Diástase dos músculos retoabdominais no puerpério imediato de primíparas e multíparas após o parto vaginal

O presente estudo comparou a diástase dos músculos retoabdominais (DMRA) supra-umbilical (SU) e infra-umbilical (IU) entre primíparas e multíparas, correlacionou com a paridade, idade materna, índice de massa corporal (IMC) e tempo de trabalho de parto (TTP). Foram incluídas 100 primíparas com idade de 21,0±4,4 anos e 100 multíparas com idade de 27,2±6,2 anos submetidas ao parto vaginal. A DMRA foi avaliada nos pontos 4,5 cm acima e abaixo da cicatriz umbilical com o paquímetro. Foram empregados o test t de Student e correlação de Pearson, adotando-se pThe present study compared the diastasis of rectus abdominis muscle (DRAM) above and below umbilicus in primiparous and multiparous and correlated these with maternal's age, number of births, body mass index (BMI) and labour. Women's submitted to a vaginal delivery were included: 100 primiparous women (aged 21.0±4.4 years) and 100 multiparous women (27.2±6.2 years). The DRAM was measurements 4.5 cm above and below de umbilical scar with a caliper. Statistical analysis was conducted by Student's t-test for dependent samples and Pearson´s correlation, considering p<0.05. The DRAM above umbilicus in primiparous was 2.3±1.2 cm and 2.6± 1.4 cm in multiparous and below umbilicus were 1.2±0.9 cm and 1.2±1.0, showing no difference. The DRAM above umbilicus was higher than below in primiparous and multiparous (p<0.0001). It was found a significant association between the DRAM above and below the umbilicus, and DRAM above umbilicus and maternal's age and number of births. No correlations with the BMI and labor were observed. DRAM above umbilicus was significantly greater in both groups, but similar when primiparous and multiparous were compared. A significant correlation was observed among DRAM above and below umbilicus, DRAM above umbilicus and maternal's age and number of births

Suture repair of umbilical hernia during caesarean section: a case-control study

PURPOSE: The objective of this study was to investigate the additional burdens in terms of pain, prolongation of surgery and morbidity which is added to elective caesarean section if umbilical hernia suture repair is performed simultaneously. Secondly, patient's satisfaction and hernia recurrence rate were assessed. METHODS: Consecutive women with symptomatic umbilical hernia undergoing internal or external suture repair during elective caesarean were included in this retrospective cohort-control study. Data on post-operative pain, duration of surgery and morbidity of a combined procedure were collected. These patients were matched 1:10 to women undergoing caesarean section only. Additionally, two subgroups were assessed separately: external and internal suture hernia repair. These subgroups were compared for patient's satisfaction, cosmesis, body image and recurrence rate. RESULTS: Fourteen patients with a mean age of 37 years were analysed. Internal suture repair (n = 7) prolonged caesarean section by 20 min (p = 0.001) and external suture repair (n = 7) by 34 min (p < 0.0001). Suture repair did not increase morphine use (0.38 ± 0.2 vs. 0.4 ± 02 mg/kg body weight), had no procedure-related morbidity and prolonged hospitalization by 0.5 days (p = 0.01). At a median follow-up of 37 (5-125) months, two recurrences in each surgical technique, internal and external suture repair, occurred (28 %). Body image and cosmesis score showed a higher level of functioning in internal suture repair (p = 0.02; p = 0.04). DISCUSSION: Despite a high recurrence rate, internal suture repair of a symptomatic umbilical hernia during elective caesarean section should be offered to women if requested. No additional morbidity or scar is added to caesarean section. Internal repair is faster, and cosmetic results are better, additional skin or fascia dissection is avoided, and it seems to be as effective as an external approach. Yet, women must be informed on the high recurrence rate