Vajinal Doğumda Epidural Analjezi Kullanımı ve Anne-Bebek Sağlığına Etkisi

Yıl 2017, Cilt: 7 Sayı: 3, 137 - 147, 01.12.2017

Zekiye Karaçam , Nurdan Gezer

Öz

Epidural analjezi, doğum ağrısının kontrolü için kullanılan Uluslararası literatürde epidural analjezinin anne ve bebek sağlığı ve güvenliği üzerine etkileri konusunda önemli bilgiler yer almaktadır. Obstetrik bakım hizmetlerinin sunulduğu cerrahi kliniklerinde çalışan ebe ve hemşirelerin, yaygın kullanılan bu uygulamanın anne - bebek sağlığı ve güvenliğine olan olumsuz etkilerinin farkında olmaları, anne - bebeğin sağlığı ve güvenliğini sürdürmeleri gerekmektedir. Türkiye’de bir yandan doğum ağrısı endişesi ile ilişkili isteğe bağlı sezaryen oranlarının azaltılması çalışmaları yapılırken, diğer yandan da epidural analjezi gibi bir başka medikal/ agresif doğuma müdahale yöntemleri gündeme getirilmektedir. Epidural analjezi doğum yapan kadına çok iyi analjezi sağlayabilir. Ancak epidural analjezi, anne ve bebek sağlığını olumsuz etkileyen bazı obstetrik problemlere ve emzirme zorluklarına neden olabilir. Gelişen problemlere bağlı olarak, anne ve bebeğin hastanede kalma süresini uzayabilir ve sağlık bakım maliyeti artabilir. Literatüre dayalı olarak hazırlanan bu makalede, doğum eyleminde epidural analjezi kullanımı ve bu yöntemin anne ve bebek sağlığına etkileri ile ilgili güncel bilgilerin paylaşılması hedeflenmiştir

Anahtar Kelimeler

Doğum, vajinal, analjezi, epidural, kadın, bebek, sağlık, ebelik, bakım

Using of epidural analgesia in the vaginal birth and its effects on the health of mother and baby

Öz

Abstract Epidural analgesia is one the pharmacological methods used for the control of birth pain. International literature contains important information on the effect of epidural analgesia on mother and baby health. Nurses and midwives working in surgical clinics offered the obstetric care services are might aware the adverse effects of this practice widely used on maternal and infant health and safety and maintain to the patient safety. In Turkey, when it is labored to reduce the rate of optional caesarean related to the anxiety of birth pain, on the other hand, another aggressive / medical intervention method such as epidural analgesia is brought to the agenda. Epidural analgesia can provide very good analgesia to the delivering woman. However, epidural analgesia may cause some obstetric problems and breastfeeding difficulties negatively affected the health of maternal and infant. Depending on the problems developed, the length of hospital stay of the mother and baby may be prolonged and the cost of health care may increase. In this study prepared on the basis of literature, it has been intended to share current information about the use of epidural analgesia during labour and its effects on the health of maternal and infant.

Anahtar Kelimeler

Birth, vaginal, analgesia, epidural, female, baby, health, midwifery, care

Kaynakça

• Türkiye İstatistik Kurumu, Haber Bülteni. Sayı: , Nisan Erişim: (http://www.tuik.gov.tr/PreHaberBultenleri.do?id=21514). Erişim Tarihi: 15 Ocak 2017. Sağlık Bakanlığı Normal ve Sezaryen Doğum Oranları. Erişim:
• (http://rapor.saglik.gov.tr/istatistik/rapor/). Erişim Tarihi: 15 Ocak 2017.
• Genç Moralar D, Aygen Türkmen Ü, Altan A, Arısoy R, Tahaoğlu E, Özakın E. Doğum Analjezisinde Epidural Sürekli İnfüzyon ve Hasta Kontrollü Epidural Bolus Uygulamasının Karşılaştırılması. Ağrı 2013; (1): 19-26.
• Anim-Somuah M, Smyth RMD, Jones L. Epidural versus Non-Epidural or No Analgesia in Labour. Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD000331. DOI: 1002/14651858.CD000331.pub3.
• Jones L, Othman M, Dowswell T, Alfirevic Z, Gates S, Newburn M, Jordan S, Lavender T, Neilson JP. Pain Management for Women in Labour: An Overview of Systematic Reviews. Cochrane Database of Systematic Reviews 2012, Issue 3. Art. No.: CD009234. DOI: 10.1002/14651858.CD009234.pub2.
• Tien JC, Lim MJ, Leong WL, Lew E. Nine-Year Audit of Post-Dural Puncture Headache in a Tertiary Obstetric Hospital in Singapore. Int J Obstet Anesth 2016; 28: 34–38.
• Wilson M, Macarthur C, Smith FG, Homer L, Handley K, Daniels J. The RESPITE Trial: Remifentanil Intravenously Administered Patient-Controlled Analgesia (PCA) Versus Pethidine Intramuscular Injection for Pain Relief in Labour: Study Protocol for a Randomised Controlled Trial. Trials 2016; 17: 1–
• Heesen M, Van de Velde M, Klöhr S, Lehberger J, Rossaint R, Straube S. Meta-Analysis of The Success of Block Following Combined Spinal-Epidural vs. Epidural Analgesia during Labour. Anaesthesia 2014; : 64–71.
• Sng BL, LeongWL, Zeng Y, Siddiqui FJ, AssamPN, LimY, Chan ESY, Sia AT. Early Versus Late Initiation of Epidural Analgesia for Labour. Cochrane Database of Systematic Reviews 2014; Issue 10. Art. No.: CD007238. DOI: 10.1002/14651858.CD007238.pub2.
• Calthorpe N. The History of Spinal Needles: Getting to the Point. Anaesthesia 2004; 9(12): 1231-41.
• Bonouvrie K, van den Bosch A, Roumen FJME, van Kuijk SM, Nijhuis JG, Evers SMAA, Wassen MMLH. Epidural Analgesia during Labour, Routinely or on Request: A Cost-Effectiveness Analysis. Eur J Obstet Gynecol Reprod Biol European 2016; 207: 23–31.
• Heesen M, Klimek M. Obstetric Analgesia – Update 2016. J Perinat Med 2016; DOI 10.1515/jpm-2016
• Kemp E, Kingswood CJ, Kibuka M, Thornton JG. Position in the Second Stage of Labour for Women with Epidural Anaesthesia. Cochrane Database of Systematic Reviews 2013; Issue 1. Art. No.: CD008070. DOI: 10.1002/14651858.CD008070.pub2.
• Eriksen LM, Nohr EA, Kjærgaard H. Mode of Delivery after Epidural Analgesia in a Cohort of Low-Risk Nulliparas. BIRTH 2011; 38: 317-326.
• Korhonen AM, Valanne JV, Jokela RM, Ravaska P, Volmanen P, Korttila K. Influence of the Injection Site (L2/3 Or L3/4) and the Posture of the Vertebral Column on Selective Spinal Anesthesia for Ambulatory Knee Arthroscopy. Acta Anaesthesiol Scand 2005; 49(1): 72-7.
• Sarid JP, Mikulandra S, Gustin D, Matasid H, Tomulid K, Dokoza KP. Spinal Anesthesia at the L2-3 and L3-4 Levels: Comparison of Analgesia and Hemodynamic Response. Coll Antropol 2012; 36(1): 151-6.
• Simmons SW, Taghizadeh N, Dennis AT, Hughes D, Cyna AM. Combined Spinal-Epidural Versus Epidural Analgesia in Labour. Cochrane Database of Systematic Reviews 2012; Issue 10. Art. No.: CD003401. DOI: 10.1002/14651858.CD003401.pub3
• Köşüş A, Köşüş N, Çapar M. Nullipar Gebelerde Sürekli Epidural Analjezinin Maternal ve Fetal Sonuçları. Turkiye Klinikleri J Gynecol Obst 2007; 17: 436-441.
• Gambling DR, Yu P, Cole C, McMorland GH, Palmer L. A Comparative Study of Patient Controlled Epidural Analgesia (PCEA) and Continuous Infusion Epidural Analgesia (CIEA) During Labour. Can J Anaesth 1988; 35: 249–54.
• Wang T-T, Sun S, Huang S-Q. Effects of Epidural Labor Analgesia with Low Concentrations of Local Anesthetics on Obstetric Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Anesth Analg 2016; DOI: 10.1213/ANE.0000000000001709.
• Ohel G, Gonen R, Vaida S, Barak S, Gaitini L: Early versus Late Initiation of Epidural Analgesia in Labor: Does It Increase The Risk of Cesarean Section? A Randomized Trial. Am J Obstet Gynecol 2006; 194: –5.
• Wang F, Shen X, Guo X, Peng Y, Gu X; The Labor Analgesia Examining Group: Epidural Analgesia in the Latent Phase of Labor and The Risk of Cesarean Delivery. Anesthesiology 2009; 111(4): 871–80.
• Parameswara G, Kshama K, Murthy HK, Jalaja K, Venkat S. Early Epidural Labour Analgesia: Does It Increase the Chances of Operative Delivery? Br J Anaesth 2012; 108 (sup l2): 213–4.
• Practice Guidelines for Obstetric Anesthesia. An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology. Anesthesiology 2016; 124 (2): 270–300.
• Merchant R, Chartrand D, Dain S, Dobson G, Kurrek MM, Lagace´ A, Stacey S, Thiessen B, Chow L, Sullivan P. Guidelines to the Practice of Anesthesia – Revised Edition 2016. Can J Anesth 2016; 63: –112.
• Gümüş F, Melekoğlu R, EvrükeİC, Gelegen K, Büyükkurt S. Doğum Eylemi Sırasında Epidural Analjezi Uygulanmış Hastalarda Epidural Analjezinin Doğum Eylemi, Doğum ve Neonatal Sonuçlara Etkisi. Turkiye Klinikleri J Gynecol Obst 2015; 25(3): 146-52.
• Köken G, Şahin FK, Fidan H, Köken R, Coşar E, Kösel M, Yılmazer M. Epidural Analjezinin Maternal ve Fetal Etkileri. Turk J Obstet Gynecol 2007; 4(3): 173-7.
• Gönenç İM, Vural G. Epidural Anestezi ile Vajinal Doğum Yapan ve Anestezisiz Vajinal Doğum Yapan Primipar Annelerde İlk 24 Saatte Etkili Emzirmenin Değerlendirilmesi. Ank Üni Tıp Fak Mecm 2015; 68 (2): 81-6.
• Tekin B, Şener T, Dikdere İ, Tanriverdi B, Hassa H, Özalp S, Şahin F. Bupivakain ile Epidural Analjezinin Anne, Fetüs ve Doğum Eylemi Üzerine Etkisi. T Klin Jinekol Obst 1994; 4: 248-52.
• Angle PJ, Landy CK, Djordjevic J, Barrett J, Bch MB, Kibbe A, Sriparamananthan S, Lee Y, Hamata L, Zaki P, Kiss A. Performance of the Angle Labor Pain Questionnaire during Initiation of Epidural Analgesia in Early Active Labor. Anesth Analg 2016; 123: 1546–53.
• Sharma SK, McIntire DD, Wiley J, Leveno KJ. Labor Analgesia and Cesarean Delivery: An Individual Patient Meta-Analysis of Nulliparous Women. Anesthesiology 2004; 100: 142–8.
• Liu EH, Sia AT. Rates of Caesarean Section and Instrumental Vaginal Delivery in Nulliparous Women after Low Concentration Epidural Infusions or Opioid Analgesia: Systematic Review. BMJ 2004; 328:
• Djakovic I, Rudman SS, Kosec V. Effect of epidural analgesia on mode of delivery. Wien Med Wochenschr 2016: DOI 10.1007/s10354-016-0511-9.
• Fen W, Yun-xia C, Shan-Gao K, Tao-Hua Z, Miao Z. Effect of Combined Spinal–Epidural Analgesia in Labor on Frequency of Emergency Cesarean Delivery among Nulliparous Chinese Women. Int J Gynaecol Obstet 2016; 35: 259–63.
• Sultan P, Murphy C, Halpern S, Carvalho B. The Effect of Low Concentrations versus High Concentrations of Local Anesthetics for Labour Analgesia on Obstetric and Anesthetic Outcomes: A Meta-Analysis. Can J Anesth 2013; 60: 840–54.
• Antonakou1 A, Papoutsis D. The Effect of Epidural Analgesia on the Delivery Outcome of Induced Labour: A Retrospective Case Series. Obstet Gynecol Int 2016: Article ID 5740534, 5 pages http://dx.doi.org/10.1155/2016/5740534.
• Costley PL, East CE. Oxytocin Augmentation of Labour in Women with Epidural Analgesia for Reducing Operative Deliveries. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD009241. DOI: 10.1002/14651858.CD009241.pub3.
• French CA, Cong X, Chung KS. Labor Epidural Analgesia and Breastfeeding: A Systematic Review. J Hum Lact 2016: 32(3): 507–20.
• Akbas M, Akcan AB. Epidural Analgesia and Lactation. Eurasian J Med 2011; 43: 45-9.
• Onofrei M., Wee MY, Parker B, Wee N, Hill S. Bacterial Contamination of Saline Used for Epidural Procedures in An Obstetric Setting: A Randomised Comparison of Two Drawing-Up Techniques. Int J Obstet Anesth 2016; http://dx.doi.org/10.1016/ j.ijoa.2016.10.002.
• The American College of Obstetricians and Gynecologist. Medication for Pain Relief During Labor and Delivery. ; https://www.acog.org/-/media/For- Patients/faq086.pdf?dmc=1&ts=20161212T0152150280.
• Gizzo S, Noventa M, Fagherazzi S, Lamparelli L, Ancona E, Di Gangi S, Saccardi C, D'Antona D, Nardelli GB. Update on Best Available Options in Obstetrics Anaesthesia: Perinatal Outcomes, Side Effects and Maternal Satisfaction. Fifteen Years Systematic Literature Review. Arch Gynecol Obst 2014; 290: 21–
• Dobson G, Chong M, Chow L, Flexman A, Kurrek M, Laflamme C, Lagace´e A, Stacey S, Thiessen B. Guidelines to the Practice of Anesthesia – Revised Edition 2017. Can J Anesth 2017; 64: 65–91.