Öz
Intrapartum period is a very important period in terms of mother and fetus health. The purpose of applications made in this period is to ensure that the labour is performed in its normal physiology. Today the focus is on the applications and necessity of intrapartum period. In the context of evidence-based studies, while trying to get away from routine practices (routine enema, perineal shaving, routine episiotomy, supine position, restriction of oral intake, etc.) the search for alternative method to routine practices (limited episiotomy, promotion of upright positions, oral fluid administration, etc.) are ongoing.The American College of Obstetricians and Gynecologists (ACOG, 2016) recommends limited episiotomy instead of routine episiotomy in intrapartum period. In recent years, the practice of routine episiotomy has begun to be abandoned and the frequency of episiotomy varies between 54% and 92.3% for nulliparas and between 6% and 12% for multiparas. In our country, studies on the frequency of episiotomy are limited and studies show that the frequency of episiotomy is between 92% and 96.7% for nulliparas and between 51.8% and 72% for multiparas.There are various applications in the literature to reduce the incidence of episiotomy. These applications include perineal massage, hot application to the perineum, birth positions, hand maneuvers and pushing methods. Perineal massage attracts attention as a method very up to date and effective which aims to increase the perineal flexibility, to perineal lacerations and to decrease the incidence of episiotomy. For this reason, this review study has been carried out in accordance with the current literature to increase sensitivity to the subject and to guide health professionals by drawing attention to perineal massage application which aims to decrease episiotomy rates.
Anahtar Kelimeler
Kaynakça
- 1. Çetin A. (2012): Çetin Kadın Hastalıkları ve Doğum El Kitabı. 1. Baskı. Bursa, Sertan Yayıncılık, s.386-390. 2. Taşkın L. (2016): Doğum ve Kadın Sağlığı Hemşireliği, Genişletilmiş 13. Baskı, Ankara, Akademisyen Tıp Kitapevi, s.301-303. 3. Albers, LL., Sedler, KD., Bedrick, EJ., Teaf, D., Peralta, P. (2005): Midwifery care measures in the second stage of labor and reduction of genital tract trauma at birth: a randomized trial. J Midwifery Womens Health; 50(5): 365-372. 4. Attarha, M., Vakillian, K., Rozbahany, N., Bekhradi, R. (2009): Effect of perineal massage with lavender essence on episiotomy and laceration. J Babol Univ Med Sci; 11(4); 25-30. 5. Carroli, G., Mignini, L. (2009): Episiotomy for vaginal birth. Cochrane Database Syst Rev; (1):CD000081. doi: 10.1002/14651858.CD000081.pub2. 6. Rathfish, YG., Güngör, İ. (2009): Doğum eyleminin birinci evresinin yönetiminde kanıta dayalı uygulamalar. HEMAR-G; 11(3): 53-64. 7. Räisänen, S., Vehvila¨inen-Julkunen, K., Heinonen, S. (2010): Need for and consequences of episiotomy in vaginal birth: a critical approach. Midwifery; 26(3): 348-356. 8. Aasheim, V., Nilsen, AB., Lukasse, M., Reinar, LM. (2011): Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database Syst Rev; (12):CD006672. doi: 10.1002/14651858.CD006672.pub2. 9. Beckmann, MM., Stock, OM. (2013): Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev;(4):CD005123. doi: 10.1002/14651858.CD005123.pub3. 10. Hernández Pérez, J., Azón López, E., Mir Ramos, E., Peinado Berzosa, R., Val Lechuz, B., Mérida Donoso, A. (2014): Factors affecting the performance of a selective episiotomy in nulliparous women. Enfermeria Global;13(3):398-424. 11. Zare, O., Pasha, H., Faramarzi, M. (2014): Effect of perineal massage on the incidence of episiotomy and perineal laceration. Health; 6(1):10-14. 12. Başgöl, Ş., Beji, NK. (2015): Doğum eyleminin birinci evresinde sık yapılan uygulamalar ve kanıta dayalı yaklaşım. Düzce Üniv Sağ Bil Ens Derg; 5(2): 32-39. 13. Başgöl, Ş., Beji, NK. (2015): Doğum eyleminin ikinci ve üçüncü evresinde sık yapılan uygulamalar ve kanıta dayalı yaklaşım. Düzce Üniv Sağ Bil Ens Derg; 5(3): 66-71. 14. Demirel, G., Gölbaşı, Z. (2015): Effect of perineal massage on the rate of episiotomy and perineal tearing. Int J Gynaecol Obstet; 131 (2):183-186. 15. Berkowitz, LR., Foust-Wright, CE. (2016): Approach to episiotomy. UpToDate; Available from: https://www.uptodate.com/contents/approach-to-episiotomy/print 16. Al-Ghammari, K., Al-Riyami, Z., Al-Moqbali, M., Al-Marjabi, F., Al-Mahrouqi, B., Al-Khatri A., Al-Khasawneh, EM. (2016): Predictors of routine episiotomy in primigravida women in Oman. Appl Nurs Res; 29: 131-135. 17. Güngör, İ., Rathfish, YG. (2009): Normal doğum eyleminin ikinci ve üçüncü evresinde kanıta dayalı uygulamalar. HEMAR-G; 11(2): 56-65. 18. RCOG, (2012): Episiotomy. Available from: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/episiotomy---query-bank/ 19. ACOG, 2016, Ob-Gyns Can Prevent and Manage Obstetric Lacerations During Vaginal Delivery, Says New ACOG Practice Bulletin, Available from: http://www.acog.org/About-ACOG/News-Room/News-Releases/2016/Ob-Gyns-Can-Prevent-and-Manage-Obstetric-Lacerations 20. SOGC, 2004, Guidelines For Operative Vaginal Birth, No: 148, Available from: https://sogc.org/wp-content/uploads/2013/01/148E-CPG-August2004.pdf 21. Althabe, F., Belizan, JM., Bergel E. (2002): Episiotomy rates in primiparous women in latin america: hospital based descriptive study. BMJ; 324(7343): 945-946. 22. Van Den Bergh, JE., Sueters, M., Segaar, M., Van Roosmalen, J. (2003): Determinants of episiotomy in rural Zimbabwe. Acta Obstet Gynecol Scand; 82(10): 966-968. 23. Izuka, EO., Dim, CC., Chigbu, CO., Obiora-Izuka, CE. (2014): Prevalence and predictors of episiotomy among women at first birth in Enugu, South-East Nigeria. Ann Med Health Sci Res; 4(6): 928-932. 24. Karaçam, Z., Eroğlu, K. (2003): Effects of episiotomy on bonding and mother's health. J Adv Nur; 43(4): 384-394. 25. Şahin, NH., Yıldırım, G., Aslan, E. (2007): Evaluating the second stages of deliveries maternity hospital. Turkiye Klinikleri J Gynecol Obstet; 17(1):37-43. 26. Sayıner, FD., Demirci, N. (2007): Prenatal Perineal Masajın Vaginal Doğumlarda Etkinliği, İÜFN Hem Derg; 15(60):146-154. 27. Mei-dan, E., Walfisch, A., Raz, I., Levy, A., Hallak, M. (2008): Perineal massage during pregnancy: a prospective controlled trial. IMAJ; 10(7): 499-502. 28. Foroughipour, A., Firuzeh, F., Ghahiri, A., Norbakhsh, V., Heidari, T. (2011): The effect of perineal control with hands-on and hand-poised methods on perineal trauma and delivery outcome. J Res Med Sci; 16(8): 1040–1046. 29. Fahami, F., Shokoohi, Z., Kianpour, M. (2012): The effects of perineal management techniques on labor complications. Iran J Nurs Midwifery Res; 17(1): 52-57. 30. Rozita, R., Saatsaz, S., Chan, YH., Nia, HS. (2014): A comparison of the “hands-off” and “hands-on” methods to reduce perineal lacerations: a randomised clinical trial. J Obstet Gynaecol India; 64(6): 425-429. 31. Lemos, A., Amorim, MM., Dornelas de Andrade, A., de Souza, AI., Cabral Filho, JE., Correia, JB. (2015): Pushing/bearing down methods for the second stage of labour. Cochrane Database Syst Rev; 10: CD009124. 32. Lodge, F., Haith-Cooper, M. (2016): The effect of maternal position at birth on perineal trauma: a systematic review. BJM; 24(3):172-180. 33. Warmink-Perdijik, WD., Koelewijn, JM., de Jonge, A., van Diem, MT., Lagro-Janssen, AL. (2016): Better perineal outcomes in sitting birthing position cannot be explained by changing from upright to supine position for performing an episiotomy. Midwifery; 34: 1-6. 34. Stamp, G., Kruzins, G., Crowther, C. (2001): Perineal massage in labour and prevention of perineal trauma: randomised controlled trial. BMJ; 322(7297):1277-1280. 35. Mohamed, ML., Mohamed, SL., Gonied, AS. (2011): Comparative study between two perineal management techniques used to reduce perineal trauma during 2nd stage of labor. J Am Sci; 7(11): 228-232. 36. Karaçam, Z., Ekmen, H., Çalişir, H. (2012): The use of perineal massage in the second stage of labor and follow-up of postpartum perineal outcomes. Health Care Women Int; 33(8):697-718. 37. Harlev, A., Pariente, G., Kessous, R., Aricha-Tamir, B., Weintraub, AY., Eshkoli, T. Dukler, D., Ayun, SB., Sheiner, E. (2013): Can we find the perfect oil to protect the perineum? A randomized-controlled double-blind trial. J Matern Fetal Neonatal Med; 26(13): 1328-1331. 38. Geranmayeh, M., Habibabadi, ZR., Fallahkish, B., Farahani, A., Khakbazan, Z., Mehran, A. (2012): Reducing perineal trauma through perineal massage with vaseline in second stage of labor. Arch Gynecol Obstet; 285(1):77-81. 39. Araújo, NM., Oliveira, SMJV. (2008): The use of liquid petroleum jelly in the prevention of perineal lacerations during birth. Rev Lat Am Enfermagem; 16(3): 375-381. 40. Schaub, AF., Litschgi, M., Hoesli, I., Holzgreve, W., Bleul, U., Geissbühler, V. (2008): Obstetric gel shortens second stage of labor and prevents perineal trauma in nulliparous women: a randomized controlled trial on labor facilitation. J Perinat Med; 36(2): 129-135.
Öz
İntrapartum dönem anne ve fetüs sağlığı açısından oldukça önemli bir dönemdir. Bu dönemde yapılan uygulamaların amacı doğum eyleminin normal fizyolojisinde gerçekleşmesini sağlamaktır. Günümüzde intrapartum dönemde yapılan uygulamalar ve gerekliliği üzerine odaklanılmıştır. Kanıt temelli çalışmalar eşliğinde, bir yandan rutin uygulamalardan uzaklaşılmaya çalışılırken (rutin lavman, perineal tıraş uygulaması, rutin epizyotomi, sırtüstü pozisyon, oral alımının kısıtlanması vb.), diğer yandan rutin uygulamalara alternatif olacak yöntem (sınırlı epizyotomi, dik pozisyonların teşviki, oral yoldan sıvı alımının sağlanması vb.) arayışları devam etmektedir. Amerikan Jinekoloji ve Obstetrik Akademisi (ACOG, 2016) intrapartum dönemde rutin epizyotomi yerine sınırlı epizyotomi uygulamasını önermektedir. Son yıllarda rutin epizyotomi uygulanmasından vazgeçilmeye başlanmış olup, yapılan çalışmalarda epizyotomi sıklığı nulliparlar için %54 ile %92.3 arasında, multiparlar için %6 ile %12 arasında değişmektedir. Ülkemizde epizyotomi uygulanma sıklığına yönelik çalışmalar sınırlı sayıda olup, yapılan çalışmalarda epizyotomi uygulanma sıklığı nullipar için %92 ile %96,7 arasında, multipar için %51,8 ile %72 arasındadır. Literatürde epizyotomi insidansını azaltmaya yönelik yapılan çeşitli uygulamalara rastlanmaktadır. Bu uygulamalar arasında perineal masaj, perineye sıcak uygulama, doğum pozisyonları, el manevraları ve ıkınma yöntemi yer almaktadır. Perineal masaj, perine esnekliğini artırmak, perineal laserasyonları ve epizyotomi insidansını azaltmaya yönelik yapılan uygulamalar içerisinde çok güncel ve etkinliği ortaya konulmaya çalışılan bir yöntem olarak dikkat çekmektedir. Bu nedenle bu derleme çalışması, ilgili güncel literatür doğrultusunda epizyotomi oranlarını azaltmaya yönelik yapılan perineal masaj uygulamasına dikkat çekerek konuya olan duyarlılığın artırılması ve sağlık profesyonellerine yön gösterici olması amacıyla ele alınmıştır.
Anahtar Kelimeler
Kaynakça
- 1. Çetin A. (2012): Çetin Kadın Hastalıkları ve Doğum El Kitabı. 1. Baskı. Bursa, Sertan Yayıncılık, s.386-390. 2. Taşkın L. (2016): Doğum ve Kadın Sağlığı Hemşireliği, Genişletilmiş 13. Baskı, Ankara, Akademisyen Tıp Kitapevi, s.301-303. 3. Albers, LL., Sedler, KD., Bedrick, EJ., Teaf, D., Peralta, P. (2005): Midwifery care measures in the second stage of labor and reduction of genital tract trauma at birth: a randomized trial. J Midwifery Womens Health; 50(5): 365-372. 4. Attarha, M., Vakillian, K., Rozbahany, N., Bekhradi, R. (2009): Effect of perineal massage with lavender essence on episiotomy and laceration. J Babol Univ Med Sci; 11(4); 25-30. 5. Carroli, G., Mignini, L. (2009): Episiotomy for vaginal birth. Cochrane Database Syst Rev; (1):CD000081. doi: 10.1002/14651858.CD000081.pub2. 6. Rathfish, YG., Güngör, İ. (2009): Doğum eyleminin birinci evresinin yönetiminde kanıta dayalı uygulamalar. HEMAR-G; 11(3): 53-64. 7. Räisänen, S., Vehvila¨inen-Julkunen, K., Heinonen, S. (2010): Need for and consequences of episiotomy in vaginal birth: a critical approach. Midwifery; 26(3): 348-356. 8. Aasheim, V., Nilsen, AB., Lukasse, M., Reinar, LM. (2011): Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database Syst Rev; (12):CD006672. doi: 10.1002/14651858.CD006672.pub2. 9. Beckmann, MM., Stock, OM. (2013): Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev;(4):CD005123. doi: 10.1002/14651858.CD005123.pub3. 10. Hernández Pérez, J., Azón López, E., Mir Ramos, E., Peinado Berzosa, R., Val Lechuz, B., Mérida Donoso, A. (2014): Factors affecting the performance of a selective episiotomy in nulliparous women. Enfermeria Global;13(3):398-424. 11. Zare, O., Pasha, H., Faramarzi, M. (2014): Effect of perineal massage on the incidence of episiotomy and perineal laceration. Health; 6(1):10-14. 12. Başgöl, Ş., Beji, NK. (2015): Doğum eyleminin birinci evresinde sık yapılan uygulamalar ve kanıta dayalı yaklaşım. Düzce Üniv Sağ Bil Ens Derg; 5(2): 32-39. 13. Başgöl, Ş., Beji, NK. (2015): Doğum eyleminin ikinci ve üçüncü evresinde sık yapılan uygulamalar ve kanıta dayalı yaklaşım. Düzce Üniv Sağ Bil Ens Derg; 5(3): 66-71. 14. Demirel, G., Gölbaşı, Z. (2015): Effect of perineal massage on the rate of episiotomy and perineal tearing. Int J Gynaecol Obstet; 131 (2):183-186. 15. Berkowitz, LR., Foust-Wright, CE. (2016): Approach to episiotomy. UpToDate; Available from: https://www.uptodate.com/contents/approach-to-episiotomy/print 16. Al-Ghammari, K., Al-Riyami, Z., Al-Moqbali, M., Al-Marjabi, F., Al-Mahrouqi, B., Al-Khatri A., Al-Khasawneh, EM. (2016): Predictors of routine episiotomy in primigravida women in Oman. Appl Nurs Res; 29: 131-135. 17. Güngör, İ., Rathfish, YG. (2009): Normal doğum eyleminin ikinci ve üçüncü evresinde kanıta dayalı uygulamalar. HEMAR-G; 11(2): 56-65. 18. RCOG, (2012): Episiotomy. Available from: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/episiotomy---query-bank/ 19. ACOG, 2016, Ob-Gyns Can Prevent and Manage Obstetric Lacerations During Vaginal Delivery, Says New ACOG Practice Bulletin, Available from: http://www.acog.org/About-ACOG/News-Room/News-Releases/2016/Ob-Gyns-Can-Prevent-and-Manage-Obstetric-Lacerations 20. SOGC, 2004, Guidelines For Operative Vaginal Birth, No: 148, Available from: https://sogc.org/wp-content/uploads/2013/01/148E-CPG-August2004.pdf 21. Althabe, F., Belizan, JM., Bergel E. (2002): Episiotomy rates in primiparous women in latin america: hospital based descriptive study. BMJ; 324(7343): 945-946. 22. Van Den Bergh, JE., Sueters, M., Segaar, M., Van Roosmalen, J. (2003): Determinants of episiotomy in rural Zimbabwe. Acta Obstet Gynecol Scand; 82(10): 966-968. 23. Izuka, EO., Dim, CC., Chigbu, CO., Obiora-Izuka, CE. (2014): Prevalence and predictors of episiotomy among women at first birth in Enugu, South-East Nigeria. Ann Med Health Sci Res; 4(6): 928-932. 24. Karaçam, Z., Eroğlu, K. (2003): Effects of episiotomy on bonding and mother's health. J Adv Nur; 43(4): 384-394. 25. Şahin, NH., Yıldırım, G., Aslan, E. (2007): Evaluating the second stages of deliveries maternity hospital. Turkiye Klinikleri J Gynecol Obstet; 17(1):37-43. 26. Sayıner, FD., Demirci, N. (2007): Prenatal Perineal Masajın Vaginal Doğumlarda Etkinliği, İÜFN Hem Derg; 15(60):146-154. 27. Mei-dan, E., Walfisch, A., Raz, I., Levy, A., Hallak, M. (2008): Perineal massage during pregnancy: a prospective controlled trial. IMAJ; 10(7): 499-502. 28. Foroughipour, A., Firuzeh, F., Ghahiri, A., Norbakhsh, V., Heidari, T. (2011): The effect of perineal control with hands-on and hand-poised methods on perineal trauma and delivery outcome. J Res Med Sci; 16(8): 1040–1046. 29. Fahami, F., Shokoohi, Z., Kianpour, M. (2012): The effects of perineal management techniques on labor complications. Iran J Nurs Midwifery Res; 17(1): 52-57. 30. Rozita, R., Saatsaz, S., Chan, YH., Nia, HS. (2014): A comparison of the “hands-off” and “hands-on” methods to reduce perineal lacerations: a randomised clinical trial. J Obstet Gynaecol India; 64(6): 425-429. 31. Lemos, A., Amorim, MM., Dornelas de Andrade, A., de Souza, AI., Cabral Filho, JE., Correia, JB. (2015): Pushing/bearing down methods for the second stage of labour. Cochrane Database Syst Rev; 10: CD009124. 32. Lodge, F., Haith-Cooper, M. (2016): The effect of maternal position at birth on perineal trauma: a systematic review. BJM; 24(3):172-180. 33. Warmink-Perdijik, WD., Koelewijn, JM., de Jonge, A., van Diem, MT., Lagro-Janssen, AL. (2016): Better perineal outcomes in sitting birthing position cannot be explained by changing from upright to supine position for performing an episiotomy. Midwifery; 34: 1-6. 34. Stamp, G., Kruzins, G., Crowther, C. (2001): Perineal massage in labour and prevention of perineal trauma: randomised controlled trial. BMJ; 322(7297):1277-1280. 35. Mohamed, ML., Mohamed, SL., Gonied, AS. (2011): Comparative study between two perineal management techniques used to reduce perineal trauma during 2nd stage of labor. J Am Sci; 7(11): 228-232. 36. Karaçam, Z., Ekmen, H., Çalişir, H. (2012): The use of perineal massage in the second stage of labor and follow-up of postpartum perineal outcomes. Health Care Women Int; 33(8):697-718. 37. Harlev, A., Pariente, G., Kessous, R., Aricha-Tamir, B., Weintraub, AY., Eshkoli, T. Dukler, D., Ayun, SB., Sheiner, E. (2013): Can we find the perfect oil to protect the perineum? A randomized-controlled double-blind trial. J Matern Fetal Neonatal Med; 26(13): 1328-1331. 38. Geranmayeh, M., Habibabadi, ZR., Fallahkish, B., Farahani, A., Khakbazan, Z., Mehran, A. (2012): Reducing perineal trauma through perineal massage with vaseline in second stage of labor. Arch Gynecol Obstet; 285(1):77-81. 39. Araújo, NM., Oliveira, SMJV. (2008): The use of liquid petroleum jelly in the prevention of perineal lacerations during birth. Rev Lat Am Enfermagem; 16(3): 375-381. 40. Schaub, AF., Litschgi, M., Hoesli, I., Holzgreve, W., Bleul, U., Geissbühler, V. (2008): Obstetric gel shortens second stage of labor and prevents perineal trauma in nulliparous women: a randomized controlled trial on labor facilitation. J Perinat Med; 36(2): 129-135.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Derleme |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Ağustos 2018 |
| Yayımlandığı Sayı | Yıl 2018Cilt: 3 Sayı: 1 |
