APPROACHES IN PREVENTION OF PERINEAL TRAUMA IN VAGINAL BIRTH ACTION

Yıl 2019, Cilt: 2 Sayı: 2, 38 - 45, 21.11.2019

Esma Nur Aktuna , Nuran Aydın Ateş Asiye Ayar Kocatürk

Öz

Perineal trauma is a problem that can occur in the genital area spontaneously or after episiotomy during the intervention period, which can occur even after birth and sometimes lasts 3 months after birth. It is very common in our lives. often encountered. In the vaginal delivery, the misplaced birth position, the impetus without giving birth to its own course, the large infant, especially the routine episiotomy applied to each primipara woman and the routine, unnecessary interventions are some of the applications that cause perineal trauma. Negative effects such as painful sexual intercourse, stool, and urinary incontinence, perineal pain negativities, delayed breastfeeding and delayed involution of the mother in the long term negatively affect the daily lives of women. Extraction techniques taught in the latent phase, hot-cold compresses to be applied to perineum, perineal massages, manual protection of perineum, avoiding a routine episiotomy and steep birth position are some of the interventions that have an effect on preventing perineal trauma. The midwives who play an active role in a vaginal delivery are those who have a great responsibility and importance in implementing these interventions that prevent perineal trauma.

Anahtar Kelimeler

Perineal trauma, vaginal delivery, midwifery approach

VAJİNAL DOĞUM EYLEMİNDE PERİNEAL TRAVMANIN ÖNLENMESİNDE YAKLAŞIMLAR

Öz

Perineal travma, müdahaleli doğum esnasında genital bölgede kendiliğinden veya epizyotomi nedeniyle ortaya çıkan hasar olarak tanımlanan doğum sonrasında karşılaşılan ve bazen doğumdan 3 ay sonraya kadar bile sürebilen bir problemdir. Vajinal doğum eyleminde doğum pozisyonu yanlışlığı,doğumun kendi seyrine bırakılmadan aceleci davranılması,iri bebek,özellikle her primipar kadına uygulanan rutin epizyotomi ve rutin,gereksiz girişimler perineal travmaya neden olan uygulamalardan bazılarıdır.Vajinal doğum yapan kadınların %85‟inde perineal travma bulunduğu kanıtlanmıştır. Kadınların günlük yaşamlarını olumsuz etkileyen ve uzun vadede ağrılı cinsel ilişki,gaita ve üriner inkontinans,perine ağrısı olumsuzluklarının yanında anne ve bebeği geç bağlanma,emzirmenin gecikmesi,annenin kendini geç toparlaması gibi olumsuz etkilere sebep olmaktadır. Latent fazda öğretilen ıkınma teknikleri,perineye uygulanacak sıcak-soğuk kompresler, perine masajları, perinenin elle korunması, rutin epizyotomiden kaçınmak ve dik doğum pozisyonu perineal travmayı önlemekte etkisi olan girişimlerden bazılarıdır. Vajinal doğum eyleminde aktif rol oynayan ebeler perineal travmayı önleyen bu girişimleri uygulamakta büyük sorumluluğa ve öneme sahip kişilerdir.

Anahtar Kelimeler

Perineal travma, vajinal doğum, ebelik yaklaşımı

Kaynakça

• McCandlish R1, Bowler U, van Asten H, Berridge G, Winter C, Sames L, Garcia J, Renfrew M, Elbourne D. A randomised controlled trial of care of the perineum during second stage of normal labour: Br J Obstet Gynaecol.1998;105(12):1262-72.
• Albers L, Garcia J, Renfrew M et al. Distribution of genital tract trauma in childbirth and related postnatal pain: Birth.1999;26(1):7–11
• Johanson R. Perineal massage for prevention of perineal trauma in childbirth:Lancet 2000;3(55): 250–251.1
• Kettle C, Tohil S. Perineal Care; BJM Clin.2008; 24(10): 1-14
• Grant A Sleep J,. et al West Berkshire Perineal Management.1984;2(98):578-690.
• Kettle C, Julie F “Perineal care.”: Clin Evid.2002;7:1284-95
• Sayıner F.D, Özerdoğan N, Doğal Doğum. Maltepe Üniversitesi Hemşirelik Bilim ve Sanat Dergisi .2009; 3-143
• Albers L, Sedler KD, Bedrick EJ et al.. Factors related to genital tract trauma in normal spontneous vaginal births. Birth (2006)32 (2): 94–100.
• Glazener CM, Abdalla M, Stroud P et al. Postnatal maternal morbidity: extent, causes, prevention and treatment:British Journal of Obstetrics and Gynecology.1995;102(4): 282–287.
• Taşkın L. Riskli Doğum Eylemi. Doğum ve Kadın Sağlığı Hemşireliği, 6.baskı, Ankara, 2003;292- 293
• Society of Obstetricians and Gynaecologists of Canada Guıdelınes For Operatıve Vagınal Bırth.2004.
• Karaçam Z, Epizyotominin Doğum Sonrası Dönemde Cinsel Fonksiyona Etkisi:Hemşirelikte Araştırma Geliştirme Dergisi.2008;38-46
• Bodner-Adler B Mayerhofer K. et al., Traditional care of the perineum during birth. A prospective, randomized, multicenter study of 1076 women.:J Reprod Med.2002; 47: 477–82.
• American College of Obstetricians and Gynecologists.ACOG Recommends Restricted Use of Episiotomies.2006.
• Dahlen, H.G., Homer, C.S.E., Cooke, M., Upton, A. M., Nunn, R.A., Brodrick, B.S. Soothing The Ring of Fire: Australian Women's and Midwives Experiences of Using Perineal Warm Packs in The Second Stage of Labour Midwifery.2009;25(2):39–48
• Albers, L.L.. Reducing Genital Tract Trauma at Birth: Launching A Clinical Trial in Midwifery:Journal of Midwifery & Women’s Health.2003;48(2):105–110.
• Stamp, G.E. Care of The Perineum in The Second Stage of Labour: A Study of Views and Practices of Australian Midwives. Midwifery.1997;13(2):100–104
• Balaskas, J. New Active Birth. (2nd edition). London: Thorsons.1991; p.125.
• Musgrove, H.. Perineal Preservation and Heat Application During Second Stage of LaborRandomised Controlled Trial:Midwifery Today E- News.1999;1(33).
• Hobbs, L. The Best Labor Possible? (1st edition). Oxford: Butterworth-Heinemann Medical.2001;p.102
• Simkin, P., Boldig, A. Update on Nonpharmacologic Approaches to Relieve Labor Pain and Prevent Suffering:Journal of Midwifery and Womens Health.2004;49(6), 489–504.
• Davis, E. Heart & hands: A Midwife’s Guaide to Pregnancy and Birth. (4thedition). California: Celestıal Arts.2004;p.122–123.
• Berghella V, Baxter JK, Chauhan SP. Evidence-based labor and delivery management. 1989.
• American journal of obstetrics and gynecology. 2008;199(5):445-54.
• Aasheim V, Nilsen ABV, Lukasse M, Reinar LM. Perineal techniques during the second stage of labour for reducing perineal trauma:The Cochrane Library. 2011
• Dahlen HG, Homer CSWhat are the views of midwives in relation to perineal repair?: Women and Birth.2008;21(1):27-35.
• Harrison R, Brennan M. Comparison of two formulations of lignocaine spray with mefenamic acid in the relief of post-episiotomy pain: a placebo-controlled study:Current Medical Research and Opinion.1987;10(6):375-9.
• Yıldırım G.,Beji K. N. Effects of pushing techniques in birth on mother and fetus: a randomized study: Birth. 2008;35(1):25-30
• Roberts CL, Torvaldsen S, Cameron CA, Olive E Delayed versus early pushing in women with epidural analgesia: a systematic review and meta-analysis:BJOG.2004; 111:1333-40.
• Güngör İ, Rathfish YG. Normal doğum eyleminin ikinci ve üçüncü evresinde kanıta dayalı uygulamalar:HEMAR-G.2009;11(2): 56-65.
• Başgöl Ş., Kızılkaya Beji N., Doğum Eyleminin İkinci ve Üçüncü Evresinde Sık Yapılan Uygulamalar ve Kanıta Dayalı Yaklaşım:DÜ Sağlık Bil Enst Derg.2015; 5(3):66-71
• Balenbois E, Ratier N, Letouzey V, Marès P, de Tayrac R [Methods of pushing at vaginal delivery and pelvi-perineal consequences.. Progres en Urologie : Journal de L’Association Francaise D’urologie et de la Societe Francaise D’urologie.2015; 25(4):180-7.
• Erbaba H , Pınar G, Postpartum Perineal Travmanın Önlenmesi ve Yönetimine İlişkin Güncel Yaklaşımlar: Hemşirelikte eğitim ve araştırma dergisi.2016;13 (3): 272-281
• Altman D. Ragnar I, , Tyden T, Olsson SE. Comparison of the maternal experience and duration of labour in two upright delivery positions-a randomised controlled trial: An İnternational Journal of Obstetrics & Gynaecology.2006;113(2):165-70.
• Force UPST. Guide to clinical preventive services: Dıane.1989
• Baxter, K.J Berghella, V.,., Chauhan, P.S. Evidence – Based Labor and Delivery Management:American Journal of Obstetrics and Gynecology.2008;199(5), 445-454
• Joyce T, Di Franco AM, Romano RK Care practice spontaneous pushing in upright or gravityneutral positions: Journal of Perinatal Education.2007;16(3):35–38.
• Beckmann MM, Garrett AJ Antenatal perineal massage for reducing perineal trauma: Cochrane Database of Systematic Reviews.200; 25(1)
• Shipman MK, Boniface DR, Tefft ME et al.. Antenatal perineal massage and subsequent perineal outcomes: a randomised controlled trial:British Journal of Obstetrics and Gynecology.1997;10(4):787–791.
• Sayıner FD, Demirci N Prenatal Perineal Masajın Vaginal Doğumlarda Etkinliği:İ.Ü.F.N. Hem. Derg.2007;15(60):146-154
• Labrecque M 1 , Eason D , Marcoux S , Lemieux F , Pinault JJ , Feldman P , Laperrière L . Randomized controlled trial of prevention of perineal trauma by perineal massage during pregnancy. Am J Obstet Gynecol. 1999;180(3 Pt 1):593-600.
• Labrecque M, Eason E, Marcoux S. Women's views on the practice of prenatal perineal massage: An international journal of obstetrics and gynaecology.2001;108 (5): 499-550.