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Uvod: Eden izmed razlogov poškodb presredka med porodom je izvajanje epiziotomije. Definira se jo kot rez, narejen skozi telo presredka, za razširitev vaginalnega izhoda med prodiranjem plodove glave. Poznamo 7 vrst epiziotomij, med njimi tudi lateralno epiziotomijo. Namen: Namen diplomskega dela je predstaviti lateralno epiziotomijo, prednosti/slabosti v odnosu do drugih epiziotomij, ter pogostost uporabe. Poleg tega smo ugotavljali, kakšen vpliv ima izvajanje lateralne epiziotomije na doživljanje bolečine v poporodnem obdobju ženske. Metode dela: V diplomskem delu smo uporabili deskriptivno metodo s sistematičnim pregledom znanstvene literature. Pri iskanju smo uporabili časovni okvir, od leta 2000 do 2018. Literatura je bila iskana v angleškem in slovenskem jeziku v podatkovnih bazah CINAHL, Medline, ScienceDirect, PROQUEST, Pubmed, Springer Link, Cochrane Library in COBISS. Za kvalitativno metasintezo smo uporabili 10 raziskav. Članki so bili ovrednoteni po štiristopenjski lestvici glede na moč dokazov. Rezultati: Rezultati študij, vključenih v metasintezo, namigujejo, da lateralna epiziotomija zaščiti ženske z večjim tveganjem pred nastankom obporodnih poškodb analnega sfinktra vendar med postopkom izvajanja vakuumskega poroda ne predstavlja zaščitne funkcije presredka. Lateralna epiziotomija ne povzroča večjih bolečin v primerjavi z mediolateralno in mediano epiziotomijo v poporodnem obdobju. Razprava in zaključek: Lateralna epiziotomija je iatrogena poškodba presredka, ki lahko vpliva na poporodne komplikacije in nadaljnjo kakovost življenja ženske, istočasno pa lahko prepreči poškodbe analnega sfinktra in posledično inkontinenco za blato. Pomembno je, da se lateralna epiziotomija izvaja ob prisotnosti indikacij zanjo, ko koristi presegajo z njo povezana tveganja. Za spremembe babiške prakse v Sloveniji glede priporočene vrste epiziotomije bi bilo potrebno primerjati mediolateralno in lateralno epiziotomijo ter analizirati morebitne prednosti in slabosti ene vrste epiziotomije pred drugo. Introduction: The execution of episiotomy is one of the reasons of perineum injuries during labour. It is defined as a cut through a perineum corpus with intent to expand vaginal way out during penetration of an fetus head. There are seven types of episiotomy. Lateral episiotomy is one of them. Purpose: The purpose of the diploma work is to present lateral episiotomy, its advantages/disadvantages in relation to other episiotomies and its application frequency. In addition, we were establishing the effect of the execution of lateral episiotomy on pain experience in the puerperium. Methods: In the diploma work we used the descriptive method with the systematic examination of scientific writings. During the research we used the time frame between 2000 and 2018. The writings were searched in English and Slovenian language in the databases: CINAHL, Medline, ScienceDirect, PROQUEST, Pubmed, Springer Link, Cochrane Library and COBISS. For the qualitative meta-synthesis we used 10 researches. The articles were estimated in the four-level ranking in respect of the power of proofs. Results: The results of the studies included in the meta-synthesis hint that lateral episiotomy protects women with greater risk, before the obstetric anal sphincter injuries, but it does not present the protection function of perineum during vacuum extraction. Lateral episiotomy does not induce stronger pain than mediolateral or midline episiotomy in the puerperium. Discussion and conclusion: Lateral episiotomy is an iatrogenic damage to the perineum that may affects woman’s quality of life, but may also prevent anal sphincter injury and subsequent fecal incontinence. It is important that the procedure is performed when the indications for it are present and the benefits outweigh the risks associated with it. For changes in Slovenian midwifery practice concerning the recommended type of episiotomy, further studie comparing of mediolateral and lateral episiotomy are needed. |
