Perineal Travmayı Azaltmaya Yönelik Alternatif Yöntemler

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

ALTERNATIVE METHODS FOR REDUCING PERINEAL TRAUMA

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.

Keywords:

Alternative method, obstetrics and gynecology nurse, midwife episiotomy, perineal trauma,

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