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

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

İlkay Güngör Gülay Yıldırım Rathfısch

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

Anahtar Kelimeler

Second stage of labor, evidencebased practices, management of labor, care

NORMAL DOĞUM EYLEMİNİN İKİNCİ VE ÜÇÜNCÜ EVRESİNDE KANITA DAYALI UYGULAMALAR

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

Anahtar Kelimeler

Doğumun ikinci evresi, kanıta dayalı uygulamalar, doğumun yönetimi, bakım

Kaynakça

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