تعیین ارتباط عوامل زایمانی و نوزادی با بهبود زخم اپی‌زیاتومی در زنان نخست زای بیمارستان امالبنین (س) شهر مشهد در سال 1392

نوع مقاله : اصیل پژوهشی

نویسندگان

1 کارشناس ارشد مامایی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی تربت حیدریه، تربت حیدریه، ایران.

2 مربی گروه مامایی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

3 کارشناس ارشد مامایی، بیمارستان رازی تربت حیدریه، تربت حیدریه، ایران.

چکیده

مقدمه: تأخیر ترمیم اپی‌زیاتومی منجر به نتایج بد آناتومیکی، افزایش عفونت، کاهش عملکرد جنسی، اختلال روابط عاطفی مادر و نوزاد می‌شود، ولی تحقیقات اندکی در این زمینه انجام شده است، لذا مطالعه حاضر با هدف تعیین ارتباط عوامل زایمانی و نوزادی با بهبود اپی‌زیاتومی در زنان نخست‌زا انجام شد.
روش‌کار: این مطالعه همبستگی در سال 1392 بر روی 119 مادر واجد مشخصات پژوهش مراجعه کننده به بیمارستان ام‌البنین (س) مشهد انجام شد. اطلاعات مربوط به زایمان، نوزاد و مادر با پرسشنامه‌های مربوطه جمع‌آوری و ارتباط آن‌ها با بهبود زخم اندازه‌گیری شده با فرم ریدا در روزهای اول، هفتم، دهم و چهاردهم بعد زایمان بررسی شد. تجزیه و تحلیل داده‌ها با استفاده از نرم‌افزار آماری SPSS (نسخه 16) و آزمون‌های کولموگروف اسمیرنوف، آنالیز واریانس یک طرفه، رگرسیون، اسپیرمن و پیرسون انجام شد.میزان p کمتر از 05/0 معنی‌دار در نظر گرفته شد.
یافته‌ها: در روز 10 و 14 بعد از زایمان طول برش پوست (037/0=p، 026/0=p)، تعداد بخیه‌های با نخ دو صفر (042/0=p، 028/0=p)، میزان فعالیت منجر به کشش و فشار در محل بخیه‌ها (037/0=p، 048/0=p) و میزان نشستن (011/0=p، 030/0=p) با ترمیم اپی‌زیاتومی همبستگی معکوس و رعایت موارد بهداشتی (048/0=p، 039/0=p) با ترمیم اپی‌زیاتومی همبستگی مستقیم داشت. درد با ترمیم اپی‌زیاتومی در روز هفتم (015/0=p) و دهم (035/0=p) همبستگی معکوسی داشت. تعداد بخیه‌های پوست (012/0=p) با ترمیم اپی‌زیاتومی در روز چهاردهم بعد زایمان همبستگی معکوسی داشت، یعنی تعداد بخیه‌های پوستی بیشتر باعث تأخیر در ترمیم زخم اپی زیاتومی شد.
نتیجه‌گیری: از میان تمامی متغیرها، برش پوستی وسیع‌تر، تعداد بیشتر بخیه‌های پوستی و بخیه‌های با نخ دو صفر، نشستن طولانی ‌مدت و ایجاد فشار و کشش در محل بخیه‌ها، درد شدیدتر اپی‌زیاتومی و عدم رعایت بهداشت باعث تأخیر ترمیم اپی‌زیاتومی می‌شوند. پیشنهاد می‌شود اهمیت این عوامل به پرسنل بهداشتی و مادران آموزش داده شود..

کلیدواژه‌ها

عنوان مقاله [English]

Relationship between delivery and neonatal factors with healing of episiotomy in primiparous women at Mashhad Omalbanin Hospital in 2013

نویسندگان [English]

  • Maryam Aradmehr 1
  • Sedigheh Azhari 2
  • Sedigheh Ahmadi 3
  • Elham Azmodeh 1
1 M.Sc. of Midwifery, School of Nursing and Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.
2 Instructor of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
3 M.Sc. of Midwifery, Razi Hospital of Torbat Heydariyeh, Torbat Heydariyeh, Iran.
چکیده [English]

Introduction: Delay in episiotomy repair leads to adverse anatomic outcomes, increased infections, decreased sexual function, and impaired relationships between mother and baby, but little research has been done in this field. Therefore, this study was performed with aim to determining the relationship between delivery and neonatal factors with healing of episiotomy in primiparous women.
Methods: This correlation study was conducted on 119 eligible mothers referring to Mashhad Omolbanin Hospital in 2013. Information about delivery, neonate and mother was gathered by the questionnaires and their relationship with wound healing as measured by Reda form on 1st, 7th, 10th and 14th days after delivery was determined. Data was analyzed using SPSS software (version 16) and Kolmogorov-Smirnov, one-way ANOVA, regression, Spearman’s test, and Pearson’s correlation tests. P Results: At 10th and 14th days after delivery, inverse correlation was found between length skin incision (P=0.037, P=0.026), the number of sutures with 2/0 catgut (P=0.042, P=0.028), the activity leading to tension and pressure on the stitches (P=0.037, P=0.048), rate of sitting (P=0.011, P=0.030) with episiotomy healing; and direct correlation was found between hygiene (P=0.048, P=0.039) with episiotomy healing. Inverse correlation was found between pain and episiotomy healing at 7th (P=0.015) and 10th days (P=0.035). Also, inverse correlation was observed between the number of skin sutures (P=0.012) and episiotomy healing at 14th days after delivery; it means that more number of skin sutures leads to delay in episiotomy healing.
Conclusion: Among all variables, more extensive incision, more number of skin sutures and more sutures with 2/0 catgut, long sitting, tension and pressure on the stitches, severe episiotomy pain and lack of hygiene lead to delay in healing of episiotomy. Therefore, it is recommended to train health care providers and mothers about these factors.

کلیدواژه‌ها [English]

  • Episiotomy
  • Perineum
  • Wound healing

مراجع

  1. Cunningham FG. Williams obstetrics. 23th ed. New York: McGraw Hill; 2011. P. 400–6, 831.
  2. Myles MF, Ruth B, Linda B. Myles textbook for midwives. 16th ed. London: Churchill Livingstone; 2010. P. 458-63.
  3. Rezaei M, Shahoei R, Shahghibi S, Afkhamzade A. Farhadifar F. Comparison of perineal lacerations in routine vs. selective mediolateral episiotomy among women referring to the obstetrics department of besat hospital in Sanandaj in 2011. Iran Obstet Gynecol Infertil 2014; 17(116):8-14. (Persian).
  4. Jahdy F, Eghdampour F, Naghizadeh S, Kheyrkhah M, Taghizadeh M. Effect of Aloe vera and Calendula persica ointment on pain intensity of episiotomy in primiparous women. Q Horizon Med Sci 2013; 19(1):23-8. (Persian).
  5. Aradmehr M, Azhari S, Shakeri MT. Study of factors associated with postoperative pain following episiotomy in primiparous women at Mashhad Omalbanin hospital in 2012. J Midwifery Reprod Health 2015; 3(1):305-14. (Persian).
  6. Navabi Rigi SH, Abedian Z, Poorjavad M, Smaeli H. Comparing the effect of cooling jell pads and ice pack, after episiotomy on the intensity of perineal pain. Tabibe Shargh 2007; 9(1):27-36. (Persian).
  7. Shojae KK, Dawati A, Zayeri F. Frequency and side effect of episiotomy in primiparous women: a three-month longitudinal survey. Qom Univ Med Sci J 2009; 3(2):47-50. (Persian)
  8. Johnson R, Taylor W. Skills for midwifery practice. 1th ed. Trans: Shamaeyan N, Hadizadeh F, Ferozi M. Mashhad: Gonabad University Press; 2007. P. 267-300, 440-1. (Persian)
  9. Azhari S, Aradmehr M, Rakhshandeh H, Tara F, Taghi Shakeri M. The effects of chamomile cream on wound healing of episiotomy in primiparous women. Iran J Obestet Gynecol Infertil 2014; 17(93):16-26. (Persian).
  10. Peter EA, Janssen PA, Grange CS, Douglas MJ. Ibuprofen versus acetaminophen with codeine for the relief of perineal pain after childbirth: a randomized controlled trial. CMAJ 2001; 165(9):1203-9.
  11. Yari F. The effect of lidocaine 2% and gel Lidocaine 2% during episiotomy on pain perineal area of the city of Khorramabad in primiparous women. [Master's Thesis]. Mashhad, Iran: School of Nursing and Midwifery Mashhad University of Medical Sciences; 1999. (Persian)
  12. Albers LL, Sedler KD, Bedrick EJ, Teaf D, Peralta P. Midwifery care measures in the second stage of labor and reduction of genital tract trauma at birth: a randomized trial. J Midwifery Womens Health 2005; 50(5):365-72.
  13. Yahya S, Ozgholi G, Mojab F, Alavi Majd H, Shojaee A, Mirhaghjou N. The effect of Hypericum cream on perineal pain after episiotomy in primiparous women. Iran J Obestet Gynecol Infertil 2015; 18(159):1-7. (Persian)
  14. Ahmadi Z. Review of effective methods to reduce damage to the perineum during delivery and its recovery. Iran Obstet Gynecol Infertil 2015; 18(155-156):19-30. (Persian).
  15. Wheeler L. Nurse- midwifery handbook: a practical guide to prenatal and postpartum care. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2002. P. 242.
  16. Boback IM, Jensen MD. Essential of maternity nursing. 10th ed. St Louis: Mosby Elsevier Health Science; 1990. P. 420-617.
  17. Delaram M, Dadkhah N. Comparing the effects of lidocaine cream and mefenamic acid on post episiotomy pain. Iran J Obestet Gynecol Infertil 2014; 17(96):6-11. (Persian)
  18. Macarthur A, Imarengaiy C, Tureanu L, Downey K. A randomized, double-blind, placebo-controlled trial of epidural morphine analgesia after vaginal delivery. Anesth Analg 2010; 110(1):159-64.
  19. Estaj Z, Toufeghean T, Najjar L. Techniques and Principles of care: according to the latest headlines course of care principles and techniques of the Supreme Council for Planning Emergency Medical Course. 1st ed. Tehran: Andesheh Rafeei; 2008. P. 75-6. (Persian).
  20. Klossner NJ. Introductory maternity nursing. Philadelphia: Lippincott Williams & Wilkins; 2006. P. 252-8.
  21. Vakilian K, Attarha M, Bekhrady R, Ghebleh F, Hatami Z, Siraj A. The effect of lavender in care of postpartum episiotomy wounds. Shahrekord Univ Med Sci J 2009; 10(3):63-9. (Persian).
  22. Taylor C, Laylsyn C. Taylor's nursing fundamentals of nursing concepts. Trans: Eftekharimanesh A, Larijani F. 2th ed. Tehran: Boshri; 2010. P. 230-6, 316.
  23. Nobahar M. Techniques and principles of care: according to the latest headlines course of care principles and techniques of the Supreme Council for Planning Emergency Medical Course. 2nd ed. Tehran: Boshri; 2009. P. 192. (Persian)..
  24. Carolyn M, Sandra H, Sampselle F. Spontaneous pushing during  relationship to perineal outcomes. Journal of Nurse-Midwifery 1999; 44( 1): 36-39.
  25. Tork Zahrani SH, Amir Ali Akbari S, Vlaei N. Comparison of iodine and water in healing episiotomy. Journal of Sciences and research Feaz 2002; (20): 80-85.(Persian) 
  26. Grant A, Steep J. The Rellef of perineal pain following childbirth, A survey of midwifery practice. Midwifery 1988;( 4): 118-22.
  27. Ling W. Nursing or the wound of lateral Episiotomy. Scand J Nurs 1995; 9:701-9.
  28. Pazandeh F, Savadzadeh S. Effect chamomile essential oil on healing episiotomy in nulliparous women. J Ardebil Univ Med Sci 2010; 8(4):364-70. (Persian).
  29. Bondad R, Abedian Z, Hassanabady H, Esmaili H. The relationship between sleep pattern and depression in pregnant women in the third trimester. J Kermanshah Univ Med Sci 2005; 9(2):41-4. (Persian)
  30. Broussard BS. The constipation assessment scale for pregnancy. J Obstet Gynecol Neonatal Nurs 1998; 27(3):297-301.
  31. Tabatabae Chehr M. Comparison of the incidence and severity of common gastrointestinal complaints housewives and employed women Referred prenatal care city Bojnoord. [Master's Thesis]. Mashhad, Iran: School of Nursing and Midwifery Mashhad University of Medical Sciences; 2001. (Persian).
  32. Mackay D, Miller AL. Nutritional support for wound healing. Altern Med Rev 2003; 8(4):359-77.
  33. Shwartz SI. Principles of Surgery. Trans: Ahmadi Amoli H, Salemi J, Tavakkoli H. 1th ed. Tehran: Computer Science Publishing in Collaboration with Medical Artin; 2011. P. 185-9. (Persian).
  34. Khajavi Shojae K, Dawati A, Zayeri F. Persistent perineal pain after episiotomy in nulliparous women admitted to hospitals in Tehran. Journal of Medical Sciences Ghom 2010; 3(2):57-62. [Persian] 
  35. Klein MC, Gauthier RJ, Robbins JM, Kaczorowski J, Jorgensen SH, Franco ED, et al. Relationship of episiotomy to perineal trauma and morbidity, sexual dysfunction, and pelvic floor relaxation. Am J Obstet Gynecol 1994; 171(3):591-8.
  36. Ardekani Y, Derakhshanfar A, Esmaeelpour K, Mostafavi A. Effect extracts of chamomile on Ulcerated colitis induced by acetic acid in adult male rats. Iran Soci Physiol Pharmacol 2010; 14(3):268-80. (Persian)
  37. Macarthur AJ, Macarthur C. Incidence, severity, and determinants of perineal pain after vaginal delivery: a prospective cohort study. Am J Obstet Gynecol 2004; 191(4):1199–2042004;191:1199–204.
  38. Andrews V, Thakar R, Sultan AH, Jones PW. Evaluation of postpartum perineal pain and dyspareunia-- a prospective study. Eur J Obstet Gynecol Reprod Biol 2008; 137(2):152-6.
مجله زنان، مامایی و نازایی ایران
دوره 19، شماره 17
هفته اول مرداد ماه 1395
مرداد 1395
صفحه 13-23

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