Miadında Gebelerde Membran Stripping Yönteminin Gebelik Süresine Etkisi

Amaç: Doğum indüksiyon metodlarından membran sıyırma veya stripping yöntemi obstetrikte miadında gebelerde sık kullanılan işlemlerden biridir, non-farmakolojik yöntemlerdendir. Çalışmada bu yöntemin doğum sürecindeki etkileri, doğumu başlatma ve gebelik süresini kısaltma, postterm gebeliği önleme, indüksiyon gereksinimini azaltma yönlerinden etkinliği, etkinliğine etki eden faktörleri ve bu yönteme bağlı fetal ve maternal sonuçları araştırmak hedeflendi. Gereç ve Yöntemler: Çalışmaya, ilk obstetrik değerlendirmede tekil canlı gebeliği olan, 38-40 hafta arası miadında olan, C/S (sezaryen) veya herhangi bir uterin cerrahi geçirmemiş olan, Bishop skoru 4 veya daha küçük olan, vajinal yoldan doğum için kontrendikasyonu olmayan olgular alındı. Çalışma toplam 216 olgu üzerinde yapıldı. 108 olgu (42 multipar, 66 nullipar) çalışma, 105 olgu (48 multipar, 57 nullipar) kontrol grubunu oluşturdu. Bulgular: Çalışma grubunda uygulamadan doğuma kadar geçen süre (gün) ortalaması 7,04 ± 3,96 kontrol grubunda ise 9,24 ± 5,01 bulundu. Çalışma grubunda 7 gün içerisinde vajinal doğum yapma oranı (%68,5), kontrol grubundan (%43,8) istatistiksel olarak ileri düzeyde anlamlı yüksek bulundu. Çalışma grubunda 41. Gebelik haftasından önce doğum yapma oranı (%84,3), kontrol grubundan (%69,5) istatistiksel olarak anlamlı düzeyde yüksek bulundu. İndüksiyon gereksinimi çalışma grubunda (%11,1) kontrol grubuna (%23,8) kıyasla istatistiki olarak anlamlı düzeyde düşük bulunmuştur. Her iki grup doğum şekli, erken membran rüptürü, neonatal sonuçlar, maternal enfeksiyon açısından karşılaştırıldıklarında sonuçlar benzer bulundu. Sonuç: Membran sıyırma yönteminin, komplike olmayan 38-40 hafta arasındaki term gebelerde, maternal-fetal sonuçları değiştirmeden, uygulamadan doğuma kadar geçen süreyi, postterm gebelik oranlarını ve indüksiyon gereksinimini azaltma açısından etkili ve güvenilir bir yöntem olduğu gözlemlenmiştir.

Anahtar Kelimeler:

doğum indüksiyonu, miad aşımı, servikal olgunlaştırma

Membrane Stripping Method’s Effect on Pregnancy Period for Term Pregnants

Objective: The membrane-stripping birth induction method is frequently used in term pregnant women in obstetrics; it is non-pharmacological. Here, the aim was to investigate the effects of this method on the delivery process, its effectiveness in terms of initiating delivery and shortening the gestation period, preventing post-term pregnancy, reducing the need for induction, and the factors affecting its efficacy and fetal and maternal outcomes related to this method. Materials and Method: Our study was performed on 213 cases with 38-40 weeks of pregnancy without any problem preventing vaginal birth. The control group consisted of 105 patients (48 multiparous and 57 nulliparous), while the study group consisted of 108 patients (42 multiparous and 66 nulliparous). Results: The mean time (day) from application to delivery was 7.04 ± 3.96 in the study group and 9.24 ± 5.01 in the control group. The vaginal delivery rate in the study group (68.5%) and the rate of delivery before the 41st week of gestation in the study group (84.3%) were statistically significantly higher than the control group (43.8% and 69.5%). The induction requirement was statistically significantly lower in the study group (11.1%) compared to the control group (23.8%). The groups were similar regarding delivery, early membrane rupture, neonatal results, and maternal infection. Conclusion: The study showed that the membrane stripping method is effective and reliable in reducing uncomplicated term pregnancies between 38-40 weeks without changing the maternal-fetal results, from application to delivery, post-term pregnancy rates, and induction requirement.

Keywords:

Cervical ripening, Prolonged pregnancy, Induction of labor,

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