گزارش سری موارد پارگی‌های شدید پرینه حین زایمان طبیعی

نوع مقاله: مروری

نویسندگان

1 دانشجوی دکتری بهداشت باروری، مرکز تحقیقات مراقبت‌های پرستاری و مامایی، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

2 دانشیار گروه زنان و مامایی، دانشکده پزشکی، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

3 دانشیار گروه بهداشت باروری، مرکز تحقیقات ایمنی بیمار، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

چکیده

مقدمه: پارگی‌های شدید پرینه حین زایمان از طریق کاهش سطح سلامتی و رضایت‌­مندی مادر، پذیرش و ترویج زایمان طبیعی را با چالش مواجه می‌سازد، لذا مطالعه حاضر با هدف شناسایی عوامل خطر همراه با پارگی‌های شدید پرینه حین زایمان طبیعیانجام شد.
روش‌کار: مطالعه حاضر از نوع سری موارد بود که با استفاده از پرونده پزشکی و مصاحبه با زنانی که در فاصله زمانی اول اردیبهشت تا پنجم دی ماه 1395 در بیمارستان ام‌البنین (س) مشهد زایمان کرده و دچار پارگی درجه 3 و 4 پرینه شده بودند، انجام شد. اطلاعات مستخرج از پرونده بیماران شامل داده‌های دموگرافیک و همچنین زایمانی (تعداد زایمان، طول مراحل اول و دوم زایمان، طول و فاصله انقباضات، داروهای تجویز شده در لیبر، عامل زایمان، نوع زایمان، درجه پارگی، نحوه ترمیم و وزن نوزاد) در فرم‌های مربوطه ثبت گردید. مصاحبه‌ها نیز در طی یک‌سال اول بعد از زایمان با دعوت تلفنی از بیماران و حول شکایت اصلی آنان انجام شد. تجزیه و تحلیل داده‌ها با استفاده از روش آمار توصیفی انجام شد.
یافته‌ها: از 7 بیمار ایرانی مورد بررسی، 4 مورد چندزا (2/57%) و 3 مورد نخست‌زا بودند. بیشترین فاکتورهای همراه پارگی‌های پرینه شامل 6 مورد (7/85%) القاء با اکسی‌توسین، 3 مورد (8/42%) دیابت بارداری، 3 مورد (8/42%) گذشتن از تاریخ زایمان و 2 مورد (5/28%) ماکروزومی بود. تنها در یک مورد عامل زایمان، از پرسنل رسمی اتاق زایمان بوده و در موارد دیگر زایمان توسط رزیدنت، اینترن و یا دانشجوی مامایی صورت گرفته بود. در 6 بیمار (7/85%) بیش از یک عامل خطر وجود داشت. شایع‌ترین مشکل سلامتی بعد از زایمان، بی‌اختیاری دفع گاز بود.
نتیجه‌گیری: القاء با اکسی‌توسین، دیابت بارداری و گذشتن از تاریخ زایمان، از عوامل خطر شایع همراه با پارگی‌های شدید پرینه حین زایمان طبیعی می‌باشند. اکثر مادران از بی‌اختیاری دفع گاز حتی پس از ترمیم موفقیت‌آمیز رنج می‌کشند.

کلیدواژه‌ها


عنوان مقاله [English]

A case series of severe perineal lacerations during normal childbirth

نویسندگان [English]

  • Nahid Jahani Shourab 1
  • Masoumeh Mirteimouri 2
  • Robab Latifnejad Roudsari 3
1 Ph.D Student of Reproductive Health, Nursing and Midwifery Care Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran.
2 Associate Professor, Department of Obstetrics & Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
3 Associate Professor, Department of Reproductive Health, Patient Safety Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
چکیده [English]

Introduction: Severe perineal tears during delivery decrease maternal health and satisfaction. This is a challenge for promotion and acceptance of normal vaginal birth. Therefore, this study was performed with aim to identify the risk factors associated with severe perineal tears during normal vaginal delivery.
Methods: This was a case-series study which was performed by reviewing medical records and interviewing with women who gave birth from 20th April to 25th December 2016 at Omolbanin Hospital, Mashhad, Iran and had third and fourth degree perineal lacerations. Data extracted from patients’ medical records included demographic and childbirth-related data (number of parity, the length of the first and second stage of labour, frequency and duration of  uterine contractions, prescribed medications in labour, birth attendant, mode of delivery, degree of perineal tear, method of perineal repair and neonatal weight) that was recorded in related forms. Interviews were conducted within the first year after childbirth following telephone invitation, focusing on women’s chief complains. Descriptive statistics were used for data analysis.
Results: Out of the seven Iranian patients studied, four cases (57.2%) were multiparous and three cases were primiparous. The most risk factors associated with perineal lacerations included 6 cases of induction by oxytocin (85.7%), 3 cases of gestational diabetes (42.8%), 3 cases of postdate pregnancy (42.8%) and 2 cases of macrosomia (28.50%). The delivery of only one case was done by the skilled stuff of labor and the others were accomplished by medical and midwifery students. In 6 cases (%85.7), more than one risk factor was seen. The most common postpartum complication was gas incontinence.
Conclusion: Labor induction with oxytocin, gestational diabetes, and postdate pregnancy are the most common risk factors associated with severe perineal tears during normal delivery. The majority of women suffer of gas incontinence, even after successful repair of perineal lacerations.

کلیدواژه‌ها [English]

  • Laceration
  • Normal childbirth
  • Perineum
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