شیوع پارگی‌های درجه 3 و 4 پرینه حین زایمان و برخی عوامل مرتبط با آن در زایشگاه نیک‌نفس رفسنجان در طی سالهای 96-1394

نوع مقاله : اصیل پژوهشی

نویسندگان

1 استادیار گروه مامایی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی رفسنجان، رفسنجان، ایران.

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

3 استادیار گروه روان پرستاری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی رفسنجان، رفسنجان، ایران.

چکیده

مقدمه: صدمه به پرینه، یک عارضه­ شایع در زایمان واژینال بوده که می‌تواند سلامت جسمی، روانی و اجتماعی زنان را تحت تأثیر قرار دهد. مطالعه حاضر با هدف تعیین شیوع پارگی‌های درجه 3 و 4 پرینه حین زایمان و برخی عوامل مرتبط با آن انجام شد.
روش­کار: در این مطالعه توصیفی- تحلیلی گذشته‌نگر، اطلاعات از پرونده‌های مادران زایمان کرده در طی سال‌های 96-1394 استخراج شد. گروه کنترل 129 نفر از افرادی که دچار پارگی شدید نبوده و با روش نمونه‌گیری سیستماتیک از بین زایمان‌های انجام شده در طی سال‌های مورد نظر انتخاب شدند. پس از جمع آوری اطلاعات مربوط به عوامل مرتبط با پارگی پرینه، تجزیه و تحلیل داده‌ها با استفاده از نرم‌افزار SPSS (نسخه 18) و آزمون‌های کای دو، دقیق فیشر و تی مستقل انجام شد. میزان p کمتر از 05/0 معنی‌دار در نظر گرفته شد.
یافته­ها: از 8814 زایمان واژینال انجام شده در طی سال‌های مربوطه، پارگی‌های درجه سه و چهار پرینه 32 مورد (363/0%) بود که از این تعداد، 22 مورد نولی‌پار (8/68%) بودند. در مقایسه بین دو گروه مورد (32) و کنترل (129)، سابقه کار عامل زایمان (02/0=p)، زایمان ابزاری (023/0=p) و مدت زمان مرحله دوم زایمان (0001/0>p) گروه مورد بیشتر بود.
نتیجه­گیری: پارگی‌های درجه 3 و 4 پرینه با مرحله دوم زایمان طولانی‌تر و زایمان ابزاری که نیازمند به حضور عامل زایمان با سابقه کاری بالاتر است، ارتباط دارند.

کلیدواژه‌ها

عنوان مقاله [English]

Prevalence of third and fourth degree of perineal lacerations during vaginal delivery and some related factors in Nik Nafs maternity of Rafsanjan in 2015-2017

نویسندگان [English]

  • Marzieh Loripour 1
  • Marzieh Najar Mohiabadi 2
  • Pooran Allahbakhshi Nasab 2
  • Ahmadreza Sayadi 3
1 Assistant Professor, Department of Midwifery, School of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
2 Instructor, Department of Midwifery, School of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
3 Assistant Professor, Department of Psychiatric Nursing, School of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
چکیده [English]

Introduction: Perineal injury is a common complication of vaginal delivery that can affect women's physical, mental and social health. This study was performed with aim to determine the prevalence of third and fourth degree of perineal laceration during delivery and some related factors.
Methods: In this retrospective analytical -descriptive study, information was extracted from the records of mothers who gave birth during 2015-2017. The control group consisted of 129 mothers who did not have severe rupture and were selected by systematic randomization among vaginal deliveries performed during the mentioned years. After collecting information about the factors related to the perineal laceration, data were analyzed by SPSS software (version 18) and Chi-square and Fisher Exact and independent t tests. P<0.05 was considered statistically significant.
Results: Among 8814 vaginal deliveries performed during the relevant years, there were 32 cases of third and fourth degree of perineal laceration (0.363%), of these, 22 cases were noli par (68.8%). In comparison between the case (n=32) and control (n=129) groups, the work experience of the delivery agent (p<0.02), instrumental delivery (p<0.023) and the duration of the second stage of labour (p<0.0001) were more in the case group.
Conclusion: Third and fourth degree of perineal lacerations are associated with the second stage of longer labour and instrumental labour that requires the presence of a labour agent with a longer work experience.

کلیدواژه‌ها [English]

  • Delivery
  • Laceration
  • Perineum

مراجع

  1. Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, et al. Williams Obstetrics. 25nd ed. New York: McGraw-Hill Education; 2018.
  2. Jahani Shourab N, Mirteimouri M, Latifnejad Roudsari R. A case series of severe perineal lacerations during normal childbirth. Iran J Obstet Gynecol Infertil 2018; 21(8):103-14.
  3. Rezaie M, Shahoei R, Shahgibi S, Afkhamzadeh 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 J Obstet Gynecol Infertil 2014; 17(116):8-14.
  4. Bharathi A, Reddy DD, Kote GS. A prospective randomized comparative study of vicryl rapide versus chromic catgut for episiotomy repair. Journal of clinical and diagnostic research: JCDR 2013; 7(2):326.
  5. Eskandar O, Shet D. Risk factors for 3rd and 4th degree perineal tear. Journal of Obstetrics and Gynaecology 2009; 29(2):119-22.
  6. Hals E, Øian P, Pirhonen T, Gissler M, Hjelle S, Nilsen EB, et al. A multicenter interventional program to reduce the incidence of anal sphincter tears. Obstetrics & Gynecology 2010; 116(4):901-8.
  7. Keriakos R, Gopinath D. Obstetric anal sphincter injuries. Journal of Acute Disease 2015; 4(4):259-65.
  8. Zare O, Pasha H, Faramarzi M. Effect of perineal massage on the incidence of episiotomy and perineal laceration. Health 2014; 6(1):10-14.
  9. Baghestan E, Irgens LM, Børdahl PE, Rasmussen S. Trends in risk factors for obstetric anal sphincter injuries in Norway. Obstetrics & Gynecology 2010; 116(1):25-34.
  10. Abedzadeh-Kalahroudi M, Talebian A, Sadat Z, Mesdaghinia E. Perineal trauma: incidence and its risk factors. Journal of Obstetrics and Gynaecology 2019; 39(2):206-11.
  11. Kalichman L. Perineal massage to prevent perineal trauma in childbirth. The Israel Medical Association journal: IMAJ 2008; 10(7):531-3.
  12. Leeman L, Rogers R, Borders N, Teaf D, Qualls C. The effect of perineal lacerations on pelvic floor function and anatomy at 6 months postpartum in a prospective cohort of nulliparous women. Birth 2016; 43(4):293-302.
  13. Evers EC, Blomquist JL, McDermott KC, Handa VL. Obstetrical anal sphincter laceration and anal incontinence 5-10 years after childbirth. American journal of obstetrics and gynecology 2012; 207(5):425-e1.
  14. Priddis H, Dahlen HG, Schmied V, Sneddon A, Kettle C, Brown C, et al. Risk of recurrence, subsequent mode of birth and morbidity for women who experienced severe perineal trauma in a first birth in New South Wales between 2000–2008: a population based data linkage study. BMC pregnancy and childbirth 2013; 13(1):1-7.
  15. Lane TL, Chung CP, Yandell PM, Kuehl TJ, Larsen WI. Perineal body length and perineal lacerations during delivery in primigravid patients. InBaylor University Medical Center Proceedings 2017; 30(2):151-53.
  16. Halperin O, Raz I, Ben-Gal L, Or-Chen K, Granot M. Prediction of perineal trauma during childbirth by assessment of striae gravidarum score. Journal of Obstetric, Gynecologic & Neonatal Nursing 2010; 39(3):292-7.
  17. Sereshti M, Deris F. Severity of Striae Gravidarum and its relationship with perineal trauma and vaginal lacerations during vaginal delivery of pregnant women referred to Hajar Hospital of Shahr-e-Kord in 2010-2011. J Adv Med Biomed Res 2013; 21(89):107-16.
  18. Van Delft K, Sultan AH, Thakar R, Schwertner‐Tiepelmann N, Kluivers K. The relationship between postpartum levator ani muscle avulsion and signs and symptoms of pelvic floor dysfunction. BJOG: An International Journal of Obstetrics & Gynaecology 2014; 121(9):1164-72.
  19. Quist-Nelson J, Hua Parker M, Berghella V, Biba Nijjar J. Are Asian American women at higher risk of severe perineal lacerations?. The Journal of Maternal-Fetal & Neonatal Medicine 2017; 30(5):525-8.
  20. Hirayama F, Koyanagi A, Mori R, Zhang J, Souza JP, Gülmezoglu AM. Prevalence and risk factors for third‐and fourth‐degree perineal lacerations during vaginal delivery: a multi‐country study. BJOG: An International Journal of Obstetrics & Gynaecology 2012; 119(3):340-7.
  21. Carroll TG, Engelken M, Mosier MC, Nazir N. Epidural analgesia and severe perineal laceration in a community-based obstetric practice. The Journal of the American Board of Family Practice 2003; 16(1):1-6.
  22. Mesdaghinia E, Abbaszadeh F, Mesdaghinia A. Incidence of perineal trauma in normal spontaneous vaginal delivery in Shabih-khani Maternity Hospital of Kashan during 2007-9. KAUMS Journal (FEYZ) 2011; 14(5):533-8.
  23. Zafarghandi N, Hadavand SH, Zayeri F, Hamzeloo L. Risk factors associated with forth-degree laceration during vaginal delivery. Tehran University Medical Journal TUMS Publications 2006; 64(7):65-74.
  24. Suto M, Takehara K, Misago C, Matsui M. Prevalence of Perineal Lacerations in Women Giving Birth at Midwife‐Led Birth Centers in Japan: A Retrospective Descriptive Study. Journal of Midwifery & Women’s Health 2015; 60(4):419-27.
  25. Handa VL, Zyczynski HM, Burgio KL, Fitzgerald MP, Borello-France D, Janz NK, et al. The impact of fecal and urinary incontinence on quality of life 6 months after childbirth. American journal of obstetrics and gynecology 2007; 197(6):636-e1.
  26. Baumann P, Hammoud AO, McNeeley SG, DeRose E, Kudish B, Hendrix S. Factors associated with anal sphincter laceration in 40,923 primiparous women. International Urogynecology Journal 2007; 18(9):985-90.
  27. Ampt AJ, Ford JB, Roberts CL, Morris JM. Trends in obstetric anal sphincter injuries and associated risk factors for vaginal singleton term births in N ew S outh W ales 2001–2009. Australian and New Zealand Journal of Obstetrics and Gynaecology 2013; 53(1):9-16.
  28. Pergialiotis V, Vlachos D, Protopapas A, Pappa K, Vlachos G. Risk factors for severe perineal lacerations during childbirth. International Journal of Gynecology & Obstetrics 2014; 125(1):6-14.
  29. Webb SS, Hemming K, Khalfaoui MY, Henriksen TB, Kindberg S, Stensgaard S, et al. An obstetric sphincter injury risk identification system (OSIRIS): is this a clinically useful tool?. International urogynecology journal 2017; 28(3):367-74.
مجله زنان، مامایی و نازایی ایران
دوره 24، شماره 6
شهریور 1400
صفحه 10-16

فایل ها

هم رسانی

ارجاع به این مقاله

آمار