Aplicabilidade de um algoritmo de apoio à decisão no processo de avaliação perineal na assistência ao parto

• Ano de defesa: 2020
• Autor(a) principal: Cesar, Monica Bimbatti Nogueira [UNIFESP]
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Episiotomy; Injuries; Perineum; Nursing; Information technology; Episiotomia; Lacerações; Períneo; Enfermagem; Tecnologia da informação
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=9879125; https://hdl.handle.net/11600/64398

Introduction: Among childbirth’s care actions and procedures, two topics are debatable: the perineal evaluation and the decision to either preserve the perineum intact or to perform an episiotomy. There is a lack of evidence-based methods and decision criteria, potentially leading to professional distress regarding maternal practice, besides morbidity due to lacerations in the vaginal canal and perineal region. The use of algorithms, implemented via decision support computer systems (DSS), can standardize evaluations involving multiple variables and suggest a course of action aligned to assistance assurance and to scientific evidence. Objective: To evaluate the applicability of an algorithm to support conscious and safe decisions about maintaining or not perineal integrity in childbirth care. Materials and method: Applied research of technological development. Relevant information acquired in the literature led to the initial algorithm design, which senior healthcare professionals reviewed and validated. In order to evaluate its applicability on the field, this algorithm based the writing of an online mobile decision support system (DSS) prototype. After approval by the Research Ethics Committee, a pilot test took place: obstetric nurses of a public hospital in São Paulo made use of the algorithm in the form of the mobile DSS prototype for two months to support their decisions during 305 vaginal births. Nurses filled out assessment forms about the applicability of DSS. Results: Ten out of twelve study participating professionals declared they would certainly recommend DSS use during perineal evaluation to fellow nurses. Two declared being uncertain about its usage. The study’s data show concordance between DSS suggested procedure and professional’s decision in 93.1% of deliveries. When professionals decided to follow DSS's recommendation, results were favorable to mothers: unfavorable cases, like 2nd or 3rd-degree postpartum laceration, remained as low as 13.4%. Contrarily, when professionals decided not to follow DSS recommendations, such unfavorable cases’ frequency raised to 28.6%. Regarding newborn unfavorable scenarios, like 5-minute Apgar score scoring less than 7, when professionals decided to follow DSS’ recommendations incidence remained as low as 0.4%. That rate raised to 9.5% when professionals did not follow the system’s recommendations. There is a correlation between conduct divergence and number of adverse events (p = 0.001): when DSS recommendation was followed by participating professionals, the incidence of adverse events topped 33.3%. On the other hand, when participants’ actions diverged from DSS recommendation, incidence raised to 66.7%. Thus, it is clear adverse events incidence tends to be lower when DSS recommendations are followed. Conclusion: The proposed Algorithm, implemented as a mobile DSS prototype for perineal assessment, proved to be an applicable and useful tool to guide professionals during delivery care. We believe the continuity of this study may lead to significant improvement and utility of the algorithm and its implementations through more elaborated Decision Support Systems.