TY  - JOUR
T1  - DÜNYADA PLANLI EV DOĞUMLARINA GÜNCEL BAKIŞ; RİSKLER VE FAYDALARI
TT  - A CURRENT OVERVIEW OF PLANNED HOME DELIVERIES IN THE WORLD; RISKS AND BENEFITS
AU  - Kumru, Doç. Dr. Pınar
AU  - Topuzoğlu, Prof. Dr. Ahmet
PY  - 2019
DA  - June
DO  - 10.16948/zktipb.531769
JF  - Zeynep Kamil Tıp Bülteni
PB  - Zeynep Kamil Kadın ve Çocuk Hastalıkları EAH
WT  - DergiPark
SN  - 1300-7971
SP  - 82
EP  - 90
VL  - 50
IS  - 2
LA  - tr
AB  - DÜNYADA PLANLI EV DOĞUMLARINA GÜNCELBAKIŞ; RİSKLER VE FAYDALARIÖZET:Gelişmiş ülkelerde planlıevde doğum oranı %0,1-%20 arasında değişmektedir. Son 20 yıldır özelliklegelişmiş ülkelerde evde doğum planlayan kadın sayısında artış dikkatçekicidir. Planlı ev doğumlarındaçoğu literatürde birbiri ile uyumlu şekilde maternal sonuçları olumlu olarakbildirilmişse de yenidoğan sonuçları açısından daha değişkendir.Daha öncekiaraştırmalarda, düşük riskli kadında planlı ev doğumlarında, oksitosinindüksiyonu, sezaryen/operatif doğum, doğum sonrası kanama, perineallaserasyon, farmakolajik analjezik ihtiyacı ve epizyotomi gibi müdahale vematernal morbiditeler azalmış olarak bildirilmiştir. Düşük riskli kadındaintrapartum fetal ölümler, yenidoğan ölümleri, düşük Apgar skorları veyenidoğan yoğun bakım ünitesine kabul açısından hastane ve ev doğumlarıarasında fark bulunmadığını bildiren araştırmalar yanında artmış olumsuzyenidoğan sonuçları gösteren araştırmalarda mevcuttur. Planlı ev doğumlarıözellikle nulliparlar gebeler için küçük de olsa artmış yenidoğan riskleri ileilişkili bulunmuşken multipar gebeler için daha güvenli olduğu bildirilmiştir.Fakat makat prezentasyon, çoğul gebelik, ve geçirilmiş sezaryen öyküsü olankadınlarda evde doğum önerilmemektedir. Kadınların evdoğumlarında çevrelerini daha iyi kontrol edebildikleri, kendi şartlarınıbelirleyebildikleri, istemedikleri müdahalelerden kaçınabilecekleri ve doğumsırasında karar almada etkin rol alabildikleri için memnuniyetlerinin arttığı bildirilmiştir. Evde doğumda bildirilendiğer avantaj ise maliyet etkinliğidir.Evde doğum konusunda,radomize kontrollü çalışmalar yapmak mümkün değildir ayrıca araştırmatasarımları ile ilgili bir çok zorluk vardır. Planlı ev doğumlarının sonuçlarını gebelik sırasındaalınan annelik bakımı, gebelik ve doğum sırasında destek veren obstetrisyen veebelerin eğitim düzeyi, hastaneye uzaklık ve transfer koşulları gibi bir çokfaktör etkilemektedir. Uluslararası kabul görmüşstandartlara dayanan uygulama ve kılavuzların kullanımı evde doğum güvenliğiiçin önemlidir.Evde doğum, klavuzlar rehberliğinde,eğitimli ebe/obstetrisyen eşliğinde veyasağlık sistemine entegre transfer sistemlerinin varlığında, düşük risklikadınlar için özellikle yenidoğan sonuçları açısından risklerin çok az veyahastane doğumlarına benzer olduğu tespit edilmiştir. Bu derleme, planlı evdoğumlarını maternal ve neonatal sonuçlar ile olan ilişkisinini güncelaraştırmalar ışığında gözden geçirecekve planlı ev doğumlarının riskleri ve faydaları tartışacaktır.Anahtar Kelimeler: Ev doğumu, hastane doğumu, Düşük riskli gebelik,riskler, faydalar, maternal sonuçlar, yenidoğan sonuçları
KW  - Ev doğumu
KW  - hastane doğumu
KW  - Düşük riskli gebelik
KW  - riskler
KW  - faydalar
KW  - maternal sonuçlar
N2  - A CURRENT OVERVIEW OF PLANNED HOME DELIVERIES IN THEWORLD; RISKS AND BENEFITSSUMMARY: In developed countries, the plannedhome delivery rate varies between 0.1% and 20%. Inthe last 20 years, especially in developed countries, the number of womenplanning birth at home increased noteworthy. For planned home births, mostmaternal outcomes were reported positive, and are compatible with each otheraccording to the results in the previous literature. However, the results forthe neonatal outcomes are more variable. Planned home births in low-risk womenresults with lower levels of oxytocin induction, cesarean/operative delivery,postpartum hemorrhage, perineal laceration, needfor pharmacologic analgesic and episiotomy intervention and maternal morbidity, according to the previous reports. In addition to the studiesindicating that there are no differences for low-risk women between hospitaland home births; in terms of intrapartum fetal deaths, neonatal deaths, lowApgar scores, and admission to the neonatal intensive care unit rates, other studies report increased negative neonatal outcomes.Planned home births are reported tobe safer for multiparous pregnancies, especially when they are compared withnulliparous women who have small but significantly increased neonatal risks.However, home delivery is not recommended for women with breech presentation,multiple pregnancies and previous cesarean section. It has been reported that women arebetter able to control their environment in home births, determine their ownconditions, avoid undesired interventions, and increase their satisfactionbecause they can play an active role in decision-making at birth. Another advantage for home deliveriesis cost effectiveness. On the subject of birth at home,there is an obstacle on research designs because it is not feasible to conductrandomized controlled studies. Planned home births were effected bymaternal care during pregnancy, the level of education of obstetricians andmidwives who support during pregnancy and delivery, and the distance tohospital and transfer conditions for the mothers. The practices and guidelines based onthe internationally accepted standards are important for the home birth safety.It was found that in the presence oftrained midwives / obstetrician guided guidance and integrated transfersystems, the risks of home birth for low-risk women were very few or similar tohospital deliveries, especially in the terms of newborn results.This review will evaluate therelationship between planned home births and maternal and neonatal outcomeswith regard to current studies and discuss the risks and benefits of plannedhome births. Keywords: Home birth, hospitalbirth, low risk pregnancy,without risk, benefit maternal outcomes, neonatal outcomes
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UR  - https://doi.org/10.16948/zktipb.531769
L1  - https://dergipark.org.tr/tr/download/article-file/774571
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