MEHMET AKİF SARGIN, Murat YASSA, Arzu Yıldırım AR, Emrah ERGUN, Emrah ORHAN, Niyazi TUĞ

Epidural Analjezinin Nullipar Gebelerde Doğumun Aktif Fazı ve Yenidoğan Üzerine Etkilerinin Araştırılması

GİRİŞ ve AMAÇ: Vajinal doğumda ağrı kontrolünün geliştirilmesi anne isteğine bağlı sezaryen oranlarının düşürülmesi çalışmalarında önemli bir köşe taşıdır. Epidural analjezi; santral sinir sisteminde depresyon yapmaması, doğum sürecine kooperasyonunu kolaylaştırması ve komplikasyon oranlarının düşük olması sebebiyle doğum analjezisi amacıyla kullanılan en sık yöntemlerdendir. Bu çalışmada nullipar gebelerde uygulanan epidural analjezi tekniğinin hiçbir analjezi yöntemi uygulanmayan nullipar gebeler ile karşılaştırılması ve yenidoğan üzerindeki etkilerinin değerlendirilmesi amaçlandı. GEREÇ ve YÖNTEM: Mayıs 2014 ile Aralık 2014 tarihleri arasında epidural analjezi uygulanan ve uygulanmayan nullipar gebeler takip edilerek, gereğinde augmentasyon uygulandı. Obstetrik veriler, bebek doğum kilosu ve yenidoğan APGAR skorları retrospektif olarka incelendi. Tanımlayıcı analizin yanı sıra Student-t testi, Pearson Ki-Kare testi, Yates (Continuity Correction) Ki-Kare Testi ve Fisher's exact testi kullanıldı. BULGULAR: Çalışmaya dahil eden 70 nullipar gebede augmentasyon uygulanan hasta sayısı, augmentasyon süresi, doğumun birinci ve ikinci evre süreleri epidural analjezi grubunda anlamlı olarak yüksek bulunmuştur. Gruplar arasında vajen/perine yırtığı, sezaryen/operatif doğum oranları, yan etkiler ve yenidoğan APGAR skorları açısından istatistiksel olarak anlamlı bir fark bulunamamıştır TARTIŞMA ve SONUÇ: Gebeye ait aşırı korku, endişe, panik gibi durumlar ve vajinal doğum sürecine uyumsuzluğun maternal ve fetal sonuçları üzerine olumsuz etkileri yadsınmamalıdır. Epidural analjezi alan hastalara rutin augmentasyon eklenmesi travay süresini kısaltma açısından önemli olabilir.

Effects of Epidural Analgesia on Active Phase of The Labour and Newborn Among Nulliparous Pregnant Women

INTRODUCTION: Improving the pain management in vaginal birth is considered a cornerstone in reducing the cesarean delivery on maternal request. Epidural anesthesia is a commonly used technique with regard to its low complication rates, increase adaptation to birth process and not depressing the maternal central nervous system. In this study, it is aimed to compare the clinical findings of epidural analgesia in nulliparous women and to evaluate the effects on newborns. METHODS: Nulliparous women who have administered epidural analgesia were followed and retrospectively compared to whom had no analgesia between May-December 2014. Augmentation has been performed when required. Obstetric data, birth weight and newborn APGAR scores were recorded. Statistical analyzes were performed with using descriptive statistics, Student-t test, Pearson Ch-square test, Yates (Continuity Correction) Chi-square test and Fisher's exact tests. RESULTS: 70 pregnancies were included to the study. Number of patients who were performed augmentation, duration of labor augmentation and the duration of first and second stage of labor were found statistically significantly higher in the epidural analgesia group. Statistical analyzes demonstrated similarity between groups with regard to vaginal/perineal lacerations, cesarean section rates, operative birth rates, side effects and the newborn APGAR scores DISCUSSION and CONCLUSION: Maternal and fetal adverse effects of pregnants' anxiety, panic and fear status should not be ignored. Routine administration of labor augmentation to pregnant women who are on epidural analgesia may be beneficial for reducing the duration of active labor. Epidural analgesia is considered safe for the newborns. It should be used more frequently for pain management with regard to enhancing the vaginal birth.

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