Evidence Based Practices in the Management of First Stage of Labor

Yıl 2009, Cilt: 11 Sayı: 3, 53 - 64, 01.12.2009

Gülay Yıldırım Rathfısch İlkay Güngör

Öz

Routine care in normal labor may range fromsupportive care at home to intensive monitoringand multiple interventions in hospital, but someof them may not always be really necessary. Good evidence of effectiveness is necessary to justifyinterventions in the normal process of labor. Theobjective of this review was to provide evidencebased guidance for management of care and decisions during the first stage of labor. Evidencebased good quality data favor hospital births,midwife led care in low risk women, delayed admission, labor support, training birth assistantsin developing countries. Home-like births, enema, shaving, routine vaginal irrigation, restricting mobilization in the first stage of labor, andearly amniotomy can be associated with complications without sufficient benefits and shouldprobably be avoided. Both benefits and risks areassociated with routine amniotomy, oxytocin augmentation, prostaglandin use, food and liquidrestriction in labor, continuous electronic fetalheart rate monitoring and epidural analgesia. Itwas concluded that labor and delivery interventions supported by good quality data as just described should be routinely performed during theprenatal care and the first stage of labor

Anahtar Kelimeler

First stage of labor, evidence based practices, active management of labor, care

Doğum Eyleminin Birinci Evresinin Yönetiminde Kanıta Dayalı Uygulamalar

Öz

Normal doğumda rutin bakım, evde doğumlarda destekleyici bakımdan, hastanede yoğun izlem ve çeşitli müdahalelere kadar değişengeniş bir alanda uygulanmakta ancak bu girişimlerden bazıları herzaman gerçekten gerekli olmayabilmektedir. Normal doğum sürecindemüdahalelerin gerekliliğini doğrulayabilmek için bu yöntemlerin etkinliğine ilişkin iyi kanıtların olması gerekmektedir. Bu derlemeninamacı, doğumun birinci evresinin yönetimi ve bakıma ilişkin kararlarkonusunda kanıta dayalı öneriler sunmaktır. Kanıta dayalı iyi kaliteliveriler; hastanede doğum, riskli olmayan kadınlarda ebe yönetimindedoğum, doğuma geç kabul, doğumda destekleyici bakım ve gelişmekte olan ülkelerde doğuma yardımcı olan kişilerin eğitimini desteklemektedir. Ev ortamı sunan doğum merkezleri, lavman, perineal tıraş,rutin vajinal irrigasyon, doğumun ilk evresinde mobilizasyonun sınırlandırılması ve erken amniotomi gibi uygulamalara ilişkin komplikasyonların beklenen yararlardan fazla bulunması nedeniyle bunların rutin kullanımından kaçınılması önerilmektedir. Rutin amniotomi, oksitosin indüksiyonu, prostaglandin kullanımı, doğumda besin ve sıvı alımının engellenmesi, sürekli elektronik monitörizasyon ve epiduralanaljezi gibi uygulamaların faydaları kadar bazı risklerle de ilişkiliolduğu bildirilmektedir. Sonuç olarak, doğum öncesi bakım ve doğumun birinci aşamasında yapılan rutin uygulamaların burada belirtilen şekilde, kaliteli veriler tarafından desteklenerek uygulanması önerilmektedir

Anahtar Kelimeler

Doğumun birinci evresi, kanıta dayalı uygulamalar, doğumun aktif yönetimi, bakım

Kaynakça

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