Doğum eylemi ile ilişkili perine travmalarının azaltılmasına yönelik yaklaşımlar

Yıl 2020, Cilt: 7 Sayı: 2, 125 - 130, 30.06.2020

Gamze Acavut Gülden Güvenç

Öz

Perineal travma doğum eylemin sırasında oluşan yırtık, laserasyon ya da epizyotomi uygulanması sonucunda ortaya çıkan hasardır. Doğum ile ilişkili perineal travma, kadının hayatını etkileyen birçok kısa ve uzun vadeli fiziksel ve psikolojik morbiditeye yol açabilmektedir. Doğum sonu erken dönemde ağrı, kanama ve anne bebek bağlanmasında gecikme gibi sorunlar ortaya çıkmaktadır. İlerleyen dönemde prolapsus, inkontinans, seksüel disfonksiyon ve anksiyete gibi sorunlar yaşanabilmektedir. Perineal travmaların azaltılması amacı ile literatürde perineal masaj, perineye sıcak uygulama, doğum pozisyonları, el manevraları ve ıkınma teknikleri gibi pek çok kanıta dayalı uygulama yer almaktadır. Ebe ve hemşireler; perineal travmaların azaltılması ve kanıta dayalı bu uygulamaların gerçekleştirilmesinde önemli rolleri olan sağlık profesyonelleridir. Bu makalede, doğum eylemi ile ilişkili perine travmalarının azaltılmasına yönelik yaklaşımlar değerlendirilmiştir.

Anahtar Kelimeler

Perine travması, Kanıta dayalı uygulamalar, hemşirelik, ebelik

Destekleyen Kurum

Hiç bir kurumdan destek alınmamıştır.

Approaches to reduce birth-related perineal trauma

Öz

Perineal trauma is the damage caused by rupture, laceration or episiotomy during labor. Perineal trauma associated with labor can lead to many short and long-term physical and psychological morbidities that affect the woman's life. Problems such as pain, bleeding and delay in the attachment of mother and baby appear in the early postpartum period. In the following period, problems such as prolapse, incontinence, sexual dysfunction and anxiety may be experienced. It is seen in the literature that there are many evidence-based practices such as perineal massage, warm application to the perineum, birth positions, hand maneuvers and strain techniques in reducing perineal traumas. Midwives and nurses; health professionals who have an important role in reducing perineal traumas and performing these evidence-based practices. In this article, approaches to reduce perineal trauma related to labor are evaluated.

Anahtar Kelimeler

perineal trauma, evidence-based practices, nursing, midwifery

Kaynakça

• 1. Moore KL., Dalley, AF. Clinically Oriented Anatomy. Lippincott Williams &Wilkins. USA Philadelphia, PA 19106. 2006, Pages 357-391. ISBN 0-7817-3639-0.
• 2. Erbaba, H., Pınar, G. (2016). Primipar Kadınların Perineal Travmaya İlişkin Görüşleri ve Uygulamaları: Nitel Bir Çalışma. Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi, 13(3);89-94.
• 3. Shoorab, NJ., Mirteimouri, M., Taghipour, A., Roudsari, RL.(2019). Women’s Experiences of Emotional Recovery from Childbirth-Related Perineal Trauma: A Qualitative Content Analysis IJCBNM, 7(3); 181-191.
• 4. Frolich, J., Kettle C. (2015). Perineal Care. Clinical Evidence, 03;1401.
• 5. Van Limbeek, S., Davis, D., Currie, M. Wong, N. (2016). Non-Surgical Intrapartum Practices for The Prevention of Severe Perineal Trauma: A Systematic Review Protocol. JBI Database System Rev Implement Rep., 14(4):30-40.
• 6. Royal College of Midwives. Midwifery Blue Top Guidance No.1. (2018). Midwifery Care in Labour Guidance For All Women in All Settings. https://www.rcm.org.uk/media/2539/professionals-blue-top-guidance.pdf , Erişim Tarihi: 08.01.2020.
• 7. Karaçam, Z. (2012). The Use of Perineal Massage in the Second Stage of Labor and Follow-up of Postpartum Perineal Outcomes. Health Care for Women International, 33:697-718.
• 8. Demirel, G., Golbasi, Z. (2015). Effect of Perineal Massage on the Rate of Episiotomy and Perineal Tearing. International Journal of Gynecology and Obstetrics, 131;183-6.
• 9. East, CE., Lau, R., Biro, MA. (2015). Midwives' and doctors' perceptions of their preparation for and practice in managing the perineum in the second stage of labour: A cross-sectional survey. Midwifery, 31(1):122-31.
• 10. Johanson, R. (2000). Perineal Massage For Prevention of Perineal Trauma in Childbirth. THE LANCET, 355(22);250-251.
• 11. ACOG Practice Bulletin. (2016). Prevention and Management of Obstetric Lacerations at Vaginal Delivery. Number 165. 128(1), e1-15.
• 12. Bick, DE., Ismail, KM., Macdonald, S., Thomas, P., Tohill, S., Kettle, C. (2012). How Good are We at Implementing Evidence to Support the Management of Birth Related Perineal Trauma? A UK Wide Survey of Midwifery Practice. BMC Pregnancy and Childbirth, 12:57.
• 13. Sayıner, FD., Demirci, N. (2007). Prenatal Perineal Masajın Vaginal Doğumlarda Etkinliği. İ.Ü.F.N. Hem. Derg., (60);146-154.
• 14. Frass, KA., Al-Harazi, AH. (2010). Episiotomy is Still Performed Routinely in Yemeni Women. Saudi Med J.,31(7):764-7.
• 15. Carroli, G., Mignini, L. (2014). Episiotomy for Vaginal Birth. Cochrane Database Syst Rev., (1):CD00008.
• 16. D’Souza, J., Monga, A., Tincello, DG. (2019). Risk Factors for Perineal Trauma in the Primiparous Population During Non-Operative Vaginal Delivery. International Urogynecology Journal, May.
• 17. Ellington, JE., Rizk, B., Criso, S. (2017). Antenatal Perineal Massage Improves Women’s Experience of Childbirth and Postpartum Recovery: A Review to Facilitate Provider and Patient Education on the Technique. J Womens Health Issues Care, 6(2).
• 18. Obioha, KC., Ugwu, EO., Obi, SN., Dim, CC., Oguano, TC. (2015). Prevalence and Predictors of Urinary/Anal Incontinence After Delivery: Prospective Study of Nigerian Women. Int Urogynecol J., 26;1347-54.
• 19. Yildirim, G., Beji, NK. (2008). Effects of Pushing Techniques in Birth on Mother and Fetus: A Randomized Study. BIRTH, 35(1);25-30.
• 20. Australian Commission on Safety and Quality in Health Care. (2018). Perineal Tears: A literature review. Sydney NSW 2000, ISBN: 978-1-925665-76-5, 1-48.
• 21. Kaya, N., Demirel, G. (2018). İntrapartum Perine Masajı Uygulamasına Güncel Bakış. Cumhuriyet Üniv. Sağ. Bil. Enst. Derg.,(3)1:33-40.
• 22. Royal College of Obstetricians&Gynaecologist. Green-top Guideline No. 29. (2015). The Management of Third and Fourth Degree Perineal Tears. https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-29.pdf , Erişim Tarihi: 10.01.2020.
• 23. Aasheim, V., Nilsen, ABV., Reinar, LM., Lukasse, M. (2017). Perineal techniques during the second stage of labour for reducing perineal trauma (Review). Cochrane Database of Systematic Reviews, Issue 6. Art. No.:CD006672
• 24. Karaöz, B., Saruhan, A. (2012). Perinenin Korunması İçin İntrapartum Girişimler. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi,1(4);323-332.
• 25. Barasinski, C., Debost-Legrand, A., Lemery, D., Vendittelli, F.(2018). Practices During The Active Second Stage of Labor: A Survey of French Midwives. Midwifery, 60:48-55.
• 26. Shahoei, R., Zaheri, F., Nasab, LH., Ranaei, F. (2017). The Effect of Perineal Massage During the Second Stage of Birth on Nulliparous Women Perineal: A randomization clinical trial. Electronic Physician, 9(10);5588-95.
• 27. Geranmayeh, M., Habibabadi, ZR., Fallahkish, B., Farahani, MA., Khakbazan, Z., Mehran, A. (2012). Reducing Perineal Trauma Through Perineal Massage with Vaseline in Second Stage of Labor. Arch Gynecol Obstet, 285:77-81.
• 28. Albers, LL., Borders, N. (2007). Minimizing Genital Tract Trauma and Related Pain Following Spontaneous Vaginal Birth. J Midwifery Womens Health. 52(3), 246-253.
• 29. Dönmez, S., Kavlak, O. (2015). Effects of Prenatal Perineal Massage and Kegel Exercises on the Integrity of Postnatal Perine. Health, 7, 495-505.
• 30. Beckmann, MM., Stock, OM. (2013). Antenatal Perineal Massage for Reducing Perineal Trauma. Cochrane Database Syst Rev. Apr 30;(4).
• 31. Ibrahim, HA., Elgzar, WTI., Hassan, HE. (2017). Effect of Warm Compresses Versus Lubricated Massage during the Second Stage of Labor on Perineal Outcomes among Primiparous Women. IOSR Journal of Nursing and Health Science, 6(4),Ver. V. PP 64-76.
• 32. Ganji, J., Shirvani, MA., Rezaei-Abhari, F., Danesh, M. (2013). The Effect of Intermittent Local Heat and Cold on Labor Pain And Child Birth Outcome. Iranian Journal of Nursing and Midwifery, 18(4), 298-303.
• 33. Dahlen, HG., Homer, CSE., Cooke, M., Upton, AM., Nunn, R., Brodrick, BS. (2007). Perineal Outcomes and Maternal Comfort Related to the Application of Perineal Warm Packs in the Second Stage of Labor: A Randomized Controlled Trial. BIRTH 34:4
• 34. Akbarzadeh, M., Vaziri, F., Farahmand, M., Masoudi, Z., Amooee, S., Zare, N. (2016). The Effect of Warm Compress Bistage Intervention on the Rate of Episiotomy, Perineal Trauma, and Postpartum Pain Intensity in Primiparous Women with Delayed Valsalva Maneuver Referring to the Selected Hospitals of Shiraz University of Medical Sciences in 2012-2013. Advances in Skin&Wound Care, 29(2), 79-84.
• 35. Albers, LL., Sedler, KD., Bedrick, EJ., Teaf, D., Peralta, P. (2005). Midwifery Care Measures in the Second Stage of Labor and Reduction of Genital Tract Trauma at Birth: A Randomized Trial. J Midwifery Womens Health. 50(5), 365-372.
• 36. Akbarzadeh, M., Nematollahi, A., Farahmand, M., Masoudi, Z., Amooee, S. (2018). The Effect of Two-Staged Warm Compress on the Pain Duration of First and Second Labor Stages and Apgar Score in Prim Gravida Women: a Randomized Clinical Trial. Journal of Caring Sciences, 7 (1), 21-26.
• 37. Fatemeh, A., Abedi, P., Afshary, P., Haghighi, MR., Hazeghi, N. (2018). Investigating the Effect of Perineal Heating Pad on the Frequency of Episiotomies and Perineal Tears in Primiparous Females. Medical-Surgical Nursing Journal,;7(1).
• 38. Magoga, G., Saccone, G., Al-Kouatly, HB., Dahlen, GH., Akbarzadeh, M., Özcan, T., Berghella, V. (2019). Warm Perineal Compresses during the Second Stage of Labor for Reducing Perineal Trauma: A Meta-Analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology, 240;93-98.
• 39. Meyvis I, Rompaey BV, Goormans K, Truijen S, Lambers S, Mestdagh E et al. Maternal Position and Other Variables: Effects on Perineal Outcomes in 557 Births. Birth 2012; 39: 115-20.
• 40. Fay Lodge, Melanie Haith-Cooper. (2016). The effect of maternal position at birth on perineal trauma: A systematic review. British Journal of Midwifery Vol. 24, No. 3.
• 41. Warmink-Perdijk WDB, Koelewijn JM, de Jonge A, van Diem MT, Lagro- Janssen ALM. (2016). Better Perineal Outcomes in Sitting Birthing Position cannot be Explained by Changing from Upright to Supine Position for Performing an Episiotomy. Midwifery 34: 1-6.
• 42. Osborne, KM. Pushing Techniques Used by Midwives When Providing Second Stage Labor Care. Dissertations, Theses, Marquette University, (2010).
• 43. WHO Recommendation On Techniques For Preventing perineal trauma during labour. (2018). https://extranet.who.int/rhl/topics/preconception-pregnancy-childbirth-and-postpartum-care/care-during-childbirth/care-during-labour-2nd-stage/who-recommendation-techniques-preventing-perineal-trauma-during-labour, Erişim Tarihi: 10.01.2020.
• 44. Hayata, E., Nakata, M., Umemura, N., Nagasaki, S., Oji, A., Maemura, T., Katagiri, Y., Morita, M. (2019). Safety of Uterine Fundal Pressure Maneuver During Second Stage of Labor in a Tertiary Perinatal Medical Center: A Retrospective Observational Study. Taiwanese Journal of Obstetrics & Gynecology, 58;375-379.
• 45. Çalik, KY., Karabulutlu, Ö., Yavuz, C. (2018). First Do No Harm - Interventions During Labor and Maternal Satisfaction: A Descriptive Cross-Sectional Study. BMC Pregnancy and Childbirth, 18:415.
• 46. Cuerva, MJ., Tobias, P., Espinosa, JA., Bartha, JL. (2015). Intrapartum Ultrasound Prior to Kristeller Maneuver: An Observational Study. J Perinat Med., Mar;43(2):171-5.
• 47. Petrocnik, Marshall. (2015). Hands-poised technique: The future technique for perineal management of second stage of labour? A modified systematic literature review. Mdwifery, 31(2):274-279.
• 48. Habek, D., Tikvica Luetić, A., Marton, I., Prka, M., Pavlović, G., Kuljak, Z., Svanjug, D., Mužina, Z. (2018). Modified Ritgen Maneuver in Perineal Protection-Sixty-Year Experience. Acta Clin Croat, 57;116-121.
• 49. Kaddoura, R., DeJonq, J., Zurayk, H, Abbyad, C., Mirza, FG. (2019). Episiotomy Practice in The Middle East: A Lebanese Teaching Tertiary Care Centre Experience. Women and Birth 32;e223-e228.
• 50. Wu, LC., Malhotra, R., Allen, JC., Lie, D., Tan, TC., Østbye T. (2013). Risk factors and midwife-reported reasons for episiotomy in women undergoing normal vaginal delivery. Arch Gynecol Obstet., 288;1249-56.
• 51. Lai, CY., Cheung, HW., Hsi Lao, TT., Leung, TY. (2009). Is the Policy of Restrictive Episiotomy Generalisable? A Prospective Observational Study. The Journal of Maternal-Fetal and Neonatal Medicine, 22(12):1116-1121.
• 52. EURO-PERISTAT Project, European Perinatal Health Report: Health and Care of Pregnant Women and Babies in Europe in 2010. (2013). Editors: Zeitlin, J., Mohangoo, A., Delnord, M.
• 53. Frankman, EA., Wang, Li., Bunker, CH., Lowder, JL. (2009). Episiotomy in the United States: has anything changed? Am J Obstet Gynecol, 200:573.e1-573.e7.
• 54. Woolley, RJ. (1995). Benefits and Risks of Episiotomy: A Review of the English-language Literature Since 1980. Part II. Obstet Gynecol Surv., 50(11);821-35.
• 55. Labrecque, M., Baillargeon, L., Dallaire, M., Trembly, A., Pinault, JJ., Gingras, S. (1997). Association Between Median Episiotomy and Severe Perineal Lacerations in Primiparous Women. Can Med Assoc J., 156:797-802.
• 56. Bansal, RK., Tan, WM., Ecker JL., Bishop JT., Kilpatrick SJ. (1996). Is there a Benefit to Episiotomy at Spontaneous Vaginal Delivery? A Natural Experiment. Am J Obstet Gynecol.,175:897-901.
• 57. Jiang, H., Qian, X., Carroli, G., Garner, P. (2017). Selective Versus Routine Use of Episiotomy for Vaginal Birth (Review). Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD000081.
• 58. Nassar, AH., Visser, GHA., Ayres-de-Campos, D., Rane, A., Gupta, S. (2019). FIGO Statement: Restrictive Use Rather Than Routine Use of Episiotomy. Int J Gynecol Obstet, 146: 17-19.
• 59. Care in Normal Birth: A Practical Guide (2017). Technical Working Group, World Health Organization, 24(2);121-3.
• 60. WHO Managing Complications in Pregnancy and Childbirth: A Guide for Midwives and Doctors. (2017). Geneva, 2nd ed. ISBN 978-92-4-156549-3.
• 61. Sooklim, R., Thinkhamrop, J., Lumbiganon, P., Prasertcharoensuk, W., Pttamadilok, J., Seekorn, K., Chongsomchai, C., Pitak, P., Chansamak, S. (2007). The outcomes of midline versus medio-lateral episiotomy. Reproductive Health 4:10.
• 62. Kalis, V., Laine, K., de Leeuw, JW., Ismail KM., Tincello DG. (2012). Classification of episiotomy: towards a standardisation of terminology. BJOG,119:522-526.
• 63. Revicky, V., Nirmal, D., Mukhopadhyay, S., Morris, EP., Nieto, JJ. (2010). Could a mediolateral episiotomy prevent obstetric anal sphincter injury? European Journal of Obstetrics & Gynecology and Reproductive Biology, 150;142-6.
• 64. Dencker, A., Smith, V., McCann, C., Begley, C. (2017). Midwife-Led Maternity Care in Ireland – A Retrospective Cohort Study. BMC Pregnancy and Childbirth, 17:101.