Doğum eylemi süresini kısaltmada ve vajinal perine bütünlüğünü korumada obstetrik jel uygulamasının etkinliği: prospektif gözlemsel çalışma

Yıl 2023, Cilt: 20 Sayı: 2, 1723 - 1729, 03.07.2023

Derya Burkankulu , Özlem Moraloğlu Tekin , Sevgi Koç , Ayça Nazlı Bulut

https://doi.org/10.38136/jgon.1192217

Öz

Amaç: Bu çalışmanın amacı, obstetrik jel uygulamasının doğum eylemi sonuçlarına etkisini belirlemektir.
Gereç ve Yöntem: Bu randomize olmayan kontrollü çalışma, Ocak 2019 ile Haziran 2019 tarihleri arasında üçüncü basamak bir hastanede gerçekleştirildi. Düşük riskli, verteks pozisyonunda, 16-40 yaş arası, tahmini fetal ağırlığı 2500-4000 gram, gebelik haftası 37-41 hafta arasında olan nullipar gebeler çalışmaya dahil edildi. Çalışma grubunun (n=142) vajinal kanalına, doğumun ilk aşamasında (5 cm servikal açılmadan önce) 3-5 ml hidroksietil selüloz jel aplikatör ile uygulandı. İşlem bebeğin doğumuna kadar her iki saatte bir tekrarlandı. Kontrol grubu (n=191) standart antenatal bakım aldı.
Bulgular: Epizyotomi ihtiyacı çalışma grubunda kontrol grubuna göre anlamlı olarak daha düşüktü (n=72 (%50.7) ve n=175 (%91.6)) (Z=18.902, p<0.001). Ayrıca, çalışma grubundaki kadınların vajinal perineal bütünlüğün korunması açısından anlamlı derecede daha iyi sonuçlara sahip oldukları bulundu (n=53 (%37,3) ve n=160 (%83,7)) (Z=134,893, P<0,001) . Ayrıca çalışma grubunda doğumun ikinci evresinde kontrol grubuna göre (36.68~34.37 dk ve 58.03~30.35 dk) anlamlı kısalma gözlendi (p<0.001).
Sonuç: Obstetrik jel kullanımı doğumun birinci ve ikinci aşamalarını kısaltmakta, epizyotomi ihtiyacını azaltmakta ve perine bütünlüğünün korunmasına yardımcı olmaktadır. Bu nedenle nullipar normal vajinal doğumlarda uygulandığında maliyet etkin olabilir ve yaşam kalitesine olumlu katkı sağlayabilir.

Anahtar Kelimeler

Doğum, Perine bütünlüğü, ikinci aşama

The effectiveness of obstetric gel application in shortening labor duration and preserving vaginal perineal integrity: prospective observational study

Öz

Aim: The aim of this study to determine the effects of obstetric gel application on labor outcomes.
Materials and Method: This nonrandomized controlled study was carried out between January 2019 and June 2019 in a tertiary-care hospital. Nulliparous pregnant women with low risk, vertex position, between the ages of 16-40 years, with an estimated fetal weight of 2500-4000 grams and a gestational week between 37-41 weeks were included in the study. Using an applicator, 3-5 ml of a hydroxyethyl cellulose gel was applied to the vaginal canal of the study group (n=142) at the first stage of labor (before 5 cm cervical opening). The procedure was repeated every two hours until the birth of the baby. The control group (n=191) received standard antenatal care.
Results: The need for episiotomy was significantly lower in the study group compared to the control group (n=72 (50.7%) vs. n=175 (91.6%)) (Z=18.902, p<0.001). Moreover, it was found that women in the study group had significantly better outcomes concerning the preservation of the vaginal perineal integrity (n=53 (37.3%) vs. n=160 (83.7%)) (Z=134.893, P<0.001). Also, significant shortening was observed in the second stage of labor in the study group compared to the control group (36.6834.37 min vs. 58.0330.35 min) (p<0.001).
Conclusion: The use of obstetric gel shortens the first and second stages of labor, reduces the need for episiotomy, and helps preserve perineal integrity. Thus, it can be cost-effective and contribute positively to life quality if administered in nulliparous normal vaginal deliveries

Anahtar Kelimeler

Labor, Perineal integrity, second stage

Kaynakça

• 1. Aasheim V, Nilsen ABV, Reinar LM, Lukasse M. Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database Syst Rev. 2017;(6).
• 2. Kearney R, Miller JM, Ashton-Miller JA, DeLancey JOL. Obstetric factors associated with levator ani muscle injury after vaginal birth. Obstet Gynecol. 2006 Jan;107(1):144–9.
• 3. Zakšek TŠ. Sexual activity during pregnancy in childbirth and after childbirth. Sexol Midwifery. 2015;87.
• 4. de Jesús-García A, Paredes-Solís S, Valtierra-Gil G, Los Santos FRS, Sánchez Gervacio BM, Ledogar RJ, et al. Associations with perineal trauma during childbirth at home and in health facilities in indigenous municipalities in southern Mexico: a cross- sectional cluster survey. BMC Pregnancy Childbirth. 2018 May;18(1):198.
• 5. Bulbul T, Ozen B, Copur A, Kayacık F. Investigation the fear of labor and decision making about delivery type in pregnant. J Heal Sci. 2016;25:126–30.
• 6. Aquino CI, Saccone G, Troisi J, Zullo F, Guida M, Berghella V. Use of lubricant gel to shorten the second stage of labor during vaginal delivery. J Matern neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet. 2019 Dec;32(24):4166–73.
• 7. Ehsanipoor RM, Saccone G, Seligman NS, Pierce-Williams RAM, Ciardulli A, Berghella V. Intravenous fluid rate for reduction of cesarean delivery rate in nulliparous women: a systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2017 Jul;96(7):804–11.
• 8. Ciardulli A, Saccone G, Anastasio H, Berghella V. Less-Restrictive Food Intake During Labor in Low-Risk Singleton Pregnancies: A Systematic Review and Meta- analysis. Obstet Gynecol. 2017 Mar;129(3):473–80.
• 9. Schaub AF, Litschgi M, Hoesli I, Holzgreve W, Bleul U, Geissbühler V. Obstetric gel shortens second stage of labor and prevents perineal trauma in nulliparous women: a randomized controlled trial on labor facilitation. J Perinat Med. 2008;36(2):129–35.
• 10. Aydıner B, Kıyak H, Mete F, Ekiz A, Polat İ, Gedikbasi A. Use of obstetric gel in nulliparous pregnant women: Maternal and neonatal outcomes. Perinat J. 2017;25(4):127–32.
• 11. Schulz KF, Altman DG, Moher D. The CONSORT Statement: Revised Recommendations for Improving the Quality of Reports of Parallel Group Randomized Trials (Turkish Translation). Euras J Fam Med. 2013;2(1):1–10.
• 12. Faul F, ErdFelder E, Lang A-G, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):1149–60.
• 13. Priddis H, Dahlen HG, Schmied V, Sneddon A, Kettle C, Brown C, et al. Risk of recurrence, subsequent mode of birth and morbidity for women who experienced severe perineal trauma in a first birth in New South Wales between 2000-2008: a population based data linkage study. BMC Pregnancy Childbirth. 2013 Apr;13:89.
• 14. Barjon K, Mahdy H. Episiotomy. In: StatPearls [Internet]. StatPearls Publishing; 2019.
• 15. Sultan AH, Thakar R, Ismail KM, Kalis V, Laine K, Räisänen SH, et al. The role of mediolateral episiotomy during operative vaginal delivery. Eur J Obstet Gynecol Reprod Biol. 2019 Sep;240:192–6
• 16. Jiang H, Qian X, Carroli G, Garner P. Selective versus routine use of episiotomy for vaginal birth. Cochrane database Syst Rev. 2017 Feb;2(2):CD000081.
• 17. Johnson A, Thakar R, Sultan AH. Obstetric perineal wound infection: is there underreporting? Br J Nurs. 2012 Mar;21(5):S28, S30, S32-5.
• 18. Trinh AT, Roberts CL, Ampt AJ. Knowledge, attitude and experience of episiotomy use among obstetricians and midwives in Viet Nam. BMC Pregnancy Childbirth. 2015 Apr;15:101.
• 19. Laopaiboon M, Lumbiganon P, McDonald SJ, Henderson-Smart DJ, Green S, Crowther CA. Use of evidence-based practices in pregnancy and childbirth: South East Asia Optimising Reproductive and Child Health in Developing Countries project. PLoS One. 2008 Jul;3(7):e2646.
• 20. Haseli A, Ghiasi A, Hashemzadeh M. Do Breathing Techniques Enhance the Effect of Massage Therapy in Reducing the Length of Labor or not? a Randomized Clinical Trial. J caring Sci. 2019 Dec;8(4):257–63.
• 21. Hutchison J, Mahdy H, Hutchison J. Stages of Labor. In Treasure Island (FL); 2020.
• 22. Wong CA. Advances in labor analgesia. Int J Womens Health. 2009;1:139.
• 23. Sheiner E, Walfisch A, Hallak M, Harlev S, Mazor M, Shoham-Vardi I. Length of the second stage of labor as a predictor of perineal outcome after vaginal delivery. J Reprod Med. 2006 Feb;51(2):115–9.
• 24. Seval MM, Yüce T, Yakıştıran B, Şükür YE, Özmen B, Atabekoğlu C, et al. Effects of obstetric gel on the process and duration of labour in pregnant women: Randomised controlled trial. J Obstet Gynaecol J Inst Obstet Gynaecol. 2017 Aug;37(6):714–8.