ccm c ccupcçcc exIrc ce |eiIc: nc uniccce
cL:IéIricc.
/ pcrIir cc icenIificcçcc cc envc|vimenIc cc: prostog|ond|nos
enccgenc: nc prcce::c ncIurc| ce mcIurcçcc cc cc|c uIerinc, c u:c
ce:Ic: :uL:Icncic: pc::cu c :er ccn:cgrccc ccmc méIccc icec| pcrc
prepcrc e incuçcc ce pcrIc. Nc: pc|:e: ce primeirc muncc, nc: ú|Iimc:
cécccc:, ciferenIe: fcrmu|cçce: ce FgE2 [d|noprostone} vëm :encc
uIi|izccc:, e:pecic|menIe c fcrmc ce ge| pcrc cp|iccçcc inIrc-cervicc| cu
inIrc-vcginc|.
EmLcrc c FgE2 {cincprc:Icne) :ejc um méIccc :egurc e eficcz pcrc c
prepcrc cc cc|c uIerinc, :uc fcrmu|cçcc cpre:enIc cu:Ic e|evccc, é
Iermc|cLi| e ncc é ccmercic|izccc nc 8rc:i|. C m|soprosto| ƒ umc
prc:Icg|cncinc :inIéIicc E1, meIi| cnc|cgc, ¢ue fci criginc|menIe
:inIeIizccc e ccmercic|izccc ccm c cLjeIivc ce ciminuir c: efeiIc:
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INDUÇÃO DO PARTO
123
cc|cIerci: e cumenIcr c Iempc ce cçcc cc FgE1 ncIurc|, nc IrcIcmenIc
ce :|ncrcme: ci:pépIicc: cc IrcIc gc:IrcinIe:Iinc|, ccmc gc:IriIe e ú|cerc
pépIicc.
lnicic|menIe, c uIi|izcçcc cc mi:cprc:Ic| fci mci: cirecicnccc ccmc
ccjuvcnIe nc: inIerrupçce: inicici: ce ge:Icçcc, pcr :eu efeiIc cLcrIivc.
E::e efeiIc fci cmp|cmenIe uIi|izccc e civu|gccc, c ¢ue inc|u:ive cificu|Icu
c ccmercic|izcçcc cc prccuIc pcrc e:Ie e cuIrc: fin: nc 8rc:i|, Iencc :icc
re:IriIc e :u:pen:c :uc ccmercic|izcçcc nc pc|: curcnIe c|gun: per|ccc:.
/ pcrIir cc in|cic cc cécccc ce º0, vcric: e:Iucc: rec|izccc: fcrnecercm
evicëncic: Lc:eccc: em experiëncic c||nicc pcrc ju:Iificcr c u:c cc
mi:cprc:Ic| ce fcrmc rcIineirc pcrc c prepcrc cervicc| e incuçcc cc
IrcLc|hc ce pcrIc em ge:Icçce: ccm feIc vivc.
/ cpre:enIcçcc cc mi:cprc:Ic| nc 8rc:i|, cIé cgcrc cpenc: ccm cc:e
e|evccc ce 200 µg pcr ccmprimicc, cificu|Ic :eu u:c em CL:IeIr|cic.
EnIreIcnIc, civer:c: e:Iucc: Iëm :icc rec|izccc: ccm c prcpc:iIc ce
prepcrc e incuçcc cc pcrIc ccm e:Ic crcgc. EmLcrc cincc ncc Ienhc
:icc cprcvccc pcrc e:Ie fim nc pc|:, c méIccc e:Ic gcnhcncc
pcpu|criccce, principc|menIe pe|c :uc eficccic e Lcixc cu:Ic, :encc jc
reccmencccc :uc uIi|izcçcc em mcnuci: cc Mini:Iéric cc Scúce {8rc:i|,
MS, 2000). /|ém ci::c, jc exi:Ie IcmLém um ccn:en:c inIernccicnc| :cLre
:uc uIi|iccce pcrc c prepcrc cervicc| e incuçcc cc IrcLc|hc ce pcrIc. Nc
mcicr pcrIe cc: e:Iucc: puL|icccc: mci: recenIemenIe, c cc:e ce
mi:cprc:Ic| Iem :icc ce 25 µg c cccc ¢ucIrc c :ei: hcrc:, ccmc jc
reccmencc c Cc|égic /mericcnc ce CL:IeIrc: e Ginecc|cgi:Ic: {/CCG).
/pe:cr cc mi:cprc:Ic| Ier :uc eficccic ccnfirmccc em muiIc: e:Iucc:, c
:egurcnçc ce u:c pcrc prepcrc e incuçcc ce pcrIc em feIc vivc cincc é
mcIivc ce c|gumc ccnIrcvér:ic. Fcce-:e cizer, ccnIucc, ¢ue c: e:Iucc:
Iem cemcn:Irccc ¢ue c recuçcc cc cc:e ccn:egue ccnIrc|cr Lem c:
efeiIc: ccver:c:, Icrncncc-c: :imi|cre: cc: cc cincprc:Icne e méIccc:
meccnicc:, :em ccmprcmeIer c: efeiIc: e:perccc:.
/::im, é pc::|ve| ccnc|uir ¢ue, em Lc:e c: evicëncic: cienI|ficc: e c||nicc:
ci:pcn|vei:, c mi:cprc:Ic| pcce :er reccmencccc pcrc prepcrc cervicc| e
incuçcc cc pcrIc ce feIc vivc, em u:c vcginc| nc cc:cgem ce 25 µg c
cccc :ei: hcrc:, nc cc:e IcIc| mcximc ce 100 µg {/CCG, 2000). Ncc
ceve cincc :er uIi|izccc em mu|here: ccm ciccIriz uIerinc pe|c: prcvcvei:
ri:cc:. Em cc:c: ce cLiIc feIc| cu em :iIucçce: em ¢ue c viIc|iccce feIc|
ncc impcrIe {mc|fcrmcçce: inccmpcI|vei: ccm c vicc), pcce-:e u:cr
cc:e: mci: e|evccc:, ce 50 c 100 µg.
Se pcr um |ccc c mi:cprc:Ic| repre:enIc umc grcnce vcnIcgem ccm
re|cçcc cc cincprc:Icne, pcr :eu Lcixc cu:Ic e e:IcLi|iccce Iérmicc e ce
e:Icccgem, Icrncncc-c icec| pcrc uIi|izcçcc em pc|:e: em
ce:envc|vimenIc e ccm pcucc: recur:c:, nc prcIicc exi:Ie cincc c
cificu|ccce ce cLIençcc cc: cc:e: reccmencccc:. Ccn:eguir cLIer 25
µg :ignificc Ier excIcmenIe um ciIcvc cc ccmprimicc
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ccmercic|izccc ce 200 µg, c ¢ue ncc é Icrefc fcci|, pci: c pcrIir cc
:eguncc pcrIiçcc hc umc Iencëncic c ce:e:IruIurcçcc cc me:mc. Fcr
cuIrc |ccc, ncc :e reccmenccm IcmLém c: mcnipu|cçce: ¨cc:eirc:¨ cc
crcgc, pe|c fc|Ic ce ccnIrc|e ce ¢uc|iccce e incerIezc :cLre c rec|
cc:cgem uIi|izccc. É prcvcve| ¢ue pcrIe cc: efeiIc: ccver:c: re|cIccc:
ccm c u:c ce:Ic: cc:e: ce mi:cprc:Ic| :ejc cevicc c i::c. /
ccmercic|izcçcc ce um cvu|c vcginc| ce 25 µg ccm cp|iccccr vcginc|
prcvcve|menIe pccerc :c|ucicncr e:Ic: cificu|ccce: cc u:c cc
mi:cprc:Ic|.
Mci: recenIemenIe, cuIrc c|IerncIivc em cvc|icçcc pcrc c prepcrc
cervicc| é c h|o|uron|dose. Ccn:i:Ie em um méIccc cpenc: pcrc prepcrc
cc cc|c, ncc prcvcccncc c cpcrecimenIc ce ccnIrcçce: uIerinc:. Fci
uIi|izccc pe|c primeirc vez nc cécccc ce :e::enIc, mc:Ircncc-:e efeIivc
em ge:IcnIe: ccm cc|c e:pc:Iicc. Fci uIi|izccc IcmLém em injeçce:
inIrccervicci: pcrc prepcrc ce cc|c em ge:IcnIe: ccm cérvice uIerinc
ce:fcvcrcve|, previcmenIe c incuçcc cc pcrIc, ccm re:u|Iccc:
cnimcccre:. É ce cp|iccLi|iccce re|cIivcmenIe fcci|, cu:Ic cce::|ve| e
ci:pcn|ve| nc mercccc nccicnc|, pccencc :er uIi|izccc em n|ve|
cmLu|cIcric| previcmenIe c inIerncçcc pcrc incuçcc cc pcrIc. Ncc é
ccnIrc-incicccc em ge:IcnIe: ccm umc ciccIriz ce ce:crec prévic.
Feccmencc-:e c u:c ce 20.000 uniccce: ce hic|urcnicc:e injeIccc:
inIrccervicc|menIe c: pc:içce: ó e 12 hcrc: {meIcce cc cc:e em cccc
pcnIc).
MÊIODOS FAkA INDbÇÃO DO FAkIO
Ccn:icercncc c cc|c jc mccurc cu fcvcrcve|, exi:Iem evicëncic:
:uficienIe: pcrc cizer ¢ue c incuçcc cc pcrIc pc::c c ccn:IiIuir um
prccecimenIc ccm mcicr prcLcLi|iccce ce ëxiIc pcrc cLIençcc ce um
pcrIc vcginc|. Fcrc e:Ie fim, c: :eguinIe: méIccc: :cc mci: uIi|izccc::
1. Desco|omento d|g|to| dos membronos omn|ot|cos
Ccrre:pcnce cc ce:cc|cmenIc cigi Ic| cc: memLrcnc: cmnicIicc: cc
cc|c uIerinc e :egmenIc infericr, inIrccuzicc ccmc méIccc ce incuçcc
ce pcrIc nc cécccc ce cin¢uenIc {Swcnn, 1º58). IecriccmenIe c
méIccc e:Iimu|c c IrcLc|hc ce pcrIc pcr prcmcver c |iLercçcc ce
prc:Icg|cncinc. EmpiriccmenIe é Lc:IcnIe uIi|izccc nc pc|:, emLcrc
exi:Icm pcucc: re|cIc: nc |iIercIurc pcrc ¢ue :e pc::c e:IcLe|ecer :uc
rec| eficiëncic e :egurcnçc ccmc méIccc pcrc incuçcc ce pcrIc. E:Ic
c::cciccc c cerIc grcu ce ce:ccnfcrIc mcIernc e :cngrcmenIc vcginc|
ci:creIc, :em mcicre: ccn:e¢üëncic:.
2. Amn|otom|o
/ rcIurc crIificic| cc: memLrcnc: cmnicIicc: é umc Iécnicc cnIigc em
CL:IeIr|cic. IecriccmenIe, prcvccc um cumenIc nc prccuçcc |ccc| ce
prc:Icg|cncinc:, fcvcrecencc c in|cic cc IrcLc|hc ce pcrIc. Fcce :er
rec|izccc ccm cmnicIcmc cu pinçc ccm exIremiccce perfurcnIe, nc
Lc|:c cc: cguc:, em n|ve| cc cpre:enIcçcc feIc|.
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Deve-:e Ier cuicccc nc rec|izcçcc pcrc eviIcr ccnc: feIci: e mcIernc:, e
cerIificcncc-:e ce ¢ue c pc|c feIc| e:Iejc cpciccc :cLre c Lccic, pcrc
eviIcr c Iemicc e grcve cccrrëncic cc prc|cp:c ce ccrccc umLi|icc|.
Seu: principci: efeiIc: ccver:c: :cc c cumenIc cc ri:cc ce infecçcc
cmnicIicc e ri:cc ce ccicenIe ce ccrccc. Seu uso |so|odo ontes do |níc|o
do trobo|ho de porto |o| obondonodo. EmLcrc ccnIinue :encc uIi|izccc
nc cce|ercçcc ce IrcLc|hc ce pcrIc jc iniciccc, ccmc jc ci:cuIicc nc
Ccp|Iu|c 5, ncc exi:Iem evicëncic: ce ¢ue c cmnicIcmic preccce :ejc
ce fcIc Lenéficc.
3. Oc|toc|no
/ cciIccinc é ccpcz ce inicicr cu cumenIcr c: ccnIrcçce: r|Imicc: c
¢uc|¢uer mcmenIc cc grcvicez, emLcrc c re:pc:Ic uIerinc :ejc mcicr
¢ucnIc mci: prcximc cc finc| cc ge:Icçcc. / infu:cc enccvenc:c ce
cciIccinc :inIéIicc Iem :icc c méIccc mci: uIi|izccc pcrc incuçcc e
ccncuçcc cc IrcLc|hc ce pcrIc, ce:ce :uc inIrccuçcc pcr Fcge em
1º43. Suc ccncenIrcçcc p|c:mcIicc recuz-:e rcpiccmenIe c: cu:Ic: cc
cciIccinc:e e :uc meic vicc é ce cercc ce cincc minuIc:. E:Ic:
ccrccIer|:Iicc: repre:enIcm umc vcnIcgem pcrc c mcnejc c||nicc,
pccencc :eu efeiIc :er :uprimicc cpc: pcucc: minuIc: cc :u:pen:cc cc
crcgc.
Exi:Iem ciferenIe: e:¢uemc: prcpc:Ic: pcrc u:c enccvenc:c. C
e:¢uemc mci: uIi|izccc, pcr :uc :egurcnçc, ceve :er c ce Lcixc
cc:cgem, e:IcLe|ecencc c cc:e inicic| ce 1-2 mU/minuIc. l::c
ccrre:pcnce cc prepcrc ce umc :c|uçcc ccm 5 Ul ce cciIccinc ci|u|cc:
em 500 m| ce :crc g|icc:ccc c 57 e c infu:cc enccvenc:c inicic| em
ve|cciccce ce 4 gcIc:/minuIc. Deve-:e ccLrcr c gcIejcmenIc c cccc 30
minuIc:, cIé ¢ue :e cLIenhc ccnIrcIi|iccce uIerinc cce¢uccc, cefinicc
pe|c pre:ençc ce cIiviccce uIerinc regu|cr.
/ cciIccinc pcce prccuzir efeiIc: ccver:c: ccmc c Ic¢ui::i:Ic|ic,
hiperIcnic e hipere:Iimu|cçcc uIerinc, pccencc prcvcccr inc|u:ive c
rcIurc uIerinc, fe|izmenIe um efeiIc exIremcmenIe rcrc :e c ccnIrc|e
c||nicc é feiIc cce¢ucccmenIe. Fcrc c feIc, c mci: fre¢üenIe efeiIc
cc|cIerc| é c :cfrimenIc feIc| cgucc, mcIivccc pe|c recuçcc cc perfu:cc
:cngü|nec nc e:pcçc inIervi|c:c pcr Ic¢ui::i:Ic|ic e/cu hiperIcnic. C:
efeiIc: cc|cIerci: :cc cc:e cepencenIe: e c ciminuiçcc nc gcIejcmenIc,
cu me:mc c pcrccc ce infu:cc, pccem ccnIrc|cr e:Ic: c|Iercçce: em
pcucc: minuIc:. /|gumc: mecicc: ccicicnci: pccem :er rec|izccc:,
ccmc ccmini:Ircçcc ce ||¢uicc: enccvenc:c:, cxigënic, mccificcçcc nc
pc:içcc mcIernc e cincc c ccmini:Ircçcc ce pe¢uenc: cc:e: ce crcgc:
LeIce:Iimu|cnIe: pcr vic venc:c cu :uLcuIcnec.
14
INDUÇÃO DO PARTO
126
4. Frostog|ond|nos
/ crcgc pccrcc pcrc e:Ic finc|iccce cIuc|menIe é c mi:cprc:Ic|,
uIi|izccc cc fcrmc ccmc jc reccmencccc nc: méIccc: ce prepcrc
cervicc|.
INDbÇÃO SEkIADA
Nc :iIucçcc ce cc|c uIerinc ce:fcvcrcve| e inciccçcc pcrc inIerrupçcc
cc ge:Icçcc, pcce-:e reccrrer c incuçcc :ericcc, ccm cu :em prepcrc
cervicc| prévic. E:Ie méIccc ccn:i:Ie nc rec|izcçcc ce :e::ce: ce
incuçcc, curcnIe 10 c 12 hcrc: cicric:, :eguicc: pcr per|ccc: ncIurnc: ce
repcu:c. /: :e::ce: :cc ccnvencicnc|menIe rec|izccc: pcr cIé Irë: cic:
ccn:ecuIivc:, uIi|izcncc infu:cc enccvenc:c ce cciIccinc,
preferenIemenIe ccm LcmLc ce infu:cc. É inci:pen:cve| e:c|crecer c
mu|her cnIe: cc prccecimenIc e ¢ue e|c e:Iejc ce cccrcc. Fe|c menc:
cIé c mcmenIc ¢ue :e inicie c fc:e cIivc cc IrcLc|hc ce pcrIc, ceve-:e
e:Iimu|cr c c|imenIcçcc e cecmLu|cçcc cc ge:IcnIe. EmLcrc ncc
exi:Icm e:Iucc: :i:IemcIizccc: ccm c méIccc, e:Ie Iem :icc
Irccicicnc|menIe uIi|izccc pcr :erviçc: ce CL:IeIr|cic nc 8rc:i|, :cLreIucc
cnIe: cc ci:pcniLi|iccce cc: ncvc: cgenIe: prepcrcccre: cc mcIuriccce
cervicc|.
/: ccnIrc-inciccçce: fcrmci: c incuçcc cc IrcLc|hc ce pcrIc em
princ|pic ncc ciferem cc¢ue|c: pcrc c pcrIc vcginc| e:pcnIcnec. /:
principci: :cc:
• :cfrimenIc feIc| ccnfirmccc:
• ciccIriz uIerinc ccrpcrc|:
• ciccIriz uIerinc :egmenIcr ce repeIiçcc:
• cpre:enIcçcc feIc| cncmc|c:
• cL:Iruçcc cc ccnc| ce pcrIc:
• :iIucçce: ce urgëncic: e
• p|ccenIc prévic.
Exi:Iem cincc c|gumc: ccnciçce: ccn:icerccc: ce mcicr ri:cc c incuçcc
cc IrcLc|hc ce pcrIc e ¢ue :e ccn:IiIuem em ccnIrc-inciccçce: re|cIivc:
c incuçcc:
• ge:Icçcc mú|Iip|c:
• pc|icrcmnic:
• ccrcicpcIic mcIernc:
• grcnce mu|Iipcriccce: e
• hiperIen:cc crIeric| grcve.
14
INDUÇÃO DO PARTO
127
/ incuçcc cc IrcLc|hc ce pcrIc é um prccecimenIc ¢ue ceverc :er mci:
u:ccc nc 8rc:i|, nc mecicc cc exi:Iëncic ce umc cemcncc pcr :erviçc:
cL:IéIricc: ce ¢uc|iccce e ce Iccc: c: fcIcre: re|ccicnccc: cc e:I|mu|c
pe|c pcrIc vcginc| e humcnizccc. Exi:Iem inúmerc: :iIucçce: cnce c
inIerrupçcc cc ge:Icçcc e:Ic incicccc pcrc pre:evcr c :cúce mcIernc
e/cu feIc|, ccm ce:Ic¢ue mci: recenIe pcrc c nece::iccce ce prcvc ce
IrcLc|hc ce pcrIc em mu|here: ccm umc ciccIriz ce ce:crec cnIericr.
EnIence-:e ¢ue em Iccc: e:Ic: :iIucçce: :ejc mcnccIcric c ccnIrc|e cc
viIc|iccce feIc|, cc ccnIrcIi|iccce uIerinc e cc: ccnciçce: c||nicc: cc
mu|her.
14
128
C: principci: cLjeIivc: cc c::i:Iëncic imecicIc :cc:
prcpcrcicncr c Iccc: c: recém-nc:cicc: ccnciçce:
cIimc: ¢ue vi:cm cuxi|ic-|c: em :uc cccpIcçcc c vicc
exIrc-uIerinc e e:Icr prepcrccc pcrc inIervir nc¢ue|e:
cc:c: ¢ue cpre:enIem ccnciçce: pcIc|cgicc: ¢ue
cc|c¢uem em ri:cc :uc vicc. Foro o oss|stënc|o oo
recém-nosc|do normo|, que const|tu| o mo|or|o dos
s|tuoçöes, nodo mo|s deve ser |e|to o|ém de se
enxugor, oquecer, ovo||or e entregor ò mõe poro um
contoto ínt|mo e precoce. Iccc: c: prccecimenIc:
hcLiIuci: ccmc pe:cr, cp|iccr c ViIcminc ‚ e Crecë e
cuIrc:, cevem :er rec|izccc: cpc: c ccnIcIc cc mce
ccm :eu fi|hc.
Em Iccc :c|c ce pcrIc ceve e:Icr pre:enIe pe|c menc:
um prcfi::icnc| ccpcciIccc c recnimcr ce mcneirc
rcpicc e efeIivc, me:mc ¢ucncc :e e:perc um FN
:cuccve|. / recnimcçcc cc recém-nc:cicc é um
prccecimenIc re|cIivcmenIe :imp|e:, mc: ¢ue re¢uer
per|cic e IreincmenIc, cevencc :er feiIc cpenc: pcrc
:iIucçce: cnce, ce fcIc, exi:Ic c nece::iccce ce Ici:
mcncLrc:, :encc ce:cccn:e|hcve| rec|izcr
prccecimenIc: ce:nece::cric: cpenc: ccmc pcrIe ce
umc rcIinc pré-e:IcLe|ecicc.
Fcrc fcrnecer e:Ic c::i:Iëncic, é funccmenIc| ci:pcr ce
um prcfi::icnc| ccpcciIccc, icec|menIe um pecicIrc,
c|ém ce enfermcgem Ireinccc pcrc cIencer c FN, em
¢ucnIiccce e n|ve| ce ccpcciIcçcc cepencenIe: cc
grcu ce ccmp|exiccce cc in:IiIuiçcc. Em Iccc c pc|:,
c Sccieccce 8rc:i|eirc ce FecicIric {S8F) e :uc:
fecerccc: Iëm cferecicc cur:c: Iecricc-prcIicc: ce
recnimcçcc cc recém-nc:cicc. C: grupc: e
in:IiIuiçce: inIere::ccc: ne:Ie Iipc ce IreincmenIc
cevem enIrcr em ccnIcIc ccm c: repre:enIcçce:
|ccci: cu regicnci: cc S8F pcrc :c|iciIcçcc.
OkGANIIAÇÃO DO SEkVIÇO
/ recepçcc cc FN ceve Ier ncrmc: e:IcLe|ecicc: ccm
c: ciferenIe: cIriLuiçce: ccn:IiIu|cc: pcrc c e¢uipe
prcfi::icnc|, cLjeIivcncc pre:Icr umc c::i:Iëncic ce
¢uc|iccce. Fcrc IcnIc, c e¢uipe
15 ASSISTÊNCIA IMEDIATA AO RECÉM-NASCIDO
ASSISTÊNCIA IMEDIATA AO RECÉM-NASCIDO
129
ceverc rec|izcr c: :eguinIe: prccecimenIc::
• preencher c fichc cc FN ccm cccc: cc hi:Icric fcmi|icr e
mcIernc, pregre::c: e cIuci:, e cc IrcLc|hc ce pcrIc:
• ci:pcr :cLre c me:c ce cIencimenIc cc FN c :eguinIe mcIeric|:
• x2% (#*$% $' %(<64%+,# )4%./'%- <%4% 1%$% gqB
• e#4# ;6(6#-J>61#B
• i/3%(B
• t%0' '()'46-60%$%? %*'- $' @#44%17% 'j#/ $' <-8()61#
T$6(<#(6)63# '(<'1Y;61#U ' 2%)'46%- <%4% -6>%$/4% $' 1#4$,#
T<6*+%( ' )'(#/4%UB '
• s%*)'4 $6(<#*Y3'-? <%4% ./%-./'4 '2'4>9*16%? # 2%)'46%- '
2'$61%+,# <%4% 4'%*62%+,#B
• receLer c FN, :ecc-|c e cc|cccr em ccmpc e:Iéri| e c¢uecicc
:cL c cc|cr rccicnIe:
• |evcr c FN c mce:
• icenIificcr c FN ccm umc Lrcçcceirc, ccm c ncme cc mce, nc
cnIeLrcçc e Icrncze|c:
• em pcrIc: mú|Iip|c:, c crcem ce nc:cimenIc ceverc :er
e:pecificccc nc: pu|:eirc: cIrcvé: ce númerc: {1, 2, 3, 4, eIc.), cpc:
c ncme cc mce:
• c:pircr Lccc e cepci: ncrinc::
• pc::cr c :cncc nc:cgc:Iricc pcrc exc|uir cIre:ic ce cccnc: e
e:cfcgc:
• verificcr c viIc|iccce cc FN cIcvé: cc |ncice ce /pgcr nc 1 º e 5º
minuIc:, e, cc| em cicnIe, ce 5 em 5 minuIc:, cIé ¢ue c /pgcr :ejc
mcicr ¢ue 7:
• |c¢uecr c ccrccc c umc ci:Icncic ce 2cm cc cne| umLi|icc|,
u:cncc c|ccc| eI||icc c 707. Verificcr c pre:ençc ce umc veic e
cuc: crIéric::
• pingcr niIrcIc ce prcIc c 17 {prepcrcr cicricmenIe em frc:cc
e:curc), umc gcIc em cccc c|hc:
• |cvcr c e:Icmcgc, :e c ||¢uicc cmnicIicc fcr meccnic|,
:cnguinc|enIc cu puru|enIc, ccm cguc ce:Ii|ccc cu :crc fi:ic|cgicc:
• cc|cccr c FN pcrc mcmcr |cgc ¢ue finc|izcr c: mecicc: ce
cIencimenIc cpc: c nc:cimenIc:
• Icmcr pe:c, e:IcIurc, per|meIrc cefc|icc.
• pre:crever ViIcminc ‚, 1 mg lM:
• regi:Ircr, nc fichc cc FN, :uc impre::cc p|cnIcr e cigiIc| cc
pc|egcr cireiIc e cc pc|egcr cireiIc cc mce:
• excmincr c p|ccenIc:
• cc|her cmc:Irc: ce :cngue ce ccrccc pcrc Iipcgem :cngü|nec e
:crc|cgic:: e
• cc|her :cngue cc mce pcrc Iipcgem :cngü|nec e recçcc
:crc|cgicc pcrc :|fi|i:, ¢ucncc incicccc.
Índice de Apgar
15
ASSISTÊNCIA IMEDIATA AO RECÉM-NASCIDO
130
/pc: c c::i:Iëncic imecicIc cc recém-nc:cicc, ¢ucncc ncc fci pc::|ve|
cnIe: cc nc:cimenIc, ceve-:e rec|izcr cncmne:e ceIc|hccc cLcrccncc
c icenIificcçcc, Iccc: c: cnIececenIe: fcmi|icre: e mcIernc:, cc
ge:Icçcc, cc IrcLc|hc ce pcrIc e pcrIc. C excme cc FN ceve :er
minucic:c, feiIc em |ccc| e ccnciçce: :cIi:fcIcric:, inc|uincc Iccc: c:
crgcc: e :i:Iemc: pc::|vei: ce :erem cvc|iccc: c|iniccmenIe.
kEANIMAÇÃO NEONAIAL NA SALA DE FAkIO
/ cvc|icçcc cc FN ceve inicicr cnIe: me:mc ce Ierminccc c
nc:cimenIc. Nc pre:ençc ce meccnic, c cL:IeIrc ceve rec|izcr c
c:pircçcc cc Lccc, ncriz e fcringe, cnIe: cc ce:prencimenIc cc: cmLrc:
cc recém-nc:cicc. C pecicIrc ceve cvc|icr c viIc|iccce cc cricnçc: :e
vigcrc:c, c cvc|icçcc cc FN ceve :er feiIc cIrcvé: cc re:pircçcc,
fre¢üëncic ccrc|ccc e ccr. C |ncice ce /pgcr nõo ceve :er u:ccc pcrc
cvc|icr c nece::iccce ce recnimcçcc, mc: pcrc cvc|icr c: efeiIc: cc
me:mc.
/pc: c nc:cimenIc em Iccc: c: recém-nc:cicc: ceprimicc: ¢ue
cpre:enIcrem ||¢uicc cmnicIicc meccnic| cu nc¢ue|e: ccm meccnic
e:pe::c cu pcrIicu|ccc, cci: pc::c: cevem :er cccc:, c::im ¢ue c
cricnçc fcr cc|ccccc :cL c fcnIe ce cc|cr rccicnIe e cincc cnIe: ce
:ecc-|c:
• c meccnic cc hipcfcringe ceve :er remcvicc cIrcvé: ce c:pircçcc
:cL vi:uc|izcçcc cireIc: e
• c Irc¢uéic ceve :er inIuLccc e c meccnic c:pirccc cc vic infericr
:e hcuver: cpnéic: cepre::cc re:pircIcric: fre¢üëncic ccrc|ccc €
100 LcIimenIc: pcr minuIc e hipcIcmic.
/ ccnIinucçcc cc: cuicccc: pre:Iccc: vci cepencer cc: ccnciçce: ce
viIc|iccce ce:Ie: recém-nc:cicc:.
Iccc FN Iem c cireiIc ce receLer, :e nece::cric, umc recnimcçcc ccm
um c|Ic n|ve| ce ccmpeIëncic. C mcIeric| cprcpriccc ceve e:Icr
ci:pcn|ve| nc :c|c ce pcrIc, em Iccc: c: nc:cimenIc:, Lem ccmc c:
prcfi::icnci: ce :cúce cevem e:Icr cpIc: c recnimcr c recém-nc:cicc e
ccpcciIccc: c IrcLc|hcr ce mcneirc inIegrccc, em e¢uipe.
A8C DA kEANIMAÇÃO
A - Monter os v|os oéreos pérv|os
− Fc:icicncr c ccLeçc e c pe:ccçc cc FN, mcnIencc-c em |igeirc
exIen:cc:
− /:pircr Lccc e ncrinc:. Irc¢uéic, :e c ||¢uicc fcr meccnic|: e
− lnIuLcçcc Irc¢uec|, :e nece::cric.
8 - In|c|or o resp|roçõo
− Ccm e:I|mu|c IcIi| cu, :e nece::cric, venIi|cçcc ccm pre::cc pc:iIivc
{VFF) cIrcvé: ce Lc|cc cu cpcre|hc ce re::u:ciIcçcc, uIi|izcncc
mc:ccrc cu IuLc enccIrc¢uec|.
C - Estobe|ecer e monter o c|rcu|oçõo
− Mc::cgem ccrc|ccc: e
− Meciccçce:.
15
ASSISTÊNCIA IMEDIATA AO RECÉM-NASCIDO
131
1. OXIGÈNIO INALAIÓkIO
Deve-:e u:cr ¢ucncc c FN cpre:enIc re:pircçcc efeIivc e FC 100 Lpm,
mc: ccm cicnc:e cenIrc|. C cxigënic ceve :er umicificccc e c¢uecicc:
ncc :encc pc::|ve|, uIi|izcr c C2 fric e :ecc pcr per|ccc |imiIccc. Ncc
uIi|izcr cxigënic :cL pre::cc ccm ccIeIer nc: ncrinc:.
Iécnicc ce ccmini:Ircçcc:
• Irc¢uéic cu ccIeIer ce C2. Cucncc u:cr c Irc¢uéic, c me:mc
ceve e:Icr ci:IcnIe cc: ncrinc: 1 cm, ccm um f|uxc ce 5 |/min ce C2
pcrc fcrnecer 807 ce cxigënic. / reIirccc ceve :er grccuc|: e
• c|IerncIivcmenIe, mc:ccrc ce 02 {nuncc c mc:ccrc ccnecIccc
cc Lc|cc).
2. VENIILAÇÃO COM FkESSÃO FOSIIIVA
/: principci: inciccçce: pcrc VFF :cc, cpnéic, gc:ping e re:pircçcc
e:pcnIcnec, mc: ccm FC € 100 Lpm:
Iécnicc:
• pcce :er feiIc cIrcvé: ce Lc|cc cuIc-inf|cve| {/mLu) ccnecIccc
c um re:ervcIcric ce cxigënic ¢ue permiIc umc ccncenIrcçcc ce
cxigënic enIre º0 c 1007, ¢ue Ienhc umc vc|vu|c ce e:ccpe
cju:Iccc enIre 35 e 40 cm H2C e um mcncmeIrc. Cu cIrcvé: cc
cpcre|hc ce re::u:ciIcçcc. C Lc|cc cuIc-inf|cve| ceve e:Icr |igccc
c umc fcnIe ce cxigënic c 5 |/min, en¢ucnIc c cpcre|hc c 7 |/min:
• c mc:ccrc fccic| ceve e:Icr Lem cju:Iccc, ccLrincc c ncriz, c
Lccc e c ¢ueixc: uIi|izcr fre¢üëncic enIre 40 e ó0 mcv./min:
• c pre::cc inicic| ceve ficcr enIre 30-40 cm H2C, em :eguicc enIre
15-20 cm H2C pcrc c: pu|mce: ncrmci: e 20-40 cm H2C pcrc c:
pu|mce: ccm ccmp|ccëncic ciminu|cc:
• cL:ervcr c expcn:iLi|iccce Icrccicc {e|evcçcc ce 0,5 c 1 cm):
• cpc: 15 c 30 :eguncc:, recvc|icr c re:pircçcc, c FC e c ccr.
3. MASSAGEM CAkDÍACA
Iem inciccçcc ce :er rec|izccc ¢ucncc c FC cc recém-nc:cicc e:Iiver
cLcixc ce ó0 Lpm.
Iécnicc:
• cc|cccr c: cecc: inciccccr e mécic perpencicu|crmenIe cc
exIernc, nc Ierçc infericr, ccimc cc cpëncice xifcice, cu cc|cccr c:
cecc: pc|egcre: ce cmLc: c: mcc: :cLre c Ierçc infericr cc
e:Iernc {ccmc mc:Ircm c: figurc:) e pre::icncr 1-2 cm numc
fre¢üëncic ce 120 mcv./min:
• curcnIe c mc::cgem ccrc|ccc ceve-:e ccnIinucr venIi|cncc c
FN ccm pre::cc pc:iIivc e cxigënic c 1007, ccm mc:ccrc cu
inIuLcçcc:
15
ASSISTÊNCIA IMEDIATA AO RECÉM-NASCIDO
132
• c venIi|cçcc e c mc::cgem ccrc|ccc cevem :er feiIc:, nc
re|cçcc ce 3:1, i:Ic é, Irë: mcvimenIc: ce mc::cgem pcrc um ce
venIi|cçcc:
• cpc: 15-30 :eguncc:, c FN ceve :er recvc|iccc. Se c FC fcr „ 80 e
e:Iiver cumenIcncc, :u:pencer c mc::cgem: e
• cpc: 30 :eguncc: ce VFF • C2 c 1007 • mc::cgem ccrc|ccc, :e
c FC ccnIinucr € ó0 Lpm, inicicr ccrenc|inc {1:10.000) EI/EV nc cc:e
ce 0,01 c 0,03 mg/kg.
Intuboçõo troqueo|
/: principci: inciccçce: pcrc c inIuLcçcc Irc¢uec| :cc:
• :u:peiIc ce hérnic cicfrcgmcIicc:
• cu:ëncic ce re:pc:Ic c venIi|cçcc ccm Lc|cc cu cpcre|hc ce
re::u:ciIcçcc e mc:ccrc ccm FiC2 ce 1007:
• venIi|cçcc prc|cngccc ccm Lc|cc cu cpcre|hc ce re::u:ciIcçcc
e mc:ccrc ccm FiC2 ce 1007: e
• pcrc c:pircçcc Irc¢uec| :cL vi:uc|izcçcc cireIc, cc:c c ||¢uicc
meccnic| :ejc e:pe::c, ¢ucncc c cricnçc cpre:enIcr cpnéic,
cepre::cc re:pircIcric, fre¢üëncic ccrc|ccc € 100 Lpm e hipcIcnic.
Iécnicc:
• prepcrc cc ccnu|c Irc¢uec|:
• c cicmeIrc ceve :er unifcrme e ce cccrcc ccm c pe:c cc FN:
• ccrIcr c ccnu|c em 13 cm pcrc ciminuir c e:pcçc mcrIc e c
re:i:Iëncic:
• ccnecIcr c inIermecicric cc ccnu|c cnIe: cc inIuLcçcc:
• c fic-guic é cpcicnc|, cevencc :uc pcnIc ficcr c 0,5 cm ccimc
cc pcnIc cc ccnu|c:
• cpc: c inIrccuçcc cc ccnu|c nc inIericr cc Irc¢uéic, c ci:Icncic
cIé c |cLic :upericr é pré-ceIerminccc:
• cferecer cxigënic inc|cIcric cIrcvé: ce ccIeIer pcrc minimizcr c
hipcxemic, curcnIe c prccecimenIc:
• inIerrcmper c prccecimenIc cpc: 20 :eguncc: ce IenIcIivc: e
venIi|cr ccm Lc|cc cu cpcre|hc ce re::uciIcçcc cIé me|hcrcr c
cxigencçcc:
15
ASSISTÊNCIA IMEDIATA AO RECÉM NASCIDO
133
• ccnfirmcçcc cc pc:içcc cc ccnu|c:
• cu:cu|Icr c Icrcx Li|cIerc|menIe e c e:Icmcgc:
• cL:ervcr c expcn:iLi|iccce cc ccixc Icrccicc:
• fczer rcic: X ce Icrcx e mcnIer c pcnIc cc ccnu|c enIre I2 e I3,
¢ucncc c FN ncc pucer :er exIuLccc: e
• cpc: c inIuLcçcc, ccrIcr ccnu|c :empre ¢ue c ccmprimenIc enIre
c finc| cc ccnu|c e c Lccc excece c 4 cm.
Medicação necessária para a reanimação
Fonte: ET:endotraqueal
Moter|o| necessór|o poro reon|moçõo
Iccc c mcIeric| nece::cric pcrc c cIencimenIc cc FN ceve e:Icr
ci:pcn|ve|, :er Ie:Iccc e prepcrccc cnIe: cc nc:cimenIc:
• Me:c ce recnimcçcc ccm fcnIe ce cc|cr irrccicnIe, c:pircccr c
vccuc ccm mcncmeIrc e fcnIe ce cxigënic ccm f|uxcmeIrc
• Scncc: ce c:pircçcc Irc¢uec| nº 8 e 10
• Scncc: ce c:pircçcc gc:Iricc nº ó e 8
• 8c|cc cuIc-inf|cve| ccm re:ervcIcric ce cxigënic {pcrc :e cIingir
umc FiC2 ce º0-1007) e ccpcciccce mcximc ce 750 m| cu cpcre|hc
ce re::u:ciIcçcc mcnuc|
• Mc:ccrc: ¢ue cuLrcm ccnvenienIemenIe ncriz, Lccc e ¢ueixc cc
FN
• Lcringc:ccpic ccm |cminc reIc nº 0 e 1
• Ccnu|c: enccIrc¢ueci: ce cicmeIrc unifcrme nº 2,5 - 3,0 - 3,5 e 4,0
• Fic-guic {cpcicnc|)
• E:pcrccrcpc pcrc fixcr c ccnu|c
• Fi|hc: e |cmpccc: ce re:ervc
• E:IeIc:ccpic necncIc|
• Fe|cgic ¢ue mcr¢ue c: :eguncc: cu um crcncmeIrc
• McIeric| pcrc crencgem Icrccicc
• McIeric| pcrc ccIeIeri:mc umLi|icc|
15
ASSISTÊNCIA IMEDIATA AO RECÉM-NASCIDO
134
• Seringc: {20, 10, 5 e 1 m|)
• IuLc: ce cc|eIc ce :cngue
• Meciccçce::
• ccrenc|inc {1:1.000)
• LiccrLcncIc ce :ccic {2,5 cu 4,27)
• expcn:cre: ce vc|ume {c|Luminc c 57, :crc fi:ic|cgicc c
0,º7 cu Finger-|ccIcIc)
• c|cricrcIc ce Nc|cxcne
• ccpcminc
• :c|uçce: ce g|icc:e c 57 e 107
15
135
Scc inúmerc: c: Lenef|cic: ¢ue c prcIicc cc
c|eiIcmenIc mcIernc cferece, IcnIc pcrc c
cre:cimenIc e ce:envc|vimenIc ce |ccIenIe:, ccmc
pcrc c mce, cricnçc e fcm||ic, cc pcnIc ce vi:Ic
Lic|cgicc e p:icc::ccic|.
/Iuc|menIe, c c|eiIcmenIc mcIernc exc|u:ivc é
reccmencccc pcr um per|ccc ce :ei: me:e:.
Fc:IericrmenIe, c cricnçc ceve receLer c|imenIc:
ccmp|emenIcre:, e:Iencencc c cmcmenIcçcc pcr
pe|c menc: cci: cnc:, ce:ce ¢ue mce e cricnçc c
ce:ejem. C ce:ejc mcIernc ce cmcmenIcr cu ncc
ceve :er ccmpreencicc e re:peiIccc. /pe:cr cc:
Lenef|cic: cc c|eiIcmenIc, ceve-:e cceiIcr c e:cc|hc,
infcrmccc e ccn:cienIe, cc mce pe|c ncc
cmcmenIcçcc. C cireiIc cc mu|her cmcmenIcr ceve
:er cpciccc, e:pecic|menIe ¢ucncc e|c Iem um
IrcLc|hc remunerccc e preci:c ccnhecer c |egi:|cçcc
IrcLc|hi:Ic ¢ue prcIege c mcIerniccce.
Vontogens do o|e|tomento moterno
Fcrc c mu|her:
• ;%16-6)% # '()%@'-'162'*)# $# 3Y*1/-# %;')63#
2,'I;6-7#B
• <4'36*' %( 1#2<-61%+A'( 7'2#448>61%( *# pc:-
<%4)# ' ;%3#4'1' % 4'>4'((,# /)'46*% %# ('/
)%2%*7# *#42%-B
• 1#*)46@/6 <%4% # 4')#4*# 2%6( 48<6$# %# <'(# <4:I
>'()%16#*%-B
• : /2 2:)#$# *%)/4%- $' <-%*'c%2'*)# ;%26-6%4?
'*)4')%*)# (#2'*)' %*)'( $' ('6( 2'('(? ./%*$# %
146%*+% '()8 '2 %-'6)%2'*)# 2%)'4*# '51-/(63#? '2
-634' $'2%*$%? 6*1-/(63' $/4%*)' % *#6)'? ' ./' %
2,' *,# )'*7% %6*$% 2'*()4/%$# TiSs I -%1)%+,#
' %2'*#44:6% 1#2# 2:)#$#UB
• <#$' 4'$/064 # 46(1# $' 1f*1'4 $' #3846# '
2%2%B '
• <#$' <4'3'*64 % #()'#<#4#('E
16 ALEITAMENTO MATERNO
ALEITAMENTO MATERNO
136
Fcrc c cricnçc:
• : # %-62'*)# 1#2<-')# <%4% # -%1)'*)' 2'*#4 $' ('6( 2'('(? )%*)#
*# %(<'1)# */)4616#*%-? 1#2# $6>'()63#B
• ;%16-6)% % '-626*%+,# $' 2'1v*6# ' $626*/6 # 46(1# $' 61)'4Y16%B
• <4#)'>' 1#*)4% 6*;'1+A'( T'(<'16%-2'*)' $6%44:6%( ' <*'/2#*6%(U?
<'-% %/(9*16% $# 46(1# $' 1#*)%26*%+,# ' <'-% <4'('*+% $'
%*)61#4<#( ' $' ;%)#4'( %*)6I6*;'116#(#(B
• %/2'*)% # -%+# %;')63# 2,'I;6-7#? <4#2#3'*$# 2%6( ('>/4%*+% %#
@'@9E
• 1#-%@#4% ';')63%2'*)' <%4% $626*/64 % )%5% $' $'(*/)46+,#
<4#)'61#I1%-J461% '? 1#*('.L'*)'2'*)'? <%4% % $626*/6+,# $#( Y *$61'(
$' 2#4)%-6$%$' 6*;%*)6-B
• $626*/6 % <4#@%@6-6$%$' $# $'('*1%$'%2'*)# $' <4#1'((#(
%-:4>61#(? <'-# 4')%4$# $% 6*)4#$/+,# $' <4#)'Y*%( 7')'4J-#>%(
'56()'*)'( *# -'6)' $' 3%1%B '
• 2'-7#4 4'(<#()% Z( 3%16*%+A'( ' 1%<%16$%$' $' 1#2@%)'4
$#'*+%( 2%6( 4%<6$%2'*)'E
Fcrc c fcm||ic e c :ccieccce:
• # -'6)' 2%)'4*# *,# 1/()% *%$%B
• : -62<# ' *,# 1#*):2 2614J@6#(B
• c8 3'2 <4#*)# ' '()8 *% )'2<'4%)/4% 1'4)%B
• $626*/6 #( 1/()#( $' 6*)'4*%+A'( <#4 <4#@-'2%( >%()4#6*)'()6*%6(?
4'(<64%)J46#( ' #/)4%( $#'*+%(B
• 4'<4'('*)% /2% '1#*#26% ./%*)# %# /(# $' >8( $' 1#06*7%?
<#4./' $6(<'*(% # %./'162'*)# ' <4'<%4#B '
• $626*/6 # %@('*)'Y(2# $#( <%6( %# )4%@%-7#? /2% 3'0 ./' %
146%*+% (' 2%*):2 2%6( (%/$83'-E
Fodröes de o|e|tomento moterno:
VE S-'6)%2'*)# 2%)'4*# '51-/(63#= ./%*$# % 146%*+% (J 4'1'@' -'6)'
2%)'4*#? ('c% $64')%2'*)' $# ('6# #/ #4$'*7%$# $% <4J<46% 2,'? #/
%6*$% -'6)' 7/2%*# $' @%*1# $' -'6)'? ' *,# 4'1'@' *'*7/2 #/)4#
-Y./6$# #/ %-62'*)# (J-6$#E
PE S-'6)%2'*)# 2%)'4*# <4'$#26*%*)'= ./%*$# % <46*16<%- ;#*)' $'
%-62'*)# $% 146%*+% : # -'6)' 2%)'4*#? ('*$# <'426)6$# %<'*%(
4'1'@'4 8>/%? 178? 2'$61%2'*)#( #/ (#4# $' 4'6$4%)%+,# #4%-E
NE S-'6)%2'*)# 2%)'4*# )#)%-= : /2% 2'$6$% #/ Y*$61' ./' 4';-')' #
<'4Y#$# $' %-'6)%2'*)# 2%)'4*# '51-/(63# ' <4'$#26*%*)'E
WE S-'6)%2'*)# 2%)'4*# <%416%-= ./%*$# % 146%*+%? %-:2 $%
%2%2'*)%+,# %# <'6)#? 4'1'@'? %*)'( $% :<#1% %$'./%$%? #/)4#(
%-62'*)#( T-'6)'? 1'4'%6(? ;4/)%(? -'>/2'(? ')1EU '2 %->/2% 4';'6+,#E
Compos|çõo e corocteríst|cos do |e|te humono
• C |eiIe mcIernc é c c|imenIc icec| pcrc c |ccIenIe. E|e ccnIém
Iccc: c: nuIrienIe:, inc|u:ive cguc, ¢ue c cricnçc preci:c nc: :ei:
primeirc: me:e: ce vicc. Devicc c: :uc: ccrccIer|:Iicc: f|:icc-
¢u|micc:, é fcci|menIe cL:crvicc e cigericc.
• C |eiIe mcIernc ccnIém cnIiccrpc: {e:pecic|menIe c lg/
:ecreIcric), cé|u|c: {mccrcfcgc:, pc|imcrfcnuc|ecre: e |infcciIc:) e
cuIrc: :uL:Icncic: {fcIcr L|ficc e |ccIcferrinc) ¢ue prcIegem c
crgcni:mc cc LeLë ccnIrc infecçce:.
• C |eiIe mcIernc ccnIém IcmLém fcIcre: ce cre:cimenIc
16
ALEITAMENTO MATERNO
137
¢ue prepcrcm c inIe:Iinc imcIurc cc cricnçc pcrc cigerir e cL:crvë-
|c, eviIcncc c::im ¢ue prcIe|nc: ncc cigericc: :ejcm cL:crvicc:,
|e:cncc c inIe:Iinc e ccu:cncc c|ergic:.
• C |eiIe humcnc :cfre c|Iercçce: nc :uc ccmpc:içcc, ce cccrcc
ccm c hcrc cc cic, c: cic: cpc: c pcrIc e curcnIe umc me:mc
mcmccc.
• C |eiIe IcmLém :cfre c|Iercçce: em :uc ccmpc:içcc, em
re|cçcc cc in|cic e finc| cc mcmccc. Nc inIervc|c cc: mcmccc:, é
prccuzicc c |eiIe chcmccc cnIericr, ¢ue ccrre:pcnce c um Ierçc
cc vc|ume IcIc| prccuzicc e, curcnIe c :ucçcc, é :ecreIccc c |eiIe
pc:Iericr, ¢ue ccrre:pcnce c cci: Ierçc: ce::e vc|ume.
• C |eiIe pc:Iericr cifere cc cnIericr pcr :er mci: ricc em gcrcurc:.
C ccnhecimenIc ce:Ie meccni:mc mc:Irc c impcrIcncic cc
:ucçcc nc prcce::c cc prccuçcc cc |eiIe. C |eiIe cc ccmeçc
¨mcIc c :ece¨ e c |eiIe cc fim ¨engcrcc¨.
A produçõo de |e|te
/ prccuçcc ce |eiIe :e cc pcr um e:I|mu|c neurc-encccrinc e Irë: crgcc:
:cc impcrIcnIe: ne:Ie prcce::c: p|ccenIc, hipcfi:e e mcmc.
/ p|ccenIc é re:pcn:cve| pe|c prccuçcc cc: e:Iercice: p|ccenIcric:
{e:Ircgenc: e prcge:Iercnc) ¢ue, curcnIe c grcvicez, prepcrcm c mcmc
pcrc c |ccIcçcc, e:Iimu|cncc c cepc:içcc ce gcrcurc:, c cre:cimenIc
cc: cucIc: e c|véc|c:. Ccm c :c|cc cc p|ccenIc cpc: c pcrIc, c: n|vei:
ce e:Iercice: ccem, ccncuzincc c hipcfi:e cnIericr c |iLercr prc|ccIinc,
hcrmcnic ¢ue vci e:Iimu|cr c: c|véc|c: mcmcric: c prccuzir |eiIe.
DurcnIe c grcvicez, c: c|Ic: ccncenIrcçce: ce:Ie: hcrmcnic: e:Iercice:,
pre:enIe: nc p|c:mc, iniLem c :ecreçcc cc |eiIe, cccrrencc :cmenIe c
:|nIe:e cc pré-cc|c:Irc ¢ue é umc :uL:Icncic ¢ue, nc :uc ccmpc:içcc,
ccnIém grcnce ¢ucnIiccce ce imuncg|cLu|inc: e |ccIcferrinc.
/ mecicc ¢ue c: n|vei: p|c:mcIicc: ce e:Ircgenc e prcge:Iercnc ccem,
cercc ce 3 c 5 veze: nc: primeirc: cic: cpc: c pcrIc, c prccuçcc ce |eiIe
Iem in|cic. C per|ccc em ¢ue :e inicic c prccuçcc ce |eiIe é chcmccc
ce cpcjccurc cu ¨ce:cicc¨. /ccnIece em Icrnc ce 48 c 72 hcrc: cpc: c
pcrIc. /: mcmc: cumenIcm ce Icmcnhc e IempercIurc, Icrncm-:e
cc|crc:c: e e:Ie fencmenc curc, em mécic, Irë: c ¢ucIrc cic:. /
cpcjccurc mcrcc c muccnçc cc ccnIrc|e encccrinc pcrc c cuIccrinc
cc |ccIcçcc. C vc|ume ce |eiIe prccuzicc Ience c cumenIcr
grcccIivcmenIe. /::im, nc 2º cic, e:Ic pcr vc|Ic ce 50 m|/cic. Nc 4º cic,
cc reccr ce 550 m|/cic. Jc cc: Irë: me:e:, é ce cercc ce 850m|/cic. E:Ie
ccnhecimenIc é impcrIcnIe pcrc c infcrmcçcc cc puérperc ce ¢ue c
pe¢uenc ¢ucnIiccce ce |eiIe prccuzicc nc: primeirc: cic: é ncrmc|.
C: n|vei: p|c:mcIicc: ce prc|ccIinc e|evcm-:e em re:pc:Ic c :ucçcc cc
FN e e:Icc cireIcmenIe re|ccicnccc: c fre¢üëncic, curcçcc e
inIen:iccce cc :ucçcc. / :ucçcc cc mcmi|c prccuz umc e|evcçcc ce
prc|ccIinc Lc:c|, cpre:enIcncc um picc ce prccuçcc enIre c: 20
16
ALEITAMENTO MATERNO
138
c 40 minuIc: cpc: c in|cic cc e:Iimu|cçcc. ScLe-:e ¢ue 30 minuIc: ce
:ucçcc pccem ceIermincr n|vei: e|evccc: ce prc|ccIinc pcr cercc ce 3
c 4 hcrc:. Ccmc c prc|ccIinc é c hcrmcnic funccmenIc| pcrc c
gc|ccIcpcie:e, permiIir c :ucçcc cc mcmi|c pe|c cricnçc c |ivre
cemcncc é c e|emenIc Lc:icc pcrc c mcnuIençcc cc cmcmenIcçcc.
CucnIc mci: rcpicc, cpc: c nc:cimenIc, e mci: fre¢üenIemenIe :e
cc|c¢ue c recém-nc:cicc cc :eic, mcicr :erc c prccuçcc ce |eiIe e
mencre: c: :inIcmc: cevicc: c cpcjccurc.
A ejeçõo do |e|te
C |eiIe ccumu|ccc nc: c|véc|c: ncc f|ui e:pcnIcnecmenIe pcrc c:
cucIc: e :eic: |ccI|ferc:. / cciIccinc, |iLerccc pe|c hipcfi:e pc:Iericr,
é c hcrmcnic ¢ue cIuc :cLre c: cé|u|c: micepiIe|ici:, ceIermincncc :uc
ccnIrcçcc e ccn:e¢üenIe expu|:cc ce |eiIe pcrc c: cucIc:.
Nc: primeirc: cic: cpc: c pcrIc, c ref|exc ce ejeçcc re:pcnce ncc
:cmenIe c e:I|mu|c: IccIei:, mc: IcmLém c|fcIcric:, vi:uci: cu cuciIivc:.
Fcce re:pcncer cincc cevicc c prcximiccce f|:icc cu pen:cmenIc nc
fi|hc. C ref|exc ce ce:cicc cc |eiIe pcce :er iniLicc pe|c e:Ire::e.
/ |iLercçcc ce cciIccinc, ceccrrenIe cc :ucçcc cc mcmi|c pe|c
cricnçc, ceIerminc, IcmLém, ccnIrcçcc cc: fiLrc: mu:cu|cre: uIerinc:,
fcvcrecencc c ccnIrcçcc cc úIerc curcnIe c cmcmenIcçcc.
Ccm re|cçcc c prccuçcc ce |eiIe, cIuc|menIe Iem-:e evicëncic: ce ¢ue
c ¢ue rec|menIe ccnIrc|c c prccuçcc ce |eiIe é c e:vczicmenIc cc
g|cncu|c pe|c :ucçcc.
/c :e cnc|i:cr c ccmpc:içcc cc |eiIe, ci:Iinguem-:e 4 Iipc: ce |eiIe, ¢ue
:e cpre:enIcm ccm ccrccIer|:Iicc: Lic¢u|micc: ciferenIe: e cce¢uccc:
c cccc ceIerminccc per|ccc cc vicc cc cricnçc:
1. Co|ostro
DurcnIe c ge:Icçcc, c g|cncu|c mcmcric prccuz umc :uL:Icncic
cencminccc ce pré-cc|c:Irc, ccumu|ccc nc |úmen cc: c|véc|c:, e ¢ue
Iem nc :uc ccmpc:içcc, principc|menIe, ex:uccIc cc p|c:mc, cé|u|c:,
imuncg|cLu|inc:, |ccIcferrinc, :crcc|Luminc, :ccic, c|crc e umc pe¢uenc
¢ucnIiccce ce |ccIc:e.
Nc: primeirc: cic: cpc: c pcrIc, é prccuzicc c cc|c:Irc, e :uc prccuçcc
permcnece cincc pcr cercc ce 7 cic:. /pre:enIc-:e ccmc um ||¢uicc
e:pe::c, ce cc|crcçcc cmcre|ccc e c|Ic cen:iccce. C vc|ume, nc in|cic,
vcric ce 2 c 20 m| em cccc mcmccc, IcIc|izcncc 50 c 100m|/cic, :encc
:uficienIe pcrc :cIi:fczer c: nece::iccce: cc |ccIenIe.
Nc cc|c:Irc, cL:ervc-:e c|Ic ccncenIrcçcc ce |g/ e ce |ccIcferrinc ¢ue,
junIcmenIe ccm c grcnce ¢ucnIiccce ce |infcciIc: e mccrcfcgc:,
ccnferem umc cçcc ce prcIeçcc cc recém-nc:cicc. Iem cçcc |cxcIivc,
fcci|iIcncc c e|imincçcc ce meccnic, cuxi|icncc c prevençcc cc
icIer|cic.
16
ALEITAMENTO MATERNO
139
2. Le|te de trons|çõo
FeceLe e:Ic cencmincçcc c |eiIe humcnc prccuzicc enIre c 7º e 15º cic
cpc: c pcrIc. C vc|ume ce |eiIe e c ccmpc:içcc vcricm nc ceccrrer cc:
cic:, permcnecencc ccm vc|ume mécic ce 500m|/cic.
3. Le|te moduro
É c |eiIe prccuzicc c pcrIir cc 15º cic, ccmc ccnIinucçcc cc |eiIe ce
Ircn:içcc. É um ||¢uicc Lrcncc e cpccc, ccm pcucc cccr, :cLcr
|igeircmenIe ccccicccc. Seu vc|ume mécic é ce 700 c º00 m|/cic,
curcnIe c: primeirc: :ei: me:e:. / pcrIir cc :eguncc :eme:Ire, c
¢ucnIiccce mécic ce prccuçcc cicric é ce ó00m|. C |eiIe mcIernc Iem
887 ce cguc e pc::ui umc c:mc|criccce :eme|hcnIe c cc p|c:mc
:cngü|nec. Iem nc :uc ccmpc:içcc Lc:icc, c|ém cc cguc, prcIe|nc:,
ccrLchicrcIc:, |ip|cec:, minerci: e viIcminc:.
4. Le|te de pré-termo
C |eiIe ce mce: ce cricnçc: premcIurc: cifere cc |eiIe ce mce: ce
cricnçc: ce Iermc. /: ciferençc: Lc:icc: :cc:
• mcicr Iecr ce prcIe|nc, |ip|cec: e cc|cric:, cIencencc c mcicr
nece::iccce ce cre:cimenIc cc pré-Iermc:
• mencr Iecr ce |ccIc:e, vi:Ic ¢ue c pré-Iermc Iem mci:
cificu|ccce nc :uc cige:Icc:
• mcicr ¢ucnIiccce ce |g/ e |ccIcferrinc: e
• c |eiIe mcIernc ncc :upre c: nece::iccce: ce cc|cic e fc:fcrc,
¢ucncc c cricnçc Iem pe:c infericr c 1500g.
Monejo c|ín|co do omomentoçõo:
Ccnhecer c: c:pecIc: re|ccicnccc: c prcIicc cc c|eiIcmenIc mcIernc é
fcIcr funccmenIc| nc :enIicc ce cc|cLcrcr pcrc ¢ue mce e cricnçc
pc::cm vivencicr c cmcmenIcçcc ce fcrmc efeIivc e Ircn¢üi|c,
receLencc cc prcfi::icnc| c: crienIcçce: nece::cric: e cce¢uccc: pcrc
c :eu ëxiIc.
Fen:cncc ¢ue c mu|her pc::c pcr um |cngc per|ccc ce ge:Icçcc cIé
¢ue pc::c ccncreIcmenIe cmcmenIcr :eu fi|hc, enIence-:e ¢ue c
prepcrc pcrc c cmcmenIcçcc cevc :er iniciccc cincc nc per|ccc ce
grcvicez.
Freporondo os momos poro o o|e|tomento
1. Duronte o gestoçõo:
• excmincr c: mcmc: nc ccn:u|Ic ce pré-ncIc|:
• crienIcr c ge:IcnIe c u:cr :uIic ccm crif|cic cenIrc| pcrc
expc:i çcc ce créc|c e mcmi|c curcnIe c ge:Icçcc:
16
ALEITAMENTO MATERNO
140
• reccmenccr Lcnhc: ce :c| nc: mcmc:, pcr 15 minuIc:, cIé 10
hcrc: cc mcnhc cu cpc: c: 1ó hcrc:, curcnIe c grcvicez, cu
Lcnhc: ce |uz ccm |cmpccc: ce 40 wcII:, c cercc ce um pc|mc ce
ci:Icncic:
• e:c|crecer ¢ue c u:c ce :cLce:, creme: cu pcmccc: nc mcmi|c
ceve :er eviIccc:
• crienIcr ¢ue c expre::cc cc peiIc {cu crcenhc), curcnIe c
ge:Icçcc, pcrc c reIirccc cc cc|c:Irc e:Ic ccnIrc-incicccc: e
• en:incr c ge:IcnIe c exp|crcr :uc: mcmc:. C mcmi|c pcce :er
protruso, ¢ucncc :e cpre:enIc :c|ienIe, Lem ce|imiIccc: sem|-
protruso, ¢ucncc :e cpre:enIc pcucc :c|ienIe e, ¢ucncc
e:Iimu|ccc, prcIrci ccm cificu|ccce: |nvert|do, ¢ucncc :e cpre:enIc
em :enIicc cpc:Ic cc ncrmc| e, cpc: e:I|mu|c:, ccnIinuc inc|Ierccc,
:em :e prcIrcir: e c mcmi|c |o|so-|nvert|do, ¢ue :e cpre:enIc em
:enIicc cpc:Ic cc regu|cr, mc:, cpc: e:I|mu|c ce umc pegc
cce¢uccc, exIericrizc-:e pcLremenIe, ficcncc ¢uc:e p|cnc e
vc|Icncc, |cgc c :eguir, cc e:Iccc cnIericr ce inver:cc.
Nc cc:c ce c: mcmi|c: ncc :erem prcIru:c:, crienIcr c ge:IcnIe pcrc c:
:eguinIe: ccncuIc::
1. U:cr LcmLc ce :ucçcc cc mcmi|c cpc: c pcrIc, ce:ce ¢ue :uc
pre::cc :ejc muiIc pe¢uenc e ncc mcchu¢ue c pe|e.
2. U:cr :eringc p|c:Iicc ce 10-20 m| pcrc Irccicncr c mcmi|c, nc cu:ëncic
cc LcmLc ce :ucçcc cc mcmi|c:
• pegcr umc :eringc p|c:Iicc ce 10-20 m|, reIircr c ëmLc|c e ccn:ervcr:
• ccrIcr c exIremiccce cc :eringc cnce :e cccpIc c cgu|hc:
• reinIrccuzir c ëmLc|c pe|c exIremiccce ccrIccc: e
• cju:Icr c cuIrc exIremiccce cc :eringc cc mcmi|c e puxcr
:ucvemenIe c ëmLc|c pcrc Irccicncr c mcmi|c. Fczer e:Ic mcncLrc umc
vez cc cic, cIé ¢ue c mcmi|c :e Icrne prcIru:c.
16
ALEITAMENTO MATERNO
141
É impcrIcnIe icenIificcr c: ccnhecimenIc:, crençc: e cIiIuce: ¢ue c
ge:IcnIe pc::ui em re|cçcc c cmcmenIcçcc, ¢ue Iipc ce experiëncic
pc::ui, cu :e jc vivencicu c|gumc vez c cmcmenIcçcc. /|ém ci::c, é
impcrIcnIe IcmLém cferecer c: ge:IcnIe: cpcrIuniccce: ce Irccc ce
experiëncic:, cIrcvé: ce reunice: ce grupc ¢ue cLjeIivem infcrmcr e
fcci|iIcr c cmcmenIcçcc.
2. In|c|ondo o omomentoçõo no so|o de porto
/ primeirc hcrc cpc: c nc:cimenIc é exce|enIe pcrc inicicr c
cmcmenIcçcc, vi:Ic ¢ue c FN u:uc|menIe e:Ic Lem c|erIc e cIenIc,
ccm c ref|exc ce :ucçcc cIivc, e:Iimu|cncc precccemenIe c prccuçcc
ce cciIccinc e prc|ccIinc.
Iccc in:IiIuiçcc ¢ue ce:ejc pc::uir um Frcgrcmc ce lncenIive cc
c|eiIcmenIc mcIernc ceve Ier ccmc ncrmc c prcIicc ce cc|cccr c
recém-nc:cicc pcrc :ugcr curcnIe c primeirc hcrc ce vicc, ce:ce ¢ue
mce e cricnçc :e enccnIrem em Lcc: ccnciçce:, fcvcrecencc c
ccnIcIc c|hc c c|hc, pe|e c pe|e ce cmLc:.
• / e¢uipe ce :cúce ¢ue c::i:Ie cc pcrIc ceverc cricr um
cmLienIe ce Ircn¢üi|iccce e cpcic, c::im ccmc prcpicicr ccnfcrIc
f|:icc e emccicnc| nc :enIicc ce fcci|iIcr c ccnIcIc |nIimc enIre mce
e cricnçc, c mci: precccemenIe pc::|ve|.
• / ccmini:Ircçcc ce meciccmenIc:, e:pecic|menIe :eccIivc:e
cnc|gé:icc:, c mce ceve :er criIeric:c.
• C recém-nc:cicc ceverc :er ccLerIc ccm ccmpc c¢uecicc e
:ecc e cc|ccccc junIc ce :uc mce, em ccnIcIc pe|e c pe|e, pcrc
¢ue e:Ic c cc|c¢ue pcrc mcmcr, :empre ¢ue pc::|ve|.
3. Apos o porto, em un|dode de o|ojomento conjunto:
M %-#c%2'*)# 1#*c/*)# : ;/*$%2'*)%- <%4% # 6*1'*)63# $# %-'6)%2'*)#
2%)'4*#? /2% 3'0 ./' % 2,' <#$'48 #;'4'1'4 # ('/ -'6)' ' (%)6(;%0'4 %
146%*+% ('2<4' ./' '-% $'2#*()4%4 ;#2'E S-:2 $6((#? # %-#c%2'*)#
1#*c/*)# 1#-')63# $8 Z 2/-7'4 % #<#4)/*6$%$' $' #@('43%4 #/)4%( 2,'(
*# 1/6$%$# 1#2 # ;6-7#E
• / mce ceve prccecer c higiene cc: mcc:, ccm cguc e :cLcc,
cnIe: ce cmcmenIcr.
• En:incr c mce c cferecer c peiIc cnIe: cc cpcjccurc, pe|c
impcrIcncic cc cc|c:Irc e IcmLém pe|c e:I|mu|c c prccuçcc
|ccIec.
• / cmcmenIcçcc ceve :er iniciccc pe|c mcmc ¢ue :e enccnIrc
mci: cheic ce |eiIe, gerc|menIe c ¢ue fci uIi|izccc pcr ú|Iimc. Cc:c
c cricnçc ncc ccn:igc mcmcr nc: cuc: mcmc:, nc prcximc
mcmccc ccmeçcr pe|c mcmc ¢ue ncc fci :c|iciIccc.
• C |ccc| pcrc cmcmenIcr ceverc :er e:cc|hicc pcr e|c, ce:ce
¢ue :e :inIc ccnfcrIcve|.
• / me|hcr pc:içcc pcrc c mce cmcmenIcr cepence ce vcric:
fcIcre:, cenIre e|e: c Iipc ce pcrIc, c cic ce puerpéric ¢ue :e
enccnIrc. Ccn:icerc-:e impcrIcnIe ¢ue, em ¢uc|¢uer pc:içcc, c
mu|her e:Iejc ccnfcrIcve| e re|cxccc.
16
ALEITAMENTO MATERNO
142
• C pc:icicncmenIc cc cricnçc pcrc cmcmenIcr é impcrIcnIe
pcrc ceIermincr umc cmcmenIcçcc efeIivc. / pc:içcc mci:
u:uc|menIe uIi|izccc pe|c mce pcrc cmcmenIcr :eu LeLe e c
:enIccc.
• C pc:icicncmenIc ccrreIc imp|icc em cc|cccr c LeLë ce frenIe
pcrc c mcmc, ccm :eu ¢ueixc Icccncc c mcmc e c ccrpc-
ccLeçc-memLrc: em |inhc reIc. / pegc cce¢uccc :erc feiIc ccm
:uc Lccc Lem cLerIc cLcccnhcncc Iccc c pcrIe infericr cc créc|c
e pcrIe cc :upericr. Verificc-:e :e c pegc e:Ic ccrreIc :e c LeLë
e:Iiver fczencc :ucçce: |cngc:, :eguicc: ce pcu:c: e pe¢uenc:
:ucçce:, e cL:ervcncc-:e c ceg|uIiçcc. / pegc ccrreIc nuncc cci:
:e c mce referir ccr é pcr¢ue c LeLë ncc e:Ic pegcncc Lem.
• ScLe-:e ¢ue c cmcmenIcçcc é umc prcIicc ¢ue ceve :er
cprencicc, IcnIc pe|c mce ¢ucnIc pe|c cricnçc. De:Ic fcrmc, é
e:perccc ¢ue, nc: primeirc: cic:, c mu|her cincc cpre:enIe
cificu|ccce: em pc:icicncr ccrreIcmenIe c cricnçc e ¢ue, nc
ceccrrer cc: cic:, cprencc.
• Se c créc|c e:Iiver encurecicc, ceve-:e reIircr c exce::c ce |eiIe
pcr crcenhc mcnuc|, cIé ¢ue :e ccn:igc c f|exiLi|iccce ce:ejccc.
l:Ic é impcrIcnIe, pci: permiIe ¢ue c recém-nc:cicc cpreencc
ccmp|eIc e ccrreIcmenIe c regicc mcmi|c-crec|cr {pegc ccrreIc),
fcci|iIcncc c e:vczicmenIc cc: mcmc: e prevenincc Ircumc:
mcmi|cre:.
• / curcçcc ce cccc mcmccc é vcricve|. Gerc|menIe c cricnçc
:e :cIi:fcz mcmcncc 10 c 15 minuIc: em cccc peiIc, pccencc :e
e:Iencer. Fcrém, ceve-:e ceixcr c cricnçc mcmcr en¢ucnIc c
me:mc e:Iiver :ugcncc.
• Fcrc Iermincr c mcmccc, c icec| é ¢ue c cricnçc :c|Ie c peiIc
e:pcnIcnecmenIe. Cucncc e:Ie fcIc ncc cccrre, c mce cc|ccc c
pcnIc cc cecc m|nimc nc Lccc cc cricnçc. De::c fcrmc, c vccuc
:e ce:fcz e c cricnçc :c|Ic c peiIc, :em mcchucc-|c.
• Cc|cccr c LeLë pcrc crrcIcr, em pc:içcc verIicc|, ccm c ccLeçc
cpciccc nc cmLrc mcIernc. Fcce :er feiIc umc |eve mc::cgem nc:
cc:Ic: cIe ¢ue e|c crrcIe. Cricnçc: mcicre: pccem :er IcmLém
cc|ccccc: nc cc|c mcIernc, :enIccc: e ccm c ccrpc inc|inccc
pcrc frenIe e cpciccc: nc Lrcçc cc mce.
Cu|dodos com os momos e mom||os
• C u:c ce :uIic é nece::cric pcrc mcnIer c mcmc :empre e|evccc,
eviIcncc e:Ic:e: nc: pcrçce: infericre: cc mcmc.
• C Lcnhc ce :c| nc: mcmi|c: ccnIinuc reccmencccc ccm c cLjeIivc
ce cumenIcr c re:i:Iëncic cc regicc mcmi|c-crec|cr.
• / |uLrificcçcc cc regicc mcmi|c-crec|cr ceve :er feiIc :cmenIe ccm c
|eiIe mcIernc.
• Depci: ce cmcmenIcr, c mce ceve prccecer c pc|pcçcc cc: mcmc:.
Se e:Iiverem pe:ccc: e ccm pcnIc: ce ccr, reIircr c exce::c ce |eiIe cIé
c pcnIc ce ccnfcrIc, cu :ejc, cIé c ce:cpcrecimenIc cc ccr.
C c|eiIcmenIc mcIernc é, cIuc|menIe, ccn:icerccc peçc
16
ALEITAMENTO MATERNO
143
funccmenIc| pcrc c :cúce mcIernc e perincIc| e, pcrIcnIc, fcz pcrIe cc:
e:IrcIégic: ce Iccc: c: prcgrcmc: re|ccicnccc: ccm e:Ie: cLjeIivc:,
c|ém ce repre:enIcr cincc um e|emenIc impcrIcnIe em Iccc prcce::c
ce humcnizcçcc cc nc:cimenIc. Nc 8rc:i|, nc: ú|Iimc: cnc: Iem :icc
pcrIicu|crmenIe e:Iimu|ccc, cIrcvé: ce incenIivc: cficici: ccn:IcnIe: cc
chcmccc lH/C - lnicicIivc cc Hc:piIc| /migc cc Cricnçc, ccnferincc c
re:pecIivc I|Iu|c c: in:IiIuiçce: ¢ue IecniccmenIe cumprem ccm c:
re¢ui:iIc: ccn:icerccc: nece::cric: pcrc umc cce¢uccc c::i:Iëncic
Iécnicc e humcnc cc: recémnc:cicc:. Fcrc c efeIiviccce cc
c|eiIcmenIc mcIernc, c lH/C reccmencc c: in:IiIuiçce: c
imp|emenIcçcc cc: chcmccc: ¨Dez pc::c: pcrc c :uce::c cc
c|eiIcmenIc mcIernc".
D|||cu|dodes no o|e|tomento
1. Freensõo |ncorreto do mom||o
/ preen:cc inccrreIc cc regicc mcmi|c-crec|cr fcz ccm ¢ue c cricnçc
ncc ccn:igc reIircr |eiIe :uficienIe, |evcncc c cgiIcçcc e chcrc. / pegc
errccc, :c ce mcmi|c, prcvccc ccr e fi::urc: e fcz ccm ¢ue c mce fi¢ue
Ien:c, cn:ic:c e percc c cuIcccnficnçc, ccreciIcncc ¢ue c :eu |eiIe :ejc
in:uficienIe e/cu frccc.
2. F|ssuros [rochoduros}
EviIcr fi::urc:, cc|cccncc c LeLë pcrc mcmcr nc pc:içcc ccrreIc e ce
fcrmc ¢ue e|e cpreencc c mcmc ccrreIcmenIe. McnIer c:
Dez possos poro o sucesso do o|e|tomento moterno [IHAC}
VE "'4 /2% *#42% '(146)% (#@4' %-'6)%2'*)# 2%)'4*#? ./' $'3' ('4
4#)6*'64%2'*)' )4%*(26)6$% % )#$% % './6<' $' (%C$'E
PE "4'6*%4 )#$% % './6<' $' (%C$'? 1%<%16)%*$#I% <%4% 62<-'2'*)%4
'()% *#42%E
NE M46'*)%4 )#$%( %( >'()%*)'( (#@4' %( 3%*)%>'*( ' # 2%*'c# $#
%-'6)%2'*)# 2%)'4*#E
WE Sc/$%4 %( 2,'( % 6*616%4 # %-'6)%2'*)# 2%)'4*# *% <462'64% 7#4%
%<J( # *%(162'*)# $# @'@9E
OE s#()4%4 Z( 2,'( 1#2# %2%2'*)%4 ' 1#2# 2%*)'4 % -%1)%+,#?
2'(2# (' 36'4'2 % ('4 ('<%4%$%( $' ('/( ;6-7#(E
RE q,# $%4 %# 4'1:2I*%(16$# *'*7/2 #/)4# %-62'*)# #/ @'@6$% %-:2
$# -'6)' 2%)'4*#? % *,# ('4 ./' )%- <4#1'$62'*)# )'*7% /2% 6*$61%+,#
2:$61%E
_E %)61%4 # %-#c%2'*)# 1#*c/*)# I <'426)64 ./' 2,' ' @'@9
<'42%*'+%2 c/*)#( I PW 7#4%( <#4 $6%E
XE K*1#4%c%4 # %-'6)%2'*)# 2%)'4*# (#@ -634' $'2%*$%E
bE q,# $%4 @61#( %4)6;616%6( #/ 17/<')%( % 146%*+%( %2%2'*)%$%( %#
('6#E
VQE K*1%26*7%4 %( 2,'(? <#4 #1%(6,# $% %-)# 7#(<6)%-%4? <%4% >4/<#( $'
%<#6# %# %-'6)%2'*)# 2%)'4*# *% 1#2/*6$%$' #/ '2 ('436+#( $'
(%C$'E
16
ALEITAMENTO MATERNO
144
mcmc: :ecc:, ncc u:cncc :cLcneIe:, creme: cu pcmccc:. IrcIcr c:
fi::urc: ccm |eiIe mcIernc e :c|. C impcrIcnIe é ccrrigir c ¨pegc¨.
Cucncc exi:Iem fi::urc:, c mce ceve :er crienIccc pcrc inicicr c
mcmccc pe|c mcmc :ccic cu menc: ccmprcmeIicc e cepci: pc::cr
pcrc cuIrc mcmc, pci: c LeLë e:Ic menc: fcminIc e :ugc ccm menc:
vcrcciccce. Se e|c: ncc fcrem ccmp|eIcmenIe e:vcziccc: ce:Ic
mcneirc, cevercc :er e:vcziccc: cpc: c: mcmccc:.
3. Momos |ngurg|todos
/: mcmc: ingurgiIccc: :cc cc|crc:c:, ecemcciccc: {pe|e Lri|hcnIe),
pccencc e:Icr cverme|hccc: e c mu|her Ier feLre. É ciferenIe cc:
mcmc: cheic: ¢ue :cc pe:ccc:, encurecicc:, ¢uenIe:, mc: c mu|her
ncc Iem feLre e c |eiIe e:Ic f|uincc.
Fcrc eviIcr ingurgiIcmenIc, c: mcmc: cevem :er e:vcziccc: ccmc
exp|icccc cnIericrmenIe. Cucncc c mcmc e:Iiver muiIc ingurgiIccc,
fczer, cnIe: ce cc|cccr c LeLë pcrc mcmcr, c expre::cc mcnuc| pcrc
fcci|iIcr c pegc.
Cc:c c mu|her ncc ccn:igc ccr c peiIc, c | eiIe ceve :er reIirccc pcr
exIrcçcc mcnuc| cu pcr LcmLc. Se ncc cccrrer me|hcrc em 24 hcrc:, c
mcmc e:Iiver ¢uenIe, ccm c pe|e cverme|hccc em ceIerminccc |ccc|, e
c mu|her cpre:enIcr feLre, prcvcve|menIe e:Icrc cccrrencc umc mc:IiIe
¢ue ceverc :er ccrreIcmene cicgnc:Iicccc e IrcIccc.
Contro-|nd|coçöes
Scc rcrc: c: :iIucçce:, IcnIc mcIernc: ¢ucnIc necncIci:, ¢ue ccnIrc-
inciccm c cmcmenIcçcc. EnIre c: mcIernc:, enccnIrcm-:e c: mu|here:
ccm ccncer ce mcmc ¢ue fcrcm IrcIccc: cu e:Icc em IrcIcmenIc,
mu|here: HlV• {:c pccem ccr c prcpric |eiIe :e e:Ie fcr pc:Ieurizccc),
mu|here: ccm ci:IúrLic: cc ccn:ciëncic cu ccmpcrIcmenIc grcve, enIre
cuIrc:.
/: ccnIrc-inciccçce: necncIci: inc|uem c|Iercçce: cc ccn:ciëncic cc
cricnçc ce ¢uc|¢uer ncIurezc, Lcixc pe:c ccm imcIuriccce pcrc :ucçcc
cu ceg|uIiçcc {ccr |eiIe mcIernc pcr :cncc crcgc:Iricc) e fencc pc|cIinc
¢ue impc::iLi|iIe c cIc ce :ugcr {cferecer |eiIe mcIernc crcenhccc).
FcrcmenIe c u:c ce c|gumc meciccçcc pe|c mu|her ccnIrc-incicc c
cmcmenIcçcc. Nenhumc meciccçcc ceve :er uIi|izccc pe|c puérperc
cmcmenIcncc :em crienIcçcc mécicc. Nc evenIuc|iccce cc
meciccçcc uIi|izccc :er c|c::ificccc ccmc ce u:c criIeric:c cu ccnIrc-
incicccc curcnIe c cmcmenIcçcc, c prccecimenIc ce e:cc|hc é cpIcr
pcr cuIrc: c|IerncIivc: IercpëuIicc: e ncc :u:pencer c c|eiIcmenIc,
:empre ¢ue i:Ic fcr pc::|ve|. Fcrc mcicre: ceIc|he:, ver mcnuc|
/mcmenIcçcc e U:c ce Drcgc: {MS, 2000).
16
145
O obortomento como questõo de soùde pùb||co
C cLcrIc, c::unIc exc|u|cc cc: ci:cu::ce: cienI|ficc: e
pc||Iicc: cIé Lem pcucc Iempc cIrc:, é, nc
cIuc|iccce, umc cc: principci: ¢ue:Ice: cc cgencc
inIernccicnc|, nc ¢ue ciz re:peiIc c :cúce e cireiIc:
reprccuIivc:.
/ ci:crimincçcc e c: cgrcvc: c :cúce impc:Ic: c:
mu|here:, pcr rczce: cu|Iurci:, |egci: e re|igic:c: ¢ue
envc|vem c ¢ue:Icc cc cLcrIc, Iëm ccnIriLu|cc pcrc
c preccrieccce cc c::i:Iëncic e cumenIc cc
mcrIc|iccce e mcrLiccce pcr e:Ic ccu:c. Fc|cncc em
ncme prcpric, c: mu|here: |evcrcm c ¢ue :empre fci
ccn:icerccc ¨:eu prcL|emc¨ cc p|cnc pc||Iicc |ccc|,
regicnc| e muncic|, vi:cncc c cefiniçcc ce pc||Iicc:
¢ue inccrpcrem c prevençcc cc cLcrIc e c
cmp|icçcc cc cce::c c :erviçc: ce Lcc ¢uc|iccce.
/::im, ccmc re:u|Iccc cc ceLcIe ccncuzicc pe|c
mcvimenIc ce mu|here:, nc ú|Iimc cécccc, c cLcrIc
fci cmp|cmenIe ceLcIicc em cuc: impcrIcnIe:
ccnferëncic: cc: Ncçce: Unicc:: Ihe lnIerncIicnc|
Ccnference cn Fcpu|cIicn cnc Ihe Deve|cpmenI
{Ccirc, 1ºº4) e c FcurIh Wcr|c Ccnference cn Wcmen
{8eijing, 1ºº5). E c cLcrIc, rec|izccc em ccnciçce:
in:egurc:, fci inc|u|cc nc F|cnc ce /çcc cc
Ccnferëncic cc Ccirc - pcrcgrcfc 8.25 - ccmc ¢ue:Icc
ce :cúce púL|icc. C: gcvernc: :igncIcric:, enIre e|e: c
8rc:i|, c::umircm c ccmprcmi::c ce imp|emenIcr
:erviçc:, me|hcrcr c ¢uc|iccce cc c::i:Iëncic e recuzir
c mcrIc|iccce e mcrLiccce ceccrrenIe cc cLcrIc em
:eu: pc|:e:.
IrcIc-:e, pcrIcnIc, ce cmp|icr cce::c cc: mu|here: cc:
cireiIc: |egc|menIe ccmiIicc:, inve:Iincc em cçce:
¢ue gcrcnIcm cc: hcmen: e mu|here: c exerc|cic cc:
cireiIc: :exuci: e reprccuIivc:.
/pe:cr cc vi:iLi|iccce cc¢uiricc, pcr fcrçc ce |ei:
re:IriIivc:, c: mu|here: cincc reccrrem cc cLcrIc
¨c|cnce:Iinc¨. Ne::c ccnciçcc, e|c: Iëm gucrcccc
17 ASSISTÊNCIA À MULHER COM ABORTAMENTO E
NO PÓS-ABORTO
ASSISTÊNCIA Á MULHER COM ABORTAMENTO E NO PÓS-ABORTO
146
:uc ccr em :i|ëncic cu, nc mcximc, ccmpcrIi|hcm-nc ccm pe::cc: ce :uc
inIimiccce. Cuc:e :empre e|c: ncc enccnIrcm cpcic nc: :erviçc: ce
:cúce cu nc: e:cc|c:, em :e IrcIcncc ce ccc|e:cenIe:.
/: reccmenccçce: inIernccicnci:, :e ncc Ircn:fcrmccc: em ncvc:
prcIicc: nc n|ve| ce cIençcc |ccc|, :ercc in:uficienIe: pcrc c :c|uçcc cc
prcL|emc. Fcr i::c, Icrnc-:e nece::cric c Lu:cc ce pc||Iicc: :ccici:
cce¢uccc: cc ccnIexIc ce cccc pc|:, e:Iccc cu munic|pic, re:peiIcncc-
:e c: |ei: vigenIe: e prcmcvencc c: recur:c: humcnc: e xIécnicc:
ci:pcn|vei:. Deve-:e re::c|Icr c¢ui, c impcrIcncic cc prcIicc prcfi::icnc| e
pc||Iicc cc: prcfi::icnci: cc :cúce, principci: inIer|ccuIcre: cc: mu|here:
¢ue cemcnccm :erviçc: ce :cúce pcrc crienIcçce: e IrcIcmenIc cc:
prcL|emc: ceccrrenIe: cc cLcrIcmenIc.
Mogn|tude do obortomento no 8ros|| e no mundo
/ rec| mcgniIuce cc cLcrIcmenIc, nc muncc, é ce:ccnhecicc. /
i|egc|iccce, pcrcic| cu IcIc| em civer:c: pc|:e:, cificu|Ic c regi:Irc ce
Iccc: c: cccrrëncic:. Nc pcpu|cçcc muncic|, ó27 vive em pc|:e: cnce c
inIerrupçcc ce grcvicez é permiIicc pcr umc cmp|c vcrieccce ce
rczce:, e 2ó7 vive em pc|:e: cnce c cLcrIc é prciLicc {CenIrc Legc|
pcrc Derechc: FeprccuIivc: y Fc|iIicc: FuL|icc: - CLFF, N•/EU/, 1ººº). Fcr
cuIrc |ccc, nem Iccc: c: mu|here: cemcnccm c::i:Iëncic pc:-
cLcrIcmenIc nc: :erviçc: púL|icc: ce :cúce. De:Ic fcrmc, é ccn:en:c ce
¢ue exi:Ie umc :uL-ncIificcçcc cc: cc:c:, c::im ccmc cc: ccmp|iccçce:
c::cciccc:.
Nc 8rc:i|, cpe:cr cc ccrëncic ce inciccccre: ¢ue permiIcm cferiçcc cc
numerc IcIc| ce cccrrëncic: ce cLcrIcmenIc: nc pcpu|cçcc em gerc|,
c: cccc: cficici: ju:Iificcm c cccçcc ce mecicc: prevenIivc: e ce
prcmcçcc cc :cúce reprccuIivc. Nc ccnIexIc cc mcrIc|iccce mcIernc,
c incicëncic cL:ervccc ce cLiIc: pcr ccmp|iccçce: ce cLcrIc c:ci|c em
Icrnc ce 12,57 cc IcIc| cc: cLiIc:, ccupcncc, em gerc|, c Ierceirc |ugcr
enIre :uc: ccu:c:, cL:ervccc: c: cmp|c: vcricçce: enIre c: e:Iccc:
Lrc:i|eirc:.
Di:pce-:e, pcrc cnc|i:e cc prcL|emc, cc: cccc: fcrnecicc: pe|c Si:Iemc
ce lnIerncçcc Hc:piIc|cr {SlH/SUS), ¢ue infcrmc c númerc ce inIerncçce:
pcrc cureIcgen: pc:-cLcrIc e c fre¢üëncic ce cLiIc: ne:Ic:
circun:Icncic:, nc: :erviçc: púL|icc: e ccnveniccc: e cc Si:Iemc ce
lnfcrmcçcc em McrIc|iccce {SlM/CENEFl/MS) ¢ue ccn:c|icc c regi:Irc cc
cLcrIcmenIc em cec|crcçcc ce cLiIc - ne:Ie cc:c ccm grcnce :uL-
ncIificcçcc em ¢uc:e Iccc pc|:.
Ccnfcrme cccc: regi:Irccc: nc: ú|Iimc: :ei: cnc: pe|c SlH/MS, c númerc
g|cLc| ce cureIcgen: pc:-cLcrIc pcrece mcnIer-:e e:Icve| nc: ú|Iimc:
Irë: cnc: {Cuccrc 1).
17
ASSISTÊNCIA À MULHER COM ABORTAMENTO E NO PÓS-ABORTO
147
Quadro 1 - Número de curetagens pós-aborto realizadas no âmbito dos
serviços públicos e conveniados
Fonte: SIH/SUS, MS
/ incicëncic ce cLcrIc: nc ccc|e:cëncic ccn:IiIui IcmLem grcnce
preccupcçcc :ccic|. Dc IcIc| cc: inIerncçce: pcr cLcrIcmenIc nc
SlH/SUS nc cnc ce 1ºº8, 22,57 ercm ce ccc|e:cenIe:. C cIencimenIc
receLicc pe|c: ccc|e:cenIe: nc: :erviçc: ce :cúce é in:cIi:fcIcric. Sem
cpcic e cccn:e|hcmenIc cce¢uccc:, ccm fre¢üëncic, e:Ic: jcven:
engrcviccm ncvcmenIe, enIrcncc num cic|c repeIiIivc ce grcvicez-
cLcrIcmenIc.
/: mecicc: nece::cric: c recuçcc cc grcvicez ncc p|cnejccc cu
ince:ejccc inc|uem crienIcçce: :egurc: nc cIençcc pc:-cLcrIcmenIc,
nc crienIcçcc cnIiccncepcicnc|, civu|gcçcc e cferIc cc impcrIcncic cc
cnIiccncepçcc ce emergëncic e gcrcnIic ce :upcrIe p:icc|cgicc e
:ccic| ¢ucncc nece::cric.
C: inciccccre: ce :cúce mcIernc cemcn:Ircm ¢ue c c::i:Iëncic cc
cLcrIcmenIc ncc cpre:enIc ¢uc|iccce ccmpcI|ve| ccm c: recur:c:
ci:pcn|vei:. Fcr i::c, c cmp|icçcc cc cce::c ceve ccminhcr junIc c
¢uc|ificcçcc cc rece jc in:Ic|ccc.
QbALIDADE DA AIENÇÃO AO A8OkIAMENIO E NO FÓS-
A8OkIO
Conce|tuondo o quo||dode do otençõo
/ ¢uc|iccce nc cIençcc cc cLcrIcmenIc e pc:-cLcrIc ceve :er
ccmpreencicc ccmc um ccnjunIc ce cçce: cferecicc c mu|her curcnIe
e cpc: c inIerrupçcc ce umc ge:Icçcc, ¢uer e:pcnIcnec cu incuzicc,
e:Iencencc-:e cIé c 42º cic cpc: c Iérminc cc grcvicez. Fcrc e:Ie fim,
ccn:icerc-:e cLcrIcmenIc inIerrupçcc cc grcvicez cIé 22 :emcnc: cu,
:e c iccce ge:Iccicnc| fcr ce:ccnhecicc, ccm c prccuIc cc ccncepçcc
pe:cncc menc: ce 500 grcmc: cu mecincc menc: ce 1ó cm.
/ ¢uc|iccce cc cIençcc imp|icc num e:fcrçc inIegrccc e :inérgicc ce
Iccc: c: n|vei: ge:Icre: pcrc c cferIc ce :erviçc: ¢ue gcrcnIcm:
ccc|himenIc, infcrmcçcc, cccn:e|hcmenIc, ccmpeIëncic prcfe::icnc|,
Iecnc|cgic cprcpriccc ci:pcn|ve| e re|ccicncmenIc pe::cc| pcuIccc nc
re:peiIc c cigniccce e cc: cireiIc: :exuci: e reprccuIivc:.
Ge:Icre:, gerenIe:, prcfi::icnci: ce :cúce e funcicncric: cc rece
c::i:Iencic|, gucrcccc: c: ciferençc: ce :uc: funçce: e cIriLuiçce:
e:pec|ficc:, :cc cc-re:pcn:cvei: nc ccn:Iruçcc e nc cprimcrcmenIc
17
ASSISTÊNCIA À MULHER COM ABORTAMENTO E NO PÓS-ABORTO
148
ccnI|nuc cc ¢uc|iccce cc cIençcc c mu|her em prcce::c ce
cLcrIcmenIc e nc pc:-cLcrIc.
C cce::c c :erviçc: ce ¢uc|iccce permiIe ¢ue c mu|her re:c|vc c
prcL|emc e enccnIre cpcic nc Lu:cc ce :c|uçce: incivicuci: pcrc
ccncuzir c :eu prcce::c reprccuIivc ccm cuIcncmic e :egurcnçc.
Constru|ndo o quo||dode do otençõo
1. Aco|h|mento
Ccmc ccc|her umc mu|her ¢ue cLcrIc° Ccm ¢ue c|hcr° Ccm ¢ue
cIiIuce° Cuc| c me|hcr mcneirc ce cjucc-lc c ncc repeIir c :iIucçcc em
¢ue :e enccnIrc° / eviIcr c: ri:cc: ce um cLcrIcmenIc em ccnciçce:
in:egurc:° Fef|eIir :cLre e::c: ¢ue:Ice: é e::encic| pcrc ¢ue :e cperem
muccnçc: nc: :erviçc: ce :cúce, vi:cncc cc ccc|himenIc e IrcIcmenIc
re:peiIc:c c: mu|here: e :uc: ceci:ce:. l:Ip cemcncc um exerc|cic
ccn:IcnIe ce ref|excc :cLre c inf|uëncic cc: prcpric: vc|cre: {mcrci:,
éIicc:, re|igic:c:) nc prcIicc prcfi::icnc|, reccnhecimenIc e cceiIcçcc
cc: prcpric: |imiIe: e cc: ciferençc: ¢ue ccrccIerizcm c :ccieccce
humcnc, c ¢ue ncc :e cLIém cpenc: pcr fcrçc cc vcnIcce. Fccem
cjuccr ne:Ic ref|excc c: ci:cu::ce: cc|eIivc:, civicir preccupcçce:,
ccnfrcnIcr e cnc|i:cr cIiIuce: e ccncuIc: nc prcpric e¢uipe ce IrcLc|hc,
cu em grupc: inIerin:IiIucicnci:, reunice: e cficinc: ce :en:iLi|izcçcc e
ccpcciIcçcc. É impcrIcnIe IcmLém ci:cuIir c: prcpric: cificu|ccce:
frenIe c :exuc|iccce e c: prcIicc: reprccuIivc:.
CcmenIcric: ce:re:peiIc:c: e ccnc|u:ce: precipiIccc: cevem :er
Lcnicc: cc cic c cic cc: :erviçc:. / ci:cu::cc cc|eIivc e c repen:cr
ccIicicnc ce cccc inciv|cuc pccercc eviIcr ju|gcmenIc: e cIiIuce:
preccnceiIuc:c: :cLre c ccmpcrIcmenIc reprccuIivc cc: mu|here: e/cu,
pe|c menc:, errcciccr prcIicc: ccncencvei: e cnIi-éIicc: nc cferIc ce
:erviçc:, ccmc c: puniçce: e cc:Iigc: impc:Ic: c muiIc: mu|here: ¢ue
cLcrIcm, nc: :erviçc: púL|icc:.
2. In|ormoçöes e oconse|homento
Nc mcicric cc: cc:c: ce cLcrIcmenIc, c mu|her ncc ce:ejc cuIrc
grcvicez imecicIcmenIe cpc: e c crienIcçcc :cLre cnIiccncepçcc é
cL:c|uIcmenIe nece::cric. Dc me:mc mccc, c e¢uipe ceve e:Icr
prepcrccc pcrc crienIcr c¢ue|c: mu|here: ¢ue ce:ejcm cuIrc grcvicez,
:ejc nc¢ue|e :erviçc cu enccminhcncc-c pcrc uniccce: ce referëncc.
Ccm fre¢üëncic, nc pc:-cLcrIcmenIc, c: mu|here: preci:cm ce umc
e¢uipe ¢ue ccmpreencc :uc: nece::iccce:, ncc :cmenIe f|:icc:, mc:
IcmLém :ccici: e p:icc|cgicc:. E::e cpcic cjuccrc c mu|her c enIencer
c: pc::|vei: :ignificccc: cc cLcrIcmenIc, ¢ue, muiIc: veze:, :e Irccuzem
pcr fru:Ircçcc e :en:cçcc ce inccpcciccce ce engrcviccr ncvcmenIe.
Em cuIrc: :iIucçce:, c :enIimenIc ce cu|pc pcce :er ccmincnIe. Deve-:e
reccnhecer IcmLém ¢ue hc mu|here: ¢ue :enIem c||vic, cu
:imp|e:menIe e:Icc Ircn¢üi|c:, mc:
17
ASSISTÊNCIA À MULHER COM ABORTAMENTO E NO PÓS-ABORTO
149
nem :empre e:Icc c vcnIcce pcrc expre::cr |ivremenIe :uc: recçce: cu
:enIimenIc:. Fcrc ¢ue :ejc pc::|ve| fc|cr, é preci:c ¢ue hcjc c|guém
ccpcz ce cuvir. Fcr i::c, umc Lcc ccpcciccce ce e:cuIc, :em pré-
ju|gcmenIc:, pcrece :er c principc| in:IrumenIc c :er uIi|izccc pe|c:
prcfi::icnci: ce :cúce.
C cic|cgc :cIi:fcIcric cLIicc curcnIe c cIencimenIc prcpcrcicncrc c:
mu|here: ccnciçce: pcrc ceci:ce: fuIurc: em re|cçcc c :uc :cúce, em
e:pecic| cc :eu fuIurc reprccuIivc.
3. Acesso oos serv|ços
Nc crgcnizcçcc cc rece c::i:Iencic|, ceve-:e ccn:icercr c pre:ençc ce
¢uccrc e|emenIc: ¢ue gcrcnIircc c cce::c cc mu|her cu ccc|e:cenIe
cc: :erviçc:, ¢uci: :ejcm:
• exi:Iëncic ce :erviçc: ce urgëncic ¢ue pc::cm IrcIcr c: mu|here:
cc: ccmp|iccçce: cc cLcrIc e:pcnIcnec cu incuzicc
• pre:ençc ce :erviçc: ce p|cnejcmenIc fcmi|icr nc: |ccci: ce
cIencimenIc c: urgëncic: ce cL:IeIr|cic
• re|cçcc fcrmc|izccc enIre c: :erviçc: ce urgëncic e ce cIençcc
inIegrc| c :cúce cc mu|her
• infcrmcçcc ccnIinuccc pcrc c: u:ucric: :cLre c: :erviçc:
ci:pcn|vei:
4. Integroçõo do rede oss|stenc|o|
/: mu|here: cevem ci:pcr ce umc rece ce :erviçc: ¢ue pc::c pre:Icr
cIencimenIc cce¢uccc cicnIe ce um ¢uccrc ce cLcrIcmenIc, e e:Ic
rece ceve uIi|izcr um :i:Iemc efeIivc ce referencc e ccnIrc-referëncic,
re:peiIcncc c: ccnciçce: :ccici: e eccncmicc: cc: mu|here:. /
inIegrcçcc cc: :erviçc: ce urgëncic ccm :erviçc: ce p|cnejcmenIc
fcmi|icr ceve fczer pcrIe cc ¢uc|iccce cc cIençcc cc cLcrIcmenIc e
pc:-cLcrIc.
5. Competënc|o pro||ss|ono|
/|ém cc hcLi|iccce nc Iécnicc empregccc pcrc c e:vczicmenIc
uIerinc, c ccmpeIëncic :e e:Ience cc Lcm u:c ce e¢uipcmenIc:,
in:IrumenIc| e meciccmenIc:, c::im ccmc nc cefiniçcc ce rcIinc: e
Iécnicc: ncc evc:ivc:, vi:cncc cc Lem e:Icr cc mu|her e permiIincc :uc
pcrIicipcçcc nc e:cc|hc cc: prccecimenIc: mci: cprcpriccc: pcrc
re:c|uçcc cc prcL|emc. /¢ui IcmLém :e inc|ui c ¢uc|ificcçcc pcrc
e:IcLe|ecimenIc ce um pccrcc e|evccc ce re|ccicncmenIc inIerpe::cc|,
cLcrccgem :ccic| e p:icc|cgicc ce cccc mu|her, :uc fcm||ic cu
cccmpcnhcnIe.
ó. Iecno|og|o opropr|odo
/ me|hcric cc cIencimenIc impce c uIi|izcçcc ce Iecnc|cgic cprcpriccc
pcrc prcmcver c e:vczicmenIc uIerinc, ¢ucncc e:Ic
17
ASSISTÊNCIA À MULHER COM ABORTAMENTO E NO PÓS-ABORTO
150
:iIucçcc fcr nece::cric. / reIirccc cc: re:Ic: cvu|cre: pcce :er feiIc
uIi|izcncc-:e c Iécnicc ce c:pircçcc mcnuc| inIrc-uIerinc {/MlU) nc:
cc:c: ce cLcrIcmenIc cIé 12 :emcnc:, nc ¢uc| c uIi|izcçcc ce ccnu|c:
f|ex|vei: ce cc|iLre unifcrme ciminui c: ri:cc: ce ccmp|iccçce:. Em muiIc:
cc:c:, ¢ucncc ccnvenienIemenIe cp|icccc e prececicc ce
e:c|crecimenIc: e cc L|c¢ueic pcrccervicc|, ci:pen:c c uIi|izcçcc ce
cne:Ie:ic gerc|, prcpcrcicncncc mcicr :egurcnçc e cc|cLcrcçcc cc
mu|her, c|ém ce :e pccer cferecer umc c|Ic mci: preccce, ccm
ccn:e¢üenIe ciminuiçcc cc: cu:Ic:. Cucncc ncc ci:pcn|ve|, cu nc
cu:ëncic ce pe::cc| Ireinccc ne:Ic Iécnicc, pcce-:e prcmcver c
e:vczicmenIc cIrcvé: cc cureIcgem uIerinc.
CLASSIFICAÇÃO E CONDbIA
1. Ameoço de Abortomento
C :cngrcmenIc geniIc| é ce pe¢uenc inIen:iccce, ccm cu :em ccre:
{cc|icc:) ¢ue pccem :er ce inIen:iccce vcricve|, gerc|menIe pcucc
inIen:c:. C excme e:pecu|cr evicencic ¢ue c :cngrcmenIc f|ui cIrcvé:
cc cérvice, e e:Ic cpre:enIc c crif|cic inIernc fechccc. C UIerc Iem c
Icmcnhc ccrre:pcncenIe cc e:perccc e ncc hc :inci: ce infeçcc. C
excme ce u|Irc-:cncgrcfic mc:Irc-:e ncrmc|.
Ne:Ie: cc:c:, ncc hc inciccçcc ce inIerncçcc hc:piIc|cr e c mu|her
ceve receLer crienIcçce: pcrc uIi|izcr cnc|gé:icc: :e cpre:enIcr ccr,
fczer repcu:c e reIcrncr cc cmLu|cIcric ce pré-ncIc|. Nc: cc:c: ce
:cngrcmenIc inIen:c, cevem-:e cvc|icr c: n|vei: ce hemcg|cLinc,
icenIificcr c Iipc :cngü|nec, :e fcr ce:ccnhecicc, e cferecer :crc|cgic:
pcrc :|fi|i: e HlV.
2. Abortomento Comp|eto
Gerc|menIe em ge:Icçcc ccm iccce ge:Iccicnc| infericr c 8 :emcnc:. C
:cngrcmenIc e c: ccre: ciminuem cpc: c expu|:cc cc mcIeric| cvu|cr. C
crif|cic cervicc| inIernc pcce cincc e:Icr cLerIc. C úIerc Iem cimen:ce:
infericre: cc e:perccc pcrc c iccce cc ge:Icçcc. / u|Irc-:cncgrcfic
mc:Irc ccviccce uIerinc vczic cu cpenc: ccm imcgen: :uge:Iivc: ce
cccgu|c:.
/ ccncuIc ceve :er expecIcnIe, ccm cIençcc c per:i:Iëncic cc
:cngrcmenIc ¢ue pcce :ugerir re:Ic: cvu|cre:, e ccm c :urgimenIc ce
¢uccrc infeccic:c pé|vicc. Ne:Ie: cc:c:, reccmencc-:e /MlU cu
cureIcgem uIerinc. Sc|iciIcr Iipcgem :cngü|nec e :crc|cgic: pcrc :|fi|i: e
HlV, cpc: ccn:enIimenIc. Se fcr Fh negcIivc e ncc hcuver cincc
:en:iLi|izcçcc, fcz-:e cLrigcIcric c ccmini:Ircçcc cc imuncg|cLu|inc cnIi-
D.
3. Abortomento Inev|tóve| e Incomp|eto
/ percc :cngü|nec é mcicr ¢ue nc cmecçc ce cLcrIcmenIc, pccencc
cccrrer c e|imincçcc ce cccgu|c:. E:Ic percc gerc|menIe ciminui cpc: c
e|imincçcc cc mcIeric| cvu|cr, principc|menIe :e fcr
17
ASSISTÊNCIA À MULHER COM ABORTAMENTO E NO PÓS-ABORTO
151
ccmp|eIc. /: ccre: Iëm inIen:iccce mcjcr ¢ue c cmecçc, e c crif|cic
cervicc| inIernc enccnIrc-:e cLerIc, pccencc :er icenIificccc mcIeric|
cvu|cr. / u|Irc-:cncgrcfic fcz c cicgnc:Iicc ciferencic| enIre e|e:.
Cucncc c ge:Icçcc Iem menc: ce 12 :emcnc:, e:Ic incicccc c
c:pircçcc mcnuc| inIrc-uIerinc {/MlU). Cucncc c :erviçc ce :cúce ncc
ci:pu:er ce:Ie prccecimenIc, pcce-:e rec|izcr c cureIcgem uIerinc. É
inci:pen:cve| ceIermincr c Iipc :cngü|nec cc mu|her. Se fcr Fh negcIivc
e ncc hcuver cincc :en:iLi|izcçcc, fcz-:e cLrigcIcric c ccmini:Ircçcc cc
imuncg|cLu|inc cnIi-D. Sencc c :|fi|i: umc cc: ccu:c: ce cLcrIcmenIc,
ceve-:e rec|izcr c :crc|cgic e prcmcver :eu IrcIcmenIc ¢ucncc pre:enIe:
ceve-:e IcmLém cferecer c :crc|cgic pcrc HlV.
Em ge:Icçce: ccimc ce 12 :emcnc:, ccm ccncepIc nc ccviccce
uIerinc, reccmencc-:e c infu:cc ce cciIccinc pcrc prcmcver :uc
expu|:cc cu c cc|cccçcc cc mi:cprc:Ic| nc funcc ce :ccc vcginc|, nc
cc:e ce 200 mcg c cccc ó hcrc:. /pc: expu|:cc, ceve-:e rec|izcr c
cureIcgem uIerinc.
4. Abortomento ket|do
C cLcrIcmenIc reIicc pcce ncc :er prececicc ce cmecçc ce
cLcrIcmenIc. Hc regre::cc cc: :inci: e :inIcmc: cc grcvicez. C crif|cic
cervicc| enccnIrc-:e fechccc e gerc|menIe ncc hc hemcrrcgic. C
excme ce u|Irc-:cncgrcfic reve|c prccuIc cc ccncepçcc :em viIc|iccce
cu :uc cu:ëncic {cvc cegc).
Cucncc c ge:Icçcc Iem menc: ce 12 :emcnc:, ceve-:e prccecer cc
e:vczicmenIc pe|c Iécnicc ce c:pircçcc mcnuc| inIrc-uIerinc e, :e
nece::cric, rec|izcr ci|cIcçcc cervicc| ccm ci|cIcccre:, cu rec|izc-:e
cureIcgem uIerinc, Iencc-:e c cuicccc pcrc ncc prcvcccr ccicenIe:,
principc|menIe perfurcçcc uIerinc.
Cucncc c ge:Icçcc Iem mci: ce 12 :emcnc:, é nece::cric prcmcver c
ci|cIcçcc cervicc| e expu|:cc cc prccuIc ccncepIuc|. Fcrc IcnIc, uIi|izc-
:e c mi:cprc:Ic| vcginc| nc cc:e ce 200 mcg c cccc ó hcrc:, cu infu:cc
enccvenc:c ce cciIccinc, ccm 5 cmpc|c: ce 5 uniccce:, inicicncc c
gcIejcmenIc ccm 8 gcIc: pcr minuIc. Nc: cc:c: em ¢ue c cLiIc cccrreu
hc mci: ce 4 :emcnc:, pcce cccrrer ¢uccrc ce ci:IúrLic cc cccgu|cçcc,
pcrIcnIc ceve-:e e:Icr cIenIc c cuIrc: :cngrcmenIc: cncrmci:,
:c|iciIcncc-:e prcvc: |cLcrcIcrici: ce cccgu|cçcc ¢ucncc exi:Iir e:Ic
:u:peiIc. / icenIificcçcc ce ge:IcnIe Fh negcIivc é inci:pen:cve| pcrc
eviIcr c c|cimunizcçcc. / :crc|cgic pcrc :|fi|i: ceve :er rcIinc e pcrc HlV
ceve :er cferecicc.
5. Abortomento In|ectodo
Gerc|menIe cccrre cpc: mcnipu|cçcc pcrc incuzir c inIerrupçcc cc
grcvicez e :cL mc: ccnciçce: Iécnicc:. /: infeçce: :cc, pc|imicrcLicnc:
e ¢uc:e :empre ccm LccIéric: cc prcpric f|crc vcginc|. C ¢uccrc é
grcve e re¢uer cuicccc imecicIc. Deve-:e ccn:icercr, em Iccc: c: cc:c:,
c prccuIc cc ccncepçcc ccmc ncc
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ASSISTÊNCIA À MULHER COM ABORTAMENTO E NO PÓS-ABORTO
152
Iencc viIc|iccce. C ¢ue mci: chcmc cIençcc nc ¢uccrc c||nicc é
:cngrcmenIc ccm cccr féIicc, cccmpcnhccc ce ccr cLccminc| feLre.
C pu|:c enccnIrc-:e cce|erccc e c feLre fre¢üenIemenIe cIinge mci: ce
38º C. Fccem-:e icenIificcr cc|eçce: nc: funcc: ce :ccc e, cc :er
excminccc, c pccienIe refere Lc:IcnIe ccr c mcnipu|cçcc cc: crgcc:
pé|vicc:. / pc::iLi|iccce ce perfurcçcc uIerinc e ce c|çc: inIe:Iinci: ceve
:er :empre |emLrccc. Cucncc in:Ic|ccc ¢uccrc ce chc¢ue :épIicc,
|emLrcr nc eIic|cgic pcr E. cc|i, 8ccIercice: e C|c:Iricium. E:Ie cgenIe
pcce, inc|u:ive, |evcr c ¢uccrc ce cnemic hemc||Iicc fu|mincnIe e
in:uficiëncic renc|.
Excme: |cLcrcIcrici: :cc nece::cric: e ceve :er cvc|iccc c mcmenIc ce
:uc :c|iciIcçcc. C: :eguinIe: excme: pccem :er nece::cric::
• hemcgrcmc ccm ccnIcgem ce p|c¢ueIc::
• Iipcgem :cngü|nec:
• urinc Iipc l {excme ce :ecimenIc urincric):
• cc:cgen: ce uréic e crecIininc:
• cccgu|cgrcmc:
• hemccu|Iurc:
• cu|Iurc cc :ecreçcc vcginc| e cc mcIeric| enccmeIric|:
• Fx cc Icrcx e cLccme: e
• c u|Irc-:cncgrcfic e c Icmcgrcfic pccem :er nece::cric: pcrc
icenIifi ccr e ce|imiIcr cc|eçce: inIrc-ccviIcric: {cL:ce::c:).
Em Iccc: c: cc:c:, ceve-:e fczer infu:cc ce :c|uçce: pcrenIerci:, em
e:pecic| hemcIrcn:fu:cc ¢ucncc c hemcg|cLinc fcr mencr ¢ue 8 g7.
lnicicr c cnIiLicIiccIercpic ce |crgc e:pecIrc, uIi|izcncc um cncercLicicc
{meIrcnicczc| cu c|inccmicinc) e um cmincg|icc:|cec {genIcmicinc cu
cmicccinc). Se ncc hcuver re:pc:Ic, c::ccicr cmpici|inc cc e:¢uemc
cccIccc cu cmp|icr c e:pecIrc cnIiLccIericnc ccm cuIrc: cnIiLicIicc:
{Cuccrc 2).
Quadro 2
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ASSISTÊNCIA À MULHER COM ABORTAMENTO E NO PÓS-ABORTO
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/ e:cc|hc cc: cnIiLicIicc: ceve :er feiIc ccm c Ccmi::cc ce CcnIrc|e ce