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Evidence Based Practices in the Second and Third Stage of Normal Labor

Yıl 2009, Cilt: 11 Sayı: 2, 56 - 65, 01.08.2009

Öz

Good evidence of effectiveness is necessary tojustify interventions in the normal process of labor. The objective of this literature review was toprovide evidence-based recommendations formanagement of care and decisions during the second and third stage of labor and delivery. Early pushing, "hands-on" method, prophylactic oxygen and tocolysis administration, fundal pressure, and routine episiotomy can be associated with complications without sufficientbenefits. It is suggested that, second stage of labor can be allowed to continue if maternal or fetal health is not affected, to avoid uncessary operative interventions for prolonged second stage.Both benefits and risks are associated with valsalva type pushing technique in the second stageof labor and oxytocin–ergometrine use to prevent postpartum haemorrhage. More evidence isneeded regarding misoprostol for primary prevention of postpartum haemorrhage. Evidencebased data favor upright position in the secondstage, perineal massage, postpartum uterinemassage and delivery of placenta with controlledcord traction. In conclusion, instead of routine interventions, using evidence based practices such as restrictive use of episiotomy, supporting delayed pushing and postpartum uterine massage etc., are recommended in the management of second stageof labor

Kaynakça

  • Albers LL, Sedler KD, Bedrick EJ, Teaf D, Peral- ta P(2005) Midwifery care in the second stage of labor and reduction of genital tract trauma at birth: a randomi- zed trial. J Midwifery Womens Health 50:365-72.
  • Althabe F, Belizán JM, Villar J, Alexander S, Ber- gel E, Ramos S, Romero M, Donner A, Lindmark G, Langer A, Farnot U, Cecatti JG, Carroli G, Kestler E (2004) Latin American Caesarean Section Study Group. Mandatory second opinion to reduce rates of unnecessary caesarean sections in Latin America: a cluster randomi- sed controlled trial. Lancet 12;363(9425):1934-40.
  • Berghella V, Baxter JK, Chauhan SP(2008) Evi- dence-based labor and delivery management. American Journal of Obstetrics & Gynecology 199(5): 445-454.
  • Bloom SL, Casey BM, Schaffer JI, McIntire DD, Leveno KJ(2006) A randomized trial of coached versus uncoached maternal pushing during the second stage of labor. Am J Obstet Gynecol 194:10-3.
  • Carroli G, Mignini L(2009) Episiotomy for vaginal birth. Cochrane Database of Systematic Reviews Issue 1. Art. No.: CD000081. DOI: 10.1002/14651858. CD000081.pub2.
  • Cotter AM, Ness A, Tolosa JE(2001) Prophylactic oxytocin for the third stage of labour. Cochrane Databa- se of Systematic Reviews Issue 4. Art. No.: CD001808. DOI: 10.1002/14651858.CD001808.
  • Cox J, Cotzias CS, Siakpere O, Osuagwu FL, Hol- mes EP, Paterson-Brown S(1999) Does an inflatable obstetric belt facilitate spontaneous vaginal delivery in nulliparae with epidural analgesia? BJOG 106:1280-6.
  • Crenshaw J(2007) Care Practice #6: No Separation of Mother and Baby, With Unlimited Opportunities for Breastfeeding. Journal of Perinatal Education 16(3), 39–43.
  • Dahlen HG, Homer CSE, Cooke M, Upton AM, Nunn R, Brodrick B(2007) Perineal outcomes and ma- ternal comfort related to the application of perineal warm packs in the second stage of labor: a randomized control- led trial. Birth 34:282-90.
  • Fawole B, Hofmeyr GJ(2003) Maternal oxygen ad- ministration for fetal distress. Cochrane Database Syst Rev. 4 : CD000136.
  • Gupta JK, Hofmeyr GJ, Smyth R(2003) Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst Rev 2 : CD002006.
  • Gülmezoglu AM, Forna F, Villar J, Hofmeyr GJ (2007) Prostaglandins for preventing postpartum ha- emorrhage. Cochrane Database of Systematic Reviews Issue 3. Art. No.: CD000494. DOI: 10.1002/14651858 .CD000494.pub3.
  • Hofmeyr GJ (2005) Evidence-based intrapartum ca- re. Best Practice & Research Clinical Obstetrics and Gynaecology 19(1): 103–115.
  • Hofmeyr GJ, Abdel-Aleem H, Abdel-Aleem MA (2008) Uterine massage for preventing postpartum ha- emorrhage. CochraneDatabase of Systematic Reviews Is- sue 3. Art.No.:CD006431.DOI: 10.1002/14651858. CD006431.pub2.
  • Hofmeyr GJ, Kulier R(1996) Tocolysis for preven- ting fetal distress in second stage of labour. Cochrane Database of Systematic Reviews Issue 1. Art. No.: CD000037. DOI: 10.1002/14651858.CD000037.
  • Joy SD, Sanchez-Ramos L, Kaunitz AM(2003) Misoprostol use during the third stage of labor. Internati- onal Journal of Gynecology and Obstetrics 82(2): 143- 152.
  • Joyce T, Di Franco AM, Romano RK(2007) Care practice #5: spontaneous pushing in upright or gravity- neutral positions. Journal of Perinatal Education 16(3): 35–38.
  • McCandlish R, Bowler U, Van Asten H, Berridge G, Winter C, Sames L, Garcia J, Renfrew M, Elbour- ne D(1998) A randomised controlled trial of care of the perineum during second stage of normal labour. Br J Obstet Gynaecol 105(12):1262-72.
  • McDonald SJ, Abbott JM, Higgins SP(2004) Prophylactic ergometrine-oxytocin versus oxytocin for the third stage of labour. Cochrane Database of Systema- tic Reviews Issue 1. Art. No.: CD000201. DOI: 10.1002/14651858.CD000201.pub2.
  • McDonald SJ, Middleton P(2008) Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database of Systema- tic Reviews Issue 2. Art. No.: CD004074. DOI: 10.1002/14651858.CD004074.pub2.
  • Parnell C, Langhoff-Roos J, Iversen R, Damgaard P(1993). Pushing method in the expulsive phase of la- bor: a randomized trial. Acta Obstet Gynecol Scand 72:31-5.
  • Peña-Martí GE, Comunián-Carrasco G(2007) Fundal pressure versus controlled cord traction as part of the active management of the third stage of labour. Coch- rane Database of Systematic Reviews Issue 4. Art. No.: CD005462. DOI: 10.1002/14651858.CD005462.pub2.
  • Qian Xu, Simit H, Liang H, Garner P(2006) Evi- dence-informed obstetric practice during normal birth in China: trends and influences in four hospital. BMC He- alth Services Research 6(29): 1-9.
  • Roberts CL, Torvaldsen S, Cameron CA, Olive E (2004) Delayed versus early pushing in women with epi- dural analgesia: a systematic review and meta-analysis. BJOG 111:1333-40.
  • Schaffer JI, Bloom SL, Casey BM, McIntire DD, Nihita MA, Leveno KJ(2005) A randomized trial of the effects of coached vs uncoached maternal pushing during the second stage of labor on postpartum pelvic floor structure and function. Am J Obstet Gynecol 192:1692-6.
  • Stamp G, Kruzins G, Crowther C(2001) Perineal massage in labour and prevention of perineal trauma: ran- domized controlled trial. BMJ 322:1277-80.
  • Su LL, Chong YS, Samuel M(2007) Oxytocin ago- nists for preventing postpartum haemorrhage. Cochrane Database of Systematic Reviews Issue 3. Art. No.: CD005457. DOI: 10.1002/14651858.CD005457.pub2.
  • Yıldırım G, Beji NK(2008) Effects of pushing tech- niques in birth on mother and fetus: A randomized study. Birth 35(1): 25-30.
  • Zupan J, Garner P, Omari AA(2004) Topical um- bilical cord care at birth. Cochrane Database of Systema- tic Reviews Issue 3. Art. No.: CD001057. DOI: 10.1002/14651858.CD001057.pub2

NORMAL DOĞUM EYLEMİNİN İKİNCİ VE ÜÇÜNCÜ EVRESİNDE KANITA DAYALI UYGULAMALAR

Yıl 2009, Cilt: 11 Sayı: 2, 56 - 65, 01.08.2009

Öz

Normal doğum sürecinde müdahalelerin gerekliliğini doğrulayabilmek için kullanılacak uygulamaların etkinliklerine ilişkin iyi kanıtların olması gerekmektedir. Bu derlemenin amacı, doğumun ikinci veüçüncü evresinin yönetimi ve bakımına ilişkin kararlar konusunda kanıta dayalı öneriler sunmaktır. Ikınmaya erken başlanması, doğumda perinenin elle korunması,profilaktik oksijen ve tokoliz uygulanması, fundal basınç ve rutin epizyotomi yapılması gibi uygulamalarda yaşanan komplikasyonlar, beklenen yararlardan fazla olabilmektedir. İkinci evre uzadığında gereksiz operatif girişimleri önleyebilmek için anne veya fetal sağlık etkilenmemiş ise ikinci evrenin uzamasına izin verilebileceği belirtilmektedir. Doğumun ikinci evresinde valsalva tipi ıkınma ile postpartumkanamanın önlenmesinde oksitosin-ergometrine kullanımının faydaları kadar bazı riskleri de olduğu bildirilmektedir. Postpartum kanamanın önlenmesinde misoprostol kullanımı ile ilgili daha fazla kanıta gereksinim duyulmaktadır. Kanıta dayalı veriler doğumun ikinci evresinde dik pozisyon alma, perine masajı, doğum sonrası uterus masajınınyapılmasını ve kontrollü olarak kordonun çekilmesi yoluyla plasentanın doğurtulmasını desteklemektedir. Sonuç olarak, rutin uygulamaların yerine, sınırlı epizyotominin uygulanması, geç ıkınmanın desteklenmesi ve doğum sonrası uterus masajının yapılması gibi kanıt temelli uygulamaların kullanılması önerilmektedir

Kaynakça

  • Albers LL, Sedler KD, Bedrick EJ, Teaf D, Peral- ta P(2005) Midwifery care in the second stage of labor and reduction of genital tract trauma at birth: a randomi- zed trial. J Midwifery Womens Health 50:365-72.
  • Althabe F, Belizán JM, Villar J, Alexander S, Ber- gel E, Ramos S, Romero M, Donner A, Lindmark G, Langer A, Farnot U, Cecatti JG, Carroli G, Kestler E (2004) Latin American Caesarean Section Study Group. Mandatory second opinion to reduce rates of unnecessary caesarean sections in Latin America: a cluster randomi- sed controlled trial. Lancet 12;363(9425):1934-40.
  • Berghella V, Baxter JK, Chauhan SP(2008) Evi- dence-based labor and delivery management. American Journal of Obstetrics & Gynecology 199(5): 445-454.
  • Bloom SL, Casey BM, Schaffer JI, McIntire DD, Leveno KJ(2006) A randomized trial of coached versus uncoached maternal pushing during the second stage of labor. Am J Obstet Gynecol 194:10-3.
  • Carroli G, Mignini L(2009) Episiotomy for vaginal birth. Cochrane Database of Systematic Reviews Issue 1. Art. No.: CD000081. DOI: 10.1002/14651858. CD000081.pub2.
  • Cotter AM, Ness A, Tolosa JE(2001) Prophylactic oxytocin for the third stage of labour. Cochrane Databa- se of Systematic Reviews Issue 4. Art. No.: CD001808. DOI: 10.1002/14651858.CD001808.
  • Cox J, Cotzias CS, Siakpere O, Osuagwu FL, Hol- mes EP, Paterson-Brown S(1999) Does an inflatable obstetric belt facilitate spontaneous vaginal delivery in nulliparae with epidural analgesia? BJOG 106:1280-6.
  • Crenshaw J(2007) Care Practice #6: No Separation of Mother and Baby, With Unlimited Opportunities for Breastfeeding. Journal of Perinatal Education 16(3), 39–43.
  • Dahlen HG, Homer CSE, Cooke M, Upton AM, Nunn R, Brodrick B(2007) Perineal outcomes and ma- ternal comfort related to the application of perineal warm packs in the second stage of labor: a randomized control- led trial. Birth 34:282-90.
  • Fawole B, Hofmeyr GJ(2003) Maternal oxygen ad- ministration for fetal distress. Cochrane Database Syst Rev. 4 : CD000136.
  • Gupta JK, Hofmeyr GJ, Smyth R(2003) Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst Rev 2 : CD002006.
  • Gülmezoglu AM, Forna F, Villar J, Hofmeyr GJ (2007) Prostaglandins for preventing postpartum ha- emorrhage. Cochrane Database of Systematic Reviews Issue 3. Art. No.: CD000494. DOI: 10.1002/14651858 .CD000494.pub3.
  • Hofmeyr GJ (2005) Evidence-based intrapartum ca- re. Best Practice & Research Clinical Obstetrics and Gynaecology 19(1): 103–115.
  • Hofmeyr GJ, Abdel-Aleem H, Abdel-Aleem MA (2008) Uterine massage for preventing postpartum ha- emorrhage. CochraneDatabase of Systematic Reviews Is- sue 3. Art.No.:CD006431.DOI: 10.1002/14651858. CD006431.pub2.
  • Hofmeyr GJ, Kulier R(1996) Tocolysis for preven- ting fetal distress in second stage of labour. Cochrane Database of Systematic Reviews Issue 1. Art. No.: CD000037. DOI: 10.1002/14651858.CD000037.
  • Joy SD, Sanchez-Ramos L, Kaunitz AM(2003) Misoprostol use during the third stage of labor. Internati- onal Journal of Gynecology and Obstetrics 82(2): 143- 152.
  • Joyce T, Di Franco AM, Romano RK(2007) Care practice #5: spontaneous pushing in upright or gravity- neutral positions. Journal of Perinatal Education 16(3): 35–38.
  • McCandlish R, Bowler U, Van Asten H, Berridge G, Winter C, Sames L, Garcia J, Renfrew M, Elbour- ne D(1998) A randomised controlled trial of care of the perineum during second stage of normal labour. Br J Obstet Gynaecol 105(12):1262-72.
  • McDonald SJ, Abbott JM, Higgins SP(2004) Prophylactic ergometrine-oxytocin versus oxytocin for the third stage of labour. Cochrane Database of Systema- tic Reviews Issue 1. Art. No.: CD000201. DOI: 10.1002/14651858.CD000201.pub2.
  • McDonald SJ, Middleton P(2008) Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database of Systema- tic Reviews Issue 2. Art. No.: CD004074. DOI: 10.1002/14651858.CD004074.pub2.
  • Parnell C, Langhoff-Roos J, Iversen R, Damgaard P(1993). Pushing method in the expulsive phase of la- bor: a randomized trial. Acta Obstet Gynecol Scand 72:31-5.
  • Peña-Martí GE, Comunián-Carrasco G(2007) Fundal pressure versus controlled cord traction as part of the active management of the third stage of labour. Coch- rane Database of Systematic Reviews Issue 4. Art. No.: CD005462. DOI: 10.1002/14651858.CD005462.pub2.
  • Qian Xu, Simit H, Liang H, Garner P(2006) Evi- dence-informed obstetric practice during normal birth in China: trends and influences in four hospital. BMC He- alth Services Research 6(29): 1-9.
  • Roberts CL, Torvaldsen S, Cameron CA, Olive E (2004) Delayed versus early pushing in women with epi- dural analgesia: a systematic review and meta-analysis. BJOG 111:1333-40.
  • Schaffer JI, Bloom SL, Casey BM, McIntire DD, Nihita MA, Leveno KJ(2005) A randomized trial of the effects of coached vs uncoached maternal pushing during the second stage of labor on postpartum pelvic floor structure and function. Am J Obstet Gynecol 192:1692-6.
  • Stamp G, Kruzins G, Crowther C(2001) Perineal massage in labour and prevention of perineal trauma: ran- domized controlled trial. BMJ 322:1277-80.
  • Su LL, Chong YS, Samuel M(2007) Oxytocin ago- nists for preventing postpartum haemorrhage. Cochrane Database of Systematic Reviews Issue 3. Art. No.: CD005457. DOI: 10.1002/14651858.CD005457.pub2.
  • Yıldırım G, Beji NK(2008) Effects of pushing tech- niques in birth on mother and fetus: A randomized study. Birth 35(1): 25-30.
  • Zupan J, Garner P, Omari AA(2004) Topical um- bilical cord care at birth. Cochrane Database of Systema- tic Reviews Issue 3. Art. No.: CD001057. DOI: 10.1002/14651858.CD001057.pub2

Ayrıntılar

Birincil Dil Türkçe
Bölüm Research Article
Yazarlar

İlkay GÜNGÖR Bu kişi benim

Gülay YILDIRIM RATHFISCH Bu kişi benim

Yayımlanma Tarihi 1 Ağustos 2009
Yayımlandığı Sayı Yıl 2009 Cilt: 11 Sayı: 2

Kaynak Göster

APA GÜNGÖR, İ., & YILDIRIM RATHFISCH, G. (2009). NORMAL DOĞUM EYLEMİNİN İKİNCİ VE ÜÇÜNCÜ EVRESİNDE KANITA DAYALI UYGULAMALAR. Hemşirelikte Araştırma Geliştirme Dergisi, 11(2), 56-65.