مروری بر روش های مؤثر بر کاهش آسیب به پرینه طی زایمان و بهبود آن

نوع مقاله: مروری

نویسنده

مربی گروه مامایی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی شهید صدوقی یزد، یزد، ایران.

چکیده

مقدمه: اپی زیاتومی به معنای برش عضلات پرینه در مرحله دوم زایمان با هدف وسیع کردن دهانه خروجی لگن و افزایش سرعت خروج سر جنین و شایع ترین برش جراحی در مامایی است. امروزه از روش های غیردارویی مختلفی در زمان بارداری و حین زایمان جهت کاهش نیاز به اپی زیاتومی و بعد از زایمان جهت کاهش درد و ترمیم زود هنگام آن استفاده می شود. مطالعه حاضر با هدف مروری بر تعدادی از این روش ها انجام شد.
روش کار: در این مطالعه از تمام کارآزمایی های بالینی انجام شده در مورد روش های کاهش نیاز به اپی زیاتومی و بهبود سریع و کاهش درد آن تا دی 1393 استفاده شد. برای دستیابی به اطلاعات لازم از پایگاه های اطلاعاتی PubMed، Sciencedirect، googlescholar، SID و IranMedex استفاده شد. در مجموع 20 مطالعه بر اساس معیار جداد مورد بررسی قرار گرفت که از میان آن ها 17 مقاله ایرانی و 3 مقاله خارجی بود.
یافته ها: بررسی ها نشان داد اکثر روش های کاهش نیاز به اپی زیاتومی (ماساژ پرینه، ورزش های کگل و ...) که در دوران بارداری و حین زایمان صورت گرفته و نیز گیاهان دارویی (آلوئه ورا، زردچوبه، اسطوخودوس، گل همیشه بهار، آناناس، بابونه و ..) که بعد از اپی زیاتومی جهت بهبود زخم و کاهش درد مورد استفاده قرار گرفته است، مؤثر بوده است، ولی در مجموع برای شناخت بهتر این گیاهان و عوارض احتمالی آن ها مطالعات بیشتری لازم است.
نتیجه گیری: به طور کلی اکثر روش های استفاده شده برای کاهش نیاز به اپی زیاتومی و بهبود آن مؤثر بوده، ولی باید مطالعات بیشتری برای شناخت عوارض احتمالی آن ها انجام شود.

کلیدواژه‌ها


عنوان مقاله [English]

Review of effective methods to reduce damage to the perineum during delivery and its recovery

نویسنده [English]

  • Zohre Ahmadi
Instructor of Midwifery, School of Nursing and Midwifery, Yazd Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
چکیده [English]

Introduction: Episiotomy means cutting the muscles of perineum during the second stage of labor to widen pelvic outlet and speed up the withdrawal of the fetal head; it is the most common surgical incision in midwifery. Today, a variety of non-pharmacological methods during pregnancy and labor are used to reduce need for episiotomy and after delivery for pain reduction and early recovery. This study was performed with aim to review some of these approaches.
Methods: In this study, all clinical trials which have been conducted to reduce the need for episiotomy and quick recovery and pain reduction after that until 2014 were used. To obtain the necessary information, the databases of PubMed, Sciencedirect, googlescholar, SID and Iranmedex were used. A total of 20 studies were evaluated based on the Jadad criteria and among them, there were 17 Iranian paper and 3 English articles.
Results: The results showed that the majority of methods used during pregnancy and childbirth for reducing the need to episiotomy (perineal massage, Kegel exercises, etc.), as well as medicinal plants (Aloe vera, turmeric, lavender, marigold, pineapple, chamomile, etc.) used after episiotomy for wound healing and reducing pain are effective, but generally, further studies are needed for better understanding of these plants and their possible complications.
Conclusion: In general, most of the methods used to reduce the need for episiotomy and improve healing are effective, but more studies should be performed for better understanding of their possible complications. 

کلیدواژه‌ها [English]

  • Episiotomy
  • Reducing pain
  • Healing
  • Medicinal herbs
1-       Khani S, Ahmad Shirvani M, Bagheri-Nesami M. Why do obstetricians and midwives tend to use routine episiotomy? A qualitative study in Iran. Int J Gynecol Obstet 2009; 107(Suppl 2):S481-2.

2-       Lowdermilk DL, Perry SE, Bobak IM. Maternity and women health care. 8th ed. St. Louis: Mosby; 2004. P. 594-6.

3-       Cunningham FG, Leveno KJ, Bloom SL, Williams JW. Williams’s obstetrics. 23rd ed. New York: McGraw-Hill Medical; 2010.

4-       Khajave K. Sedens episiotomy and complication episiotomy in primiparous women. J Ghom Univ Med Sci 2010; 3(2):1-4. (Persian).

5-       Masumi Z, Keramat A, Haji Aghaee R. Systematic review of effect of herbs on pain of cesarean section and episiotomy. J Med Plant 2011; 10(4):1-12. (Persian).

6-       Tara F, Golmakani N, Rabiei Motlagh E, Assili J, Shakeri M. The effects of turmeric (Curcuma Longa L) ointment on healing of episiotomy site in Primiparous women. Int J Gynecol Obstet 2009; 107(2):S493-4.

7-       Wilson PD, Herbison RM, Herbison GP. Obestetrics and Gynocology. Int J Obstet Gynaecol 1996; 103(2):154-61.

8-       Jahdi F, Kheyrkhah M, Haghani H, Taghizadeh M, Mehrabi E, Eghdampour F. The effect of Aloe Vera ointment the intensity of perineal pain following episiotomy: a randomized blind clinical. J Sabzevar Univ Med Sci 2012; 18(4):243-9. (Persian).

9-       <http://WWW.irteb.com/herb/plant bank .htm>

10-    Foster M, Hunter D, Samman S. Evaluation nutritional and metabolic effects of Aloe vera. In: Packer L, Cadnas E, editors. Herbal Medicin. 2nd ed. Los Angeles: CRC Press; 2011.

11-    Dat AD, Poon F, Pham KB, Doust J. Aloe vera for treating acute and chronic wound. Cochrane Database Syst Rev 2012; 2:CD008762.

12-    Hubbard TJ, Denegar CR. Does cryotherapy improve outcomes with soft tissue injury? J Athl Train 2004; 39(3):278-9.

13-    Eyvan BR, Fardi AZ, Kamranpour SB, Ghochanzadeh M. The comparison of the effect of acetaminophen tablets, diclofenac suppositories and ice packs on the relief of perineal pain after episiotomy in patients admitted to Al-zahra teaching hospital in Tabriz, Iran. J Sabzevar Univ Med Sci 2006; 13(3):145-51. (Persian).

14-    Navvabi S, Abedian Z, Steen-Greaves M. Effectiveness of cooling gel pads and ice packs on perineal pain. Br J Midwifery 2009; 17(11):724-9.

15-    Abedian Z, Salari E, Latifnejad Roudsari R, Poorjavad M, Esmaily H. A comparison perineal pain in two methods of episiotomy repair with and without skin suture in primiparous women. Iran J Obstet Gynecol Infertil 2005; 8(3):64-72.
16-    Labrecque M, Eason E, Marcoux S, Lemieux F, Pinault JJ, Feldman P, et al. Randomized controlled trial of prevention of perineal trauma by perineal massage during pregnancy. Am J Obstet Gynecol 1999; 180(3 Pt 1):593-600.

17-    Stillerman E. Prenatal massage: a textbook of pregnancy, labor, and postpartum bodywork. 1st ed. St. Louis: Mosby; 2008. P. 186-7.

18-    Johanson R. Perineal massage for prevention of perineal trauma in childbirth. Lancet 2000; 355(9200):250-1.

19-    Tork Zahrani Sh, Amirali Akbari S, Valaie N. Comparison of the effect of Betadine and water in episiotomy wound healing. KAUMS J 2002; 5(4):80-5.

20-    Attarha M, Vacilian C, Akbary Torkestany N, Heydary T, Bayateyan Y. Effect of perineal massage during second phase of labor on episiotomy and laceration rates among nulliparous women. Hayat 2009; 15(2):15-22.

21-    Fallah Hoseini H, Zahmat kesh M. Review of use of Curcuma longa in traditional and modern medicine. J Herbal Drug 2011; 9(1):88-95.

22-    Jajundian R. Curcuma longa in traditional medicine. J Nurs Midwifery, Urmia Univ Med Sci 2005; 2(4):154-61. (Persian).

23-    Arora RB, Kapoor V, Basu N, Jain AP. Anti-inflammatory studies on Curcuma longa (turmeric). Indian J Med Res 1971; 59(8):1289-95.

24-    Malekpoor H. Effect of curcumin liquid on relieving of episiotomy. [Doctorate Thesis]. Iran.Tabriz Medical Sciences University; 1389. (Persian).

25-    Darshan S, Doreswamy R. Patented antiinflammatory plant drug development from traditional medicine. Phytother Res 2004; 18(5):343-57.

26-    Catherine J, Ch U, Kemper KJ. Page 1. Longwood herbal task. 2008; Available at: URL: www.mcp.edu/herbal/.

27-    Cavanagh HM, Wilkinson JM. Biological activities of lavender essential oil. Phytother Res 2002; 16(4):301-8.

28-    Edwards-Jones V, Buck R, Shawcross SG, Dawson MM, Dunn K. The effect of essential oils on methicillin-resistant staphylococcus aureus using a dressing model. Burns 2004; 30(8):772-7.

29-    Khadivzadeh T, Melekizadeh M, Rakhshandeh M. Effect of lavender ointment on pain severity and treatment on episiotomy in primiparous. J Nurs Midwifery Mashhad 2009; 9(1):19-24.

30-    Jahdi F, Sheikhan F, Marghati KE, Haghani H. The effect of lavender essence on the post-episiotomy pain intensity of perineum. J Sabzevar Univ Med Sci 2009; 16(3):127-33. (Persian).

31-    Ardehold KJ, Perry L. Jet hydrotherapy for labor and postpartum pain relief. MCN Am J Matern Child Nurs 1991; 16(2):97-9.

32-    McGuinness M, Norr K, Nacion K. Comparison between different perineal outcomes of tissue healing. J Nurs Midwifery 1991; 36(3):192-8.

33-    Lorenzi EA. Relaxation: episiotomy incisional pain and overall discomfort. J Adv Nurs 1991; 16(6):701-9.

34-    Roberts JE. The "push" for evidence: management of the second stage. J Midwifery Women Health 2002; 47(1):2-15.

35-    Hansen SL, Clark SL, Foster JC. Active pushing versus passive fetal descent in the second stage of labor: a randomized controlled trial. Obstet Gynecol 2002; 99(1):29-34.

36-    Nichols FH, Humenick SS. Childbirth education: practice, research and theory. 2nd ed. Philadelphia: WB Saunders company; 2000.

37-    Varney H, Kriebs JM, Gegor CL. Varney's Midwifery. 3rd ed. Burlington: Jones & Bartlett Learning; 2004. P. 446-54.

38-    Sampselle CM, Hines S. Spontaneous pushing during birth. Relationship to perineal outcome. J Nurse Midwifery 1999; 44(1):36-9.

39-    Asali R. [Effect of pushing on second stage of labour on perineal trauma]. Obstet Gynacol Infertil J 2009; 2(8):43-8.

40-    Mirheydar H. Education plants (plants used in the prevention and treatment of diseases). 6th ed. Tehran: Office Islamic culture; 2007.

41-    Rezaei I. [Traditional Medicin]. Tehran: Shahid Beheshti University; 2007.

42-    Jahdi F, Khoei EM, Shamsalizadeh N, Sheikhan M. Effect of Calendula Persica on perineal pain after episiotomy. J Orumiye Univ Med Sci 2010; 2(4):245-52.

43-    Tochi BN, Wang Z, Xu SY, Zhang W. Therapeutic application of pineapple protease (bromelain): a review. Pakistan J Nutr 2008; 7(4):513-20.

44-    Maurer HR. Bromelain: biochemistry, pharmacology and medical use. Cell Mol Life Sci 2001; 58(9):1234-45.

45-    Orsini RA, Plastic Surgery Educational Foundation Technology Assessment Committee. Bromelain. Plast Reconstr Surg 2006; 118(7):1640-4.

46-    Zatuchni GI, Colombi DJ. Bromelains therapy for the prevention of episiotomy pain. Obstet Gynecol 1967; 29(2):275-8.

47-    Golozar S, Namjouian F, Latifi SM, Mirahi A. Evaluating the effect of oral bromelain (pineapple) on episiotomy wound healing primiparus women. Feyz J Kashan Univ Med Sci 2011; 15(2):84-90. (Persian).

48-    Jarrahi M, Khorasani M, Taherian AA, Meladi H, Safakhah HA. Effect of topical chamomile oil extracts the shear cutaneous wound healing in rats. J Med Plants Semnan 2008; 1(8):94-9.

49-    Pazandeh F, Savadzadeh SH. Effect chamomile essential oil on healing episiotomy in nulliparous women. J Ardebil Univ Med Sci 2010; 8(4):364-70. (Persian).

50-    Craker LE, Simon JE. Herb, spices, and medicinal plants: recent advances in botany, horticulture, and pharmacology. 1st ed. Philadelphia: Haworth Press; 1989. P. 235-80.

51-    Azhari S, Radmehr M, Rakhshandeh H, Tara F, Shakeri MT. The effects of chamomile cream on wound healing of episiotomy in primiparous women. Iran J Obstet Gynecol Infertil 2014; 17(93):16-26. (Persian).

52-    Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995; 273(5):408-12.

53-    Chalmers TC, Matta RJ, Smith H Jr, Kunzler AM. Evidence favoring the use of anticoagulants in the hospital phase of acute myocardial infarction. N Engl J Med 1977; 297(20):1091-6.

54-    McQuay H, Carroll D, Moore A. Variation in the placebo effect in randomized controlled trials of analgesics: all is as blind as it seems. Pain 1996; 64(2):331-5.

55-    Jahdi F, Sheikhan F, Margan Khoyi ES, Haghani H. The effect of of colling gel pads on the post-episiotomy pain intensity of perineum. J Arak Univ Med Sci 2010; 13(3):76-83.

56-    Motevasselian M, Farnia F. [Effect of relaxation on episiotomy incisional pain]. J Yazd Univ Med Sci 2002; 10(3):25-31. (Parsion).

57-    Ahmadi Z, Tork Zahrani SH. Effect of pushing with breathing techniques on perineum and deliveri outcome. [The Master Degree Thessis]. Iran. Shahid Beheshti University of Medical Sciences; 2014. (Persion).

58-   Salehian T, Safdari-Dehchshmeh F, Rahimi-Madiseh M, Beigi M, Delaram M. Comparing the effects of spontaneous pushing versus Valsalva pushing technique on outcome of delivery in primiparous women. J ShahreKord Univ Med Sci 2012; 14(2):31-9. (Persian)