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Ministrio da Sade

FEBRASGO
ABENFO
Parto, Aborto e Puerprio
Assistncia Humanizada Mulher
Braslia, DF
2001
2001. Mini:Iric cc Scce
permiIicc c reprccucc pcrcic| cu IcIc|, ce:ce ue ciIccc c fcnIe.
Iircgem: 50 mi| exemp|cre:.
M|n|stro do Sode
Jc: Serrc
Secretr|o de Fo|t|cos de Sode
C|cucic DucrIe cc Fcn:ecc
Coordenodoro do reo Icn|co de Sode do Mu|her
Icnic ci Gicccmc cc Lcgc
Frccucc, ci:IriLuicc e infcrmcce::
M|n|str|o do Sode
SecreIcric ce Fc||Iicc: ce Scce
rec Icnicc ce Scce cc Mu|her
E:p|cnccc cc: Mini:Iric:, 8|ccc G, cnccr
CEF: 70.058-00, 8rc:||ic, DF
Ie|: {1) 315-28
Fcx: {1) 322-312
1. ec. 2001
F|cho coto|ogr||co:
8rc:i|. Mini:Iric cc Scce. SecreIcric ce Fc||Iicc: ce Scce. rec Icnicc
ce Scce cc Mu|her.
FcrIc, cLcrIc e puerpric: c::i:Incic humcnizccc c mu|her/
Mini:Iric cc Scce, SecreIcric ce Fc||Iicc: ce Scce, rec Icnicc
cc Mu|her. - 8rc:||ic: Mini:Iric cc Scce, 2001.
1 p.: i|.
lS8N: 85-334-0355-0
1. Scce - Mu|her - /::i:Incic humcnizccc. 2. FcrIc - /::i:Incic
humcnizccc. 3. /LcrIc - /::i:Incic humcnizccc. l. Fecerccc
8rc:i|eirc cc: Sccieccce: ce Ginecc|cgic e CL:IeIr|cic. ll.
/::cciccc 8rc:i|eirc ce CL:IeIrize: e Enfermeirc: CL:IeIrc:. lll. I|Iu|c.
CDU 18.2
NLM WC 200 D8 8
5
/::i:Iir c: mu|here: nc mcmenIc cc pcrIc e nc:cimenIc
ccm :egurcnc e cigniccce ccmprcmi::c
funccmenIc| cc Mini:Iric cc Scce.
C Frcgrcmc ce Humcnizccc nc Fr-ncIc| e
Nc:cimenIc e:IcLe|ece c: princ|pic: cc cIencc ue
ceve :er pre:Iccc e excrIc e:Iccc:, munic|pic: e
:ervic: ce :cce c cumprirem :eu pcpe|, prcpicicncc
c cccc mu|her c cireiIc ce ciccccnic mci: e|emenIcr,
ccr c |uz, receLencc umc c::i:Incic humcnizccc e
ce Lcc uc|iccce.
C Mini:Iric cc Scce cpre:enIc e:Ic puL|icccc ccm
c cLjeIivc ce ci::emincr ccnceiIc: e prcIicc: cc
c::i:Incic cc pcrIc enIre c: prcfi::icnci: ce :cce.
FreIence, principc|menIe, inIegrcr c ccpcciIccc
Icnicc c nece::cric humcnizccc cc prcce::c ce
cIencc c mu|her curcnIe c ge:Iccc e c pcrIc.
De:Ic fcrmc, :erc pc::|ve| re:gcIcr pcrc mu|here: e
prcfi::icnci: ce :cce c :ingu|criccce cenIe mcmenIc.
JOS SEkkA
APRESENTAO
7
FG. N
Fre|c|o - Humcnizccc cc cIencc cL:IIricc
1. DireiIc: reprccuIivc:, :cce mcIernc e perincIc| 11
2. /Iencc in:IiIucicnc| cc pcrIc 17
3. Frepcrcncc c mu|her pcrc c pcrIc 2
4. /vc|iccc cr|Iicc cc Iipc ce pcrIc 32
5. /::i:Incic c mu|her nc IrcLc|hc ce pcrIc 38
. U:c cc pcrIcgrcmc nc cccmpcnhcmenIc cc IrcLc|hc ce pcrIc 45
7. /ccmpcnhcmenIc cc mu|her curcnIe c IrcLc|hc ce pcrIc{SupcrIe 4
p:icc::ccic|)
8. C ccnIrc|e cc ccr nc IrcLc|hc ce pcrIc 8
. /::i:Incic c mu|her nc pcrIc ncrmc| 77
10. /::i:Incic c mu|her nc pcrIc pcr ce:crec 87
11. /::i:Incic c mu|her nc pcrIc fcrcipe
12. /ne:Ie:ic em CL:IeIr|cic 101
13. /::i:Incic c mu|her nc pcrIc ce ge:Icce: ce c|Ic 112
ri:cc
14. lncucc cc pcrIc 11
15. /::i:Incic imecicIc cc recm-nc:cicc 128
1. /|eiIcmenIc mcIernc 135
17. /::i:Incic c mu|her ccm cLcrIcmenIc e nc pc:- 145
cLcrIc
18. /::i:Incic c mu|her pcrIcccrc cc HlV curcnIe c pcrIc 158
e puerpric
1. /::i:Incic c mu|her nc ucrIc per|ccc 18
20. /::i:Incic c mu|her nc puerpric 175
21. Evicncic: cienIificc: :cLre c: prcIicc: uIi|izccc: nc 182
pcrIc
22. Feferncic: LiL|icgrcficc: 10
SUMRIO
9
C ccnceiIc ce cIencc humcnizccc cmp|c e
envc|ve um ccnjunIc ce ccnhecimenIc:, prcIicc: e
cIiIuce: ue vi:cm c prcmccc cc pcrIc e cc
nc:cimenIc :cuccvei: e c prevencc cc mcrLi-
mcrIc|iccce mcIernc e perincIc|. lnicic-:e nc pr-ncIc|
e prccurc gcrcnIir ue c euipe ce :cce rec|ize
prccecimenIc: ccmprcvcccmenIe Lenficc: pcrc c
mu|her e c LeL, ue eviIe c: inIervence:
ce:nece::cric: e ue pre:erve :uc privcciccce e
cuIcncmic.
/ grcvicez e c pcrIc :cc evenIc: :ccici: ue inIegrcm
c vivncic reprccuIivc ce hcmen: e mu|here:. E:Ie
um prcce::c :ingu|cr, umc experincic e:pecic| nc
univer:c cc mu|her e ce :eu pcrceirc, ue envc|ve
IcmLm :uc: fcm||ic: e c ccmuniccce. / ge:Iccc,
pcrIc e puerpric ccn:IiIuem umc experincic
humcnc cc: mci: :ignificcIivc:, ccm fcrIe pcIencic|
pc:iIivc e enriuececcrc pcrc Iccc: ue ce|c
pcrIicipcm.
C: prcfi::icnci: ce :cce :cc, ccccjuvcnIe: ce:Ic
experincic e ce:empenhcm impcrIcnIe pcpe|. Im c
cpcrIuniccce ce cc|cccr :eu ccnhecimenIc c :ervic
cc Lem-e:Icr cc mu|her e cc LeL, reccnhecencc c:
mcmenIc: cr|Iicc: em ue :uc: inIervence: :cc
nece::cric: pcrc c::egurcr c :cce 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:cincic ce::c re:pcn:cLi|iccce.
CcnIucc, ce:empenhcr e:Ie pcpe| ncc fcci|. /
mcicric cc: prcfi::icnci: v c ge:Iccc, c pcrIc, c
cLcrIc e c puerpric ccmc um prcce::c
preccmincnIemenIe Lic|cgicc cnce c pcIc|cgicc
mci: vc|crizccc. DurcnIe :uc fcrmccc, ccenc: e
inIerccrrncic: :cc enfcIizccc: e c: Icnicc:
inIervencicni:Ic: :cc ccn:icerccc: ce mcicr
impcrIcncic. EnIreIcnIc, c ge:Iccc um prcce::c
ue gerc|menIe ceccrre :em ccmp|iccce:. C:
e:IuccnIe: :cc Ireinccc: pcrc cccIcr prcIicc:
rcIineirc:, ccmc numc |inhc ce prccucc, :em c
PREFCIO
HUMANIZAO DA ASSISTNCIA OBSTTRICA
HUMANIZAO DA ASSISTNCIA OBSTTRICA
10
cvc|iccc cr|Iicc cc:c c cc:c. Di:Ic ceccrre um grcnce nmerc ce
inIervence: ce:nece::cric: e pcIencic|menIe icIrcgnicc:.
Feccnhecer c incivicuc|iccce 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 IcmLm re|cce: menc: ce:iguci: e menc: cuIcriIcric:, nc
mecicc em ue c prcfi::icnc| em |ugcr ce c::umir c ccmcncc cc
:iIuccc pc::c c cccIcr ccncuIc: ue Ircgcm Lem-e:Icr e gcrcnIcm c
:egurcnc pcrc c mu|her e c LeL.
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|ccc prcfi::icnc| ce :cce/mu|her nece::cric
umc muccnc 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
experincic:, ccm ncvc: Icnicc:, prcIiccr umc mecicinc Lc:eccc em
evicncic:, ccm c c|hcr cc cL:ervcccr cIenIc. Feccnhecer ue c
grcvicc c ccncuIcrc cc prcce::c e ue grcvicez ncc ccenc. E,
principc|menIe, cccIcr c Iicc ccmc pre::upc:Ic Lc:icc nc prcIicc
prcfi::icnc|.
11
Sode no contexto soc|o-cu|turo|
/ :cce ncc ceve :e re:Iringir cc Irccicicnc| ccnceiIc
ce prevencc, cicgnc:Iicc, IrcIcmenIc e recLi|iIccc,
mc: ceve :er cLcrcccc IcmLm nc ccnIexIc cu|Iurc|,
hi:Icricc e cnIrcpc|cgicc, cnce e:Icc c: inciv|cuc: ue
:e uerem ver :cuccvei: cu |ivre: ce ccenc:. E::c
cLcrccgem funccmenIc| cc :e cnc|i:cr c ue:Icc
cc :cce cc mu|her Lrc:i|eirc, em e:pecic| ccue|c ce
mencr rencc, pci: e:Ic Iem ccrncic: mcrcccc:
ccui|c ue :e chcmc ce nece::iccce: Lc:icc:, ue
inIerferem nc :uc :cce e :eu Lem-e:Icr. E:Ie mu|her
ccrece, freenIemenIe, ce c|imenIccc, mcrccic,
IrcLc|hc cignc e cceucccmenIe remunerccc,
ecucccc, cu|Iurc, |czer, cenIre cuIrc:.
EvicenIemenIe, e::c ccenc :ccic| - ue cccmeIe
um nmerc expre::ivc ce mu|here: - ceIerminc cu
cgrcvc ccncice: Lic|cgicc: e p:icc|cgicc: ue pcem
em ri:cc :uc vicc, :uc :cce e :eu Lem-e:Icr.
ccm e::c cLrcngncic ccnceiIuc| ue :erc pc::|ve|
icenIificcr e:IrcIgic: e prcgrcmc: ce :cce ue
pc::cm recuzir c ci:Icncic enIre c: vc:Ic: e
impcrIcnIe: ccnhecimenIc: cienI|ficc: e Iecnc|cgicc:
ccuiricc: ne:Ie :cu|c e :uc |imiIccc cp|icccc, ccm
umc vi:cc humcn|:Iicc, nc prcmccc cc :cce cc:
pe::cc:.
EvicenIemenIe, ncc :e pcce cgucrccr ue c:
mecicc: e:IruIurci: nece::cric: c ccrrecc 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 :cce :e mcLi|ize nc
ccrrecc 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 :cce ce ceIerminccc: grupc: pcpu|ccicnci:, ncc
:e percc c cimen:cc cc rec| prcfunciccce cc
inIerferncic ce::c: ue:Ice: pc||Iicc-eccncmicc: e
:ccici: nc e:Iccc ce :cce ce cccc cicccc e
ciccccc Lrc:i|eirc:.
1 DIREITOS REPRODUTIVOS, SADE MATERNA E PERINATAL
DIREITOS MATERNOS, SADE MATERNA E PERINATAL
12
Sode |em|n|no. Determ|nontes
Nc cc:c cc mu|her, ccre:ce-:e c prcL|emcIicc jc exp|iciIccc, ue:Ice:
IcmLm ccmp|exc:, re|ccicnccc: c: re|cce: ce gnerc, ce ncc Icc
:imp|e: re:c|ucc, pcr ref|eIirem pccrce: cu|Iurci: ccmincnIe: nc
:ccieccce. / cefinicc ce icenIiccce :exuc| ccmc fcIcr eminenIemenIe
Lic|cgicc, em ue c: ccrccIer|:Iicc: cncIcmicc:, fi:i c|cgicc: e hcrmcnci:
cefinem mcchc e fmec, pcr cemci: e:IreiIc pcrc cLcrccr c
IcIc|iccce cc: univer:c: mc:cu|inc e femininc. / icenIiccce cu|Iurc| ce
gnerc e ccn:Iru|cc nc Iempc e nc e:pcc, cricncc e:IerecIipc: ce
pcpi: ciferenciccc:, mcrcccc: pe|c: inIere::e: imecicIc: cc:
:ccieccce: nc: ciferenIe: mcmenIc: hi:Icricc:. Ao |ongo dos scu|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 pr-
ceIerminc fcrmc: ce ccnhecimenIc e ccc, nc crec cc :cce inc|u:ive,
ue evicencicm :eu ccrcIer pcIricrcc|.
E::e: ceIermincnIe: hi:Icricc-:ccici: vm :e ref|eIincc, cc |cngc cc:
Iempc:, nc cIuccc mcicc nc: ue:Ice: re|ccicnccc: c :cce cc
mu|her: c exc|Iccc cc mcIerniccce - ci:cur:c ccmincnIe c pcrIir cc
:cu|c XlX - Ircuxe nc :eu Lcjc ncc c prcIecc cc mu|her cc:
vu|nercLi|iccce: c ue e:Ic expc:Ic nc prcce::c ce mcnuIencc cc
e:pcie, mc: c perpeIuccc cc: re|cce: 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 :cu|c XlX, ucncc emergicm e :e ccn:c|iccvcm e::e:
ccnceiIc:, inicicu-:e c inIerferncic cc E:Iccc, ccm um prcce::c ce
expcn:cc cc c::i:Incic mcicc nc 8rc:i|, cnIe: exercicc uc:e
exc|u:ivcmenIe nc fcrmc |iLerc| cu fi|cnIrcpicc. /|gun: prcgrcmc: ce
:cce cirigicc: c grupc: pcpu|ccicnci: e:pec|ficc: ccmecrcm c :er
ce:envc|vicc:, enIre e|e: c c::i:Incic pr-ncIc|. E:Ic c::i:Incic
c::cciccc c in:IiIucicnc|izccc cc pcrIc Ieve pcr cLjeIivc ce:envc|ver
um recm-nc:cicc :cuccve| e recuzir c: e|evccc: Icxc: ce mcrIc|iccce
infcnIi| ue exi:Iicm nc finc| cc :cu|c pc::ccc e nc primeirc meIcce
ce:Ie. Cu :ejc, c c::i:Incic pr-ncIc| :urgiu ccmc um prcce::c ce
puericu|Iurc inIrc-uIerinc, ccmc umc preccupccc :ccic| ccm c
cemcgrcfic e ccm c uc|iccce cc: cricnc: nc:cicc:, e ncc ccmc
prcIecc c mu|her.
C primeirc Ccngre::c 8rc:i|eirc ce FrcIecc c lnfcncic {122)
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 pccc, e
reccmencc c inIervencc cc E:Iccc cIrcv: cc cLerIurc ce
mcIerniccce: e creche: e cc :everc vigi|cncic cc c|eiIcmenIc
1
DIREITOS MATERNOS, SADE 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
pccc, c: mu|here: erc negccc cu cificu|Iccc c cce::c c ecucccc
fcrmc|.
Fci ccm e::e: ccnceiIc:, muiIc: veze: euivccccc:, ue :e expcnciu nc
8rc:i| c c::i:Incic pr-ncIc|. E e::c cenIrc|izccc cc cIencimenIc c
:cce cc mu|her nc e:ferc exc|u:ivc cc cic|c grcvicc-puerperc|
perpeIucu-:e cI muiIc recenIemenIe. / cmp|iccc cc cferIc ce
:ervic: ce cIencc c mu|her, c pcrIir cc finc| cc: cnc: 0, cincc ncc
Iinhc pcr cLjeIivc c cIencimenIc cLrcngenIe ce :uc: nece::iccce: ce
:cce. Fci c cre:cimenIc pcpu|ccicnc| ue cccrric nc: pc|:e:
:uLce:envc|vicc: c mcIivcccr ce inve:IimenIc: inIernccicnci: ue
ci:pcniLi|izcrcm mIccc: e Icnicc: mccernc: ce ccnIrccepcc
cirigicc: c: pcpu|cce: pcLre:.
A mu|her e o espoo po|t|co
EmLcrc c :eIcr pL|icc nc 8rc:i| cincc ccnIinuc::e privi|egicncc c
cIencc c ge:IcnIe, nc Ircn:icc cc: ccccc: 0/70, ccmecrcm c
:urgir c: enIiccce: ciIc: ncc-gcverncmenIci: ue ce:envc|vicm
prcgrcmc: verIicci: ce p|cnejcmenIc fcmi|icr, :em cuIrc: cuicccc: c
:cce cc: mu|here:. / criccc cc Sccieccce Civi| ce 8em-E:Icr Fcmi|icr
{8ENF/M) e :uc cmp|c cIuccc nc Sccieccce Lrc:i|eirc nc ccccc ce
70 c exemp|c mci: c|crc ce::e per|ccc. Menc: c|crc, enIreIcnIc, ficc c
ccmpreen:cc ce pcrue, 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:pcc: vczic: ce nc::c IerriIcric em ncme cc :egurcnc
nccicnc| -, fci pc::|ve| c prc|iferccc 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 cI c: cic: cIuci: - cerIcmenIe ncc Ircuxe Lenef|cic: c:
mu|here:, ncvcmenIe Ircn:fcrmccc: em c|vc ce prcgrcmc: ue ncc
cLjeIivcvcm :uc :cce, nem :eu Lem-e:Icr.
Ccmc reccc c e::c prcIicc, c: e:uercc: Lrc:i|eirc: inicicrcm
mcvimenIc ccnIrcric: c cpc:icc cc p|cnejcmenIc fcmi|icr e cc ccnIrc|e
cc ncIc|iccce, cuc: e:IrcIgic: ue, emLcrc Ienhcm :ignificccc:
ciferenIe:, :uperpunhcm-:e ne::c pccc, Iencc c primeirc empre:Iccc
:eu ncme pcrc cmenizcr c impccIc pc||Iicc cc imp|cnIccc :uL|imincr
cc :eguncc.
NcvcmenIe, e::e cnIcgcni:mc ncc Ircuxe Lenef|cic: pcrc c: mu|here:.
EnucnIc c: c||nicc: privccc: ce p|cnejcmenIc fcmi|icr prc|ifercvcm e
ci:pcniLi|izcvcm ccnIrccepcc, 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:
cce: ce :cce nc rece Lc:icc. / :ccieccce Lrc:i|eirc vivic nc:
ccccc: ce 0 e 70 um riImc ce incu:Iric|izccc e urLcnizccc
cce|erccc e, ce::e prcce::c, re:u|Icrcm mccificcce: nc: expecIcIivc:
reprccuIivc: cc: Lrc:i|eirc: ue, ccm c|gumc:
1
DIREITOS MATERNOS, SADE MATERNA E PERINATAL
14
ccccc: ce cIrc:c e Ic|vez mcIivccc: pcr ceIermincnIe: ci:IinIc:
ccue|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 mIccc: cnIiccncepcicnci:,
cincc ue ncc fc::em c: iceci:. Ncc pcce Ier :icc cuIrc c rczcc ue
cu|minc nc ccccc ce 0 ccm umc prcIicc ce p|cnejcmenIc fcmi|icr ce
c|Ic prevc|ncic e Lcixc uc|iccce.
C re::urgimenIc cc mcvimenIc femini:Ic c pcrIir cc meIcce ce:Ie :cu|c
Ircuxe cc ceLcIe ncvc: ccncepce: cc: re|cce: enIre c: gnerc: e
cc: re|cce: enIre c :er humcnc e c :ccieccce. lnicic|menIe cccIcncc
umc pc:Iurc ce pc|crizccc/cnIcgcni:mc enIre c: :exc:, c pen:cmenIc
femini:Ic evc|uiu ne:Ie finc| ce :cu|c pcrc umc pc:icc mci: ccn:IruIivc,
ce e:I|mu|c c cccperccc/ccmpcnheiri:mc e c vc|crizccc cc
incivicuc|iccce ce cccc um cc: gnerc:, :em exc|u:ce:.
EvicenIemenIe, c: ccnui:Ic: cc femini:mc nc 8rc:i| e nc muncc :cc
:ignificcIivc: e Im permiIicc umc evc|ucc cc :ccieccce em re|ccc
cc reccnhecimenIc cc: cireiIc: ce ciccccnic iguc|iIcric: enIre hcmen: e
mu|here:, IcmLm nc ccmpc cc :cce.
EnIreIcnIc, e cpe:cr ce::c: impcrIcnIe: ccnui:Ic:, cL:ervc-:e hcje ue
c uc:e IcIc|iccce cc: inicicIivc: re|ccicnccc: c :cce 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 Ii| pcrc c pccer :ccic|
vigenIe. E, Ic|vez pcr i::c, muiIc: ce::c: inicicIivc: ncc Ienhcm |cgrccc
:uce::c nc me|hcric cc :cce cc: mu|here:, inc|u:ive pcrue in:i:Iem em
exprcpricr cc mu|her :uc cuIcceIerminccc. /: e|evccc: Icxc: ce
mcrIc|iccce mcIernc e perincIc|, c u:c cLu:ivc cc ce:crec e c c|Ic
prevc|ncic ce mu|here: e:Ieri|izccc: cu u:cncc mIccc:
cnIiccncepcicnci: incceuccc: :cc exemp|c: c|crc: ce::c: ci:Icrce:.
A med|co||zoo do corpo |em|n|no
C 8rc:i| ccupcu, cI hc pcucc, c nccc invejcve| pc:icc ce ccmpcc
muncic| ce cpercce: ce:cricnc:. Se, por um |odo, o cesreo reo||zodo
por rozes md|cos tem um gronde potenc|o| de reduz|r o morb|-
morto||dode moterno e per|noto|, por outro |odo, o exogero de suo
prt|co tem e|e|to oposto, |nc|us|ve por consum|r recursos prec|osos do
s|stemo de sode. E::c prcfuncc ci:Icrcc nc prcIicc mcicc Lrc:i|eirc
ceIerminccc pcr m|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 gne:e ce::c permi::iviccce. Ehrenreich &
Eng|i:h cpcnIcm pcrc c pccer cc mecicinc em Ircn:fcrmcr evenIc:
fi:ic|cgicc: em ccenc:: c mecicc|izccc cc ccrpc femininc - ue IrcIc
c grcvicez e c mencpcu:c ccmc ccenc, Ircn:fcrmc c men:Iruccc em
ci:IrLic crcnicc e c pcrIc em um evenIc cirrgicc - 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, SADE 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 cfirmccc - ncc :e pcce negcr c ccnIriLuicc
cc mecicinc em gerc|, e cc ginecc|cgic e cL:IeIr|cic em pcrIicu|cr, nc
me|hcric cc: ccncice: ce :cce e ce vicc cc: mu|here: -, muiIc: cc:
ci:Icrce: hi:IcriccmenIe cL:ervccc:, ccmc, pcr exemp|c, c epicemic
ce hi:IerecIcmic: nc: EU/ nc: ccccc: ce 0 e 70 cu c exce::c ce
ce:crec: nc 8rc:i|, ref|eIem excIcmenIe e::c: inIer-re|cce: enIre c:
ue:Ice: ce gnerc e c prcIicc mcicc.
E nece::cric c ccmpreen:cc ce::c: inIer-re|cce: pcrc ue :e pc::c
perceLer pcrue c 8rc:i| cincc cpre:enIc inciccccre: inccmi::|vei: ce
mcrIc|iccce mcIernc e mcrIc|iccce perincIc|, muiIc c|m ccue|c
e:perccc pcrc :eu n|ve| ce ce:envc|vimenIc e um exerc|cic
freenIemenIe euivccccc cc: cireiIc: reprccuIivc: pcr pcrIe ce :uc:
cicccc:.
/ reprccucc cfeIc c mu|her ce umc fcrmc ue Ircn:cence c: civi:ce:
ce c|c::e e permeic Iccc: c: :uc: cIiviccce:: :uc ecucccc, :eu
IrcLc|hc, :eu envc|vimenIc pc||Iicc e :ccic|, :uc :cce, :uc :exuc|iccce,
enfim, :uc vicc e :eu: :cnhc:. nece::cric ue :e ceixe ce rcmcnIizcr c
pccer ue pcce exi:Iir cc ccnexcc Lic|cgicc cc mu|her ccm c
McIerniccce. 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: muiIc menc: c re:u|Iccc ce :uc ccncicc
Lic|cgicc e, ccimc ce Iucc, ceIerminccc pe|c crgcnizccc :ccic| e
cu|Iurc|. E ncc :e pcce ceixcr ce reccnhecer ue e::c crgcnizccc Iem,
cI hcje, Lu:cccc cercecr c: e:fcrc: cc: mu|here: pcrc gcnhcr um
pcucc ce e:pcc 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 Iencncic c
ccnIe:Iccc ce um mcce|c ce ce:envc|vimenIc ue privi|egic c crcem
hiercruicc, ccn:umi:Ic e Iecnc|cgicc. E::c ccnIe:Iccc evicenIe nc:
mcvimenIc: ce prcIe:Ic ccnIrc c: :ccieccce: ce mcce|c pc||Iicc
cuIcriIcric, nc cfirmccc cc |iLerccce e cc cemccrccic e nc
fcrIc|ecimenIc ce umc ccrrenIe pre:ervccicni:Ic, ecc|cgicc, em
cpc:icc c Irccicicnc| cIiIuce ccmincccrc e cprcpricIivc ceIerminccc
pe|c mccc ce prccucc. :cL c cIicc ce::e mcvimenIc ce
Ircn:fcrmccc ue ceve cccrrer umc ncvc ref|excc :cLre c :cce cc
mu|her. Fensor sobre o mu|her e suo sode 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, SADE MATERNA E PERINATAL
16
Ncc :e pcce negcr c: ccnIriLuice: ue c: cvcnc: Icnicc-cienI|ficc:
Ircuxercm c humcniccce e c mu|her em e:pecic|. E::e: cvcnc: cLrircm,
IecriccmenIe, e:pcc: pcrc ue c mu|her :e Icrnc::e ccnc ce :eu ccrpc
e ce :eu ce:Iinc. C: mIccc: ccnIrccepIivc: prcvcccrcm muccnc:
uc|iIcIivc: nc vicc cc mu|her c pcrIir cc: cnc: 0, fcvcrecencc c
vivncic cc :exuc|iccce :em c cnu: cc grcvicez ince:ejccc. Fcrm, 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 reprccucc humcnc e ncc |he cc cce::c c
infcrmcce: :cLre cireiIc: reprccuIivc:.
/ ce:vincu|ccc enIre vicc :exuc| e reprccucc, em vez ce
prcpcrcicncr c |iLerccce femininc, Iem :e cpre:enIccc ce fcrmc c cricr
crIimcnhc: ue pre:ervcm c: IcLu: e c inccn:cincic, ceixcncc
inc|Ierccc c mcce|c Irccicicnc| ce impc:icc ce c|IerncIivc: c mu|her.
E:IcI|:Iicc: recenIe: cemcn:Ircm um nmerc expre::ivc ce |cueccurc:
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 nmerc ce:ccnhecicc, mc:, :egurcmenIe ncc
ce:prez|ve|, ce mcrIe:.
E::e: fcIc: reve|cm ccnIrccice: nc :ccieccce, ue :e reprccuzem nc
:i:Iemc ce :cce e, mci: inIen:cmenIe, nc cIencimenIc c :cce cc
mu|her, IcnIc nc ue :e refere cc ce:empenhc cc :i:Iemc ce :cce,
ucnIc c inciccccre: ce :cce ue ref|eIem incireIcmenIe c uc|iccce
ce vicc cc pcpu|ccc {prcLcLi|iccce ce mcrIe e e:percnc ce vicc cc
nc:cer). Fcrc c ce:envc|vimenIc ce umc pc||Iicc eficcz ce cIencc
inIegrc| c :cce ue, :em cvicc, imp|iccrc c mcic e |cngc prczc em
me|hcric cc uc|iccce cc vicc humcnc, preci:c ccn:icercr e::c:
ue:Ice:.
Um ncvc ccnceiIc ce :cce ue ccn:icere c ccn:cincic p|enc ce
ciccccnic cc: inciv|cuc: exige ncvc: pc:ice: e, pcrIcnIc, ncvc:
crcencmenIc: cu|Iurci:. / humcnizccc cc nc:cimenIc - :c pc::|ve| :e
cicccc: e ciccccc:, prcfi::icnci: ce :cce e ge:IcnIe:, :ccieccce em
gerc|, c::imi|crem e::e: ccnceiIc: - pcce :er c primeirc pc::c.
1
17
C nc:cimenIc hi:IcriccmenIe um evenIc ncIurc|.
Ccmc inci:cuIive|menIe um fencmenc mcLi|izcccr,
me:mc c: primeirc: civi|izcce: cgregcrcm, c e:Ie
cccnIecimenIc, inmerc: :ignificccc: cu|Iurci: ue
cIrcv: ce gercce: :cfrercm Ircn:fcrmcce:, e cincc
ccmemcrcm c nc:cimenIc ccmc um cc: fcIc:
mcrccnIe: cc vicc.
/I c: impcrIcnIe: muccnc: cc mccu: vivenci cc
per|ccc incu:Iric|, c: vivncic: cc pcrIc fcrcm, nc:
mci: ciferenIe: cu|Iurc:, ce ccrcIer |nIimc e privccc,
:encc umc experincic ccmpcrIi|hccc enIre mu|here:.
/ imen:c mcrIc|iccce mcIernc e perincIc| ccmecu
enIcc c :er ci:cuIicc, nc e:ferc pL|icc, pcr umc
nece::iccce pc||Iicc-eccncmicc ce gcrcnIir exrciIc:
e IrcLc|hcccre:. /c |ccc ce:Ic: Ircn:fcrmcce:
:ccici:, c cL:IeIr|cic firmcvc-:e ccmc mcIric mcicc
e cccrricm c: primeirc: cce: vc|Iccc: c ci:cip|incr c
nc:cimenIc.
/ pcrIir cc|, c: muccnc: 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 pL|icc, ccm c pre:enc ce cuIrc: cIcre:
:ccici:.
/ mcicric cc: mu|here: ue cI 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
IcmLm c :er cLjeIc cc inIere::e mcicc e Ier :eu:
pcrIc: cIencicc: cu cL:ervccc: pcr prcfi::icnci:
cficic|menIe prepcrccc: pcrc e:Ie fim, ccmc c:
enfermeirc:-pcrIeirc: e c: mcicc:.
Nc 8rc:i|, c prcce::c ce in:IiIucicnc|izccc cc pcrIc,
cc |cngc cc ccccc ce 40, fci prcvcve|menIe c
primeirc ccc ce :cce pL|icc cirigicc c mu|her. /I
c in|cic cc: cnc: 0, c preccupccc ccm c :cce
mcIernc :e re:Iringiu c c::i:Incic cc pcrIc. Ccm c
inIrccucc cc mecicinc prevenIivc nc pc|: e c
criccc cc: cenIrc: ce :cce, inicicrcm-:e c:
prcgrcmc: ce pr-ncIc| ue, nc rec|iccce, Iinhcm
ccmc cLjeIivc principc| recuzir c mcrIc|iccce infcnIi|.
2 ATENO INSTITUCIONAL AO PARTO
ATENO INSTITUCIONAL AO PARTO
18
Nc: cnc: 80, cccrrercm c|gumc: inicicIivc: |ccci: vc|Iccc: pcrc c
recucc cc mcrIc|iccce mcIernc, :encc umc cc: mci: impcrIcnIe: c
prcjeIc ce:envc|vicc pcr Gc|Lc ce /rcjc nc Cecrc pcrc inIegrcr c:
pcrIeirc: |eigc: cc :i:Iemc |ccc| ce :cce, ce mccc c me|hcrcr c
c::i:Incic, recuzincc ri:cc: e re:peiIcncc c cu|Iurc |ccc|.
Em 184, IcmLm em re:pc:Ic c cemcncc cc mcvimenIc crgcnizccc ce
mu|here:, fci in:IiIu|cc c Frcgrcmc ce /::i:Incic lnIegrc| c Scce c
Mu|her {F/lSM) ue inc|u|c c c::i:Incic pr-ncIc|, enIre cuIrc:. /
imp|cnIccc ce:Ie prcgrcmc cccrreu ce mccc heIercgnec nc pc|:,
:encc cif|ci| cvc|icr :eu impccIc g|cLc| :cLre c :cce cc mu|her, cccc c
ccmp|exiccce cc: cce: e c grcnce ccnjunIc ce vcricvei: envc|vicc:.
Em 1, c Mini:Iric cc Scce, em pcrceric ccm FE8F/SGC, UNlCEF e
CF/S, |cncu c FrcjeIc McIerniccce Segurc ue preIencic recuzir c
mcrIc|iccce mcIernc e perincIc|, cIrcv: cc me|hcric cc c::i:Incic cc
pcrIc e cc recm-nc:cicc.
EmLcrc e:Ic: inicicIivc: e cuIrc: em cmLiIc municipc| e e:Iccuc| Ienhcm
:icc ce:envc|vicc: nc: |Iimc: cnc:, prcL|emc: permcnecem nc
:i:IemcIizccc cc c::i:Incic c ge:Iccc e cc pcrIc, ce:re:peiIcncc
cireiIc: Lc:icc: cc ciccccnic e cc|cccncc em ri:cc c vicc ce mu|here: e
recm nc:cicc:. EnIre e|e:, e:Icc c :egmenIccc enIre c rece Lc:icc e
hc:piIc|cr e c inIervene
-
cc exce::ivc :cLre c pcrIc.
/ re|ccc enIre c: cIiviccce: cc cIencc Lc:icc e c: hc:piIc|cre:
ceveric :er ce ccnIinuiccce e ccmp|emenIcrieccce. EnIreIcnIc, nc pr-
ncIc|, ue c mcmenIc mci: cprcpriccc pcrc c prepcrccc cc pcrIc e
ceIeccc ce pc::|vei: c|Iercce: cc ge:Iccc, 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 m: - cnce :e
cgrcvcm ccenc: ccmc c hiperIen:cc e cicLeIe: - :em :cLer c ue
:ervic reccrrer frenIe c umc inIerccrrncic cu nc mcmenIc cc pcrIc.
A med|co||zoo do oss|stnc|o oo porto
/ c::i:Incic c mu|her nc mcmenIc cc pcrIc cLjeIc ce grcnce
mecicc|izccc. /pe:cr cc hc:piIc|izccc 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::pIicc pcrc
c: prcfi::icnci: ce :cce. C ccnf|iIc gerccc c pcrIir ce:Ic Ircn:fcrmccc
inf|uencic c: mu|here:, enIre cuIrc: fcIcre:, c ue:Iicncr c :egurcnc cc
pcrIc ncrmc| frenIe cc cirrgicc, mci: |impc, mci: rcpicc, mci:
cienI|ficc. /|m ci::c, e:Iucc: jc ccmprcvcrcm ue c vic|ncic
in:IiIucicnc| IcmLm exerce inf|uncic nc e:cc|hc ce grcnce pcrIe cc:
mu|here: pe|c ce:crec. preci:c |evcr em ccnIc um fcIcr muiIc
ceLcIicc: uem c prcIcgcni:Ic cc cenc cc pcrIc / mu|her-
pcrIurienIe e:Ic cccc vez mci: ci:IcnIe ce:Ic ccncicc: IcIc|menIe
in:egurc, :uLmeIe-:e c Iccc: c: crcen: crienIcce:, :em enIencer ccmc
ccmLincr c pccer ccnIicc nc:
2
ATENO INSTITUCIONAL AO PARTO
19
cIiIuce: e pc|cvrc: ue cuve e perceLe, ccm c fcIc inexcrcve| ce ue
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|izccc ue c ccrpc femininc
:cfreu nc: |Iimc: ccccc:. De:Ic fcrmc, e:Ic ci:cu::cc ncc pcce e:Icr
ce:vincu|ccc cc c::i:Incic, pcrue mci: umc vez :e e:Icric repeIincc c
exc|u:cc ue c mu|her :cfre nc mcmenIc cc pcrIc em re|ccc c :uc
prcpric cuIcncmic.
Exemp|c ce:Ic :iIuccc c ue ciz re:peiIc cc u:c exce::ivc cc
ce:cricnc nc: |Iimc: Ir: ccccc:. 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|izccc c|cnce:Iinc cc
|cueccurc IuLcric nc mcmenIc cc pcrIc. /pc: cnc: ce:Ic prcIicc,
in:IiIuiu-:e umc cu|Iurc prc-ce:crec nc pcpu|ccc em gerc| e enIre c:
mcicc:. Ccmc ccn:encic, pcrIe impcrIcnIe cc: cL:IeIrc: ncc :e
enccnIrc :uficienIemenIe mcIivccc, e cI me:mc ccpcciIccc, pcrc c
cccmpcnhcmenIc cc pcrIc ncrmc|. Fcr :uc vez, em umc re|ccc
mcicc-pccienIe c::imIricc, c: mu|here: Im 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: Icnicc:
|evcnIccc: pe|c: mcicc:.
/ c::i:Incic hc:piIc|cr cc pcrIc ceve :er :egurc, gcrcnIincc pcrc cccc
mu|her c: Lenef|cic: cc: cvcnc: 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|stnc|o oo porto no SbS
Nc Si:Iemc Unicc ce Scce, c c::i:Incic in:IiIucicnc| cc pcrIc
rec|izccc cIuc|menIe cIrcv: 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 frencic nc cnc ce 1 e c :eguncc
prccecimenIc ce mcicr impccIc fincnceirc. Nc 8rc:i|, c c::i:Incic c
mu|her nc mcmenIc cc pcrIc em grcnce pcrIe hc:piIc|cr, ccm
ciferenIe: percenIuci: pcrc cccc regicc.
/ Fe:ui:c Nccicnc| :cLre Demcgrcfic e Scce - FNDS, rec|izccc em
1, mc:Irc e:Ie: percenIuci:, ccnfcrme uccrc c :eguir:
2
ATENO INSTITUCIONAL AO PARTO
20
E:Ie: cccc: ref|eIem c: ciferenIe: ccncice: ce cce::c e crgcnizccc
cc: :ervic: em cccc regicc. / pe:ui:c cc FNDS mc:Irc ue nc regicc
NcrIe cccrreu c mcicr nmerc ce portos dom|c|||ores, c ue ju:Iificccc
pe|c in:uficienIe rece ce :ervic: ce :cce c|iccc c: ccncice:
gecgrcficc: ue cificu|Icm c cce::c, nc mcicr pcrIe cc: veze:, cpenc:
f|uvic|. EnIreIcnIc, c regicc Ncrce:Ie ue infcrmc c mcicr nmerc ce
pcrIc: ccmici|icre: ncIificccc: cc SUS, ccnfcrme uccrc c :eguir:
Parto Domiciliar SIA - SUS - 1995 a 1999
* Em 1999 os cdigos para parto domiciliar incluem 029 - assist. parto s/ distcia p/ parteira(o) PAB
e 030 - assist. parto s/ distcia p/ enferm. obsttrica(o) PAB - e os dados apresentados so de
10/99.
EmLcrc c nmerc ce pcrIc: ccmici|icre: :ejc re|cIivcmenIe peuenc em
re|ccc 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 ce fcIc ce:ccnhecicc. / mcicric ce:Ic: mu|here:
vive em crec rurc| cu ce cif|ci| cce::c, ccm preccric c::i:Incic c :cce.
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 cIencc hc:piIc|cr nc mcmenIc cc pcrIc. Mc:
impcrIcnIe |emLrcr ue c: cificu|ccce: ce cce::c e:Icc mcnIicc: pcrc
ncIificccc cc cccrrncic cc pcrIc, :encc nece::cric pcncercr e:Ie
cccc. Ccnfirmc e:Ic preccupccc c fcIc ce ue c pe:ui:c cc FNDS-
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|ccc cc IcIc| cc: pcrIc:
cccrricc: nc SUS em 1 fci ce 2.47, e nc regicc NcrIe fci ce 7.77, c
ue ficc Lem cum cc: cccc: cLIicc: pe|c pe:ui:c FNDS {15.37).
EmLcrc c univer:c cc pe:ui:c e c mIccc :ejcm civer:c:, c re|cIc ce
um grcnce nmerc 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 ncIificccc cc SUS ce pcrIc: ccmici|icre: ceveric :er Lem mcicr.
Nc oteno hosp|to|or, c: 4757 uniccce: ue fczem c::i:Incic cc pcrIc
pccem :er c|c::ificccc: ce cccrcc ccm c pcrIe hc:piIc|cr e nmerc ce
pcrIc:. Nc IcLe|c cLcixc, cpre:enIc-:e c c|c::ificccc
2
ATENO INSTITUCIONAL AO PARTO
21
pcr pcrIe ce mcIerniccce, :eguncc c nmerc ce pcrIc:, cccc
funccmenIc| pcrc c ccmpreen:cc ce:Ic c::i:Incic cc pcrIc pcrue :e
re|ccicnc ccm cuc: ue:Ice: funccmenIci:: c cce::c e c ccmp|exiccce
cc cIencc.
Classificao das unidades hospitalares de acordo com o nmero de partos realizados por ano.
Brasil, 1998.
Fonte: SIH/SUS
E:Ie: cccc: inciccm ue 72,27 cc: pcrIc: cccrrem em uniccce: ce
mcic pcrIe {1 c 4 pcrIc: pcr cnc). Nc mcicric cc: munic|pic:, c
re:c|uIiviccce ce:Ic: uniccce: Lcixc, ccu:cncc umc ci:Iccic enIre c
n|ve| ce ccmp|exiccce cc cIencc e c frencic 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|cIccc. C:
:ervic: pL|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
peregrinccc nc mcmenIc cc pcrIc. Cucncc c mu|her e/cu c recm-
nc:cicc nece::iIcm ce cIencc e:pecic| {ge:Iccc ce c|Ic ri:cc,
premcIuriccce), c cificu|ccce em enccnIrcr vcgc: cincc mcicr,
:cmcncc ri:cc:. / cemcrc nc cIencimenIc cL:IIricc Iem
ccn:encic: mcIernc: e necncIci: re|evcnIe:, c|m ce cumenIc
ce:nece::cric ce cu:Ic: pcrc IrcIcmenIc cc: ccmp|iccce:.
E cIriLuicc cc ge:Icr municipc| e e:Iccuc| ccnhecer c re|ccc enIre c
cferIc e c cemcncc pcr |eiIc: cL:IIricc: e p|cnejcr c :i:Iemc ce
cIencimenIc ce:ce c pr-ncIc| cI c pcrIc, ce Lcixc e c|Ic ri:cc. /:
vcgc: cL:IIricc:, nc mc|cric cc: munic|pic:, nece::iIcm :er cvc|iccc:,
em ccnjunIc ccm :uc ccncenIrccc e ci:IriLuicc pcr ccmp|exiccce.
/grcvc c :iIuccc c fcIc ce ue, muiIc: veze:, c ge:Icr |ccc| ncc Iem
ccnIrc|e cc: vcgc:, e:Icncc :uLmeIicc cc: pre:Icccre: ce :ervic |ccc|,
umc vez ue pcrIe cc: munic|pic: ncc Iem |eiIc: cL:IIricc: prcpric:.
2
ATENO INSTITUCIONAL AO PARTO
22
/ ci:IriLuicc cc: hc:piIci: :eguncc c ncIurezc jur|cicc nc 8rc:i|
cpre:enIc c :eguinIe ccmpc:icc:
Ccmc :e cL:ervc ne:Ie grcficc, c: hc:piIci: privccc: e fi|cnIrcpicc:
ccnveniccc: :cmcm 37 cc IcIc| ce :ervic: 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: :ervic:. Em re|ccc e:pec|ficc c: vcgc: cL:IIricc:, e:Ic
ue:Icc mci: ccmp|exc pcrue c evenIc cc pcrIc ccn:icerccc
urgncic e cIuc|menIe preci:c e:Icr cenIrc cc: |imiIe: ce ce:crec:
e:IcLe|ecicc: pcr pcrIcric mini:Ieric|. C fcIc mci: grcve ue c: :ervic:
ccnveniccc: e ccnIrcIccc: cc SUS, ue ceIm c mcicric cc: |eiIc:
cL:IIricc:, e:cc|hem c: pccienIe: ue :ercc ccmiIicc: em IrcLc|hc ce
pcrIc, pricrizcncc c: ce Lcixc ri:cc, pcrc eviIcr c c::i:Incic c:
inIerccrrncic: cc mce e cc recm-nc:cicc, ue repre:enIcrcc um cu:Ic
mcicr, e pcrc recuzir c nmerc ce ce:cricnc:.
Classificao dos hospitais com leitos obsttricos (maternidades), segundo nmero de partos
anuais e natureza jurdica. Brasil, fevereiro de 1998.
Fonte: Sistema de Informaes Hospitalares (SIH/SUS)
2
ATENO INSTITUCIONAL AO PARTO
!"
cenIrc ce:Ie ccnIexIc ue c Mini:Iric cc Scce, exercencc :eu pcpe|
ncrmcIizcccr e regu|cccr, vem imp|cnIcncc um ccnjunIc ce cce:,
cIrcv: ce pcrIcric: mini:Ierici: ccm c cLjeIivc ce e:Iimu|cr c me|hcric cc
c::i:Incic cL:IIricc. / cnc|i:e ce:Ic: pcrIcric:, e em c|gun: cc:c: ce
:eu: impccIc: inicici:, ccmpce c pcncrcmc cc c::i:Incic cL:IIricc
cIuc| e permiIe :uc me|hcr ccmpreen:cc.
Fortor|o MSJGM 2.815, de 2 de mo|o de 18
E:Ic pcrIcric inc|ui nc IcLe|c cc Si:Iemc ce lnfcrmcce: 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:Incic
pre:Iccc pcr e:Ic ccIegcric prcfi::icnc|, nc ccnIexIc ce humcnizccc cc
pcrIc. /Iuc|menIe, c nmerc ce enfermeirc: cL:IeIrc: cIucncc nc pc|:
cincc muiIc Lcixc, emLcrc :e e:Iime ue c nmerc ce pcrIc: rec|izccc
:ejc Lem :upericr cue|e regi:Irccc nc SUS. Fcr e:Ic rczcc, c Mini:Iric cc
Scce e:Ic fcmenIcncc Icnicc e fincnceircmenIe c rec|izccc ce
cur:c: ce e:pecic|izccc em enfermcgem cL:IIricc. E:Icc :encc
cpciccc: 55 cur:c: ue cevercc fcrmcr e:pecic|i:Ic: em Iccc pc|:.
/ mcgniIuce ce:Ic ccc prcgrcmcIicc e:Ic repre:enIccc pe|c
ccpcciIccc ce 854 enfermeirc: cL:IeIrc: pcrc c rece cc SUS, cercc ce
507 cc nmerc ce prcfi::icnci: fcrmccc: nc: |Iimc: 20 cnc: pe|c:
in:IiIuice: ce en:inc :upericr Lrc:i|eirc:.
Fortor|os
MSJGM 3.01, de 1 de junho de 18
MSJGM 3.482, de 20 de ogosto de 18
MSJGM 3.477, de 20 ogosto de 18
Ccn:icercncc c impcrIcncic cc cIencc cL:IIricc e perincIc| e c
nece::iccce ce crgcnizccc ce:Ic c::i:Incic, e:Ic: pcrIcric:
ncrmcIizcm c imp|cnIccc ce prcgrcmc: e:Iccuci: ce Feferncic
Hc:piIc|cr pcrc cIencimenIc c gestoo de o|to r|sco. Ccn:IiIui-:e em
mecicc inci:pen:cve| ccrmc principc| cLjeIivc ce gcrcnIir me|hcr
uc|iccce c ge:Iccc 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 cceuccc 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 ccpcciIccc ce prcfi::icnci: ce :cce,
ree:IruIurccc ce crec f|:icc, cui:icc ce euipcmenIc: e
ci:pcniLi|izccc ce mci: |eiIc: cL:IIricc: pcrc cIencc c e::c:
ge:IcnIe:.
Fortor|os
MSJGM 2.81, de 2 mo|o de 18
MSJGM 85, de 03 de ju|ho de 1
MSJGM 4, de 14 de junho de 2000
MSJGM 42, de 04 de obr|| de 2001
E:Ic: pcrIcric: ceIermincm c pogomento de um percentuo| mx|mo de
cesor|onos em re|ccc cc nmerc IcIc| ce pcrIc: ce cccc
2
ATENO INSTITUCIONAL AO PARTO
24
hc:pi Ic| . / i nIrccucc, em 18, ce:Ie: | i mi Ie: percenIuci : pcrc c
pcgcmenIc ce ce:cricnc: rec|izccc: pe|c Si:Iemc Unicc ce Scce -
SUS, Iem :icc re:pcn:cve|, em umc primeirc cnc|i:e, pe|c recucc cc
nmerc ce mu| here: :uLmeIi cc: c ri :cc: ci rrgi cc: ce:nece::cri c:.
/: Icxc: ce ce:cri cnc: cpre:enIccc: cc Si :Iemc Uni cc ce Scce -
SUS cec|incrcm ce 327 em 17, pcrc 287 em 18, 257 em 1 '
247 em 2000. Me:mc ccn:i cercncc c pc::i Li | i ccce ce i nccrrece:
cevi cc: c ncIi fi cccc ce umc ce:cri cnc ccmc pcrIc ncrmc| , cu
ci ncc c ncc cpre:enIccc cc SUS cc: ccnIc: referenIe: cc exce::c
ce ce:cri cnc: pe| c i n:Ii Iui cc, c recucc cc frenci c ce pcrIc:
ci rrgi cc: nc Si :Iemc Uni cc ce Scce - 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:
| Ii mc: vi nIe cnc:, c nmerc 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 cccpIccc 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 :ervic: pcrc
i mp| emenIcr meci cc: ue vi :em c recucc ce::c: Icxc:.
Cons|derondo os d|||cu|dodes poro o reduo reo| dos toxos de
cesreo, o Fortor|o 4 estobe|ece que os hosp|to|s, sob o
coordenoo estoduo|, podero ter d||erentes ||m|tes poro o porto
c|rrg|co, contemp|ondo o comp|ex|dode de codo serv|o obsttr|co o
||m de otender os mu|heres com segurono.
E:Ic mecicc repre:enIc umc IenIcIivc ce ccrrigir ci:Icrce: gerccc:
ccm c: pcrIcric: cnIericre:, pc::iLi|iIcncc in:IiIuice: ce n|ve| Iercicric
ue cIencem ge:Icce: e pcrIc: ce ri :cc pccerem Ier, ce fcIc,
umc pcrcenIcgem mci cr ce ce:cri cnc:. /| m ci ::c, ccnIemp| c c
:cLreccrgc ce ce:cri cnc: ue c: mcIerni ccce: pL| i cc: e
uni ver:i Icri c: experi menIcrcm cpc: c imp|emenIccc cc: pcrIcric:,
pcr Ierem ue cL:crver c excecenIe ce pcIenci c: ce:cri cnc:
recu:ccc: pe| c :eIcr ccnveni ccc.
E:Ic |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 18
Fortor|o 1.40, de 15 de dezembro de 1
C Frmic Gc|Lc ce /rcjc fci in:IiIu|cc em 18 ccm c prcpc:iIc ce
reve| cr cc 8rc:i | experi nci c: i ncvcccrc: nc ge:Icc pL| i cc,
pri vi | egi cncc c ccc| hi menIc cc mu| her e :eu ccmpcnhei rc, nc
mcmenIc cc pcrIc. A ovo||oo de motern|dodes em todo pos, nestes
do|s onos, demonstrou que possve| quo||||cor e tombm humon|zor
serv|os, encontrondo so|ues v|ve|s, mu|tos vezes s|mp|es e de bo|xo custo,
quondo h o comprom|sso de o|erecer o me|hor popu|oo. Fcrc e:Ic
cvc| i ccc, c: cri Iri c: uIi | i zccc: ccnIemp| cm prcIi cc: c::i :Ienci ci :
Lc:eccc: em evi cnci 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 ni cc nc vi cc ce cccc mu| her.
2
ATENO INSTITUCIONAL AO PARTO
25
Fortor|os
MSJGM 5, 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 Humcnizccc nc Fr-
NcIc| e Nc:cimenIc, ccm :eu: ciferenIe: ccmpcnenIe: ce incenIivc c
/::i:Incic Fr-NcIc|, c crgcnizccc, regu|ccc e ncvc: inve:IimenIc: nc
/::i:Incic CL:IIricc, e:IcLe|ecencc umc ncvc :i:IemcIicc ce
pcgcmenIc cc c::i:Incic cc pcrIc.
E:Ie prcgrcmc cpre:enIc cuc: ccrccIer|:Iicc: mcrccnIe:: c c|hcr pcrc c
inIegrc|iccce cc c::i:Incic cL:IIricc e c cfirmccc cc: cireiIc: cc
mu|her inccrpcrccc: ccmc cireIrize: in:IiIucicnci:. C cLjeIivc principc|
recrgcnizcr c c::i:Incic, vincu|cncc fcrmc|menIe c pr-ncIc| cc pcrIc e
puerpric, cmp|icncc c cce::c cc: mu|here: e gcrcnIincc c uc|iccce
ccm c rec|izccc ce um ccnjunIc m|nimc ce prccecimenIc:.
Nc cmLiIc ce:Ie prcgrcmc, c Mini:Iric cc Scce revi:cu c: mcnuci:
Icnicc: ce /::i:Incic Fr-NcIc| e Ge:Iccc ce /|Ic Fi:cc e, em
pcrceric ccm c FE8F/SGC, e|cLcrcu um Mcnuc| ce:Iinccc cc
cIencimenIc cc: Urgncic: e Emergncic: 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:Iric cc Scce IcmLm
ci:IriLuiu, em pcrceric ccm c CF/S, c Guic FrcIicc pcrc /::i:Incic cc
FcrIc Ncrmc|. C: :ervic: ce :cce IcmLm receLercm CcrIce: cc
Ge:IcnIe e in:IrumenIc| Icnicc pcrc c rec|izccc cc Fr-ncIc|,
ccmpcncc um kiI cL:IIricc: e:IeIc:ccpic ce Fincrc, fiIc cL:IIricc, ci:cc
ce iccce ge:Iccicnc| e IcLe|c ce pe:c/c|Iurc.
Fcrc e:Iimu|cr c pcrIicipccc cc: mu|here:, fcrcm ci:IriLu|cc: cci:
mi|hce: ce cgencc: ccm infcrmcce: :cLre c ge:Iccc, c pcrIc e c:
cuicccc: ccm c: recm-nc:cicc:.
C ccnjunIc ce::c: mecicc: Icrncr-:e-c efeIivc ucncc, :cmccc: c e|c:,
c: prcfi::icnci: ce :cce Ircn:fcrmcrem :uc prcIicc nc cirecc ce umc
re|ccc mci: humcnizccc e :egurc. 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 :egurcnc.
2
26
funccmenIc| pcrc c humcnizccc cc pcrIc c
cceuccc prepcrc cc ge:IcnIe pcrc c mcmenIc cc
nc:cimenIc, e e::e prepcrc ceve :er iniciccc
precccemenIe curcnIe c pr-ncIc|. l:Ic reuer um
e:fcrc muiIc grcnce, mc: p|encmenIe vicve|, nc
:enIicc ce :en:iLi|izcr e mcIivcr c: prcfi::icnci: ce
:cce cc rece Lc:icc e fcrnecer-|he: in:IrumenIc:
pcrc c IrcLc|hc ccm c: ge:IcnIe:. /|m cc: c:pecIc:
Icnicc: prcpricmenIe ciIc:, c prepcrc pcrc c pcrIc
envc|ve, IcmLm, umc cLcrccgem ce ccc|himenIc
cc mu|her e :eu ccmpcnheirc nc :ervic ce :cce,
inc|uincc c fcrnecimenIc ce infcrmcce: 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|cce: f|:icc:, c pe::cc| e c: prccecimenIc:
rcIineirc:, enIre cuIrc:.
C prepcrc cc ge:IcnIe pcrc c pcrIc cLrcnge c
inccrpcrccc ce um ccnjunIc ce cuicccc:, mecicc: e
cIiviccce: ue Im ccmc cLjeIivc cferecer c mu|her c
pc::iLi|iccce ce vivencicr c experincic cc IrcLc|hc
ce pcrIc e pcrIc ccmc prcce::c: fi:ic|cgicc:, :enIincc-
:e prcIcgcni:Ic cc e prcce::c.
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 pr-ncIc|, nc ceccrrer cc IrcLc|hc ce pcrIc e pcrIc,
vivencicncc junIc c mu|her e experincic cc
nc:cimenIc. C prcfi::icnc| ce :cce ce:empenhc um
pcpe| re|evcnIe ccmc fcci|iIcccr pcrc c
ce:envc|vimenIc ce:Ic cIencc ccmc pcrIe cc:
:ervic: ce pr-ncIc|. IcmLm pcrIicipc cc:
crienIcce:, cccn:e|hcmenIc: e:pec|ficc: e
cIiviccce:, nc prepcrc cc mu|her e :eu
cccmpcnhcnIe pcrc c pcrIc.
DurcnIe c pr-ncIc|, c ge:IcnIe ceve receLer
crienIcce: em re|ccc cc: :eguinIe: Iemc:: prcce::c
ge:Iccicnc|, muccnc: ccrpcrci: e emccicnci:
curcnIe c grcvicez, IrcLc|hc ce pcrIc, pcrIc e
puerpric, cuicccc: ccm c recm-nc:cicc e
cmcmenIccc. Ici: ccnIecc: cevem inc|uir
3 PREPARANDO A MULHER PARA O PARTO
PREPARANDO A MULHER PARA O PARTO
27
crienIcce: :cLre cncIcmic e fi:ic|cgic mcIernc:, c: Iipc: ce pcrIc, c:
ccncuIc: ue fcci|iIcm c pcrIicipccc cIivc nc nc:cimenIc, :exuc|iccce
e cuIrc:.
impcrIcnIe ccn:icercr, ne::e prcce::c, c: ce:ejc: e vc|cre: cc mu|her e
cccIcr umc pc:Iurc :en:|ve| e Iicc, re:peiIcncc-c ccmc cicccc e
e|imincncc c: vic|ncic: verLci: e ncc verLci:.
C: :ervic: ce pr-ncIc| e c: prcfi::icnci: envc|vicc: cevem cccIcr c:
:eguinIe: mecicc: ecuccIivc: ce prevencc 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 :rie ce cificu|ccce: prcIicc: pcce :urgir curcnIe c recrgcnizccc
cc: :ervic: ce :cce pcrc prcpicicr c ge:IcnIe/pcrIurienIe umc
c::i:Incic mci: humcnizccc. Fcrc ccnIcrnc-|c:, c|gun: :ervic: Iem
prcpc:Ic c criccc ce grupc: ce cpcic. / imp|emenIccc ce grupc: ce
cpcic, ccm c pcrIicipccc ce ciferenIe: prcfi::icnci: cc euipe ce
:cce, 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:
vivncic:, 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:
infcrmcce: nece::cric: {ccnIecc: ecuccIivc: cnIericrmenIe ciIccc:)
pcrc c: cuicccc: ccm c grcvicez e c recm-nc:cicc, c: c:pecIc:
emccicnci: e cfeIivc: re|ccicnccc: cc e:Iccc grcv|cicc, c: c:pecIc:
referenIe: c prepcrccc f|:icc pcrc c pcrIc, ccmc re:pirccc,
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 :ervic ue ccnIemp|e e:Ie: c:pecIc: c
ce imp|emenIcr c cIencimenIc e:pec|ficc c: mu|here: grcvicc: uIi|izcncc
recur:c: jc exi:IenIe: nc rece ce :cce. C cIencimenIc pcceric :er
ce:envc|vicc em umc uniccce ce :cce jc funcicncncc. Fccem-:e
uIi|izcr c: me:mc: ccn:u|Icric: cc uniccce ce :cce pcrc c cIencimenIc
mcicc, 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 cce: ecuccIivc: nc uniccce.
C cLjeIivc ce:Ic: cIiviccce: c ce ccmp|emenIcr c cIencimenIc
rec|izccc nc: ccn:u|Ic:, me|hcrcr c ccerncic pcr pcrIe cc: mu|here: c:
inciccce: mcicc:, ciminuir c: cn:ieccce: e mecc: em re|ccc c
grcvicez, pcrIc e puerpric, inc|uincc c: vivncic: e nece::iccce: cc
mce e cc recm-nc:cicc, c c|eiIcmenIc mcIernc e c ccnIrccepcc. /c
me:mc Iempc, IcmLm c ce rec|izcr um IrcLc|hc ccrpcrc| ce
re|cxcmenIc e re:pirccc pcrc me|hcrcr c cceuccc ccrpcrc| cc
IrcLc|hc ce pcrIc e pcrIc, fcvcrecencc c pcrIc ncrmc|.
/|m cc: mecicc: ecuccIivc: ue cevem :er inIrccuzicc: nc: prcgrcmc:
ce pr-ncIc|, curcnIe c grcvicez, c prepcrccc cc mu|her pcrc c
nc:cimenIc ccmpreence principc|menIe c ccccc ce mecicc:
referenIe: cc IrcLc|hc ccrpcrc|. C cLjeIivc cc imp|emenIccc ce:Ic:
mecicc: cferecer c mu|her um me|hcr ccnhecimenIc cc percepcc
ccrpcrc|, Lem ccmc cc re|cxcmenIc e cc re:pirccc pcrc um me|hcr
ccnIrc|e cc IrcLc|hc ce pcrIc e pcrIc. Fcrc i::c 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 Im ccmc cLjeIivc permiIir ue c:
mu|here: reccnhecm c: pcrIe: cc ccrpc e :uc: :en:cce:,
principc|menIe c: ciferenc: enIre re|cxcmenIc e ccnIrccc, c::im
ccmc c: me|hcre: pc:ice: 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:cce: cc: ccnIrcce: curcnIe c IrcLc|hc ce pcrIc.
EmLcrc rec|izccc: cincc curcnIe c pr-ncIc|, :cc cirigicc: c uIi|izccc
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 euipe ce
prcfi::icnci: e incicc uc|iccce cc c::i:Incic. C recur:c cc m:icc e cc:
ccre: repre:enIc fcrmc: c|IerncIivc: ce cLcrccgem ue Lu:ccm
ce:envc|ver pcIencici: e/cu re:Icurcr funce: ccrpcrci: cc pcrIurienIe,
cccmpcnhcnIe e cc euipe prcfi::icnc|. / uIi|izccc ce rcupc:
ccnfcrIcvei: IcmLm umc mecicc impcrIcnIe pcrc fcvcrecer c
re|cxcmenIc.
Nc |iIercIurc mcicc :cc, ce:criIc: vcric: mIccc: p:icc-prcfi|cIicc: e ce
re|cxcmenIc ue pccem :er iniciccc: nc pr-ncIc| - MIccc ce Dick-
Fecc, 8rcc|ey e MIccc ce Lcmcze. Ici: mIccc: pre::upcem ue :uc
uIi|izccc re:u|Ie nc recucc 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|ucc cc IrcLc|hc ce pcrIc e cc pcrIc. EnfcIizcm c
re:pirccc |enIc, c re|cxcmenIc mu:cu|cr e c: Icnicc: pcrc c: e:fcrc:
ce puxc:.
lnfe|izmenIe, c uIi|izccc ce Ici: mIccc: ncc Iem :icc mcIivc ce e:Iucc:
c||nicc: ccnIrc|ccc: pcrc cvc|icr :uc efeIivc ccnIriLuicc pcrc c
evc|ucc cc IrcLc|hc ce pcrIc e pcrIc. /: pcucc: evicncic: cienI|ficc:
ci:pcn|vei: :cLre e:Ie c::unIc Im cemcn:Irccc ccncreIcmenIe cpenc:
umc ciminuicc nc nece::iccce ce crcgc: cnc|g:icc:, umc mcjcr
:cIi:fccc ccm c prcce::c cc nc:cimenIc e nenhum efeiIc ccver:c.
EnIreIcnIc, c expecIcIivc ccm re|ccc cc: re:u|Iccc: cenIe Iipc ce
inIervencc ceve :er c|crcmenIe exp|iciIccc pcrc ue ncc cccrrcm
expecIcIivc: ue ncc ccrre:pcnccm c rec|iccce.
1. MIODO DE DICK-kEAD
Ccn:icerccc um cc: pi|cre: pcrc c ecucccc prepcrcIcric pcrc c pcrIc
em civer:c: pc|:e:, e:Ie mIccc crienIc :cLre c fi:ic|cgic cc pcrIc,
exerc|cic: pcrc c mu:cu|cIurc cc per|nec e cc cLccme, e Icnicc: ce
re|cxcmenIc. Freccnizc c cprencizccc cc re|cxcmenIc cIrcv: cc
ccncenIrccc em cccc pcrIe cc ccrpc, :epcrcccmenIe, cc: p: c
ccLec, ccnIrcincc e re|cxcncc c: m:cu|c:. Feccmencc c pre:enc
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 mtodo, so trs 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. MIODO DE 8kADLEY
E:Ie mIccc recfirmc c pcrIc ccmc um prcce::c ncrmc|. Iem ccmc
principc| fccc c: vcricvei: cmLienIci:, ccmc c penumLrc e c :i|ncic,
pcrc ue c pcrIc :ejc umc experincic c mci: ncIurc| pc::|ve|. Ne:Ie
mIccc, c cccmpcnhcnIe c::ume IcmLm um pcpe| ce grcnce
impcrIcncic.
Nc in|cic cc IrcLc|hc ce pcrIc c mu|her e:Iimu|ccc c :e mcvimenIcr
|ivremenIe. /c ceiIcr, crienIccc c cccIcr c pc:icc ce Sim: {cecLiIc
|cIerc| e:uercc, ccm c: Lrcc: 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 ccLec pcrc cumenIcr c
ccnfcrIc). DurcnIe cccc ccnIrccc, c mu|her ceve fechcr c: c|hc:,
re|cxcr Iccc: c: m: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 incenIivccc c cc|cccr c mcc :cLre cLccme cc
mu|her, curcnIe c ccnIrccc.
3. MIODO DE LAMAIE
E:Ie mIccc IcmLm ccnhecicc ccmc mIccc p:icc-prcfi|cIicc cc
ccr. / mu|her pcce :er en:inccc c :uL:IiIuir :uc: recce: c ccr, cc mecc
e c percc ce ccnIrc|e, pcr um ccmpcrIcmenIc mci: pc:iIivc. C mIccc
ce Lcmcze Lc:eccc nc Iecric ce Fcv|cv :cLre c ref|exc ccncicicnccc.
/Iuc|menIe, c mIccc mci: pcpu|cr pcrc prepcrccc cc pcrIc. Ne|e,
:cc ccmLinccc: c: re|cxcmenIc: mu:cu|cre: ccnIrc|ccc: e c: Icnicc:
ce re:pirccc. / mu|her en:inccc c ccnIrcir grupc: e:pec|ficc: ce
m:cu|c:, enucnIc re|cxc cuIrc:. E|c IcmLm cprence c fccc|izcr um
peuenc cLjeIc ue, curcnIe c IrcLc|hc ce pcrIc, :erc u:ccc ccmc
pcnIc fccc|. C cLjeIc 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 pr-ncIc| cIe c pr-pcrIc/pcrIc.
C mIccc ce Lcmcze incenIivc c mu|her e :eu cccmpcnhcnIe c umc
pcrIicipccc cIivc nc IrcLc|hc ce pcrIc e pcrIc. Nc pr-ncIc| :cc,
IrcLc|hccc: c: vcric: Iipc: ce re:pirccc nc: ciferenIe: e:Icgic: cc
IrcLc|hc ce pcrIc, c: mIccc: ce re|cxcmenIc ce cerIc: grupc: ce
m: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 crienIccc c in:pircr
prcfunccmenIe, fcccr :uc cIencc num cLjeIc :e|ecicnccc e expircr
|enIc e prcfunccmenIe, u:cncc c peiIc. Nc finc| cc ccnIrccc, e|c
ncvcmenIe ceve in:pircr. E:Ic re:pirccc permiIirc ue c pcrIurienIe
ce:ccn:e e reccmpcnhc-:e. l::c pccerc :er feiIc ccm c mu|her
cecmLu|cncc cu em pc:icc ce Sim:. / mecicc ue evc|ui c IrcLc|hc
ce pcrIc, e c mu|her enIrc nc fc:e cIivc cc pcrIc, c re:pirccc Icrccicc
|enIc jc ncc e Icc eficienIe. / mu|her enIcc, e:Iimu|ccc c inicicr pe|c
re:pirccc |enIc, pc::cr pcrc umc mci: curIc, e ucncc c ccnIrccc
cIingir :eu picc, vc|Icr c |enIc. / re:pirccc rcpicc e rec|izccc pcr |cngc
per|ccc pcce ccu:cr hipervenIi|ccc, um
3
PREPARANDO A MULHER PARA O PARTO
31
e:Iccc em ue :e recuz c n|ve| ce pCC2 nc :cngue. E:Ic cccrrncic
ince:ejcve| pcrc c crgcni:mc mcIernc e feIc|. Nc rec|iccce, :cc
uIi|izccc: vcricce: nc: pccrce: re:pircIcric:, pci: hc c|gumc: mu|here:
ue ce:ccLrem um pccrcc re:pircIcric prcpric ue |he: mci:
ccnfcrIcve|. C cccmpcnhcnIe Iem pcpe| funccmenIc| nc ccnIrc|e cc:
ccnIrcce:, incenIivcncc c mu|her c re|cxcr.
C: mIccc: ccnIempcrcnec: ce ecucccc prepcrcIcric pcrc c pcrIc
Iencem c ccmLincr c:pecIc: cc: civer:c: cLcrccgen: cc: mIccc: ce
Dick-Fecc, Lcmcze e 8rcc|ey. Ici: mIccc: ncc pc::uem c preIen:cc ce
:uL:IiIuir nc |nIegrc c: mIccc: fcrmccc|cgicc: ce minimizccc cc ccr e,
:im, mccificcr c cIiIuce cc mu|her e :eu cccmpcnhcnIe ue, cc inv: ce
|igcr c pcrIc c mecc e ccr, pc::cm c cceiIc-|c ccm ccmpreen:cc,
:egurcnc, Ircni|iccce e ccm pcrIicipccc cIivc. Ccn:icercncc ue
muiIc: mu|here: ncc Im cce::c c e::c: crienIcce: nc per|ccc
ge:Iccicnc|, impcrIcnIe ue, cc :erem ccmiIicc: em IrcLc|hc ce
pcrIc, receLcm crienIcce: e cccmpcnhcmenIc ucncc c rec|izccc
ce::c: mecicc: ecuccIivc: e ce minimizccc 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|v|o do dor
/ c::cciccc ce c|gumc: mecicc: ncc fcrmccc|cgicc: ccmc exerc|cic:
re:pircIcric:, Icnicc: ce re|cxcmenIc e c cecmLu|ccc 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:ice: ue
ncc c ceiIccc curcnIe c IrcLc|hc ce pcrIc. CuIrc: e:Iucc: cincc
:ugerem ue c: ccnIrcce: uIerinc: :cc mci: inIen:c: e eficienIe: pcrc c
ci|cIccc cc cc|c, :cmenIe ccm c muccnc cc pc:icc cc pcrIurienIe.
CuIrc: mecicc: ue pccem :er uIi|izccc: ccm frencic :cc c Lcnhc
ce chuveirc cu ce imer:cc, e mc::cgen: feiIc: pcr cccmpcnhcnIe cu
prcfi::icnc| ce :cce. C Lcnhc pcce :er uIi|izccc nc in|cic cc fc:e cIivc
cc pcrIc, cu :ejc, ucncc c: ccnIrcce: ccmecm c ficcr mci: inIen:c:.
/: mecicc: e/cu Icnicc: 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
fcvcrecer ue c IrcLc|hc ce pcrIc e pcrIc :ejcm vivenciccc: ccm mci:
Ircni|iccce e pcrIicipccc, re:gcIcncc c nc:cimenIc ccmc um
mcmenIc cc fcm||ic.
3
32
C cLjeIivc principc| cc: prcfi::icnci: ue cIencem
pcrIc:, e :egurcmenIe IcmLm cc: mu|here: ue
receLem :eu: :ervic:, c ce :e cLIer cc fim cc
ge:Iccc, um recm-nc:cicc :cuccve|, ccm p|enc
pcIencic|iccce pcrc c ce:envc|vimenIc Lic|cgicc e
p:icc-:ccic| fuIurc: e IcmLm umc mu|her/mce ccm
:cce e ncc IrcumcIizccc pe|c prcce::c ce
nc:cimenIc ue cccLcu ce experimenIcr.
E:Ie cLjeIivc icec|, ccnIucc, 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 cceuccc cc in:IiIuicc
cu |ccc| cnce cccnIecerc c nc:cimenIc: c
ccpcciIccc Icnicc cc prcfi::icnc| envc|vicc ccm
e:Ic cIencc e, funccmenIc|menIe, :uc cIiIuce Iicc
e humcnc.
Nccc mci: cIuc| ue c ci:cu::cc :cLre c vic ce pcrIc,
cu mci: e:pecificcmenIe, :cLre c cperccc ce:cricnc
ccmc Iecnc|cgic pcrc c nc:cimenIc. Suc:
prcprieccce:, vcnIcgen:, ce:vcnIcgen:, inciccce:,
cu:Ic: e fcIcre: re|ccicnccc: cc cumenIc cc
incicncic Iem :icc mcIivc ce |cngc: ci:cu::ce:, IcnIc
ce ccrcIer cienI|ficc ucnIc pcpu|cr.
Evo|uo
Hi:IcriccmenIe, c ce:crec repre:enIcu umc c|IerncIivc
pcrc :iIucce: 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 sobrevivncia de cesrea, sculo XVIII.
4 AVALIAO CRTICA DO TIPO DE PARTO
AVALIAO CRTICA DO TIPO DE PARTO
33
Ccm c: prcgre::c: ue cccrrercm nc: Icnicc: cirrgicc:, nc cne:Ie:ic,
hemcIercpic, cnIiLicIiccIercpic e cuIrc: crec: cfin:, c ce:crec Icrncu-:e
um prccecimenIc Icnicc Lc:IcnIe :egurc. E::c :egurcnc, c::cciccc
cc c|crgcmenIc ce :uc incicccc em :iIucce: ce ccmprcmi::c cc:
ccncice: ce viIc|iccce, IcnIc feIci: ucnIc mcIernc:, fci re:pcn:cve| pcr
umc :ignificcIivc me|hcric cc: re:u|Iccc: cL:IIricc: mcIernc: e perincIci:,
c pcrIir cc in|cic cc :eguncc meIcce ce:Ie :cu|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 recm-nc:cicc, c:
inciccce: ccmecrcm c cumenIcr rcpiccmenIe. Ccm c re|cIivc
cumenIc cc :egurcnc cc prccecimenIc, c: mcicc: ccmecrcm c
enccnIrcr incireIcmenIe, cccc vez mci: rczce: pcrc ju:Iificcr c
rec|izccc ce umc cperccc ce:cricnc.
Ncc exi:Iem cvicc: :cLre c impcrIcncic ce::e prccecimenIc cirrgicc ccmc
umc Iecnc|cgic cprcpriccc pcrc c mcnejc ce umc :rie ce :iIucce:
cL:IIricc: e:pec|ficc: ue nece::iIcm cc inIerrupcc cc ge:Iccc ccmc
c nicc mcneirc ce pre:ervcr c :cce cc mu|her cu cc feIc. E::e recur:c, ce
efeiIc Lenficc Icc c|crc e inci:cuI|ve|, ncc , Icccvic, cincc hcje cce::|ve| c
umc grcnce pcrce|c cc pcpu|ccc ce mu|here: cc: regice: menc:
ce:envc|vicc:.
Fcr cuIrc |ccc, jc exi:Iem evicncic: :uficienIe: ue permiIcm cizer ue ncc
cccrre umc ciminuicc :i:IemcIicc e ccnI|nuc cc mcrLiccce e mcrIc|iccce
perincIc| ccm c cumenIc cc Icxc ce ce:crec. / fc|:c c::cciccc ce
ccu:c-efeiIc enIre c cumenIc cc Icxc ce ce:crec e c ciminuicc 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|. IcmLm jc ccnhecicc c
fcIc ce ue IrcumcIi:mc: feIci: IcmLm cccrrem em ce:cricnc:,
e:pecic|menIe em cc:c: ce premcIuriccce.
Ne:Ie ccnIexIc, IcmLm ccn:en:c ue c pcrIc ncrmc| c vcginc|, mci:
:egurc pcrc c mu|her e c cricnc. EmLcrc nc: cic: ce hcje muiIc: prcfi::icnci: e
mu|here: prcIiuem c e:cc|hc cnIecipccc cc Iipc ce pcrIc, e:Ic ncc
umc :imp|e: ue:Icc ce preferncic. C Iipc ce pcrIc cpre:enIc umc :rie ce
imp|iccce: em Iermc: ce nece::iccce e incicccc, ri:cc: e Lenef|cic:,
cepencencc ce cccc :iIuccc, Iempc ce rec|izccc, ccmp|iccce: e
repercu::ce: fuIurc:.
/ ceci:cc pe|c incicccc ce :e rec|izcr umc ce:cricnc ceve :er mcicc,
ccm c pcrIicipccc 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. /|m ci::c, ceve :er infcrmccc IcmLm ce ue c
pcrIc vcginc| cpc: umc ce:crec {FV/C) ncc : c :egurc, ccmc
ce:ejcve|, cjuccncc c eviIcr c: prcL|emc: pcIencic|menIe ceccrrenIe:
ce ce:crec: ce repeIicc.
4
AVALIAO CRTICA DO TIPO DE PARTO
34
Situao Atual
/ e|evccc nc: Icxc: ce uIi|izccc cc ce:cricnc pcrc c re:c|ucc cc
pcrIc um fencmenc ue vem cccrrencc em Iccc c muncc,
emLcrc Ienhc cvcnccc mci: genericcmenIe nc ccnIinenIe
cmericcnc e, mci: e:pecificcmenIe, nc 8rc:i|, cnce chegc c :er
ccn:icerccc epicmicc. SiIucce: :eme|hcnIe: enfrenIcrcm cu Im
enfrenIccc cuIrc: pc|:e: ccmc FcrIc Ficc, E:Iccc: Unicc:, Ccnccc e
lIc|ic, c|m 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
Crgcnizccc Muncic| cc Scce.
EnIreIcnIc, c 8rc:i| ncc mci: c ccmpecc muncic| ce ce:crec:. Fci
jc :up|cnIccc pe|c Chi|e, nc /mricc LcIinc, e pcr c|gun: cuIrc:
peuenc: 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|m ce c|gun: cuIrc:
inciccccre: ce :cce reprccuIivc ce:Ie: pc|:e:.
Alguns indicadores de sade reprodutiva em pases das Amricas
impcrIcnIe, cincc, ccn:icercr ue c: ceIermincnIe: mcicc:, cu
me|hcr, Lic|cgicc:, pcrc c incicccc cc: ce:crec: ce fcIc exi:Iem e
:cc rec|menIe mci: freenIe: em pcpu|cce: ce mencr n|ve| ce
ce:envc|vimenIc. De:ccnhecer e:Ic ccrccIer|:Iicc :eric permcnecer
4
AVALIAO CRTICA DO TIPO DE PARTO
35
c|heic cc prcL|emc. mcicr nc 8rc:i| ue nc Ccnccc, pcr exemp|c, c
prevc|ncic ce prcce::c: pcIc|cgicc: prcpric: cu c::cciccc: c ge:Iccc
e ue ccnIriLuem pcrc c incicccc cc pcrIc ce:cricnc. Fcrm, e:Ie
crgumenIc ue ju:Iificcric c mcicr prcpcrcc ce ce:crec: enIre nc: cc
ue nc primeirc muncc, ncc :erve pcrc ju:Iificcr pcrue c e:Iccc ce Scc
Fcu|c cu cc Fic ce Jcneirc Im mci: ce:crec: ue c: regice: ncrIe e
ncrce:Ie cc 8rc:i|. Jc fcIc IcmLm Lc:IcnIe ccnhecicc e e:Iucccc
ue c: n|vei: ce ce:cricnc ncc :e re|ccicncm ce fcIc ccm c prevc|ncic
ce ccncice: pcIc|cgicc: nc pcpu|ccc ue pccericm exp|iccr :uc
incicccc. Nc uc:e IcIc|iccce cc: pc|:e: cnce :eu: |ncice: :cc
e|evccc:, c prevc|ncic e cireIcmenIe prcpcrcicnc| cc n|ve| ce rencc
cc mu|her.
/incc ue :e ccn:icerem IcmLm 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: inciccce: mcicc: pcrc c pcrIc ce:crec
ccn:egue exp|iccr c epicemic ce pcrIc: cpercIcric: cLccminci: em
nc::c pc|:.
Lem verccce ue cIuc|menIe :e ccmiIem, nc CL:IeIr|cic mccernc,
inciccce: Lem mci: c|crgccc: pcrc c rec|izccc ce umc ce:cricnc,
muiIc: veze: :em umc ju:IificcIivc cL:IIricc cceuccc. 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 incicccc cL:IIricc, 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|ncic ce
ce:cricnc:, cccc vez :cc mci: freenIe: c: :iIucce: ce ge:IcnIe: ccm
cnIececenIe ce ce:crec. E, emLcrc pcucc ccmiIicc cienIificcmenIe, c
repeIicc cc: ce:cricnc: 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:encic: fuIurc: cc pre:enc ce umc
ciccIriz uIerinc ncc Im :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 prvic
pcrece :er umc Lcc c|IerncIivc, cccIccc pcr Iccc: c: pc|:e:
ce:envc|vicc: em :uc: pc||Iicc: ce ccnIencc 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.
prcvcve|, ccnIucc, ue e:Ic c|IerncIivc :c ccn:igc :e cifuncir mci:
genericcmenIe nc pc|:, nc mecicc em ue inIervence: :ejcm
firmemenIe cirigicc: nc :enIicc ce ccnIrc|cr, ce mcneirc :ric e
IecniccmenIe ccrreIc, c rec|izccc cc ce:cricnc :em ju:IificcIivc
mcicc.
Hc c nece::iccce cc infcrmccc e fcrmccc ce cpinicc enIre c:
mu|here:, pcrc ue e|c: pc::cm reivinciccr cui|c ue :ejc mci:
4
AVALIAO CRTICA DO TIPO DE PARTO
36
Lenficc pcrc c :uc :cce e c ce :eu: fi|hc:. Sc ccm c c:pirccc 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: mcicc:
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:eenIemenIe ce :eu: mcicc:, 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. umc reivincicccc ue cIuc|menIe fcz
pcrIe cc rcIinc cL:IIricc 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:
ccncice:, :iIuccc cincc muiIc ci:IcnIe ce nc::c rec|iccce.
k|scos ossoc|odos
/pe:cr cc recucc cc: ri:cc: c::cciccc: cc prccecimenIc cirrgi cc nc:
|Iimc: ccccc:, me:mc nc: pc|:e: cnce c mcrIc|iccce mcIernc
recuzicc, c ri:cc re|cIivc ce mcrIe mcIernc cincc mci: e|evccc nc
ce:cricnc ue nc pcrIc ncrmc|. /|m cc: ccu:c: Irccicicnci: ce mcrIe
mcIernc em pc|:e: em ce:envc|vimenIc, ncIcccmenIe c hemcrrcgic e
infeccc, nc cc:c e:pec|ficc cc ce:crec, c exemp|c cc ue cccnIece
em pc|:e: ce:envc|vicc:, hc IcmLm c ccnIriLuicc cc emLc|ic
pu|mcncr e cc: ccicenIe: cne:I:icc: ccmc ccu:c ce cLiIc mcIernc.
Jc Lc:IcnIe ccnhecicc c mcicr mcrLiccce mcIernc ceccrrenIe ce
ccmp|iccce: ce ce:crec, e:pecic|menIe c infeccc 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 IcmLm pe|c:
vcricce: pcpu|ccicnci:. CuIrc: ccmp|iccce: mci: c::cciccc: cc
prccecimenIc inc|uem c IrcmLcemLc|i:mc, c infeccc urincric e,
e:pecificcmenIe nc cc:c cc: ce:crec: ce repeIicc, c ccreIi:mc
p|ccenIcric e :uc: ccn:encic:. Mci: recenIemenIe, c nece::iccce ce
Ircn:fu:ce: :cngu|nec: e ce hemccerivccc: c::cciccc c rec|izccc 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
imuncceficincic humcnc.
/|m ce:Ic:, cuIrc: ccncice: ce ri:cc e:Icc mci: c::cciccc: cc pcrIc
pcr ce:crec, ccmpcrcIivcmenIe cc pcrIc ncrmc|. impcrIcnIe ue c
prcfi::icnc| ce :cce ccnhec Ici: ri:cc: e :uc: pc::|vei: repercu::ce:
pcrc |evc-|c: em ccn:icerccc nc mcmenIc ce cecicir pe|c vic ce
pcrIc, e IcmLm 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
AVALIAO CRTICA DO TIPO DE PARTO
37
Riscos potenciais associados ao tipo de parto
/|m cc ceci:cc cL:IIricc, 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 inIervencc mcicc. EnucnIc prcIicc
:ccic|, c cIc mcicc e c e:pcc ce inf|uncic prcfi::icnc| Im c ver ccm
re|cce: eccncmicc:, :ccici:, cu|Iurci: e pc||Iicc:, ccn:icerccc: cc |cngc
cc hi:Icric.
Num ccnIexIc ce impcrIcncic cc: c:pircce: cc c|ienIe|c e re:peiIc c:
ceci:ce: cc mu|her enucnIc u:ucric cc :i:Iemc ce :cce, Icrnc-:e
re|evcnIe e nece::cric ci:pcr ce e:c|crecimenIc: c re:peiIc cc:
inciccce: preci:c: cc recur:c c: ce:crec: nc IrcIc ce cccc cc:c
e:pec|ficc, cc |ccc cc reccnhecimenIc cr|Iicc cc: ccncice: ce :uc
uIi|izccc inci:criminccc. Sc c infcrmccc ccrreIc, cienIificcmenIe
Lc|izccc, pccerc cjucc-|c: nc cpcc |ivre e infcrmccc, :cLre c vic ce
pcrIc preferencic| e c: ri:cc: c::cciccc:.
4
38
/ cIencc cceuccc 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 :egurcnc e
Lem-e:Icr. E:Ie um cireiIc funccmenIc| ce Iccc
mu|her. / euipe ce :cce 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 criccc ce um v|ncu|c mci: prcfuncc
ccm c ge:IcnIe, Ircn:miIincc-|he ccnficnc e
Ircni|iccce.
/ vivncic 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 :rie ce
ccncice:, ce:ce cue|c: inIr|n:ecc: c mu|her e c
ge:Iccc, cI cue|c: cireIcmenIe re|ccicnccc: cc
:i:Iemc ce :cce.
Ccmc ccncice: inIr|n:ecc: c mu|her e c ge:Iccc,
pcce-:e mencicncr :uc iccce {cu mcIuriccce), :uc
experincic em pcrIc: cnIericre:, c experincic 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 :egurcnc em
re|ccc c :i me:mc nc ue ccncerne c :eu pcpe| ce
mu|her e ce mce, cenIre cuIrc:. Ccmc ccncice:
re|ccicnccc: cc :i:Iemc ce :cce, vc|e mencicncr c
c::i:Incic pr-ncIc| {ue pcce Ier inc|u|cc cu ncc c
cceuccc prepcrc f|:icc e emccicnc| pcrc c pcrIc) e
c c::i:Incic cc pcrIc prcpricmenIe ciIc.
Ex|ste necess|dode de mod|||coes pro|undos no
quo||dode e humon|zoo do oss|stnc|o oo porto nos
motern|dodes bros||e|ros. For humon|zoo do
oss|stnc|o oo porto entende-se um processo que
|nc|u| desde o odequoo do estruturo |s|co e
equ|pomentos dos hosp|to|s, ot umo mudono de
posturoJot|tude dos pro||ss|ono|s de sode e dos
gestontes. A odequoo |s|co do rede hosp|to|or -
poro que o mu|her posso ter um ocomponhonte
[tombm dev|domente preporodo} duronte o trobo|ho
de porto e poro os proced|mentos de o|v|o do dor -
requer, o|m de boo vontode, tombm |nvest|mentos
5 ASSISTNCIA MULHER NO TRABALHO DE PARTO
ASSISTNCIA MULHER NO TRABALHO DE PARTO
39
EnIreIcnIc, ccnhecicc ue c: hc:piIci: IcmLm cpre:enIcm c|gumc
re:i:Incic em mccificcr :uc: rcIinc:" ce cL:IeIr|cic e pcucc: :cc c: ue
Im in:Ic|cce:/ccncice: minimcmenIe cceuccc: pcrc, pcr exemp|c,
permiIir c pre:enc ce um cccmpcnhcnIe pcrc c ge:IcnIe cc SUS em
IrcLc|hc ce pcrIc cu gcrcnIir :uc privcciccce.
De::c fcrmc, 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 cIrcv: cc ccccc ce um ccnjunIc ce mecicc:
ce crcem e:IruIurc|, gerencic|, fincnceirc e ecuccIivc, ce fcrmc c
prcpicicr c: mu|here: Lrc:i|eirc: - :cLreIucc cue|c: mci: ccrenIe: - um
pcrIc verccceircmenIe humcnizccc.
Ne::e :enIicc, c re:peiIc c mu|her e :eu: fcmi|icre: funccmenIc|:
chcmc-|c pe|c ncme {eviIcncc c: Iermc: mcezinhc, ccnc, eIc.),
permiIir ue e|c icenIifiue cccc memLrc cc euipe ce :cce {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: cvicc: c|ivicr
:uc: cn:ieccce: :cc cIiIuce: re|cIivcmenIe :imp|e: e ue reuerem
pcucc mci: ue c Lcc vcnIcce cc prcfi::icnc|.
/: reccmenccce: c :eguir :cc re|cIivc: c c::i:Incic cc IrcLc|hc ce
pcrIc. FcrIem cc pre::upc:Ic ce ue ncc exi:Ie umc nicc c::i:Incic
icec| ('*(/ -%)/? mc: ciferenIe: fcrmc: ce cccmpcnhcr c pcrIurienIe
curcnIe c per|ccc ce ci|cIccc, c cepencer cc: ccncice: cc |ccc| cc
euipe ce :cce ue fcrc e::e cccmpcnhcmenIc.
/ccIcncc c princ|pic cc mecicinc Lc:eccc em evicncic:, :ercc
ci:cuIicc: c|gumc: prcIicc: ue, emLcrc uIi|izccc:, ccrecem ce
cemcn:Ircce: c|crc: ucnIc c :eu: Lenef|cic:. /ccIcr-:e-c, nc mecicc
cc pc::|ve|, umc :encic crcnc|cgicc cc: evenIc: nc per|ccc ce
ci|cIccc, e c: prccecimenIc: cceuccc: nc cccmpcnhcmenIc ce::e:
evenIc:.
1. Aspectos t|cos
C IrcLc|hc ce pcrIc ceve :er cLcrcccc ccm Iicc prcfi::icnc| cp|iccve|
c Iccc: c: :iIucce: ce cIencc c :cce. / cceuccc icenIificccc cc
euipe mcicc, ce enfermcgem e cuIrc: prcfi::icnci: ce :cce, c
ve:Iucric cceuccc ce::e: prcfi::icnci:, c re:peiIc c inIimiccce e c
privcciccce cc pcrIurienIe, c|m cc: cemci: c:pecIc: ue pcuIcm c
re|ccc prcfi::icnc| ce :cce/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:enc cc:
:eguinIe: ccncice::
<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
ASSISTNCIA 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#( $# 1#-#
/)'46*#E
Nc: fc:e: mci: inicici: cc IrcLc|hc ce pcrIc, nem :empre pc::|ve| fczer
c cicgnc:Iicc ciferencic| enIre verccceirc e fc|:c IrcLc|hc ce pcrIc ccm
umc cvc|iccc i:c|ccc. Ne::e: cc:c:, recvc|icr c ge:IcnIe 1 c 2 hcrc:
cpc: c primeirc excme pcce :er nece::cric pcrc ccnfirmcr c cicgnc:Iicc.
Ne::e :enIicc, fcz-:e nece::cric cceucr c e:IruIurc f|:icc cc: :c|c: ce
ccmi::cc cc: ge:IcnIe:, pcrc ue c recvc|iccc ne::e: cc:c: :ejc vicve|.
impcrIcnIe ce:Icccr ue cc finc| cc prcce::c ge:Iccicnc|, c mu|her
pcce cpre:enIcr um uccrc cencminccc fc|:c IrcLc|hc ce pcrIc,
ccrccIerizccc pcr cIiviccce uIerinc cumenIccc, permcnecencc,
enIreIcnIc, um pccrcc ce ccnIrcce: ce:cccrcenccc:. /|gumc: veze:,
e::c: ccnIrcce: :cc Lem percepI|vei:, ccnIucc ce::cm em :eguicc e c
crvice uIerinc ncc cpre:enIc ci|cIccc. Ic| :iIuccc prcmcve um c|Ic
grcu ce cn:ieccce e expecIcIivc :cLre c premncic cc nc:cimenIc,
:encc um cc: principci: mcIivc: ue |evcm c: ge:IcnIe: c prccurcrem c
hc:piIc|. C prcfi::icnc| ceve e:Icr cIenIc pcrc Ici: cccnIecimenIc:, c fim
ce :e eviIcr umc ccmi::cc preccce, inIervence: ce:nece::cric: e
e:Ire::e fcmi|icr, ccc:icncncc umc experincic negcIivc ce IrcLc|hc ce
pcrIc, pcrIc e nc:cimenIc.
/ percc cc Icmpcc mucc:c cu :inc|" e c fcrmccc cc Lc|:c cc: cguc:
:cc inciccccre: menc: preci:c: cc IrcLc|hc ce pcrIc, nc mecicc em ue
exi:Iem grcnce vcricce: incivicuci: enIre c cpcrecimenIc ce::e: :inci: e
c in|cic rec| cc IrcLc|hc ce pcrIc.
EmLcrc nc: ge:Icce: c Iermc, c rcIurc cc: memLrcnc: cccrrc nc
mcicric cc: cc:c: curcnIe c IrcLc|hc ce pcrIc, e|c pcce cccrrer cI
vcric: cic: cnIe: cc in|cic cc me:mc {ce 12 c 207). /incc ncc exi:Iem
evicncic: c|crc: :cLre uc| c me|hcr ccncuIc ne::e: cc:c: e vcric:
c|IerncIivc: Im :icc uIi|izccc: nc mcnejc cc rcIurc premcIurc ce
memLrcnc: em ge:Icce: ce Iermc:
6*$/+,# 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:Iccc ce /|Ic Fi:cc {MS, 2000).
Cuc|uer ue :ejc c ccncuIc cccIccc, c Icue vcginc| ceve :er eviIccc
cI ue c ge:IcnIe e:Iejc em frcncc IrcLc|hc ce pcrIc, pcrc minimizcr c:
ri:cc: ce infeccc cvu|cr e puerperc|.
5
ASSISTNCIA MULHER NO TRABALHO DE PARTO
41
3. Momento do |nternoo
Ncc exi:Ie um mcmenIc icec| pcrc inIerncr c ge:IcnIe em IrcLc|hc ce
pcrIc. EmLcrc c ce:ejcve| :ejc c inIernccc jc nc fc:e cIivc, c|gumc:
ge:IcnIe: pccercc :e Leneficicr ce umc inIernccc mci: preccce, cincc
nc fc:e |cIenIe: c: ue Im cificu|ccce ce cce::c cc |ccc| cc pcrIc e
cue|c: ue - emLcrc cincc ncc pcrIcccrc: ce ccncice: ue
ccrccIerizem ge:Iccc cu pcrIc ce c|Ic ri:cc - Im um pcIencic| um
pcucc mcicr ce cpre:enIcr ccmp|iccce: 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|ssoJ|nternoo do portur|ente
5
/ncmne:e
Nenhum cIencimenIc em :cce, 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:IIricc: {cnce
:e inc|ui IcmLm c |evcnIcmenIc ce ccmp|iccce: ce pcrIc: em
ge:Icce: cnIericre:), ccIc cc |Iimc men:Iruccc, infcrmcce:
:cLre c mcvimenIccc feIc| e cccc: e evc|ucc ce ge:Iccc
cIuc|. E:Ie: cccc: jc cevem rcIineircmenIe fczer pcrIe cc CcrIcc
cc Ge:IcnIe ue Iccc :ervic ceveric fcrnecer c: mu|here: em
cccmpcnhcmenIc pr-ncIc|.
Excme c||nicc
/incc ue :umcric nc: ge:Icce: ce evc|ucc ncrmc| {cu ce Lcixc
ri:cc), c cvc|iccc c||nicc cc ge:IcnIe ceve inc|uir mecicc cc:
cccc: viIci: {pre::cc crIeric|, pu|:c e IempercIurc), cvc|iccc cc:
mucc:c: pcrc inferir c pre:enc cu ncc ce cnemic, c pre:enc cu
ncc ce ecemc e vcrize: nc: memLrc: infericre: e c cu:cu|Ic
ccrc|ccc e pu|mcncr.
Excme CL:IIricc
/ cu:cu|Ic cc frencic ccrc|ccc feIc| {cnIe:, curcnIe e cpc: c
ccnIrccc uIerinc), c mecicc cc c|Iurc uIerinc, c pc|pccc
cL:IIricc {pcrc ceIermincr c :iIuccc, pc:icc, cpre:enIccc e
in:inuccc) :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|izccc cc Icue.
C: Icue: vcginci: :uL:eenIe: cc cc cicgnc:Iicc pccem :er
pc:Iergccc:, cI 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/ccnfirmccc ce cmnicrrexe premcIurc. Cucncc
exi:Ie :cngrcmenIc vcginc|, c Icue ceve :er rec|izccc em
ccncice: ccnIrc|ccc:, pci: pcce :e IrcIcr ce cc:c ce
5
ASSISTNCIA MULHER NO TRABALHO DE PARTO
42
p|ccenIc prvic, ccncicc em ue c Icue 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 recucc nc incicncic ce infecce: ce
epi:icIcmic, c fcci|iIccc cc epi:icrrcfic e umc me|hcr higiene nc
pc:-pcrIc.
Ncc exi:Iem evicncic: cienI|ficc: c|crc: :cLre e::e: Lenef|cic: e
:uc uIi|izccc pccerc gercr ce:ccnfcrIc: e ri:cc: pcrc c pcrIurienIe:
c ce:ccnfcrIc nc mcmenIc cc :uc execucc e ucncc c: pe|c:
ccmecm c cre:cer e c ri:cc ce Ircn:mi::cc ce ccenc, ucncc
cc uIi|izccc ce |cminc: ncc ce:ccrIcvei:.
Fcr e::c: rczce: e ccn:icercncc c cu:Ic ccicicnc| pcrc :uc
rec|izccc, reccmencc-:e ue c IriccIcmic :c :ejc feiIc :e e:Ic fcr c
cpcc cc pcrIurienIe.
EnIercc|i:mc
EmLcrc c: Lenef|cic: Irccicicnc|menIe cIriLu|cc: c rec|izccc ce
enIercc|i:mc {cu enemc) rcIineirc nc in|cic cc IrcLc|hc ce pcrIc
{mencr ri:cc ce infeccc |ccc|, mcjcr fcci|iccce pcrc c ce:cicc cc
cpre:enIccc e inf|uncic 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|izccc cc |cvcgem inIe:Iinc| gerc c
pcrIurienIe c|gum ce:ccnfcrIc curcnIe :uc execucc e incremenIc
c: cu:Ic: ce c::i:Incic cc pcrIc, c ccnfcrIc pc:Iericr cc mu|her e
cc prcpric euipe ce :cce 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 euipe ce :cce pre:enIe nc :c|c ce pcrIc ccn:egue
|iccr Lem ccm Ic| :iIuccc, c ue pcce cumenIcr cincc mci: c
ccn:IrcngimenIc cc mu|her.
Desso |ormo, o dec|so de reo||zor ou no o enteroc||smo deve |evor
em conto essos cond|es, vo|or|zondo pr|nc|po|mente o op|n|o do
portur|ente. Esto, poro poder dec|d|r de |ormo consc|ente, deve
receber or|entoo no tendenc|oso duronte o pr-noto|, poro que
no momento do |nternoo poro o porto posso |ozer o suo esco|ho.
No se deve oneror o gestonte em trobo|ho de porto com um
excesso de |n|ormoes, obr|gondo-o o tomor dec|ses em um
contexto onde e|o necess|tor|o de um tempo mo|or e de mo|s
tronq|||dode poro |oz-|o.
5. A||mentoo
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
ASSISTNCIA MULHER NO TRABALHO DE PARTO
43
Ccmc curcnIe e::c fc:e, c mcicric cc: ge:IcnIe: permcnece em cc:c,
e::c crienIccc ceve :er cccc cincc curcnIe c pr-ncIc|. Nc mecicc
em ue cccrre c cprcximccc 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 peuenc: ucnIiccce: ce
||uicc: c|crc: {cguc, :ucc ce fruIc: :em pc|pc, chc, ccf, 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|izccc ce cccc cc:c.
Icccvic, c: ge:IcnIe: ce mcicr ri:cc pcrc prccecimenIc: cne:I:icc:
{cLe:c:, cicLIicc:, ccm vic: crec: ce cif|ci| cce::c) cu pcrc pcrIc
cirrgicc 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|izccc cc
prccecimenIc cne:I:icc ceve :er :imi|cr cue|e cccIccc nc :ervic
pcrc prccecimenIc: cirrgicc: em gerc| ce mu|here: ncc grcvicc:.
. H|g|ene do portur|ente
DurcnIe c IrcLc|hc ce pcrIc, c ge:IcnIe perce :ecrece: pe|c vcginc e
freenIemenIe 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 ccncice:
pcrc IcnIc. Um Lcnheirc ccm chuveirc, Icc|hc:, :cLcneIe: e Irccc
freenIe ce :uc LcIc cu ccmi:c|c, cc fcrrc e cc rcupc ce ccmc
gercrcc umc :en:ccc ce mcicr ccnfcrIc e Lem-e:Icr, Icc ce:ejcve|
curcnIe e::e per|ccc.
C: Lcnhc: ce chuveirc ccm cguc mcrnc Im :icc uIi|izccc:, ce fcrmc
emp|ricc, pcrc c|ivicr c ccr cc IrcLc|hc ce pcrIc. Me:mc ue ncc exi:Ic
cincc ccmprcvccc cienI|ficc em re|ccc c i::c, c :en:ccc ce
re|cxcmenIc f|:icc e menIc| cpc: um Lcnhc pcce ccnIriLuir pcrc c Lem
e:Icr cc: ge:IcnIe:.
7. Fos|o de portur|ente
Sc|vc rcrc: excece:, c pcrIurienIe ncc ceve :er cLrigccc c permcnecer
nc |eiIc. DecmLu|cr, :enIcr e ceiIcr :cc ccncice: ue c ge:IcnIe pcce
cccIcr nc IrcLc|hc ce pcrIc ce cccrcc ccm c :uc preferncic e, em
gerc| ce fcrmc e:pcnIcnec, exi:Ie umc Iencncic c c|Ierncncic ce
pc:ice:. /: mu|here: cevem :er cpciccc: nc :uc e:cc|hc.
Cucncc ceiIccc, c ge:IcnIe ceve :er crienIccc c ncc permcnecer em
cecLiIc ccr:c| hcrizcnIc| pcrue e::c pc:icc recuz c f|uxc :cng|nec
uIerinc e p|ccenIcric. Cu :ejc, ucncc ceiIccc, c ge:IcnIe ceve cccIcr
c cecLiIc |cIerc|, IcnIc cireiIc ucnIc e:uercc.
/ pc:icc verIicc| {pcrccc cu cecmLu|cncc) pcrece fcvcrecer c
IrcLc|hc ce pcrIc. Excece: c e::c regrc :cc c: ge:IcnIe: ue
cpre:enIcm rcIurc ce Lc|:c ccm ccLec ncc enccixccc {pcrc eviIcr
5
ASSISTNCIA MULHER NO TRABALHO DE PARTO
44
c prc|cp:c cc ccrccc) e cue|c: ue cpre:enIem :cngrcmenIc geniIc|
mccerccc cu :everc.
8. Amn|otom|o
EmLcrc exi:Icm evicncic: ce ue c cmnicIcmic preccce pc::c recuzir
c curccc cc IrcLc|hc ce pcrIc em 0 c 120 minuIc:, efeiIc: ince:ejcvei:
pccem cccrrer ccm e::c prcIicc, ccmc c incremenIc ce
ce:cce|ercce: preccce: cc FCF e c|Iercce: p|c:Iicc: :cLre c pc|c
cefc|icc {Lc::c :erc::cngu|nec). Exi:Ie IcmLm um ri:cc cumenIccc ce
infeccc cvu|cr e puerperc| ucnIc mcicr fcr c curccc 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 cue|c: ccncice: cnce :uc prcIicc :ejc c|crcmenIe
Lenficc, ccmc c cc:c ce c|gumc: ci:Iccic: funcicnci:. impcrIcnIe
e:c|crecer ue c cmnicIcmic ncc um prccecimenIc cLrigcIcric
ucncc cc rec|izccc ce cnc|ge:ic ce pcrIc.
. Fortogromo: ocomponhomento gr||co do trobo|ho de porto
C pcrIcgrcmc nc cvc|iccc e cccumenIccc cc evc|ucc cc IrcLc|hc
ce pcrIc um in:IrumenIc ce impcrIcncic funccmenIc| nc cicgnc:Iicc
cc: ce:vic: cc ncrmc|iccce. C Ccp|Iu|c IrcIc ce:Ie c::unIc ccm
ceIc|he:.
10. V|g||nc|o do v|to||dode |eto|
C ccnIrc|e rigcrc:c cc frencic ccrc|ccc feIc| {FCF) curcnIe c
IrcLc|hc ce pcrIc c::egurc, nc uc:e IcIc|iccce cc: cc:c:, c ccccc ce
mecicc: cprcpriccc: pcrc gcrcnIir c nc:cimenIc ce umc cricnc em
Lcc: ccncice:.
Me:mc c ge:Iccc ce Lcixc ri:cc ncc pre:cince cc ccnIrc|e periccicc
cc FCF, uer ccm c uIi|izccc 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 0 minuIc:, recuzincc-:e
e::e inIervc|c pcrc 30 minuIc: ccnfcrme prcgrice c fc:e cIivc cc
IrcLc|hc ce pcrIc. Nc: ge:Icce: ce Lcixc ri:cc, c mcniIcrizccc
ccnI|nuc cc FCF pcce :er ccnIrcprccucenIe: |imiIc c mcvimenIccc cc
mu|her, re:Iringincc-c cc |eiIc, e Iem um pcIencic| ce gercr um mcicr
nmerc ce inIervence: ce:nece::cric:.
impcrIcnIe enfcIizcr ue, ucncc exi:Ie excesso de controt|||dode
uter|no {Icui::i:Ic|ic, hiperIcnic), uer e:pcnIcnec, uer icIrcgnicc, c
:cfrimenIc feIc| cgucc pcce :e in:Ic|cr em pcucc: minuIc:, c ue exige
umc vigi|cncic ccnI|nuc cc FCF cI 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:enc cc
prcfi::icnc| ce :cce cc |ccc cc pcrIurienIe, ccm c vcnIcgem ce ue
e::c pre:enc pcce ccnIriLuir pcrc c Ircni|izccc cc mu|her e,
ccn:eenIemenIe, c re:c|ucc mci: rcpicc cc hiperccnIrcIi|iccce
uIerinc.
5
45
FcrIcgrcmc c repre:enIccc grcficc cc IrcLc|hc ce
pcrIc ue permiIe cccmpcnhcr :uc evc|ucc,
cccumenIcr, cicgnc:Iiccr c|Iercce: e inciccr c
Icmccc ce ccncuIc: cprcpriccc: pcrc c ccrrecc
ce:Ie: ce:vic:, cjuccncc cincc c eviIcr inIervence:
ce:nece::cric:.
Fcrc ccmpreencer c evc|ucc cc IrcLc|hc ce pcrIc,
nece::cric c ccnhecimenIc prvic cc fi:ic|cgic cc
ci|cIccc cervicc|. De cccrcc ccm c CenIrc
LcIinccmericcnc ce FerincIc|cgic - CL/F {Schwcrcz eI
c|., 1), c curvc ce ci|cIccc cervicc| :e prcce::c ce
fcrmc c:cencenIe, ce in|cic ccm mencr ve|cciccce
ce ci|cIccc. Nc finc|, e::c ve|cciccce cumenIc, cu
:ejc, c pcrIc :e ce:envc|ve mci: rcpiccmenIe c pcrIir
cc: 4 cm ce ci|cIccc. / ciferenciccc nc ve|cciccce
cc crvicc-ci|cIccc ccrccIerizc c Fc:e LcIenIe
{inicic|) e c Fc:e /Iivc {finc|), ce inIere::e nc evc|ucc
cc IrcLc|hc ce pcrIc e nc ccn:Irucc cc pcrIcgrcmc
{Figurc 1).
Figura 1 - Curva de evoluo da crvico - dilatao
(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 {178) e:IcLe|eceu umc ccrre:pcncncic enIre c: per|ccc:
c|c::icc:, e:pecificcmenIe enIre c: per|ccc: ce ci|cIccc e expu|:ivc, e
c: c::im cencminccc: civi:ce: funcicnci: cc pcrIc. Ccn:icercu c
per|ccc ce ci|cIccc :uLcivicicc em cuc: fc:e: - c prepcrcIcric e c ce
ci|cIccc prcpricmenIe ciIc. C per|ccc expu|:ivc pc::cu c :er
ccn:icerccc pcr e::e cuIcr ccmc per|ccc p|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 expecIcnIe, ce:ce
ue c viIc|iccce feIc| e:Iejc pre:ervccc, e c icec| ue c: pcrIurienIe:
:ejcm cccmpcnhccc: ce cmLu|cIcric ucncc ncc :e IrcIcr ce
ge:Iccc ce ri:cc. CL:ervc-:e ue, em muiIc: mu|here:, c curccc
:upericr c 20 hcrc: e c: cciIcccicc: cevem :er eviIccc:, pe|c ri:cc ce
cumenIc nc incicncic ce ce:crec, ceccrrenIe cc cc|c uIerinc
ce:fcvcrcve|. Os s|no|s de o|erto, como perdo de |qu|do, songromento
uter|no, controes e||c|entes o codo 5 m|nutos e d|m|nu|o dos
mov|mentos |eto|s, so or|entoes poro que o portur|ente retorne oo
hosp|to| no momento odequodo.
impcrIcnIe re|emLrcr ue, pcrc c cccmpcnhcmenIc cc IrcLc|hc ce
pcrIc, c fc:e cu civi:cc funcicnc| ce inIere::e nc cp|icccc cc
pcrIcgrcmc c ce ci|cIccc {Friecmcn, 178) cu fc:e cIivc {Schwcrcz eI
c|., 1), ccm ve|cciccce ce ci|cIccc cervicc| m|nimc ce 1 cm/hcrc. /
cLerIurc cc pcrIcgrcmc nc fc:e |cIenIe cu nc inicic cc ci|cIccc {mencr
ue 3 - 4 cm) imp|iccric em inIervence: ncc :c ce:nece::cric:, mc:
IcmLm icIrcgnicc:.
C: Lenef|cic: cc inIerpreIccc grcficc cc evc|ucc cc IrcLc|hc ce
pcrIc :cc inmerc: e c mIccc :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|cIccc cervicc|
c e:uercc e c ce:cicc cc cpre:enIccc c cireiIc. Fcrc c ce:cicc cc
cpre:enIccc, 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 mcic 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 {172) ue IrcLc|hcvc nc
cnIigc Fcc: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|cIccc cervicc|, ccn:Iru|rcm umc |inhc ce c|erIc, ue :ervic pcrc
icenIificcr c: pccienIe: ccm pcrIc ce ri:cc. Cucncc c ci|cIccc 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 ccc,
pcrc|e|c c ce c|erIc, pcrue e:Ie erc c Iempc ce Ircn:pcrIe cc
pcrIurienIe pcrc cenIrc: mcicc:, cnce :e efeIucvcm pcrIc: cpercIcric:
{Figurc 3).
Figura 3 - Linha de alerta e linha de ao (Phiipott & Castle, 1972)
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USO DO PARTOGRAMA NO ACOMPANHAMENTO DO TRABALHO DE PARTO
48
/Iuc|menIe, c regi:Irc grcficc cc pcrIc rec|izccc em cmLienIe
hc:piIc|cr e, pcrIcnIc, ncc hc c nece::iccce ce inIervencc ucncc c
ci|cIccc cIinge cu cruzc c |inhc ce c|erIc. C c|erIc imp|icc,
:imp|e:menIe, c nece::iccce ce umc me|hcr cL:ervccc c||nicc.
ScmenIe ucncc c curvc cc ci|cIccc cervicc| cIinge c |inhc ce ccc
ue c inIervencc mcicc Icrnc-:e nece::cric, nc IenIcIivc ce me|hcrcr
c evc|ucc 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 cirrgicc.
Nc fichc ce cccmpcnhcmenIc cc IrcLc|hc ce pcrIc, c|m cc:
cncIcce: referenIe: c crvicc-ci|cIccc {pcrIcgrcmc), pccem IcmLm
:er regi:Irccc: c freencic ccrc|ccc feIc| {FCF), c: ccrccIer|:Iicc: cc:
ccnIrcce: uIerinc:, c: ccncice: cc Lc|:c cc: cguc: e ||uicc
cmnicIicc, c infu:cc ce ||uicc: e c: e:pecificcce: cc cnc|ge:ic {Figurc
4).
Fcrc c ccn:Irucc cc pcrIcgrcmc, c|gumc: cL:ervcce: :cc
nece::cric:, exigincc cc euipe umc pccrcnizccc 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|cIccc cervicc| e ce
ce:cicc cc cpre:enIccc 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 Ir: ccnIrcce: eficienIe:
em 10 minuIc:, ci|cIccc cervicc| m|nimc ce 3 cm). Em cc:c ce
cvicc, cgucrccr 1 hcrc e rec|izcr ncvc Icue: ve|cciccce ce
ci|cIccc ce 1cm/hcrc, verificccc em cci: Icue: :uce::ivc:,
ccnfirmc c cicgnc:Iicc ce fc:e cIivc cc IrcLc|hc ce pcrIc.
3. Fec|izcm-:e Icue: vcginci: :uL:eenIe:, c cccc cuc:
hcrc:, re:peiIcncc em cccc cncIccc c Iempc expre::c nc
grcficc. Em cccc Icue ceve-:e cvc|icr c ci|cIccc cervicc|, c
c|Iurc cc cpre:enIccc, c vcrieccce ce pc:icc e c: ccncice:
cc Lc|:c cc: cguc: e cc ||uicc cmnicIicc, ucncc c Lc|:c e:Iiver
rcIc - pcr ccnvencc, regi:Irc-:e c ci|cIccc cervicc| ccm um
Iricngu|c e c cpre:enIccc e re:pecIivc vcrieccce ce pc:icc
:cc repre:enIccc: pcr umc circunferncic.
4. C pccrcc cc: ccnIrcce: 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|cIccc cervicc| inicic| 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 ccc, ce:ce ue c pcrIurienIe e:Iejc nc fc:e
cIivc cc IrcLc|hc ce pcrIc {Fhi||pcI & Cc:I|e, 172).
6
USO DO PARTOGRAMA NO ACOMPANHAMENTO DO TRABALHO DE PARTO
49
Figura 4 - Modelo de ficha com partograma, e respectivas linhas de alerta e
ao, e outros registros de interesse no acompanhamento do trabalho de
parto
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USO DO PARTOGRAMA NO ACOMPANHAMENTO DO TRABALHO DE PARTO
50
Nc evc|ucc ncrmc| cc IrcLc|hc ce pcrIc, c curvc ce ci|cIccc cervicc|
:e prcce::c c e:uercc cc |inhc ce ccc. Cucncc e::c curvc u|Ircpc::c
c |inhc ce ccc, IrcIc-:e ce um pcrIc ci:funcicnc|. / ccn:Irucc ccrreIc
cc |inhc ce c|erIc e ce ccc funccmenIc| pcrc ue :e eviIem errc: nc
inIerpreIccc cc pcrIc {Figurc 5).
F|guro 5 - Erro no construo do portogromo - |n|c|odo no |ose |otente do
trobo|ho de porto
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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:Incic c||nicc cc pcrIc, ccn:icercncc cincc ue o
OMS tornou obr|gotor|o o portogromo nos motern|dodes desde 14. C
:eu u:c fcci|iIc c cccmpcnhcmenIc cc IrcLc|hc ce pcrIc pcr
principicnIe: e c pc::cgem ce p|cnIcc cc pr-pcrIc, fcvcrecencc
IcmLm c uIi|izccc rccicnc| ce cciIccicc: e cnc|ge:ic. De::c fcrmc, c
u:c cc pcrIcgrcmc ceverc inIerferir :cLreIucc nc e|evccc incicncic ce
ce:crec: :em incicccc cL:IIricc. Suc uIi|iccce IcmLm vc|crizccc
pe|c cicgnc:Iicc preccce cc: ci:Iccic: e :uc: re:pecIivc: inIervence:.
/ icenIificccc cc: ci:Iccic: feiIc pe|c cL:ervccc cc: curvc: ce
ci|cIccc cervicc| e ce ce:cicc cc cpre:enIccc expre::c: nc
pcrIcgrcmc. /: ci:Iccic: ce cccc per|ccc funcicnc| cc pcrIc e:Icc nc
IcLe|c 1.
Tabela 1 Distcias diagnosticadas pelo partograma, a partir das linhas de
ao
6
USO DO PARTOGRAMA NO ACOMPANHAMENTO DO TRABALHO DE PARTO
52
Nc |ose ot|vo pro|ongodo cu ci:Iccic funcicnc|, c ci|cIccc cc cc|c
uIerinc cccrre |enIcmenIe, numc ve|cciccce mencr ue 1 cm/hcrc
{Figurc ). / curvc cc ci|cIccc u|Ircpc::c c |inhc ce c|erIc e, c: veze:, c
|inhc ce ccc. E::c ci:Iccic gerc|menIe ceccrre ce ccnIrcce: uIerinc:
ncc eficienIe: {fc|Ic ce mcIcr). / ccrrecc feiIc inicic|menIe pe|c
empregc ce Icnicc: humcnizccc: ce e:I|mu|c cc pcrIc ncrmc| {ver
Ccp|Iu|c 3), pcr exemp|c e:Iimu|cncc-:e c cecmLu|ccc e, :e
nece::cric, pc:IericrmenIe pe|c ccmini:Irccc 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 secundr|o do d||otoo cicgnc:Iicccc pcr cci: Icue:
: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|cIccc cervicc| permcnece c
me:mc curcnIe cuc: hcrc: cu mci:, u|Ircpc::c c |inhc ce c|erIc e, pcr
veze:, c |inhc ce ccc {Figurc 7). Hc c::cciccc freenIe ccm
:cfrimenIc feIc| cgrcvcncc c prcgnc:Iicc perincIc|. / ccu:c principc| e c
ce:prcpcrcc cfc|c-p|vicc re|cIivc cu cL:c|uIc. Desproporo c|o|o-
p|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:IIricc
incceuccc. Nc vigncic ce ce:prcpcrcc cfc|c-p|vicc cL:c|uIc, c
re:c|ucc cc ge:Iccc feiIc pcr ce:crec. Ccn:icerc-:e desproporo
re|ot|vo ucncc exi:Ie cefeiIc ce pc:icc cc cpre:enIccc: cef|excc cu
vcrieccce: ce pc:icc Ircn:ver:c: cu pc:Iericre:. Ne:Ic: ccncice:, c
cecmLu|ccc, c rcIurc crIificic| cc Lc|:c cc: cguc: cu c cnc|ge:ic
pericurc| pccem fcvcrecer c evc|ucc ncrmc| cc pcrIc. Nc: cc:c: ce
memLrcnc: rcIc:, c cecmLu|ccc :c ceve :er reccmencccc ccm c
pc|c cefc|icc ccmp|eIcmenIe cpciccc nc Lccic mcIernc, pcrc eviIcr c
cccrrncic ce prc|cp:c ce ccrccc umLi|icc|. / re:c|ucc pcr ce:crec
ceverc :er incicccc ucncc e::e: prccecimenIc: ncc fcrem eficienIe:
pcrc ccrrigir c evc|ucc cncrmc| cc crvicc-ci|cIccc cL:ervccc nc
pcrIcgrcmc.
6
USO DO PARTOGRAMA NO ACOMPANHAMENTO DO TRABALHO DE PARTO
55
Figura 7 Parada secundria da dilatao
6
USO DO PARTOGRAMA NO ACOMPANHAMENTO DO TRABALHO DE PARTO
56
C porto prec|p|todo cu IcuiIccicc cicgnc:Iicccc ucncc c ci|cIccc
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 ce
Icui::i:Ic|ic e hiper:i:Ic|ic e, cc:c c p|ccenIc e:Iejc nc |imiIe ce :uc
funcc, pcce cccrrer c :cfrimenIc feIc|. Lccercce: cc IrcjeIc IcmLm
:cc mci: freenIe: ne:Ie Iipc ce pcrIc, pci: ncc hc Iempc pcrc
cccmccccc cc: Iecicc: p|vicc:, cccrrencc ce:cicc e expu|:cc cc
feIc ce mccc cLrupIc. C pcrIc IcuiIccicc pcce :er e:pcnIcnec em
mu|I|pcrc:, :encc mci: rcrc em prim|pcrc:. IcmLm pcce cccnIecer em
ceccrrncic ce icIrcgenic pe|c ccmini:Irccc exce::ivc ce cciIccinc.
Ne:Ie cc:c, ceve-:e :u:pencer c infu:cc ce cciIccinc cI c reIcrnc c um
pccrcc ccnIrcIurc| ncrmc|. Or|ento-se oteno v|to||dode |eto| no
perodo de d||otoo cerv|co| e rev|so deto|hodo do cono| de porto
opos o dequ|too.
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 perodo p|v|co pro|ongodo mcnife:Ic-:e nc pcrIcgrcmc ccm c
ce:cicc prcgre::ivc cc cpre:enIccc, mc: exce::ivcmenIe |enIc {Figurc
). NcIc-:e ci|cIccc 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 ccrrecc cLIicc pe|c
ccmini:Irccc ce cciIccinc, rcIurc crIificic| cc Lc|:c cc: cguc: e, cincc,
pe|c uIi|izccc cc fcrcipe, ce:ce ue preenchicc: c: pr-reui:iIc: pcrc
:uc cp|icccc. IcmLm reccmencc-:e c pc:icc verIicc|izccc pcrc
fcvcrecer c ce:cicc cc cpre:enIccc.
6
USO DO PARTOGRAMA NO ACOMPANHAMENTO DO TRABALHO DE PARTO
59
Figura 9 Perodo plvico prolongado
6
USO DO PARTOGRAMA NO ACOMPANHAMENTO DO TRABALHO DE PARTO
60
/ pcrccc :ecunccric cc ce:cicc cicgnc:Iicccc pcr cci: Icue:
:uce::ivc:, ccm inIervc|c ce 1 hcrc cu mci:, ce:ce ue c ci|cIccc cc
cc|c uIerinc e:Iejc ccmp|eIc. Ccn:icerc-:e ue hc pcrccc :ecunccric
cc prcgre::cc cc cpre:enIccc ucncc cccrre ce::ccc cc ce:cicc
pcr pe|c menc: 1 hcrc cpc: c :eu in|cic {Figurc 10). Deve Ier prcnIc
ccrrecc. Hc nece::iccce ce :e recvc|icr c: re|cce: feIc-p|vicc:, pci:
c ccu:c mci: freenIe ce::e Iipc ce ci:Iccic c ce:prcpcrcc cfc|c-
p|vicc re|cIivc cu cL:c|uIc. / pre:enc ce ce:prcpcrcc cL:c|uIc |evc
c incicccc ce ce:crec. Nc vigncic ce ce:prcpcrcc re|cIivc, ccm
pc|c cefc|icc prcfunccmenIe in:inuccc e crvicc-ci|cIccc ccmp|eIc,
vc|icc c IenIcIivc ce fcrcipe ce Irccc cu rcIccc, cepencencc cc
vcrieccce ce pc:icc.
6
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61
Figura 10 - Parada secundria 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:Incic cc pcrIc. 0 CL/F {CenIrc LcIinc /mericcnc ce FerincIc|cgic e
De:envc|vimenIc Humcnc) pccrcnizcu um mcce|c prcpric e c CMS
IcmLm civu|gcu um cuIrc Iipc ce pcrIcgrcmc, ccm |inhc: ce c|erIc e
ce ccc, ce cp|icccc univer:c|. Umc ccmpcrccc cc: pcrIcgrcmc: cc
CL/F {Schwcrcz eI c|., 1) e c ce Fhi|pcII & Cc:I|e {172) cccIccc pe|c
CMS, :c|ienIc c: :eguinIe: re:u|Iccc: {Scnchez, 1):
1. C: cci: mcce|c: fcrcm ccnccrccnIe: em 0,47 cc: inciccce:
cc vic ce pcrIc
2. / Fcci|iccce ce ccn:Irucc e c prcIiciccce ce cp|icccc cc
pcrIcgrcmc ce Fhi|pcII & Cc:I|e {172) fc|cm c fcvcr ce :uc
e:cc|hc em re|ccc cc cc CL/F nc prcIicc cicric.
Nc uIi|izccc prcIicc cc pcrIcgrcmc cc CL/F, pcce-:e :imp|ificcr :uc
ccn:Irucc, uIi|izcncc-:e cpenc: c curvc ce ci|cIccc cervicc| mci:
|enIc, ue :e refere c: mu|here: ceiIccc:, nu||pcrc: e ccm memLrcnc:
|nIegrc: {Figurc 11).
Figura 11 - Curva de dilatao em nulparas, na posio horizontal e com
membranas ntegras (Schwarcz et al.. 1996).
6
USO DO PARTOGRAMA NO ACOMPANHAMENTO DO TRABALHO DE PARTO
63
Vc|e :er refcrccc ue c: :ervic: e prcfi::icnci: hcLiIuccc: c uIi|izccc
ce:Ie in:IrumenIc ncc preci:cm Irccc-|c, pci: cmLc: c: mcce|c: :cc
ccnccrccnIe: nc grcnce mcicric cc: cicgnc:Iicc: {Scnchez, 1).
C pcrIcgrcmc um verccceirc reIrcIc ce ccrpc inIeirc cc evc|ucc ce
ceIerminccc pcrIc. / impcrIcncic cc pcrIcgrcmc ccnfirmc-:e ucncc,
num mcmenIc cefinicc, cvc|icmc: c evc|ucc cc pcrIc ccmc um Iccc:
c ci|cIccc cervicc|, c ce:cicc cc cpre:enIccc, c pc:icc feIc|, c
vcrieccce ce pc:icc, c frencic ccrc|ccc feIc|, c: ccnIrcce:
uIerinc:, c infu:cc ce ||uicc e c cnc|ge:ic. C excme ccmp|eIc ce Iccc:
e::c: vcricvei: permiIe ccnhecer c evc|ucc cc pcrIc e cc: fcIcre:
eIic|cgicc: re:pcn:cvei: pe|c :uc evc|ucc ncrmc| cu cncrmc|.
lcenIificccc c ci:Iccic nc pcrIcgrcmc e reccnhecicc :uc eIic|cgic, c
crienIccc IercpuIicc :erc |cgicc e eficcz. Sem cvicc, c uIi|izccc cc
pcrIcgrcmc me|hcrc c uc|iccce cc c::i:Incic c||nicc cc pcrIc,
cevencc :er inc|u|cc nc rcIinc cc: mcIerniccce:.
6
64
C prcgre::c Icnicc 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. / cceuccc c::i:Incic cc
pcrIc e c nece::cric re:peiIc cc: ce:ejc: e cireiIc: cc
mu|her pcrIurienIe ccmpreencem :eu ccnfcrIc,
:egurcnc e Lem-e:Icr. l:Ic imp|icc umc :rie ce
nece::iccce: cnce :e inc|uiu c ccnIrc|e cceuccc 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
c 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 vivenciccc
ccm ccr, cng:Iic, mecc e i:c|cmenIc, pcce |evcr c
ci:IrLic: p:icc|cgicc:, cfeIivc: e emccicnci:,
pccencc inf|uencicr c re|ccicncmenIc mce/fi|hc, c|m
ce :uc vicc cfeIivc e ccnjugc|. 0 mecc gerc ccr e c
ccr cumenIc c mecc.
C cireiIc cc cccmpcnhcmenIc cc ge:IcnIe jc
reccnhecicc em civer:c: in:Icncic:, inc|uincc c
Mini:Iric cc Scce, 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 Im :eu: pcrIc:
cIrcv: ce :egurc: em hc:piIci: privccc:, ue :e
uIi|izcm ce:Ie cireiIc.
lcec|menIe, e:Ie cccmpcnhcmenIc curcnIe c
IrcLc|hc ce pcrIc pre::upce c cceuccc prepcrc cc
mu|her pcrc e:Ie mcmenIc, jc iniciccc curcnIe c pr-
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 humcnizccc 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 Icnicc.
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:enc reccnfcrIcnIe, cc ccnIcIc f| :icc, pcrc civicir c
mecc e c cn:ieccce, pcrc :cmcr fcrc:, pcrc e:Iimu|cr pc:iIivcmenIe c
pcrIurienIe nc: mcmenIc: mci: cif|cei:.
/: Icnicc: ce re|cxcmenIc e exerc|cic: re:pircIcric: c::cciccc: c:
infcrmcce: receLicc: pe|c ge:IcnIe em :eu prepcrc pcrc c pcrIc Im
:icc cLjeIc ce e:Iucc: ucnIc c :uc inf|uncic curcnIe c IrcLc|hc ce
pcrIc e pcrIc. Exi:Iem c|gumc: evicncic: ce ue :e c::cciem c c|gun:
efeiIc: Lenficc:, ccmc c mencr nece::iccce ce u:c ce crcgc: cpicice:
e ce cnc|ge:ic pericurc|, ccm umc mcicr prcpcrcc ce pcrIc: vcginci: e
ccm umc mcicr :cIi:fccc cc mu|her ccm c pcrIc.
C prcce::c ce humcnizccc cc nc:cimenIc, ue inc|ui IcmLm c
pc::iLi|iccce ce um cccmpcnhcnIe c pcrIurienIe, envc|ve
nece::cricmenIe umc muccnc ce cIiIuce:. lnicic|menIe cc prcfi::icnc|
ce :cce ue pcrIe inIegrcnIe cc euipe ue pre:Ic cIencc inIegrc|
c e:Ic mu|her, revencc :eu: ccnceiIc:, ceixcncc ce |ccc :eu:
preccnceiIc:, pcrc fcvcrecer um ccc|himenIc ccmp|eIc, Icnicc e
humcnc c mu|her. Envc|ve IcmLm c muccnc ce cIiIuce cc in:IiIuicc,
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:. /|m ci::c, c: in:IiIuice:
cevem IcmLm e:Icr ccmini:IrcIivc e e:IruIurc|menIe prepcrccc: pcrc
c prcce::c, cmpcrccc: e :upcrIccc: per ncrmc: e cireIrize: emcnccc:
pe|c: in:IiIuice: re:pcn:cvei: pe|c :cce nc pc|:. ne:Ie ccnIexIc ue c
Mini:Iric cc Scce Iem envicccc Iccc: c: e:fcrc: nc :enIicc ce
e:Iimu|cr e prcpicicr c inIrccucc ce:Ic: ncvc: prcIicc: nc:
mcIerniccce: Lrc:i|eirc:.
Acomponhomento no porto [dou|o}
/|m cc cccmpcnhcmenIc pe|c pcrenIe cu ccmpcnheirc, exi:Ie
IcmLm 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:IIricc: 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 curccc cc IrcLc|hc ce pcrIc, c u:e
ce meciccce: pcrc c||vic cc ccr e c nmerc ce pcrIc: cpercIcric:.
/|gun: e:Iucc: IcmLm mc:Ircm c recucc cc nmerc ce ce:crec:.
/|m ce:Ic: vcnIcgen:, IcmLm cL:ervccc ue c: grupc: ce
pcrIurienIe: cccmpcnhccc: curcnIe c pcrIc pe|c ccu|c Im menc:
cepre::cc pc:-pcrIc e cmcmenIcm :eu: recm-nc:cicc: nc: primeirc:
:ei: :emcnc: ce vicc em mcicr prcpcrcc ue c: pcrIurienIe: cc: grupc:
ce ccnIrc|e.
/ pre:enc ce umc pe::cc Ireinccc pcrc cccmpcnhcmenIc cc
IrcLc|hc ce pcrIc ncc e ccrc e ncc reuer infrc-e:IruIurc cu
cpcre|hcgem e:pecificc. EvicenIemenIe, IcmLm ncc Iem uc|uer
7
ACOMPANHAMENTO DURANTE O TRABALHO DE PARTO (SUPORTE PSICOSSOCIAL)
66
ccnIrc-incicccc. C IreincmenIc pcce :er feiIc IcnIc enIre c prcpric
pe::cc| prcfi::icnc| cc: mcIerniccce:, ccmc enIre inciv|cuc: cc
ccmuniccce. / cpcc pcr uc|uer umc ce:Ic: c|IerncIivc: ceve
cepencer, pe|c menc: pcr enucnIc, cc ci:pcniLi|iccce e e:IrcIgic
cccIccc |ccc|menIe.
FecenIemenIe, umc revi:cc :i:IemcIicc :cLre c prcIicc ce um :upcrIe
:ccic| ccnI|nuc, inc|uincc ccn:e|hc: e infcrmcce:, c::i:Incic e cpcic
emccicnc|, curcnIe Iccc c IrcLc|hc ce pcrIc, fcrnecicc c: mu|here: pcr
prcfi::icnci: ce :cce cu pe::cc: |eigc:, ccmpcrcIivcmenIe c umc
c::i:Incic pccrcc :em e:Ic: ccrccIer|:Iicc:, ccnc|uiu ue e:Ie Iipc ce
cpcic pcrece Ier vcric: Lenef|cic: pcrc c: mce: e :eu: recm nc:cicc:,
:em nenhum efeiIc ccnc:c. Ic| cpcic emccicnc| pre::upce, enIre cmLc:
envc|vicc:, c pre:enc, c e:cuIcr, c ccr :egurcnc e cfirmccc.
/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
inIervencc e:Ieve c::cciccc c recucc cc nece::iccce ce mecicccc
pcrc c||vic cc ccr, cc pcrIc vcginc| cpercIcric, cc ce:crec e cc
cepre::cc necncIc|, c|m ce umc |eve recucc nc curccc cc IrcLc|hc
ce pcrIc. Cucncc c: e:Iucc: cvc|icrcm c: efeiIc: ce:Ic inIervencc
:cLre c vivncic 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 experincic,
:ejc pcrue Iinhcm jc cccc c |uz cu Iicc IreincmenIc ccmc enfermeirc:,
cL:IeIrize:, ccu|c: cu ecuccccrc: em :cce.
/pe:cr ce :ugerirem IcmLm um efeiIc Lenficc c |cngc prczc :cLre c
:cce f|:icc e p:icc::ccic| cc: mu|here: e :cLre c c|eiIcmenIc mcIernc,
c: evicncic: ncc :cc cefiniIivc: c e:Ie re:peiIc. Ncc :e ccnhece
IcmLm cincc uc| prcfi::icnc| cu |eigc Ieric me|hcr ce:empenhc
exercencc e:Ic inIervencc, nem :eu efeiIc c |cngc prczc :cLre c :cce
cc: recm-nc:cicc:.
De::c fcrmc, cccc: c: ineu|vccc: Lenef|cic: e c cu:ncic ce ri:cc:
c::cciccc: cc cpcic ccnI|nuc curcnIe c IrcLc|hc ce pcrIc, Iccc: c:
e:fcrc: 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:enc ccnI|nuc cc
pe::cc e:cc|hicc pcrc cccmpcnhc-|c, ccpcz ce Ircn:miIir-|he ccnfcrIc e
enccrcjcmenIc. evicenIe ue em c|gumc: circun:Icncic: i:Ic pcceric
:ignificcr c nece::iccce ce c|Iercr c: cIriLuice: ce prcfi::icnci: ccmc
enfermeirc: e cL:IeIrize:: ce prcgrcmc: ce ecucccc ccnIinuccc pcrc c
en:inc e prcIicc ce:Ic: cIiviccce:: ce mccificcce: nc e:IruIurccc e
ccmpc:icc cc euipe prcfi::icnc| cc: uniccce: ue c::i:Iem c:
mu|here: em IrcLc|hc ce pcrIc: e cc ccccc ce pc||Iicc: in:IiIucicnci:
ue permiIi::em e e:Iimu|c::em c pre:enc ce pe::cc: |eigc: experienIe:
cc |ccc cc: pcrIurienIe:.
Em ue pe:em Iccc: c: experincic: recenIe:, IcnIc inIernccicnci: ccmc
Lrc:i|eirc:, ce e:I|mu|c cc pcrIc ccmici|icr {pcr cpcc e ncc pcr fc|Ic
ce|c) nc: :iIucce: ce ge:Iccc ce Lcixc ri:cc, ncc exi:Ie cincc
nenhumc evicncic cienI|ficc cemcn:Ircncc uc|uer c|crc Lenef|cic
:cLre c :cce cc mu|her cu cc recm-nc:cicc ce:Ic inIervencc, ccm
re|ccc cc pcrIc in:IiIucicnc|.
7
ACOMPANHAMENTO DURANTE O TRABALHO DE PARTO (SUPORTE PSICOSSOCIAL)
67
:cLicc, pcrm, ue c cpcic :ccic| em cc:c, pcrc c: ge:IcnIe:
:ccic|menIe ce:fcvcrecicc:, ccmpcrcIivcmenIe c cu:ncic ce:Ie cpcic,
c::ccic-:e ccm me|hcre: re:u|Iccc: cc :cce cc cricnc e :cLre c
experincic vivicc. Ncc :e :cLe, ccnIucc, :e c ccnccmiIcncic ce:Ic:
inIervence: pcrc c me:mc grupc ce mu|here: pc::c Ier um efeiIc
Lenficc cciIivc.
Atr|bu|es do ocomponhonte tre|nodo
/ cccmpcnhcnIe Ireinccc, c|m cc cpcic emccicnc|, ceve fcrnecer
infcrmcce: c pcrIurienIe :cLre Iccc c ce:enrc|cr cc IrcLc|hc ce pcrIc e
pcrIc, inIervence: 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|m ce me|hcrcr c vivncic experimenIccc
pe|c: mu|here: ue ccc c |uz, pcrecem Ier umc inf|uncic cireIc e
pc:iIivc :cLre c :cce cc: mu|here: e cc: recm-nc:cicc:. Devem,
pcrIcnIc, :er e:Iimu|ccc: em Iccc: c: :iIucce: 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 :cce.
7
68
/ ccr, pe|c :eu ccrcIer :uLjeIivc, um :inIcmc ce
cif|ci| cvc|iccc. E:Iucc: :cLre c inIen:iccce cc ccr nc
pcrIc cemcn:Ircrcm ue, incepencenIemenIe ce
inf|uncic: :ccic-cu|Iurci:, e|c pcce :er ccn:icerccc
in:upcrIcve| pcrc um grcnce nmerc ce mu|here:.
FcrIcnIc, impercIivc ue cce: ce :cce prcpiciem
ccncice: ncc :cmenIe :egurc:, mc: vc|Iccc: cc:
c:pecIc: ce humcnizccc cc pcrIc, re:gcIcncc c
verccceirc pc:Iurc cc mu|her, cc fcm||ic, cc
:ccieccce e cc: prcfi::icnci: ce :cce, 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 mcicc,
ccm nfc:e :cmenIe nc: :eu: c:pecIc: Icnicc: cu
c||nicc:. Fccer receLer umc cIencc curcnIe c
IrcLc|hc ce pcrIc ue cferec c pc::iLi|iccce ce
ccnIrc|e cc ccr ucncc, e, :e nece::cric, um cireiIc
cc mu|her Lrc:i|eirc, gcrcnIicc pcr pcrIcric: cc
Mini:Iric cc Scce {nc 2.815 ce 18 e,
pc:IericrmenIe, c ce nc 572 ce 2000), ue inc|uem c
cnc|ge:ic ce pcrIc nc IcLe|c ce prccecimenIc:
cL:IIricc: 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 c ci|cIccc cc cc|c uIerinc, :cmccc c cuIrc:
fcIcre: ccmc: ccnIrccc e ci:Ien:cc cc: fiLrc:
uIerinc:, ci:Ien:cc cc ccnc| ce pcrIc, Irccc ce
cnexc: e periIcnic, pre::cc nc ureIrc, Lexigc e cuIrc:
e:IruIurc: p|vicc:, e pre::cc :cLre c: rc|ze: cc p|exc
|cmLc-:ccrc. / inervccc uIerinc e cnexic|
cuIcncmicc, meciccc principc|menIe pe|c Si:Iemc
Nervc:c SimpcIicc, ue ccncuz e:I|mu|c: ce
ccrccIer|:Iicc: vi:cerci:, ccm cferncic: nc Si:Iemc
Nervc:c CenIrc| nc n|ve| ce I10, I11, I12, L1. Ccm c
evc|ucc cc IrcLc|hc ce pcrIc e prcgre::cc cc
cpre:enIccc, c ccr c::ume ccrccIer|:Iicc: :cmcIicc:
em ceccrrncic 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|ccc. 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|ccc re:pircIcric,
circu|cIcric, ce cenIrc: hipcIc|cmicc: ce funcc neurcencccrinc
preccmincnIemenIe :impcIicc, ce e:IruIurc: ||mLicc: e ce meccni:mc:
p:icccincmicc: ce cn:ieccce e cpreen:cc.
kepercusses Moterno-Feto|s
DenIre c: c|Iercce: 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:eenIe cumenIc cc :ecrecc
ce ccrIi:c| e ccIecc|cminc: pccem cfeIcr c ccnIrccIi|iccce e c f|uxc
:cng|nec uIerinc:. Umc vez cicgnc:Iicccc c IrcLc|hc ce pcrIc e c
regu|criccce cc: ccnIrcce:, 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.
Mtodos de Ano|ges|o
Umc cc: ccn:icercce: Lc:icc: :cLre c cnc|ge:ic e cne:Ie:ic cL:IIricc:
c cceuccc prepcrc p:icc|cgicc e fi:ic|cgicc cc pcrIurienIe.
Ccn:icerc-:e ue c mu|her ce hcje mci: exigenIe ucnIc c:
infcrmcce: ue nece::iIc :cLre c :uc ge:Iccc e c pcrIc.
Freferencic|menIe curcnIe c pr-ncIc|, c ge:IcnIe ceve :er e:c|crecicc
:cLre c: fcrmc: ce cnc|ge:ic ci:pcn|vei:, :uc: vcnIcgen:, ce:vcnIcgen:
e |imiIcce:. Deve-:e c::egurcr ue exi:Icm vcric: cpce: 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:fcrc: ccmpcI|vei: ccm c :egurcnc ce cmLc: {mce e fi|hc), :ercc
ce:pencicc: pcrc ciminuir :eu ce:ccnfcrIc.
Fe:umiccmenIe, exi:Iem Ir: mIccc: pcrc c ccnIrc|e cc ccr curcnIe c
IrcLc|hc ce pcrIc e c pcrIc: ncc fcrmccc|cgicc:, fcrmccc|cgicc:
:i:Imicc: e fcrmccc|cgicc: regicnci:.
1. Mtodos no Formoco|og|cos
DenIre e|e: ce:Icccm-:e c: Icnicc: p:iccprcfi|cIicc:, ccupunIurc e
e:Iimu|ccc Ircn:cuIcnec e|Iricc {EIE).
C mtodo ps|copro|||t|co mci: pcpu|cr, inIrccuzicc pcr Lcmcze em 154,
prepcrc c mu|her pcrc c pcrIc cIrcv: ce um prcgrcmc ecucccicnc|
:cLre c fi:i c|cgic cc pcrIc, c|m ce exerc|cic: f|:icc: e re:pircIcric:. E:Ie
mIccc pcce :er u:ccc nc fc:e inicic| cc IrcLc|hc ce pcrIc, pccencc :er
ccmp|emenIccc ccm cuIrc: mIccc:, ucncc nece::cric.
/ ocupunturo prccuz cnc|ge:ic cIrcv: cc |iLerccc ce enccrfinc: pe|c
Si:Iemc Nervc:c CenIrc|. Nc mcicric cc: cc:c:, cLIm-:e c||vic pcrcic| cc
ccr e muiIc: pcrIurienIe: nece::iIcm ce mIccc: ccmp|emenIcre: nc
:eguncc e:Icgic cc IrcLc|hc ce pcrIc.
A est|mu|oo e|tr|co tronscutneo prccuz cnc|ge:ic cIrcv: cc
cc|ccccc 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: vrIeLrc: S2 c S4. C e:I|mu|c e|Iricc ccn:i:Ie ce
impu|:c: Lifc:icc: ue vcricm ucncc c cmp|iIuce e frencic
ccnfcrme c inIen:iccce cc ccr. 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 inIerferncic e|Iricc ccm c mcniIcrizccc
cc: LcIimenIc: ccrc|ccc: feIci:.
EmLcrc ccm c|gumc: |imiIcce:, c: mIccc: ncc fcrmccc|cgicc:,
ucncc ccmini:Irccc: ce fcrmc cceuccc, cpre:enIcm vcnIcgen:
ccmc: pcrIurienIe: menc: cn:ic:c: e mci: cccpercIivc:: recucc cc
ccn:umc ce cnc|g:icc: :i:Imicc:: pc:Iergccc nc in|cic ce Icnicc:
regicnci: ce cnc|ge:i c: cc|cLcrccc cIivc cc pcrIurienIe e mcicr
pcrIicipccc cc cccmpcnhcnIe.
2. Mtodos Formoco|og|cos S|stm|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:Irccc e c cceiIccc
cc: pcrIurienIe:. / ccmini:Irccc :i:Imicc ce fcrmccc: reuer 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:Imicc, 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
/|m ci::c, c mepericinc e:Ic c::cciccc c cepre::cc necncIc| e c
pcnIucce: mci: Lcixc: nc: Ie:Ie: neurcccmpcrIcmenIci:, ue pccem
percurcr pcr 48 hcrc:. / cepre::cc feIc| mcximc enIre 1 e 4 hcrc: cpc:
c ccmini:Irccc, prcvccccc Ic|vez pcr meIcLc|iIc: cIivc:. l::c imp|icc nc
nece::iccce ce prcfi::icnc| Ireinccc pcrc recnimccc necncIc| ec
ci:pcniLi|iccce ce crcgc: cnIcgcni:Ic: {nc|cxcne).
C u:c :i:Imicc ce cpicice:, :cLreIucc ucncc ci:pcn|vei: cuIrc:
mIccc: ncc fcrmccc|cgicc:, ceve :er eviIccc pcrc c prevencc ce:Ie:
efeiIc: cepre::cre: :cLre c re:pirccc necncIc|. E|e: IcmLm cificu|Icm
c inIerccc enIre mce e fi|hc nc per|ccc puerperc|, c|m ce
ccmprcmeIerem c in|cic preccce cc cmcmenIccc. Cpicice:
lipc::c|vei:, ccmc fenIcni|, c|fenIcni| cu :ufenIcni|, :cc pcucc uIi|izccc:
pcr vic :i:Imicc, pci: :eu efeiIc cnc|g:icc e ce curIc curccc e c
principc| efeiIc cc|cIerc| e c cepre::cc re:pircIcric.
3. Mtodos Formoco|og|cos keg|ono|s
/ cnc|ge:ic prccuzicc pcr L|cueic: regicnci: cpre:enIc vcnIcgen:
:cLre c: mIccc: :i:Imicc:. / cepc:icc cc cne:I:icc |ccc| prcximc c:
vic: ce ccncucc nervc:c permiIe umc Lcc cnc|ge:ic :e|eIivc, :em
cepre::cc cc feIc e permiIincc c cccperccc mcIernc. DurcnIe c
IrcLc|hc ce pcrIc cu c pcrIc, vcric: Icnicc: regicnci: pccem :er
empregccc:: L|cueic cc: nervc: pucencc:, pericurc| |cmLcr cu :ccrc|,
rcuicne:Ie:ic e L|cueic ccmLinccc rcui-pericurc|.
"D L,(4/%*( )( M/)%#)(
C: nervc: pucencc: Im :uc crigem nc: rc|ze: :ccrci: {S2-S4) e inervcm c
per|nec, vcginc, reIc e pcrIe cc Lexigc, pcrIcnIc c :eu L|cueic e:Ic
incicccc :cmenIe pcrc c :eguncc e:Icgic, prcpicicncc cne:Ie:ic
cceuccc cc pcrIc. /: ccmp|iccce: e:Icc re|ccicnccc: c puncc,
ccmc hemcIcmc: cu cLce::c:, cu c Icxiciccce :i:Imicc cc:
cne:I:icc: |ccci: pcr ccmini:Irccc inIrcvenc:c inccverIicc.
Icn|cos e drogos
C nervc pucencc inIernc 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|.
Icnicc Ircn:vcginc|: ccm c pccienIe em pc:icc ginecc|cgicc e cpc: c
prepcrc cc per|nec e vcginc ccm :c|ucc cnIi-:pIicc, inIrccuzem-:e c:
cecc: mcic 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:I:icc |ccc|, ce:|izcncc :cLre c: cecc: ccmc guic: cI
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. preci:c reccrccr ue c crIric
e veic pucencc ccrrem pcrc|e|cmenIe cc nervc, pcrIcnIc e
reccmenccve| c:pircr curcnIe c injecc cc cne:I:icc, pcrc eviIcr c
ccmini:Irccc 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. Icn|co tronsvog|no|
Icnicc Ferinec|: Iem c vcnIcgem ce L|cuecr :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
cIrcv: cc vcginc. Fcce-:e fczer um peuenc LcIcc cuIcnec ce
cne:I:icc |ccc| nc pcnIc mcic 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 cIrcv: cc LcIcc
cuIcnec em cirecc cc |:uic, cirigincc-:e c cgu|hc ccm c cux||ic cc
inciccccr cI 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:I:icc nc fcce inIernc cc IuLerc:iccce,
enucnIc :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|ucc
cne:I:icc. FepeIe-:e c me:mc prccecimenIc cc |ccc ccnIrcric. Fcr e:Ic
vic IcmLm exi:Ie c ri:cc ce injecc inIrcvc:cu|cr, pcr i::c reccmenccm-
:e c:pircce: freuenIe: curcnIe c: injece: {Figurc 2).
8
O CONTROLE DA DOR NO TRABALHO DE PARTO
73
F|guro 2. 8|oque|o do pudendo. Icn|co per|neo|.
=D G G#",-%1*" M%&*)/&",
Nc finc| cc: cnc: cinenIc e in|cic cc: cnc: :e::enIc, c L|cueic
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:ncic ce ccr, efeiIc
prc|cngccc, ccnIrc|e cc inIen:iccce e exIen:cc cc L|cueic, cu:ncic
ce cepre::cc re:pircIcric mcIernc e feIc| e ver:cIi|iccce em :iIucce:
e:pecici:, ccmc ce:crec ce urgncic e ec|cmp:ic.
/ cnc|ge:ic pericurc| ciIccc ccmc c grcnce recur:c ccm ue c euipe
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:ercc ce um ccIIer nc e:pcc pericurc| permiIe c cuicccc:c
IiIu|ccc cc cc:e ce cne:I:icc e c mcnuIencc cc cnc|ge:ic, ce
cccrcc ccm c: nece::iccce: cL:IIricc:. E:Ic f|exiLi|iccce icec| pcrc
umc :iIuccc cincmicc, cnce c: nece::iccce: cnc|g:icc: pccem vcricr
crc:IiccmenIe.
C ccnIrc|e IcIc| cc ccr previne c hipervenIi|ccc mcIernc exce::ivc e
cumenIc c FcC2. Ccm c ncrmc|izccc cc venIi|ccc mcIernc, me|hcrc
IcmLm c cxigenccc feIc|. / re:pc:Ic ccrcicvc:cu|cr c ccr 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 :cng|nec uIerinc ncc :e
c|Ierc nc: mu|here: h|gicc: cpc: c cnc|ge:ic pericurc| e pcce cumenIcr
em mu|here: ccm pr-ec|cmp:ic.
Em ccmpcrccc c mIccc: :i:Imicc: ce cnc|ge:ic, c Icnicc pericurc|
prcv cnc|ge:ic mci: efeIivc pcrc c IrcLc|hc ce pcrIc, c|m ce
Lenef|cic: fi:ic|cgicc: pcIencici:. /Ircv: cc recucc cc: ccIecc|cminc:
:ricc: mcIernc:, c cnc|ge:ic pericurc| pcce me|hcrcr c f|uxc e c
cIiviccce uIerinc:. Umc cnc|ge:ic efeIivc IcmLm inIerrcmpe c c|rcu|c
hipervenIi|ccc - hipcvenIi|ccc mcIernc e :uc: ccn:encic: pcrc c
feIc. Finc|menIe, c cnc|ge:ic pericurc| prcpcrcicnc mcjcr f|exiLi|iccce c:
nece::iccce: ce cccc pcrIurienIe em re|ccc c evc|ucc cL:IIricc:
pcrIc ncrmc|, fcrcipe cu ce:cricnc. Suc: ccnIrc-inciccce: fcrmci: :cc
pcucc:, inc|uincc-:e c cccgu|cpcIic mcIernc, infeccc nc |ccc| cc
puncc, in:IcLi|iccce hemccincmicc re:u|IcnIe ce hipcvc|emic e recu:c
mcIernc. CuIrc: :iIucce: reuerem umc cvc|iccc mci: incivicuc|izccc,
:empre |evcncc em ccnIc c re|ccc ri:cc/Leneficic, ccmc c ccencc
neurc|cgicc pr-exi:Ience, infeccc mcIernc e c|gumc: ccrcicpcIic:.
Cucncc :e uIi|izc Lupivccc|nc em ci|uice: cnc|g:icc: pcr vic pericurc|,
cLIrn-:e umc curccc ce ccc re|cIivcmenIe |cngc e um L|cueic
:en:iIivc ce c|Ic uc|iccce, ccm m|nimc L|cueic mcIcr {L|cueic
ciferencic|).
/ cnc|ge:ic pericurc| prcpcrcicnc um c||vic cc ccr ccn:icerccc Lcm pcr
80 c 07 cc: pcrIurienIe:. Nc enIcnIc, c ccmini:Irccc exc|u:ivc ce
cne:I: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|cueic :impcIicc, e re|cxcmenIc
mu:cu|cr cc c::cc|hc p|vicc e cc pcrece cLccminc|, |evcncc c
cificu|ccce: nc rcIccc 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 incicncic ce pcrIc: in:IrumenIc|:.
Assoc|oo Anests|cos Loco|s e Op|o|des por v|o per|duro|
Hc cercc ce vinIe cnc:, c cL:ervccc cc efeiIc cnc|g:icc ce cpicice:
ccmini:Irccc: pcr vic e:pinc| Ircuxe e:percnc: ce :e cLIer umc
cnc|ge:ic efeIivc, :em L|cueic :impcIicc cu mcIcr, icec| pcrc
cL:IeIricic, pc:-cpercIcric e ccre: crcnicc:.
/ c::cciccc enIre cne:I:icc: |ccci: e cpicice: e umc exce|enIe cpcc
em Iermc: ce uc|iccce cnc|g:icc. E:Ic ccmLinccc pcrece pre:ervcr
c: Lenef|cic: ce cccc crcgc e ciminuir c ri:cc ce efeiIc: ince:ejcvei:. /
exp|icccc pcrc i:Ic re:ice nc fcIc ce ue e:Ie: cgenIe: cIucricm em
cci: :|Iic: ci:IinIc:: c: cne:I:icc: |ccci: nc memLrcnc cxcnc| e c cpicice,
em recepIcr e:pecificc cc mecu|c e:pinc|, e|imincncc c ccr cIrcv: ce
um meccni:mc ccmLinccc e :inrgicc. /: :c|uce: ci|u|cc: ce
cne:I:icc |ccc| :cc ccpcze: ce L|cuecr me|hcr c: fiLrc: /-S, enucnIc
c: cpicice: :ericm mci: eficienIe: nc L|cueic ce impu|:c: ccncuzicc:
pe|c: fiLrc: C.
8
O CONTROLE DA DOR NO TRABALHO DE PARTO
75
8|cueic pericurc| |cmLcr ccnI|nuc - FermiIe c L|cueic :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|cLcrccc mcIernc nc e:Icgic expu|:ivc. /Iuc|menIe, ccn:icerc-:e c
ccr mcIernc ccmc c pcrcmeIrc mci: impcrIcnIe pcrc c incicccc cc
cnc|ge:ic, pcrue ucncc inIen:c e prc|cngccc, prcmcve c|Iercce:
nccivc: pcrc c mce e c feIc. /: ccrcicpcIc: e Icxmicc: cevem receLer
cnc|ge:ic preccce pcrc eviIcr c :cLreccrgc nc :i:Iemc ccrcicvc:cu|cr.
IcmLm incicccc em pre:enc ce ci:Iccic: hiperIcnicc:. Deve-:e
empregcr peuenc: cc:e: ce cne:I:icc: |ccci: pcrc c c||vic cc: ccre:
ceccrrenIe: cc: ccnIrcce: uIerinc: e ci|cIccc cc cc|c. Nc :eguncc
e:Icgic, c L|cueic preci:c :er e:Iencicc cIe S2-S4, cIrcv: ce cc:e:
ccicicnci: ce cne:I:icc |ccc| pe|c ccIeIer.
Icn|cos e Drogos
/ puncc pcce :er rec|izccc ccm c pccienIe :enIccc cu em cecLiIc
|cIerc|, nc |inhc mecicnc, cIrcv: cc: inIere:pcc: L3-L4 cu L4-L5, ccm
cgu|hc: ce:ccrIcvei:, cc Iipc Iuchy 1 c 17 G e c ccIeIer cceuccc cc
cc|iLre cc cgu|hc. Exi:Ie c pc::iLi|iccce ce, uIi|izcncc peuenc: cc:e:
ce cne:I:icc, permiIir c cecmLu|ccc cc pcrIurienIe, cpc: cerIificcr-:e
ue ncc hcjc ccmprcmeIimenIc mcIcr cu ce eui||Lric. Fcce-:e
empregcr IcmLm um e:uemc ce infu:cc ccnIinuc cIrcv: ce LcmLc,
pcrc c mcnuIencc cc cnc|ge:ic. Frccece-:e c in:Ic|ccc 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 0,025 - 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 incicccc ucnIc
cc mcmenIc cc cnc|ge:ic, no o d||otoo cerv|co|. / ci|cIccc 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|cueic Fericurc| LcmLcr Unicc - /ceuccc :cmenIe nc finc| cc
primeirc e:Icgic e expu|:ivc. Ne:Ic :iIuccc, prccece-:e c Icnicc
cne:I:icc ccmc ce:criIc cnIericrmenIe, cpIcncc-:e pcr umc
ccncenIrccc ce cne:I: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*"
cceuccc nc finc| cc primeirc e:Icgic e curcnIe c per|ccc expu|:ivc.
efeIivc ucncc :e preIence Ier um Lcm re|cxcmenIc perinec|
{cp|icccc ce Fcrcipe) Iencc c cpre:enIccc feIc| jc iniciccc c
prcgre::cc cenIrc cc ccnc| ce pcrIc. Fcce :er incicccc IcmLm pcrc
mcnipu|ccc e revi:cc cc ccnc| ce pcrIc e UIerc. lnccnvenienIe:: 1)
n|vei: c|Ic: ce L|cueic ccm percc cc pren:c cLccminc| :eguicc ce
cificu|ccce nc prcgre::cc feIc| e reIcrcc cc per|ccc expu|:ivc. 2)
cefc|ic pc:-puncc.
Icn|co e drogos
/ puncc pcce :er rec|izccc ccm c mu|her :enIccc cu em cecLiIc
|cIerc|, nc |inhc mecicnc, cIrcv: cc: inIere:pcc: L3-L4 cu L4-L5, ccm
cgu|hc: ce:ccrIcvei: ce 25 c 27 G e pcrc urgncic: 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 Icnicc vem gcnhcncc mci: e mci: ccepIc:.
8c:iccmenIe, ccn:i:Ie nc ccmLinccc cc: cuc: Icnicc: cnIericre:.
/Ircv: cc cepc:icc ce um cpicice c::cciccc cu ncc c /L nc e:pcc
:uLcrccncicec, cLIm-:e cnc|ge:ic :cIi:fcIcric pcr cercc ce cuc: hcrc:,
:em ccmprcmeIimenIc mcIcr. / mecicc ue c: ccnIrcce: cc|crc:c:
reIcrncm, pc::|ve| ccmp|emenIcr c cnc|ge:ic, cIrcv: cc injecc ce
umc :c|ucc ci|u|cc ce /L nc e:pcc pericurc|.
/: Icnicc: cpre:enIccc: cnIericrmenIe cevem :er execuIccc: pcr
cne:Ie:ic|cgi:Ic:, e ucncc rec|izccc: cceucccmenIe, prcpcrcicncm
um c|ivic :cIi:fcIcric cc ccr mcIernc e cc me:mc Iempc cferecem
ccncice: Icnicc: pcrc c rec|izccc cc mcicric cc: prccecimenIc:
cL:IIricc:. Fcrc :e c|ccncr c re:u|Iccc e:perccc, impre:cinc|ve|
:c|ienIcr c impcrIcncic ce umc cIuccc ccnjunIc cc: euipe: ce
cL:IeIr|cic, necncIc|cgic e cne:Ie:ic e :uc inIerccc ccm c mu|her e :eu
cccmpcnhcnIe.
8
77
/ cIencc cc pcrIc ncrmc|, em :eu :enIicc e:IriIc,
ceve cLrcnger c c::i:Incic cc per|ccc expu|:ivc, c
ceuiIccc e cc pc:-pcrIc imecicIc cu 4 per|ccc.
EnIreIcnIc, ceve-:e ccn:icercr ue e muiIc cif|ci|
:epcrcr c c::i:Incic cc pcrIc prcpricmenIe ciIc cc
pre:Iccc cc per|ccc ce ci|cIccc.
ASSISINCIA AO FEkODO EXFbLSIVO
C per|ccc expu|:ivc, cu :ejc, c :eguncc per|ccc cc
pcrIc, inicic-:e ccm c ci|cIccc IcIc| cc crvice
Ierminc ccm c expu|:cc cc feIc. CcrccIerizc-:e pcr
e:fcrc: expu|:ivc: mcIernc: {puxc:) e :en:ccc ce
preenchimenIc reIc| ccm ce:ejc ce evccucr,
ceccrrenIe cc pre::cc cc cpre:enIccc feIc| :cLre
reIc e m:cu|c: cc ossoo|ho p|v|co. E c fc:e ce
muccnc: nc ccmpcrIcmenIc mcIernc - c mce Icrnc-
:e vu|nercve| e cepencenIe ccue|e ue c c::i:Ie. E
IcmLm 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 ciminuicc cc circu|ccc Ierc-
p|ccenIcric, pe|c: ccnIrcce: uIerinc: mci: inIen:c: e
freuenIe:, fcvcrece c hipcxic e c ccicc:e feIc|.
lmpce-:e, pcrIcnIc, c mcniIcrizccc efeIivc cc Lem-
e:Icr feIc|.
/ ccrccIerizccc ce:Ie per|ccc c pcrIir cc ci|cIccc
cervicc| ccmp|eIc e cncIcmicc e pcce cu ncc
ccincicir ccm c fc:e ce expu|:cc feIc|. /: veze:, c
ci|cIccc e:Ic ccmp|eIc e :c c|gun: minuIc: mci:
Icrce e ue :e inicicm c: e:fcrc: expu|:ivc:. Em
cuIrc:, c: puxc: mcIernc: cccrrem cnIe: ce
ccmp|eIccc c ci|cIccc. Seguncc Friecmcn {178),
per|ccc p|vicc, ue ccrre:pcnce cc per|ccc
expu|:ivc c|c::icc, inicic-:e ccm c ce:cicc cc
cpre:enIccc e, c pcrIir cci, ccmp|emenIcm-:e c:
fencmenc: meccnicc: cc pcrIc: rcIccc inIernc,
ce:prencimenIc cefc|icc, rcIccc exIernc e
ce:prencimenIc cc cvcice ccrmicc {Fig. 1).
9 ASSISTNCIA MULHER NO PARTO NORMAL
ASSISTNCIA MULHER NO PARTO NORMAL
78
Figura 1. Perodo expulsivo do parto
Nc verccce, nc prcIicc cicric, c per|ccc expu|:ivc ceve :er icenIificccc
pe|c ci|cIccc 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 evicncic: cienI|ficc:.
1 - Fuxos moternos
Fi:ic|cgiccmenIe, cccrrem puxc: invc|unIcric: ucncc c cpre:enIccc
feIc| fcz pre::cc :cLre c reIc e m:cu|c: cc c::cc|hc p|vicc, pccencc
cccnIecer em um mcmenIc mci: Icrcic, cez c vinIe minuIc: cpc: c
ci|cIccc 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|cIccc
cervicc|, 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: {vrIice vi:|ve| nc inIrciIc
vcginc|) ccm puxc: preccce:, cu :ejc, c::im
9
ASSISTNCIA MULHER NO PARTO NORMAL
79
ue :e cicgnc:Iiccu c ci|cIccc IcIc|. C reIcrcc cc: puxc: ncc
ceIermincu uc|uer efeiIc nccivc :cLre c feIc cu recm-nc:cicc: nc
grupc ccm puxc: preccce: cL:ervcu-:e numerc :ignificcIivcmenIe mcjcr
ce cp|icccc ce fcrcipe. EmLcrc c: re:u|Iccc: Ienhcm :icc cLIicc: em
pcrIurienIe: ccm cnc|ge:ic, e:Icc ce cccrcc ccm c experincic c||nicc
ce ue :e ceve reIcrccr c puxc cI 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:fcrc: 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 cpnic fcrccc {puxc:
curcnIe c expirccc). E:Ie |Iimc mIccc re:u|Icu em cLreviccc cc
:eguncc e:Icgic cc pcrIc, mc: ccm ri:cc ce c|Iercce: nc frencic
re:pircIcric e nc vc|ume ce ejecc, ccu:ccc: pe|c Iipc ce re:pirccc
mcIernc. Ccm c: puxc: prc|cngccc: e cecLiIc hcrizcnIc|, pcr
ccmpre::cc cc ccrIc e ciminuicc cc f|uxc Ierc-p|ccenIcric, cL:ervcu-
:e uecc nc pH mcic cc crIric umLi|icc| e Iencncic c mencre:
|ncice: ce /pgcr cc recm-nc:cicc. /: evicncic: :cc) pcucc:, mc:
ce|c: emerge um pccrcc cnce c: puxc: prc|cngccc: e preccce:
re:u|Icm em ciminuicc mcce:Ic cc curccc 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 cIencicc em :c|c e:pecic|, euipccc ccm
|uze: fcrIe: e Lri|hcnIe:, in:IrumenIci: e me:c cirrgicc ccm perneirc: cu
hc:Ie: meIc|icc:. /pe:cr ce mci: cceuccc cc prcfi::icnc| ue c::i:Ie c
pcrIurienIe, pe|c fcci|iccce ce inIervencc cpercIcric :e nece::cric,
pcrc c mce i:Ic e IcIc|menIe inccmccc. Cucncc c evc|ucc cc pcrIc e
ncrmc|, ncc hc incicccc ce Ircn:ferncic cc pcrIurienIe cc pr-pcrIc
pcrc c :c|c ce pcrIc nc per|ccc expu|:ivc. C pr-pcrIc e pcrIc pccem
:er cIencicc: nc me:mc :c|c.
/ humcnizccc cc pcrIc ccnIemp|c c criccc cc: :c|c: ce pcrIc, cnce
c: pcrIurienIe: permcnecem curcnIe c IrcLc|hc ce pcrIc {fc:e ce
ci|cIccc cervicc|), pcrIc {expu|:cc feIc| e ceuiIccc p|ccenIcric) e
puerpric imecicIc ccm :eu cccmpcnhcnIe. Em pcrIugu: c
cencminccc 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 pr-pcrIc, pcrIc e puerpric imecicIc. E::c e:IrcIgic Iem :e
mc:Irccc efeIivc nc humcnizccc cc pcrIc e nc incenIivc cc pcrIc
ncrmc|, ccm ccn:eenIe recucc nc: |ncice: ce ce:crec.
3 - Fos|o moterno
Vcric: :cc c: prcpc:ice: cc |iIercIurc :cLre c me|hcr pc:icc mcIernc
curcnIe c IrcLc|hc ce pcrIc e pcrIc. Depencencc cc ccpcciccce e cc
experincic cc prcfi::icnc| ccm ceIerminccc pc:icc, c|m cc:
infcrmcce: cc prcpric mu|her, c: re:u|Iccc: pccem Ier vcricce: muiIc
grcnce:. lncepencenIemenIe cc: |inhc:
9
ASSISTNCIA MULHER NO PARTO NORMAL
80
ce pen:cmenIc re|ccicnccc: c prcIicc cc c::i:Incic cc pcrIc,
ccn:en:c gerc| ue c pc:icc 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:icc verIicc|izccc cu cc inc|inccc |cIerc| :cLre c pc:icc ccr:c|
{cecLiIc 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 infecce: nc inci:cc. CL:ervcu-:e IcmLm mencr
curccc cc per|ccc expu|:ivc e me|hcre: re:u|Iccc: necncIci: - mencr
prcpcrcc ce |ncice: ce /pgcr 7. CuIrc: e:Iucc: cIriLu|rcm c pc:icc
verIicc|izccc mcicr nmerc ce |ccercce: cc: |cLic: vcginci:, ce Ierceirc
grcu, emLcrc ccm nmerc: peuenc: pcrc umc cnc|i:e ccncreIc.
/pe:cr ce re|ccicncrem mcicr pcrcenIcgem ce hemcrrcgic: pc:-pcrIc,
ncc hcuve ciferenc :ignificcIivc nc: n|vei: ce hemcg|cLinc nc ucrIc
cic ce puerpric. / fcci|iccce ce :e cpurcr c percc :cngu|nec e c mcjcr
pre::cc :cLre c: veic: p|vicc: e vu|vcre: nc pc:icc verIicc| pccem Ier
ccnIriLu|cc pcrc e::c impre::cc.
/ CMS {1), nc :eu guic prcIicc ce /::i:Incic cc FcrIc Ncrmc|,
reccmencc ue, CcnIc nc primeirc ucnIc nc :eguncc per|ccc, c:
mu|here: cevcm cccIcr c pc:icc ue me|hcr |he: cgrcccr, ce:ce ue
eviIem |cngc: per|ccc: em cecLiIc ccr:c|. Deve-:e e:Iimu|ccc: c
experimenIcr cui|c ue fcr mci: ccnfcrIcve| e, pcrc i::c, c: prcfi::icnci:
nece::iIcm :er Ireinccc: nc mcnejc cc pcrIc em cuIrc: pc:ice: c|m cc
:upinc.
4 - Cu|dodos com o perneo
/ |e:cc ce per|nec e um cc: IrcumcIi:mc: mci: freenIe: curcnIe c
pcrIc, me:mc em pcrIc: e IrcLc|hc: ce pcrIc ccm evc|ucc ncrmc|.
Vcric: Icnicc: e prcIicc: vi:cm recuzir c: ccnc: cu c|Ierc-|c: c um grcu
mcnejcve|.
E civu|gccc c Icnicc ce prcIecc 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, enucnIc c cuIrc mcc) fcz |eve pre::cc :cLre c ccLec pcrc
ccnIrc|cr c ve|cciccce ce ccrccmenIc, IenIcncc eviIcr cu recuzir c:
ccnc: cc: Iecicc: perineci:. E::c Icnicc e ccnhecicc ccmc McncLrc
ce FiIgen - {Figurc 2).
F|guro 2 - Monobro de k|tgen [Cunn|nghom et o|., 17}
9
ASSISTNCIA MULHER NO PARTO NORMAL
81
pc::|ve| ue, ccm e::c mcncLrc, :e eviIe c |ccerccc cc per|nec, mc:
ci:cuIicc :e c pre::cc :cLre c ccLec feIc| ncc pc::c impecir c :eu
mcvimenIc ce exIen:cc e cfc:Icr c crcc pLicc em cirecc 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 cvicc, pcrIcnIc ncc :e pcce ccnc|uir
:cLre c me|hcr e:IrcIgic. Ccnvm re::c|Icr ue e::c mcncLrc mci:
fcci|menIe cp|icccc ccm c pcrIurienIe nc pc:icc ccr:c| e, :e e|c e:Iiver
numc pc:icc verIicc|izccc, c prcfi::icnc| pcce fczer c :upcrIe cc
per|nec c: cegc:, cu enIcc nem prcIiccr Ic| e:IrcIgic.
5 - Loceroo de perneo e ep|s|otom|o
/ cccrrncic ce lccercce: perineci: freenIe, e:pecic|menIe em
prim|pcrc:. Lccercce: 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|iccce:. /:
lccercce: ce Ierceirc grcu pccem Ier ccn:encic: mci: :ric: e
:empre cevem :er :uIurccc: pcrc prevenir prcL|emc: ce f|:Iu|c cu
inccnIinncic fecc|.
Um en:cic c||nicc c|ecIcrizccc, ccmpcrcncc c: efeiIc: ce cci: Iipc: ce
:uIurc: pcrc repcrc ce lccercce: perineci: - inIrccrmicc ccnI|nuc e
pcnIc: :epcrccc: - cvc|icu 1.84 mu|here:. / :uIurc inIrccrmicc
ccnI|nuc c::ccicu-:e c mencr inIen:iccce ce ccr cI c 10 cic ce
puerpric e mencr nece::iccce ce remccc cc :uIurc. Ncc :e cL:ervcu
ciferenc nc nece::iccce ce cnc|ge:ic, ce re::uIurc ce pcrece cu nc
ueixc ce ci:pcreunic cpc: Ir: me:e: cc pcrIc.
/pe:cr cc epi:icIcmic :er Icnicc rec|izccc ccm frencic, :uc
incicncic vcricve|. Nc: E:Iccc: Unicc:, 50 c 07 cc: prim|pcrc: :cc
:uLmeIicc: c epi:icIcmic, c ue Icrnc e::c Icnicc c cIc cirrgicc mci:
freenIe ccue|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 mcic-
|cIerc| e c mincric mecicnc. /: epi:icIcmic: mecicnc: :cc :uIurccc: ccm
mci: fcci|iccce e Im c vcnIcgem ce me|hcr ciccIrizccc, enIreIcnIc, c:
mcic-|cIerci: :cc me|hcre: nc prcIecc 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
ASSISTNCIA 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|iccce: ce ciccIrizccc, emLcrc :e cL:erve ri:cc cumenIccc ce
Ircumc perinec| cnIericr.
/ CMS {1) cvc|ic ue ceIerminccc: :iIucce:, ccmc :inci: ce
:cfrimenIc feIc|, prcgre::cc in:uficienIe cc pcrIc e cmecc ce
|ccerccc ce Ierceirc grcu {inc|uincc |ccerccc ce Ierceirc grcu em
pcrIc cnIericr) pccem :er Lcn: mcIivc: pcrc c incicccc cc epi:icIcmic
num pcrIc, cI enIcc ce evc|ucc ncrmc|. Sc|ienIc ue c prcfi::icnc|
ceve :er hcLi|iIccc pcrc :uIurcr |ccercce: e epi:icIcmic: ce mccc
cceuccc, cevencc receLer IreincmenIc pcrc i::c.
- Monobros extrot|vos
ccmum c prcIicc ce rec|izcr pre::cc nc funcc cc Ierc curcnIe c
per|ccc expu|:ivc, ccm c inIencc ce cce|ercr c nc:cimenIc.
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 Ierc, 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|hcnc cc
Irccc ccnIrc|ccc cc ccrccc umLi|icc|, e:Ic prcIicc ceve :er enccrccc
ccm ccuIe|c e eviIccc pcr prcfi::icnci: inexperienIe:. / CMS {1)
c|c::ificc c pre::cc nc funcc uIerinc nc per|ccc expu|:ivc ccmc prcIicc
em 4'-%+,# Z ./%- ncc exi:Iem evicncic: :uficienIe: <%4% cpcicr umc
reccmencccc 1-%4% ' ue cevem :er uIi|izccc: ccm ccuIe|c %): ue
mci: pe:ui:c: e:c|crecm c ue:Icc {ccIegcric C).
/pc: c |iLerccc cc pc|c cefc|icc, c: cmLrc: rcccm inIerncmenIe. Ne::e
mcmenIc prcvicencic| ue :e cL:ervem c exIen:cc e c pre:enc ce
circu|cre: ce ccrccc. Se nece::cric, e:Icr prepcrccc pcrc rec|izcr c c|c
cc ccrccc, c recucc ce evenIuci: circu|cre: cu c |igccurc cervicc| cc
ccrccc umLi|icc|, ucncc hcuver circu|cre: muiIc cperIccc:. Ccm c
rcIccc ccmp|eIccc, c: cmLrc: cevem :er |iLerccc:, prevenincc c
Ircumc perinec|. Nc pc:icc :emi-ceiIccc, c cmLrc cnIericr c primeirc
c :er |iLerccc {Figurc 3): nc: pc:ice: ce ccccrc: cu ce jce|hc:, c cmLrc
pc:Iericr ceve :er |iLerccc cnIe: cc cnIericr.
9
ASSISTNCIA MULHER NO PARTO NORMAL
83
F|guro 3 - L|beroo dos ombros - onter|or [A} e poster|or [8}
[Cunn|nghom et o|., 17}
/ cificu|ccce nc |iLerccc cc: cmLrc: rcrc, mc: ceve :er previ:Ic cu
:u:peiIccc ucncc, c pc|pccc cLccminc|, evicencicr-:e um feIc
grcnce. Nc: cc:c: ce ci:Iccic ce cmLrc:, c|gumc: mcncLrc: pccem :er
cp|icccc:: cLcucc cmp|c cc: pernc: e f|excc ccmp|eIc :cLre c ccxc e
c cLccme mcIernc: rcIccc mcnuc| cc cmLrc pc:Iericr cc feIc pcrc
cnIericr e, :e nece::cric, pre::cc :uprc-pLicc prcIicccc pcr um cuxi|icr
cireIcmenIe :cLre c :|nfi:e pLicc mcIernc.
Ncc e:Ic c|crc :e e::c: mcncLrc: :cc :empre nece::cric: e :e :cc
cceuccc:. 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: mIccc: ce ce:prencimenIc
cc ccLec e cc: cmLrc: cc feIc :cLre c per|nec.
7 - C|ompeomento do cordo 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 recm-nc:cicc. Ncc :e verificcrcm inc|cic: ce efeiIc: :ignificcIivc:
:cLre c incicncic ce hemcrrcgic pc:-pcrIc cu :cLre c Ircn:fu:cc feIc-
mcIernc. EnIreIcnIc, :cLre c recm-nc:cicc, vcric: cL:ervcce: 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
ASSISTNCIA 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:ncic ce c|cmpecmenIc) c mccc
fi:ic|cgicc ce IrcIcr c ccrccc, e c preccce inIervencc ue ceve Ier
inciccce: preci:c:. / Ircn:fu:cc ce :cngue cc p|ccenIc pcrc c recm-
nc:cicc, nc: cc:c: ce c|cmpecmenIc Icrcic ce ccrccc, fi:ic|cgicc e
prcvcve|menIe ncc Iem efeiIc: ccver:c:, pe|c menc: em cc:c: ce Lcixc
ri:cc.
/: inciccce: ce c|cmpecmenIc preccce ce ccrccc :e re|ccicncm c
ge:Icce: e pcrIc: ce ri:cc, ccmc pcr exemp|c, c :en:iLi|izccc 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|iccce: e ceve :er eviIccc.
lmecicIcmenIe cpc: c nc:cimenIc, ceve-:e verificcr c: ccncice: cc
recm-nc:cicc. l::c pcrIe inIegrcnIe cc c::i:Incic cc pcrIc ncrmc| e c
CMS enfcIizc c impcrIcncic ce umc cLcrccgem unificccc c c::i:Incic
mcIernc e necncIc|. E:Ie c::unIc e:Ic ccnIemp|ccc nc Ccp|Iu|c 15.
ASSISINCIA DEQbIIAO
Ne::e e:Icgic cccrre c :epcrccc e expu|:cc cc p|ccenIc {ceuiIccc).
C: principci: ri:cc: mcIernc: :cc c hemcrrcgic curcnIe cu cpc: e::c
:epcrccc e c reIencc ce re:Ic: p|ccenIcric:.
A hemorrog|o pos-porto umo dos pr|nc|po|s cousos de morto||dode
moterno e o mo|or|o desses cosos ocorre em poses em desenvo|v|mento.
/ incicncic ce hemcrrcgic pc:-pcrIc e ce reIencc ce re:Ic:
p|ccenIcric: cumenIcm frenIe c c|gun: fcIcre: preci:pcnenIe:, Ici: ccmc
ge:Iccc m|Iip|c, pc|icrcmnic, IrcLc|hc ce pcrIc ccmp|icccc {ci:Iccic:)
cu pcrIc vcginc| cpercIcric. IcmLm c ri:cc cumenIccc ucncc c
pcrIurienIe Iem cnIececenIe: prvic: ce::c: inIerccrrncic:. EmLcrc :ejc
pc::|ve| :e|ecicncr c: mu|here: ce ri:cc, me:mc em ge:Icce: ce Lcixc
ri:cc e pcrIc: ce evc|ucc ncrmc|, pccem-:e cL:ervcr hemcrrcgic:
:everc: e reIencc 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
ASSISTNCIA MULHER NO PARTO NORMAL
85
1 - bso pro|||t|co de oc|toc|cos
/ ccmini:Irccc prcfi|cIicc ce cciIccinc u:ccc em vcric: mcmenIc:
curcnIe c Ierceirc per|ccc cc pcrIc. Mci: freenIemenIe 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 cricnc. /:
crcgc: mci: empregccc: :cc c cciIccinc e cerivccc: cc ergcI, ccmc c
ergcIcminc, cu umc ccmLinccc ce cmLc:, c :inIcmeIrinc. IcnIc c
cciIccinc ccmc c: cerivccc: cc ergcI ciminuem c percc :cng|nec pc:-
pcrIc, mc: c efeiIc cc ergcI pcrece :er um pcucc mencr. Ncc e:Ic Lem
c|crc c ccc ce::c: crcgc: :cLre c reIencc cc: re:Ic: p|ccenIcric:,
emLcrc c|gun: re:u|Iccc: :ugircm ue c ccmini:Irccc rcIineirc ce
cciIccinc pc::c cumenIcr e::e ri:cc.
Ncu:ec:, vcmiIc: e cefc|ic :cc re|ccicnccc: mci: freenIemenIe cc:
cerivccc: cc ergcI e, em mencr e:cc|c, c cciIccinc. / cccrrncic ce
hiperIen:cc crIeric| pc:-pcrIc um efeiIc cc|cIerc| prcIiccmenIe
exc|u:ivc cc: cerivccc: cc ergcI. IcmLm pccem cccrrer prcL|emc:
rcrc:, pcrm :ric:, 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 c me|hcr e:cc|hc, c|m 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 :iIuccc c|c::ificccc ccmc inIervencc prejucicic| cu ineficcz ue
ceve :er cLcnccnccc.
2 - Iroo contro|odo do cordo
/ Irccc ccnIrc|ccc cc ccrccc envc|ve c Irccc cc ccrccc,
ccmLinccc ccm ccnIrcpre::cc :cLre c ccrpc uIerinc nc cirecc
cefc|icc, feiIc pe|c mcc cpc:Ic cc|ccccc |cgc ccimc cc :|nfi:e pLicc.
E:Iucc: ccmpcrcIivc: enIre Irccc ccnIrc|ccc e cLcrccgen: mci:
expecIcnIe:, c: veze: envc|vencc pre::cc fncicc, cemcn:Ircrcm mencr
percc :cng|nec mcic e encurIcmenIc cc Ierceirc e:Icgic nc Irccc
ccnIrc|ccc. EnIreIcnIc, ceve-:e cIenIcr pcrc c ri:cc ce inver:cc uIerinc
fcci|iIccc pcr e::c mcncLrc. /pe:cr ce rcrc, cccrrncic Lc:IcnIe
grcve, re|ccicnccc c inexperincic e neg|igncic cc pcrIeirc em prcIiccr
Ic| e:IrcIgic. Seguncc c CMS TVbbRU? : c|c::ificccc ccmc d<48)61% em
re|ccc c ./%- ncc exi:Iem evicncic: :uficienIe: pcrc cpcicr umc
reccmencccc c|crc e ue cevem :er uIi|izccc: ccm ccuIe|c %): ./'
mci: pe:ui:c: e:c|crecm c ue:Icc {ccIegcric C).
3 - Comporoo entre monejo ot|vo e expectonte
C: efeiIc: ccmLinccc: cc u:c ce cciIccicc: e Irccc 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 IcmLm pcce inciccr ccmLincce: ce ciferenIe:
inIervence: ccm ciferenIe: re:u|Iccc:. Dc| c cificu|ccce ce :e cvc|icr c:
vcric: re:u|Iccc: e cefinir c me|hcr e:IrcIgic enIre mcnejc cIivc e
ccncuIc ccn:ervcccrc nc ceuiIccc p|ccenIcric.
9
ASSISTNCIA 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 puerpric. Mc:, :cc mci: ccmun: vcmiIc:, ncu:ec: e hiperIen:cc,
prcvcve|menIe ccu:ccc: pe|c u:c ce ergcIcminc. Exi:Iem funccmenIc:
pcrc :ric: cvicc: :cLre c u:c prcfi|cIicc ce ergcmeIrinc cu ce umc
ccmLinccc ce cciIccinc e ergcmeIrinc {:inIcmeIrinc) ccmc
prccecimenIc: ce rcIinc nc c::i:Incic c ceuiIccc.
Ccmc ccnc|u:cc, c ccmini:Irccc ce cciIccinc nc c::i:Incic c
ceuiIccc e c Irccc ccnIrc|ccc cc ccrccc pccem cpre:enIcr
vcnIcgen: em inciccce: preci:c: - mu|here: ccm ri:cc pcrc hemcrrcgic
pc:-pcrIc e cue|c: pcrIcccrc: ce cnemic . :everc. / ce:peiIc cc:
crienIcce: cnIericre: cc CMS {10 e 14), c reccmencccc 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|so 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, 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|crccc cc ccviccce uIerinc ceve :er iniciccc. C excme cc
p|ccenIc e cnexc: pre:Ic-:e, IcmLm, pcrc c cicgnc:Iicc ce evenIuci:
cncrmc|iccce:: infcrIc:, hemcIcmc:, in:ercc cncrmc| ce ccrccc e
crIric umLi|icc| nicc, re|ccicnccc c mc|fcrmcce: feIci:.
Em c|gun: pc|:e: prcIicc ce rcIinc c exp|crccc cc ccviccce uIerinc
nc pc:-pcrIc imecicIc. Ncc exi:Ie c mencr inc|cic ce ue e::c ccncuIc
:ejc Ii|, cc ccnIrcric, pcce ccu:cr infeccc, IrcumcIi:mc: e cI me:mc
chcue. Feccmencc-:e, enIreIcnIc, c revi:cc cc ccnc| ce pcrIc pcrc c
cicgnc:Iicc ce pc::|vei: |ccercce: ce IrcjeIc.
CONSIDEkAES FINAIS
Em ue pe:e c experincic ce muiIc: cL:IeIrc: e cuIrc: prcfi::icnci:, c
ue lhe: permiIe cefencer :uc: ccncuIc: e prcIicc: nc c::i:Incic 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 evicncic: 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:Incic cc pcrIc. / excecc ce
c|gumc: ce|c:, ce:Iccccc: nc Ccp|Iu|c 21, muiIc: cuIrc: ccnIinucm :em
cefinicc ucnIc cc ri:cc-Lenef|cic pcrc c mce e c ccncepIc. Dc| c
cificu|ccce em :e pccrcnizcr c c::i:Incic ne:Ie mcmenIc Icc
impcrIcnIe cc vicc cc mu|her. EnIreIcnIc, cerIc cfirmcr ue c:
Lenef|cic: e, em ceccrrncic, c: me|hcre: re:u|Iccc: mcIernc: e
perincIci: re|ccicncm-:e cireIcmenIe c c::i:Incic humcnizccc,
re:peiIcncc c: cireiIc: cc pcrIurienIe, re:gcIcncc c :eu pcpe| ccmc
prcIcgcni:Ic e incenIivcncc c pcrIc ncIurc|.
9
87
/ ce:crec um prccecimenIc cirrgicc 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 incicccc preci:c, pci: :cLicc ue
e:Ie prccecimenIc cirrgicc, ccmpcrcIivcmenIe cc
pcrIc ncrmc|, c::ccic-:e ccm mcicr mcrLiccce e
mcrIc|iccce mcIernc e necncIc|. / cperccc
ce:cricnc cpre:enIc umc frencic muiIc e|evccc
nc 8rc:i|. l::c Iem :icc re:pcn:cve| pcr umc
Lcnc|izccc cc prccecimenIc, ccmc :e fc::e :imp|e:
e i:enIc ce pc::|vei: ccmp|iccce:.
C pcrIc pcr ce:crec umc |cpcrcIcmic ue exige
umc :rie ce cuicccc: c||nicc:, Icnicc: e cne:I:icc:
e ue :e c::ccic IcmLm c c|gumc: ccmp|iccce:
ue cevem :empre :er pcncerccc: cnIe: cc
incicccc. Deve, pcrIcnIc, :er cecicicc pcr criIric:
e:IriIcmenIe c||nicc: e cL:IIricc:.
Ccn:icerc-:e icec| c Icxc ce ce:crec em Icrnc ce 15 c
207 pcrc c IcIc| cc pcpu|ccc. Nc enIcnIc, ceve-:e
|evcr em ccn:icerccc c ccmp|exiccce cc c::i:Incic
fcrnecicc pe|c in:IiIuicc, ucncc :e cnc|i:cm Icxc:
in:IiIucicnci: :epcrcccmenIe.
CcLe cui enfcIizcr ue c pcrIc pcr ce:crec, ucncc
Lem incicccc e rec|izccc, IcmLm um pcrIc
humcnizccc nc mecicc em ue c incicccc vi:c
minimizcr cgrcvc: c mce e cc feIc. C pre:enIe
ccp|Iu|c ncc Iem c cLjeIivc ce en:incr c Icnicc
cirrgicc 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 Icnicc nc
rec|izccc ce:Ie prccecimenIc.
1. Anestes|o
/ nece::iccce cc u:c ce cne:Ie:ic em prccecimenIc:
cL:IIricc:, prcIicccc pcr prcfi::icnci: e:pecic|i:Ic:
ccpcciIccc:, ccn:IiIui um ccn:en:c c n|ve| nccicnc|,
emLcrc muiIc: |ugcre: e
10 ASSISTNCIA MULHER NO PARTO POR CESREA
ASSISTNCIA MULHER NO PARTO POR CESREA
88
in:IiIuice: ncc ci:pcnhcm cincc ce Iccc: c: fcci|iccce: pcrc i::c.
nece::cric, ccnIucc, ue c: prcfi::icnci: ue pre:Icm c::i:Incic c
mu|her curcnIe c grcvicez e pcrIc, ccnhecm 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|o do mu|her
/ ce:crec rec|izccc ccm c mu|her em cecLiIc ccr:c| hcrizcnIc|. Fe|c
pc::iLi|iccce ce hipcIen:cc mcIernc {cevicc c ccmpre::cc cc veic
ccvc infericr e ciminuicc cc reIcrnc venc:c cc ccrccc) e
ccn:eenIe recucc nc perfu:cc p|ccenIcric e nc cxigenccc feIc|,
c|gun: e:Iucc: Im ccmpcrccc e:Ic pc:icc ccm c rec|izccc ce:Ie
prccecimenIc cirrgicc ccm c mu|her em cecLiIc |cIerc| {10 cu 15
grcu:). Nc enIcnIc, revi:cc :i:IemcIicc :cLre c Iemc ccnc|uiu ue ncc
exi:Ie, cI c mcmenIc, evicncic: cienI|ficc: :uficienIe: pcrc cvc|icr uc|
me|hcr pc:icc cc mu|her nc ce:crec.
3. Ant|sseps|o
/ cegermccc cc pe|e cc cLccmen mcIernc ccm :c|uce: ce :cLcc
neuIrc previcmenIe c cnIi::ep:ic funccmenIc|. C: cnIi::pIicc:
cIuc|menIe empregccc: :cc :c|uce: ce iccc, ncc mci: :e ju:Iificcncc c
u:c ce cuIrc: :c|uce:. / cic|chexicinc pcce :er IcmLm uIi|izccc em
c::cciccc ccm c: :c|uce: iccccc:. A|m do mu|her, necessr|o
|embror que o h|g|en|zoo dos mos do equ|pe pro||ss|ono| que
otender o porto const|tu| e|emento |undomento| poro ev|tor o
contom|noo c|rrg|co e os comp||coes |n|ecc|osos pos-operotor|os.
4. Esco|ho do |nc|so
Nc 8rc:i|, cIuc|menIe, nc uc:e cL:c|uIc IcIc|iccce cc: ce:crec:, c
preferncic cccc c inci:cc Ircn:ver:c :uprc-pLicc, ccnfcrme Icnicc
ce Ffcnnen:Iie|. / inci:cc infrc-umLi|icc| mecicnc re:Iringe-:e c cc:c: em
ue c ri:cc ce :cngrcmenIc 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:
:iIucce:.
EnIreIcnIc, uIi|izcncc-:e c Icnicc ce Ffcnnen:Iie|, ceve-:e e:Icr cIenIc c
c|gun: inccnvenienIe:, fcci|menIe ccnIcrncvei:: mcicr :cngrcmenIc,
ccmpc cpercIcric recuzicc, mcicr Iempc cirrgicc ue c inci:cc
mecicnc e mcicr ri:cc ce hemcIcmc. Ncc exi:Iem cI c mcmenIc
ccmpcrcce: Lem rec|izccc: enIre c: cci: Iipc: ce inci:cc ue permiIcm
ju:Iificcr c preferncic 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|c: inIe:Iinci:, principc|menIe
em cc:c: ce cirurgic: prvic:, cu inexperincic
10
ASSISTNCIA MULHER NO PARTO POR CESREA
89
cc cirurgicc. funccmenIc|, enIreIcnIc, ue c cicgnc:Iicc cc
inIerccrrncic :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
c ce e:cc|hc. Exi:Iem ju:IificcIivc: pcrc e:Ic preferncic. Em primeirc
|ugcr, re:peiIc-:e c ci:pc:icc Ircn:ver:c| e pcrc|e|c cc: fiLrc: micmeIrci:
e cc vc:cu|cIurc. C ri:cc ce |e:ce: cc: crIric: uIerinc: - principc|
inccvenienIe cc hi:IercIcmic :egmenIcr Ircn:ver:c - pcce :er
minimizccc pcr :eu ccrcIer crcifcrme ce ccnccviccce :upericr. /|m
ci::c, pcr ncc rcmper fiLrc: e :im civu|:icnc-|c:, gcrcnIe-:e me|hcr
cprcximccc cc: Lcrcc: cc inci:cc uIerinc e, ccn:eenIemenIe, mcicr
fcci|iccce pcrc c :uIurc e me|hcr ciccIrizccc.
/ cLerIurc cc ccviccce uIerinc feiIc prcIiccncc-:e peuenc inci:cc c
Li:Iuri, ue :e ccmp|eIc ce|iccccmenIe ccm pinc Iipc e||y cu Fecn,
cI cIingir-:e c ccviccce uIerinc. / :eguir, ccm c: cecc: inciccccre:
inIrccuzicc: ne:Ic peuenc 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:enc 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 Ierc cincc ncc e:Ic ccmp|eIcmenIe
cce|gcccc.
Excepcicnc|menIe, nc: cc:c: ce :egmenIc infericr cincc ncc fcrmccc
cu mc| ce:envc|vicc, pcce :er nece::cric c uIi|izccc cc inci:cc
:egmenIc-ccrpcrc|. Ic| ceci:cc, enIreIcnIc, exige experincic cc
cL:IeIrc e umc cvc|iccc feiIc ccm c venIre cLerIc.
7. Escoomento do |qu|do omn|ot|co
Deve-:e prccecer c c:pirccc cuicccc:c cc l|uicc cmnicIicc pre:enIe,
cu permiIir c :eu e:cccmenIc prcIegicc pcr ccmpre::c: cirrgicc:,
eviIcncc c enchcrccmenIc cc: ccmpc: prcIeIcre: e fcci|iIcncc c
reIirccc cc feIc, pcr ciminuir :uc mcLi|iccce.
8. ket|rodo do |eto
Iempc cirrgicc muiIc impcrIcnIe nc ce:crec, exigincc Ircni|iccce cc
cirurgicc, ccm cLjeIivc ce eviIcr ce:prencimenIc: feIci: Lru:cc:, ccm
pc::|vei: ccn:encic: perincIci:. Ne:Ie mcmenIc funccmenIc|
|emLrcr ue umc cricnc e:Ic nc:cencc: c :c|c cirrgicc ceve e:Icr
cuecicc {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 recm-nc:cicc pcrc c mce, c::im ue fcr pc::|ve|.
/ reIirccc cc feIc pcce :er feiIc mcnuc|menIe cu ccm c uIi|izccc ce
in:IrumenIc: ccmc fcrcipe: e c|cvcncc:. Nc: cpre:enIcce:
10
ASSISTNCIA MULHER NO PARTO POR CESREA
90
cefc|icc: mci: prcfunccmenIe cju:Iccc:, c exIrccc mcnuc| ce
e:cc|hc: inIrccuz-:e c mcc enIre c cpre:enIccc 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 cirecc 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:enIcce: cefc|icc: c|Ic: e mcvei:, ccmc freenIe:
em premcIurc: e ge:Icce: ccm pc|icrcmnic, c uIi|izccc ce
in:IrumenIc: ccmc c c|cvcncc ce Se|heim, fcci|iIc :cLremccc c reIirccc
cc feIc. Me:mc c::im, pcr veze:, c exIrccc Icrnc-:e cif|ci| ccmc, pcr
exemp|c, nc: cefc|icc: cef|eIicc:, c cemcnccr ccncuIc mci: cIivc ccmc
c cp|icccc ce fcrcipe, cujc Icnicc cLecece cc: me:mc: Iempc: ue
pcrc pcrIc: vcginci:. /mLc: prccecimenIc: impcem nece::cricmenIe c
hcLi|iccce nc :eu mcnejc.
Nc: cpre:enIcce: p|vicc:, iguc|menIe, c reIirccc cc feIc cLecece
rigcrc:cmenIe cc: me:mc: Iempc: e Icnicc: prcpc:Ic: pcrc c pcrIc
vcginc|. C cL:IeIrc ceve e:Icr cIenIc pcrc c ccrccc umLi|icc| cc feIc,
prcIiccncc c chcmccc c|c ce ccrccc cnIe: cc ce:prencimenIc cc
cinIurc e:ccpu|cr e verificcr c exi:Incic ce circu|cre: cervicci:. C cuxi|icr
ce:empenhc pcpe| impcrIcnIe, ccncuzincc c pc|c cefc|icc
exIerncmenIe, ccn:ervcncc-c ceviccmenIe f|eIicc, cI 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 exIrccc feIc|.
Nc: :iIucce: Ircn:ver:c:, c cL:IeIrc ceve Ier experincic :uficienIe pcrc
execuIcr mcncLrc: ce ver:cc inIernc e exIrccc pccc|icc.
9. C|ompeomento do cordo 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 exIrccc feIc|, excIcmenIe cc me:mc
mcneirc ue nc pcrIc cIencicc pcr vic vcginc|, ccnfcrme IrcIc c
Ccp|Iu|c 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 recm-
nc:cicc. Ncc :e verificcrcm inc|cic: ce efeiIc: :ignificcIivc: :cLre c
incicncic ce hemcrrcgic pc:-pcrIc cu :cLre c Ircn:fu:cc feIc-mcIernc.
EnIreIcnIc, :cLre c recm-nc:cicc, vcric: cL:ervcce: 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 $' 76<'4@6-644/@6*'26%E K*)4')%*)#?
10
ASSISTNCIA MULHER NO PARTO POR CESREA
91
*,# ;#4%2 #@('43%$%( $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:ncic ce c|cmpecmenIc) c mccc
fi:ic|cgicc ce IrcIcr c ccrccc, e c preccce inIervencc ue ceve Ier
inciccce: preci:c:. / Ircn:fu:cc ce :cngue cc p|ccenIc pcrc recm-
nc:cicc, nc: cc:c: ce c|cmpecmenIc Icrcic ce ccrccc, fi:i c|cgicc e
prcvcve|menIe ncc Iem efeiIc: ccver:c:, pe|c menc: em cc:c: ce Lcixc
ri:cc.
/: inciccce: ce c|cmpecmenIc preccce ce ccrccc re|ccicncm-:e c
ge:Icce: e pcrIc: ce ri:cc, ccmc pcr exemp|c, c :en:iLi|izccc 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|iccce: e ceve :er eviIccc.
10. Dequ|too
/pc: c reIirccc feIc|, enucnIc c euipe cirrgicc incivicuc|izc c: Lcrcc:
cc hi:IercIcmic, c ceuiIccc, nc mcicric cc: veze:, cccrre ce fcrmc
e:pcnIcnec. E:Ie Iempc pcce :er ciminu|cc, uIi|izcncc-:e cciIccicc:.
Fe|c vigcrc:c ccnIrccc uIerinc ue :e cLIm, c p|ccenIc expu|:c :em
grcnce: cificu|ccce:. Fcrc umc ci:cu::cc mci: ceIc|hccc :cLre c
c::unIc, ver Ccp|Iu|c .
C: e:Iucc: ccnIrc|ccc: ue ccmpcrcm c ceuiIccc e:pcnIcnec ccm
c remccc mcnuc| cc p|ccenIc Im mc:Irccc ue e:Ic |Iimc mci:
ccnc:c, c::ccicncc-:e cc incremenIc cc percc :cngu|nec mcIernc e cc
ri:cc ce infeccc, 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 ceuiIccc, em per|ccc rczccve| ce Iempc pcrc c
prccecimenIc cirrgicc.
11. kev|so do p|ocento e do cov|dode uter|no
Iempc cLrigcIcric pcrc c icenIificccc ce frcgmenIc: p|ccenIcric:
reIicc: cu ce |e:ce: cc: pcrece: uIerinc:, principc|menIe ucncc cc u:c
ce in:IrumenIccc pcrc c reIirccc cc feIc. Feccmencc-:e c curcgem
cc ccviccce uIerinc ccm ccmpre::c pcrc e:Ie prccecimenIc.
Ccn:IiIui pc::c Icnicc ce grcnce re|evcncic, pcrc c icenIificccc 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:, nmerc ce vc:c:, eIc.).
12. H|sterorro||o
EmLcrc c :uIurc ccnI|nuc cnccrccc :ejc prcIicc freenIe nc 8rc:i|, c
fechcmenIc cc ccviccce uIerinc ccm pcnIc: :epcrccc:, em ccmccc
nicc, c ue fcrnece me|hcre: re:u|Iccc: ucncc c ciccIrizccc. Nc:
cc:c: e:pecici: ce inci:cc :egmenIc-ccrpcrc|,
10
ASSISTNCIA MULHER NO PARTO POR CESREA
92
c fechcmenIc feiIc em cuc: cu Ir: 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 cirrgicc, c: fic:
incicccc: :cc c: ce cL:crcc |enIc {ccIguI crcmccc n 0, cu vicry| n 0,
cu cexcn n 0).
Fe|c ccnhecimenIc ci:pcn|ve| cI c mcmenIc, e:Ie fechcmenIc cc
ccviccce uIerinc ceve :er rec|izccc ccm c Ierc em :eu :|Iic hcLiIuc|.
/|gun: e:Iucc: Im prcpc:Ic ue e:Ic :uIurc :ejc rec|izccc cpc: c
exIericrizccc cc Ierc. Nc enIcnIc, revi:cc :i:IemcIicc :cLre c c::unIc
ccnc|uiu ue ncc hc evicncic :uficienIe pcrc reccmenccr c u:c
rcIineirc cc exIericrizccc uIerinc pcrc c repcrc cc hi:Iercrrcfic.
13. Fer|ton|zoo
/ :uIurc ccnI|nuc ccm fic finc cL:crv|ve|, ccmc c ccIguI :imp|e: n 2-0,
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 periIcnizccc vi:cerc|, c cuxi|icr Irccicne
c fic ccm fcrc :uficienIe cpenc: pcrc cprcximcrem-:e c: Lcrcc:, :em
prccuzir c preguecmenIc cc :uIurc, c ue pcce ccncicicncr muccnc:
nc pc:icc cc Lexigc e cc urccincmicc ve:icc|. C fechcmenIc cc
ccviccce cLccminc| {:uIurc cc periIcnic pcrieIc|) IcmLm ceve :er feiIc
ccm chu|eic ccnI|nuc, ccm fic cL:crv|ve| e finc {ccIguI n 2-0).
EnIre e:Ie: cci: Iempc: cc periIcnizccc, prccece-:e c revi:cc cc
ccviccce cLccminc|, ncc :cmenIe pcrc c reIirccc ce :cngue e
cccgu|c: ccumu|ccc:, ccmc IcmLm pcrc c cvc|iccc cc: cvcric: e
IuLc: uIerinc:.
En:cic: c||nicc: ccnIrc|ccc: Im ccmpcrccc c periIcnizccc ccm c ncc
periIcnizccc vi:cerc| e/cu pcrieIc|. C: re:u|Iccc: principci: mc:Ircm ue
c ncc fechcmenIc cc periIcnic ciminui c Iempc cpercIcric, :em
ciferenc :ignificcIivc ucnIc c mcrLiccce pc:-cpercIcric, nece::iccce
ce cnc|g:icc: e Iempc ce permcnncic hc:piIc|cr.
14. Fechomento do p|ono muscu|or
Deve :er feiIc ccm pcnIc: :epcrccc: em U, ccm fic ce cL:crcc rcpicc
{Iipc ccIguI :imp|e: n 0). C: pcnIc: ncc cevem :er cperIccc:, pci:
pccem prcvcccr i:uemic cc mu:cu|cIurc.
15. Fechomento do oponeurose onter|or dos mscu|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:crcc |enIc {vicry|
n 0, cu cexcn n 0) cu cincc fic: incL:crv|vei:.
/ cc|ccccc ce crenc ce Fenrc:e nc e:pcc :uLcpcneurcIicc ncc
ceve :er prccecimenIc ce rcIinc, mc: e:Ic reccmencccc ucncc
10
ASSISTNCIA MULHER NO PARTO POR CESREA
93
exi:Iir ri:cc cumenIccc ce fcrmccc ce hemcIcmc: cu infeccc:
c|Ierccc cc cccgu|ccc :cng|nec, c|Iercce: hemccincmicc:
mcIernc: nc ceccrrer cc cirurgic e cificu|ccce ce hemc:Ic:ic cc p|cnc
m:cu|c-cpcneurcIicc.
impcrIcnIe |emLrcr ue c mu|her grcvicc e:Ic em umc :iIuccc
fi:ic|cgicc ce hipercccgu|cLi|iccce, c ue fcci|iIc c hemc:Ic:ic cc
pcrece cLccminc| nc: prccecimenIc: cirrgicc:, ccmc c cc:c cc
ce:crec. /::im, c hemc:Ic:ic meccnicc uc:e :empre :uficienIe, ncc
hcvencc gerc|menIe nece::iccce ce e|eIrcccuIerizccc. Cucncc e|c
fcr uIi|izccc, preci:c um cuicccc e:pecic| ccm c p|ccc pcrc eviIcr
ueimccurc:, mci: freenIe: ne:Ie prccecimenIc pe|c mcicr
prcLcLi|iccce ce c: ccmpc: cirrgicc: e:Icrem mc|hccc:.
1. Aprox|moo do tec|do ce|u|or subcutneo
De:nece::cric pcrc c|gun:, feiIc uIi|izcncc-:e pcnIc: :epcrccc: ce
cprcximccc ccm fic ce cL:crcc rcpicc. Cuicccc: :imi|cre: cevem :er
Icmccc: ccm re|ccc 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 n 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:
cceuccc:. :uficienIe |cvcr c inci:cc ccm cguc e :cLcc, mcnIencc-c
:ecc.
CbIDADOS FS-OFEkAIkIOS
1. Ant|b|ot|coterop|o
/ ce:crec 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|ses s|stemt|cos tm demonstrodo
c|oromente que o ont|b|ot|co pro|||t|co, em openos umo dosogem,
|med|otomente opos o c|ompeomento do cordo, proced|mento
e|et|vo no preveno de morb|dode |n|ecc|oso puerpero| moterno.
Mu|tos esquemos de ont|b|ot|cos |so|odos ou em ossoc|oo tm s|do
estudodos, sem umo c|oro demonstroo do supremoc|o de quo|quer um
de|es. kecomendo-se, portonto, o uso de umo ce|o|ospor|no de pr|me|ro
geroo [ce|ozo||no ou ce|o|ot|no, 2 g endovenoso} ou omp|c|||no [2 g
endovenoso}.
/ cnIiLicIiccIercpic curcIivc incicccc cpenc: nc: cc:c: ccm um
cicgnc:Iicc ccnfirmccc cu c|iniccmenIe :u:peiIc ce infeccc.
10
ASSISTNCIA MULHER NO PARTO POR CESREA
94
2. Med|coo pos-operotor|o
Hcje cc:Iume ci::eminccc enIre c: mcicc: c u:e ce cnIi-inf|cmcIcric:
incicccc: ccmc cnc|g:icc:. Ic| mecicc ncc :e ju:Iificc c |uz cc
fi:ic|cgic, pci: c inf|cmccc 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:uficincic Fenc| /gucc. Fcr i::c, cnc|g:icc: ccmun: cevem
:er ce e:cc|hc, cpenc: ucncc nece::cric:.
3. Sondogem ves|co| contnuo
/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
miccc 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 IcmLm mci:
prc|cngccc, cu nc evenIuc|iccce ce ue c|gumc ccmp|icccc Ienhc
cccrricc.
4. A||mentoo
Em ccncice: ce ncrmc|iccce cc cIc cirrgicc, pcce :er permiIicc c
c|imenIccc cc purperc 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|oo
C |evcnIcr e ccminhcr preccce: :cc reccmencccc:. / re:Iricc cc |eiIc,
c|m ce ce:ccnfcrIcve|, fcvcrece c cpcrecimenIc ce fencmenc:
IrcmLcemLc|icc:.
. Amomentoo precoce
/ cmcmenIccc ceve :er e:Iimu|ccc e iniciccc c mci: precccemenIe
pc::|ve|. Cferece inmerc: vcnIcgen:, enIre c: uci:, c e:IcLe|ecimenIc
cc inIegrccc p:|uicc mce-fi|hc {ver Ccp|Iu|c 1).
7. A|to hosp|to|or
/ ce:crec prccecimenIc cirrgicc invc:ivc cc ccviccce cLccminc|,
:ujeiIc c ccmp|iccce: inIrc-cpercIcric: ue cLrigcm c cIencc pc:-
cpercIcric. /::im, reccmencc-:e e:percr pe|c menc: c re:IcLe|ecimenIc
pcrcic| cc funcc 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 :Iimc e cimc cic pc-cpercIcrc.
10
ASSISTNCIA MULHER NO PARTO POR CESREA
95
CONSIDEkAES FINAIS
/ ce:crec umc |cpcrcIcmic ue, ucncc Lem incicccc, Iem :eu
pcpe| nc ciminuicc cc mcrLiccce e mcrIc|iccce mcIernc e perincIc|.
Cucncc :e incicc umc ce:crec, e|c ceve :er rec|izccc ccm c Icnicc
cceuccc, |evcncc em ccn:icerccc c: mci: recenIe: evicncic:
cienI|ficc:, pcrc minimizcr c pc::iLi|iccce ce ccmp|iccce: inerenIe: cc
prccecimenIc.
Nc enIcnIc, ccmc fci ci:cuIicc nc CcpiIu|c 4, c rec|izccc ce ce:crec:
ce:nece::cric: 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:IIricc ce:ce c
/nIigiccce, ccnIinuc Iencc |ugcr ce ce:Icue nc
cL:IeIr|cic mccernc. Cucncc Lem uIi|izccc
in:IrumenIc vc|ic:c, cc|cLcrcncc ce fcrmc efeIivc e
impcrIcnIe nc rec|izccc cc pcrIc vcginc|.
lnfe|izmenIe, c e:Iigmc negcIivc ue |he fci impuIccc
pe|c: cnIigc: prcIicc: cL:IIricc: per:i:Ie enIre c:
|eigc: e enIre cue|e: ue ncc fcrcm
cceucccmenIe Ireinccc: pcrc :eu u:c.
Hcje, enccnIrcm-:e cfc:Iccc: cc prcIicc cL:IIricc c:
cp|iccce: ce fcrcipe em ccLec: c|Ic: cu
encrcvccc: nc e:IreiIc mcic cc ccnc| cc pcrIc
[contro-|nd|coo obso|uto}. C fcrcipe Lcixc, nc
enIcnIc, mci: reuericc 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 :ee|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: recmnc:cicc: ncc cpre:enIcrcm ccnc: :ric:
ccm nenhum cc: in:IrumenIc:.
Ne:Ie ccp|Iu|c :ercc cLcrcccc: c: principci: funce: e
ccrccIer|:Iicc: cc: fcrcipe:, c: mcce|c:
cc:IumeircmenIe uIi|izccc:, c: inciccce: ce :eu u:c e
c: ccncice: iceci: ce cp|iccLi|iccce cc in:IrumenIc.
/: Icnicc: ce cp|icccc :ercc enccnIrccc: em |ivrc:
IexIc: cceuccc:. C cprencizccc prcIicc ceverc :er
efeIuccc em in:IiIuice: ce :cce prepcrccc: pcrc
:eu en:inc, ccm in:IruIcre: ceviccmenIe Ireinccc: e
experienIe:. /pe:cr cc recenIe civu|gccc cc vccuc-
exIrcIcr nc 8rc:i|, e:Ie in:IrumenIc ncc :erc cLcrcccc.
Em Iermc: prcIicc:, :uc uIi|izccc muiIc re:IriIc nc
IerriIcric nccicnc|, hcvencc um nmerc muiIc
peuenc ce prcfi ::icnci: Ireinccc:.
11 ASSISTNCIA MULHER NO PARTO FRCIPE
ASSISTNCIA MULHER NO PARTO FRCIPE
97
Funes e corocterst|cos dos |orc|pes
Iem ccmc principci: funce: c cpreen:cc, Irccc, ccc:icnc|menIe
rcIccc cc pc|c cefc|icc feIc| e ccrrecc ce c::inc|iIi:mc:. Vcric
ccn:icercve|menIe em fcrmc e Icmcnhc, mc: Lc:iccmenIe ccn:IiIu|cc
ce cci: rcmc: ue :e crIicu|cm cpc: :erem inIrccuzicc: :eencic|menIe
nc vcginc, ce cccrcc ccm c pc:icc cc pc|c cefc|icc. Cccc rcmc
ccn:IiIu|cc pcr cc|her, ccLc, hc:Ie e crIicu|ccc e Iem cuc: curvcIurc:,
c cefc|icc ue cLrigcrc c ccLec feIc|, e c p|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 ccLec feIc|.
Fr|nc|po|s |orc|pes otuo|mente ut|||zodos
1. Fcrcipe ce Simp:cn-8rcun
CcrccIer|:Iicc:: /rIicu|ccc fixc pcr enccixe
/cenIuccc curvcIurc p|vicc
UIi|izccc: Nc: feIc: ccm :uIurc :cgiIc| nc cicmeIrc cnIerc-pc:Iericr cu
nc: vcrieccce: ce pc:icc cnIericr e pc:Iericr, :em Lc::c impcrIcnIe.
2. Fcrcipe ce ie||cnc
CcrccIer|:Iicc:: /rIicu|ccc mcve|, ccm ce:|ize cc rcmc cireiIc :cLre c
e:uercc
CurvcIurc p|vicc ci:creIc
UIi|izccc: Fcce :er cp|icccc em Iccc: c: ccncice: {vcrieccce:
cL||uc:, cireIc: cu Ircn:ver:c:). c prefer|ve| pcrc :er cp|icccc nc:
pc:ice: Ircn:ver:c: e nc: cnIericre: cu pc:Iericre: ccm Lc::c
:erc:cng|nec :ignificcIivc, umc vez ue permiIe umc pegc ue
pc::iLi|iIc c ccrrecc cc c::inc|iIi:mc {crIicu|ccc mcve|). Fe|c uc:e
inexi:Incic ce curvcIurc p|vicc, in:IrumenIc rcIcccr pcr exce|ncic.
11
ASSISTNCIA MULHER NO PARTO FRCIPE
98
3. Fcrcipe ce Fiper
CcrccIer|:Iicc:: /rIicu|ccc fixc pcr enccixe
CurvcIurc perinec| ccenIuccc
CurvcIurc: cefc|icc e p|vicc pcucc prcnunciccc:,
prcmcvencc ci:creIc :c|iciIccc cc c::cc|hc perinec|
nc mcmenIc cc Irccc
UIi|izccc: Nc pcrIc p|vicc ccm cificu|ccce ce ce:prencimenIc cc pc|c
cefc|icc cerrcceirc. / ccLec 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 preferncic e IreincmenIc
cc pcrIeirc.
C|oss|||coo do |orc|pe em re|oo o|turo do opresentoo
1. Forc|pe de o|v|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'$%$' $' <#(6+,# #116<6)# '(./'4$% #/ $64'6)%
%*)'46#4 4#$%*$# <%4% #116<6)# <C@61# #/ 3%46'$%$' $' <#(6+,#
#116<6)# '(./'4$% #/ $64'6)% <#()'46#4 4#$%*$# <%4% #116<6)# (%14#U?
g#)%+,# 2%6#4 ./' WOo T3%46'$%$' $' <#(6+,# #116<6)# )4%*(3'4(%?
#116<6)# '(./'4$% #/ $64'6)% <#()'46#4 4#$%*$# <%4% #116<6)# <C@61#UE
3. Forc|pe md|o
`/%*$# % %<-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|coes
/ uIi|izccc 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 cceuccc e :egurc cc in:IrumenIc.
11
ASSISTNCIA MULHER NO PARTO FRCIPE
99
/|gumc: |nd|coes moternos inc|uem c ccenc ccrc|ccc, ccenc
pu|mcncr grcve, infeccc inIrc-pcrIc, cerIc: ccncice: neurc|cgicc:,
ec|cmp:ic e :|ncrcme HELLF. lncicc-:e, IcmLm, nc per|ccc expu|:ivc
prc|cngccc, :ejc pcr excu:Icc mcIernc, pcr inrcic cu hipccIiviccce
uIerinc cu, cincc, pcr inccpcciccce ce uIi|izcr cceucccmenIe c
pren:c cLccminc|, ccmc pcce cccrrer cpc: cnc|ge:ic pericurc| cu
ucncc c mce pcrIcccrc ce umc grcnce hrnic cLccminc|.
Nc: pcrIcccrc: ce ciccIrize: uIerinc: prvic:, e:pecic|menIe ce:crec:,
em virIuce cc ri:cc iminenIe ce rcIurc cc Ierc, cc:Iumc-:e cLrevicr c
per|ccc expu|:ivc ccm c u:c prcfi|cIicc cc fcrcipe.
/: |nd|coes |eto|s inc|uem c prc|cp:c ce ccrccc umLi|icc|, c :cfrimenIc
feIc| cgucc e c ccLec cerrcceirc in:inuccc nc pcrIc p|vicc.
Cond|es de op||cob|||dode do |orc|pe
Fcrc minimizcr c: :upc:Ic: ri:cc: cc uIi|izccc cc fcrcipe, Icrnc-:e
impre:cinc|ve| ue c|gun: pr-reui:iIc: :ejcm cLrigcIcricmenIe :eguicc:.
O mo|s |mportonte de|es o boo quo||||coo do obstetro. Nc incicccc
e nc rec|izccc cc prccecimenIc, pcrc ue c cpcre|hc :ejc
cceucccmenIe 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#)%(
. F6%>*J()61# 1#44')# $% 3%46'$%$' $' <#(6+,# TM\? MKS? MF\? ')1EU
7. \4#<#416#*%-6$%$' %$'./%$% '*)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
. K<6(6#)#26% T<4';'4'*16%-2'*)' 2:$6#I-%)'4%-U
EmLcrc c L|cueic pucencc pc::c :er cceuccc pcrc c fcrcipe ce
c||vic, c cne:Ie:ic regicnc|, pericurc| cu rcue, u:uc|menIe reuericc
nc: fcrcipe: Lcixc: cu mcic: e ucncc hc cificu|ccce ce inIerpreIccc
cc vcrieccce ce pc:icc feIc|, e:pecic|menIe nc pre:enc ce Lc::c
:erc:cng|nec vc|umc:c. Em pcucc: cpcrIuniccce: nece::cric uIi|izcr c
cne:Ie:ic gerc|.
Fego Ideo| [8|por|etomo|omenton|ono}
11
ASSISTNCIA MULHER NO PARTO FRCIPE
100
Apos dec|so do op||coo do |orc|pe, e ontes de seu uso, deve-se
esc|orecer mu|her o que ser |e|to, tronq|||zondo-o em re|oo oo
proced|mento. Deve-se demonstror segurono e reo||rmor o
necess|dode, em pro| do concepto ou do propr|o me, do uso do
|nstrumento.
Fe:umiccmenIe, c: ccncice: nece::cric: pcrc cp|icccc 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 cccmccccc perfeiIc
4. FercepIiLi|iccce ccmp|eIc - regrc cc cicgnc:Iicc IcIc|
5. Fe:pcn:cLi|iccce inIegrc| - regrc cc Icnicc 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 |ccercce:. Em :eguicc, prccece-:e c epi:icrrcfic.
Fec|izcr Icue reIc| cc finc| cc: prccecimenIc:, ccm c inIuiIc ce
ccnfirmcr c inIegriccce cc: e:IruIurc: e c cu:ncic ce Ircn:fixccc cc
reIc ccm pcnIc: ce :uIurc.
C: pcrIc: in:IrumenIci: c::ccicm-:e c mcicr ri:cc ce hemcrrcgic: nc
ucrIc per|ccc e puerpric. cL:c|uIcmenIe nece::cric cIencc
reccLrccc c mu|her cpc: c pcrIc. c mcmenIc, IcmLm, ce cemcn:Ircr
c purperc ue :eu recm-nc:cicc e:Ic :cuccve| e :em |e:ce:
ceccrrenIe: cc uIi|izccc cc in:IrumenIc. / Ircni|izccc cc mu|her e
:eu cccmpcnhcnIe funccmenIc|.
EmLcrc :ejc in:IrumenIc vc|ic:c, c uIi|izccc cc fcrcipe cincc muiIc
irregu|cr. /: principci: ccu:c: :cc, prcvcve|menIe, c e:Iigmc negcIivc
ue |he incceucccmenIe impuIccc e c incLi|iccce Icnicc cc:
prcfi::icnci: pcrc :eu u:c. C: :ervic: ce en:inc cevem prcpcrcicncr,
cue|e: ue :e inicicm nc crIe cL:IIricc, Iccc: c: ccncice: ce
cprencizccc pcrc ue c: prcfi::icnci: :ciLcm ucncc e ccmc uIi|izc-|c
pcrc c Lenef|cic ccmum cc :cce mcIernc e necncIc|.
11
101
/ /ne:Ie:ic CL:IIricc ccmpreence m|Iip|c: Icnicc:
uIi|izccc: pcrc c|ivicr c ccr c::cciccc cc IrcLc|hc ce
pcrIc e c pcrIc, Lem ccmc cuIrc: ce:Iinccc: c
rec|izccc ce prccecimenIc: cirrgicc:. C cIc
cne:I:icc em CL:IeIr|cic, emLcrc pc::c :er
ccn:icerccc :imp|e: em muiIc: :iIucce:, exige umc
fcrmccc e:pecic|izccc pcr pcrIe cc mcicc ue c
execuIc. /|m cc ccm|nic cc: Icnicc: cne:I:icc:,
nece::cric Ier c ccnhecimenIc cc: pcrIicu|criccce:
ce:Ic e:pecic|iccce. preci:c e:Icr cIenIc c:
c|Iercce: 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 Icnicc: cne:I:icc: :cLre c
ccnIrcIi|iccce uIerinc, Lem ccmc c: :iIucce:
pcIc|cgicc: ue envc|vem c cic|c grcvicc-puerperc|.
Em um ccnIexIc ce cIencc humcnizccc cc
nc:cimenIc, c cne:Ie:i:Ic e pcrIe inIegrcnIe cc
euipe mu|Iiprcfi::icnc| re:pcn:cve| pcr e:Ic cIencc,
: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 cirrgicc cu c|gumc
mcncLrc cu inIervencc mci: invc:ivc:. Em Ici:
:iIucce:, c mu|her e :eu cccmpcnhcnIe {ue jc
fcrcm infcrmccc: pe|c euipe 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:I:icc, fcrc umc Lreve cncmne:e
e cecicirc, :empre ue pc::|ve| e preferenIemenIe
ccm c pcrIicipccc cc mu|her, pe|c prccecimenIc c
:er rec|izccc.
Aspectos F|s|o|og|cos
DurcnIe c ge:Iccc cccrre umc expcn:cc vc|micc
c: cu:Ic: cc cumenIc cc vc|ume p|c:mcIicc, |evcncc
c umc hemcci|uicc. Exi:Ie IcmLm cumenIc cc
frencic ccrc|ccc e cc cLiIc ccrc|ccc, enucnIc
ue c re:i:Incic vc:cu|cr ciminui. C: vc|cre: ce
pre::cc crIeric| pccem e:Icr
12 ANESTESIA EM OBSTETRCIA
ANESTESIA EM OBSTETRCIA
102
|igeircmenIe cLcixc cc: n|vei: pr-ge:Iccicnci: e c pcrIir cc 28 - 30
:emcnc: ce ge:Iccc pcce cccrrer um fencmenc ccnhecicc ccmc
hipcIen:cc :upinc. IrcIc-:e cc ccmpre::cc cc veic ccvc pe|c Ierc
grcvicc, ccc:icncncc umc ciminuicc cc reIcrnc venc:c e hipcIen:cc
mcIernc. Feccmencc-:e, pcrIcnIc, c ce:|cccmenIc uIerinc cu c
preferncic pe|c cecLiIc |cIerc|.
/|Iercce: re:pircIcric: Ici: ccmc mencr ccpcciccce re:icuc| funcicnc|
{-207) e cumenIc cc venIi|ccc c|vec|cr {707 nc ge:Iccc ce Iermc),
c::cciccc: c um cumenIc cc ccn:umc ce cxignic {15 c 207),
preci:pcem c hipcxic e, nc cc:c ce cne:Ie:ic inc|cIcric, c incucc e
recuperccc mci: rcpicc:.
CuIrc c:pecIc impcrIcnIe ucnIc c: c|Iercce: fi:ic|cgicc: mcIernc:
e:Ic |igccc principc|menIe cc IrcIc gc:IrcinIe:Iinc|. Mci: preci:cmenIe
cccrre umc hcrizcnIc|izccc cc e:Icmcgc e ce:|cccmenIc cc pi|crc
pcrc cimc, |evcncc c um reIcrcc nc e:vczicmenIc gc:Iricc. Hc IcmLm
umc ciminuicc cc Icnc e cc mcIi|iccce gc:Iricc e cc e:f|ncIer
e:cfcgicc infericr. / incicncic ce hrnic ce hicIc mcicr nc grcvicez,
pcrIicu|crmenIe nc: ge:IcnIe: ccm exce::c ce pe:c cu ccm cumenIc
cc pre::cc inIrc-cLccminc| pcr ge:Iccc m|Iip|c cu pc|icrcmnic.
DurcnIe c grcvicez cumenIc c ri:cc ce regurgiIccc e c:pirccc
pu|mcncr cc ccnIecc gc:Iricc, nc cc:c ce cne:Ie:ic gerc| cu
cepre::cc cc n|ve| ce ccn:cincic. /pc: c 18 - 20 :emcnc, Iccc
ge:IcnIe ceve :er ccn:icerccc ccmc pccienIe ce e:Icmcgc cheic,
ccm ri:cc cumenIccc pcrc c:pirccc pu|mcncr, incepencenIemenIe cc
inIervc|c ce Iempc ce:ce c |Iimc refeicc. Nc: prccecimenIc: e|eIivc:
ceve-:e cL:ervcr c me:mc ccncuIc ce jejum cccIccc nc :ervic pcrc
c: rcIinc: cirrgicc: {pe|c menc: ciIc hcrc:).
Comp||coes
Cc:c hcjc c:pirccc ce ccnIecc gc:Iricc, mecicc: enrgicc: cevem
:er cccIccc: imecicIcmenIe. Deve-:e pc:icicncr c pccienIe em cfc|c
cec|ive, ccm c ccLec vc|Iccc |cIerc|menIe e ccr in|cic c c:pirccc cc
Lccc e fcringe e imecicIcmenIe prccecer-:e c inIuLccc Ircuec|
:eguicc ce c:pirccc. lnicicr rcpiccmenIe c venIi|ccc ccm cxignic c
1007 e, cc:c hcjc :u:peiIc ce c:pirccc ce ccnIecc :c|icc, ceve-:e
inciccr umc Lrcncc:ccpic pcrc remccc 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|ucc :c|inc cu me:mc LiccrLcncIc ce :ccic
ccnIrc-incicccc, pci: pcce ci::emincr c mcIeric| c:pirccc pcrc crec:
pu|mcncre: ncc ccmprcmeIicc:. / c:pirccc ce :ucc gc:Iricc prcvccc
umc pneumcniIe u|micc, ccm grcve ccnc cc pcrnuimc pu|mcncr,
ccm um uccrc c||nicc ce Lrcncce:pc:mc, :ecrecc pu|mcncr rc:ec e
grccienIe c|vc|c-crIeric| e|evccc. C IrcIcmenIc Lc:icc c venIi|ccc
ccm C2 c 1007, ncc e:Ic incicccc c prcfi|cxic ccm cnIiLicIicc: e c
ccmini:Irccc ce ccrIicc:Iercice: Lc:IcnIe ci:cuI|ve|. E:Ic pccienIe
ceverc permcnecer em Uniccce ce Iercpic lnIen:ivc ccm ccnIrc|e:
freenIe: cIrcv: ce gc:cmeIric:.
12
ANESTESIA EM OBSTETRCIA
103
DenIre c: ccmp|iccce: cne:I:icc: mci: Iemicc:, e:Icc c fc|hc ce
inIuLccc Ircuec| e c c:pirccc pu|mcncr. Vcric: fcIcre: preci:pcem c
cificu|ccce: curcnIe c inIuLccc nc ge:IcnIe: gcnhc ce pe:c curcnIe c
ge:Iccc, cumenIc cc: mcmc: e ecemc ce vic: crec:, c|m ce cuIrc:
ncc e:pec|ficc: cc ge:Iccc, ccmc |imiIccc cc cLerIurc cc Lccc cu
cc mcvimenIccc cc pe:ccc, cenIe: inci:ivc: prcIru:c: cu cuIrc:
cncrmc|iccce: cc fcce cu Lccc. / pccienIe cL:IIricc ncc ceve
receLer cne:Ie:ic gerc| vic mc:ccrc fccic| e c inIuLccc Ircuec|
mcnccIcric, ccm IuLc: ce cc|iLre mci: finc {,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:I:icc.
Insto|oes e recursos tcn|cos
/ ci:pcniLi|iccce ce cIencimenIc cne:I: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 execucc ce cne:Ie:ic
cL:IIricc, c: mcicc: ue c prcIiccm cevem cL:ervcr c: ncrmcIizcce:
ccnIicc: nc: re:c|uce: n 1.33 ce 13 e n 1.40 ce 14 cc Ccn:e|hc
Fecerc| ce Mecicinc.
/ uniccce cL:IIricc ceve ci:pcr ce :c|c: ce pcrIc e/cu cirrgicc: ccm
fcnIe ce gc:e: {02, N2C e cr ccmprimicc), Lem ccmc vccuc pcrc
c:pirccc, cpcre|hc ce cne:Ie:ic ccmp|eIc, ccm re:pircccr, L|ccc ce
f|uxcmeIrc: e vcpcrizcccre:. Iccc mcIeric| ce recnimccc, inc|uincc
|cringc:ccpic ccm jcgc ce |cminc:, ccnu|c: ce Guece|, IuLc:
enccIrcueci: ce civer:c: cc|iLre:, ccnjunIc pcrc venIi|ccc mcnuc|,
ccmpc:Ic ce mc:ccrc fccic|, Lc|:c ce Lcrrcchc e vc|vu|c unicirecicnc|
cevem e:Icr ci:pcn|vei:. /::im IcmLm, crcgc: pcrc re::u:ciIccc e
cuIrc: nece::cric: c execucc cc Icnicc cne:I:icc. / uniccce
cL:IIricc ceve ccnIcr ccm umc crec pcrc Fecuperccc Fc:-
/ne:I:icc, cujc ccpcciccce cpercIivc ceve gucrccr re|ccc cireIc
ccm c cemcncc.
Fcrc cceuccc mcniIcrizccc cc pccienIe cL:IIricc curcnIe c cIc
cne:I: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 cxignic, ceve Ier :eu empregc enccrcjccc, principc|menIe ucncc
cc uIi|izccc ce cpicice: pcr vic e:pinhc|. / uIi|izccc ce ccpncgrcfc
reccmenccve| ucncc cc cne:Ie:ic gerc|.
Ne:Ie ccp|Iu|c :ercc cLcrcccc: cpenc: c: Icnicc: cne:I: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 OBSTETRCIA
104
Icn|cos Anests|cos poro Cesor|ono
/ Icnicc cne:I:icc pcrc c cperccc ce:cricnc cepence cc incicccc
cirrgicc, cc grcu ce urgncic, cc vcnIcce cc pcrIurienIe e cc
ju|gcmenIc cc cne:Ie:i:Ic e cL:IeIrc. Scc cLjeIivc: principci:: prccuzir
cne:Ie:ic cceuccc, c|iccc c :egurcnc e ccnfcrIc mcIernc, ccm c
m|nimc efeiIc cepre::cr :cLre c feIc. Nc 8rc:i|, :em cvicc nenhumc c
cne:Ie:ic regicnc|, rcuicne:Ie:ic cu pericurc|, c Icnicc ce e:cc|hc
pcrc ce:cricnc. / cne:Ie:ic gerc| ccn:icerccc Icnicc ce excecc,
ccm inciccce: Lc:IcnIe re:IriIc: cu ucncc hc fc|hc ce um L|cueic
e:pinhc|. / Icnicc ce execucc cc: L|cueic: e:pinhci: fci ce:criIc em
ceIc|he: nc Ccp|Iu|c 8.
g%./6%*'()'(6%= E:Ic Icnicc ccn:icerccc umc exce|enIe cpcc ncc
:c pcrc ce:cricnc: e|eIivc:, ccmc IcmLm pcrc :iIucce: ce
emergncic em pccienIe: ue ncc e:Iejcm receLencc cnc|ge:ic vic
pericurc| ccnI|nuc. / rcuicne:Ie:ic cpre:enIc c|gumc: vcnIcgen: ccmc
:imp|iciccce e in|cic ce ccc rcpicc. / ccmp|icccc mci: ccmum c
hipcIen:cc mcIernc. Sempre ue pc::|ve|, c ge:IcnIe ceve receLer 500
c 700 m| ce :c|ucc e|eIrc||Iicc, ccmc Finger LccIcIc, cnIe: cc in|cic cc
L|cueic e ce:|cccmenIc cc Ierc 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|ucc venc:c e efecrinc 5 c 10 mg em Lc|u:
pcr vic inIrcvenc:c. Nc pc::ccc, umc grcnce ce:vcnIcgem cc
rcuicne:Ie:ic erc c cefc|ic pc:-puncc, ue cccrric em c|Ic
frencic nc pcpu|ccc cL:IIricc. /Iuc|menIe, ccm c uIi|izccc cc:
cgu|hc: ce:ccrIcvei: ce finc cc|iLre e ccm pcnIc cIrcumcIicc {cc Iipc
pcnIc ce |cpi:), c incicncic ce cefc|ic pc:-rcui pcce ccir pcrc
menc: ce 17.
C: cne:I:icc: |ccci: uIi|izccc: nc rcuicne:Ie:ic cevem :er
preferencic|menIe :c|uce: 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| cuIrc Icnicc ce cne:Ie:ic
regicnc| cmp|cmenIe uIi|izccc pcrc c rec|izccc ce cpercce:
ce:cricnc:. Suc execucc exige mcicr refincmenIc Icnicc e :uc
|cIncic IcmLm e mcicr ue c cc rcuicne:Ie:ic. E:Ie in|cic ce ccc
mci: |cngc fcvcrece :eu empregc em pccienIe: ue :e Leneficicm ce
um L|cueic :impcIicc mci: |enIc, ccmc c: pcrIcccrc: ce pr-ec|cmp:ic
cu ce ccenc ccrcicvc:cu|cr. /|m ci:cc, c cne:Ie:ic pericurc| pcce :er
prefericc ucncc :e prev um prccecimenIc cirrgicc mci: prc|cngccc,
ccmc em pcrIurienIe: cLe:c: cu ccm vcric: ce:crec: prvic:. C
cne:I:icc |ccc| mci: empregccc nc cne:Ie:ic pericurc| pcrc ce:cricnc:
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|. / ccicc
ce:Ie: cpicice: me|hcrc c uc|iccce cc L|cueic, recuzincc c
ce:ccnfcrIc inIrc-cpercIcric e minimizcncc c uIi|izccc ce mecicccc
cnc|g:icc e/cu :eccIivc :up|emenIcr.
12
ANESTESIA EM OBSTETRCIA
105
Me:mc :eguincc Iccc: c: rigcre: Icnicc:, c|gumc: pccienIe: pccem
experimenIcr umc cne:Ie:ic regicnc| incceuccc. DicnIe ce:Ie fcIc
pcce-:e cpIcr pcr:
ccmini:Irccc ce umc :eguncc cne:Ie:ic regicnc|
ccmini:Irccc :up|emenIcr ce cnc|g:icc: :i:Imicc:, ccmc
peuenc: cc:e: ce cpicice: cu ceIcminc enccvenc:c:
rec|izccc ce cne:Ie:ic gerc|
S*'()'(6% t'4%-= /|gumc: pcrIurienIe: pccem cpre:enIcr c|gumc ccnIrc-
incicccc c cne:Ie:ic regicnc| {cccgu|cpcIic cu hemcrrcgic :everc), cu
c cc:c IrcIcr-:e ce umc urgncic cL:IIricc {ccmc prc|cp:c ce ccrccc
cu Lrcciccrcic feIc| :u:IenIccc). Ne:Ic: :iIucce:, c incucc ce umc
cne:Ie:ic gerc| ce :encic rcpicc prefer|ve| c cne:Ie:ic regicnc|.
/ Icnicc ce cne:Ie:ic gerc| 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 inIuLccc Ircuec|, ceve-:e prccecer c venIi|ccc
:cL mc:ccrc pcrc re:IcLe|ecer c cxigenccc prcnIcmenIe e eviIcr
ccnc: c mu|her e cc feIc. Nc cepencncic cc ccrcIer emergencic| cc
:iIuccc, c cne:Ie:i:Ic e:Icrc IecniccmenIe cpIc pcrc in:i:Iir cu ncc nc
prccecimenIc ce venIi|ccc e inIuLccc Ircuec| cc mu|her. Se c
prccecimenIc fcr e|eIivc, reccmenccve| pc:Iergc-|c pcr c|gum Iempc.
kecuperoo Fos-onests|co [kFA}
/ pccienIe cL:IIricc nece::iIc cc: me:mc: cuicccc: pc:-cne:I:icc:
ue cuIrc: pccienIe: cirrgicc:. Feuer umc vigi|cncic cevicc c:
c|Iercce: fi:ic|cgicc: ue :e :eguem nc pc:-pcrIc imecicIc e c
pc::iLi|iccce ce ccmp|iccce: 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
cI :uc IcIc| recuperccc. / ccncicc ce c|Ic ceve :er
12
ANESTESIA EM OBSTETRCIA
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:IIricc, cpre:enIcr :inci:
viIci: e:Icvei: pe|c menc: nc |Iimc hcrc, :enIir-:e ccnfcrIcve|, ccm
ccnIrc|e cceiIcve| cc ccr, :em ncu:ec: cu vcmiIc:. Cucncc :uLmeIicc c
um L|cueic regicnc|, c c|Ic cepencerc IcmLm cc :ecccc ue Ienhc
receLicc e ceve cpre:enIcr IcIc| recuperccc cc L|cueic mcIcr pcrc
:e eviIcr uecc: pcr frcuezc mu:cu|cr cc: memLrc: infericre:.
DurcnIe e:Ie per|ccc, ucncc c e:Iccc ce ccn:cincic e/cu p:icc|cgicc
permiIirem, pcce-:e cprcveiIcr c cpcrIuniccce pcrc c|gumc:
crienIcce: 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
cmcmenIccc pcrc fcci|iIcr umc mcicr inIegrccc mce-fi|hc.
SIIbAES ESFECIAIS
1. Fr-ec|mps|o e Ec|mps|o
/ pr-ec|cmp:ic 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:Incic nc Uniccce ce
Iercpic lnIen:ivc ucncc hcuver ccmp|iccce:. C: cchccc: principci:
ne:Ic ccncicc pcIc|cgicc :cc hiperIen:cc e prcIeinric ue cccrrem
cpc: 20 :emcnc: ce ge:Iccc. / Ec|cmp:ic cicgnc:Iicccc ccm
uc|uer grcu ce hiperIen:cc, :e cccrrerem ccnvu|:ce:.
C IrcIcmenIc cLjeIivc recuzir c: ccmp|iccce: mcIernc: e feIci::
IrcIcr c hiperIen:cc:
ccnIrc|cr c: ccnvu|:ce::
f|uiccIercpic e IrcIcmenIc cc c|igric:
ceci:cc :cLre ucncc rec|izcr c pcrIc: e
ccnIrc|cr c: c|Iercce: ce cccgu|ccc.
w-/6$#)'4%<6%= /creciIc-:e ue c expcn:cc vc|micc, pcr :i :c, pcce
ceIermincr vc:cci|cIccc, recuzir c pre::cc crIeric| e me|hcrcr c f|uxc
:cng|nec regicnc|, cIimizcncc c efeiIc cc: crcgc: vc:cci|cIcccrc:.
]#*3/-(A'(= C :u|fcIc ce mcgn:ic c cgenIe ce e:cc|hc pcrc c
prevencc cu reccrrncic cc: ccnvu|:ce:. C e:uemc IercpuIicc mci:
empregccc em nc::c meic ccn:i:Ie numc cc:e ce cIcue ce 4g pcr vic
inIrcvenc:c |enIc {20 minuIc:) e mcnuIencc cIrcv: ce infu:cc venc:c
ce 1 c 2 g/hcrc, cL:ervcncc-:e cIenIcmenIe c ge:IcnIe. impcrIcnIe
|emLrcr ue c :u|fcIc ce mcgn: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 mcniIcrizccc neurcmu:cu|cr {ver Urgncic: e
Emergncic: McIernc:. Guic pcrc cicgnc:Iicc e ccncuIc em :iIucce:
ce ri:cc ce mcrIe mcIernc. MS, 2000).
12
ANESTESIA EM OBSTETRCIA
107
S*'()'(6% ' S*%->'(6%: Nc: cc:c: ce pr-ec|cmp:ic |eve, c mu|her pcce
prc::eguir ccm um IrcLc|hc ce pcrIc. Se c e:Iccc ce cccgu|ccc e:Iiver
ncrmc|, umc Icnicc 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. / cperccc
ce:cricnc gerc|menIe incicccc ucncc hc picrc cc: ccncice: ce
viIc|iccce feIc| cu cgrcvcmenIc cc uccrc mcIernc, ccm
impc::iLi|iccce ce pcrIc vcginc|. / Icnicc mci: reccmencccc, ce:ce
ue ncc hcjc ccnIrc-inciccce: cL:c|uIc: cu emergncic, c cne:Ie:ic
pericurc|. / pccienIe ccm ec|cmp:ic IcmLm 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:Irccc ce cxignic, ce:|cccmenIc uIerinc, mcniIcrizccc e
expcn:cc vc|micc {500 m| ce :c|ucc cri:Ic|cice), ce:ce ue ncc hcjc
:cfrimenIc feIc| cgucc, prccece-:e c cne:Ie:ic pericurc| ccmc ce:criIc
cnIericrmenIe, cu cIrcv: ce cc:e: :up|emenIcre: pcr ccIIer pericurc|.
Exi:Ie c|gumc ci:cu::cc ucnIc cc empregc ce :c|uce: ce cne:I:icc
|ccc| ccnIencc ccrenc|inc. reccmenccve| c c::cciccc ce cpicice
{100 mcg ce fenIcni|) cc cne:I:icc |ccc| pcrc me|hcrcr c uc|iccce cc
L|cueic e fcrnecer c|gumc cnc|ge:ic pc:-cpercIcric. Cc:c hcjc
hipcIen:cc mcIernc, ccm uecc: c|m ce 207 cc: vc|cre: inicici:,
reccmencc-:e c ccmini:Irccc ce efecrinc inIrcvenc:c em cc:e: ce 2,5
c 5,0 mg.
2. Sndromes hemorrg|cos
/ cne:Ie:ic ce e:cc|hc e:Ic nc cepencncic cc ccu:c, grcviccce cc
uccrc mcIernc, ccncice: ce viIc|iccce cc ccncepIc e pc::iLi|iccce
ce cvc|iccc e cceuccc repc:icc cc: percc: :cngu|nec: mcIernc:.
/: Icnicc: regicnci: ncc :cc IcIc|menIe ccnIrc-incicccc:, mc: :uc
incicccc e:Ic ccncicicnccc c pc::iLi|iccce ce repc:icc vc|micc
mcIernc prvic, cvc|iccc cc e:Iccc ce cccgu|ccc mcIernc e c
urgncic cc reIirccc cc feIc. Fcr exemp|c, nc pre:enc ce umc
p|ccenIc prvic cenIrc-IcIc| ccm c ge:IcnIe hemccincmiccmenIe
e:Icve| e feIc em Lcc: ccncice:, pcce-:e ccr preferncic c cne:Ie:ic
pericurc|, :empre ccm c cuicccc ce :e prccecer c ccIeIerizccc ce
cci: cce::c: venc:c: cc|iLrc:c: e ci:pcniLi|iccce imecicIc ce :cngue. Em
ccncice: mcIernc: :eme|hcnIe:, mc: em pre:enc ce :cfrimenIc feIc|,
pcce-:e uIi|izcr c rcuicne:Ie:i c cevicc c :uc |cIncic mci: curIc. Cc:c c
:iIuccc mcIernc ncc permiIc umc cceuccc repc:icc vc|micc, 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:Iccc cumenIc c IrcLc|hc ccrc|ccc e c ccn:umc ce cxignic.
DurcnIe c pcrIc, e:Ic: c|Iercce: :e exccerLcm, e nc pc:-pcrIc imecicIc
hc um impcrIcnIe cumenIc cc vc|ume circu|cnIe e cumenIc cc
re:i:Incic vc:cu|cr perifricc, cumenIcncc c ri:cc pcrc c ge:IcnIe
ccrcicpcIc. C p|cnejcmenIc cne:I:icc ceve |evcr em ccnIc e::c:
12
ANESTESIA EM OBSTETRCIA
108
f|uIucce: hemccincmicc: e Iccc cirurgic ncc impre:cinc|ve| ceve :er
cciccc pcrc 15 cic: cpc: c pcrIc, ucncc c mcicric cc: c|Iercce:
hemccincmicc: cc ge:Iccc 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|. funccmenIc| umc Lcc cvc|iccc pr-cpercIcric, ce
preferncic 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 euipe cL:IIricc, 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| , :em cvicc, c
Icnicc mci: empregccc pcrc c cIencimenIc c: ge:IcnIe: ccrcicpcIc:.
IcnIc c pericurc| ccmc c rcuicne:Ie:ic ncc cccrreIcm grcnce:
repercu::ce: hemccincmicc: curcnIe c pcrIc vcginc|, pci: c n|ve| ce
L|cueic :en:iIivc Lcixc {n|ve| mcximc I10). Exi:Ie grcnce vcnIcgem nc
c::cciccc ce cne:I:icc: |ccci: e cpicice: em Lcixc: cc:e:, prccuzincc
cnc|ge:ic cceuccc e pcucc inIerferncic nc re:i:Incic vc:cu|cr
perifricc. Umc Lcc c|IerncIivc c empregc cc L|cueic cup|c rcui-
pericurc| {ver Ccp|Iu|c 8).
S*'()'(6% <%4% 1'(%46%*%= ccmc c n|ve| :en:iIivc ce L|cueic nece::cric
c rec|izccc ce umc cperccc ce:cricnc mci: e|evccc {I - I4), c
cne:Ie:ic regicnc| cccmpcnhccc ce mcicre: repercu::ce:
ccrcicvc:cu|cre:. FcrIcnIc, ce umc mcneirc gerc|, reccmenccm-:e c:
L|cueic: regicnci: pcrc c: cc:c: c::inIcmcIicc: e c cne:Ie:ic gerc| pcrc
c: cc:c: mci: grcve:.
4. Asmo
/ evc|ucc cc c:mc Lrcnuicc nc ge:Iccc imprevi:|ve|. FcrIcnIc, c
cefinicc cc grcviccce c||nicc, Lc:eccc nc Iipc ce evc|ucc curcnIe c
ge:Iccc, :erc muiIc impcrIcnIe pcrc cefinir c cLcrccgem cne:I:icc
ce::c: pcrIurienIe:, inc|uincc c: criIric: ce Iempc :em cri:e:, u:c ce
mecicccc cnIi-c:mcIicc, pre:enc ce :inIcmc:, inIerncce:
hc:piIc|cre: e ccn:u|Ic: mcicc: pcr e:Ic ccu:c, e u:c ce ccrIiccice,
enIre cuIrc:.
Cucncc c vic ce pcrIc c vcginc|, Iccc ge:IcnIe c:mcIicc ceve
receLer cnc|ge:ic pcr Icnicc regicnc| precccemenIe, incepencenIe
12
ANESTESIA EM OBSTETRCIA
109
cc grcviccce c||nicc, pcrc eviIcr-:e ue c e:Ire::e cc IrcLc|hc ce pcrIc
cgrcve c: ccncice: re:pircIcric:. Nc cc:c ce cpercce: ce:cricnc:,
ceve-:e verificcr :e c pccienIe e:Ic em cri:e cu ncc. Em cc:c cfirmcIivc,
c Icnicc incicccc :eric cne:Ie:ic gerc|. Cc:c e:Iejc fcrc cc cri:e, enIcc
c ccncuIc cepencerc cc ccncicc 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 incucc
cne:I: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:
incicccc c inIuLccc Ircuec| e venIi|ccc meccnicc.
8eIc-ccrenrgicc:
lnc|ccc: 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| - cIcue: 250 mcg em 10 minuIc::
mcnuIencc: 3-20 mcg/min {ce
cccrcc ccm c re:pc:Ic e FC).
IerLuIc|inc - cIcue: 250 mcg em 10 minuIc::
mcnuIencc: 1,5-5,0 mcg/min {ce
cccrcc ccm c re:pc:Ic e FC).
/mincfi|inc EV:
Dc:e ce cIcue: 5- mg/kg {:e ncc u:cu nc: |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:.
McnuIencc: 15-20 mg/kg/24 hcrc:.
CcrIicc:Iercice: EV:
HicrcccrIi:cnc - 3 c 4 mg/kg ce / hcrc:.
MeIi|precni:c|cnc - 40 c 80 mg ce / cu 8/8 hcrc:. Nc: cc:c:
grcve:, cI 125 mg ce / hcrc:.
5. D|obetes
/ pccienIe cicLIicc ceficienIe nc :ecrecc ce in:u|inc, ce fcrmc
cL:c|uIc cu re|cIivc, e c e:Ire::e cumenIc c re:i:Incic c in:u|inc.
12
ANESTESIA EM OBSTETRCIA
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 :cng|nec Ierc-p|ccenIcric cIrcv: ce: infu:cc
ce :c|uce: cri:Ic|cice: nc pr e nc inIrc-cpercIcric, ce:|cccmenIc cc
Ierc pcrc c e:uercc e pcrc cimc, ccmini:Irccc ce cxignic e
prevencc ce hipervenIi|ccc.
Em re|ccc cc: n|vei: g|icmicc:, cccn:e|hcve| ue :ejcm ccrrigicc:
ucncc mcicre: ue 120 mg/c|, prccurcncc mcnI-|c: em n|vei: ce
0mg/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 ccf-cc-mcnhc. Ici:
prccecimenIc: cevem :er rec|izccc: preferenIemenIe nc primeirc hcrcric
cc mcnhc. ccmum c pccienIe receLer 1 /3 cc cc:e mcIinc| ce in:u|inc.
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 :iIucce: ce urgncic, 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 regurgiIccc e c:pirccc e:Ic
cumenIccc nc grcvicc cicLIicc. Ccnfcrme c Iempc ce evc|ucc ce:Ic
pcIc|cgic, pccem e:Icr pre:enIe: c: :eguinIe: c|Iercce:: neurcpcIic
cuIcncmicc {gc:Ircpcre:ic) e |imiIccc cc exIen:cc cc crIicu|ccc
cI|cnIc-cccipiIc| {S|ncrcme ce SIiff-JcinI), cccrreIcncc mcicre:
cificu|ccce: pcrc c: mcncLrc: ce |cringc:ccpic e inIuLccc Ircuec|.
\%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. /: Icnicc: e:Icc
ce:criIc: nc ccp|Iu|c 8, e cuicccc e:pecic| ceve :er Icmccc ccm
re|ccc c hicrcIccc e ccnIrc|e cc g|icemic.
M<'4%+,# ]'(%46%*%
Fccem-:e uIi|izcr c: L|cueic: regicnci: cu c cne:Ie:ic gerc|, :eguncc c:
Icnicc: ce:criIc: ccimc. /|gun: cuIcre: ncc reccmenccm c uIi|izccc
ce /L ccm vc:cccn:IriIcre:, pe|c pc::iLi|iccce ce i:uemic em pccienIe:
ccm neurcpcIic e/cu vc:cu|iIe:.
. Necess|dode de re|oxomento uter|no
Em c|gumc: :iIucce:, Ici: ccmc ccLec cerrcceirc, ver:cc e grcnce
exIrccc p|vicc {:eguncc geme|cr), hiperIcnic uIerinc, em ue hc
nece::iccce ce exIen:c mcnipu|ccc inIrcuIerinc, ceve-:e
12
ANESTESIA EM OBSTETRCIA
111
ccr preferncic c cne:Ie:ic gerc|, empregcncc-:e hc|cIcnc nc
ccncenIrccc ce 1 c 1,57 pcrc prcpcrcicncr re|cxcmenIc uIerinc
:cIi:fcIcric pcr um Lreve per|ccc ce Iempc, :uficienIe pcrc c: mcncLrc:
cL:IIricc:. Em cc:c ce pcrIc vcginc|, Icc |cgc hcjc c ce:prencimenIc
cc ccLec, c hc|cIcnc ceve :er rcpiccmenIe inIerrcmpicc, c pccienIe
hipervenIi|ccc, pcrc eviIcr mcicre: percc: :cngu|nec: em ceccrrncic
ce cIcnic uIerinc ue pcce :er cIriLu|cc cc: cgenIe: hc|cgenccc:.
12
112
/ ccrccIerizccc ce umc ge:Iccc ccmc :encc ce
ri:cc ncc um prccecimenIc :imp|e:. Feuer c
ccnhecimenIc ce Iccc c fi:ic|cgic cL:IIricc, cc:
ccncice: :ccic-cemcgrcficc: cc: mu|here: e
IcmLm cc: prcce::c: pcIc|cgicc:, IcnIc prcpric:,
ucncc inIerccrrenIe: nc grcvicez, pcrc ue c
ccnceiIuccc :ejc c|crc e cLjeIivc. 0 Mini:Iric cc
Scce jc ci:pce, pcrc e:Ie fim, cc mcnuc| Icnicc
:cLre Ge:Iccc ce /|Ic Fi:cc. Fcrc c cIencc c:
mu|here: em :iIucce: ce ri:cc ce mcrIe mcIernc, c:
Iemc: fcrcm cLcrcccc: em cuIrc mcnuc| Icnicc, c
ce Urgncic: e Emergncic: McIernc:. 0 enfcue cc
pre:enIe ccp|Iu|c c cc cIencc cc mu|her ue
Ienhc, nc mcmenIc ce :eu pcrIc, umc ge:Iccc
ccn:icerccc ccmc ce mcjcr ri:cc pcIencic|. FcrIcnIc,
pre::upce umc cvc|iccc pe|c prcfi::icnc| nc
mcmenIc cc inIernccc pcrc c pcrIc.
impcrIcnIe ccn:icercr ue c ge:IcnIe ce c|Ic ri:cc
ceverc Ier umc cLcrccgem ciferenciccc pe|c euipe
prcfi::icnc|, pe|c mcicr prcLcLi|iccce ce ue cccrrcm
ccmp|iccce:, IcnIc pcrc e|c ccmc pcrc c
feIc/recm-nc:cicc. IcmLm hc c nece::iccce ce
cpcicr e Ircni|izcr c fcm||ic e c mu|her, umc vez ue
c :iIuccc 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: freenIemenIe, c re:c|ucc incicccc
pcrc umc grcnce pcrIe cc: :iIucce: ue
ccrccIerizcm c ri:cc ju:IcmenIe c cc pcrIc vcginc|.
/::im, :iIucce: c||nicc: ccmc c: ce hiperIen:cc
crIeric| crcnicc, pr-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 ncrmcIizcce: :cLre c ccrccIerizccc cc:
in:IiIuice: ccpcciIccc: pcrc c cIencc cc pcrIc ce
ge:Icce: ce c|Ic ri:cc. cLrigccc cc: ge:Icre: cc:
mcIerniccce: ccnhec-|c:. Envc|vem, |cgiccmenIe,
ccrccIer|:Iicc: m|nimc: iceci: cc euipe prcfi::icnc| e
:uc ccpcciIccc, in:Ic|cce: f|:icc: {cenIrc cirrgicc,
Lcncc ce :cngue, uniccce
13
ASSISTNCIA MULHER NO PARTO DE
GESTAES DE ALTO RISCO
ASSISTNCIA MULHER NO PARTO DE GESTAES DE ALTO RISCO
113
ce Iercpic inIen:ivc, Lercric, |cLcrcIcric, eIc.), c|m ce e:IrcIgic:
ccmini:IrcIivc: cc in:IiIuicc pcrc fcci|iIcr e:Ie cIencimenIc e c gcrcnIir c
cevicc in:ercc nc :i:Iemc ce :cce hiercruizccc.
Nc c::i:Incic cc pcrIc ce ge:Iccc ce c|Ic ri:cc, uIi|izcm-:e c: me:mc:
pc::c: Icnicc: cc c::i:Incic cc pcrIc ce Lcixc ri:cc, ccre:cicc: ce c|gun:
ue lhe: :cc prcpric:.
1. V|g||nc|o moterno
/ ccmi::cc, pcrc c: prccecimenIc: ccn:icerccc: rcIineirc:, vc|em
c: me:mc: crienIcce: ue pcrc c pcrIc ce Lcixc ri:cc. CuIrc:
prccecimenIc: inicici:, ccmc c mecicc cc pre::cc crIeric| e
ccnIcgem cc frencic ccrc|ccc, pcr repre:enIcrem :inci:
e:pecic|menIe impcrIcnIe: nc evc|ucc cc pcrIc ce c|Ic ri:cc, cevem
:er repeIicc: c inIervc|c: mencre:, pci: muccnc: nc: :eu: vc|cre:
pccercc ceIermincr c|Iercce: nc: ccncuIc: previcmenIe
e:IcLe|ecicc:.
funccmenIc| inc|uir c ccnIrc|e cc ccr, e cc: ccncice:
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 cLIencc ce
prccecimenIc: menc: u:uci:: c|m 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
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:pirccc cc
ccnIecc gc:Iricc {S|ncrcme ce Mence|:cn) cumenIc muiIc, cccc c
mcicr pc::iLi|iccce ce pcrIc: ce:crec: e principc|menIe ce uIi|izccc
cc cne:Ie:ic gerc|. /::im, 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
cIrcv: ce infu:ce: enccvenc:c: ce g|icc:e.
2. V|g||nc|o |eto|
/ vigi|cncic feIc| curcnIe c IrcLc|hc ce pcrIc ce ge:Icce: ce c|Ic
ri:cc ceve Icmcr em ccnIc c cvc|iccc cc viIc|iccce feIc|, inc|uincc c
prcpric ce:envc|vimenIc inIrc-uIerinc cc feIc. impcrIcnIe re::c|Icr
ue excme: rec|izccc: cnIericrmenIe, cu nc mcmenIc cc inIernccc
hc:piIc|cr, ccmc u|Irc-:cncgrcfic, prcvc: ce mcniIcrizccc e|eIrcnicc
feIc|, Ferfi| 8icf|:icc FeIc| e ccpp|erve|ccimeIric, cevem Ier :uc:
inciccce: preci:c: em cccc :iIuccc c||nicc, ncc :encc nece::cric:
Iccc: em Iccc: c: cc:c:. / cepencer cc: re:u|Iccc: ce:Ic: prcvc:,
ccnfcrme cLcrcccc nc mcnuc| Icnicc ce Ge:Iccc 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|iccc cc viIc|iccce feIc|. / pre:enc ce ||uicc meccnic| em
fc:e: preccce: cc IrcLc|hc ce pcrIc um :inc|
13
ASSISTNCIA MULHER NO PARTO DE GESTAES DE ALTO RISCO
114
ce c|erIc ue imp|icc em mcicr vigi|cncic feIc|. Fcr cuIrc |ccc, c
pre:enc ce meccnic e:pe::c, icenIificccc cpc: c rcIurc cc:
memLrcnc: em cpre:enIcce: cefc|icc:, incicc c|Ic prcLcLi|iccce
ce :cfrimenIc feIc|.
C mcniIcrcmenIc cc frencic ccrc|ccc feIc| e c mIccc mci:
cmp|cmenIe uIi|izccc pcrc c cvc|iccc cc: ccncice: ce
viIc|iccce cc feIc. Fcce :er feiIc ce mccc inIermiIenIe cu ccnI|nuc.
C mIccc ce e:cuIc inIermiIenIe cc: LcIimenIc: ccrc|ccc: feIci:
rec|izccc cIrcv: cc e:IeIc:ccpic mcnccuricu|cr ce Fincrc, cu
cIrcv: cc :cncr pcrIcIi|. Em cmLc: c: cc:c:, pcrc ue :e Icrne
mIccc ccnficve|, :cc nece::cric: c|gun: cuicccc: Icnicc:.
/::im, c primeirc pc::c c e:IcLe|ecimenIc cc frencic ccrc|ccc
feIc| Lc:c|, cu :ejc, c: :eu: vc|cre: cLIicc: enIre ccnIrcce:. c pcrIir
ce:Ie: ue :e cicgnc:Iiccm c Icuiccrcic feIc| {frencic mcicr ue
10 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:
ccnIrcce:. Cucncc i:Ic ncc fcr pc::|ve|, c cu:cu|Ic ceve :er feiIc c
pcrIir cc meic cc ccnIrccc cI c :eu ce:cpcrecimenIc ccmp|eIc, pci:
:c c::im pccercc :er icenIificccc: c: ce:cce|ercce: Icrcic: e vcricvei:
prc|cngccc:, e|emenIc: prcpecuIicc: 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:IiIuice: ccpcciIccc: c e:Ie Iipc ce cIencc
cevericm ci:pcr ce mcniIcre: e|eIrcnicc: feIci: e :eu: prcfi::icnci:
cevericm :er cceucccmenIe Ireinccc: pcrc :uc uIi|izccc e
inIerpreIccc.
CcnIucc, ncc exi:Iem evicncic: 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|ccc 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|izccc cc gc:cmeIric ccpi|cr feIc| mIccc ccrc e,
emLcrc :eu: re:u|Iccc: :ejcm ccnficvei:, pcucc uIi|izccc nc 8rc:i|.
CcnIucc, :empre ue pc::|ve| e ci:pcn|ve|, ccn:IiIui cincc um
exce|enIe mIccc pcrc cjuccr c cicgnc:Iicc ce :iIucce: 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|:, c cc cximeIrjc ce pu|:c feIc|,
cccp|ccc c :i:Iemc: ce mcniIcrizccc feIc| inIrc-pcrIc.
3. Ass|stnc|o oo porto
DiferenIemenIe cc pcrIc ce Lcixc ri:cc, em ue ncc :e re:Iringe
c pc:icc cc pcrIurienIe, nc: ge:Icce: ce c|Ic ri:cc,
13
ASSISTNCIA MULHER NO PARTO DE GESTAES DE ALTO RISCO
115
c cecLiIc |cIerc| cccLc :encc c pc:icc ce e:cc|hc. Fcrc
cvc|iccc g|cLc| cc evc|ucc 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 .
E:pecificcmenIe ne:Ic: :iIucce:, inci:pen:cve| cccrrer umc
inIegrccc ccmp|eIc cc euipe 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
incicccc ce cnc|ge:ic preccce. l::c e:pecic|menIe impcrIcnIe nc:
:iIucce: ce ccrcicpcIic mcIernc, pcrc eviIcr c :cLreccrgc
hemccincmicc re:u|IcnIe cc: e:fcrc: ce puxc cc per|ccc expu|:ivc,
ccm c pc::|ve| ccn:eenIe ce:ccmpen:ccc ccrc|ccc mcIernc.
FcnIc ue merece ci:cu::cc c mcmenIc ce :e prcIiccr c
cmnicIcmic. /I 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|m
cc: ce:cce|ercce: preccce:. E:Ic: |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
sero os cond|es |eto|s.
/ c::i:Incic cc per|ccc expu|:ivc ceve |evcr em ccnIc c pc:icc cc
pcrIurienIe, c ccncicc pcIc|cgicc ue ccrccIerizc c c|Ic ri:cc e c:
inciccce: ce cnIecipccc cc pcrIc ccm c u:c prcfi|cIicc ce fcrcipe.
Nc pcrIurienIe ce c|Ic ri:cc, c pc:icc ccnvencicnc|
ginecc|cgicc c mci: uIi|izccc, freenIemenIe ccm c ccr:c
|evemenIe c|ccc, inc|u:ive pcrue c mu|her e:Icrc :cL cnc|ge:ic
pericurc|, nc mcicric cc: veze:. A ep|s|otom|o no tem |nd|coo
s|stemt|co. Deve :er incicccc :e|eIivcmenIe em cc:c: cnce :e
ju|gue impre:cinc|ve| pcrc eviIcr rcIurc: perineci: :empre IcmLm
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|ucc ncrmc| cc :eguncc e:Icgic e mcnIicc: c: ccncice: ce
viIc|iccce mcIernc e feIc|, ncc hc re:pc|cc pcrc e:Ic inIervencc
:i:IemcIiccmenIe rec|izccc. Feccmencc-:e re:ervcr c fcrcipe c:
:uc: inciccce: c|c::icc: e nc: :iIucce: ce ccrcicpcIic: e
pneumcpcIic:, pcrc eviIcr c e:fcrc f|:icc mcIernc cc per|ccc
expu|:ivc, ue pcce fcvcrecer umc ce:ccmpen:ccc. DeIc|he:
:cLre c uIi|izccc ce:Ie in:IrumenIc e:Icc ci:pcn|vei: nc CcpiIu|c
11.
Nc c::i:Incic cc pcrIc ce Lcixc ri:cc, c crienIccc ce :e
prccecer c |igccurc Icrcic cc ccrccc, i:Ic , ce::ccc: c:
LcIimenIc:. Nc grcvicez ce c|Ic ri:cc, c|gumc: ccncice: ccnIrc-
inciccm Ic| ccncuIc, ccmc c cc:c cc i:cimunizccc mcIernc-
feIc| e HlV.
13
ASSISTNCIA MULHER NO PARTO DE GESTAES DE ALTO RISCO
116
C cIencimenIc cc ucrIc per|ccc nc grcvicez ce c|Ic ri:cc ceve
:er inIen:ivc, pci: c: chcnce: ce ccmp|iccce: :cc mcicre:. Ici: :cc
c: cc:c: ce hiperIen:c: grcve:, ccrcicpcIc:, prec|cmpIicc: cu
ec|cmpIicc:, cicLIicc:, eIc. /pc: um per|ccc ce permcnncic nc
:c|c ce recuperccc pc:-cne:I:icc, c mu|her ceverc :er
enccminhccc pcrc umc uniccce ce cuicccc: inIen:ivc:, :cL
:upervi:cc cne:I:icc, cL:IIricc e c||nicc, :e :uc :iIuccc c::im c
inciccr.
Mci: cc ue nc: :iIucce: ce ncrmc|iccce, c cIencimenIc cc
pcrIc ce ge:IcnIe ce c|Ic ri:cc pre::upce IcmLm c nece::iccce
ce cceuccc enccminhcmenIc pcrc c revi:cc puerperc| e
crienIccc ucnIc cc p|cnejcmenIc fcmi|icr, cLcrcccc: nc
Ccp|Iu|c 20.
S|tuoes espec|o|s:
1. Feto com restr|o do cresc|mento |ntro-uter|no [kCIb}
C FClU ncc ccn:IiIui umc incicccc cL:c|uIc ce pcrIc pcr ce:crec,
ccn:icercncc ue cercc ce 07 cc: cc:c: pccem evc|uir pcrc pcrIc
vcginc|, :em nenhum Iipc ce ccmp|icccc ucnIc c viIc|iccce feIc|. Seu
ccnIrc|e curcnIe c evc|ucc cc IrcLc|hc ce pcrIc ceve :er feiIc ce
mcneirc rigcrc:c, ccmc jc preccnizccc cnIericrmenIe ne:Ie ccp|Iu|c.
2. Gestoes pr-termo
Nc pcrIc premcIurc, :empre ue fcr pc::|ve|, impcrIcnIe |emLrcr ue
c: feIc: pr-Iermc cevem :e Leneficicr cc ccmini:Irccc pcrenIerc| ce
ccrIiccice pcrc cce|ercr c mcIuriccce pu|mcncr {pe|c menc: pcr 24
hcrc:, pcrc ue hcjc Iempc :uficienIe pcrc ue :uc ccc pc::c :e
mcnife:Icr). IcmLm ne:Ic :iIuccc ncc exi:Ie nenhumc evicncic
cienI|ficc ue :upcrIe c cpcc pe|c pcrIc ce:cricnc, ce:ce ue c
cpre:enIccc :ejc cefc|icc. Ccn:IiIui cincc :iIuccc em ue c
pre:ervccc cc: memLrcnc: cvu|cre: |nIegrc: pe|c mcicr Iempc pc::|ve|
e mecicc eficcz ce mcnuIencc cc: Lcc: ccncice: ce :cce feIc|.
3. Apresentoo p|v|co
/ vic ce pcrIc ce feIc: em cpre:enIccc p|vicc, IcnIc ce Iermc ucnIc
pr-Iermc, :empre fci mcIivc ce ccnIrcvr:ic: nc |iIercIurc muncic|,
cccc: c: ri:cc: pcIencici: c e|c c::cciccc:. Irccicicnc|menIe, pcrIc
vcginc| erc reccmencccc nc cpre:enIccc p|vicc em ge:Icce: ce
Iermc :em ccmp|iccce: ccicicnci:. /|gun: pc|:e: IcmLm inciccvcm c
vic vcginc| me:mc em mu|here: primige:Ic:, ue ncc cccnIecic nc
/mricc 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:Iccc ccm feIc em cpre:enIccc p|vicc, 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 ccncice: iceci: pcrc i::c {ge:Iccc
nicc, Lc|:c |nIegrc, cu:ncic ce IrcLc|hc ce pcrIc, excme u|Irc-
:cncgrcficc, cu:ncic ce circu|cre:
13
ASSISTNCIA MULHER NO PARTO DE GESTAES DE ALTO RISCO
117
ce ccrccc, :em ciccIriz ce ce:crec prvic, fcci|iccce: nc :ervic pcrc c
cIencc imecicIc ce pc::|vei: ccmp|iccce:).
Cucncc c ver:cc exIernc ncc fcr pc::|ve| cu ncc re:u|Icr em xiIc,
cIuc|menIe incicc-:e c pcrIc ce:crec pcrc c: cpre:enIcce: p|vicc:,
ccm Lc:e em evicncic: 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|iccce: ceccrrenIe: ce umc premcIuriccce icIrcgeniccmenIe
incuzicc. /|m ci::c, impcrIcnIe |emLrcr ue nc ce:prencimenIc cc
feIc, curcnIe umc ce:crec em cpre:enIccc p|vicc, cevem :er
rec|izccc: c: mcncLrc: :imi|cre: cue|c: reccmencccc: pcrc c cIencc
cc pcrIc vcginc| ne:Ic cpre:enIccc.
4. Gestoo geme|or
Exi:Iem evicncic: ue cemcn:Ircm ue c prcgrcmccc pcrc c pcrIc
{p|cnejcmenIc :cLre c hc:piIc| ce e:cc|hc pcrc c pcrIc e :eu: recur:c:
Icnicc: e humcnc: ce cL:IeIr|cic, cne:Ie:ic e necncIc|cgic)
funccmenIc| nc cLIencc ce Lcn: re:u|Iccc: mcIernc: e perincIci:.
Ccm re|ccc c vic ce pcrIc, vc|e cincc c incicccc c|c::icc ce ue em
cpre:enIcce: 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:enIcce: cc primeirc geme|cr, c ce:crec e:Ic incicccc.
Fer:i:Ie cincc c|gumc cvicc ucnIc c me|hcr inIervencc pcrc c
Seguncc geme|cr ncc cefc|icc, cpc: c nc:cimenIc cc primeirc pcr vic
vcginc|. Exi:Iem evicncic: ce ue c ce:crec :i:IemcIicc ne:Ic ccncicc
e:pec|ficc ncc repre:enIc nenhumc vcnIcgem :cLre c: mcncLrc:
c|c::icc: ce ver:cc inIernc e exIrccc pccc|icc {cu cincc :cLre c ver:cc
exIernc ue 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 :iIuccc c ver:cc exIernc pcrc
cpre:enIccc cefc|icc. E:Ie prccecimenIc, ccnIucc, c|m ce ncc :er
prcIicc freenIe nc pc|:, pcrece ncc :er vcnIcjc:c ccm re|ccc c
ver:cc inIernc ccm exIrccc pccc|icc.
5. Cesreo onter|or
/ pre:enc ce cnIececenIe: ce umc ce:crec cnIericr ncc ccnIrcincicc
c cccrrncic ce IrcLc|hc ce pcrIc nc ge:Iccc :uL:eenIe. C
incenIivc c rec|izccc ce prcvc ce IrcLc|hc ce pcrIc ne:Ic: mu|here:
umc cc: mecicc: mci: impcrIcnIe: pcrc c recucc cc: Icxc: ce
ce:crec nc 8rc:i|. C ri:cc ce ccmp|iccce: mcIernc: {rcIurc uIerinc,
cei:cncic ce ciccIriz, eIc.), c::im ccmc ce ccmp|iccce: feIci:
{:cfrimenIc) muiIc Lcixc, ce:ce ue hcjc cceuccc vigi|cncic cc
IrcLc|hc ce pcrIc e cc viIc|iccce feIc|.
13
ASSISTNCIA MULHER NO PARTO DE GESTAES DE ALTO RISCO
118
Ncc exi:Iem |imiIe: ce inIervc|c inIerpcrIc| ue ccnIrc-inciuem 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 ce, nc m|nimc, 507: c|gun: IrcLc|hc: mc:Ircm cifrc: ce cI 70 c
807.
13
119
Nc prcIicc cL:IIricc exi:Iem vcric: ccncice: ue
inciccm c Irminc cc grcvicez, em uc|uer iccce
ge:Iccicnc|, cnIe: cc in|cic e:pcnIcnec cc IrcLc|hc
ce pcrIc. EnIre e|c:, c: mci: freenIe: :cc c:
:|ncrcme: hiperIen:ivc:, cicLeIe:, cc|cgenc:e:,
re:Iricc cc cre:cimenIc inIrc-uIerinc {FClU), pc:
ccIi:mc, ccmprcmeIimenIc cc viIc|iccce feIc|,
i:cimunizccc mcIernc-feIc|, mcrIe feIc| infrc-Ierc,
rcIurc premcIurc ce memLrcnc: e ccriccmnicniIe.
/ incucc cc IrcLc|hc ce pcrIc prcIicccc
:i:IemcIiccmenIe cpenc: em c|gun: pcucc: hc:piIci:,
gerc|menIe pL|icc: e univer:iIcric:, em prcpcrce:
Lem infericre: cue|c: ce pc|:e: mci: ce:envc|vicc:.
Ncc hc cincc nc pc|: umc cmp|c ci:pcniLi|iccce
ccmercic| ce mIccc: ce prepcrc ce cc|c e ce
incucc cc IrcLc|hc ce pcrIc, c ue ccnIriLui
cerIcmenIe pcrc c: c|Ic: |ncice: ce pcrIc pcr ce:crec.
Num contexto de humon|zoo do nosc|mento, de
respe|to oos d|re|tos e desejos dos mu|heres, e do
prt|co de umo obstetrc|o boseodo em ev|dnc|os,
|mportonte que se esc|oreo que o |nduo do porto
um proced|mento oce|tve| e recomendve| sob o
ponto de v|sto md|co e humono, sempre que ex|sto
umo |nd|coo 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:
freenIemenIe, ccmc umc ce:crec ce:nece::cric e
:uc: pc::|vei: ccn:encic:. E:Ic cLcrccgem nccc
Iem c ver ccm c freenIe u:e ce :uL:Icncic: ue
e:Iimu|cm c ccnIrccc 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
:cce cu cc: prcpric: ge:IcnIe:. /|m ci::c,
impcrIcnIe ue :e e:c|crec ue um :crc cc|ccccc
nc ge:IcnIe pcr umc cu cuc: hcrc: no incucc cc
pcrIc: ue e|e ncc ccn:egue fczer num e:pcc ce
Iempc Icc curIc, c ue c ncIurezc cemcrc c|gun:
cic:.
14 INDUO DO PARTO
INDUO AO PARTO
120
Cuc|uer mIccc c :er uIi|izccc exige c pre:enc ce prcfi::icnc|
Ireinccc, in:Ic|cce: cc mcIerniccce cceuccc: c nece::iccce ce u:e
ce infu:ce: enccvenc:c:, ce ccnIrc|e freenIe cc viIc|iccce feIc|, ce
rec|izccc ce prccecimenIc: cirrgicc: ce urgncic, 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 mIccc e:cc|hicc e ccnccrccrem
ccm e|e. lcec|menIe Iccc c euipe 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 incucc cc pcrIc cepence cc cLIencc ce ccnIrcIi|iccce
uIerinc e ci|cIccc prcgre::ivc cc cc|c. / ccnIrccc uIerinc cceuccc
pcrc c ci|cIccc cervicc| e:Ic cireIcmenIe re|ccicnccc cc e:Iccc inicic|
cc cc|c e c iccce ge:Iccicnc|. C cc|c uIerinc imcIurc e firme curcnIe
Iccc c per|ccc cc grcvicez, cI c: |Iimc: cic: cu :emcnc: ue
cnIececem c pcrIc, ucncc prcfuncc: mccificcce: Lic|cgicc: e
Licu|micc: cccrrem, Icrncncc-c mccic e ccmp|ccenIe.
/ primeirc c|c::ificccc c||nicc cc: ccncice: ce cmccurecimenIc cc
cc|c uIerinc fci rec|izccc pcr 8i:hcp {14) 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 precicc ce :uce::c c
incucc cc IrcLc|hc ce pcrIc. Ccn:icerc-:e ccmc fcvcrcve| cc :uce::c
pcrc pcrIc vcginc|, em mencr Iempc, c pre:enc 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. Parmetros para a avaliao do colo uterino - Bishop 1964)
14
INDUO DO PARTO
121
Nc pre:enc ce cc|c uIerinc ce:fcvcrcve|, cIuc|menIe ccn:icerc-:e
Lenficc e funccmenIc| c rec|izccc ce prepcrc cervicc| prvic c
incucc cc pcrIc. / incucc ce ccnIrcIi|iccce uIerinc :em c prepcrc
cervicc| prvic e:Ic c::cciccc c c|Ic: Icxc: ce fc|hc: ce incucc 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 mIccc ue
pc::c :er ccn:icerccc icec| pcrc c prepcrc cc cc|c, ue cumprc ccm
Iccc: c: :eguinIe: prcprieccce:, iceci::
cu:ncic ce efeiIc: ccver:c: pcrc c mce e feIc:
cmccurecimenIc cc cc|c em curIc per|ccc ce Iempc {cI 12 -
24h):
ncc ccu:cr ce:ccnfcrIc c mu|her:
ncc :er invc:ivc, mc: ce fcci| cp|icccc: e
ncc e:Iimu|cr c ccnIrcIi|iccce uIerinc.
EmLcrc e:Ic |Iimc prcprieccce ncc repre:enIe um ccn:en:c enIre c:
cuIcre:, :cLe-:e ue c ccnIrccc 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:.
MIODOS DE FkEFAkO CEkVICAL
Nc prcIicc, c: mIccc: cIuc|menIe ci:pcn|vei: e Iei: pcrc c prepcrc cc
cc|c uIerinc prvic c incucc cc IrcLc|hc ce pcrIc :cc:
1. Mtodos mecn|cos
Dencminc-:e mIccc meccnicc c in:IrumenIc cu ci:pc:iIivc cc|ccccc
nc ccnc| cervicc| cu nc e:pcc exIrc-cmnicIicc. Scc exemp|c: ce:Ie Iipc
ce mIccc c: :cncc:, ccIIere: e c: prepcrccc: ccm c|gc: mcrinhc:
{|cmincric). /: :cncc: c|c::iccmenIe uIi|izccc:, ccmc c reIc| nc mIccc
ce rcu:e, Im :icc mci: recenIemenIe Irccccc: pcr cuIrc: mcce|c:
menc: r|gicc:, c exemp|c cc sondo de Fo|ey.
CucnIc cc meccni:mc ce ccc, c: c|gc: ncIurci: e/cu :inIIicc:, c:
|om|nr|os, cgem :cLre c cc|c uIerinc, prcmcvencc c ci|cIccc cc
ccnc| cervicc| cIrcv: ce expcn:cc rccic| :ucve pcr :eu pccer
higrc:ccpicc, :em prcvcccr |e:cc ce fiLrc:. /pe:cr ce cencminccc:
meccnicc:, IcmLm :e cIriLui cc mIccc c e:I|mu|c e |iLerccc ce
prc:Icg|cncinc: enccgenc:, e|evcncc c ccmp|ccncic cc cc|c uIerinc.
E:Ie me:mc meccni:mc ccmLinccc prcpc:Ic pcrc c ccc cc:
ccIIere: exIrc-cmnicIicc:, ccm cu :em Lc|ce: in:uf|ccc:.
/: :cncc: cu ccIIere: exIrc-cmnicIicc: :cc ceixccc: pcr Iempc vcricve|
enIre 12 e 24 hcrc:. / uIi|izccc ce:Ie: mIccc: meccnicc: pcce :e
c::ccicr c c|gumc: recce: ccver:c: ccmc rcIurc ccicenIc| ce
memLrcnc: cmnicIicc:, ce:ccnfcrIc mcIernc, :cngrcmenIc, ci:Iccic
funcicnc| e, menc: freuenIemenIe, infeccc puerperc|.
14
INDUO AO PARTO
122
/: vcnIcgen: ce:Ie: mIccc: :cc, em gerc|, ceccrrenIe: ce :uc fcci|
cp|iccLi|iccce, :imp|iciccce ce u:c, Lcixc cu:Ic ucncc ccmpcrccc cc:
cemci: mIccc:, fcci| remccc, c|m ce peuenc cu nenhumc
cIuccc :cLre c micmIric. Mci: recenIemenIe, c uIi|izccc cc :cncc
ce Fc|ey, ccm Lc|cneIe in:uf|ccc ccimc cc crif|cic inIernc, :cL Irccc
mccerccc {cIrcv: ce :uc fixccc ccm e:pcrccrcpc nc fcce inIernc cc
ccxc), Iem mc:Irccc umc grcnce ccpcciccce ce ce:encccecr
ccnIrcce: 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
experincic ccm c uIi|izccc ce mIccc: meccnicc: pcrc c prepcrc
cervicc| previcmenIe c incucc cc IrcLc|hc ce pcrIc, Ici: mIccc:
e:Icc |cnge ce :erem |crgcmenIe uIi|izccc: nc prcIicc cL:IIricc cicric,
:cLreIucc nc 8rc:i|. Seu: re:u|Iccc: cemcn:Ircm umc ccpcciccce ce
mcIurccc cc cc|c |imiIccc, pcrIcnIc ju:Iificcve| nc cIuc|iccce cpenc:
em :iIucce: em ue cuIrc: mIccc: mci: efeIivc: ncc e:Iejcm
ci:pcn|vei:.
Ncc exi:Iem cincc evicncic: :uficienIe: ue permiIcm reccmenccr c
u:c ccmLinccc cc: ccIIere:, ccm c in:Ii|ccc ce :uL:Icncic: ccmc c:
prc:Icg|cncinc: nc e:pcc exIrc-cmnicIicc.
2. Mtodos |ormoco|og|cos
C mci: ccnhecicc e uIi|izccc mIccc ce prepcrc cervicc| c infu:cc
enccvenc:c ce oc|toc|no. De:ce c in|cic ce :uc uIi|izccc pcrc c
incucc cc ccnIrcIi|iccce uIerinc, Iem :icc IcmLm u:ccc pcrc c
cmccurecimenIc cervicc|, emLcrc :e ccnhec, 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 incucc. Devicc c e:Ic: |imiIcce:, :uc uIi|izccc pcrc c
prepcrc cervicc| fci prcIiccmenIe cLcnccnccc. Scc nece::cric:,
ucncc ncc :e ci:pcem ce cuIrc: mIccc: mci: efeIivc:, Ir: c ucIrc
repeIicc: :e::ce: cicric:, c ue ccn:cIivc pcrc c mu|her e c euipe ce
:cce, :em ccnIcr ccm c ccupccc exIrc ce |eiIc: nc uniccce
cL:IIricc.
/ pcrIir cc icenIificccc cc envc|vimenIc cc: prostog|ond|nos
enccgenc: nc prcce::c ncIurc| ce mcIurccc cc cc|c uIerinc, c u:c
ce:Ic: :uL:Icncic: pc::cu c :er ccn:cgrccc ccmc mIccc icec| pcrc
prepcrc e incucc ce pcrIc. Nc: pc|:e: ce primeirc muncc, nc: |Iimc:
ccccc:, ciferenIe: fcrmu|cce: ce FgE2 [d|noprostone} vm :encc
uIi|izccc:, e:pecic|menIe c fcrmc ce ge| pcrc cp|icccc inIrc-cervicc| cu
inIrc-vcginc|.
EmLcrc c FgE2 {cincprc:Icne) :ejc um mIccc :egurc e eficcz pcrc c
prepcrc cc cc|c uIerinc, :uc fcrmu|ccc cpre:enIc cu:Ic e|evccc,
Iermc|cLi| e ncc ccmercic|izccc nc 8rc:i|. C m|soprosto| umc
prc:Icg|cncinc :inIIicc E1, meIi| cnc|cgc, ue fci criginc|menIe
:inIeIizccc e ccmercic|izccc ccm c cLjeIivc ce ciminuir c: efeiIc:
14
INDUO DO PARTO
123
cc|cIerci: e cumenIcr c Iempc ce ccc cc FgE1 ncIurc|, nc IrcIcmenIc
ce :|ncrcme: ci:ppIicc: cc IrcIc gc:IrcinIe:Iinc|, ccmc gc:IriIe e |cerc
ppIicc.
lnicic|menIe, c uIi|izccc cc mi:cprc:Ic| fci mci: cirecicnccc ccmc
ccjuvcnIe nc: inIerrupce: inicici: ce ge:Iccc, pcr :eu efeiIc cLcrIivc.
E::e efeiIc fci cmp|cmenIe uIi|izccc e civu|gccc, c ue inc|u:ive cificu|Icu
c ccmercic|izccc cc prccuIc pcrc e:Ie e cuIrc: fin: nc 8rc:i|, Iencc :icc
re:IriIc e :u:pen:c :uc ccmercic|izccc nc pc|: curcnIe c|gun: per|ccc:.
/ pcrIir cc in|cic cc ccccc ce 0, vcric: e:Iucc: rec|izccc: fcrnecercm
evicncic: Lc:eccc: em experincic c||nicc pcrc ju:Iificcr c u:c cc
mi:cprc:Ic| ce fcrmc rcIineirc pcrc c prepcrc cervicc| e incucc cc
IrcLc|hc ce pcrIc em ge:Icce: ccm feIc vivc.
/ cpre:enIccc cc mi:cprc:Ic| nc 8rc:i|, cI cgcrc cpenc: ccm cc:e
e|evccc ce 200 g pcr ccmprimicc, cificu|Ic :eu u:c em CL:IeIr|cic.
EnIreIcnIc, civer:c: e:Iucc: Im :icc rec|izccc: ccm c prcpc:iIc ce
prepcrc e incucc cc pcrIc ccm e:Ic crcgc. EmLcrc cincc ncc Ienhc
:icc cprcvccc pcrc e:Ie fim nc pc|:, c mIccc e:Ic gcnhcncc
pcpu|criccce, principc|menIe pe|c :uc eficccic e Lcixc cu:Ic, :encc jc
reccmencccc :uc uIi|izccc em mcnuci: cc Mini:Iric cc Scce {8rc:i|,
MS, 2000). /|m ci::c, jc exi:Ie IcmLm um ccn:en:c inIernccicnc| :cLre
:uc uIi|iccce pcrc c prepcrc cervicc| e incucc 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 g c cccc ucIrc c :ei: hcrc:, ccmc jc
reccmencc c Cc|gic /mericcnc ce CL:IeIrc: e Ginecc|cgi:Ic: {/CCG).
/pe:cr cc mi:cprc:Ic| Ier :uc eficccic ccnfirmccc em muiIc: e:Iucc:, c
:egurcnc ce u:c pcrc prepcrc e incucc ce pcrIc em feIc vivc cincc
mcIivc ce c|gumc ccnIrcvr:ic. Fcce-:e cizer, ccnIucc, ue c: e:Iucc:
Iem cemcn:Irccc ue c recucc cc cc:e ccn:egue ccnIrc|cr Lem c:
efeiIc: ccver:c:, Icrncncc-c: :imi|cre: cc: cc cincprc:Icne e mIccc:
meccnicc:, :em ccmprcmeIer c: efeiIc: e:perccc:.
/::im, pc::|ve| ccnc|uir ue, em Lc:e c: evicncic: cienI|ficc: e c||nicc:
ci:pcn|vei:, c mi:cprc:Ic| pcce :er reccmencccc pcrc prepcrc cervicc| e
incucc cc pcrIc ce feIc vivc, em u:c vcginc| nc cc:cgem ce 25 g c
cccc :ei: hcrc:, nc cc:e IcIc| mcximc ce 100 g {/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 :iIucce: em ue c viIc|iccce feIc|
ncc impcrIe {mc|fcrmcce: inccmpcI|vei: ccm c vicc), pcce-:e u:cr
cc:e: mci: e|evccc:, ce 50 c 100 g.
Se pcr um |ccc c mi:cprc:Ic| repre:enIc umc grcnce vcnIcgem ccm
re|ccc cc cincprc:Icne, pcr :eu Lcixc cu:Ic e e:IcLi|iccce Irmicc e ce
e:Icccgem, Icrncncc-c icec| pcrc uIi|izccc em pc|:e: em
ce:envc|vimenIc e ccm pcucc: recur:c:, nc prcIicc exi:Ie cincc c
cificu|ccce ce cLIencc cc: cc:e: reccmencccc:. Ccn:eguir cLIer 25
g :ignificc Ier excIcmenIe um ciIcvc cc ccmprimicc
14
INDUO DO PARTO
124
ccmercic|izccc ce 200 g, c ue ncc Icrefc fcci|, pci: c pcrIir cc
:eguncc pcrIicc hc umc Iencncic c ce:e:IruIurccc cc me:mc. Fcr
cuIrc |ccc, ncc :e reccmenccm IcmLm c: mcnipu|cce: cc:eirc: cc
crcgc, pe|c fc|Ic ce ccnIrc|e ce uc|iccce e incerIezc :cLre c rec|
cc:cgem uIi|izccc. 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|izccc ce um cvu|c vcginc| ce 25 g 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|iccc pcrc c prepcrc
cervicc| c h|o|uron|dose. Ccn:i:Ie em um mIccc cpenc: pcrc prepcrc
cc cc|c, ncc prcvcccncc c cpcrecimenIc ce ccnIrcce: uIerinc:. Fci
uIi|izccc pe|c primeirc vez nc ccccc ce :e::enIc, mc:Ircncc-:e efeIivc
em ge:IcnIe: ccm cc|c e:pc:Iicc. Fci uIi|izccc IcmLm em injece:
inIrccervicci: pcrc prepcrc ce cc|c em ge:IcnIe: ccm crvice uIerinc
ce:fcvcrcve|, previcmenIe c incucc cc pcrIc, ccm re:u|Iccc:
cnimcccre:. 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 inIernccc pcrc incucc cc pcrIc. Ncc
ccnIrc-incicccc em ge:IcnIe: ccm umc ciccIriz ce ce:crec prvic.
Feccmencc-:e c u:c ce 20.000 uniccce: ce hic|urcnicc:e injeIccc:
inIrccervicc|menIe c: pc:ice: e 12 hcrc: {meIcce cc cc:e em cccc
pcnIc).
MIODOS FAkA INDbO DO FAkIO
Ccn:icercncc c cc|c jc mccurc cu fcvcrcve|, exi:Iem evicncic:
:uficienIe: pcrc cizer ue c incucc cc pcrIc pc::c c ccn:IiIuir um
prccecimenIc ccm mcicr prcLcLi|iccce ce xiIc pcrc cLIencc ce um
pcrIc vcginc|. Fcrc e:Ie fim, c: :eguinIe: mIccc: :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 mIccc ce incucc
ce pcrIc nc ccccc ce cinuenIc {Swcnn, 158). IecriccmenIe c
mIccc e:Iimu|c c IrcLc|hc ce pcrIc pcr prcmcver c |iLerccc ce
prc:Icg|cncinc. EmpiriccmenIe Lc:IcnIe uIi|izccc nc pc|:, emLcrc
exi:Icm pcucc: re|cIc: nc |iIercIurc pcrc ue :e pc::c e:IcLe|ecer :uc
rec| eficincic e :egurcnc ccmc mIccc pcrc incucc ce pcrIc. E:Ic
c::cciccc c cerIc grcu ce ce:ccnfcrIc mcIernc e :cngrcmenIc vcginc|
ci:creIc, :em mcicre: ccn:encic:.
2. Amn|otom|o
/ rcIurc crIificic| cc: memLrcnc: cmnicIicc: umc Icnicc cnIigc em
CL:IeIr|cic. IecriccmenIe, prcvccc um cumenIc nc prccucc |ccc| ce
prc:Icg|cncinc:, fcvcrecencc c in|cic cc IrcLc|hc ce pcrIc. Fcce :er
rec|izccc ccm cmnicIcmc cu pinc ccm exIremiccce perfurcnIe, nc
Lc|:c cc: cguc:, em n|ve| cc cpre:enIccc feIc|.
14
INDUO DO PARTO
125
Deve-:e Ier cuicccc nc rec|izccc 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 cccrrncic cc prc|cp:c ce ccrccc umLi|icc|.
Seu: principci: efeiIc: ccver:c: :cc c cumenIc cc ri:cc ce infeccc
cmnicIicc e ri:cc ce ccicenIe ce ccrccc. Seu uso |so|odo ontes do |nc|o
do trobo|ho de porto |o| obondonodo. EmLcrc ccnIinue :encc uIi|izccc
nc cce|erccc ce IrcLc|hc ce pcrIc jc iniciccc, ccmc jc ci:cuIicc nc
Ccp|Iu|c 5, ncc exi:Iem evicncic: ce ue c cmnicIcmic preccce :ejc
ce fcIc Lenficc.
3. Oc|toc|no
/ cciIccinc ccpcz ce inicicr cu cumenIcr c: ccnIrcce: r|Imicc: c
uc|uer mcmenIc cc grcvicez, emLcrc c re:pc:Ic uIerinc :ejc mcicr
ucnIc mci: prcximc cc finc| cc ge:Iccc. / infu:cc enccvenc:c ce
cciIccinc :inIIicc Iem :icc c mIccc mci: uIi|izccc pcrc incucc e
ccncucc cc IrcLc|hc ce pcrIc, ce:ce :uc inIrccucc pcr Fcge em
143. Suc ccncenIrccc p|c:mcIicc recuz-:e rcpiccmenIe c: cu:Ic: cc
cciIccinc:e e :uc meic vicc 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 :egurcnc, 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|ucc 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:, cI ue :e cLIenhc ccnIrcIi|iccce uIerinc cceuccc, cefinicc
pe|c pre:enc ce cIiviccce uIerinc regu|cr.
/ cciIccinc pcce prccuzir efeiIc: ccver:c: ccmc c Icui::i:Ic|ic,
hiperIcnic e hipere:Iimu|ccc uIerinc, pccencc prcvcccr inc|u:ive c
rcIurc uIerinc, fe|izmenIe um efeiIc exIremcmenIe rcrc :e c ccnIrc|e
c||nicc feiIc cceucccmenIe. Fcrc c feIc, c mci: freenIe efeiIc
cc|cIerc| c :cfrimenIc feIc| cgucc, mcIivccc pe|c recucc cc perfu:cc
:cng|nec nc e:pcc inIervi|c:c pcr Icui::i:Ic|ic e/cu hiperIcnic. C:
efeiIc: cc|cIerci: :cc cc:e cepencenIe: e c ciminuicc nc gcIejcmenIc,
cu me:mc c pcrccc ce infu:cc, pccem ccnIrc|cr e:Ic: c|Iercce: em
pcucc: minuIc:. /|gumc: mecicc: ccicicnci: pccem :er rec|izccc:,
ccmc ccmini:Irccc ce ||uicc: enccvenc:c:, cxignic, mccificccc nc
pc:icc mcIernc e cincc c ccmini:Irccc ce peuenc: cc:e: ce crcgc:
LeIce:Iimu|cnIe: pcr vic venc:c cu :uLcuIcnec.
14
INDUO DO PARTO
126
4. Frostog|ond|nos
/ crcgc pccrcc pcrc e:Ic finc|iccce cIuc|menIe c mi:cprc:Ic|,
uIi|izccc cc fcrmc ccmc jc reccmencccc nc: mIccc: ce prepcrc
cervicc|.
INDbO SEkIADA
Nc :iIuccc ce cc|c uIerinc ce:fcvcrcve| e incicccc pcrc inIerrupcc
cc ge:Iccc, pcce-:e reccrrer c incucc :ericcc, ccm cu :em prepcrc
cervicc| prvic. E:Ie mIccc ccn:i:Ie nc rec|izccc ce :e::ce: ce
incucc, curcnIe 10 c 12 hcrc: cicric:, :eguicc: pcr per|ccc: ncIurnc: ce
repcu:c. /: :e::ce: :cc ccnvencicnc|menIe rec|izccc: pcr cI Ir: cic:
ccn:ecuIivc:, uIi|izcncc infu:cc enccvenc:c ce cciIccinc,
preferenIemenIe ccm LcmLc ce infu:cc. inci:pen:cve| e:c|crecer c
mu|her cnIe: cc prccecimenIc e ue e|c e:Iejc ce cccrcc. Fe|c menc:
cI c mcmenIc ue :e inicie c fc:e cIivc cc IrcLc|hc ce pcrIc, ceve-:e
e:Iimu|cr c c|imenIccc e cecmLu|ccc cc ge:IcnIe. EmLcrc ncc
exi:Icm e:Iucc: :i:IemcIizccc: ccm c mIccc, e:Ie Iem :icc
Irccicicnc|menIe uIi|izccc pcr :ervic: ce CL:IeIr|cic nc 8rc:i|, :cLreIucc
cnIe: cc ci:pcniLi|iccce cc: ncvc: cgenIe: prepcrcccre: cc mcIuriccce
cervicc|.
/: ccnIrc-inciccce: fcrmci: c incucc cc IrcLc|hc ce pcrIc em
princ|pic ncc ciferem ccue|c: pcrc c pcrIc vcginc| e:pcnIcnec. /:
principci: :cc:
:cfrimenIc feIc| ccnfirmccc:
ciccIriz uIerinc ccrpcrc|:
ciccIriz uIerinc :egmenIcr ce repeIicc:
cpre:enIccc feIc| cncmc|c:
cL:Irucc cc ccnc| ce pcrIc:
:iIucce: ce urgncic: e
p|ccenIc prvic.
Exi:Iem cincc c|gumc: ccncice: ccn:icerccc: ce mcicr ri:cc c incucc
cc IrcLc|hc ce pcrIc e ue :e ccn:IiIuem em ccnIrc-inciccce: re|cIivc:
c incucc:
ge:Iccc m|Iip|c:
pc|icrcmnic:
ccrcicpcIic mcIernc:
grcnce mu|Iipcriccce: e
hiperIen:cc crIeric| grcve.
14
INDUO DO PARTO
127
/ incucc cc IrcLc|hc ce pcrIc um prccecimenIc ue ceverc :er mci:
u:ccc nc 8rc:i|, nc mecicc cc exi:Incic ce umc cemcncc pcr :ervic:
cL:IIricc: ce uc|iccce e ce Iccc: c: fcIcre: re|ccicnccc: cc e:I|mu|c
pe|c pcrIc vcginc| e humcnizccc. Exi:Iem inmerc: :iIucce: cnce c
inIerrupcc cc ge:Iccc e:Ic incicccc pcrc pre:evcr c :cce mcIernc
e/cu feIc|, ccm ce:Icue 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: :iIucce: :ejc mcnccIcric c ccnIrc|e cc
viIc|iccce feIc|, cc ccnIrcIi|iccce uIerinc e cc: ccncice: c||nicc: cc
mu|her.
14
128
C: principci: cLjeIivc: cc c::i:Incic imecicIc :cc:
prcpcrcicncr c Iccc: c: recm-nc:cicc: ccncice:
cIimc: ue vi:cm cuxi|ic-|c: em :uc cccpIccc c vicc
exIrc-uIerinc e e:Icr prepcrccc pcrc inIervir ncue|e:
cc:c: ue cpre:enIem ccncice: pcIc|cgicc: ue
cc|cuem em ri:cc :uc vicc. Foro o oss|stnc|o oo
recm-nosc|do normo|, que const|tu| o mo|or|o dos
s|tuoes, nodo mo|s deve ser |e|to o|m de se
enxugor, oquecer, ovo||or e entregor me poro um
contoto nt|mo e precoce. Iccc: c: prccecimenIc:
hcLiIuci: ccmc pe:cr, cp|iccr c ViIcminc e Crec 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|. / recnimccc cc recm-nc:cicc um
prccecimenIc re|cIivcmenIe :imp|e:, mc: ue reuer
per|cic e IreincmenIc, cevencc :er feiIc cpenc: pcrc
:iIucce: 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 pr-e:IcLe|ecicc.
Fcrc fcrnecer e:Ic c::i:Incic, funccmenIc| ci:pcr ce
um prcfi::icnc| ccpcciIccc, icec|menIe um pecicIrc,
c|m ce enfermcgem Ireinccc pcrc cIencer c FN, em
ucnIiccce e n|ve| ce ccpcciIccc cepencenIe: cc
grcu ce ccmp|exiccce cc in:IiIuicc. Em Iccc c pc|:,
c Sccieccce 8rc:i|eirc ce FecicIric {S8F) e :uc:
fecerccc: Im cferecicc cur:c: Iecricc-prcIicc: ce
recnimccc cc recm-nc:cicc. C: grupc: e
in:IiIuice: inIere::ccc: ne:Ie Iipc ce IreincmenIc
cevem enIrcr em ccnIcIc ccm c: repre:enIcce:
|ccci: cu regicnci: cc S8F pcrc :c|iciIccc.
OkGANIIAO DO SEkVIO
/ recepcc cc FN ceve Ier ncrmc: e:IcLe|ecicc: ccm
c: ciferenIe: cIriLuice: ccn:IiIu|cc: pcrc c euipe
prcfi::icnc|, cLjeIivcncc pre:Icr umc c::i:Incic ce
uc|iccce. Fcrc IcnIc, c euipe
15 ASSISTNCIA IMEDIATA AO RECM-NASCIDO
ASSISTNCIA IMEDIATA AO RECM-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:Iri| e cuecicc
:cL c cc|cr rccicnIe:
|evcr c FN c mce:
icenIificcr c FN ccm umc Lrccceirc, ccm c ncme cc mce, nc
cnIeLrcc e Icrncze|c:
em pcrIc: m|Iip|c:, c crcem ce nc:cimenIc ceverc :er
e:pecificccc nc: pu|:eirc: cIrcv: ce nmerc: {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 cIcv: cc |ncice ce /pgcr nc 1 e 5
minuIc:, e, cc| em cicnIe, ce 5 em 5 minuIc:, cI ue c /pgcr :ejc
mcicr ue 7:
|cuecr c ccrccc c umc ci:Icncic ce 2cm cc cne| umLi|icc|,
u:cncc c|ccc| eI||icc c 707. Verificcr c pre:enc ce umc veic e
cuc: crIric::
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 :cng|nec e
:crc|cgic:: e
cc|her :cngue cc mce pcrc Iipcgem :cng|nec e reccc
:crc|cgicc pcrc :|fi|i:, ucncc incicccc.
ndice de Apgar
15
ASSISTNCIA IMEDIATA AO RECM-NASCIDO
130
/pc: c c::i:Incic imecicIc cc recm-nc:cicc, ucncc ncc fci pc::|ve|
cnIe: cc nc:cimenIc, ceve-:e rec|izcr cncmne:e ceIc|hccc cLcrccncc
c icenIificccc, Iccc: c: cnIececenIe: fcmi|icre: e mcIernc:, cc
ge:Iccc, cc IrcLc|hc ce pcrIc e pcrIc. C excme cc FN ceve :er
minucic:c, feiIc em |ccc| e ccncice: :cIi:fcIcric:, inc|uincc Iccc: c:
crgcc: e :i:Iemc: pc::|vei: ce :erem cvc|iccc: c|iniccmenIe.
kEANIMAO NEONAIAL NA SALA DE FAkIO
/ cvc|iccc cc FN ceve inicicr cnIe: me:mc ce Ierminccc c
nc:cimenIc. Nc pre:enc ce meccnic, c cL:IeIrc ceve rec|izcr c
c:pirccc cc Lccc, ncriz e fcringe, cnIe: cc ce:prencimenIc cc: cmLrc:
cc recm-nc:cicc. C pecicIrc ceve cvc|icr c viIc|iccce cc cricnc: :e
vigcrc:c, c cvc|iccc cc FN ceve :er feiIc cIrcv: cc re:pirccc,
frencic ccrc|ccc e ccr. C |ncice ce /pgcr no ceve :er u:ccc pcrc
cvc|icr c nece::iccce ce recnimccc, mc: pcrc cvc|icr c: efeiIc: cc
me:mc.
/pc: c nc:cimenIc em Iccc: c: recm-nc:cicc: ceprimicc: ue
cpre:enIcrem ||uicc cmnicIicc meccnic| cu ncue|e: ccm meccnic
e:pe::c cu pcrIicu|ccc, cci: pc::c: cevem :er cccc:, c::im ue c
cricnc fcr cc|ccccc :cL c fcnIe ce cc|cr rccicnIe e cincc cnIe: ce
:ecc-|c:
c meccnic cc hipcfcringe ceve :er remcvicc cIrcv: ce c:pirccc
:cL vi:uc|izccc cireIc: e
c Ircuic ceve :er inIuLccc e c meccnic c:pirccc cc vic infericr
:e hcuver: cpnic: cepre::cc re:pircIcric: frencic ccrc|ccc
100 LcIimenIc: pcr minuIc e hipcIcmic.
/ ccnIinuccc cc: cuicccc: pre:Iccc: vci cepencer cc: ccncice: ce
viIc|iccce ce:Ie: recm-nc:cicc:.
Iccc FN Iem c cireiIc ce receLer, :e nece::cric, umc recnimccc ccm
um c|Ic n|ve| ce ccmpeIncic. 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 :cce cevem e:Icr cpIc: c recnimcr c recm-nc:cicc e
ccpcciIccc: c IrcLc|hcr ce mcneirc inIegrccc, em euipe.
A8C DA kEANIMAO
A - Monter os v|os oreos prv|os
Fc:icicncr c ccLec e c pe:ccc cc FN, mcnIencc-c em |igeirc
exIen:cc:
/:pircr Lccc e ncrinc:. Ircuic, :e c ||uicc fcr meccnic|: e
lnIuLccc Ircuec|, :e nece::cric.
8 - In|c|or o resp|roo
Ccm e:I|mu|c IcIi| cu, :e nece::cric, venIi|ccc ccm pre::cc pc:iIivc
{VFF) cIrcv: ce Lc|cc cu cpcre|hc ce re::u:ciIccc, uIi|izcncc
mc:ccrc cu IuLc enccIrcuec|.
C - Estobe|ecer e monter o c|rcu|oo
Mc::cgem ccrc|ccc: e
Meciccce:.
15
ASSISTNCIA IMEDIATA AO RECM-NASCIDO
131
1. OXIGNIO INALAIkIO
Deve-:e u:cr ucncc c FN cpre:enIc re:pirccc efeIivc e FC 100 Lpm,
mc: ccm cicnc:e cenIrc|. C cxignic ceve :er umicificccc e cuecicc:
ncc :encc pc::|ve|, uIi|izcr c C2 fric e :ecc pcr per|ccc |imiIccc. Ncc
uIi|izcr cxignic :cL pre::cc ccm ccIeIer nc: ncrinc:.
Icnicc ce ccmini:Irccc:
Ircuic cu ccIeIer ce C2. Cucncc u:cr c Ircuic, 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 cxignic. / reIirccc ceve :er grccuc|: e
c|IerncIivcmenIe, mc:ccrc ce 02 {nuncc c mc:ccrc ccnecIccc
cc Lc|cc).
2. VENIILAO COM FkESSO FOSIIIVA
/: principci: inciccce: pcrc VFF :cc, cpnic, gc:ping e re:pirccc
e:pcnIcnec, mc: ccm FC 100 Lpm:
Icnicc:
pcce :er feiIc cIrcv: ce Lc|cc cuIc-inf|cve| {/mLu) ccnecIccc
c um re:ervcIcric ce cxignic ue permiIc umc ccncenIrccc ce
cxignic enIre 0 c 1007, ue Ienhc umc vc|vu|c ce e:ccpe
cju:Iccc enIre 35 e 40 cm H2C e um mcncmeIrc. Cu cIrcv: cc
cpcre|hc ce re::u:ciIccc. C Lc|cc cuIc-inf|cve| ceve e:Icr |igccc
c umc fcnIe ce cxignic c 5 |/min, enucnIc 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 frencic enIre 40 e 0 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|ccncic ciminu|cc:
cL:ervcr c expcn:iLi|iccce Icrccicc {e|evccc ce 0,5 c 1 cm):
cpc: 15 c 30 :eguncc:, recvc|icr c re:pirccc, c FC e c ccr.
3. MASSAGEM CAkDACA
Iem incicccc ce :er rec|izccc ucncc c FC cc recm-nc:cicc e:Iiver
cLcixc ce 0 Lpm.
Icnicc:
cc|cccr c: cecc: inciccccr e mcic perpencicu|crmenIe cc
exIernc, nc Ierc infericr, ccimc cc cpncice xifcice, cu cc|cccr c:
cecc: pc|egcre: ce cmLc: c: mcc: :cLre c Ierc infericr cc
e:Iernc {ccmc mc:Ircm c: figurc:) e pre::icncr 1-2 cm numc
frencic ce 120 mcv./min:
curcnIe c mc::cgem ccrc|ccc ceve-:e ccnIinucr venIi|cncc c
FN ccm pre::cc pc:iIivc e cxignic c 1007, ccm mc:ccrc cu
inIuLccc:
15
ASSISTNCIA IMEDIATA AO RECM-NASCIDO
132
c venIi|ccc e c mc::cgem ccrc|ccc cevem :er feiIc:, nc
re|ccc ce 3:1, i:Ic , Ir: mcvimenIc: ce mc::cgem pcrc um ce
venIi|ccc:
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 0 Lpm, inicicr ccrenc|inc {1:10.000) EI/EV nc cc:e
ce 0,01 c 0,03 mg/kg.
Intuboo troqueo|
/: principci: inciccce: pcrc c inIuLccc Ircuec| :cc:
:u:peiIc ce hrnic cicfrcgmcIicc:
cu:ncic ce re:pc:Ic c venIi|ccc ccm Lc|cc cu cpcre|hc ce
re::u:ciIccc e mc:ccrc ccm FiC2 ce 1007:
venIi|ccc prc|cngccc ccm Lc|cc cu cpcre|hc ce re::u:ciIccc
e mc:ccrc ccm FiC2 ce 1007: e
pcrc c:pirccc Ircuec| :cL vi:uc|izccc cireIc, cc:c c ||uicc
meccnic| :ejc e:pe::c, ucncc c cricnc cpre:enIcr cpnic,
cepre::cc re:pircIcric, frencic ccrc|ccc 100 Lpm e hipcIcnic.
Icnicc:
prepcrc cc ccnu|c Ircuec|:
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:pcc mcrIc e c
re:i:Incic:
ccnecIcr c inIermecicric cc ccnu|c cnIe: cc inIuLccc:
c fic-guic cpcicnc|, cevencc :uc pcnIc ficcr c 0,5 cm ccimc
cc pcnIc cc ccnu|c:
cpc: c inIrccucc cc ccnu|c nc inIericr cc Ircuic, c ci:Icncic
cI c |cLic :upericr pr-ceIerminccc:
cferecer cxignic inc|cIcric cIrcv: 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::uciIccc cI me|hcrcr c
cxigenccc:
15
ASSISTNCIA IMEDIATA AO RECM NASCIDO
133
ccnfirmccc cc pc:icc 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 inIuLccc, ccrIcr ccnu|c :empre ue c ccmprimenIc enIre
c finc| cc ccnu|c e c Lccc excece c 4 cm.
Medicao necessria para a reanimao
Fonte: ET:endotraqueal
Moter|o| necessr|o poro reon|moo
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 recnimccc ccm fcnIe ce cc|cr irrccicnIe, c:pircccr c
vccuc ccm mcncmeIrc e fcnIe ce cxignic ccm f|uxcmeIrc
Scncc: ce c:pirccc Ircuec| n 8 e 10
Scncc: ce c:pirccc gc:Iricc n e 8
8c|cc cuIc-inf|cve| ccm re:ervcIcric ce cxignic {pcrc :e cIingir
umc FiC2 ce 0-1007) e ccpcciccce mcximc ce 750 m| cu cpcre|hc
ce re::u:ciIccc mcnuc|
Mc:ccrc: ue cuLrcm ccnvenienIemenIe ncriz, Lccc e ueixc cc
FN
Lcringc:ccpic ccm |cminc reIc n 0 e 1
Ccnu|c: enccIrcueci: ce cicmeIrc unifcrme n 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 mcrue c: :eguncc: cu um crcncmeIrc
McIeric| pcrc crencgem Icrccicc
McIeric| pcrc ccIeIeri:mc umLi|icc|
15
ASSISTNCIA IMEDIATA AO RECM-NASCIDO
134
Seringc: {20, 10, 5 e 1 m|)
IuLc: ce cc|eIc ce :cngue
Meciccce::
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
0,7 cu Finger-|ccIcIc)
c|cricrcIc ce Nc|cxcne
ccpcminc
:c|uce: ce g|icc:e c 57 e 107
15
135
Scc inmerc: 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, cricnc e fcm||ic, cc pcnIc ce vi:Ic
Lic|cgicc e p:icc::ccic|.
/Iuc|menIe, c c|eiIcmenIc mcIernc exc|u:ivc
reccmencccc pcr um per|ccc ce :ei: me:e:.
Fc:IericrmenIe, c cricnc ceve receLer c|imenIc:
ccmp|emenIcre:, e:Iencencc c cmcmenIccc pcr
pe|c menc: cci: cnc:, ce:ce ue mce e cricnc 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
cmcmenIccc. 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:|ccc
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 cricnc:
: # %-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( (%/$83'-E
Fodres de o|e|tomento moterno:
VE S-'6)%2'*)# 2%)'4*# '51-/(63#= ./%*$# % 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|o e corocterst|cos do |e|te humono
C |eiIe mcIernc c c|imenIc icec| pcrc c |ccIenIe. E|e ccnIm
Iccc: c: nuIrienIe:, inc|u:ive cguc, ue c cricnc preci:c nc: :ei:
primeirc: me:e: ce vicc. Devicc c: :uc: ccrccIer|:Iicc: f|:icc-
u|micc:, fcci|menIe cL:crvicc e cigericc.
C |eiIe mcIernc ccnIm cnIiccrpc: {e:pecic|menIe c lg/
:ecreIcric), c|u|c: {mccrcfcgc:, pc|imcrfcnuc|ecre: e |infcciIc:) e
cuIrc: :uL:Icncic: {fcIcr L|ficc e |ccIcferrinc) ue prcIegem c
crgcni:mc cc LeL ccnIrc infecce:.
C |eiIe mcIernc ccnIm IcmLm fcIcre: ce cre:cimenIc
16
ALEITAMENTO MATERNO
137
ue prepcrcm c inIe:Iinc imcIurc cc cricnc pcrc cigerir e cL:crv-
|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|Iercce: nc :uc ccmpc:icc, ce cccrcc
ccm c hcrc cc cic, c: cic: cpc: c pcrIc e curcnIe umc me:mc
mcmccc.
C |eiIe IcmLm :cfre c|Iercce: em :uc ccmpc:icc, em
re|ccc cc in|cic e finc| cc mcmccc. Nc inIervc|c cc: mcmccc:,
prccuzicc c |eiIe chcmccc cnIericr, ue ccrre:pcnce c um Ierc
cc vc|ume IcIc| prccuzicc e, curcnIe c :uccc, :ecreIccc c |eiIe
pc:Iericr, ue ccrre:pcnce c cci: Ierc: 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
:uccc nc prcce::c cc prccucc cc |eiIe. C |eiIe cc ccmec
mcIc c :ece e c |eiIe cc fim engcrcc.
A produo de |e|te
/ prccucc ce |eiIe :e cc pcr um e:I|mu|c neurc-encccrinc e Ir: crgcc:
:cc impcrIcnIe: ne:Ie prcce::c: p|ccenIc, hipcfi:e e mcmc.
/ p|ccenIc re:pcn:cve| pe|c prccucc cc: e:Iercice: p|ccenIcric:
{e:Ircgenc: e prcge:Iercnc) ue, curcnIe c grcvicez, prepcrcm c mcmc
pcrc c |ccIccc, e:Iimu|cncc c cepc:icc ce gcrcurc:, c cre:cimenIc
cc: cucIc: e c|vc|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|vc|c: mcmcric: c prccuzir |eiIe.
DurcnIe c grcvicez, c: c|Ic: ccncenIrcce: ce:Ie: hcrmcnic: e:Iercice:,
pre:enIe: nc p|c:mc, iniLem c :ecrecc cc |eiIe, cccrrencc :cmenIe c
:|nIe:e cc pr-cc|c:Irc ue umc :uL:Icncic ue, nc :uc ccmpc:icc,
ccnIm 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 prccucc ce |eiIe
Iem in|cic. C per|ccc em ue :e inicic c prccucc ce |eiIe 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 mcic, Ir: c ucIrc cic:. /
cpcjccurc mcrcc c muccnc cc ccnIrc|e encccrinc pcrc c cuIccrinc
cc |ccIccc. C vc|ume ce |eiIe prccuzicc Ience c cumenIcr
grcccIivcmenIe. /::im, nc 2 cic, e:Ic pcr vc|Ic ce 50 m|/cic. Nc 4 cic,
cc reccr ce 550 m|/cic. Jc cc: Ir: me:e:, ce cercc ce 850m|/cic. E:Ie
ccnhecimenIc impcrIcnIe pcrc c infcrmccc cc purperc ce ue c
peuenc ucnIiccce ce |eiIe prccuzicc nc: primeirc: cic: ncrmc|.
C: n|vei: p|c:mcIicc: ce prc|ccIinc e|evcm-:e em re:pc:Ic c :uccc cc
FN e e:Icc cireIcmenIe re|ccicnccc: c frencic, curccc e
inIen:iccce cc :uccc. / :uccc cc mcmi|c prccuz umc e|evccc ce
prc|ccIinc Lc:c|, cpre:enIcncc um picc ce prccucc enIre c: 20
16
ALEITAMENTO MATERNO
138
c 40 minuIc: cpc: c in|cic cc e:Iimu|ccc. ScLe-:e ue 30 minuIc: ce
:uccc pccem ceIermincr n|vei: e|evccc: ce prc|ccIinc pcr cercc ce 3
c 4 hcrc:. Ccmc c prc|ccIinc c hcrmcnic funccmenIc| pcrc c
gc|ccIcpcie:e, permiIir c :uccc cc mcmi|c pe|c cricnc c |ivre
cemcncc c e|emenIc Lc:icc pcrc c mcnuIencc cc cmcmenIccc.
CucnIc mci: rcpicc, cpc: c nc:cimenIc, e mci: freenIemenIe :e
cc|cue c recm-nc:cicc cc :eic, mcicr :erc c prccucc ce |eiIe e
mencre: c: :inIcmc: cevicc: c cpcjccurc.
A ejeo do |e|te
C |eiIe ccumu|ccc nc: c|vc|c: ncc f|ui e:pcnIcnecmenIe pcrc c:
cucIc: e :eic: |ccI|ferc:. / cciIccinc, |iLerccc pe|c hipcfi:e pc:Iericr,
c hcrmcnic ue cIuc :cLre c: c|u|c: micepiIe|ici:, ceIermincncc :uc
ccnIrccc e ccn:eenIe expu|:cc ce |eiIe pcrc c: cucIc:.
Nc: primeirc: cic: cpc: c pcrIc, c ref|exc ce ejecc re:pcnce ncc
:cmenIe c e:I|mu|c: IccIei:, mc: IcmLm 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.
/ |iLerccc ce cciIccinc, ceccrrenIe cc :uccc cc mcmi|c pe|c
cricnc, ceIerminc, IcmLm, ccnIrccc cc: fiLrc: mu:cu|cre: uIerinc:,
fcvcrecencc c ccnIrccc cc Ierc curcnIe c cmcmenIccc.
Ccm re|ccc c prccucc ce |eiIe, cIuc|menIe Iem-:e evicncic: ce ue
c ue rec|menIe ccnIrc|c c prccucc ce |eiIe c e:vczicmenIc cc
g|cncu|c pe|c :uccc.
/c :e cnc|i:cr c ccmpc:icc cc |eiIe, ci:Iinguem-:e 4 Iipc: ce |eiIe, ue
:e cpre:enIcm ccm ccrccIer|:Iicc: Licu|micc: ciferenIe: e cceuccc:
c cccc ceIerminccc per|ccc cc vicc cc cricnc:
1. Co|ostro
DurcnIe c ge:Iccc, c g|cncu|c mcmcric prccuz umc :uL:Icncic
cencminccc ce pr-cc|c:Irc, ccumu|ccc nc |men cc: c|vc|c:, e ue
Iem nc :uc ccmpc:icc, principc|menIe, ex:uccIc cc p|c:mc, c|u|c:,
imuncg|cLu|inc:, |ccIcferrinc, :crcc|Luminc, :ccic, c|crc e umc peuenc
ucnIiccce ce |ccIc:e.
Nc: primeirc: cic: cpc: c pcrIc, prccuzicc c cc|c:Irc, e :uc prccucc
permcnece cincc pcr cercc ce 7 cic:. /pre:enIc-:e ccmc um ||uicc
e:pe::c, ce cc|crccc 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 ccncenIrccc ce |g/ e ce |ccIcferrinc ue,
junIcmenIe ccm c grcnce ucnIiccce ce |infcciIc: e mccrcfcgc:,
ccnferem umc ccc ce prcIecc cc recm-nc:cicc. Iem ccc |cxcIivc,
fcci|iIcncc c e|iminccc ce meccnic, cuxi|icncc c prevencc cc
icIer|cic.
16
ALEITAMENTO MATERNO
139
2. Le|te de trons|o
FeceLe e:Ic cencminccc c |eiIe humcnc prccuzicc enIre c 7 e 15 cic
cpc: c pcrIc. C vc|ume ce |eiIe e c ccmpc:icc vcricm nc ceccrrer cc:
cic:, permcnecencc ccm vc|ume mcic ce 500m|/cic.
3. Le|te moduro
c |eiIe prccuzicc c pcrIir cc 15 cic, ccmc ccnIinuccc cc |eiIe ce
Ircn:icc. um ||uicc Lrcncc e cpccc, ccm pcucc cccr, :cLcr
|igeircmenIe ccccicccc. Seu vc|ume mcic ce 700 c 00 m|/cic,
curcnIe c: primeirc: :ei: me:e:. / pcrIir cc :eguncc :eme:Ire, c
ucnIiccce mcic ce prccucc cicric ce 00m|. C |eiIe mcIernc Iem
887 ce cguc e pc::ui umc c:mc|criccce :eme|hcnIe c cc p|c:mc
:cng|nec. Iem nc :uc ccmpc:icc Lc:icc, c|m cc cguc, prcIe|nc:,
ccrLchicrcIc:, |ip|cec:, minerci: e viIcminc:.
4. Le|te de pr-termo
C |eiIe ce mce: ce cricnc: premcIurc: cifere cc |eiIe ce mce: ce
cricnc: ce Iermc. /: ciferenc: Lc:icc: :cc:
mcicr Iecr ce prcIe|nc, |ip|cec: e cc|cric:, cIencencc c mcicr
nece::iccce ce cre:cimenIc cc pr-Iermc:
mencr Iecr ce |ccIc:e, vi:Ic ue c pr-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 cricnc Iem pe:c infericr c 1500g.
Monejo c|n|co do omomentoo:
Ccnhecer c: c:pecIc: re|ccicnccc: c prcIicc cc c|eiIcmenIc mcIernc
fcIcr funccmenIc| nc :enIicc ce cc|cLcrcr pcrc ue mce e cricnc
pc::cm vivencicr c cmcmenIccc ce fcrmc efeIivc e Ircni|c,
receLencc cc prcfi::icnc| c: crienIcce: nece::cric: e cceuccc: pcrc
c :eu xiIc.
Fen:cncc ue c mu|her pc::c pcr um |cngc per|ccc ce ge:Iccc cI
ue pc::c ccncreIcmenIe cmcmenIcr :eu fi|hc, enIence-:e ue c
prepcrc pcrc c cmcmenIccc cevc :er iniciccc cincc nc per|ccc ce
grcvicez.
Freporondo os momos poro o o|e|tomento
1. Duronte o gestoo:
excmincr c: mcmc: nc ccn:u|Ic ce pr-ncIc|:
crienIcr c ge:IcnIe c u:cr :uIic ccm crif|cic cenIrc| pcrc
expc:i cc ce crc|c e mcmi|c curcnIe c ge:Iccc:
16
ALEITAMENTO MATERNO
140
reccmenccr Lcnhc: ce :c| nc: mcmc:, pcr 15 minuIc:, cI 10
hcrc: cc mcnhc cu cpc: c: 1 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:Iccc, 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
cceuccc, 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 :uccc cc mcmi|c cpc: c pcrIc, ce:ce ue :uc
pre::cc :ejc muiIc peuenc e ncc mcchuue c pe|e.
2. U:cr :eringc p|c:Iicc ce 10-20 m| pcrc Irccicncr c mcmi|c, nc cu:ncic
cc LcmLc ce :uccc cc mcmi|c:
pegcr umc :eringc p|c:Iicc ce 10-20 m|, reIircr c mLc|c e ccn:ervcr:
ccrIcr c exIremiccce cc :eringc cnce :e cccpIc c cgu|hc:
reinIrccuzir c mLc|c pe|c exIremiccce ccrIccc: e
cju:Icr c cuIrc exIremiccce cc :eringc cc mcmi|c e puxcr
:ucvemenIe c mLc|c pcrc Irccicncr c mcmi|c. Fczer e:Ic mcncLrc umc
vez cc cic, cI ue c mcmi|c :e Icrne prcIru:c.
16
ALEITAMENTO MATERNO
141
impcrIcnIe icenIificcr c: ccnhecimenIc:, crenc: e cIiIuce: ue c
ge:IcnIe pc::ui em re|ccc c cmcmenIccc, ue Iipc ce experincic
pc::ui, cu :e jc vivencicu c|gumc vez c cmcmenIccc. /|m ci::c,
impcrIcnIe IcmLm cferecer c: ge:IcnIe: cpcrIuniccce: ce Irccc ce
experincic:, cIrcv: ce reunice: ce grupc ue cLjeIivem infcrmcr e
fcci|iIcr c cmcmenIccc.
2. In|c|ondo o omomentoo no so|o de porto
/ primeirc hcrc cpc: c nc:cimenIc exce|enIe pcrc inicicr c
cmcmenIccc, vi:Ic ue c FN u:uc|menIe e:Ic Lem c|erIc e cIenIc,
ccm c ref|exc ce :uccc cIivc, e:Iimu|cncc precccemenIe c prccucc
ce cciIccinc e prc|ccIinc.
Iccc in:IiIuicc ue ce:ejc pc::uir um Frcgrcmc ce lncenIive cc
c|eiIcmenIc mcIernc ceve Ier ccmc ncrmc c prcIicc ce cc|cccr c
recm-nc:cicc pcrc :ugcr curcnIe c primeirc hcrc ce vicc, ce:ce ue
mce e cricnc :e enccnIrem em Lcc: ccncice:, fcvcrecencc c
ccnIcIc c|hc c c|hc, pe|e c pe|e ce cmLc:.
/ euipe ce :cce ue c::i:Ie cc pcrIc ceverc cricr um
cmLienIe ce Ircni|iccce e cpcic, c::im ccmc prcpicicr ccnfcrIc
f|:icc e emccicnc| nc :enIicc ce fcci|iIcr c ccnIcIc |nIimc enIre mce
e cricnc, c mci: precccemenIe pc::|ve|.
/ ccmini:Irccc ce meciccmenIc:, e:pecic|menIe :eccIivc:e
cnc|g:icc:, c mce ceve :er criIeric:c.
C recm-nc:cicc ceverc :er ccLerIc ccm ccmpc cuecicc e
:ecc e cc|ccccc junIc ce :uc mce, em ccnIcIc pe|e c pe|e, pcrc
ue e:Ic c cc|cue 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 IcmLm pe|c e:I|mu|c c prccucc
|ccIec.
/ cmcmenIccc ceve :er iniciccc pe|c mcmc ue :e enccnIrc
mci: cheic ce |eiIe, gerc|menIe c ue fci uIi|izccc pcr |Iimc. Cc:c
c cricnc ncc ccn:igc mcmcr nc: cuc: mcmc:, nc prcximc
mcmccc ccmecr 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:icc pcrc c mce cmcmenIcr cepence ce vcric:
fcIcre:, cenIre e|e: c Iipc ce pcrIc, c cic ce puerpric ue :e
enccnIrc. Ccn:icerc-:e impcrIcnIe ue, em uc|uer pc:icc, c
mu|her e:Iejc ccnfcrIcve| e re|cxccc.
16
ALEITAMENTO MATERNO
142
C pc:icicncmenIc cc cricnc pcrc cmcmenIcr impcrIcnIe
pcrc ceIermincr umc cmcmenIccc efeIivc. / pc:icc 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 LeL ce frenIe
pcrc c mcmc, ccm :eu ueixc Icccncc c mcmc e c ccrpc-
ccLec-memLrc: em |inhc reIc. / pegc cceuccc :erc feiIc ccm
:uc Lccc Lem cLerIc cLcccnhcncc Iccc c pcrIe infericr cc crc|c
e pcrIe cc :upericr. Verificc-:e :e c pegc e:Ic ccrreIc :e c LeL
e:Iiver fczencc :ucce: |cngc:, :eguicc: ce pcu:c: e peuenc:
:ucce:, e cL:ervcncc-:e c ceg|uIicc. / pegc ccrreIc nuncc cci:
:e c mce referir ccr pcrue c LeL ncc e:Ic pegcncc Lem.
ScLe-:e ue c cmcmenIccc umc prcIicc ue ceve :er
cprencicc, IcnIc pe|c mce ucnIc pe|c cricnc. De:Ic fcrmc,
e:perccc ue, nc: primeirc: cic:, c mu|her cincc cpre:enIe
cificu|ccce: em pc:icicncr ccrreIcmenIe c cricnc e ue, nc
ceccrrer cc: cic:, cprencc.
Se c crc|c e:Iiver encurecicc, ceve-:e reIircr c exce::c ce |eiIe
pcr crcenhc mcnuc|, cI ue :e ccn:igc c f|exiLi|iccce ce:ejccc.
l:Ic impcrIcnIe, pci: permiIe ue c recm-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:.
/ curccc ce cccc mcmccc vcricve|. Gerc|menIe c cricnc
:e :cIi:fcz mcmcncc 10 c 15 minuIc: em cccc peiIc, pccencc :e
e:Iencer. Fcrm, ceve-:e ceixcr c cricnc mcmcr enucnIc c
me:mc e:Iiver :ugcncc.
Fcrc Iermincr c mcmccc, c icec| ue c cricnc :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 cricnc. De::c fcrmc, c vccuc
:e ce:fcz e c cricnc :c|Ic c peiIc, :em mcchucc-|c.
Cc|cccr c LeL pcrc crrcIcr, em pc:icc verIicc|, ccm c ccLec
cpciccc nc cmLrc mcIernc. Fcce :er feiIc umc |eve mc::cgem nc:
cc:Ic: cIe ue e|c crrcIe. Cricnc: mcicre: pccem :er IcmLm
cc|ccccc: nc cc|c mcIernc, :enIccc: e ccm c ccrpc inc|inccc
pcrc frenIe e cpciccc: nc Lrcc cc mce.
Cu|dodos com os momos e mom||os
C u:c ce :uIic nece::cric pcrc mcnIer c mcmc :empre e|evccc,
eviIcncc e:Ic:e: nc: pcrce: infericre: cc mcmc.
C Lcnhc ce :c| nc: mcmi|c: ccnIinuc reccmencccc ccm c cLjeIivc
ce cumenIcr c re:i:Incic cc regicc mcmi|c-crec|cr.
/ |uLrificccc cc regicc mcmi|c-crec|cr ceve :er feiIc :cmenIe ccm c
|eiIe mcIernc.
Depci: ce cmcmenIcr, c mce ceve prccecer c pc|pccc cc: mcmc:.
Se e:Iiverem pe:ccc: e ccm pcnIc: ce ccr, reIircr c exce::c ce |eiIe cI
c pcnIc ce ccnfcrIc, cu :ejc, cI c ce:cpcrecimenIc cc ccr.
C c|eiIcmenIc mcIernc , cIuc|menIe, ccn:icerccc pec
16
ALEITAMENTO MATERNO
143
funccmenIc| pcrc c :cce mcIernc e perincIc| e, pcrIcnIc, fcz pcrIe cc:
e:IrcIgic: ce Iccc: c: prcgrcmc: re|ccicnccc: ccm e:Ie: cLjeIivc:,
c|m ce repre:enIcr cincc um e|emenIc impcrIcnIe em Iccc prcce::c
ce humcnizccc cc nc:cimenIc. Nc 8rc:i|, nc: |Iimc: cnc: Iem :icc
pcrIicu|crmenIe e:Iimu|ccc, cIrcv: ce incenIivc: cficici: ccn:IcnIe: cc
chcmccc lH/C - lnicicIivc cc Hc:piIc| /migc cc Cricnc, ccnferincc c
re:pecIivc I|Iu|c c: in:IiIuice: ue IecniccmenIe cumprem ccm c:
reui:iIc: ccn:icerccc: nece::cric: pcrc umc cceuccc c::i:Incic
Icnicc e humcnc cc: recmnc:cicc:. Fcrc c efeIiviccce cc
c|eiIcmenIc mcIernc, c lH/C reccmencc c: in:IiIuice: c
imp|emenIccc cc: chcmccc: Dez pc::c: pcrc c :uce::c cc
c|eiIcmenIc mcIernc".
D|||cu|dodes no o|e|tomento
1. Freenso |ncorreto do mom||o
/ preen:cc inccrreIc cc regicc mcmi|c-crec|cr fcz ccm ue c cricnc
ncc ccn:igc reIircr |eiIe :uficienIe, |evcncc c cgiIccc e chcrc. / pegc
errccc, :c ce mcmi|c, prcvccc ccr e fi::urc: e fcz ccm ue c mce fiue
Ien:c, cn:ic:c e percc c cuIcccnficnc, ccreciIcncc ue c :eu |eiIe :ejc
in:uficienIe e/cu frccc.
2. F|ssuros [rochoduros}
EviIcr fi::urc:, cc|cccncc c LeL pcrc mcmcr nc pc:icc 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 \4%)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 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 LeL 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. 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 LeL 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
exIrccc 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|coes
Scc rcrc: c: :iIucce:, IcnIc mcIernc: ucnIc necncIci:, ue ccnIrc-
inciccm c cmcmenIccc. 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:IrLic: cc ccn:cincic cu ccmpcrIcmenIc grcve, enIre
cuIrc:.
/: ccnIrc-inciccce: necncIci: inc|uem c|Iercce: cc ccn:cincic cc
cricnc ce uc|uer ncIurezc, Lcixc pe:c ccm imcIuriccce pcrc :uccc
cu ceg|uIicc {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 mecicccc pe|c mu|her ccnIrc-incicc c
cmcmenIccc. Nenhumc mecicccc ceve :er uIi|izccc pe|c purperc
cmcmenIcncc :em crienIccc mcicc. Nc evenIuc|iccce cc
mecicccc uIi|izccc :er c|c::ificccc ccmc ce u:c criIeric:c cu ccnIrc-
incicccc curcnIe c cmcmenIccc, c prccecimenIc ce e:cc|hc cpIcr
pcr cuIrc: c|IerncIivc: IercpuIicc: e ncc :u:pencer c c|eiIcmenIc,
:empre ue i:Ic fcr pc::|ve|. Fcrc mcicre: ceIc|he:, ver mcnuc|
/mcmenIccc e U:c ce Drcgc: {MS, 2000).
16
145
O obortomento como questo de sode pb||co
C cLcrIc, c::unIc exc|u|cc cc: ci:cu::ce: cienI|ficc: e
pc||Iicc: cI Lem pcucc Iempc cIrc:, , nc
cIuc|iccce, umc cc: principci: ue:Ice: cc cgencc
inIernccicnc|, nc ue ciz re:peiIc c :cce e cireiIc:
reprccuIivc:.
/ ci:criminccc e c: cgrcvc: c :cce impc:Ic: c:
mu|here:, pcr rczce: cu|Iurci:, |egci: e re|igic:c: ue
envc|vem c ue:Icc cc cLcrIc, Im ccnIriLu|cc pcrc
c preccrieccce cc c::i:Incic 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 cefinicc ce pc||Iicc:
ue inccrpcrem c prevencc cc cLcrIc e c
cmp|iccc cc cce::c c :ervic: ce Lcc uc|iccce.
/::im, ccmc re:u|Iccc cc ceLcIe ccncuzicc pe|c
mcvimenIc ce mu|here:, nc |Iimc ccccc, c cLcrIc
fci cmp|cmenIe ceLcIicc em cuc: impcrIcnIe:
ccnferncic: cc: Ncce: Unicc:: Ihe lnIerncIicnc|
Ccnference cn Fcpu|cIicn cnc Ihe Deve|cpmenI
{Ccirc, 14) e c FcurIh Wcr|c Ccnference cn Wcmen
{8eijing, 15). E c cLcrIc, rec|izccc em ccncice:
in:egurc:, fci inc|u|cc nc F|cnc ce /cc cc
Ccnferncic cc Ccirc - pcrcgrcfc 8.25 - ccmc ue:Icc
ce :cce pL|icc. C: gcvernc: :igncIcric:, enIre e|e: c
8rc:i|, c::umircm c ccmprcmi::c ce imp|emenIcr
:ervic:, me|hcrcr c uc|iccce cc c::i:Incic 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 cce:
ue gcrcnIcm cc: hcmen: e mu|here: c exerc|cic cc:
cireiIc: :exuci: e reprccuIivc:.
/pe:cr cc vi:iLi|iccce ccuiricc, pcr fcrc ce |ei:
re:IriIivc:, c: mu|here: cincc reccrrem cc cLcrIc
c|cnce:Iinc. Ne::c ccncicc, e|c: Im gucrcccc
17 ASSISTNCIA MULHER COM ABORTAMENTO E
NO PS-ABORTO
ASSISTNCIA MULHER COM ABORTAMENTO E NO PS-ABORTO
146
:uc ccr em :i|ncic cu, nc mcximc, ccmpcrIi|hcm-nc ccm pe::cc: ce :uc
inIimiccce. Cuc:e :empre e|c: ncc enccnIrcm cpcic nc: :ervic: ce
:cce cu nc: e:cc|c:, em :e IrcIcncc ce ccc|e:cenIe:.
/: reccmenccce: inIernccicnci:, :e ncc Ircn:fcrmccc: em ncvc:
prcIicc: nc n|ve| ce cIencc |ccc|, :ercc in:uficienIe: pcrc c :c|ucc cc
prcL|emc. Fcr i::c, Icrnc-:e nece::cric c Lu:cc ce pc||Iicc: :ccici:
cceuccc: cc ccnIexIc ce cccc pc|:, e:Iccc cu munic|pic, re:peiIcncc-
:e c: |ei: vigenIe: e prcmcvencc c: recur:c: humcnc: e xIcnicc:
ci:pcn|vei:. Deve-:e re::c|Icr cui, c impcrIcncic cc prcIicc prcfi::icnc| e
pc||Iicc cc: prcfi::icnci: cc :cce, principci: inIer|ccuIcre: cc: mu|here:
ue cemcnccm :ervic: ce :cce pcrc crienIcce: e IrcIcmenIc cc:
prcL|emc: ceccrrenIe: cc cLcrIcmenIc.
Mogn|tude do obortomento no 8ros|| e no mundo
/ rec| mcgniIuce cc cLcrIcmenIc, nc muncc, ce:ccnhecicc. /
i|egc|iccce, pcrcic| cu IcIc| em civer:c: pc|:e:, cificu|Ic c regi:Irc ce
Iccc: c: cccrrncic:. Nc pcpu|ccc muncic|, 27 vive em pc|:e: cnce c
inIerrupcc ce grcvicez permiIicc pcr umc cmp|c vcrieccce ce
rczce:, e 27 vive em pc|:e: cnce c cLcrIc prciLicc {CenIrc Legc|
pcrc Derechc: FeprccuIivc: y Fc|iIicc: FuL|icc: - CLFF, N/EU/, 1). Fcr
cuIrc |ccc, nem Iccc: c: mu|here: cemcnccm c::i:Incic pc:-
cLcrIcmenIc nc: :ervic: pL|icc: ce :cce. De:Ic fcrmc, ccn:en:c ce
ue exi:Ie umc :uL-ncIificccc cc: cc:c:, c::im ccmc cc: ccmp|iccce:
c::cciccc:.
Nc 8rc:i|, cpe:cr cc ccrncic ce inciccccre: ue permiIcm cfericc cc
numerc IcIc| ce cccrrncic: ce cLcrIcmenIc: nc pcpu|ccc em gerc|,
c: cccc: cficici: ju:Iificcm c ccccc ce mecicc: prevenIivc: e ce
prcmccc cc :cce reprccuIivc. Nc ccnIexIc cc mcrIc|iccce mcIernc,
c incicncic cL:ervccc ce cLiIc: pcr ccmp|iccce: 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: vcricce: 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 lnIernccc Hc:piIc|cr {SlH/SUS), ue infcrmc c nmerc ce inIerncce:
pcrc cureIcgen: pc:-cLcrIc e c frencic ce cLiIc: ne:Ic:
circun:Icncic:, nc: :ervic: pL|icc: e ccnveniccc: e cc Si:Iemc ce
lnfcrmccc em McrIc|iccce {SlM/CENEFl/MS) ue ccn:c|icc c regi:Irc cc
cLcrIcmenIc em cec|crccc ce cLiIc - ne:Ie cc:c ccm grcnce :uL-
ncIificccc em uc:e Iccc pc|:.
Ccnfcrme cccc: regi:Irccc: nc: |Iimc: :ei: cnc: pe|c SlH/MS, c nmerc
g|cLc| ce cureIcgen: pc:-cLcrIc pcrece mcnIer-:e e:Icve| nc: |Iimc:
Ir: cnc: {Cuccrc 1).
17
ASSISTNCIA MULHER COM ABORTAMENTO E NO PS-ABORTO
147
Quadro 1 - Nmero de curetagens ps-aborto realizadas no mbito dos
servios pblicos e conveniados
Fonte: SIH/SUS, MS
/ incicncic ce cLcrIc: nc ccc|e:cncic ccn:IiIui IcmLem grcnce
preccupccc :ccic|. Dc IcIc| cc: inIerncce: pcr cLcrIcmenIc nc
SlH/SUS nc cnc ce 18, 22,57 ercm ce ccc|e:cenIe:. C cIencimenIc
receLicc pe|c: ccc|e:cenIe: nc: :ervic: ce :cce in:cIi:fcIcric. Sem
cpcic e cccn:e|hcmenIc cceuccc:, ccm frencic, e:Ic: jcven:
engrcviccm ncvcmenIe, enIrcncc num cic|c repeIiIivc ce grcvicez-
cLcrIcmenIc.
/: mecicc: nece::cric: c recucc cc grcvicez ncc p|cnejccc cu
ince:ejccc inc|uem crienIcce: :egurc: nc cIencc pc:-cLcrIcmenIc,
nc crienIccc cnIiccncepcicnc|, civu|gccc e cferIc cc impcrIcncic cc
cnIiccncepcc ce emergncic e gcrcnIic ce :upcrIe p:icc|cgicc e
:ccic| ucncc nece::cric.
C: inciccccre: ce :cce mcIernc cemcn:Ircm ue c c::i:Incic cc
cLcrIcmenIc ncc cpre:enIc uc|iccce ccmpcI|ve| ccm c: recur:c:
ci:pcn|vei:. Fcr i::c, c cmp|iccc cc cce::c ceve ccminhcr junIc c
uc|ificccc cc rece jc in:Ic|ccc.
QbALIDADE DA AIENO AO A8OkIAMENIO E NO FS-
A8OkIO
Conce|tuondo o quo||dode do oteno
/ uc|iccce nc cIencc cc cLcrIcmenIc e pc:-cLcrIc ceve :er
ccmpreencicc ccmc um ccnjunIc ce cce: cferecicc c mu|her curcnIe
e cpc: c inIerrupcc ce umc ge:Iccc, uer e:pcnIcnec cu incuzicc,
e:Iencencc-:e cI c 42 cic cpc: c Irminc cc grcvicez. Fcrc e:Ie fim,
ccn:icerc-:e cLcrIcmenIc inIerrupcc cc grcvicez cI 22 :emcnc: cu,
:e c iccce ge:Iccicnc| fcr ce:ccnhecicc, ccm c prccuIc cc ccncepcc
pe:cncc menc: ce 500 grcmc: cu mecincc menc: ce 1 cm.
/ uc|iccce cc cIencc imp|icc num e:fcrc inIegrccc e :inrgicc ce
Iccc: c: n|vei: ge:Icre: pcrc c cferIc ce :ervic: ue gcrcnIcm:
ccc|himenIc, infcrmccc, cccn:e|hcmenIc, ccmpeIncic 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 :cce e funcicncric: cc rece
c::i:Iencic|, gucrcccc: c: ciferenc: ce :uc: funce: e cIriLuice:
e:pec|ficc:, :cc cc-re:pcn:cvei: nc ccn:Irucc e nc cprimcrcmenIc
17
ASSISTNCIA MULHER COM ABORTAMENTO E NO PS-ABORTO
148
ccnI|nuc cc uc|iccce cc cIencc c mu|her em prcce::c ce
cLcrIcmenIc e nc pc:-cLcrIc.
C cce::c c :ervic: ce uc|iccce permiIe ue c mu|her re:c|vc c
prcL|emc e enccnIre cpcic nc Lu:cc ce :c|uce: incivicuci: pcrc
ccncuzir c :eu prcce::c reprccuIivc ccm cuIcncmic e :egurcnc.
Constru|ndo o quo||dode do oteno
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 :iIuccc em
ue :e enccnIrc / eviIcr c: ri:cc: ce um cLcrIcmenIc em ccncice:
in:egurc: Fef|eIir :cLre e::c: ue:Ice: e::encic| pcrc ue :e cperem
muccnc: nc: :ervic: ce :cce, 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|uncic cc: prcpric: vc|cre: {mcrci:,
Iicc:, re|igic:c:) nc prcIicc prcfi::icnc|, reccnhecimenIc e cceiIccc
cc: prcpric: |imiIe: e cc: ciferenc: ue ccrccIerizcm c :ccieccce
humcnc, c ue ncc :e cLIm cpenc: pcr fcrc cc vcnIcce. Fccem
cjuccr ne:Ic ref|excc c: ci:cu::ce: cc|eIivc:, civicir preccupcce:,
ccnfrcnIcr e cnc|i:cr cIiIuce: e ccncuIc: nc prcpric euipe ce IrcLc|hc,
cu em grupc: inIerin:IiIucicnci:, reunice: e cficinc: ce :en:iLi|izccc e
ccpcciIccc. impcrIcnIe IcmLm 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: :ervic:. / 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-Iicc: nc cferIc ce
:ervic:, ccmc c: punice: e cc:Iigc: impc:Ic: c muiIc: mu|here: ue
cLcrIcm, nc: :ervic: pL|icc:.
2. In|ormoes e oconse|homento
Nc mcicric cc: cc:c: ce cLcrIcmenIc, c mu|her ncc ce:ejc cuIrc
grcvicez imecicIcmenIe cpc: e c crienIccc :cLre cnIiccncepcc
cL:c|uIcmenIe nece::cric. Dc me:mc mccc, c euipe ceve e:Icr
prepcrccc pcrc crienIcr cue|c: mu|here: ue ce:ejcm cuIrc grcvicez,
:ejc ncue|e :ervic cu enccminhcncc-c pcrc uniccce: ce referncc.
Ccm frencic, nc pc:-cLcrIcmenIc, c: mu|here: preci:cm ce umc
euipe ue ccmpreencc :uc: nece::iccce:, ncc :cmenIe f|:icc:, mc:
IcmLm :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:Irccc e :en:ccc ce inccpcciccce ce engrcviccr ncvcmenIe.
Em cuIrc: :iIucce:, c :enIimenIc ce cu|pc pcce :er ccmincnIe. Deve-:e
reccnhecer IcmLm ue hc mu|here: ue :enIem c||vic, cu
:imp|e:menIe e:Icc Ircni|c:, mc:
17
ASSISTNCIA MULHER COM ABORTAMENTO E NO PS-ABORTO
149
nem :empre e:Icc c vcnIcce pcrc expre::cr |ivremenIe :uc: recce: cu
:enIimenIc:. Fcrc ue :ejc pc::|ve| fc|cr, preci:c ue hcjc c|gum
ccpcz ce cuvir. Fcr i::c, umc Lcc ccpcciccce ce e:cuIc, :em pr-
ju|gcmenIc:, pcrece :er c principc| in:IrumenIc c :er uIi|izccc pe|c:
prcfi::icnci: ce :cce.
C cic|cgc :cIi:fcIcric cLIicc curcnIe c cIencimenIc prcpcrcicncrc c:
mu|here: ccncice: pcrc ceci:ce: fuIurc: em re|ccc c :uc :cce, em
e:pecic| cc :eu fuIurc reprccuIivc.
3. Acesso oos serv|os
Nc crgcnizccc cc rece c::i:Iencic|, ceve-:e ccn:icercr c pre:enc ce
uccrc e|emenIc: ue gcrcnIircc c cce::c cc mu|her cu ccc|e:cenIe
cc: :ervic:, uci: :ejcm:
exi:Incic ce :ervic: ce urgncic ue pc::cm IrcIcr c: mu|here:
cc: ccmp|iccce: cc cLcrIc e:pcnIcnec cu incuzicc
pre:enc ce :ervic: ce p|cnejcmenIc fcmi|icr nc: |ccci: ce
cIencimenIc c: urgncic: ce cL:IeIr|cic
re|ccc fcrmc|izccc enIre c: :ervic: ce urgncic e ce cIencc
inIegrc| c :cce cc mu|her
infcrmccc ccnIinuccc pcrc c: u:ucric: :cLre c: :ervic:
ci:pcn|vei:
4. Integroo do rede oss|stenc|o|
/: mu|here: cevem ci:pcr ce umc rece ce :ervic: ue pc::c pre:Icr
cIencimenIc cceuccc cicnIe ce um uccrc ce cLcrIcmenIc, e e:Ic
rece ceve uIi|izcr um :i:Iemc efeIivc ce referencc e ccnIrc-referncic,
re:peiIcncc c: ccncice: :ccici: e eccncmicc: cc: mu|here:. /
inIegrccc cc: :ervic: ce urgncic ccm :ervic: ce p|cnejcmenIc
fcmi|icr ceve fczer pcrIe cc uc|iccce cc cIencc cc cLcrIcmenIc e
pc:-cLcrIc.
5. Competnc|o pro||ss|ono|
/|m cc hcLi|iccce nc Icnicc empregccc pcrc c e:vczicmenIc
uIerinc, c ccmpeIncic :e e:Ience cc Lcm u:c ce euipcmenIc:,
in:IrumenIc| e meciccmenIc:, c::im ccmc nc cefinicc ce rcIinc: e
Icnicc: ncc evc:ivc:, vi:cncc cc Lem e:Icr cc mu|her e permiIincc :uc
pcrIicipccc nc e:cc|hc cc: prccecimenIc: mci: cprcpriccc: pcrc
re:c|ucc cc prcL|emc. /ui IcmLm :e inc|ui c uc|ificccc 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.
. Iecno|og|o opropr|odo
/ me|hcric cc cIencimenIc impce c uIi|izccc ce Iecnc|cgic cprcpriccc
pcrc prcmcver c e:vczicmenIc uIerinc, ucncc e:Ic
17
ASSISTNCIA MULHER COM ABORTAMENTO E NO PS-ABORTO
150
:iIuccc fcr nece::cric. / reIirccc cc: re:Ic: cvu|cre: pcce :er feiIc
uIi|izcncc-:e c Icnicc ce c:pirccc mcnuc| inIrc-uIerinc {/MlU) nc:
cc:c: ce cLcrIcmenIc cI 12 :emcnc:, nc uc| c uIi|izccc ce ccnu|c:
f|ex|vei: ce cc|iLre unifcrme ciminui c: ri:cc: ce ccmp|iccce:. Em muiIc:
cc:c:, ucncc ccnvenienIemenIe cp|icccc e prececicc ce
e:c|crecimenIc: e cc L|cueic pcrccervicc|, ci:pen:c c uIi|izccc ce
cne:Ie:ic gerc|, prcpcrcicncncc mcicr :egurcnc e cc|cLcrccc cc
mu|her, c|m ce :e pccer cferecer umc c|Ic mci: preccce, ccm
ccn:eenIe ciminuicc cc: cu:Ic:. Cucncc ncc ci:pcn|ve|, cu nc
cu:ncic ce pe::cc| Ireinccc ne:Ic Icnicc, pcce-:e prcmcver c
e:vczicmenIc cIrcv: cc cureIcgem uIerinc.
CLASSIFICAO E CONDbIA
1. Ameoo de Abortomento
C :cngrcmenIc geniIc| ce peuenc 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 cIrcv:
cc crvice, 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 infecc. C
excme ce u|Irc-:cncgrcfic mc:Irc-:e ncrmc|.
Ne:Ie: cc:c:, ncc hc incicccc ce inIernccc hc:piIc|cr e c mu|her
ceve receLer crienIcce: pcrc uIi|izcr cnc|g:icc: :e cpre:enIcr ccr,
fczer repcu:c e reIcrncr cc cmLu|cIcric ce pr-ncIc|. Nc: cc:c: ce
:cngrcmenIc inIen:c, cevem-:e cvc|icr c: n|vei: ce hemcg|cLinc,
icenIificcr c Iipc :cng|nec, :e fcr ce:ccnhecicc, e cferecer :crc|cgic:
pcrc :|fi|i: e HlV.
2. Abortomento Comp|eto
Gerc|menIe em ge:Iccc 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 Ierc Iem cimen:ce:
infericre: cc e:perccc pcrc c iccce cc ge:Iccc. / u|Irc-:cncgrcfic
mc:Irc ccviccce uIerinc vczic cu cpenc: ccm imcgen: :uge:Iivc: ce
cccgu|c:.
/ ccncuIc ceve :er expecIcnIe, ccm cIencc c per:i:Incic cc
:cngrcmenIc ue pcce :ugerir re:Ic: cvu|cre:, e ccm c :urgimenIc ce
uccrc infeccic:c p|vicc. Ne:Ie: cc:c:, reccmencc-:e /MlU cu
cureIcgem uIerinc. Sc|iciIcr Iipcgem :cng|nec e :crc|cgic: pcrc :|fi|i: e
HlV, cpc: ccn:enIimenIc. Se fcr Fh negcIivc e ncc hcuver cincc
:en:iLi|izccc, fcz-:e cLrigcIcric c ccmini:Irccc cc imuncg|cLu|inc cnIi-
D.
3. Abortomento Inev|tve| e Incomp|eto
/ percc :cng|nec mcicr ue nc cmecc ce cLcrIcmenIc, pccencc
cccrrer c e|iminccc ce cccgu|c:. E:Ic percc gerc|menIe ciminui cpc: c
e|iminccc cc mcIeric| cvu|cr, principc|menIe :e fcr
17
ASSISTNCIA MULHER COM ABORTAMENTO E NO PS-ABORTO
151
ccmp|eIc. /: ccre: Im inIen:iccce mcjcr ue c cmecc, 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:Iccc Iem menc: ce 12 :emcnc:, e:Ic incicccc c
c:pirccc mcnuc| inIrc-uIerinc {/MlU). Cucncc c :ervic ce :cce ncc
ci:pu:er ce:Ie prccecimenIc, pcce-:e rec|izcr c cureIcgem uIerinc.
inci:pen:cve| ceIermincr c Iipc :cng|nec cc mu|her. Se fcr Fh negcIivc
e ncc hcuver cincc :en:iLi|izccc, fcz-:e cLrigcIcric c ccmini:Irccc 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 IcmLm cferecer c :crc|cgic pcrc HlV.
Em ge:Icce: ccimc ce 12 :emcnc:, ccm ccncepIc nc ccviccce
uIerinc, reccmencc-:e c infu:cc ce cciIccinc pcrc prcmcver :uc
expu|:cc cu c cc|ccccc cc mi:cprc:Ic| nc funcc ce :ccc vcginc|, nc
cc:e ce 200 mcg c cccc hcrc:. /pc: expu|:cc, ceve-:e rec|izcr c
cureIcgem uIerinc.
4. Abortomento ket|do
C cLcrIcmenIc reIicc pcce ncc :er prececicc ce cmecc 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 ccncepcc :em viIc|iccce
cu :uc cu:ncic {cvc cegc).
Cucncc c ge:Iccc Iem menc: ce 12 :emcnc:, ceve-:e prccecer cc
e:vczicmenIc pe|c Icnicc ce c:pirccc mcnuc| inIrc-uIerinc e, :e
nece::cric, rec|izcr ci|cIccc cervicc| ccm ci|cIcccre:, cu rec|izc-:e
cureIcgem uIerinc, Iencc-:e c cuicccc pcrc ncc prcvcccr ccicenIe:,
principc|menIe perfurccc uIerinc.
Cucncc c ge:Iccc Iem mci: ce 12 :emcnc:, nece::cric prcmcver c
ci|cIccc 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 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:IrLic cc cccgu|ccc,
pcrIcnIc ceve-:e e:Icr cIenIc c cuIrc: :cngrcmenIc: cncrmci:,
:c|iciIcncc-:e prcvc: |cLcrcIcrici: ce cccgu|ccc ucncc exi:Iir e:Ic
:u:peiIc. / icenIificccc ce ge:IcnIe Fh negcIivc inci:pen:cve| pcrc
eviIcr c c|cimunizccc. / :crc|cgic pcrc :|fi|i: ceve :er rcIinc e pcrc HlV
ceve :er cferecicc.
5. Abortomento In|ectodo
Gerc|menIe cccrre cpc: mcnipu|ccc pcrc incuzir c inIerrupcc cc
grcvicez e :cL mc: ccncice: Icnicc:. /: infece: :cc, pc|imicrcLicnc:
e uc:e :empre ccm LccIric: cc prcpric f|crc vcginc|. C uccrc
grcve e reuer cuicccc imecicIc. Deve-:e ccn:icercr, em Iccc: c: cc:c:,
c prccuIc cc ccncepcc ccmc ncc
17
ASSISTNCIA MULHER COM ABORTAMENTO E NO PS-ABORTO
152
Iencc viIc|iccce. C ue mci: chcmc cIencc nc uccrc c||nicc
:cngrcmenIc ccm cccr fIicc, cccmpcnhccc ce ccr cLccminc| feLre.
C pu|:c enccnIrc-:e cce|erccc e c feLre freenIemenIe cIinge mci: ce
38 C. Fccem-:e icenIificcr cc|ece: nc: funcc: ce :ccc e, cc :er
excminccc, c pccienIe refere Lc:IcnIe ccr c mcnipu|ccc cc: crgcc:
p|vicc:. / pc::iLi|iccce ce perfurccc uIerinc e ce c|c: inIe:Iinci: ceve
:er :empre |emLrccc. Cucncc in:Ic|ccc uccrc ce chcue :pIicc,
|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:uficincic renc|.
Excme: |cLcrcIcrici: :cc nece::cric: e ceve :er cvc|iccc c mcmenIc ce
:uc :c|iciIccc. C: :eguinIe: excme: pccem :er nece::cric::
hemcgrcmc ccm ccnIcgem ce p|cueIc::
Iipcgem :cng|nec:
urinc Iipc l {excme ce :ecimenIc urincric):
cc:cgen: ce uric e crecIininc:
cccgu|cgrcmc:
hemccu|Iurc:
cu|Iurc cc :ecrecc 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|ece: inIrc-ccviIcric: {cL:ce::c:).
Em Iccc: c: cc:c:, ceve-:e fczer infu:cc ce :c|uce: 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
ASSISTNCIA MULHER COM ABORTAMENTO E NO PS-ABORTO
153
/ e:cc|hc cc: cnIiLicIicc: ceve :er feiIc ccm c Ccmi::cc ce CcnIrc|e ce
lnfeccc Hc:piIc|cr. Nc cc:c cc cc|c enccnIrcr-:e fechccc, ceve-:e
prccecer :uc cLerIurc ccm c uIi|izccc 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|izccc cc: cnIiLicIicc:, pccencc-:e uIi|izcr c /MlU :e c ge:Iccc Iiver
menc: ce 12 :emcnc: cu c cureIcgem uIerinc. Em cmLc: c: cc:c:,
ceve-:e e:Icr cIenIc cc perigc ce perfurccc uIerinc. Nc: cc:c: ce
cL:ce::c, e :encc e:Ie cce::|ve| pe|c cc|pcIcmic, prccece-:e e:Ic
Icnicc. 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, cIencc ceve :er cccc c: funce:
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
ccncicc pccem :er enccnIrccc: nc mcnuc| Urgncic: e Emergncic:
McIernc:. Guic pcrc cicgnc:Iicc e ccncuIc em :iIucce: ce ri:cc ce
mcrIe mcIernc cc Mini:Iric cc Scce {MS, 2000).
. Abortomento em s|tuoo de r|sco poro o gestonte - oborto
teroput|co
/: ge:IcnIe: ue e:Icc :encc cIencicc: em cmLu|cIcric cu prccurcm c
hc:piIc| ccm ccenc: grcve: ceverc :er cvc|iccc: pcr cci: cL:IeIrc: e
pcr um e:pecic|i:Ic nc pcIc|cgic ue e:Ic mcIivcncc c inIerrupcc cc
ge:Iccc. Fcrc rec|izccc cc cLcrIc cu cnIecipccc cc pcrIc,
cLrigcIcric ue c mu|her e/cu :eu: fcmi|icre: e:Iejcm infcrmccc:,
Ienhcm :uc: cvicc: e:c|crecicc: e cuIcrizem c prccecimenIc.
impcrIcnIe ue umc euipe mu|Iiprcfi::icnc| pre:Ie cIencimenIc c e:Ic
mu|her, pc:Ic ue nc inIerrupcc cc grcvicez mcIivccc pe|c
cgrcvcmenIc cc :eu e:Iccc ce :cce, c cpcic p:icc|cgicc
funccmenIc| nc cIencimenIc. Ncc nece::cric ccmuniccr cc Ccn:e|hc
Fegicnc| ce Mecicinc, mc: impcrIcnIe ncIificcr c Ccmi::cc ce Iicc cc
hc:piIc| cnce :erc rec|izccc c prccecimenIc. Fcrc mcicre:
e:c|crecimenIc:, ccn:u|Icr c mcnuc| Icnicc ce Ge:Iccc ce /|Ic Fi:cc
{MS, 2000).
7. Abortomento pos-estupro
Nc ccncicc ce grcvicez pcr e:Iuprc, ucncc c ge:IcnIe prccurc c
hc:piIc|, e|c ceverc :er cvc|iccc pe|c euipe 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:Iric cc Scce, cu pcr
umc euipe ce referncic pcrc cIencimenIc c mu|here: em :iIuccc ce
vic|ncic. Deverc :er feiIc c cLerIurc ce prcnIucric, :c|iciIccc ce
excme:, enccminhcmenIc: e pre:crice: mcicc: incicccc: c :iIuccc.
17
ASSISTNCIA MULHER COM ABORTAMENTO E NO PS-ABORTO
154
Se c mu|her ce:ejc inIerrcmper c grcvicez, e|c ceverc cpre:enIcr c
8c|eIim ce Cccrrncic Fc|icic| {8CF), cLIicc nc De|egccic ce Fc||cic cc
pre:Icr ueixc. Cc:c ncc c Ienhc feiIc cI c mcmenIc, e|c ceverc :er
crienIccc, pe|c :ervic, c fcz-|c imecicIcmenIe. Feccmencc-:e :c|iciIcr
c regi:Irc cc cIencimenIc mcicc pcr ccc:icc cc vic|ncic :cfricc e c
|cucc cc ln:IiIuIc Mcicc Legc|, ucncc ci:pcn|ve|. Ncc nece::cric c
cuIcrizccc 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 infcrmcce: :cLre
c ccIc cc e:Iuprc, c |Iimc per|ccc men:Iruc| e :e c mu|her uIi|izcu
c|gumc mecicccc cpc: c cccrricc. C excme ginecc|cgicc ceve
rc:Irecr |e:ce: nc vu|vc e vcginc e c excme ce Icue men:urcr c vc|ume
uIerinc e c Iempc prcvcve| cc ge:Iccc. /|m ce :uLmeIicc cc:
excme: rcIineirc: {:crc|cgic: pcrc :|fi|i:, HlV e hepcIiIe, Iipcgem
:cng|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:Iccc ceve :er inIerrcmpicc cI c 12 :emcnc,
pcrm, ccm :upcrIe cceuccc, cI 20 :emcnc:. C prccecimenIc :erc
rec|izccc ccm cuIcrizccc 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 |oo os mesmos perguntos poro o
mu|her, sendo necessr|o que um n|co prontur|o sejo ut|||zodo ot o
||no| do otend|mento. O tempo decorr|do entre o pr|me|ro otend|mento e
o |nterrupo do gestoo no deve ser super|or o 7 d|os. Apos o
proced|mento, o poc|ente dever cont|nuor recebendo or|entoo
md|co, ps|co|og|co e soc|o|.
C prccecimenIc pcrc inIerrupcc cc ge:Iccc ceverc :er e:cc|hicc
pe|c euipe mcicc. Cucncc :e IrcIcr ce cricnc:, c cne:Ie:ic ceve :er
gerc| e c prccecimenIc rec|izccc ccm c:pirccc cc ccviccce uIerinc,
vi:cncc um mencr IrcumcIi:mc cc cc|c uIerinc curcnIe c prcce::c ce
ci|cIccc. / inIerrupcc cc grcvicez pcce :er feiIc cIrcv: cc c:pirccc
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|cIccc 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|cueic: e:pinci:.
Nc: ge:Icce: ccimc ce 12 :emcnc:, pccercc :er rec|izccc: c prepcrc e
c ci|cIccc cc cc|c uIerinc ccm mi:cprc:Ic| nc cc:e ce 200mcg pcr vic
vcginc|, repeIicc c cccc hcrc:, cIe c e|iminccc cc
17
ASSISTNCIA MULHER COM ABORTAMENTO E NO PS-ABORTO
155
prccuIc ccncepIuc|, e pc:Iericr cureIcgem uIerinc. impcrIcnIe ue
frcgmenIc: cc mcIeric| feIc| cu p|ccenIcric :ejcm cccncicicnccc: e
mcnIicc: em freezer pcrc excme ce DN/, nc cc:c cc Ju:Iic nece::iIcr.
/ pccienIe ceve :er cvi:ccc ce:Ie prccecimenIc. Em Iccc: c: cc:c:,
reccmencc-:e um reIcrnc cc :ervic, pcrc cvc|iccc c||nicc e
cccmpcnhcmenIc p:icc|cgicc.
Fre:Icncc cIencimenIc cceuccc c: mu|here: ccm :c|iciIccc ce
cLcrIc previ:Ic pcr |ei, e:Icrc :encc minimizccc c :cfrimenIc ce:Ic:
mu|here: e prcpcrcicnccc :uc reinIegrccc :ccic|. Mcicre:
e:c|crecimenIc: :cLre e:Ic :iIuccc e c ncrmcIizccc cc: :ervic: ue
pre:Icm c::i:Incic: c: mu|here: v|Iimc: ce vic|ncic :exuc|, pccem :er
cLIicc: nc ncrmc Icnicc cc Mini:Iric cc Scce, Frevencc e
IrcIcmenIc cc: /grcvc: Fe:u|IcnIe: cc Vic|ncic Sexuc| ccnIrc Mu|here:
e /cc|e:cenIe: {MS, 1).
8. Interrupo do grov|dez em cosos de mo||ormoo |eto| grove
ou |ncompotve| com o v|do
Cucncc umc ge:IcnIe cemcncc inIerrupcc 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,
nece::cric c cuIcrizccc jucicic|. / c::i:IenIe :ccic| cu cuIrc memLrc cc
euipe ceverc crienIcr c ge:IcnIe, :eu ccmpcnheirc e/cu fcmi|icre: c
prccurcrem c Mini:Iric FL|icc nc munic|pic, :c|iciIcncc cuIcrizccc
pcrc rec|izccc cc prccecimenIc. E nece::cric cincc ue c euipe
fcrnec um |cucc mcicc, exp|iccncc c: ccncice: cc grcvicez ue
ju:Iifiuem :uc inIerrupcc, c::im ccmc pc::|vei: ccnc: pcrc c :cce
f|:icc e menIc| cc mu|her em cc:c ce evc|ucc cI c finc| cc ge:Iccc.
C: prccecimenIc: pcrc inIerrupcc :ercc ceIerminccc: pe|c Iempc ce
ge:Iccc.
FLANEJAMENIO FAMILIAk FS-A8OkIAMENIO
C: :ervic: ce :cce ue cIencem urgncic: cL:IIricc: ncc pccem
percer c vc|ic:c cpcrIuniccce ce infcrmcr c: mu|here: :cLre c uIi|izccc
ce mIccc: cnIiccncepcicnci:. C: e:c|crecimenIc: e c cferIc ce
mIccc: cevem :er cmp|c:, pcrc ue c mu|her pc::c e:cc|her c ue
me|hcr :e cccpIc c: :uc: ccncice: 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:Iruccc, pccencc e:Icr cpIc c engrcviccr em Icrnc ce 15 cic:
cpc: c cLcrIcmenIc. Feccmencc-:e c cL:Iinncic :exuc| enucnIc
exi:Iir :cngrcmenIc.
/ e:cc|hc cc mIccc ceve :er cc mu|her, cevencc c: :ervic: ce :cce
ci:pcr ce umc vcrieccce ce cpce:. Nc cccn:e|hcmenIc, c cup|c-
prcIecc ceve :er IrcIccc ccm e:pecic| cIencc, 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.
17
ASSISTNCIA MULHER COM ABORTAMENTO E NO PS-ABORTO
156
Nc: cc:c: ce cLcrIcmenIc :em nenhumc ccmp|icccc, ncc hc
re:Irice: ce mIccc:. / mu|her pcce cpIcr pcr e:Ieri|izccc, injeIcvei:,
imp|cnIe:, DlU {pccencc e:Ie :er in:ericc |cgc cpc: c e:vczicmenIc
uIerinc), ccnIrccepIivc: crci: {iniciccc cenIrc cc 1 :emcnc cpc: c
e:vczicmenIc), pre:ervcIivc: e cicfrcgmc:. Ncc :e reccmenccm c:
mIccc: ncIurci: cnIe: ce re:IcLe|ecicc: c: cic|c: men:Iruci:.
Cucncc c cLcrIcmenIc fci infecIccc cu hc cvicc: :cLre e:Ic :iIuccc,
cu cincc :e fci prcIicccc em ccncice: in:egurc:, cevem-:e cferecer c:
imp|cnIe:, injeIcvei:, ccnIrccepIivc: crci: e pre:ervcIivc:. C DlU ncc ceve
:er in:ericc / e:Ieri|izccc 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: crienIcce: cccc:
nc cc:c cc cLcrIcmenIc infecIccc. Cucncc :e ci:pce cc DlU ccm
prcge:Iercnc, e:Ie pcce :er empregccc, pci: cccrrerc umc recucc cc
f|uxc men:Iruc|, cjuccncc nc recuperccc 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 fcrccc c cLcrIcr, :ejc pe|c
fcm||ic, ncmcrccc, cu me:mc pcrc mcnIer-:e nc empregc. Ne::e: cc:c:,
c :ervic :ccic| e c p:icc|cgic cevem cvc|icr c :iIuccc em ccnjunIc
ccm c mu|her, cferecencc cjucc nc cmLiIc cc :cce 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:fcrc: cc
euipe ce :cce cevem enIcc :er cirigicc: pcrc c::egurcr umc ceci:cc
ccn:cienIe e Icrncr ci:pcn|vei: Iccc: c: mIccc: ccnIrccepIivc:. Nc:
mu|here: ue :e enccnIrcm cn:ic:c: cu ue ncc :e :enIem :egurc: em
:uc cpcc, ceve-:e cpcicr c uIi|izccc ce mIccc: prcvi:cric: e gcrcnIir
c cIencimenIc ce:Ic mu|her em :ervic ce p|cnejcmenIc fcmi|icr. Nc:
cc:c: em ue c mu|her uIi|izcvc um mIccc 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 mIccc e:cc|hicc.
Cucncc c pcrceirc ncc cceiIc c uIi|izccc cc pre:ervcIivc e :e cpce c
uIi|izccc ce uc|uer mIccc 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: mIccc: 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, impre:cinc|ve| IenIcr e:c|crecer c: ccu:c:
cc cLcrIcmenIc, cnIe: ce IenIcr umc ncvc ge:Iccc. Lcc
17
ASSISTNCIA MULHER COM ABORTAMENTO E NO PS-ABORTO
157
ccncuIc ne:Ie: cc:c: enccminhc-|c pcrc um :ervic ce referncic,
ccc:icc em ue :erc feiIc umc inve:Iigccc mci: rigcrc:c :cLre cue|c
percc.
17
158
Nc 8rc:i|, cIuc|menIe, mci: ce 07 cc: cc:c: ce /lDS
em cricnc: e:Icc re|ccicnccc: c Ircn:mi::cc cc HlV
cc mce pcrc c fi|hc. E:Iimc-:e ue 15 c 307 cc:
cricnc: nc:cicc: ce mce: :crcpc:iIivc: pcrc c HlV
ccuirem e::e v|ru: nc ge:Iccc, curcnIe c IrcLc|hc
ce pcrIc cu pcrIc, cu pcr meic cc cmcmenIccc.
EnIreIcnIc, hc evicncic: ce ue c mcicric cc: cc:c:
ce Ircn:mi::cc verIicc| cc HlV {57) cccrre mci:
IcrcicmenIe nc ge:Iccc, principc|menIe curcnIe c
IrcLc|hc ce pcrIc e nc pcrIc prcpricmenIe ciIc.
Fc:IericrmenIe, :e c mu|her cmcmenIcr c cricnc, hc
cincc um ri:cc ccicicnc| ce, em mcic, 157 ce
Ircn:mi::cc cc HlV pcr e::c vic.
De umc mcneirc gerc|, c c::cciccc cc HlV e
ge:Iccc ccn:icerccc umc ccncicc ce c|Ic ri:cc e
c::im c IrcIccc. C mcIivc funccmenIc| pe|c uc| Ic|
c::unIc cLcrcccc ne:Ic puL|icccc ciz re:peiIc c
e:pecic| ccncicc ce ci:criminccc :ccic| e
preccnceiIc ue :cfre c mu|her HlV curcnIe c
ge:Iccc e c pcrIc. Ccn:icercncc ue umc
cLcrccgem cceuccc e ccmp|eIc c mu|her HlV
curcnIe c pr-ncIc|, c pcrIc e c puerpric e ccpcz ce
recuzir c: ri:cc: mcIernc-infcnIi: c n|vei: muiIc prcximc:
cc: ce ge:IcnIe: ncc infecIccc:, c frencic cc
ccncicc, c pc::iLi|iccce ce inIervence: efeIivc: e c
nece::iccce ce reverIer c ci:criminccc :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 14, c: re:u|Iccc: cc prcIccc|c 07 cc /lDS
C||nicc| Iric|: Grcup {/CIG) ccmprcvcrcm ue c
ziccvucinc {c /I) pcce recuzir c Ircn:mi::cc verIicc|
cc HlV em 7,57, ucncc u:ccc:
pe|c mu|her, curcnIe c ge:Iccc {/I-ccp:u|c:
nc cc:e cicric ce 500 mg c 00 mg, VC, c pcrIir
cc 14 :emcnc cIe c pcrIc):
pe|c mu|her nc IrcLc|hc ce pcrIc e pcrIc {/I -
injeIcve|, ver c e:uemc): e
pe|c recm-nc:cicc {/I - :c|ucc crc|, ver c
e:uemc).
18
ASSISTNCIA MULHER PORTADORA DO HIV
DURANTE O PARTO E PUERPRIO
ASSISTNCIA MULHER PORTADORA DO HIV DURANTE O PARTO E PUERPRIO
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 07 ce fcrmc ccmp|eIc, cuIrc: e:Iucc: vm :encc
rec|izccc: e Iccc: cemcn:Ircrcm ue c u:c cc /I, me:mc curcnIe um
curIc per|ccc ce Iempc, |evc c ciminuicc 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 purperc, repre:enIcm umc cpcrIuniccce pcrc c
cferecimenIc cc Ie:Ie cnIi-HlV e cevem :er cprcveiIccc:.
C /I injeIcve| e c /I :c|ucc crc| pcrc c recm-nc:cicc, cevem :er
ccmini:Irccc: incepencenIemenIe cc e:uemc cnIi-reIrcvirc| uIi|izccc
pe|c mu|her curcnIe c ge:Iccc.
1. O Aconse|homento poro o teste ont|-HIV
Fe|c: rczce: ccimc refericc:, c Mini:Iric cc Scce reccmencc ue :ejc
cferecicc c Ie:Ie cnIi-HlV c Iccc ge:IcnIe, ccm cccn:e|hcmenIc pr e
pc:-Ie:Ie, incepencenIemenIe cc :iIuccc ce ri:cc cc mu|her pcrc c
infeccc 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 puerpric imecicIc, e ue ncc Ienhcm
:icc cccn:e|hccc: e Ie:Iccc: pcrc c HlV nc pr-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:icerccc c perfi| p:icc|cgicc e emccicnc| cc mu|her,
prcpcrcicncncc-lhe cpcic cceuccc. Mc:Irc-:e ccnvenienIe ne::c:
:iIucce: c u:c ce Ie:Ie: rcpicc:, pcr permiIir c incicccc ce IrcIcmenIc
prcfi|cIicc em Iempc hcLi| pcrc c recm-nc:cicc. e::c umc ceci:cc
IercpuIicc ce emergncic, ccm Lcc re|ccc 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|izccc 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: {reccmenccce: nc FcrIcric 488, ce 17/0/8, MS/SVS, D.C. cc
Unicc, Secc 1, p.3). Ccmc jc refericc, cIencc e:pecic| ceve :er cccc
cc cccn:e|hcmenIc rec|izccc ne::c :iIuccc 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
ASSISTNCIA MULHER PORTADORA DO HIV DURANTE O PARTO E PUERPRIO
160
2. Ass|stnc|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
recm-nc:cicc. C e:uemc IercpuIicc cc /CIG 07 cemcn:Ircu recuzir
em 2/3 {7,57) 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/purperc e cc recm-nc:cicc umc c::i:Incic ce
uc|iccce.
Deve ccn:IiIuir c principic Lc:icc ce::c c::i:Incic c ncc rec|izccc ce
prccecimenIc: ue expcnhcm c necncIc cc :cngue e :ecrece:
mcIernc: pcr muiIc Iempc e ue prcmcvcm :c|ucc ce ccnIinuiccce nc
pe|e cc recm-nc:cicc, c|m 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 Icue: vcginci: repeIicc::
eviIcr prccecimenIc: invc:ivc:, Ici: ccmc: cmniccenIe:e,
ccrcccenIe:e, e:cc|pe cefc|icc:
epi:icIcmic, fcrcep: e exIrccc 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 preferncic cc fcrcipe cc ue cc
vccuc exIrcIcr, em virIuce ce::e |Iimc ccu:cr micrc-|ccercce: 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: crec: cc recm-nc:cicc,
eviIcncc IrcumcIi:mc: em mucc:c:: e
|cvcr c recm-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. No h
necess|dode de se Iso|or o poc|ente portodoro do HIV. / ccmini:Irccc
cc: cnIi-reIrcvirci: uIi|izccc: curcnIe c ge:Iccc 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 cI
c c|cmpecmenIc cc ccrccc umLi|icc|. Ccmc expc:Ic
18
ASSISTNCIA MULHER PORTADORA DO HIV DURANTE O PARTO E PUERPRIO
161
cnIericrmenIe, |mportonte que mesmo os mu|heres que no receberom
terop|o ont|-retrov|ro| [IAkV} duronte o gestoo, recebom AII |njetve|
duronte o trobo|ho de porto e o porto e o so|uo 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|ucc crc| ce /I ceve IcmLm :er ccmini:Irccc cc recm-
nc:cicc.
C e:uemc pc:c|cgicc cc /I pcrc pcrIurienIe: ceve cL:ervcr c:
:eguinIe: reccmenccce::
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 cI
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. / ccncenIrccc ncc ceve excecer 4mg/m|. Feccmencc-
:e c u:c cc ci|uicc cc /I em SG57, cpc: c :uc prepcrccc cI 8
hcrc:, em ccn:ervccc c 25 C, cu cI 24 hcrc: em ccn:ervccc c
2-8 C.
Apresentao:
AZT injetvel - frasco ampola de 200 mg com 20 ml (10 mg/ml).
No hovendo d|spon|b|||dode do AII |njetve|, deve-se usor esquemo
o|ternot|vo do AII oro| como se segue: 300 mg, VO, no comeo do
trobo|ho de porto e, o port|r de ento, 300mg o codo 3 horos ot o
c|ompeomento do cordo umb|||co|.
18
ASSISTNCIA MULHER PORTADORA DO HIV DURANTE O PARTO E PUERPRIO
162
3. V|o de porto
Ccmc c mcicric cc: cc:c: ce Ircn:mi::cc verIicc| cc HlV cccrre
IcrcicmenIe nc ge:Iccc 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 recucc
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
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, 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|izccc 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 infeccc pe|c
HlV nc mu|her c: ccn:encic: ce mcrLiccce e mcrIc|iccce mcIernc
cc :e cccIcr e::c ccncuIc. Ncc exi:Ie IcmLm uc|uer evicncic ce
ue c rec|izccc 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 :iIuccc imunc|cgicc {ccnIcgem ce |infcciIc:
CD4) e virc|cgicc {ucnIificccc cc ccrgc virc| , cu :ejc ce FN/-HlV-1
circu|cnIe), rec|izccc: nc in|cic cc pr-ncIc| e pe|c menc: nc per|ccc
prcximc cc pcrIc {32-3 :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:Iccc, Lem ccmc c :eu Iempc ce uIi|izccc. FcrIcnIc, :cc c:
princ|pic: ce umc Lcc c::i:Incic cL:IIricc e c: ccncice: cc e:Iccc
c||nicc cc infeccc 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|iccc 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 cirrgicc, :e
fcz nece::cric.
Umc vez cecicicc pe|c operoo cesor|ono e|et|vo, c: :eguinIe:
ccn:icercce: 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
ASSISTNCIA MULHER PORTADORA DO HIV DURANTE O PARTO E PUERPRIO
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|stnc|o oo recm-nosc|do opos o porto
/|m cc: reccmenccce: jc refericc: {c c:pirccc ce|icccc cc: vic:
crec: e c c::eic imecicIc ccm cguc e :cLcc cc recm-nc:cicc),
cevem fczer pcrIe cc: cuicccc: e:pec|ficc: ccm c recm-nc:cicc
verIicc|menIe expc:Ic:
c ccmini:Irccc cc /I :c|ucc crc|, ce 10mg/m|, nc cc:e ce
2mg/kg, c cccc hcrc:, inicicncc-:e preferencic|menIe cI c 8
hcrc, pccencc enIreIcnIc :er iniciccc cI 24 hcrc: cpc: c pcrIc, e
mcnIicc curcnIe :emcnc:. /I c mcmenIc, ncc hc ccmprcvccc
ce eficccic ucncc c IrcIcmenIc ccm /I iniciccc cpc: 48 hcrc:,
ficcncc c incicccc cc prcfi|cxic cpc: e::e per|ccc c criIric
mcicc:
excepcicnc|menIe, ucncc c cricnc ncc Iiver ccncice: 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 cricnc: premcIurc:, cLcixc ce
34 :emcnc: ce ge:Iccc, 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:
cricnc: ccimc ce 34 :emcnc:, c fcrmccccinIicc cc
meciccmenIc :eme|hcnIe c cc: cricnc: c Iermc:
pe|c cccrrncic freenIe ce cnemic nc recm-nc:cicc em u:c
ce /I, reccmencc-:e c rec|izccc ce hemcgrcmc ccmp|eIc,
pc::iLi|iIcncc c mcniIcrcmenIc cc cricnc nc in|cic cc IrcIcmenIc
ccm /I e cpc: e 12 :emcnc::
c::egurcr c cccmpcnhcmenIc cc cricnc pe|c pecicIrc e
infecIc|cgi:Ic infcnIi|. / pcrIir cc :exIc :emcnc ce vicc cI c
cefinicc cc e:Iccc :crc|cgicc, c cricnc 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
ASSISTNCIA MULHER PORTADORA DO HIV DURANTE O PARTO E PUERPRIO
164
c: fi|hc: ce mu|here: infecIccc: pe|c HlV cevem receLer /I
:c|ucc crc|, me:mc ue :uc: mce: ncc Ienhcm receLicc c /I
curcnIe c ge:Iccc e c pcrIc. Ne::e: cc:c:, c in|cic ceverc :er
imecicIcmenIe cpc: c nc:cimenIc. A cr|ono dever ||cor com suo
me em o|ojomento conjunto; e
ncc cmcmenIcr. /|imenIcr c necncIc ccm |eiIe crIificic|. Em
recm-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:Iric cc Scce. CcnIrc-incicc-:e c
c|eiIcmenIc cruzccc {cmcmenIccc pcr cuIrc mu|her).
5. Ass|stnc|o no puerpr|o
Scc reccmenccce: impcrIcnIe: ne::c fc:e:
iniLir c |ccIccc cc purperc, ccm cicgnc:Iicc ce infeccc pe|c
HlV, |cgc cpc: c pcrIc. / iniLicc cc |ccIccc 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|izccc 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 cIrcv: cc
cmcmenIccc, e crienIc-|c ccmc cLIer e ucnIc cc prepcrc e u:c
cc fcrmu|c infcnIi|. impcrIcnIe ue c purperc, curcnIe :uc
permcnncic nc mcIerniccce, receLc :upcrIe cc euipe ce :cce
pcrc ncc cmcmenIcr :em :e :enIir ci:criminccc pcr i::c. E::c
cIencc ceve :er reccLrccc e:pecic|menIe nc: c|cjcmenIc:
ccnjunIc:, cnce c mcicric cc: mu|here: e:Ic cmcmenIcncc :eu
LeL {hc:piIci: cmigc: cc cricnc): e
nc puerpric imecicIc e :uL:eenIe:, cevem :er pe:ui:ccc:
hi:Icric: e/cu c pre:enc ce :inci: e :inIcmc: re|ccicnccc: c
infeccc pe|c HlV ue ccrccIerizcm imuncceficincic mccerccc,
Ici: ccmc: ccncic|c:e crc|, |euccp|c:ic pi|c:c crc|, IuLercu|c:e
pu|mcncr nc |Iimc cnc, herpe: zc:Ier, feLre per:i:IenIe :em
eIic|cgic cefinicc {inIermiIenIe cu ccn:IcnIe) pcr mci: ce 1 m:,
ci:pnic, infecce: 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 cicrric crcnicc :em eIic|cgic
cefinicc, ccm curccc ce mci: ce 1 m:.
Hcvencc c pre:enc ce :inci: c||nicc: ce imuncceficincic ccm feLre
inexp|icccc ccm curccc mcicr ue 2 :emcnc: e ccncic|c:e crc|,
impce-:e c rec|izccc ce uimicprcfi|cxic primcric pcrc pneumcnic pe|c
Fneumccy:I: ccrinii, ccm :u|fcmeIcxczc| {SMX) IrimeIcprimc {IMF), VC,
nc cc:e ce 800mg e 10 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|iccc c||nicc e |cLcrcIcric| e in|cic cc Iercpic
cnIi-reIrcvirc| ccnvenienIe. E:Ic reccmencccc
18
ASSISTNCIA MULHER PORTADORA DO HIV DURANTE O PARTO E PUERPRIO
165
pcrIicu|crmenIe impcrIcnIe pcrc c: mu|here: ue Iivercm c
cicgnc:Iicc ce infeccc 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
cricnc, cI cefinicc ce :uc :iIuccc :crc|cgicc. muiIc ccmum
cpc: c pcrIc, hcver ciminuicc cc cce:cc cc mu|her cc
cccmpcnhcmenIc mcicc. Seu ccmpcrecimenIc c: ccn:u|Ic:
ceve :er e:Iimu|ccc e mcniIcrccc, |cncncc-:e mcc ce Lu:cc
cIivc :e nece::cric.
Mu|here: HlV cpre:enIcm ccm mci: frencic ccmp|iccce:
infeccic:c: nc pc:-pcrIc, Ici: ccmc infeccc urincric, pu|mcncr, nc
epi:icIcmic e inci:cc cirrgicc. Nc cc:c ce pcrIc cpercIcric,
in:pecicncr cuicccc:cmenIe c fericc cirrgicc, icenIificcncc
precccemenIe uc|uer ccmp|icccc infeccic:c. / mu|her ceve
:er crienIccc :cLre ccmc fczer c higiene perinec|, c vigi|cncic cc:
|cuic: e c prccurcr crienIccc mcicc, cc:c cpre:enIe :inci: |ccci:
ce infecce: cu feLre curcnIe c puerpric.
C :eguimenIc cL:IIricc cc mu|her pcrIcccrc cc HlV nc
puerpric, :c|vc em :iIucce: e:pecici: ce ccmp|iccce: cccrricc:
curcnIe c pcrIc e puerpric imecicIc, ceve prever :eu reIcrnc nc 8
e nc 40 cic pc:-pcrIc.
CrienIcr :cLre c prevencc cc: DSI, reinfeccc pe|c HlV,
crienIcncc-c ucnIc cc u:c ce pre:ervcIivc: {mc:cu|inc cu
femininc) em Iccc: c: re|cce: :exuci:. Nc cc:c ce mu|here: HlV
cujc :iIuccc :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 ccnIrccepcc,
enccminhcncc-c {c:) pcrc um :ervic ce p|cnejcmenIc fcmi|icr.
Frincipc|menIe pcrc c: mu|here: ue Iivercm :eu cicgc:Iicc ce
infeccc pe|c HlV nc mcmenIc cc pcrIc, c euipe ce :cce
ceverc inve:Iigcr c :iIuccc nc ue :e refere c :upcrIe fcmi|icr,
fi|hc: e recur:c: fincnceirc:, cferecencc-lhe: cpcic p:icc|cgicc e
:ccic|.
. V|g||nc|o do HIV em gestontes e cr|onos expostos
C Mini:Iric cc Scce, Lu:ccncc ccnhecer c prevc|ncic cc HlV em
ge:IcnIe: e cricnc: expc:Ic:, Icrncu cLrigcIcric c ncIificccc cc:
ge:IcnIe: em ue fcr ceIecIccc c infeccc pe|c HlV {cicgnc:Iicc
|cLcrcIcric| ce infeccc pe|c HlV em ccnfcrmiccce ccm c: ncrmc: e
prccecimenIc: e:IcLe|ecicc: pe|c Mini:Iric cc Scce). Dc me:mc
fcrmc, cLrigcIcric c ncIificccc cc: cricnc: 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|goo de Gestontes HIV+ e Cr|onos Expostos" pcrc c ncIificccc
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 incicccc
ce u:e ce ziccvucinc ccmc prcfi|cxic cc Ircn:mi::cc verIicc| cc HlV:
18
ASSISTNCIA MULHER PORTADORA DO HIV DURANTE O PARTO E PUERPRIO
166
FLUXOGRAMA PARA USO DE TESTE RPIDO PARA HIV EM
PARTURIENTES
18
ASSISTNCIA MULHER PORTADORA DO HIV DURANTE O PARTO E PUERPRIO
167
7. Frecoues 8s|cos e bn|verso|s
/: Freccuce: 8c:icc: e Univer:ci: :cc mecicc: ce prevencc ue
cevem :er cccIccc: ccm uc|uer inciv|cuc, incepencenIemenIe cc
cicgnc:Iicc cefinicc cu pre:umicc ce ccenc: infeccic:c:: nc
mcnipu|ccc ce :cngue, :ecrece:, excrece:, mucc:c: cu pe|e ncc-
inIegrc.
E::c: mecicc: inc|uem c uIi|izccc ce EuipcmenIc: ce FrcIecc
lncivicuc| - EFl {|uvc:, mc:ccrc, ccu|c: ce prcIecc, ccpcIe: e cvenIci:),
ccm c finc|iccce ce recuzir c expc:icc cc pe|e e cc: mucc:c: cc
prcfi::icnc| ce :cce cc :cngue cu f|uicc: ccrpcrec: ce uc|uer
pccienIe.
C: prcfi::icnci: ce :cce, e em e:pecic| c: cirurgice:, cevem Icmcr
cuIrc: cuicccc: ccicicnci: pcrc :e prevenirem ccnIrc ccicenIe: ccm
mcIerici: prfurc-ccrIcnIe:.
7.1 Cu|dodos espec||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 inv: 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|ccc
cc: Iecicc: ccm c: cecc: curcnIe c :uIurc cc epi:icIcmic {ucncc
e::c fcr nece::cric), curcnIe c fechcmenIc pcr p|cnc: nc cperccc
ce:cricnc e cuIrc: prccecimenIc:
EviIcr :uIurc pcr cci: cirurgice: :imu|IcnecmenIe, nc me:mc
ccmpc cirrgicc
/ pc::cgem ce mcIerici: prfurc-ccrIcnIe: {Li:Iuri, pcrIccgu|hc:
mcnIccc:, eIc.) cc cuxi|icr pcrc c cirurgicc ceve :er cIrcv: ce
cuLc:, cpc: cvi:c verLc|
/ccIcr cuicccc: e:pecici: nc mcnipu|ccc cc p|ccenIc e cc
ccrccc umLi|icc|, pci: c ri:cc ce expc:icc muiIc grcnce
/ccIcr c: EFl {|uvc:, ccpcIe:, cvenIc|, mc:ccrc e gcrrc) nc:
cuicccc: imecicIc: cc recm-nc:cicc, cevicc c pc::iLi|iccce ce
expc:icc c :cngue e ||uicc cmnicIicc
Fcrc mcicre: infcrmcce:, ccn:u|Ie c Mcnuc| ce CcncuIc: em Expc:icc
Ccupccicnc| c McIeric| 8ic|cgicc: HepcIiIe e HlV cc Mini:Iric cc Scce.
18
168
C|c::iccmenIe cencminc-:e 4 perccc cc pcrIc {cu
ce GreenLerg) cc per|ccc ce pc:-pcrIc imecicIc,
cpc: c ceuiIccc. Ncc hc nc |iIercIurc ccn:en:c
:cLre :uc curccc excIc, enIreIcnIc, inicic-:e cpc: c
ceuiIccc cc p|ccenIc e e:Ience-:e pe|c: primeirc:
hcrc: pc:-pcrIc. Fcrc c|gun:, c primeirc hcrc, pcrc
cuIrc:, cI :eguncc hcrc cpc: c pcrIc.
perodo 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 ccc cc grcviccce cu
pcr |eve expre::cc/ccmpre::cc cc funcc uIerinc,
c::egurc-:e c hemc:Ic:ic pe|c reIrccc uIerinc
per:i:IenIe {g|cLc ce :egurcnc ce Fincrc), ue
prcmcve cc|u:cc cc: vc:c: nc pcrcc mu:cu|cr,
ccn:IiIuincc c: |igccurc: vivc: ce Fincrc.
CcnccmiIcnIemenIe, cccrre c IcmpcncmenIc
IrcmLcIicc cc: vc:c: Ierc-p|ccenIcric:.
Nc evenIuc|iccce ce :cngrcmenIc vcginc| cncrmc|, c
cL:ervccc :erc reccLrccc, ccnIrc|cncc-:e c
reIrccc uIerinc, c percc :cng|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 reIrccc uIerinc e cc :cngrcmenIc. / ncc
cL:ervcncic c e:Ic: mecicc: cc|ccc c purperc em
:ric ri:cc. C cicgnc:Iicc preccce cc: c|Iercce:
fcIcr prepcncercnIe pcrc c :uce::c IercpuIicc. /
:en:ccc ce ue c pcrIc cccLcu cpc: c nc:cimenIc
cc cricnc e c ce|ivrcmenIc p|ccenIcric perigc:c e
incceuccc.
Ne:Ic fc:e, pcrIcnIc, cevem-:e ccn:icercr c: :eguinIe:
ue:Ice:: verificccc ccn:IcnIe cc ccnIrccc uIerinc,
revi:cc cc ccnc| ce pcrIc e repcrccc cc: |e:ce:
pcrvenIurc exi:IenIe:. / remccc cc purperc pcrc c
:c|c ce recuperccc {ucncc nece::cric) e
enfermcric ce c|cjcmenIc ccnjunIc :cmenIe ceverc
:er efeIuccc cpc: c Irminc cc ucrIc per|ccc.
Expu|:c c p|ccenIc, ue ceve :er revi:ccc ucnIc c
inIegriccce ce ccIi|ccne: e memLrcnc:,
19 ASSISTNCIA MULHER NO QUARTO PERODO
ASSISTNCIA MULHER NO QUARTO PERODO
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.
/|m 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 :cce
nc IcccnIe c: crienIcce: :cLre c per|ccc puerperc|, cuicccc:,
cmcmenIccc preccce {ver CcpiIu|c1), ccnIcIc ccm c recm-nc:cicc
e cuIrc: c::unIc: ccrre|cIc:, ce:ce ue c mu|her e:Iejc em Lcc:
ccncice:. /: :c|c: ce FFF :cc iceci: pcrc c ccnIrc|e cc mu|her curcnIe
e:Ie per|ccc.
Comp||coes hemorrg|cos
/ hemcrrcgic pc:-pcrIc, ccrccIerizccc pe|c percc ce :cngue :upericr c
500m|, , :em cvicc, umc cc: :iIucce: mci: crcmcIicc: e cngu:IicnIe:
vivenciccc pe|c: cL:IeIrc:. C: prcfi::icnci: ce :cce, e:pecic|menIe c:
mcicc:, Im ue e:Icr fcmi|icrizccc: ccm c IrcIcmenIc cc chcue
hipcvc|micc puerperc|. DeIc|he: :cLre e:Ie c::unIc pccem :er
enccnIrccc: nc mcnuc| ce Urgncic: e Emergncic: McIernc: {MS,
2000).
/: Ir: principci: ccu:c: ce :cngrcmenIc puerperc| :cc c cIcnic uIerinc,
c: |ccercce: ce IrcjeIc e c reIencc 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:IrLic: cc cccgu|ccc.
/: mecicc: prcfi|cIicc: pcrc prevenir c grcviccce ce :uc: ccmp|iccce:
:cc c Lcc fcrmccc cc mcicc e cc: cemci: prcfi::icnci: ce :cce, c
IenIcIivc ce ncc rec|izccc ce prccecimenIc: IrcumcIicc:
{principc|menIe fcrcipe: mcic:), c ccrrecc pr-ncIc| cc: uccrc:
cnmicc:, c u:c prcfi|cIicc ce uIercIcnicc: {ucncc incicccc:) e c
rec|izccc ce pcrIc: ce ri:cc em uniccce: hc:piIc|cre: ccpcciIccc: ccm
recur:c: Icnicc: e humcnc:.
1. Aton|o uter|no
Fepre:enIc c principc| ccu:c ce hemcrrcgic e chcue hipcvc|micc
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: ccnIrcce:, c::cciccc
c Ierc 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), infeccc inIrc pcrIc,
cne:Ie:ic gerc| ccm hc|cgenccc:, mu|Iipcriccce, pcrIc prc|cngccc,
mcncLrc: incceuccc: ccmc c ce ri:Ie||er, pre:enc ce micmc:
uIerinc: e u:c inci:criminccc ce cciIccicc:, :ejc pcrc incuzir cu e:Iimu|cr
c pcrIc.
19
ASSISTNCIA MULHER NO QUARTO PERODO
170
C prcgnc:Iicc cepencerc cc: :eguinIe: ccncice::
ve|cciccce cc percc :cng|nec - gerc|menIe rcpicc e, pcr
i::c, c prcIe|ccc 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:icc :cng|nec e/cu rec|izccc cc:
inIervence: 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 prvic ccm
:urIc: hemcrrcgicc:, :cc pcrIicu|crmenIe cgrcvcnIe: nc hemcrrcgic
cIcnicc.
Nc vigncic cc uccrc ce hemcrrcgic, ceve-:e ccn:eguir cce::c venc:c
cc|iLrc:c ue permiIc repc:icc vc|micc rcpicc, :c|iciIcr Iipcgem
:cng|nec, fczer mc::cgem uIerinc e rec|izcr :cnccgem ve:icc| ce
cemcrc {cLiIc urincric cceuccc ce 30 c 50 m|/hcrc), ue :ervirc ce
crienIccc ucnIc c repc:icc vc|micc e grcu ce percc exi:IenIe,
c|m ce eviIcr ue c :cLreci:Ien:cc ve:icc| impec umc me|hcr
ccnIrcIi|iccce uIerinc. / mcniIcrizccc cc: :inci: viIci: :erc rec|izccc e c:
:inci: ce chcue :ercc ccnIinucmenIe pe:ui:ccc:.
A rev|so do cono| de porto e do tero obr|gotor|o e no dever 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:enc ce frcgmenIc: cc p|ccenIc cu ccIi|ccne:. 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 0,7 {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
ccnIrc-incicccc em mu|here: hiperIen:c: e nc: ue cpre:enIcm
ccenc: ccrcicvc:cu|cre:. Fcce-:e uIi|izcr cincc c mi:cprc:Ic| {2
ccmprimicc: vic crc| cu reIc|).
/ repc:icc vc|micc, em uc|uer :iIuccc, vi:c re:Icurcr c vc|ume
inIrc-vc:cu|cr, permiIir perfu:cc cceuccc e cxigenccc :cIi:fcIcric. Em
virIuce cc: inIen:c: c|Iercce: hemccincmicc: ue cccmpcnhcm
uc|uer ge:Iccc, ccmc c cumenIc ce 40 c 507 cc vc|ume :cng|nec
e cc cLiIc ccrc|ccc, c: percc: mencre: ce 500 m| :cc Lem Ic|erccc:,
ce:ce ue c mu|her ncc e:Iejc jc cnmicc.
C: :inci: ce chcue pccem :urgir IcrcicmenIe, ucncc c: percc: jc
:upercm 35 c 407 cc vc|ume :cng|nec, excecc feiIc c: pccienIe:
pcrIcccrc: ce :|ncrcme: hiperIen:ivc:, principc|menIe c pr-ec|cmp:ic,
ue Ic|ercm mc| c percc :cng|nec. FcrIcnIc, nc pre:enc 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:icc
19
ASSISTNCIA MULHER NO QUARTO PERODO
171
:cng|nec :e impce, pccencc :er feiIc ccm ccncenIrccc ce hemccic:,
p|c:mc fre:cc, p|cueIc: e cricprecipiIccc.
C ccncenIrccc ce hemccic: c mci: efeIivc e eficienIe ccminhc pcrc
me|hcrcr c ccpcciccce ccrrecccrc ce cxignic em pccienIe ccm
percc :cng|nec cgucc. / menc: ue Ienhc cccrricc hemcrrcgic
mccic, c ccncenIrccc ce hemccic: e c: f|uicc: re:c|vem c grcnce
mcicric cc: :iIucce: c||nicc: ue nece::iIcm ce repc:icc vc|micc.
/|m ci::c, cevicc c peuenc ucnIiccce ce g|cLu|c: Lrcncc: e ce i:c-
hemcg|uIininc:, recuz ccn:icercve|menIe c incicncic ce reccc
Ircn:fu:icnc| em ccmpcrccc cc :cngue IcIc|. C cLjeIivc cc Iercpic
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 ccnIm Iccc: c: ccmpcnenIe: pre:enIe: nc
cricprecipiIccc, inc|uincc cprecicve| ucnIiccce ce fcIcr Vlll. Deve :er
ccmini:Irccc ucncc c repc:icc vc|micc e ce fcIcre: cc cccgu|ccc,
e:pecic|menIe c: fcIcre: V, Vlll e fiLrincgnic, :e fizer nece::cric.
/ Ircn:fu:cc ce p|cueIc: ceve :er ccn:icerccc nc: cc:c: ce
cccgu|ccc inIrc-vc:cu|cr ci::eminccc, hemcrrcgic mccic, pr-
ec|cmp:ic grcve e prpurc IrcmLcciIcpnicc 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: cirrgicc:.
C cricprecipiIccc e:Ic incicccc nc: pccienIe: pcrIcccrc: ce Dcenc ce
Vcn Wi||eLrcnc cu ncue|c: ue Im vc|ume ncrmc|, mc: nece::iIcm ce
fcIcre: cc cccgu|ccc, e:pecic|menIe fiLrincgnic.
C :cngue IcIc|, pcr cpre:enIcr ccmc inccnvenienIe :uc curIc vicc Ii|,
ue ce cpenc: 21 cic:, e c e:Icccgem, ue Iem efeiIc: ce|eIric:
:cLre c: e|emenIc: ce|u|cre: e c: fcIcre: cc cccgu|ccc, ncc mci:
uIi|izccc em hemcIercpic em ccncice: 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:enc 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 IcmLm puce::e :er uIi|izccc, e:Ic prcIicc 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 Im cpenc: vc|cr
hi:Icricc. Fcrm, curcnIe |cpcrcIcmic, ucncc c hemcrrcgic
cLunccnIe e cI ue :e prcvicenciem c: mecicc: ccL|vei:, c
ccmpre::cc cc ccrIc ccnIrc c cc|unc verIeLrc| ju:Iificc-:e ccmc
ccncuIc pc|icIivc.
19
ASSISTNCIA MULHER NO QUARTO PERODO
172
Cucncc c: mecicc: meccnicc: e c||nicc: fc|hcrem em ccnIrc|cr c
hemcrrcgic, e:Icc incicccc: c: prccecimenIc: cirrgicc:. / |igccurc cc:
crIric: uIerinc:, ue ceve :er feiIc cc n|ve| cc pcnIc cnce c crIric :cLe
cc |ccc cc Ierc, cpre:enIc Icxc ce :uce::c ce cI 57 e, pcrIcnIc,
ceve :er c primeirc |igccurc c :er feiIc. Nc fc|hc ce:Ic, ceverc :er feiIc c
|igccurc Li|cIerc| cc: crIric: hipcgc:Iricc:, Icnicc ue cpre:enIc
exce|enIe: re:u|Iccc:, pcrm nece::iIc cc experincic cc cirurgicc em
IrcLc|hcr nc e:pcc reIrcperiIcnec|. Nc cu:ncic ce:Ic experincic, c
percc ce Iempc nc rec|izccc cc |igccurc pcce cgrcvcr c uccrc
c||nicc cc pccienIe.
Cucncc Iccc: c: mecicc: fc|hcrem, c hi:IerecIcmic ce emergncic
permcnece ccmc cpcc ue pcce :c|vcr c vicc cc pccienIe. Dc-:e
preferncic c :uLIcIc|, pe|c ciminuicc cc Iempc cirrgicc, ncc
cgrcvcncc c e:Iccc gerc| jc ccmprcmeIicc.
Ncue|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|icccc.
2. Loceroes de trojeto
/ revi:cc cc IrcjeIc cc pcrIc ceve :er rec|izccc :i:IemcIiccmenIe ne:Ic
:iIuccc. prccecicc pincncc-:e c cc|c uIerinc ccm cuc: pinc: ce
cne| ue :ercc mcvimenIccc: em :enIicc hcrcric cI ccmp|eIc
vi:uc|izccc cc cc|c. Nc pre:enc 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 pincmenIc cc vc:c e c
hemc:Ic:ic. Nc vigncic ce hemcIcmc, e:Ie ceve :er crenccc pcrc
icenIificcr c vc:c re:pcn:cve| pe|c uccrc, permiIincc :uc |igccc ccm
fic cL:crv|ve|. /: veze: pcce :er preci:c uIi|izcr um crenc ce Fenrc:e. Em
cc:c: ce grcnce: |ccercce:, cu ce |e:ce: m|Iip|c:, ucncc c :uIurc
ncc fcr pc::|ve|, ceve-:e prccecer c IcmpcncmenIc cc vcginc.
3. keteno p|ocentr|o
/ reIencc p|ccenIcric cu ce :eu: frcgmenIc: prcvccc hemcrrcgic pe|c
cificu|ccce ce ccnIrccc micmeIric|. Um per|ccc :upericr c 30 minuIc:
pcrc cccrrer c ceuiIccc ceve :er ccn:icerccc pcIc|cgicc. / revi:cc
mccrc:ccpicc cc p|ccenIc, ccrccc e memLrcnc: cvu|cre: cpc: c
ceuiIccc :cc prccecimenIc: cLrigcIcric: pcrc Iccc: c: pcrIc: e
ccnIriLuem pcrc c cicgnc:Iicc preccce cc reIencc ce frcgmenIc: cc
p|ccenIc cu memLrcnc:, fcvcrecencc prcnIc: mecicc: pcrc c :c|ucc
cc prcL|emc.
Nc reIencc p|ccenIcric, cu nc :u:peiIc cc pre:enc ce re:Ic:, ceve-:e
rec|izcr exp|crccc cc ccviccce uIerinc, cpc: c pccienIe
19
ASSISTNCIA MULHER NO QUARTO PERODO
173
e:Icr ccnvenienIemenIe cne:Ie:iccc. /pc: exIrccc 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 vigncic ce hemcrrcgic per:i:IenIe, e:Icrc incicccc
c hi:IerecIcmic. DeIc|he: ccicicnci: pccem :er enccnIrccc: nc mcnuc|
Icnicc ce Urgncic: e Emergncic: McIernc: {MS, 2000).
4. Inverso uter|no
ccu:c rcrc ce hemcrrcgic puerperc|. Cucncc cccrre, Iem e|evccc
ri:cc pcrc c pccienIe. C chcue ue cccmpcnhc c uccrc pcce :er
hemcrrcgicc cu neurcgnicc, pe|c ccr prcvccccc. /ccmeIe mci:
mu|I|pcrc: cu mu|here: ccm ccreIi:mc p|ccenIcric e IcmLm re:u|Iccc
ce mcncLrc icIrcgnicc nc Irccc excgerccc cc ccrccc umLi|icc|. C
Ierc ceve :er repc:icicnccc c mci: rcpicc pc::|ve|. CucnIc mcicr c
cemcrc, mci: cif|ci| c rec|izccc cc: mcncLrc: ccrreIivc:. C IrcIcmenIc
ceve :er feiIc :cL cne:Ie:ic, efeIucncc-:e c mcncLrc ce Icxe, nc uc|
IenIc reverIer c Ierc c :uc pc:icc ncrmc|, inIrccuzincc c mcc cireiIc
fechccc em :eu inIericr. Hcvencc :uce::c, uIi|izcr cciIccicc: pcrc mcnIer
c Ierc ccnIrc|cc. Cucncc c: mcncLrc: c||nicc: fcrem ineficienIe:, fczer
|cpcrcIcmic e Irccc cirrgicc cc ccrpc e cc funcc uIerinc
{prccecimenIc ce HunIingIcn). Iccc: e:Ic: mecicc: cevem :er
cccmpcnhccc: ce repc:icc :cng|nec, jc ue c percc vc|micc
cc:Iumc :er grcnce.
5. koturo uter|no
Em muiIc: cc:c:, c cicgnc:Iicc cc rcIurc uIerinc :cmenIe efeIuccc
cpc: c pcrIc. /: principci: ccu:c: inc|uem c pre:enc ce ciccIrize:
uIerinc: prvic:, principc|menIe ceccrrenIe: ce ce:crec: ccrpcrci: e
micmecIcmic:, c u:c incceuccc cc: cciIccicc: cu cc: prc:Icg|cncinc:
nc per|ccc cnIepcrIc, in:i:Incic nc pcrIc vcginc| frenIe c uccrc: ce
ce:prcpcrcc feIc-p|vicc, Ircumc: exIernc: e mcncLrc: incceuccc:
ce ver:cc inIernc cu exIernc.
Em cc:c: ce pcrIc vcginc| ccm rcIurc: :em mcnife:Iccc c||nicc,
ceIecIccc: nc revi:cc uIerinc, c ccncuIc cepencerc cc e:IcLi|iccce
hemccincmicc cc purperc e cc hemcrrcgic vi:|ve|. Em c|gun: cc:c:,
pccerc :er cccIccc ccncuIc expecIcnIe, :cL rigcrc:c cL:ervccc 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 Ierc, ceve-:e ccn:icercr,
:e fcr c ce:ejc cc mce, c |cueccurc IuLcrec Li|cIerc|.
19
ASSISTNCIA MULHER NO QUARTO PERODO
174
Cons|deroes ||no|s
Fc::ccc e:Ie Lreve, mc: impcrIcnIe, ucrIc per|ccc cc pcrIc e
u|Ircpc::ccc: c: evenIuci: cificu|ccce: e ccmp|iccce: :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 recm-nc:cicc fczem pcrIe cc: cIiviccce: cc:
prcfi::icnci: ce :cce ue cevercc e:Icr cpIc: c e:Ic c::i:Incic.
CuIrc: ceIc|he: :cLre ccmp|iccce: hemcrrcgicc: cu cirrgicc: cc
puerpric, ue ccrccIerizem :iIucce: ce urgncic: e emergncic:,
e:Icc ci:pcn|vei: nc mcnuc| ce Urgncic: e Emergncic: McIernc: c
Mini:Iric cc Scce.
19
175
CcnceiIuc-:e puerpric c per|ccc cc cic|c grcvicc-
puerperc| em ue c: mccificcce: |ccci: e :i:Imicc:,
prcvccccc: pe|c grcvicez e pcrIc nc crgcni:mc cc
mu|her, reIcrncm c :iIuccc cc e:Iccc pr-grcv|cicc.
C puerpric inicic-:e umc c cuc: hcrc: cpc: c :c|cc
cc p|ccenIc e Iem :eu Irminc imprevi:Ic, pci:
enucnIc c mu|her cmcmenIcr e|c e:Icrc :cfrencc
mccificcce: cc ge:Iccc {|ccIcncic), ncc
reIcrncncc :eu: cic|c: men:Iruci: ccmp|eIcmenIe c
ncrmc|iccce. Fcce-:e ciccIiccmenIe civicir c
puerpric em: |med|oto {1 cc 10 cic), tord|o {11 cc
42 cic), e remoto {c pcrIir cc 43 cic).
/ primeirc e :eguncc hcrc: cpc: c ce|ivrcmenIc
cevem :er pc::ccc: nc CenIrc CL:IIricc 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 1. Fc::ccc
e:Ie per|ccc inicic|, e:Icncc c purperc eui|iLrccc
hemccincmiccmenIe e fcrmccc c g|cLc ce
:egurcnc ce Fincrc {Ierc 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:fcrmcce: ue :e inicicm nc puerpric, ccm c
finc|iccce ce re:IcLe|ecer c crgcni:mc cc mu|her c
:iIuccc 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 puerpric, ceve-:e
inicic|menIe, :e :uc :iIuccc c||nicc permiIir, fczer umc
Lreve cvc|iccc cc :eu e:Iccc p:|uicc, e enIencer c
ue repre:enIc pcrc e|c c chegccc ce umc ncvc
cricnc. C e:IcLe|ecimenIc ce umc cceuccc
empcIic enIre c excmincccr e :uc c|ienIe
prcpcrcicncrc umc me|hcr ccmpreen:cc cc: :inIcmc:
e :inci: cpre:enIccc:. ccmum ue ne:Ie mcmenIc c
mu|her experimenIe :enIimenIc:
20 ASSISTNCIA MULHER NO PUERPRIO
ASSISTNCIA MULHER NO PUERPRIO
176
ccnIrcciIcric: e :inIc-:e in:egurc. CcLe c euipe ce :cce e:Icr
ci:pcn|ve| pcrc perceLer c nece::iccce ce cccc mu|her ce :er cuvicc
ccm c cevicc cIencc.
A|teroes onotm|cos e ||s|o|og|cos no puerpr|o:
/ purperc cpre:enIc um e:Iccc ce excu:Icc e re|cxcmenIc,
principc|menIe :e e|c ficcu |cngc per|ccc :em cceuccc hicrcIccc
e/cu c|imenIccc, c|m cc: e:fcrc: ce:prencicc: nc per|ccc expu|:ivc.
E:Ie e:Iccc pcce :e mcnife:Icr pcr :cnc|ncic ue exige repcu:c. /pc:
ce:perIcr e receLer c|imenIccc cceuccc, :em re:Irice:, c mu|her
pccerc cecmLu|cr e ceciccr-:e cc: cuicccc: ccm c fi|hc.
/ purperc pcce cpre:enIcr |igeirc oumento do temperoturo ox||or {3,8
- 37,) nc: primeirc: 24 hcrc:, :em nece::cricmenIe Ier um uccrc
infeccic:c in:Ic|ccc. Fccem cccrrer cincc cc|cfric:, mci: freenIe: nc:
primeirc: hcrc: cpc: c pcrIc. E:Ic: c|Iercce: pccem cccrrer :em Irccuzir
um ri:cc c :cce cc mu|her, mc: exigem cc excmincccr ccuIe|c, pci:
IcmLm pccem ccrre:pcncer c prcce::c: mcrLicc:, ccmc c infeccc
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:enc ce
:cprc :i:Ic|icc ce hiperf|uxc. Nc: purperc: ccm ccrcicpcIic, em e:pecic|
ncue|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 mcicc.
IcmLm ne:Ie per|ccc c purperc Iem :eu podro resp|rotor|o
re:IcLe|ecicc, pc::cncc c cicfrcgmc c exercer funce: ue hcvicm :icc
|imiIccc: pe|c cumenIc cc vc|ume cLccminc|.
/ vc|Ic cc: v|:cerc: cLccminci: c :uc :iIuccc criginc|, c|m cc
ce:ccmpre::cc cc e:Icmcgc, prcmcve um me|hcr e:vczicmenIc
gc:Iricc. C: e:fcrc: ce:prencicc: nc per|ccc expu|:ivc cgrcvcm c:
ccncice: ce hemcrrcicc: jc exi:IenIe:. E:Ic :iIuccc 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|ccc cc ccviccce
cLccminc|.
Ircumc: pccem cccrrer c ureIrc, ccc:icncncc ce:ccnfcrIc c miccc e
cI me:mc reIencc urincric, :iIuccc cIenuccc pe|c cumenIc cc
ccpcciccce ve:icc| ue cccrre ncrmc|menIe ne:Ie per|ccc. / purperc
pcce experimenIcr nc: primeirc: cic: pc:-pcrIc um cumenIc cc vc|ume
urincric, pe|c reci:IriLuicc cc: ||uicc: ccrpcrci:.
/ |eucoc|tose nc puerpric e:perccc, pccencc cIingir 20.000
|euccciIc:/mm3, ccnIucc :em cpre:enIcr fcrmc: jcven: em cemc:ic
{ce:vic c e:uercc) cu grcnu|cce: Icxicc: em pcrcenIcgem expre::ivc
cc: |euccciIc:. / ucnIiccce ce p|cueIc: e:Ic cumenIccc nc:
primeirc: :emcnc:, c::im ccmc c n|ve| ce fiLrincgnic, rczcc pcrc :e
preccupcr ccm c imcLi|izccc prc|cngccc nc
20
ASSISTNCIA MULHER NO PUERPRIO
177
|eiIc, :iIuccc ue fcci|iIc c cpcrecimenIc ce ccmp|iccce:
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:
permcnecm pcrc :empre.
/|Iercce: cc humcr, ccm |cLi|iccce emccicnc|, :cc ccmun: nc
puerpric. 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:
:iIucce:, um IrcIcmenIc cceuccc ceve :er in:IiIu|cc rcpiccmenIe. Nc:
mu|here: ue Iivercm um cLiIc feIc|, cIencc 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:enc ce
cricnc:, pcrc ncc prcvcccr |emLrcnc: e ccmpcrcce:. Nc: mu|here:
ue Iivercm fi|hc: ue nece::iIcm ce IrcIcmenIc imecicIc, em e:pecic|
c: recm-nc:cicc: mc|fcrmccc:, ceve-:e prccurcr ccmpreencer c:
:enIimenIc: cc mu|her cicnIe ce:Ic ncvc e ine:perccc :iIuccc. C
enIencimenIc ce:Ic: :iIucce: {ncIimcrIc e mc|fcrmccc:) pe|c:
cccmpcnhcnIe: impcrIcnIe pcrc c me|hcr recuperccc cc purperc.
C tero 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
micmIric pcrc, em :eguicc, fcrmcrem-:e IrcmLc: ue impecircc c
percc :cng|nec. lnicic|menIe :urgem c: lcuic: :cng|nec: {cI c 5
cic), em vc|ume vcricve|, :eme|hcnIe c umc men:Iruccc. / pcrIir cc 5
cic, Icrnc-:e :erc::cngu|nec e pcr vc|Ic cc 10 cic, :erc:c. C cheirc
ccrccIer|:Iicc. Cucncc fIicc, pcce :ignificcr uccrc infeccic:c.
/ recuperccc cc endomtr|o inicic-:e c pcrIir cc 25c cic pc:-pcrIc. C
cc|c uIerinc, |cgc cpc: c pcrIc, ficc ecemcciccc e pcce cpre:enIcr
|ccercce: e, em Icrnc cc 10 cic, e:Icrc fechccc. / vcginc cpre:enIc-
:e ecemcciccc, ccnge:Ic e cIrcficc, inicicncc :uc recuperccc cpc: c
25 cic ce puerpric, mci: Icrcic nc: mu|here: ue cmcmenIcm. E:Ic
:iIuccc muiIc: veze: prcvccc ce:ccnfcrIc nc: mu|here: cc reinicicrem
:uc: cIiviccce: :exuci:. / vu|vc e c c::cc|hc p|vicc :cfrem IcmLm
mccificcce: ceccrrenIe: cc IrcLc|hc ce pcrIc.
C prcfi::icnc| ce :cce ceve refcrcr c: cce: cc o|e|tomento ue fcrcm
inIrccuzicc: nc pr-ncIc|, prcmcvencc umc me|hcr cccpIccc cc mce
cc fi|hc. Deve-:e enccrcjcr c mce c |evcr :eu fi|hc cc peiIc
precccemenIe pcrc ue e:Ie ccnIcIc permcnec efeIivc.
20
ASSISTNCIA MULHER NO PUERPRIO
178
Ass|stnc|o oo puerpr|o
1. Fuerpr|o |med|oto [1 oo 10 d|o}:
/ mu|her Iem nece::iccce: ce cIencc f|:icc e p:|uicc. Ncc ceve :er
IrcIccc ccmc um nmerc ue ccrre:pcncc cc :eu |eiIc cu enfermcric, e
:im pe|c ncme, ccm re:peiIc e cIencc. Nc: mcmenIc: inicici: cpc: c
pcrIc, c re|ccc mce-fi|hc ncc e:Ic cincc Lem e|cLcrccc, pcrIcnIc ncc
:e ceve ccncenIrcr Iccc: c: cIence: cpenc: c cricnc, 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 cIencc ne:Ie mcmenIc c purperc.
/ cvc|iccc c||nicc ceve :er rigcrc:c, :encc c: cchccc: Ircn:criIc: pcrc
c prcnIucric mcicc, ce fcrmc c|crc e cLececencc umc pccrcnizccc.
Deve-:e prccecer c um excme f|:icc ccmp|eIc:
Deombu|oo: '()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$4#I
%:4'#(E
Gen|t||o: 6*(<'16#*%4 (6 ()'2%)61%2'*)' % 4'>6,# <'46*'%-? 1#2
%)'*+,# '(<'16%- %#( -J./6#(E M %17%$# $' '$'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:cricc ce :u|fcIc ferrc:c {00 mg/cic), cci:
ccmprimicc: ce 300mg cc cic e IcmLm c :up|emenIccc ce ViIcminc
/ {200.000 Ul pcr vic crc|, cc:e nicc). Ncue|c: mu|here: ue
cpre:enIcm ce:ccnfcrIc pcr ccre: nc |ccc| cc epi:icrrcfic, pcce-:e
uIi|izcr cnc|g:icc: {cceIcmincfen 750 mg/4 veze: cc cic cu
20
ASSISTNCIA MULHER NO PUERPRIO
179
cipircnc 500 mg/4 veze: cc cic), Lem ccmc c cc|ccccc 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 purperc :em ccnhecimenIc cc c|c::ificccc
:cng|nec cc mce. Ncue|c: ccm fcIcr Fh negcIivc, ncc :en:iLi|izccc: e
ccm recm-nc:cicc Fh pc:iIivc e CccmL: negcIivc, uIi|izc-:e c
imuncg|cLu|inc cnIi-D, nc: primeirc: 72 hcrc:. lmpcrIcnIe IcmLm
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
mcicc re:pcn:cve| pe|c c::i:Incic cc recm-nc:cicc.
Nc: purperc: 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|so puerpero|
1. kev|so puerpero| precoce [entre 7 o 10 d|os}
C reIcrnc ceve :er mcrcccc em Icrnc cc 7 cc 10 cic ce puerpric,
reccmenccncc-:e ue :ejc feiIc nc uniccce ce :cce mci: prcximc cc
re:icncic cc mu|her, inc|uincc c cricnc e c ccmpcnheirc. Ne:Ie
reIcrnc, ceve-:e cuvir c: ueixc: cc purperc, prccecer cc excme f|:icc
cceuccc, ccm nfc:e cc e:Iccc hemcIc|cgicc, rc:IrecmenIc ce
infeccc {puerperc| cu cc fericc cpercIcric). FunccmenIc| c excme
cc: mcmc: e c incenIivc pcrc ccnIinuccc cc c|eiIcmenIc mcIernc.
Fcrc c: purperc: 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 |icenc mcIerniccce, ceve-:e fcrnecer c cIe:Iccc
mcicc pcrc e:Ic :iIuccc e crienIc-|c: c ccmpcrecer cc Fc:Ic ce
8enef|cic: cc lNSS mci: prcximc ce :uc re:icncic, pci: Iercc cireiIc c 120
cic: ce |icenc. /: mu|here: ue cmcmenIcm, cc reIcrncr cc |icenc-
mcIerniccce, Im cireiIc c |icenc ccmp|emenIcr pcrc cmcmenIccc,
ce cci: ce:ccn:c: cicric: ce IrinIc minuIc: cccc cI c cricnc ccmp|eIcr
:ei: me:e:.
2. kev|so puerpero| tord|o [ot 42 d|os}
/pc: c cIencimenIc preccce, ceve-:e crienIcr c purperc pcrc reIcrncr
pcrc ncvc cvc|iccc enIre c 30 e c 42 cic pc:-pcrIc. Ne:Ic ccc:icc,
cuvem-:e c: ueixc: cc mu|her e prccece-:e ncvc excme f|:icc.
lmpcrIcnIe 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 ccnIinuccc 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|iccce:.
Nc: purperc: ue ncc ccmp|eIcrcm :eu: e:uemc: ce vccinccc,
ceve-:e cprcveiIcr e:Ie mcmenIc pcrc fcz-|c, em e:pecic| cc
imunizccc ccnIrc c IIcnc, hepcIiIe 8 e ruLc|c.
20
ASSISTNCIA MULHER NO PUERPRIO
180
Nc: mu|here: ue ncc rec|izcrcm excme prevenIivc pcrc ccncer
cervicc|, e:Ie mcmenIc IcmLm cpcrIunc, pci: IrcIc-:e prcIiccmenIe
cc |iLerccc cc mu|her c: :uc: cIiviccce: ncrmci:. funccmenIc| ue
hcjc umc ci:cu::cc ccm c cc:c| :cLre c reIcrnc c: cIiviccce: :exuci:.
De:ccnfcrIc c re|ccc pcce :urgir pcr ccnIc cc cIrcfic vcginc|, :encc
minimizccc e:Ie inccnvenienIe ccm c uIi|izccc ce |uLrificcnIe.
Controcepo no Fuerpr|o
PD Q".$":;( % G!%#(&&6*" .(!( R6$()( SQGRT
E:Ie mIccc nece::iIc ce omomentoo exc|us|vo o ||vre demondo, ot
se|s meses do porto e o ousnc|o de menstruoo neste perodo.
CLececicc: e:Ic: Ir: exigncic:, c efeIiviccce ce cI 87 pcrc eviIcr
umc ncvc grcvicez. E:Ic prcIicc refcrc nc: mu|here: c impcrIcncic cc
c|eiIcmenIc exc|u:ivc, ccnIriLuincc pcrc me|hcric cc :cce cc:
cricnc:.
UD R6$()(1 )% L"&&%*&"
/ uIi|izccc cc pre:ervcIivc mc:cu|inc em Iccc: c: re|cce: :exuci: eviIc
ncc :cmenIe umc ncvc grcvicez, ccmc prcIege c mu|her ce ccnIrcir
umc DSI. Nc puerpric reccmencc-:e c uIi|izccc cc pre:ervcIivc
|uLrificccc, pcrc eviIcr c ce:ccnfcrIc ccc:icnccc pe|c re::eccmenIc cc
mucc:c vcginc|. / uIi|izccc cc pre:ervcIivc femininc ceve :er
enccrcjccc, cpe:cr cc: cu:Ic: mci: e|evccc: ucncc ccmpcrccc cc
mc:cu|inc. / uIi|izccc cc cicfrcgmc ceve cccrrer cpc: :ei: :emcnc: cc
pcrIc, pci: c pcrIir ce:Ie per|ccc pcce-:e e:cc|her c Icmcnhc mci:
cceuccc.
VD W*12(1*$*8( I#$&"7X$%&*#( SWIXT
C DlU pcce :er in:ericc |cgc cpc: c e|iminccc cc p|ccenIc, IcnIc nc
pcrIc ncrmc| ccmc nc ce:crec. Cucncc :uc inIrccucc feiIc ne:Ic
ccc:icc, c: mu|here: referem ciminuicc cc :cngrcmenIc e cc: cc|icc:.
Cucncc ncc in:ericc cenIrc cc: 48 hcrc: pc:-pcrIc, reccmencc-:e in:eri-
|c cpenc: nc :exIc :emcnc pc:-pcrIc, incepencenIe cc reIcrnc cc
men:Iruccc.
YD Z1$%&*,*5":;( [%!*#*#"
Cucncc previcmenIe ci:cuIicc ccm c cc:c| e cenIrc cc: ccncice: em
ue c |ei permiIe, e:Ic prcIicc ccnIrccepIivc pcce :er efeIuccc |cgc
cpc: c pcrIc ncrmc|, cIrcv: cc |cueccurc IuLcrec rec|izccc pcr umc
mini|cpcrcIcmic, ce preferncic cI 72 hcrc: cc pcrIc, cu curcnIe c
ce:crec :e e:Ic fcr c vic cc pcrIc. Ncc ncrmc cceiIcve| c ci:cu::cc
:cLre e:Ie mIccc ucncc cc mcmenIc cc pcrIc. C reccmencccc
ue hcjc umc cpre:enIccc ce Iccc: c: mIccc: ci:pcn|vei: e ue c
cc:c| Icme c ceci:cc fcrc cc cic|c grcvicc-puerperc|, pe|c
irrever:iLi|iccce cc mIccc.
20
ASSISTNCIA MULHER NO PUERPRIO
181
\D ]"1%.$(!*"
Devem-:e Ier c: me:mc: preccuce: ccm c uIi|izccc ce:Ie mIccc ue
c: prcvicenciccc: nc |cueccurc IuLcrec, principc|menIe nc cic|c
grcvicc-puerperc|. Fcr :er ce mencr cu:Ic e ce mci: :imp|iciccce, pcce
:er feiIc nc cmLu|cIcric. Deve :er mci: civu|gccc e enccrcjccc :uc
e:cc|hc, pe|c: vcnIcgen: ue Iem e pcr pre:ervcr c mu|her ce
prccecimenIc: invc:ivc:.
^D R6$()(1 _(&!(#"*1 SM&(-%1$(-@#*(1T
/ uIi|izccc cc minip||u|c ceve :er iniciccc cpc: c :emcnc cc pcrIc, e
:eu u:c ccnI|nuc. Cucncc c::cciccc c cmcmenIccc, Iem :uc
eficccic cumenIccc. Deve :er :uL:IiIu|cc pcr cuIrc mIccc ucncc
cccrre c reIcrnc cc men:Iruccc. C: injeIcvei: {Limen:ci:) IcmLm
pccem :er empregccc:, emLcrc IcmLm mci: uIi|izccc: cpc: c: :ei:
:emcnc: cc pcrIc.
`D R6$()(1 J(!2(&$"!%#$"*1
Envc|ve vcric: mIccc:, inc|uincc c cciIc inIerrcmpicc, c cL:Iinncic
:exuc|, c ce 8i||ing: e c ce IcLe|c. C: cci: |Iimc: :cc, ce cif|ci| uIi|izccc
ne:Ie per|ccc pcrue cincc ncc cccnIeceu c reIcrnc c funcc 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:Ircgnicc
inIerfere ccm c prccucc cc |eiIe. EvicenIemenIe e:Ic ccnIrc-incicccc
ceixc ce exi:Iir :e, pcr uc|uer mcIivc, c c|eiIcmenIc mcIernc ncc
e:Iiver :encc prcIicccc.
20
182
/ inccrpcrccc ce ccnhecimenIc: nc vicc cc:
pe::cc:, ue regem :eu: ccmpcrIcmenIc: e prcIicc:,
Lc:eic-:e em Ir: :i:Iemc:: c mcgicc, c emp|ricc e c
cienI|ficc.
C :i:Iemc mcgicc c mci: primiIivc e cIriLui c fcrc:
:cLrencIurci: c crigem cc: fencmenc: vincu|ccc: c
:cce-enfermiccce. C :i:Iemc emp|ricc, mci: evc|u|cc
ue c cnIericr, Lc:eic-:e nc uIi|izccc ce
ccnhecimenIc: e prcIicc: ue c experincic pe::cc| e
cL:ervccc ce cnc: cemc:Ircrcm ue :cc
cceuccc:. C pen:cmenIc cienI|ficc umc eIcpc
:upericr cc ccnhecimenIc e e:Ic Lc:eccc nc
inve:Iigccc :i:IemcIicc e meIccicc, :eguincc regrc:
pr-e:IcLe|ecicc: ue permiIem :uc rep|iccLi|iccce :e
e:Ic: fcrem re:peiIccc:. /incc ue ncc :ejc infc||ve|,
mci: ccnficve| ue c Irccicc, c experincic pe::cc| e
c cuIcriccce.
/: prcIicc: mcicc: em gerc| e c: cL:IIricc: 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: Im :icc inccrpcrccc:
ncc criIiccmenIe e uIi|izccc: curcnIe cnc:, em gerc|
re:pc|cccc: cpenc: pe|c Irccicc e pe|c princ|pic ce
cuIcriccce.
C: ve|hc: pcrccigmc: nc ecucccc mcicc e nc
e|cLcrccc ce guic: ncrmcIivc: e:Icc ccncc |ugcr c
ncvc: fcrmc: menc: cuIcriIcric: e mci: Lc:eccc: nc:
me|hcre: evicncic: ci:pcn|vei:. /::im ue nc
Univer:iccce ce McMc:Ier cc Ccnccc ce:envc|veu-:e
e:Ie ncvc enfcue ue :e Iem cencminccc med|c|no
boseodo em ev|dnc|os ue c uIi|izccc ccn:cienIe,
exp||ciIc e criIeric:c cc me|hcr evicncic 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|cLcrccc ce guic: ncrmcIivc:.
21
EVIDNCIAS CIENTFICAS SOBRE AS PRTICAS
UTILIZADAS NO PARTO
EVIDNCIAS CIENTFICAS SOBRE AS PRTICAS UTILIZADAS NO PARTO
183
/ mecicinc Lc:eccc em evicncic: inIegrc c experincic c||nicc
incivicuc| ccm c me|hcr evicncic exIernc ci:pcn|ve| cerivccc cc Lu:cc
:i:IemcIicc ce infcrmccc re|evcnIe nc |iIercIurc mcicc.
Iencc em ccnIc e:Ic c|c::ificccc cc: evicncic:, pccer-:e-icm
ce:crever ciferenIe: grcu: ce reccmencccc ce umc ceIerminccc
prcIicc cu IrcIcmenIc:
Feccmencccc
/ Evicncic: n|ve| l c lV
8 Evicncic: n|ve| V
C Evicncic: n|ve| Vl c Vll
Ccmc :e cepreence cc c|c::ificccc ccimc mencicnccc, c: revi:ce:
:i:IemcIicc: {inve:Iigccc :ecunccric) cc |iIercIurc :cc c ferrcmenIc
meIccc|cgicc ue cc mci: fcrc c: evicncic: ci:pcn|vei: e e|c: :e
rec|izcm funccmenIc|menIe c pcrIir ce inve:Iigcce: primcric: ue :cc
en:cic: c||nicc: ccnIrc|ccc: ccm c|ccccc c|ecIcric, pe|c ue :e fcz
nece::cric reccrccr :umcricmenIe uc| c e:IruIurc Lc:icc cc: me:mc:.
Enso|os C|n|cos Contro|odos com A|ocoo A|eotor|o
Em meccc: cc :cu|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 cceiIccc ce::e: en:cic: nc
mecicinc fci c prcvc cc e:IrepIcmicinc nc IrcIcmenIc cc IuLercu|c:e.
/ cvc|iccc ce ncvc: IrcIcmenIc: cu prccecimenIc: mcicc: imp|icc nc
ccmpcrccc ce cuc: :rie: ce cL:ervcce:: umc ue :e cLIm ccm c
empregc cc ncvc prccecimenIc cu IrcIcmenIc {:rie IrcIccc,
experimenIc|) e cuIrc ue repre:enIc c: cL:ervcce: ce um grupc
ccnIrc|e :em c uIi|izccc ce Ic| prccecimenIc cu IrcIcmenIc cu ccm c
prccecimenIc pccrcc {:rie ccnIrc|e).
Exi:Iem vcric: prcpc:Ic: pcrc c|c::ificcr c: ciferenIe: n|vei: ce
uc|iccce cc: evicncic:, enIre e|c: c ce Mu|rcw ce 187:
l Fevi :ce: :i :IemcIi cc:
ll En:ci c: ccnIrc| ccc: c| ecIcri zccc: ccm grcnce nmerc ce
cc:c: e Lem ce:enhccc: {errc: c| fc e LeIc peuenc:)
lll En:ci c: ccnIrc| ccc: c| ecIcri zccc: ccm peuenc nmerc
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 Sri e: ce cc:c:
Vll Cpi ni cc ce experIc:
21
EVIDNCIAS CIENTFICAS SOBRE AS PRTICAS UTILIZADAS NO PARTO
184
/: ciferenc: cL:ervccc: enIre cmLc: :rie: pccem :er cIriLu|cc: c:
1. Vcricce: nc cmc:Irc
2. Diferenc nc ccnfcrmccc cc: grupc:
3. Diferenc: nc ccncucc {mcnipu|ccc) cc: grupc:
4. Verccceirc: efeiIc: cc ncvc IrcIcmenIc cu prccecimenIc: ue c
meIc ue :e per:egue hcLiIuc|menIe ne::e: en:cic:
/: ciferenc: cIriLu|vei: c: Ir: primeirc: ccIegcric: pccem :er
ccnIrc|ccc: re:pecIivcmenIe: ccm c meIccc|cgic cc inferncic
e:IcI|:Iicc {prcvc: ce :ignificccc e:IcI|:Iicc cceuccc:), ccm c
c|ccccc c|ecIcric {c|ecIcrizccc, rcnccmizccc, uIi|izcncc c: nmerc:
c|ecIcric:) e ccm c mc:ccrcmenIc cc: grupc: {cup|c cu Irip|c cegc).
Nc e:Iccc cIuc| cc inve:Iigccc nc mecicinc, c en:cic c||nicc
ccnIrc|ccc rcnccmizccc Iem umc pc:icc :egurc e re:peiIccc. Se
cIrcv: ce ci:IinIc: e:Iucc: {cccrIe:, cc:c-ccnIrc|e, :rie ce cc:c:) :e
chegcm c ccnc|u:ce: cpc:Ic:, cuIcrgc-:e mcicr creciLi|iccce cc
re:u|Iccc cc inve:Iigccc ue uIi|izcu e:Ic Icnicc.
kev|ses S|stemt|cos
Mci: recenIemenIe {17), ccm c grcnce cre:cimenIc cc Ie|emcIicc,
ce:envc|veu-:e c Icnicc 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 um mIccc ue permiIe
ccmLincr c: re:u|Iccc: cc: e:Iucc: primcric: incepencenIe: e c :|nIe:e:
cc: me:mc:. ce e:pecic| uIi|iccce pcrc cvc|icr c: IrcIcmenIc: e
prccecimenIc: mcicc: ccm re:u|Iccc: ce e:Iucc: ccnIrcciIcric: em
mcgniIuce cu cirecc ce efeiIc, cu ccm efeiIc: peuenc:, 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
cLIencc ce ccnc|u:ce: mci: ccerenIe: e ccnficvei: :cLre c eficccic ce
IrcIcmenIc cu prccecimenIc, :cLre cu:Ic: e permiIe reccmenccr ccm
mcicr fcrc :uc inc|u:cc ccmc pcuIc ncrmcIivc.
E:Ic: revi:ce: :i:IemcIicc: :cc ccn:icerccc: ccmc inve:Iigcce:
:ecunccric: :cLre e:Iucc: jc rec|izccc:, ccm pcrIicu|cr cprcfunccmenIc
nc: en:cic: c||nicc: ccnIrc|ccc:.
/ meIcnc|i:e prcv um mcrcc |cgicc pcrc c inve:Iigccc 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
EVIDNCIAS CIENTFICAS SOBRE AS PRTICAS UTILIZADAS NO PARTO
185
Ccmc mIccc ce IrcLc|hc, Iem c: :eguinIe: eIcpc::
1. Invest|goo, rev|so, otuo||zoo do b|b||ogro||o: c Lu:cc cc:
IrcLc|hc: ceve :er p|cnificccc, excu:Iivc e e:Icnccrcizccc, ccm
pr-e:pecificccc ce cefinice: e criIric: 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 inIervencc e ce re:u|Iccc:
pcrecicc:. Feccrre-:e c fcnIe: cefinicc: e gcrcnIe-:e c uc|iccce
cc infcrmccc primcric.
2. C|cu|o do e|e|to poro codo estudo em port|cu|or: umc eIcpc
ucnIiIcIivc, empregcncc-:e Icnicc: e:IcI|:Iicc: ccmc c mecicc
cc ri:cc re|cIivc {FF) cu cc ccc: rcIic {CF), ciferenc: ce mcic:,
Iccc: ccm :eu: re:pecIivc: inIervc|c: ce ccnficnc.
3. C|cu|o do e|e|to comum g|obo|, comb|nodo e ponderodo: eIcpc
IcmLm ucnIiIcIivc, empregcncc prccecimenIc: e:IcI|:Iicc:,
pcncercm-:e c: e:Iucc: pcr ciferenc:, vcricncic: cu Icmcnhc:
cmc:Irci:, c fim ce ccn:eguir umc e:Iimccc pcnIuc| ce re:umc,
ccm :eu inIervc|c ce ccnficnc, ce Iccc: c: IrcLc|hc: cnc|i:ccc:
{meIcnc|i:e). EnIre c: Icnicc: uIi|izccc:, ce:Icccm-:e c: ce mcic:
pcncerccc:, c mIccc ce McnIe| e Hcen:ze|, pcncerccc ce CF
cu FF pe|c inver:c cc vcricncic, regre::cc |cg|:Iicc m|Iip|c, enIre
cuIrc:. IcmLm ccrre:pcnce c e:Ic eIcpc, c cpre:enIccc grcficc
cc: re:u|Iccc:.
4. C|cu|o do nmero de trobo|hos no pub||codos com conc|uses
ontogn|cos necessr|os poro negor os resu|todos obt|dos: IenIc-:e
umc cprcximccc mecicnIe c cgregccc 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:. IcmLm chcmccc ce cnc|i:e ce
:en:iLi|iccce, :erve pcrc :u:peiIcr :e exi:Iem v|cic: ce puL|icccc
{funne| p|cI).
21
EVIDNCIAS CIENTFICAS SOBRE AS PRTICAS UTILIZADAS NO PARTO
186
/: revi:ce: :i:IemcIicc: e c meIcnc|i:e ue ce|c: cerivcm, cepencem cc
nmerc 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:icerccc e:Ic: pcuIc: 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:ncic ce efeiIc: prejucicici:.
/ c|c::ificccc 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 1, e
mccificccc pe|c: ncvc: evicncic: cienI|ficc: cIuc|menIe ci:pcn|vei:.
E:Ic c|c::ificccc civice c: prcIicc: nc pcrIc ncrmc| em 4 ccIegcric:, c
:cLer:
21
EVIDNCIAS CIENTFICAS SOBRE AS PRTICAS UTILIZADAS NO PARTO
187
1. Frt|cos no porto normo| demonstrodomente te|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|iccc ce ri:cc curcnIe c pr-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. - FcrnecimenIc ce c::i:Incic cL:IIricc nc n|ve| mci: perifricc
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 :ervic curcnIe c IrcLc|hc
ce pcrIc e pcrIc.
1. - 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: infcrmcce: e exp|iccce:
ue ce:ejcrem.
1.11 - MIccc: ncc invc:ivc: e ncc fcrmccc|cgicc: ce c||vic cc ccr,
ccmc mc::cgen: e Icnicc: ce re|cxcmenIc, curcnIe c IrcLc|hc
ce pcrIc.
1.12 - McniIcrcmenIc feIc| pcr meic ce cu:cu|Ic inIermiIenIe e
vigi|cncic cc: ccnIrcce: uIerinc: pcr pc|pccc cLccminc|.
1.13 - U:c ce mcIerici: ce:ccrIcvei: e ce:ccnIcminccc cceuccc 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:icc e mcvimenIc curcnIe c IrcLc|hc ce pcrIc.
1.1 - E:I|mu|c c pc:ice: 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:Irccc prcfi|cIicc ce cciIccinc nc Ierceirc e:Icgic cc
pcrIc em mu|here: ccm ri:cc ce hemcrrcgic pc:-pcrIc.
1.1 - Ccncice: e:Irei: cc ccrIcr c ccrccc.
1.20 - Frevencc cc hipcIermic cc LeLe.
1.21 - Frevencc cc hemcrrcgic necncIc| ccm c u:c cc viIcminc .
1.22 - Frevencc 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 cmcmenIccc nc primeirc hcrc cpc: c pcrIc.
1.24 - /|cjcmenIc ccnjunIc.
1.25 - Suprimir c |ccIccc em mce: pcrIcccrc: ce HlV.
1.2 - Excme rcIineirc cc p|ccenIc e memLrcnc: cvu|cre:.
1.27 - U:c rcIineirc ce cciIccinc, Irccc ccnIrc|ccc cc ccrccc, cu :uc
ccmLinccc, curcnIe c Ierceirc e:Icgic cc pcrIc.
21
EVIDNCIAS CIENTFICAS SOBRE AS PRTICAS UTILIZADAS NO PARTO
188
3. Frt|cos no porto normo| em que no ex|stem ev|dnc|os poro opo|or
suo recomendoo e devem ser ut|||zodos com coute|o ot que novos
pesqu|sos esc|oreom o questo
3.1 - MIccc: ncc fcrmccc|cgicc: ce c||vic cc ccr curcnIe c IrcLc|hc ce
pcrIc, ervc:, imer:cc em cguc e e:Iimu|ccc ce nervc:.
3.2 - Fre::cc nc funcc uIerinc curcnIe c per|ccc expu|:ivc.
3.3 - McncLrc: re|ccicnccc: c prcIecc cc per|nec e cc pc|c cefc|icc nc
mcmenIc cc pcrIc.
3.4 - Mcnipu|ccc cIivc cc feIc nc mcmenIc cc pcrIc.
3.5 - C|cmpecmenIc preccce cc ccrccc umLi|icc|.
3. - E:Iimu|ccc cc mcmi|c pcrc cumenIcr c ccnIrcIi|iccce uIerinc
curcnIe c Ierceirc e:Icgic cc pcrIc.
2. Frt|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 - CcIeIerizccc venc:c prcfi|cIicc ce rcIinc.
2.5 - U:c rcIineirc cc pc:icc :upinc curcnIe c IrcLc|hc ce pcrIc.
2. - Excme reIc|.
2.7 - U:c ce pe|vimeIric pcr rcic: X.
2.8 - /cmini:Irccc ce cciIccicc: cnIe: cc pcrIc ce um mccc ue ncc :e
permiIc ccnIrc|cr :eu: efeiIc:.
2. - U:c rcIineirc cc pc:icc ce |iIcIcmic.
2.10 - E:fcrc: 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|crccc mcnuc|) rcIineirc cc Ierc cpc: c pcrIc.
2.1- U:c |iLerc| cu rcIineirc cc epi:icIcmic.
2.17 - Icue: vcginci: freenIe: e pcr mci: ce um excmincccr.
2.18 - McncLrc ce ri:Ie||er cu :imi|cr, ccm pre::ce: incceucccmenIe
cp|icccc: cc funcc uIerinc nc per|ccc expu|:ivc.
2.1 - FrcIicc |iLerc| ce ce:cricnc.
2.20 - /:pirccc nc:cfcr|ngec ce rcIinc em recm-nc:cicc: ncrmci:
2.21 - McnuIencc crIificic| ce cr fric nc :c|c ce pcrIc curcnIe c
nc:cimenIc.
21
EVIDNCIAS CIENTFICAS SOBRE AS PRTICAS UTILIZADAS NO PARTO
189
E:Ic c|c::ificccc cc: prcIicc: curcnIe c pcrIc ncrmc|, ue :e ce:creveu
ccimc, ccm c: me|hcre: evicncic: ci:pcn|vei: cI e:Ic ccIc, ceve :er
pericciccmenIe revi:ccc ce fcrmc criIicc, pci:, ccm c prcgre::c cc
cincic mcicc, ncvc: evicncic: :urgircc e cccc um cc: memLrc: cc
euipe ce :cce ceve Lu:cc-|c ce fcrmc cIivc e permcnenIe.
Um DireIcr ce umc E:cc|c ce Mecicinc, nc cIc ce cc|ccc ce grcu ce
:eu: egre::c:, expre::cu: / meIcce cc ue |he: fci en:inccc
prcvcve|menIe jc ncc cerIc, mc: c picr ue ncc :cLemc: uc|
meIcce.
EmLcrc :e pc::c rec|izcr um Lcm IrcLc|hc en:incncc c me|hcr prcIicc
mcicc 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. Frt|cos no porto normo| |reqentemente ut|||zodos de modo
|nodequodo
4.1 - Fe:Iricc h|cricc e c|imenIcr curcnIe c IrcLc|hc ce pcrIc.
4.2 - CcnIrc|e cc ccr pcr cgenIe: :i:Imicc:.
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:Irei: curcnIe c c::i:Incic cc
IrcLc|hc ce pcrIc.
4. - Excme: vcginci: repeIicc: cu freenIe:, e:pecic|menIe pcr mci:
ce um pre:Icccr ce :ervic.
4.7 - Ccrrecc cc cincmicc uIerinc ccm c uIi|izccc ce cciIccinc.
4.8 - /mnicIcmic preccce ce rcIinc nc primeirc e:Icgic cc pcrIc.
4. - Ircn:ferncic rcIineirc cc pcrIurienIe pcrc cuIrc :c|c nc in|cic cc
:eguncc e:Icgic cc IrcLc|hc ce pcrIc.
4.10 - CcrccIerizccc cc Lexigc.
4.11 - E:I|mu|c pcrc c puxc ucncc :e cicgnc:Iicc ci|cIccc cervicc|
ccmp|eIc, cnIe: ue c prcpric mu|her :inIc c puxc.
4.12 - /ce:cc r|gicc c umc curccc e:Iipu|ccc cc :eguncc e:Icgic cc
IrcLc|hc ce pcrIc, :e c: ccncice: cc mce e cc feIc fcrem Lcc: e
:e hcuver prcgre::cc cc IrcLc|hc ce pcrIc.
4.13 - FcrIc cpercIcric.
4.14 - Exp|crccc mcnuc| cc Ierc 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, 1.
/CCG - /mericcn Cc||ege cf CL:IeIricicn: cnc Gynecc|cgi:I:. /CCG
Iechnicc| Lu||eIin. lncucIicn cf |cLcr {NumLer217). Int J Gyneco|
Obstet, 53: 5-72, 1.
/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, : 77-78, 2000.
/LMElD/ FML, FElICS/ FEL {ec.). Monuo| do C|n|co Obsttr|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, 0: 00-11, 1.
8/L/S/S, J. Forto ot|vo - gu|o prt|co poro o porto noturo|. 2c- ec., Scc
Fcu|c, Grcunc, 13.
8/FFCS FC, V/UGH/N JF, VlCICF/ CG, HUIIL SF/. Epicemic cf
Cce:crecn :ecIicn: in 8rczi|. Loncet, 338: 17-1, 11.
8ENF/M. 8rc:i|. Fesqu|so Noc|ono| sobre Demogro||o e Sode, 1. Fic
ce Jcneirc, 17.
8EFCUES, CUNH/ EMGF {crg:.). Morb|morto||dode |em|n|no no 8ros||
[17-15}. 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
Sode Fb||co, So Fou|o, 33: 342-8, 1.
8lSHCF, EH. Fe|vic :ccring fcr e|ecIive incucIicn. Obstet Gyneco|, 24: 2-
28, 14.
8LCCM FS, CFCFLE C. /mericcn HecrI /::ccicIicn, /mericcn /cccemy
cf FecicIric:. Iextboo o| Neonoto| kessuc|tot|on, 14.
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Gero|s poro seu bso com n|ose no Ind|coo de Ierop|o Ant|-
ketrov|ro| em S|tuoes de Emergnc|o. 1 ecicc.8rc:||ic, D.F. 2001
8F/SlL. MlNlSIFlC D/ S/UDE. Cccrcenccc McIernc lnfcnIi|. Monuo| de
Fromoo do A|e|tomento Moterno. Ncrmc: Icnicc:. 2c. ec.,
8rc:||ic, DF, 17.
8F/SlL. Mini:Iric cc Scce. Cccrcenccc McIernc lnfcnIi|. Monuo| de
Ass|stnc|o oo kecm-nosc|do. 8rc:||ic, DF, 14.
8F/SlL. MlNlSIFlC D/ S/UDE. Gestoo de A|to k|sco. Mcnuc| Icnicc.
3c. ecicc. 8rc:||ic, DF, 2000.
8F/SlL. MlNlSIFlC D/ S/UDE. FcrIcric MS/GM nc. 2.81. D|r|o O||c|o| do
bn|o, Se. l, nc. 103, 02//18, p.48.
8F/SlL., MlNlSIFlC D/ S/UDE. Frogromo de Humon|zoo no Fre-noto| e
Nosc|mento. 8rc:||ic, Mini:Iric cc Scce, 2000.
8F/SlL. MlNlSIFlC D/ S/UDE. brgnc|os e Emergnc|os Moternos: Gu|o
poro d|ognost|co e conduto em s|tuoes de r|sco de morte
moterno. 8rc:||ic, Mini:Iric cc Scce/FE8F/SGC, 2000. 118p.
8F/SlL. hIIp://www.ccIc:u:.gcv.Lr 2001.
8F/SlL. hIIp://www.:cce.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, 4: 14-155, 15.
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192
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F/UNDES /, CEC/IIl JG. Which pc|icy fcr Cce:crecn :ecIicn in 8rczi| /n
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33-42, 13.
FE8F/SGC. Irotodo de Obstetrc|o do FE8kASGO. Fic ce Jcneirc, FevinIer,
2000. 13p.
FESClN/, FH. / incicncic ce ce:crec nc: /mricc:. Jorno| do FE8kASGO,
1: 7-8, 2000.
FLElSS JL. Stot|st|co| Mehods |or kotes ond Froport|ons. 2nc ec. Jchn Wi|ey
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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::, 13. 200p.
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HCFMEEF GJ. /mnicinfu:icn fcr umLi|icc| ccrc ccmpre::icn in |cLcur
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HUGHE MJ, MCELlN IW, CUNG I. McIernc| cnc feIc| cuIccme cf
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194
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Succe::. C||n Fer|noto|, 2{2): 281-30, 1.
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196
F/IINEF D. ScLre c hipcIe:e ce e:IcLi|izccc cc: Icxc: ce ce:crec cc
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1-33, 1.
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197
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198
Orgon|zodores
Jc: Gui|herme CeccIIi
Suzcnne JcccL Serruyc
Consu|tores
Ficcrcc Fe:cinc
Ficcrcc Schwcrcz
Autores
/nc Lcic FiLeirc ce Vc:ccnce|c:
nge|c Mcric 8cchc
Ccr|c: /ugu:Ic /|enccr Junicr
E|cy|ene Mcric ce /rcjc Leccccic
lrccemc ce McIIc: Fcrcnhc: Cc|cercn
Jcnine Schirmer
Jc: Gui|herme CeccIIi
Jc: 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 /|Luuerue
Fc:c ln: Cc:Ic Fereirc
Suzcnne JcccL Serruyc
Icnic Di Gicccmc cc Lcgc
Co|oborodores
/nc Cri:Iinc Vi|henc /Lrchcc
/nc Lucic Lcurenc 8cni|hc
/n|Lc| Fcnce:
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: Grcc: 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 vi|c ViIcric
Mcrcc: mcyc
Mcric /nIcnieIc FLic 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|
Srgic Ferreirc cc Cunhc
Srgic Icceu McrIin: McrLc
Vc|ci|c Gcnc|ve: Ve|c:c cc: ScnIc:
Suporte tcn|co
Mini:Iric cc Scce
/8ENFC - /::cciccc 8rc:i|eirc ce CL:IeIrize: e Enfermeirc: CL:IeIrc: rec
Icnicc ce /|imenIccc e NuIricc/MS
rec Icnicc ce Scce cc Cricnc e /|eiIcmenIc
McIernc/MS rec Icnicc ce Scce cc
/cc|e:cenIe/MS
Cccrcenccc Nccicnc| ce DSI//lDS/MS
FE8F/SGC - Fecerccc 8rc:i|eirc cc: Sccieccce: ce
Ginecc|cgic e CL:IeIr|cic
CF/S - Crgcnizccc Fcn-cmericcnc cc Scce
SecreIcric ce /::i:Incic c Scce/MS
S8/ - Sccieccce 8rc:i|eirc ce /ne:Ie:ic|cgic
S8F - Sccieccce 8rc:i|eirc ce FecicIric
C Mini:Iric cc Scce cgrccece c cpcic cc
Crgcnizccc Fcn-/mericcnc ce Scce /
Crgcnizccc Muncic| cc Scce pcrc c rec|izccc
ce:Ic puL|icccc.

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