Sınırlı Epizyotomi İçin Klinik Değerlendirme Yöntemleri

Abstract

Epizyotomi, zor doğumları kolaylaştırmak ve doğum kanalını genişletmek için perinede bulunan bulbokavernos kasa yapılan cerrahi kesi işlemidir. Epizyotominin rutin olarak yapılmaması gerektiği konusunda artık evrensel bir fikir birliği bulunmaktadır. ACOG, epizyotominin gerekli olduğu belirli bir durum olmadığını, epizyotomi kararı klinik değerlendirme yapılması gerektiğini belirtmektedir. Bu nedenle epizyotomi uygulama kararı alınırken objektif yöntemlerin kullanılması gerekliliği kaçınılmazdır. Araştırmalara göre doku elastikiyetesinin, kas uzayabilirliğinin, perineal vücut uzunluğunun değerlendirilmesi yöntemleri kullanılabilmektedir. Tüm kadınların özellikle üçüncü trimesterde pelvik taban kaslarının viskoelastik özelliklerinin değerlendirilmesi önerilmektedir. Bu şekilde doğum şekli ve önleyici stratejilerin uygulanmasında bireyselleştirilmiş bakım sunulabilecektir. Ayrıca bu değerlendirme sayesinde mediolateral epizyotomi uygulamasına ilişkin nasıl yapıldığı ve doğumdan sonra yapılması gereken bakımlara ilişkin bilgilendirme yapılabileceği belirtilmektedir. Bu tür bir doğum öncesi bilgi, müdahalenin daha iyi kabul edilmesine ve doğum sırasındaki acil durum bilgisine kıyasla gerçek bir bilgilendirilmiş onam alınmasına imkânı sunmaktadır.

Keywords

• Epizyotomi
• Perine
• Perine yırtıkları

Clinical Evaluation Methods for Limited Episiotomy

Abstract

Episiotomy is a surgical incision made in the bulbocavernos muscle in the perineum to facilitate difficult deliveries and widen the birth canal. There is now universal consensus that episiotomy should not be routinely performed. The ACOG states that there is no specific situation in which an episiotomy is necessary, and the decision to episiotomy should be based on clinical judgment. For this reason, it is inevitable to use objective methods when making the decision to perform episiotomy. According to research, methods of evaluating tissue elasticity, muscle extensibility, and perineal body length can be used. It is recommended that all women evaluate the viscoelastic properties of the pelvic floor muscles, especially in the third trimester. In this way, individualized care will be provided in the delivery method and the implementation of preventive strategies. In addition, it is stated that thanks to this evaluation, information can be given about how mediolateral episiotomy is performed and the care that should be done after birth. This type of prenatal information allows for better acceptance of the intervention and real informed consent compared to emergency information at the time of delivery.

Keywords

• Episiotomy
• perineum
• perineal tears

References

1. 1. World Health Organization. Recommendations on intrapartum care for a positive childbirth experience. 2018. p.5-20. Avaible date: 16.08.2021 Avaible at: https://apps.who.int/iris/bitstream/handle/10665/260178/9789241550215-eng.pdf
2. 2. Brandt JS, Rosen T, Van Raalte H, Kurtenos V, Egorov V. Characterization of Perineum Elasticity and Pubic Bone-Perineal Critical Distance with a Novel Tactile Probe: Results of an Intraobserver Reproducibility Study. Open J Obstet Gynecol 2020;10(4):493-503.
3. 3. Barjon K, Mahdy H. Episiotomy. Treasure Island (FL): StatPearls Publishing .Copyright © 2021.
4. 4. Demirgöz Bal M, Dereli Yılmaz S. Ebelere Yönelik Kapsamlı Doğum. Akademisyen Kitabevi; 2017.p.284
5. 5. Jiang H, Qian X, Carroli G, Garner P. Selective versus routine use of episiotomy for vaginal birth. Cochrane Database Syst Rev 2017;(2): CD000081.
6. 6. Muhleman MA, Aly I, Walters A, Topale N, Tubbs RS, Loukas MJCA. To cut or not to cut, that is the question: A review of the anatomy, the technique, risks, and benefits of an episiotomy. Clinical Anatomy 2017;30(3):362-72.
7. 7. Ghulmiyyah L, Sinno S, Mirza F, Finianos E, Nassar AH. Episiotomy: history, present and future - a review. J Matern Fetal Neonatal Med 2020:1-6.
8. 8. Carroli G, Mignini L. Episiotomy for vaginal birth. Cochrane Database Syst Rev. 2009; 21(1):CD000081.

9. 9. Oliveira DA, Parente MP, Calvo B, Mascarenhas T, Jorge RMN. Numerical simulation of the damage evolution in the pelvic floor muscles during childbirth. Journal of Biomechanics 2016;49(4):594-601.
10. 10. Turki R, Abduljabbar HS, Manikandan J, Thiagarajan J, Bajou O, Gauthaman KJBR. Severe perineal lacerations during childbirth in Saudi women-a retrospective report from King Abdulaziz University Hospital. 2017;28(8):3350-3354.
11. 11. Trinh AT, Roberts CL, Ampt AJ. Knowledge, attitude and experience of episiotomy use among obstetricians and midwives in Viet Nam. BMC Pregnancy and Childbirth 2015;15(1):1-6.
12. 12. American College of Obstetrics and Gynecology. Episiotomy. ACOG Practice Bulletin. Obstet Gynecol 2006.p.957–962.
13. 13. Jha S, Gynaecology. Episiotomy: necessity or negligence?. BJOG 2020;127(11):1408.
14. 14. American College of Obstetrics and Gynecology.ACOG Practice Bulletin No. 198: Prevention and Management of Obstetric Lacerations at Vaginal Delivery. Obstet Gynecol. 2018;132(3):87-102.
15. 15. American Collage of Nurse -Midwives. Life Saving Skills: Manual for Midwives. 4th edition. Module 4. 2008.p.4.1-4.21
16. 16. Royal College of Obstetricians and Gynaecologists .Management of Third- and Fourth-Degree Perineal Tears. Green-top Guideline No. 29. Royal College of Obstetricians and Gynaecologists 2015, London. p. 2-19.
17. 17. Aguiar BM, Silva T, Pereira SL, Sousa AMM, Guerra RB, Souza KV, et al. Factors associated with the performance of episiotomy. Rev Bras Enferm. 2020;73(suppl 4):e20190899.
18. 18. Shmueli A, Gabbay Benziv R, Hiersch L, Ashwal E, Aviram R, Yogev Y, et al. Episiotomy–risk factors and outcomes. J Matern Fetal Neonatal Med 2017;30(3):251-256.
19. 19. Ballesteros-Meseguer C, Carrillo-García C, Meseguer-de-Pedro M, Canteras-Jordana M, Martínez-Roche ME. Episiotomy and its relationship to various clinical variables that influence its performance. Rev Lat Am Enfermagem 2016;24:2793.
20. 20. Clesse C, Cottenet J, Lighezzolo-Alnot J, Goueslard K, Scheffler M, Sagot P, et al. Episiotomy practices in France: epidemiology and risk factors in non-operative vaginal deliveries. Sci Rep 2020;10(1):20208.
21. 21. Rusavý Z, Kalis V, Landsmanová J, Kasová L, Karbanová J, Dolejsová K, et al. Perineal audit: reasons for more than one thousand episiotomies. Ceska Gynekol 2011;76(5):378-85.
22. 22. Friedman AM, Ananth CV, Prendergast E, D’Alton ME. Variation in and factors associated with use of episiotomy. JAMA 2015;313(2):197-199.
23. 23. Kozhimannil KB, Karaca-Mandic P, Blauer-Peterson CJ, Shah NT, Snowden JM. Uptake and utilization of practice guidelines in hospitals in the united states: the case of routine episiotomy. Jt Comm J Qual Patient Saf 2017;43(1):41-48.
24. 24. Abolfazl M, Hamidreza TS, Narges M, Maryam YJPJMS. Gestational diabetes and its association with unpleasant outcomes of pregnancy. Pak J Med Sci 2008;24(4):566-570.
25. 25. Gachon B, Nordez A, Pierre F, Fritel XJAog, obstetrics. Tissue biomechanical behavior should be considered in the risk assessment of perineal trauma at childbirth. Archives of Gynecology and Obstetrics 2019;300(6):1821-1826.
26. 26. Alperin M, Kaddis T, Pichika R, Esparza MC, Lieber RLJAjoo, gynecology. Pregnancy-induced adaptations in intramuscular extracellular matrix of rat pelvic floor muscles. Gynecology 2016;215(2):210. e1-. e7.
27. 27. Alperin M, Lawley DM, Esparza MC, Lieber RLJAjoo, gynecology. Pregnancy-induced adaptations in the intrinsic structure of rat pelvic floor muscles. Gynecology 2015;213(2): e1- e7.
28. 28. Gachon B, Desgranges M, Fradet L, Decatoire A, Poireault F, Pierre F, et al. Is increased peripheral ligamentous laxity in term pregnant women associated with obstetric anal sphincter injury?. Int Urogynecol J 2018;29(11):1589-1595.
29. 29. Kruger JA, Budgett SC, Wong V, Nielsen PMF, Nash MP, Smalldridge J, et al. Characterizing levator-ani muscle stiffness pre- and post-childbirth in European and Polynesian women in New Zealand: a pilot study. Acta Obstet Gynecol Scand 2017;96(10):1234-1242.
30. 30. Chen L, Low LK, DeLancey JO, Ashton-Miller JA. In vivo estimation of perineal body properties using ultrasound quasistatic elastography in nulliparous women. J Biomech 2015;48(9):1575-1579.
31. 31. Gachon B, Nordez A, Pierre F, Fradet L, Fritel X, Desseauve DJIuj. In vivo assessment of the levator ani muscles using shear wave elastography: a feasibility study in women. Int Urogynecol J 2019;30(7):1179-1186.
32. 32. Rostaminia G, Awad C, Chang C, Sikdar S, Wei Q, Shobeiri SA. Shear wave elastography to assess perineal body stiffness during labor. Female Pelvic Med Reconstr Surg 2019;25(6):443-447.
33. 33. Rusavy Z, Kalis V, Aglyamov S, Egorov V. Feasibility and safety of antepartum tactile imaging. Int Urogynecol J. 2021;32(7):1785-91.
34. 34. Zanetti MRD, Petricelli CD, Alexandre SM, Paschoal A, Araujo E, Nakamura MUJSPMJ. Determination of a cutoff value for pelvic floor distensibility using the Epi-no balloon to predict perineal integrity in vaginal delivery: ROC curve analysis. Prospective observational single cohort study. Sao Paulo Med J 2015;134:97-102.
35. 35. Paschoal A, Zanetti MRD, Petricelli CD, Alexandre SM, Araujo Júnior E, Nakamura MU. Quantitative assessment of pelvic floor muscle extensibility in pregnant women with a perineal elasticity meter. J Matern Fetal Neonatal Med 2020;33(21):3591-3595.
36. 36. Moya-Jiménez LC, Sánchez-Ferrer ML, Adoamnei E, Mendiola J. New approach to the evaluation of perineal measurements to predict the likelihood of the need for an episiotomy. Int Urogynecol J 2019;30(5):815-821.