-

Abstract

Evidence-based practices, purpose standardization of health care by assimilating all the information of the existingscientific literature in the best way. Health professionals aim to provide safe, standard and quality care withimplementation of evidence-based practice in labor. In this process, in order to protect and promote the health of motherand fetus, to take control/prevention the threatening health risks are extremely important taking of evidence-basedpractice guidelines and to be integrated with clinical. In this review, common practices and evidence-based approachesin the first stage of labor will be discussed with meta-analysis of randomized controlled trials and systematic reviews.Practices; birth of the place, home-like births birth centers, management of birth by midwife/doctor, fetal monitoring,ultrasound, partograph, perineal shaving, vaginal cleaning with chlorhexidine, vaginal examination, amniotomy, oralintake, intravenous fluids, oxytocin, labor position, mobilization, pain management and being in water in first stage oflabour will be discussed in this title. In evidence, delayed admission into delivery room, upright position at birth, andtaking liquid food etc. in low risk pregnant are recommended, when routine amniotomy, enemas, and perineal shavingetc. is not recommended

Keywords

• First stage of labor; evidence-based approaches; labor; evidence-based practices

Doğum Eyleminin Birinci Evresinde Sık Yapılan Uygulamalar ve Kanıta Dayalı Yaklaşım

Abstract

Kanıta dayalı uygulamalar, var olan bilimsel literatürün sağladığı tüm bilgileri en iyi şekilde özümseyerek sağlık hizmetlerinin standartlaşmasını amaçlar. Doğum eyleminde kanıta dayalı uygulamaların gerçekleştirilmesi ile sağlık profesyonelleri tarafından güvenli, standart ve nitelikli bakım verilmesi amaçlanır. Bu süreçte, anne ve fetüs sağlığını korumak ve desteklemek, sağlığı tehdit eden riskleri kontrol altına almak/önlenmek için kanıta dayalı uygulamaların rehber alınması ve klinik ile birleştirilmesi son derece önemlidir. Bu derlemede, doğum eyleminin birinci evresinde sık yapılan uygulamalar ve kanıta dayalı yaklaşımları, randomize kontrollü çalışmaların meta-analiz ve sistematik derleme sonuçları doğrultusunda tartışılacaktır. Uygulamalar; doğumun yapıldığı yer, doğum merkezlerinin ev ortamı sağlaması, doğumların ebe/hekim yönetiminde gerçekleştirilmesi, doğumhaneye kabul, fetal monitorizasyon, ultrason, partograf, perine tıraşı, klorheksidin ile vajinal temizlik, vajinal tuşe, amniyotomi, oral alım, intravenöz sıvılar, oksitosin, doğum pozisyonu, mobilizasyon, ağrı yönetimi ve birinci evrede suda bulunma başlıklarında tartışılacaktır. Kanıtlarda, doğumhaneye geç kabul, doğumda dik pozisyonlar ve düşük riskli gebelerin tanesiz sıvı gıda alması vb. uygulamalar desteklenirken, rutinde amniotomi uygulaması, lavman ve perine tıraşı vb. önerilmemektedir.

Keywords

• Doğumun birinci evresi; kanıta dayalı yaklaşım; doğum eylemi; kanıta dayalı uygulamalar

References

1. Rathfish YG, Güngör İ. Doğum eyleminin birinci evresinin yönetiminde kanıta dayalı uygulamalar. HEMAR-G. 2009; 11(3): 53-64.
2. Arslan H. Doğum eylemi. Coşkun A, editör. Kadın Sağlığı ve Hastalıları Hemşireliği El Kitabı. İstanbul: Koç Üniversitesi yayınları; 2012. s. 195-213.
3. Rcm.org.uk [Internet]. London: The Royal College of Midwives, 2012 [Cited: 02.04.2014]. Available from: https://www.rcm.org.uk/content/evidence-based guidelines.
4. Olsen O, Clausen JA. Planned hospital birth versus planned home birth. Cochrane Database of Systematic Reviews. 2012; 12(9): 1-26.
5. de Jonge A, Mesman JA, Manniën J, Zwart JJ, van Dillen J, van Roosmalen J. Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: Nationwide cohort study. BMJ. 2013; 346: f3263. doi: 10.1136/bmj.f3263.
6. Hodnett ED, Downe S, Walsh D. Alternative versus conventional institutional settings for birth. Cochrane Database Syst Rev. 2012; (8): CD000012. doi: 10.1002/14651858.CD000012.pub4.
7. Cadth.Ca [Internet]. Canadian: Canadian agency for drugs and technologies in health, 2013 [Cited: 30.03.2014]. http://www.cadth.ca/media/pdf/htis/jun- 2013/RB0593%20Midwives%20Final.pdf. from:
8. Homer CS. Home-like environments for labour and birth: benefits for women and babies. Evidence Based Medicine. 2013; 18(4): e32. doi: 10.1136/eb-2012- 101063.

9. Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev. 10.1002/14651858.CD004667.pub3. CD004667. doi:
10. Lauzon L, Hodnett ED. Labour assessment programs to delay admission to labour wards. Cochrane Database Syst Rev. 2001; (3): CD000936. (Edited in 2009).
11. Health.qld.gov.au [Internet]. Australia: Centre for Healthcare Improvement, 2012 [Cited: 31.03.2014]. Available http://www.health.qld.gov.au/qcg/documents /g_normbirth.pdf. from:
12. Creedon D, Akkerman D, Atwood L, Bates L, Harper C, Levin A, et al. Guideline.gov [Internet]. United States: Institute for Clinical Systems Improvement, 2013 http://www.guideline.gov/content.aspx?id=44346.
13. Chuma C, Kihunrwa A, Matovelo D, Mahendeka M. Labour management and Obstetric outcomes among pregnant women admitted in latent phase compared to active phase of labour at Bugando Medical Centre in Tanzania. BMC Pregnancy Childbirth. 2014; (14): 68. doi: 10.1186/1471-2393-14-68.
14. Bailit JL, Dierker L, Blanchard MH, Mercer BM. Outcomes of women presenting in active versus latent phases of spontaneous labour. British Journal of Obstetrics and Gynaecology. 2005; 105(1): 77-9.
15. Klein MC, Kelly A, Kaczorowski J, Grzybowski S. The effect of family physician timing of maternal admission on procedures in labour and maternal and infant morbidity. Journal of Obstetrics and Gynaecology Canada. 2004; 26(7): 641-5.
16. Alfirevic Z, Devane D, Gyte GM. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev. 2013; (5): CD006066. doi: 10.1002/14651858.CD006066.pub2.
17. East CE, Begg L, Colditz PB. Cochrane.org [Internet]. London: 31.03.2014]. http://summaries.Cochrane.org Available from:
18. /CD004075/fetal-pulse-oximetry-for-fetal-assessment-in- labour.
19. Miller D, Miller LA. Electronic fetal heart rate monitoring: applying principles of patient safety. American Journal of Obstetrics and Gynecology. 2012; 206(4): 278-83.
20. Funai E, Norwitz E. UpToDate [Internet]. Canada: Equity Ownership/Stock Options: Merck; Pfizer; Abbvie, 2014 [Updated: 2014 August 11; Cited: 2014 Mart http://www.uptodate.com/contents/management-of- normal-labor-and-delivery#H16 from:
21. Jones L. Cochrane.org [Internet]. London: Evidently Cochrane, 2012 [Cited: 31.03.2014]. Available from: http://evidentlyCochrane.wordpress.com/2013/07/03/fe tal-monitoring-in-labour-the-challenge-of-balancing- the-benefits-with-harms/.
22. Khunpradit S, Lumbiganon P, Laopaiboon M. Admission tests other than cardiotocography for fetal assessment during labour. Cochrane Database of Systematic Reviews. 2011; (6): CD008410. doi: 10.1002/14651858.CD008410.pub2.
23. Lavender T, Hart A, Smyth RMD. Effect of partogram use on outcomes for women in spontaneous labour at term. Cochrane Database of Systematic Reviews. 2013; (7): 10.1002/14651858.CD005461.pub4. doi:
24. Saglik.gov.tr [Internet]. Ankara: Ana Çocuk Sağlığı ve Aile Planlaması Genel Müdürlüğü; 2012 [Erişim tarihi: 30.03.2014]. http://www.saglik.gov.tr/TR/dosya/1- 74531/h/partograf-kullanimi-hakkinda-genelge.pdf.
25. Downe S, Gyte GML, Dahlen HG, Singata M. Routine vaginal examinations for assessing progress of labour to improve outcomes for women and babies at term. Cochrane Database of Systematic Reviews. 2013; (7): CD010088. doi: 10.1002/14651858.CD010088.pub2.
26. Bugg GJ, Siddiqui F, Thornton JG. Oxytocin versus no treatment or delayed treatment for slow progress in the first stage of spontaneous labour. Cochrane Database of Systematic Reviews. 2013; (6): CD007123. doi: 10.1002/14651858.CD007123.
27. Kenyon S, Tokumasu H, Dowswell T, Pledge D, Mori R. High-dose versus low-dose oxytocin for augmentation of delayed labour. Cochrane Database of Systematic Reviews. 2013; (7): CD007201. doi: 10.1002/14651858.CD007201.pub3.
28. Demirel G, Çelik DB. Doğal doğuma müdahale: sentetik oksitosin kullanımı. Sted. 2013; 22(4): 157-64.
29. Kelly AJ, Malik S, Smith L, Kavanagh J, Thomas J. Vaginal prostaglandin (PGE2 and PGF2a) for induction of labour at term. Cochrane Database of Systematic Reviews. (4): 10.1002/14651858.CD003101.pub2. CD003101. doi:
30. Alfirevic Z, Weeks A. Oral misoprostol for induction of labour. Cochrane Database of Systematic Reviews. 2006; 10.1002/14651858.CD001338.pub2. Assessed as up-to- date: 4 JUN 2008. CD001338. doi:
31. Smyth RMD, Markham C, Dowswell T. Amniotomy for shortening spontaneous labour. Cochrane Database of Systematic Reviews. 2013; (6): CD006167. doi: 10.1002/14651858.CD006167.pub4.
32. Singata M, Tranmer J, Gyte GML. Restricting oral fluid and food intake during labour. Cochrane Database of Systematic Reviews. 2013; (8): CD003930. doi: 10.1002/14651858.CD003930.pub3.
33. American College of Obstetricians and Gynecologists ACOG. Oral Intake During Labor. Committee Opinion No. 441. Obstet Gynecol 2009; 114(3): 714.
34. Dawood F, Dowswell T, Quenby S. Intravenous fluids for reducing the duration of labour in low risk nulliparous women. Cochrane Database of Systematic Reviews. (6): 10.1002/14651858.CD007715.pub2. CD007715. doi:
35. Reveiz L, Gaitán HG, Cuervo LG. Enemas during labour. Cochrane Database of Systematic Reviews. 2013; 10.1002/14651858.CD000330.pub4. CD000330. doi:
36. Basevi V, Lavender T. Routine perineal shaving on admission in labour. Cochrane Database of Systematic Reviews. 10.1002/14651858.CD001236. (4): CD001236.doi:
37. Kovavisarach E, Jirasettasiri P. Randomised controlled trial of perineal shaving versus hair cutting in parturients on admission in labor. J Med Assoc Thai. 2005; 88(9):1167-71.
38. Chen CY, Wang KG. Are routine interventions necessary in normal birth? Taiwanese J Obstet Gynecol. 2006; 45(4): 302-6.
39. Basevi V, Lavender T. Cochrane.org [Internet]. London: Cochrane Summaries, 2009 [Cited: 30.03.2014]. Available CD001236 around-the-vagina-on-admission-to-hospital-in-labour Cited: 30.03.2014
40. Lumbiganon P, Thinkhamrop J, Thinkhamrop B, Tolosa JE. Vaginal chlorhexidine during labour for preventing maternal and neonatal infections (excluding Group B Streptococcal and HIV). Cochrane Database of Systematic Reviews. 2004; (4): CD004070. DOI: 10.1002/14651858.CD004070.pub2- Assessed as up- to-date: 8 APR 2011.
41. Cadth.Ca [Internet]. Canadian: Canadian agency for drugs and technologies in health, 2013 [Cited: 30.03.2014]. http://www.cadth.ca/media/pdf/htis/may- 2012/RC0356%20CHG%20Final.pdf. from:
42. Serçekuş P, İşbir GG. Investigation of Active Birth Method with Evidence Based Practice. TAF Prev Med Bull. 2012; 11(1): 97-110.
43. Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour. Cochrane Database of Systematic Reviews. 2013; (10): CD003934. DOI: 10.1002/14651858.CD003934.pub4.
44. Makuch MY. Maternal positions and mobility during first stage of labour: RHL commentary. The WHO Reproductive Health Library; Geneva: World Health Organization; 2010.
45. Jones L, Othman M, Dowswell T, Alfirevic Z, Gates S, Newburn M, et al. Pain management for women in labour: an overview of systematic reviews. Cochrane Database Syst Rev. 2012; (3): CD009234. DOI: 10.1002/14651858.CD009234.pub2.
46. Smith CA, Levett KM, Collins CT, Crowther CA. Relaxation techniques for pain management in labour. Cochrane Database of Systematic Reviews. 2011; (12): CD009514. DOI: 10.1002/14651858.CD009514.
47. American College of Obstetricians and Gynecologists- ACOG. Immersion in water during labor and delivery. Committee Opinion No. 594. Obstet Gynecol. 2014; 123(4): 912-5.