Perinatal Dönemdeki Hemşirelik Müdahalelerinin Doğum Sonu Kanamalardaki Etkinliğinin Değerlendirilmesi

Abstract

This study was conducted as a randomized controlled study to assess the effectiveness in postpartum hemorrhage (PPH) of nursing interventions [Antenatal education, perineum protective procedures (perineal massage, sterile obstetric gel), uterine massage, breastfeeding, telephone counseling] in the perinatal period. The study was carried out between 30/01/2016 and 15/12/2017 at Etlik Zübeyde Hanım Women’s Diseases Training and Research Hospital. Intervention and control groups are specified according to the ratio scores of age, parity and Optimality Index-TR (OI-TR) to the Perinatal Background Index. 70 pregnants (nintervention=33; ncontrol=37) have been included in the scope of samples for the research. Data Collection Forms (DCF) designed by the researcher, LATCH Breastfeeding Assessment Tool, Visual Analog Scale and Optimality Index-Turkey (OI-TR) was used to collect the study data. PPH was measured with BRASS-V Drape and precision weighing in the first 24 hours in both groups. In our study, numbers, percentage and chi-square tests for the analysis of categorical variables; mean, median, "independent sample t test", "Mann Whitney U test", "paired t test" and "two-way mixed ANOVA" were used for continuous variables. According to research findings; during the first 24 hours PPH median [300(189-822)] in intervention group were significantly lower than the control group [399(207-743)] (p<0.05). However, there was no difference between intervention (Primary= 9.1%; secondary= 6.1%) and control (Primary= 27%; secondary= 13.5%) groups in terms of primary and secondary PPH (p>0.05). Perineal trauma is the first cause of PPH. Perineal lacerations were less occured in the intervention group (18.2%) than in the control group (32.4%), but there was no statistically significant difference between groups (p> 0.05). In addition, episiotomy rates were similar in both groups (p>0.05) When comparing groups the women who participate in intervention group ; the first phase of labor was shorter, the pain they perceived during labor was less, the duration of breastfeeding was longer, the total median score of LATCH assesment tool and total median score of OI-TR was higher (p<0.05) than control group. In conclusion, suppurting optimal care in the perinatal period and maintenance of breastfeeding, perineum protective procedures are effective in controlling some of the factors that lead to PPH risk. Therefore, in perinatal period integrating nursing interventions into the care process has place in reducing PPH, promoting and strengthening of maternal health in the study.