Labor is the triggering of several physiological responses that results in the placental and fetal expulsion. Since 1985, the international healthcare community has considered the ideal rate for caesarean sections to be between 10-15% due to the benefits to child-mother binomial [1]. Thus, in the last decade there was a movement to increase the vaginal rates. The use of operative and assisted vaginal delivery, with episiotomy, vacuum or forceps, are believed to carry increased risks of perineal trauma and it is associated with pelvic floor disorders and should be restricted to complicated cases [2]. So, the aim of this study was to evaluated the mode of delivery through 8 years of assistance.

Retrospective cohort study consulting the databank of an low-risk maternity, from January 2011 to December 2018. The project was approved by the Research Ethics Committee (CAAE: 11479119.9.0000.5406) and the participants signed the Free and Informed Consent Form. The clinical and obstetric data collected were: maternal age; gestational age of delivery; number of previous pregnancies; number of prenatal consultations; labor induction; labor duration; interventions during the vaginal delivery and route of delivery.

Were analyzed 9893 (100%) records of the maternity. The ages of the majority of parturient were between 19 and 34 years old. The predominant gestational age was between 38 and 41 weeks. Concern parity 3957 (40%) were primiparous and 3066 (37%) were multiparous. The number of predominant prenatal consultations was between 7 and 9. The predominant mode of delivery was vaginal mode 6232 (63%) and 3660 (37%) cesarean mode. The distribution of vaginal delivery mode along 8 years of obstetric assistance are expressed on figure 1.

Year-over-year analysis showed that there was a gradual decrease in the frequency of episiotomy, and from 2011 to 2018 there was a change from 3732 (59.9%) to 2305 (37.5%), respectively, representing a decrease of 1395 (22,4%). There was an increase in births without interventions and perineal complications in 2011 from 1121 (18.4%) to 2018 1994 (32%), with an increase of 847 (13.6%). Regarding Grade 1 laceration, its frequency fluctuated over the years, ranging from 1003 (16.1%) to 1769 (28.4%). It was observed that in 2016 and 2017 were the years that had the highest prevalence of this occurrence. The same behaviour occurred with grade 2 lacerations, ranging from 211 (3.4%) to 891 (14.3%). It was observed that in 2014, 2015 and 2016 were the years that had the highest prevalence of occurrence. Grade 3 and 4 laceration and the occurrence of episiotomy with laceration decreased steadily, culminating in 2018 without registered cases. It was observed that 2016 was the year with the highest number of episiotomy with laceration. The use of forceps ranged from 0 to 43 (0% to 0.7%), and in 2015 there were no cases.

We concluded that the average of 8 years the caesarean section rate is higher than recommended. Although the episiotomy still higher it is decreasing along time, followed by an increase of laceration grade 1 and 2 and the no interventional vaginal delivery. As perineal interventions during vaginal delivery can be associated with maternal pelvic floor dysfunctions, strategies that reduce the need for operative vaginal delivery should be implemented.

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