Assistência Ai Parto, Aborto e Puerpério

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
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
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
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
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
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
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
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
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
!"
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
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
25
Fortor|os
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
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
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
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
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.
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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
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
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
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
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
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|.
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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
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
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
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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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
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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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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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
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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:.
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53
Figura 6 Fase ativa prolongada
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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.
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55
Figura 7 Parada secundria da dilatao
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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.
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57
Figura 8 Parto precipitado
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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.
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59
Figura 9 Perodo plvico prolongado
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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.
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61
Figura 10 - Parada secundria descida
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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).
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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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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 $' 76<'4@6-644/@6*'26%E K*)4')%*)#?
10
91
*,# ;#4%2 #@('43%$%( $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
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
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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.
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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.
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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|.
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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.
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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.
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/|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}
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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|.
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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
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
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
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
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).
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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
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
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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
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
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|
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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,
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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.
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C cIencimenIc cc ucrIc per|ccc nc grcvicez ce c|Ic ri:cc ceve
:er inIen:ivc, pci: c: chcnce: ce ccmp|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:
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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|.
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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.
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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|.
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INDUO DO PARTO
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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
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
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
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
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
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
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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:
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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
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: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
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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
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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
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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
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
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
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
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
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
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
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
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
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
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
166
FLUXOGRAMA PARA USO DE TESTE RPIDO PARA HIV EM
PARTURIENTES
18
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
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
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.
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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
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
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
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
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
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
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
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
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
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
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
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
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
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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HCFMEEF GJ, ULlEF F. ExIernc| cephc|ic ver:icn fcr Lreech pre:enIcIicn
cI Ierm {Ccchrcne Feview). ln: Ihe Cochrone L|brory, l::ue 3, 2000.
Cxfcrc: UpccIe ScfIwcre.
HCFMEEF GJ. ExIernc| cephc|ic ver:icn fcci|iIcIicn fcr Lreech
pre:enIcIicn cI Ierm {Ccchrcne Feview). ln: Ihe Cochrone L|brory,
l::ue 3, 2000. Cxfcrc: UpccIe ScfIwcre.
HCFMEEF GJ. ExIernc| cephc|ic ver:icn fcr Lreech pre:enIcIicn Lefcre
Ierm {Ccchrcne Feview). ln: Ihe Cochrone L|brory, l::ue 3, 2000.
Cxfcrc: UpccIe ScfIwcre.
HCFMEEF GJ. /mnicinfu:icn fcr umLi|icc| ccrc ccmpre::icn in |cLcur
{Ccchrcne Feview). ln: Ihe Cochrone L|brory, l::ue 3, 2000. Cxfcrc:
UpccIe ScfIwcre.
HUGHE MJ, MCELlN IW, CUNG I. McIernc| cnc feIc| cuIccme cf
Lcmcze-prepcrec pcIienI:. Obstet Gyneco|, 51{):43-7, 178.
lLLlCH, l. A expropr|oo do sode. Fic ce Jcneirc, Ncvc FrcnIeirc, 175.
p. 5.
194
lMlF. Obstetrc|o: d|ognost|co e trotomento. Fecife, MEDSl, 18. 55p.
JCH/NSCN F8 & MENCN 8V. Vccuum exIrccIicn ver:u: fcrcep: fcr
c::i:Iec vcginc| ce|ivery {Ccchrcne Feview). ln: Ihe Cochrone
L|brory, l::ue 2, 2000. Cxfcrc UpccIe ScfIwcre.
ENNELL J, L/US M, MCGF/IH S, FC8EFISCN S, HlNLE C. CcnIinucu:
emcIicnc| :uppcrI curing |cLcr in c US hc:piIc|. JAMA, 25 {17): 217-
201, 11
ElFSE C. Frc:Icg|cncin: in preincucIicn cervicc| ripening: MeIc-cnc|y:i: cf
wcr|cwice c|inicc| experience. J keprod Med, 38: 8-100, 13.
EIILE C, JCH/NSCN F8. CcnIinucu: ver:u: inIerrupIec :uIure: fcr perinec|
repcir. Cochrone L|brory. Ccchrcne DcIcLc:e Sy:I Fev 2000:
2:CD00047.
lNG FS. Como ojudor os mes o omomentor. Lcncrinc, 11.
L/US MH, ENNELL JH. Ihe ccu|c: cn e::enIic| ingrecienI cf chi|cLirIh
reci:ccverec. Acto Foed|otr 8: 1034-, 17.
L/NGEF /, C/MFEFC L, G/FCl/ C, FENCSC S. EffecI: cf p:ychc:ccic|
:uppcrI curing |cLcur cnc chi|cLirIh cn Lrec:Ifeecing, mecicc|
inIervenIicn:, cnc mcIher: we||Leing in c Mexiccn puL|ic hc:piIc|:
c rcnccmizec c|inicc| Iric|. 8r J Obstet Gynoeco|, 105{10): 105-3,
18.
LcClCEFC /. Exp|cining exce::ive rcIe: cf ce:crecn: cnc cIher chi|cLirIh
inIervenIicn:: ccnIriLuIicn: frcm ccnIempcrcry Ihecrie: cf gencer
cnc p:ychc:ccic| ceve|cpmenI. Soc|o| Sc|ences ond Med|c|ne,
37{10): 121-, 13.
M/FIlNS-CCSI/ S. ScLre c: cc:c: ce pcrIc, c: Icnicc: em cL:IeIr|cic e c
mcrIc|iccce mcIernc. Jorno| do FE8kASGO,{8): 5, 1.
M/IHl/S FS, C/FV/LHC JC/. /nc|ge:ic e cne:Ie:ic em CL:IeIr|cic. ln:
CFIENl /V, I/FDELLl M/. Anestes|o|og|o SAESF, Fic ce Jcneirc,
/Iheneu, pp 42-510.
MULFCW CD. Ihe mecicc| review crIic|e: :IcIe cf Ihe :cience. Ann Intern
Med, 10 {3): 185-8, 17.
N/IlCN/L lNSIlIUIE CF HE/LIH. CCNSENSUS SI/IEMENI. EffecI cf
ccrIicc:Iercic: fcr feIc| mcIurcIicn cn perincIc| cuIccme:, feLrucry
28 - mcrch 2, 14. Am j Obstet Gyneco|, 173 {1): 24-52, 15.
NElFEFI MF. C|inicc| /:pecI: cf LccIcIicn: FrcmcIing 8rec:Ifeecing
Succe::. C||n Fer|noto|, 2{2): 281-30, 1.
195
NEME 8 {cccrc.). Obstetrc|o 8s|co. 2c. ec., Scc Fcu|c, Scrvier, 2000.
NlEFMEEF, S. eI c| . lnIerncIicnc| Guice|ine: fcr NecncIc| Fe::uciIcIicn:
cn ExcerpI frcm Ihe Guice|ine 2000 fcr Ccrcicpu|mcncr Fe::uciIcIicn
cnc Emergency Ccrcicvc:cu|cr Ccre: lnIerncIicnc| Ccn:en:u: cn
Science. Fed|otr|cs 10 {3) 1-2, 2000.
C DFlSCCLL, . & FCLE, M. Ccrre|cIicn cf cecrec:e in perincIc| mcrIc|iIy
cnc increc:e in ce:crecn :ecIicn rcIe:. Obstetr|cs & Gyneco|ogy, 1:
1-5, 183.
CDENI, M. guo & Sexuo||dode. Scc Fcu|c, Sici|icnc, 11. 18p.
CFG/Nl/C MUNDl/L DE S/UDE. Ass|stnc|o oo Forto Normo|: bm
gu|o prt|co. Fe|cIcric ce um grupc Icnicc. GeneLrc, 1. 53p.
F/FNELL C, L/NGHCFF-FCCS J, lVEFSEN F, D/MG//FD F. Fu:hing
meIhcc in Ihe expu|:ive phc:e cf |cLcr. Acto Obstet Gyneco| Scond,
72: 31-35, 13.
F/FFlNELLl M/, CEC/IIl JG, F/UNDES /. Lcmincric ccmc ci|cIcccr
cervicc|. U:c c||nicc e meccni:mc ce ccc. Fem|no, 22: 187-13,
14.
F/UL. F.H. & MlLLEF, D./. Ce:crecn LirIh: hcw Ic recuce Ihe rcIe.
Amer|con Journo| o| Obstetr|cs ond Gyneco|ogy, 172: 103-11, 15.
F/UL/ LG, LlM/ CF, CCUIlNHC MS, M/NFFC HD, lNH/CUlIES M, LU NF.
FcrIcgrcmc. Acto Med HbF, 384-8, 184.
FEIlIIl, D: CEF/LC FC, SH/FlFC 8/, WH/LLE F. ln-hc:piIc| mcIernc|
mcrIc|iIy in Ihe UniIec SIcIe:: Iime Irenc: cnc re|cIicn Ic meIhcc cf
ce|ivery. Obstetr|cs & Gyneco|ogy, 5: -12, 182.
FHEL/N JF, CL/F SL, Dl/ F, F/UL FH. Vcginc| LirIh cfIer ce:crecn.
Amer|con Journo| o| Obstetr|cs ond Gyneco|ogy, 157{): 1510-1515,
187.
FHlLFCII FH, C/SILE WM. Cerviccgrcph: in Ihe mcncgemenI cf |cLcur in
primigrcvicce. l Ihe c|erI |ine fcr ceIecIing cLncrmc| |cLcur. J Obstet
Gyneco| 8r|t Corn, 7: 52-8, 172.
FHlLFCII FH, C/SILE WM. Cerviccgrcph: in Ihe mcncgemenI cf |cLcur in
primigrcvicce. ll Ihe ccIicn |ine cnc IrecImenI cf cLncrmc| |cLcur. J
Obstet Gyneco| 8r|t Corn, 7: 5-02, 172.
FCFIEF IF & V/FNEF MW. U:ing evicence-Lc:ec mecicine Ic cpIimize
ce:crecn :ecIicn cuIccme:. C||n|co| Obstetr|cs ond Gyneco|ogy,
40{3): 542-547, 17.
196
F/IINEF D. ScLre c hipcIe:e ce e:IcLi|izccc cc: Icxc: ce ce:crec cc
E:Iccc ce Scc Fcu|c, 8rc:i|. kev|sto de Sode Fb||co, So Fou|o, 30:
1-33, 1.
FEENDE, J. Obstetrc|o. 8c. ec., Fic ce Jcneirc, GucncLcrc ccgcn, 18.
FCSEN MG, DlClNSCN JC8, WESIHCFF CL. Vcginc| LirIh cfIer ce:crecn: c
meIc cnc|y:i: cf mcrLiciIy cnc mcrIc|iIy. Obstetr|cs & Gyneco|ogy,
77: 45-70, 11.
FUDGE MVC, C/LDEFCN lMF, DE LUC/ L/. U:c cc pcrIcgrcmc nc
cicgnc:Iicc e ccncuIc nc pcrIc ci:Iccicc. Fem|no, 17: 135-45, 18.
FUDGE MVC, DE LUC/ L/, FEF/CCLl JC. FcrIcgrcmc: UIi|iccce e
impcrIcncic. Fem|no, 1: 2-34, 188.
S/NCHES lH. Comporondo entre do|s mode|os de portogromo op||codos
no oss|stnc|o oo porto de pr|m|gestos. Di::erIccc ce Me:Irccc,
Fccu|ccce ce Mecicinc ce 8cIuccIu UNESF, 1: 80p.
S/IlN /J, LEVENC J, SHEFM/N ML, MClNIlFE DD. FccIcr: cffecIing Ihe
cc:e re:pcn:e Ic cxyIccin fcr |cLcr :Iimu|cIicn. Am J Obstet
Gyneco|, 1: 120-1, 12.
SCHW/FC F, Dl/ /G, FESClN/ FH, 8ELlI F, DE MUClC 8, DELG/DC
FCSSELLC JLD. FcrIcgrcmc ccm curvc: ce c|erIc ln: Scce reprccuIivc
mcIernc perincIc|. /Iencc pr-ncIc| e cc pcrIc ce 8cixc Fi:cc.
Fub| C|ent CLAF, n 1321.03: 134-44, 1.
SCHW/FC F, DUVEFGES C, Dl/ /G, FESClN/ FH, CL:IeIr|cic. 5 ec. Ec.
/Ienec, 8uenc: /ire:, 15. 40p.
SClSClCNE /C, MCCULLCUGH H, M/NLE JS, SHLCSSM/N F/, FCLLCC
CCLMCFGEN GHC. / prc:pecIive, rcnccmizec ccmpcri:cn cf Fc|ey
ccIheIer in:erIicn ver:u: inIrccervicc| prc:Icg|cncin E2 ge| fcr
preincucIicn cervicc| ripening. Am J Obstet Gyneco|, 180{1): 55-5,
1.
SH/FFEF N eI c|. ShcrI-ccur:e ziccvucine fcr perincIc| HlV-1 Ircn:mi::icn in
8cngkck, Ihci|cnc : c rcnccmi:ec ccnIrc||ec Iric|. Loncet, 1, 353:
773-780.
SHE/FEF, E. Ce:crecn :ecIicn: mecicc| LenefiI: cnc cc:I:. Soc|o|
Sc|ences ond Med|c|ne, 37: 1223-31, 13.
SLEEF J, FC8EFIS J, CH/LMEFS l. Ccre curing Ihe :eccnc :Icge cf |cLcr. ln:
Chc|mer: l, Enkin M, eir:e MJNC. E||ect|ve core |n pregnoncy ond
ch||db|rth [v.2}. Cxfcrc Univer:iIy Fre::, Cxfcrc, 18. p.1130-44.
SC/FES H8. Cc:c: ce pcrIc. Jorno| do FE8kASGO, [8}: , 1.
197
SICFF/FD, M. Do Grov|dez oo Nosc|mento - um gu|o comp|eto e prt|co
poro |uturos po|s. Scc Fcu|c, Mc|Ie:e, 10. 234p.
SIFlGHI, 8F. & H/FFlSCN, LC. En|ermogem Moterno e Neonoto|. 2c-
ec., Fic ce Jcneirc, GucncLcrc ccgcn S./., 18. 224p.
SW/NN FC. lncucIicn cf |cLcr Ly :Iripping memLrcne:. Obstet Gyneco|,
11: 74-78, 158.
IEDESCC JJ/. A grv|do. Suos |ndogoes e os dv|dos do obstetro. Scc
Fcu|c, EciIcrc /Iheneu, VbbbE
IHCMSCN /M. Fu:hing Iechniue: in Ihe :eccnc :Icge cf |cLcr. J Adv
Nurs,18: 171-7, 13.
V/N UNDEFI /, CSIHElMEF GW. Fo|n ke||e| Anesthes|o |n Obstetr|cs.
New crk, Churchi|| Living:Icne, 1.
VlLL/F J, H/N-NEELCFUF D. FcIIern: cf rcuIine cnIencIc| ccre fcr |cw-ri:k
pregncncy {Ccchrcne Feview). ln: Ihe Cochrone L|brory, l::ue 3,
2000. Cxfcrc: UpccIe ScfIwcre.
WlNG D/, JCNES MM, F/H/LL /, GCCDWlN IM, F/UL FH. / ccmpcri:cn
cf mi:cprc:Ic| cnc prc:Icg|cncin E2 ge| fcr preincucIicn cervicc|
ripening cnc |cLcr incucIicn. Am J Obstet Gyneco|, 172{): 1804-
1810, 15.
WCFLD HE/LIH CFG/Nl/IlCN. /pprcpricIe Iechnc|cgy fcr LirIh. Loncet,
2: 43-7, 185.
WCFLD HE/LIH CFG/Nl/IlCN, HlV in Fregncncy: c review, Jo|nt
bn|ted Not|ons Frogromme on HIV JAIDS ,GeneLrc. 1.
/M/SHlI/ /M, GC/Nl JL. Anestes|o em Obstetrc|o. Fic ce Jcneirc,
/Iheneu, 17.
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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