Doğum indüksiyonunda Dinoproston peser yerleştirilmesi öncesi vajinal duşun etkinliği, bir randomize kontrollü çalişma

Yıl 2020, Cilt: 17 Sayı: 3, 431 - 434, 30.09.2020

Banuhan Şahin , Samettin Çelik , Canan Soyer , Şafak Hatırnaz

https://doi.org/10.38136/jgon.696818

Cited By: 2

Öz

Amaç: Doğum indüksiyonu için vajene dinoproston peser yerleştirilmesi öncesi uygulanabilen vajinal duşun doğum ve yenidoğan sonuçlarına etkisini incelemek.
Materyal ve metod: Bu prospektif çalışmada doğum indüksiyonu yapılan 240 tekil, term gebe iki gruba randomize edildi. Vajinal duş ile dinoproston peser yerleştirilen grup (n=103) ile vajinal duş olmaksızın dinoproston peser yerleştirilen grup (n=116) birincil olarak vajen içi dinoproston yerleştirme süresi ikincil olarak vajen içine dinoproston yerleştirme başlangıcından aktif faza kadar olan süre, vajen içine dinoproston yerleştirme başlangıcından serviksin tamamen açılmasına kadar geçen süre, indüksiyon ihtiyacı, doğum şekli (vajinal/sezeryan), ve uterus hiper-stimülasyonu yönünden karşılaştırıldı. Doğum ağırlığı, 5. Dakika Apgar skoru, entübasyon ihtiyacı, mekonyum varlığı, ve fetal enfeksiyon her iki grubun yenidoğanları arasında karşılaştırıldı. Veriler Student’s-t test, Mann-Whitney U test and Pearson Chi-square test kullanılarak istatistiksel olarak karşılaştırıldı.
Bulgular: Vajinal duş ile vajen içine dinoproston peser yerleştirilen grubun dinoproston aplikasyon süresi (p=0.001), dinoproston peser aplikasyonu başlangıcından aktif faza kadar olan süre (p=0.001) ve dinoproston peser aplikasyonu başlangıcından serviksin tamamen açılmasına kadar geçen süre (p=0.001) vajinal duş yapılmayan gruba göre daha kısaydı. Doğum şekli gruplar arasında istatistiksel farklılık göstermiyordu (p=0.414). Uterus hiper-stimülasyonu vajinal duş yapılan grupta daha fazla olsa da istatistiksel anlama ulaşmamaktaydı (p=0.058). Yenidoğan ortalama ağırlığı ve 5. Dakika Apgar skoru vajinal duş yapılan grupta daha fazlaydı (p=0.660, 0.091), fakat entübasyon ihtiyacı, mekonyum varlığı, ve fetal enfeksiyon oranı istatistiksel anlamda daha düşüktü (sırasıyla p=0.007, 0.018, 0.011).
Sonuç: Uygulaması güvenli, kolay ve ucuz bir prosedür olan vajen içi dinoproston peser aplikasyonu öncesi vajinal duş, anne ve fetal olumsuz sonuçlara yol açmaksızın kadınlarda doğum indüksiyonunu hızlandırabilir.

Anahtar Kelimeler

Dinoproston, doğum indüksiyonu, vajinal duş

Destekleyen Kurum

Samsun Eğitim ve Araştırma Hastanesi Etik Kurul

Proje Numarası

09.2019.127

Efficacy of vaginal douching before the application of Dinoprostone pessary in labour induction, a randomized controlled study

Öz

Aim: To investigate the effects on delivery and neonatal outcomes of vaginal douching, which can be performed before the application of dinoprostone pessary in the vagina for labour induction.
Materials and method: In this prospective study 240 women with singleton, term pregnancy who underwent labour induction, were randomized into two groups. Application of dinoprostone pessary intra-vaginally with vaginal douching group (n=103) and it without vaginal douching group (n=116) were compared firstly for duration of dinoprostone application intra-vaginally secondly for duration from the beginning of dinoprostone application intra-vaginally to the active phase of labor, duration from the beginning of dinoprostone application intra-vaginally to total cervical dilatation, induction need, route of delivery (vaginal/cesarean), and uterine hyperstimulation. The birth weight, 1 and 5-minute Apgar scores, intubation need, NICU admission, presence of meconium, and fetal infection were compared between the newborns of the two groups. Data were statistically compared using the Student’s-t test, Mann-Whitney U test and Pearson Chi-square test.
Results: Intra-vaginal dinoprostone pessary application with vaginal douching compared it without douching had shorter duration of dinoprostone application (p=0.001), duration from the beginning of dinoprostone application to the active phase of labor (p=0.001) and duration from the beginning of dinoprostone application to total cervical dilatation (p=0.001). Route of delivery was not statistically different between the groups (p=0.414). Uterine hyperstimulation was more frequent in the vaginal douche group however it did not reach the statistical significance (p=0.058). Neonatal mean birth weight and 5-minute Apgar scores were higher in the vaginal douching group (p=0.660, 0.091) while intubation need, presence of meconium, and fetal infection rates were lower with statistical significance (p=0.007, 0.018, 0.011, respectively).
Conclusion: As a safe, easy to perform and cheap procedure, vaginal douching prior to dinoprostone pessary application intra-vaginally can augment the induction of labour in women without increasing maternal or fetal adverse outcomes.

Anahtar Kelimeler

delivery, delivery, dinoprostone, dinoprostone, labour induction, labour induction

Proje Numarası

09.2019.127

Kaynakça

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