Epiduralna analgezija in poškodbe presredka med porodom: pregled literature : diplomsko delo

Zajc, Hana (avtor), Petročnik, Petra (mentor), Mivšek, Ana Polona (recenzent)

Uvod: V zadnjih letih je močno priljubljena uporaba epiduralne analgezije kot način lajšanja bolečine med porodom. Zagotavlja učinkovito lajšanje in omogoča polno sodelovanje porodnice. Nekateri ugotavljajo, da epiduralna analgezija vpliva na potek in izid poroda. 85 % porodnic po svetu med porodom utrpi poškodbo presredka. Ta lahko povzroči velike telesne, psihološke, spolne in socialne težave pri porodnici. Namen: Namen je ugotoviti kakšen vpliv ima epiduralna analgezija na poškodbe presredka med porodom. Zastavili smo si 3 raziskovalna vprašanja, kakšen vpliv ima epiduralna analgezija neposredno na spontane poškodbe presredka, kakšen vpliv ima na epiziotomije ter kako posredno vpliva na poškodbe presredka. Metode dela: Za raziskovanje je bila uporabljena diskriptivna metoda dela s pregledom strokovne in znanstvene literature. Literaturo smo iskali v spletnih bazah podatkov od decembra 2022 do februarja 2023. S pomočjo Prisma diagrama smo izbrali 8 vsebinsko ustreznih in v celoti dostopnih študij v angleškem jeziku. Rezultati: Porodnice z epiduralno analgezijo večkrat rodijo v litotomnem položaju. Kar vpliva na pojav večjih raztrganin presredka. Uporaba epiduralne analgezije poveča verjetnost za podaljšano I. in II. porodno dobo in s tem za več kot 8 krat poveča verjetnost za pospeševanje poroda z uterotoniki. Medicinski postopki za hitrejše napredovanje poroda, ki se jih uporablja ob podaljšani II. porodni dobi, povečajo verjetnost za pojav večjih raztrganin presredka. Epiduralna analgezija neposredno ne vpliva na spontane poškodbe presredka. Tveganje za epiziotomijo je pri tistih z epiduralno analgezijo za 1,9 krat večje kot pri tistih brez nje. Razprava in zaključek: Večina ugotavlja, da epiduralna analgezija neposredno ne vpliva na spontane poškodbe presredka, med njimi večje raztrganine presredka. Poveča pa verjetnost za epiziotomijo preko povečane verjetnosti za inštrumentalno dokončanje poroda. Prav tako ugotavljajo, da poveča verjetnost za podaljšano II. porodno dobo, pospeševanje poroda z uterotoniki, nepravilno vstavo vodilnega plodovega dela, rojevanje v litotomnem položaju in inštrumentalno dokončanje poroda. Vsi ti dejavniki pa povečajo verjetnost za spontane poškodbe presredka ter epiziotomijo. Ugotavljamo, da epiduralna analgezija posredno vpliva na povečano verjetnost za poškodbe presredka. Pomembno je, da babice predstavljajo podporo porodnicam, da med popadki zmorejo premagovati bolečino in se za epiduralno analgezijo odločajo samo kadar jo zares potrebujejo.

• Jezik: Slovenski jezik
• Ključne besede: diplomska dela, babištvo, epiduralna analgezija, presredek, poškodbe, porod
• Vrsta gradiva: Diplomsko delo/naloga
• Tipologija: 2.11 - Diplomsko delo
• Organizacija: ZF - Zdravstvena fakulteta
• Kraj izida: Ljubljana
• Založnik: [H. Zajc]
• Leto izida: 2023
• Št. strani: 49 str.
• PID: 20.500.12556/RUL-148144
• UDK: 618.2/.7
• COBISS.SI-ID: 161731843
• Datum objave v RUL: 28.07.2023

Sekundarni jezik

• Jezik: Angleški jezik
• Naslov: Epidural analgesia and perineal trauma during labour: a literature review : diploma work

Izvleček

Introduction: For the last few years, epidural analgesia has been a very popular method used for reducing pain during labour. It provides effective relief of pain and enables the full participation of women during labour. Some note that epidural analgesia affects the course and outcome of labour. During labour, 85 % of women around the world suffer some degree of perineal laceration. It can cause major physical, psychological, sexual and social problems. Purpose: The aim is to determine the impact of epidural analgesia on perineal lacerations during childbirth. We asked ourselves three research questions: what affect does epidural analgesia have directly on spontaneous perineal lacerations, what effect does it have on episiotomies, and how does it indirectly affect perineal lacerations. Methods: For research a descriptive method was used with a review of professional and scientific literature. Literature was searched in online databases from December 2022 to February 2023. Using the Prisma diagram, we found 8 relevant, content-appropriate and fully accessible articles in English. Results: Women in labour with epidural analgesia often give birth in the lithotomy position which increases the likelihood of severe perineal lacerations. Use of epidural analgesia increases the probability of the prolonged I. and II. stage of labour and stimulation of labour with uterotonics is 8 times higher among those with epidural analgesia. Medical procedures for faster progress of labour which are used during prolonged II. stage of labour increase the likelihood of severe perineal lacerations. Epidural analgesia does not directly affect spontaneous perineal lacerations. The risk of episiotomy is 1.9 times greater in those with epidural analgesia than in those without it. Discussion and conclusion: Most researchers note that epidural analgesia does not directly affect spontaneous perineal lacerations, including severe perineal lacerations. Epidural analgesia increases the likelihood of episiotomy with the increased likelihood of instrumental delivery. They also note that it increases the likelihood of prolonged II. stage of labour, stimulation of labour with uterotonics, abnormal foetal position, birth in the lithotomy position and instrumental delivery. All those factors increase the likelihood of spontaneous perineal lacerations, including severe perineal lacerations, and episiotomy. We conclude that epidural analgesia indirectly affects the increased probability of perineal injuries. It is important that midwives provide support to the women in labour, encourage to withstand the pain during contractions so they decide to use epidural analgesia only when most necessary.

• Ključne besede: diploma theses, midwifery, epidural analgesia, perineum, lacerations, labour