Influ?ncia da cirurgia mam?ria e altera??es da mama sobre o sucesso da amamenta??o em beb?s nascidos por cesariana eletiva

• Main Author: Kuchenbecker , Grete Marta
• Other Authors: Fiori , Humberto Holmer
• Format: Others
• Language: Portuguese
• Published: Pontif?cia Universidade Cat?lica do Rio Grande do Sul 2015
• Subjects: MEDICINA; PEDIATRIA; AMAMENTA??O; CES?REA; MAMOPLASTIA; HOSPITAIS; CIENCIAS DA SAUDE::MEDICINA
• Online Access: http://tede2.pucrs.br/tede2/handle/tede/5991

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS ([e-mail]) on 2015-05-12T13:23:39Z No. of bitstreams: 1 468409 - Texto Parcial.pdf: 238946 bytes, checksum: 6a25850d96d7aa7cb5d5aca9f7acb414 (MD5) === Made available in DSpace on 2015-05-12T13:23:39Z (GMT). No. of bitstreams: 1 468409 - Texto Parcial.pdf: 238946 bytes, checksum: 6a25850d96d7aa7cb5d5aca9f7acb414 (MD5) Previous issue date: 2015-03-05 === Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES === INTRODUCTION : Breast changes can have a significant impact on breastfeeding success. In Brazil the prevalence of breast surgery is higher among the population of private health system users. Another risk factor that can interfere in successful breastfeeding in these patients is the high rate of cesarean birth, which in turn may be associated with nipple trauma.OBJECTIVES : The aim of this study was to evaluate the influence of breast surgery and other breast changes on breastfeeding success in patients undergoing elective cesarean section at a private hospital.METHODS : We included in the study newborns undergoing elective cesarean section equal to or greater than 37 weeks' gestation. Data were obtained from hospital records, interviews with the mothers during their stay in the maternity ward and via telephone at the end of the second week and three months after delivery. The variables were gestational age, presence of partners, number of pregnancies, type of nipple, previous breastfeeding, pain during breastfeeding, complementary prescription, silicone breast implants, breast reduction surgery, and bleeding nipples fissures. A logistic regression model was adjusted considering exclusive breastfeeding response at three months as a variable and as dependent variables those significant at the 30% level in previous analysis.RESULTS : The study sample consisted of 1117 newborns and their mothers whose deliveries occurred consecutively and met the inclusion criteria. Of the 1117 mothers, 741 (66.34%) had exclusive breastfeeding at three months of life. All the variables studied represented significant risk factors for the lack of exclusive breastfeeding at three months, except pain during breastfeeding and presence of cracks. In multivariate analysis, the variables that remained significant after adjusting for confounding factors were use of food supplements in the first 24 hours of life (odds ratio [OR] 2.11, confidence interval [CI] 1.62 95% 2.75); flat nipple (OR 2.40, 95% CI 1.58 to 3.65); silicone breast implant (OR 1.88, 95% CI 1.24 to 2.85); and breast reduction surgery (OR 5.65, 95% CI 2.92 to 10.85).CONCLUSIONS : In this population of patients undergoing elective cesarean section in a private health service, breast surgeries, especially breast reduction, were important risk factors for the absence of exclusive breastfeeding at three months postpartum. Another important risk factor for early weaning was the type of flat nipples. === INTRODU??O : Altera??es da mama podem ter impacto significativo sobre o sucesso da amamenta??o. No Brasil, na popula??o usu?ria do sistema privado de sa?de, a preval?ncia de cirurgias mam?rias ? alta. Outro fator de risco que pode interferir no sucesso da amamenta??o nessas pacientes ? a alta taxa de parto ces?reo, que por sua vez pode estar associado a traumas mamilares.OBJETIVOS : O objetivo deste estudo foi avaliar a influ?ncia da cirurgia mam?ria e de outras altera??es da mama no sucesso da amamenta??o em pacientes submetidas ? cesariana eletiva em um hospital privado.M?TODOS : Foram inclu?dos no estudo rec?m-nascidos por cesariana eletiva, com idade gestacional igual ou maior que 37 semanas. Os dados foram obtidos do prontu?rio hospitalar, de entrevistas com as m?es durante a estadia na maternidade e por contatos telef?nicos no final da segunda semana e tr?s meses ap?s o parto. As vari?veis em estudo foram idade gestacional, presen?a de companheiro, n?mero de gesta??es, tipo de mamilo, amamenta??o pr?via, dor durante a amamenta??o, prescri??o de complemento, implante de silicone de mama, cirurgia de redu??o mam?ria, fissura mam?ria e sangramento mam?rio. Um modelo de regress?o log?stica foi ajustado tendo como vari?vel de resposta amamenta??o exclusiva aos tr?s meses e como vari?veis dependentes as significativas ao n?vel de 30% nas an?lises anteriores.RESULTADOS : A amostra do estudo foi composta por 1117 rec?m-nascidos e suas m?es, cujos partos ocorreram de forma consecutiva e que atendiam aos crit?rios de inclus?o. Das 1117 m?es, 741 (66,34%) mantiveram amamenta??o exclusiva aos tr?s meses de vida. Todas as vari?veis estudadas representaram fatores de risco significativos para aus?ncia de aleitamento materno exclusivo aos tr?s meses, exceto dor durante a amamenta??o e presen?a de fissuras. Na an?lise multivariada, as vari?veis que se mantiveram significativas ap?s o ajuste para fatores de confus?o foram uso de complemento alimentar nas primeiras 24 horas de vida (odds ratio [OR] 2,11, intervalo de confian?a [IC] 95% 1,62-2,75); mamilo plano (OR 2,40, IC95% 1,58-3,65); implante de silicone mam?rio (OR 1,88, IC95% 1,24-2,85); e cirurgia de redu??o de mama (OR 5,65, IC95% 2,92-10,85).CONCLUS?ES : Nessa popula??o de pacientes usu?rias do sistema privado de sa?de, submetidas a parto ces?reo, as cirurgias mam?rias, especialmente a redu??o de mama, foram importantes fatores de risco para aus?ncia de amamenta??o exclusiva aos tr?s meses p?s-parto. Outro importante fator de risco para desmame precoce foi o mamilo do tipo plano.