Öz
Episiotomy, one of the causes of perineal trauma, is one of the world’s leading obstetric surgical practices that have increased significantly during the 20th century. The American Gynecology and Obstetric Union 2016 does not recommend the routine application of episiotomies during spontaneous vaginal deliveries and recommends it in cases where a rapid delivery of the fetus is required, in operative vaginal deliveries and in shoulder dystocia cases. In current studies, the episiotomy frequency in the world varies between 50% and 95% for nulliparas and 6-20% for multiparas. In our country, studies on the frequency of episiotomy are limited, but the application frequency of episiotomy is 90-99% for nulliparas and 50% -75% for multiparas in those studies. Today, much current evidence suggests that limited episiotomy is more protective than routine episiotomy in terms of perineal trauma. In this respect, there are various applications in the literature aimed at reducing the incidence of perineal trauma. These applications include perineal massage, warm application to the perineum, birth positions, hand maneuvers and push out. These methods are methods that reduce perineal trauma. The practitioners of these methods are midwives and obstetric and gynecological nurses who have a very important role and responsibility at/ during the vaginal birth. For this reason, this review study was carried out in order to increase the sensitivity to the subject and to guide health professionals by drawing attention to the alternative methods in order to reduce perineal traumas such as episiotomies and lacerations in accordance with the related current literature.
Anahtar Kelimeler
Alternative method obstetrics and gynecology nurse midwife episiotomy perineal trauma
Kaynakça
- Schantz C, Sim KL, Ly EM, Barennes H, Sudaroth S, Goyet S. Reasons for Routine Episiotomy: A Mixed-Methods Study in a Large Maternity Hospital in Phnom Penh, Cambodia. Reprod Health Matters 2015; 23: 68–77. [CrossRef]
- Althabe F, Belizan JM, Bergel E. Episiotomy Rates in Primiparous Women in Latin America: Hospital Based Descriptive Study. BMJ 2002; 324: 945-6.
- Van den Bergh JE, Sueters M, Segaar M, Van Roosmalen J. Determinants of Episiotomy in Rural Zimbabwe. Acta Obstet Gynecol Scand 2003; 82: 966-8.
- Raisanen S, Vehvilainen- Julkunen K, Heinonen S. Need for and Consequences of Episiotomy in Vaginal Birth: A Critical Approach. Midwifery 2010; 26: 348-56. [CrossRef]
- Izuka EO, Dim CC, Chigbu CO, Obiora-Izuka CE. Prevalence and Predictors of Episiotomy Among Women at First Birth in Enugu, South-East Nigeria. Ann Med Health Sci Res 2014; 4: 928–32. [CrossRef]
- Hernández Pérez J, Azón López E, Mir Ramos E, Peinado Berzosa R, Val Lechuz B, Mérida Donoso A. Factors Affecting the Performance of a Selective Episiotomy in Nulliparous Women. Julio 2014; 35: 412-24.
- Al-Ghammari K, Al-Riyami Z, Al-Moqbali M, Al-Marjabi F, Al-Mahrouqi B, Al-Khatri A et al. Predictors of Routine Episiotomy in Primigravida Women in Oman. Appl Nurs Res 2016; 29: 131–5. [CrossRef]
- Karacam Z, Eroglu K. Effects of Episiotomy on Bonding and Mother’s Health. J Adv Nur 2003; 43: 384–94.
- Şahin NH, Yıldırım G, Aslan E. Evaluating the Second Stages of Deliveries Maternity Hospital. Turkiye Klinikleri J Gynecol Obstet 2007;17: 37–43.
- Sayıner FD, Demirci N. Prenatal Perineal Masajın Vaginal Doğumlarda Etkinliği, İÜFN Hem Derg 2007; 15:146-54.
- ACOG. Ob-Gyns Can Prevent and Manage Obstetric Lacerations During Vaginal Delivery, Says New ACOG Practice Bulletin. 2016 http:// www.acog.org/About-ACOG/News-Room/News-Releases/2016/ Ob-Gyns-Can-Prevent-and-Manage-Obstetric-Lacerations RCOG. Episiotomy. 2012 https://www.rcog.org.uk/en/ guidelines-research-services/guidelines/episiotomy---query-bank/
- SOGC. Guidelines For Operative Vaginal Birth. 2004; No: 148. https:// sogc.org/wp-content/uploads/2013/01/148E-CPG-August2004.pdf
- Berkowitz LR, Foust-Wright CE. Approach to Episiotomy, UpToDate 2016 https://www.uptodate.com/contents/ approach-to-episiotomy/print
- Carroli G, Mignini L. Episiotomy for Vaginal Birth. Cochrane Database Syst Rev 2009; 21: CD000081. [CrossRef]
- Joshi A, Acharya R. Perineal Outcome After Restrictive Use of Episiotomy in Primigravidas. J Nepal Med Assoc 2009; 48: 269-72.
- Albers LL, Sedler KD, Bedrick EJ, Teaf D, Peralta P. Midwifery Care Measures in the Second Stage of Labor and Reduction of Genital Tract Trauma at Birth: A Randomized Trial. J Midwifery Womens Health 2005; 50: 365–72. [CrossRef]
- Mei-dan E, Walfisch A, Raz I, Levy A, Hallak M. Perineal Massage During Pregnancy: a Prospective Controlled Trial. Isr Med Assoc J 2008; 10: 499-502.
- Attarha M, Vakillian K, Rozbahany N, Bekhradi R. Effect of Perineal Massage with Lavender Essence on Episiotomy and Laceration. J Babol Univ Med Sci 2009; 11: 25-30.
- Aasheim V, Nilsen AB, Lukasse M, Reinar LM. Perineal Techniques During the Second Stage of Labour for Reducing Perineal Trauma. Cochrane Database Syst Rev. 2011; 7: CD006672. [CrossRef]
- Foroughipour A, Firuzeh F, Ghahiri A, Norbakhsh V, Heidari T. The Effect of Perineal Control with Hands-on and Hand-poised Methods on Perineal Trauma and Delivery Outcome. J Res Med Sci 2011;16:1040–6.
- Fahami F, Shokoohi Z, Kianpour M. The effects of Perineal Management Techniques on Labor Complications. Iran J Nurs Midwifery Res 2012; 17: 52–7.
- Beckmann MM, Stock OM. Antenatal Perineal Massage For Reducing Perineal Trauma. Cochrane Database Syst Rev 2013; 4: CD005123. [CrossRef]
- Rozita R, Saatsaz S, Chan YH, Nia HS. A Comparison of the “Hands- Off” and “Hands-On” Methods to Reduce Perineal Lacerations: A Randomised Clinical Trial. J Obstet Gynaecol India 2014; 64: 425–9. [CrossRef]
- Zare O, Pasha H, Faramarzi M. Effect of Perineal Massage on the İncidence of episiotomy and Perineal Laceration. Health 2014;6:10- 4. [CrossRef]
- Demirel G, Gölbaşı Z. Effect of Perineal Massage on the Rate of Episiotomy and Perineal Tearing. Int J Gynaecol Obstet 2015;131:183–6. [CrossRef]
- Lemos A, Amorim MM, Dornelas de Andrade A, de Souza AI, Cabral Filho JE, Correia JB. Pushing/bearing down Methods for the Second Stage of Labour. Cochrane Database Syst Rev 2015; CD009124. [CrossRef]
- Lodge F, Haith-Cooper M. The Effect of Maternal Position at Birth on Perineal Trauma: A Systematic Review, BJM 2016; 24: 172-80. [CrossRef]
- Warmink-Perdijk WDB, Koelewijn JM, de Jonge A, van Diem MT, Lagro- Janssen ALM. Better Perineal Outcomes in Sitting Birthing Position cannot be Explained by Changing from Upright to Supine Position for Performing an Episiotomy. Midwifery 2016; 34: 1-6. [CrossRef]
- Prins M, Boxem J, Lucas C, Hutton E. Effect of Spontaneous Pushing versus Valsalva Pushing in the Second Stage of Labour on Mother and Fetus: A Systematic Review of Randomised Trials. BJOG 2011;118: 662-70. [CrossRef]
- Diorgu FC, Steen MP, Keeling JJ, Mason-Whitehead E. Mothers and midwives perceptions of birthing position and perineal trauma: An exploratory study. Women Birth 2016; 9: 518-23. [CrossRef]
- Taşkın L. Riskli Doğum Eylemi. İçinde Doğum ve Kadın Sağlığı Hemşireliği. Taşkın L. Edt. 11. Baskı. Ankara: Sistem Ofset Mabaacılık, 2012: ss:370-1.
- Ballesteros-Meseguer C, Carrillo-García C, Meseguer-de-Pedro M, Canteras-Jordana M, Martínez-Roche ME. Episiotomy and its Relationship to Various Clinical Variables that İnfluence its Performance. Rev Lat Am Enfermagem 2016; 24: e2793. [CrossRef]
- Kwon HY, Park HS. Episiotomy and the Risk of Severe Perineal Injuries Among Korean Women. J Matern Fetal Neonatal Med 2017;30:1745- 49. [CrossRef]
- Dahlen HG, Homer CS, Cooke M, Upton AM, Nunn R, Brodrick B. Perineal Outcomes and Maternal Comfort Related to the Application of Perineal Warm Packs in the Second Stage of Labor: A Randomized Controlled Trial. Birth 2007; 34: 282-90. [CrossRef]
- Gupta JK, Nikodem VC. Woman’s Position During Second Stage of Labour. Cochrane Database Syst Rev 2000; 2: CD002006. [CrossRef]
- Kalis V, Stepán JJr, Králícková M, Zlůvová P, Rokyta Z. Maternal Position at the Delivery and Perineal Trauma. Ceska Gynekol 2007;72:241-6.
- Gupta JK, Hofmeyr GJ, Shehmar M. Position in the Second Stage of Labour for Women Without Epidural Anaesthesia. Cochrane Database Syst Rev 2012; 5: CD002006. [CrossRef]
- 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. [CrossRef]
- De Souza Caroci da Costa A, Gonzalez Riesco ML. A Comparison of “Hands off” versus “Hands on” Techniques for Decreasing Perineal Lacerations During Birth. J Midwifery Womens Health 2006;51:106- 11. [CrossRef]
- Berghella V. Obstetric Evidence Based Guidelines. London: İnforma Healthcare, 2007: 60.
- Varney H, Kriebs JM, Gegor CL. Varney’s Midwifery 4th edition. London: Jones and Bartlett Publishers, 2004: 842-3.
Öz
Perineal travma nedenlerinden biri olan epizyotomi, dünya çapında 20. yüzyıl boyunca önemli derecede artış gösteren obstetrik cerrahi uygulamalardan biridir. Amerika Jinekoloji ve Obstetrik Birliği 2016 spontan vajinal doğumlarda epizyotominin rutin olarak uygulanmasını önermemekte ve epizyotomi uygulamasına fetüsün hızlıca doğurtulması gereken durumlarda, operatif vajinal doğumlarda ve omuz distozisi durumlarında başvurulması gerektiğini belirtmektedir. Yapılan güncel çalışmalarda dünyada epizyotomi sıklığı nulliparlar için %50-%95, multiparlar için %6-20 arasında değişmektedir. Ülkemizde ise epizyotomi uygulanma sıklığına yönelik çalışmalar sınırlı sayıda olup, yapılan çalışmalarda epizyotomi uygulanma sıklığı nullipar için %90-%99, multipar için %50-%75 arasındadır.Günümüzde birçok güncel kanıt, sınırlı epizyotomi uygulamasının rutin epizyotomi uygulamasına göre perineal travmalar açısından daha koruyucu olduğunu bildirmektedir. Bu doğrultuda literatürde perineal travma insidansını azaltmaya yönelik yapılan çeşitli uygulamalara rastlanmaktadır. Bu uygulamalar arasında perineal masaj, perineye sıcak uygulama, doğum pozisyonları, el manevraları ve ıkınma yöntemi yer almaktadır. Bu yöntemler perineal travmayı azaltan yöntemlerdir. Bu yöntemlerin uygulayıcıları ise vajinal doğumda, çok önemli rol ve sorumluluklara sahip olan, ebeler ile doğum ve kadın hastalıkları hemşireleridir. Bu nedenle bu derleme çalışması, ilgili güncel literatür doğrultusunda epizyotomi, laserasyonlar gibi perineal travmaları azaltmaya yönelik yapılan alternatif yöntemlere dikkat çekerek konuya olan duyarlılığın artırılması ve sağlık profesyonellerine yön gösterici olması amacıyla ele alınmıştır
Anahtar Kelimeler
Alternatif yöntem doğum ve kadın hastalıkları hemşiresi ebe epizyotomi perineal travma
Kaynakça
- Schantz C, Sim KL, Ly EM, Barennes H, Sudaroth S, Goyet S. Reasons for Routine Episiotomy: A Mixed-Methods Study in a Large Maternity Hospital in Phnom Penh, Cambodia. Reprod Health Matters 2015; 23: 68–77. [CrossRef]
- Althabe F, Belizan JM, Bergel E. Episiotomy Rates in Primiparous Women in Latin America: Hospital Based Descriptive Study. BMJ 2002; 324: 945-6.
- Van den Bergh JE, Sueters M, Segaar M, Van Roosmalen J. Determinants of Episiotomy in Rural Zimbabwe. Acta Obstet Gynecol Scand 2003; 82: 966-8.
- Raisanen S, Vehvilainen- Julkunen K, Heinonen S. Need for and Consequences of Episiotomy in Vaginal Birth: A Critical Approach. Midwifery 2010; 26: 348-56. [CrossRef]
- Izuka EO, Dim CC, Chigbu CO, Obiora-Izuka CE. Prevalence and Predictors of Episiotomy Among Women at First Birth in Enugu, South-East Nigeria. Ann Med Health Sci Res 2014; 4: 928–32. [CrossRef]
- Hernández Pérez J, Azón López E, Mir Ramos E, Peinado Berzosa R, Val Lechuz B, Mérida Donoso A. Factors Affecting the Performance of a Selective Episiotomy in Nulliparous Women. Julio 2014; 35: 412-24.
- Al-Ghammari K, Al-Riyami Z, Al-Moqbali M, Al-Marjabi F, Al-Mahrouqi B, Al-Khatri A et al. Predictors of Routine Episiotomy in Primigravida Women in Oman. Appl Nurs Res 2016; 29: 131–5. [CrossRef]
- Karacam Z, Eroglu K. Effects of Episiotomy on Bonding and Mother’s Health. J Adv Nur 2003; 43: 384–94.
- Şahin NH, Yıldırım G, Aslan E. Evaluating the Second Stages of Deliveries Maternity Hospital. Turkiye Klinikleri J Gynecol Obstet 2007;17: 37–43.
- Sayıner FD, Demirci N. Prenatal Perineal Masajın Vaginal Doğumlarda Etkinliği, İÜFN Hem Derg 2007; 15:146-54.
- ACOG. Ob-Gyns Can Prevent and Manage Obstetric Lacerations During Vaginal Delivery, Says New ACOG Practice Bulletin. 2016 http:// www.acog.org/About-ACOG/News-Room/News-Releases/2016/ Ob-Gyns-Can-Prevent-and-Manage-Obstetric-Lacerations RCOG. Episiotomy. 2012 https://www.rcog.org.uk/en/ guidelines-research-services/guidelines/episiotomy---query-bank/
- SOGC. Guidelines For Operative Vaginal Birth. 2004; No: 148. https:// sogc.org/wp-content/uploads/2013/01/148E-CPG-August2004.pdf
- Berkowitz LR, Foust-Wright CE. Approach to Episiotomy, UpToDate 2016 https://www.uptodate.com/contents/ approach-to-episiotomy/print
- Carroli G, Mignini L. Episiotomy for Vaginal Birth. Cochrane Database Syst Rev 2009; 21: CD000081. [CrossRef]
- Joshi A, Acharya R. Perineal Outcome After Restrictive Use of Episiotomy in Primigravidas. J Nepal Med Assoc 2009; 48: 269-72.
- Albers LL, Sedler KD, Bedrick EJ, Teaf D, Peralta P. Midwifery Care Measures in the Second Stage of Labor and Reduction of Genital Tract Trauma at Birth: A Randomized Trial. J Midwifery Womens Health 2005; 50: 365–72. [CrossRef]
- Mei-dan E, Walfisch A, Raz I, Levy A, Hallak M. Perineal Massage During Pregnancy: a Prospective Controlled Trial. Isr Med Assoc J 2008; 10: 499-502.
- Attarha M, Vakillian K, Rozbahany N, Bekhradi R. Effect of Perineal Massage with Lavender Essence on Episiotomy and Laceration. J Babol Univ Med Sci 2009; 11: 25-30.
- Aasheim V, Nilsen AB, Lukasse M, Reinar LM. Perineal Techniques During the Second Stage of Labour for Reducing Perineal Trauma. Cochrane Database Syst Rev. 2011; 7: CD006672. [CrossRef]
- Foroughipour A, Firuzeh F, Ghahiri A, Norbakhsh V, Heidari T. The Effect of Perineal Control with Hands-on and Hand-poised Methods on Perineal Trauma and Delivery Outcome. J Res Med Sci 2011;16:1040–6.
- Fahami F, Shokoohi Z, Kianpour M. The effects of Perineal Management Techniques on Labor Complications. Iran J Nurs Midwifery Res 2012; 17: 52–7.
- Beckmann MM, Stock OM. Antenatal Perineal Massage For Reducing Perineal Trauma. Cochrane Database Syst Rev 2013; 4: CD005123. [CrossRef]
- Rozita R, Saatsaz S, Chan YH, Nia HS. A Comparison of the “Hands- Off” and “Hands-On” Methods to Reduce Perineal Lacerations: A Randomised Clinical Trial. J Obstet Gynaecol India 2014; 64: 425–9. [CrossRef]
- Zare O, Pasha H, Faramarzi M. Effect of Perineal Massage on the İncidence of episiotomy and Perineal Laceration. Health 2014;6:10- 4. [CrossRef]
- Demirel G, Gölbaşı Z. Effect of Perineal Massage on the Rate of Episiotomy and Perineal Tearing. Int J Gynaecol Obstet 2015;131:183–6. [CrossRef]
- Lemos A, Amorim MM, Dornelas de Andrade A, de Souza AI, Cabral Filho JE, Correia JB. Pushing/bearing down Methods for the Second Stage of Labour. Cochrane Database Syst Rev 2015; CD009124. [CrossRef]
- Lodge F, Haith-Cooper M. The Effect of Maternal Position at Birth on Perineal Trauma: A Systematic Review, BJM 2016; 24: 172-80. [CrossRef]
- Warmink-Perdijk WDB, Koelewijn JM, de Jonge A, van Diem MT, Lagro- Janssen ALM. Better Perineal Outcomes in Sitting Birthing Position cannot be Explained by Changing from Upright to Supine Position for Performing an Episiotomy. Midwifery 2016; 34: 1-6. [CrossRef]
- Prins M, Boxem J, Lucas C, Hutton E. Effect of Spontaneous Pushing versus Valsalva Pushing in the Second Stage of Labour on Mother and Fetus: A Systematic Review of Randomised Trials. BJOG 2011;118: 662-70. [CrossRef]
- Diorgu FC, Steen MP, Keeling JJ, Mason-Whitehead E. Mothers and midwives perceptions of birthing position and perineal trauma: An exploratory study. Women Birth 2016; 9: 518-23. [CrossRef]
- Taşkın L. Riskli Doğum Eylemi. İçinde Doğum ve Kadın Sağlığı Hemşireliği. Taşkın L. Edt. 11. Baskı. Ankara: Sistem Ofset Mabaacılık, 2012: ss:370-1.
- Ballesteros-Meseguer C, Carrillo-García C, Meseguer-de-Pedro M, Canteras-Jordana M, Martínez-Roche ME. Episiotomy and its Relationship to Various Clinical Variables that İnfluence its Performance. Rev Lat Am Enfermagem 2016; 24: e2793. [CrossRef]
- Kwon HY, Park HS. Episiotomy and the Risk of Severe Perineal Injuries Among Korean Women. J Matern Fetal Neonatal Med 2017;30:1745- 49. [CrossRef]
- Dahlen HG, Homer CS, Cooke M, Upton AM, Nunn R, Brodrick B. Perineal Outcomes and Maternal Comfort Related to the Application of Perineal Warm Packs in the Second Stage of Labor: A Randomized Controlled Trial. Birth 2007; 34: 282-90. [CrossRef]
- Gupta JK, Nikodem VC. Woman’s Position During Second Stage of Labour. Cochrane Database Syst Rev 2000; 2: CD002006. [CrossRef]
- Kalis V, Stepán JJr, Králícková M, Zlůvová P, Rokyta Z. Maternal Position at the Delivery and Perineal Trauma. Ceska Gynekol 2007;72:241-6.
- Gupta JK, Hofmeyr GJ, Shehmar M. Position in the Second Stage of Labour for Women Without Epidural Anaesthesia. Cochrane Database Syst Rev 2012; 5: CD002006. [CrossRef]
- 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. [CrossRef]
- De Souza Caroci da Costa A, Gonzalez Riesco ML. A Comparison of “Hands off” versus “Hands on” Techniques for Decreasing Perineal Lacerations During Birth. J Midwifery Womens Health 2006;51:106- 11. [CrossRef]
- Berghella V. Obstetric Evidence Based Guidelines. London: İnforma Healthcare, 2007: 60.
- Varney H, Kriebs JM, Gegor CL. Varney’s Midwifery 4th edition. London: Jones and Bartlett Publishers, 2004: 842-3.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Collection |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Haziran 2019 |
| Yayımlandığı Sayı | Yıl 2019Sayı: 2 |