Öz
The aim of this case report is to analyze in detail the feelings and thoughts of a woman who experienced severe obstetric perineal trauma. Ethics committee approval was obtained from Istanbul University-Cerrahpaşa Social and Human Sciences Research Ethics Committee. Explanations were made to B.B., who was being treated at Istanbul University Istanbul Medical Faculty Hospital, Department of Urogynecology, currently residing in Istanbul and living with her family, within the scope of informed consent, and her verbal consent was obtained. Data were obtained by the in-depth interview method.
The interview content was audio-recorded, and the statements were transcribed unchanged. The thematic analysis technique was used in the evaluation of the data.
The statements obtained from in-depth interviews were grouped under 6 themes: 1) Difficulties in accessing health care, 2) Physical consequences, 3) Psychological consequences & affected relationships, 4) Changing body perception & sexuality, 5) Lack of knowledge & awareness, and 6) Recovery process.
It was determined that obstetric perineal trauma associated with maternal morbidity negatively affected the physical, psychological, sexual health and quality of life of the woman. It was determined that the patient was prevented from accessing health services, irreversible damages occurred during the birth process, and the woman was affected for many years. It is recommended to use care approaches to prevent obstetric perineal trauma, to establish multidisciplinary clinics for pelvic floor health that will enable the treatment of detected cases, and to increase initiatives to reduce regional inequalities in women's access to quality obstetric health services.
Anahtar Kelimeler
anal sphincter injury body image obstetric perineal trauma quality of life
Kaynakça
- Cichowski S, Rogers R. Prevention and management of obstetric lacerations at vaginal delivery. Obstetrics and Gynecology 2018;132(3), e87-e102. doi:10.1097/aog.0000000000002841
- Edqvist M, Dahlen HG, Häggsgård,C, Tern H, Ängeby K, Teleman P et al. The effect of two midwives during the second stage of labour to reduce severe perineal trauma (Oneplus): a multicentre, randomised controlled trial in Sweden. The Lancet, 2022;399(10331), 1242-1253. doi.org/10.1016/S0140-6736(22)00188-X
- Lindqvist M, Persson M, Nilsson M, Uustal E, Lindberg I. ‘A worse nightmare than expected’-a Swedish qualitative study of women's experiences two months after obstetric anal sphincter muscle injury. Midwifery 2018;61, 22-28. doi.org/10.1016/j.midw.2018.02.015
- Darmody E, Bradshaw C. Women's experience of obstetric anal sphincter injury following childbirth: An integrated review. Midwifery 2020;91, 102820. doi.org/10.1016/j.midw.2020.102820
- Johannesson E, Sjöberg ÅL, Segerbrand N, Olsén MF, Gutke A. Women's experiences of obstetric anal sphincter injury and physical therapy interventions-A qualitative study. Brazilian Journal of Physical Therapy 2022;26(2), 100397. doi.org/10.1016/j.bjpt.2022.100397
- Viannay P, de la Codre F, Brochard C, Thubert T, Meurette G, Legendre G. et al. Management and consequences of obstetrical anal sphincter injuries. Journal of Visceral Surgery 2021;158(3), 231-241. doi.org/10.1016/j.jviscsurg.2020.10.010
- Gutzeit O, LevyG, Lowenstein L. Postpartum female sexual function: risk factors for postpartum sexual dysfunction. Sexual Medicine 2020;8(1), 8-13. doi: 10.1016/j.esxm.2019.10.005
- Ramage L, Yen C, Qiu S, Simillis C, Kontovounisios C, Tekkis P, Tan E Functional and quality of life outcomes following obstetric anal sphincter injury (OASI): does the grade of injury affect outcomes? International Urogynecology Journal 2017;28, 1709-1717. doi.org/10.1007/s00192-017-3334-3
- Cornelisse S, Arendsen LP, van Kuijk SMJ, Kluivers, KB, van Dillen J, Weemhoff M. Obstetric anal sphincter injury: a followup questionnaire study on longer-term outcomes. International Urogynecology Journal 2016;27, 1591-1596. doi.org/10.1007/s00192-016-3017-5
- Bidwell P, Sevdalis N, Silverton L, Harris J, Gurol-Urganci I, Hellyer A, Freeman R, van der Meulen J, Thakar R. Women's experiences of the OASI Care Bundle; a package of care to reduce severe perineal trauma. International Urogynecology Journal 2021;32(7), 1807-1816. doi: 10.1007/s00192-020-04653-2
Öz
Bu olgu sunumunun amacı, şiddetli obstetrik perineal travma yaşayan bir kadının duygu ve düşüncelerini irdelemektir. Etik kurul izni İstanbul Üniversitesi-Cerrahpaşa Sosyal ve Beşerî Bilimler Araştırmaları Etik Kurulu Başkanlığı’ndan alındı. İstanbul Üniversitesi İstanbul Tıp Fakültesi Hastanesi Ürojinekoloji Bilim Dalı’nda tedavi gören, halen İstanbul’da ikamet eden ve ailesiyle birlikte yaşayan B.B.ye bilgilendirilmiş onam kapsamında gerekli açıklamalar yapıldı ve kişinin sözlü onamı alındı. Veriler, derinlemesine görüşme yöntemiyle elde edildi. Görüşme içeriği sesli olarak kaydedildi ve ifadeler değiştirilmeden yazıya aktarıldı. Verilerin değerlendirmesinde tematik analiz tekniği kullanıldı.
Olgu ile derinlemesine görüşmeden elde edilen ifadeler 1) Sağlık hizmetine erişmede yaşanan zorluklar, 2) Fiziksel sonuçlar, 3) Psikolojik sonuçlar & etkilenen ilişkiler, 4) Değişen beden algısı & cinsellik, 5) Bilgi eksikliği & farkındalık ve 6) İyileşme süreci olmak üzere 6 tema altında toplandı.
Maternal morbidite ile ilişkili obstetrik perineal travmanın olgunun fiziksel, ruhsal, cinsel sağlığını ve yaşam kalitesini olumsuz etkilediği belirlendi. Olgunun sağlık hizmetlerine erişiminin engellendiği, doğum sürecinde geri döndürülemez hasarların meydana geldiği ve uzun yıllar kadını etkilediği saptandı. Obstetrik perineal travmayı önleyecek bakım yaklaşımlarının kullanılması, tespit edilen vakaların tedavisine olanak sağlayacak, pelvik taban sağlığına yönelik multidisipliner kliniklerin oluşturulması ve kadınların kaliteli obstetrik sağlık hizmetlerine erişiminde bölgesel eşitsizliklerin azaltılmasına yönelik girişimlerin artırılması önerilmektedir
Anahtar Kelimeler
anal sfinkter yaralanması obstetrik perineal travma yaşam kalitesi beden imajı
Etik Beyan
Etik kurul izni İstanbul Üniversitesi-Cerrahpaşa Sosyal ve Beşerî Bilimler Araştırmaları Etik Kurulu Başkanlığı’ndan alındı (Sayı: 2023/412). Olguya bilgilendirilmiş onam kapsamında gerekli açıklamalar yapıldı ve kişinin sözlü onamı alındı. Katılımcının ismi B.B. şeklinde kodlandı.
Kaynakça
- Cichowski S, Rogers R. Prevention and management of obstetric lacerations at vaginal delivery. Obstetrics and Gynecology 2018;132(3), e87-e102. doi:10.1097/aog.0000000000002841
- Edqvist M, Dahlen HG, Häggsgård,C, Tern H, Ängeby K, Teleman P et al. The effect of two midwives during the second stage of labour to reduce severe perineal trauma (Oneplus): a multicentre, randomised controlled trial in Sweden. The Lancet, 2022;399(10331), 1242-1253. doi.org/10.1016/S0140-6736(22)00188-X
- Lindqvist M, Persson M, Nilsson M, Uustal E, Lindberg I. ‘A worse nightmare than expected’-a Swedish qualitative study of women's experiences two months after obstetric anal sphincter muscle injury. Midwifery 2018;61, 22-28. doi.org/10.1016/j.midw.2018.02.015
- Darmody E, Bradshaw C. Women's experience of obstetric anal sphincter injury following childbirth: An integrated review. Midwifery 2020;91, 102820. doi.org/10.1016/j.midw.2020.102820
- Johannesson E, Sjöberg ÅL, Segerbrand N, Olsén MF, Gutke A. Women's experiences of obstetric anal sphincter injury and physical therapy interventions-A qualitative study. Brazilian Journal of Physical Therapy 2022;26(2), 100397. doi.org/10.1016/j.bjpt.2022.100397
- Viannay P, de la Codre F, Brochard C, Thubert T, Meurette G, Legendre G. et al. Management and consequences of obstetrical anal sphincter injuries. Journal of Visceral Surgery 2021;158(3), 231-241. doi.org/10.1016/j.jviscsurg.2020.10.010
- Gutzeit O, LevyG, Lowenstein L. Postpartum female sexual function: risk factors for postpartum sexual dysfunction. Sexual Medicine 2020;8(1), 8-13. doi: 10.1016/j.esxm.2019.10.005
- Ramage L, Yen C, Qiu S, Simillis C, Kontovounisios C, Tekkis P, Tan E Functional and quality of life outcomes following obstetric anal sphincter injury (OASI): does the grade of injury affect outcomes? International Urogynecology Journal 2017;28, 1709-1717. doi.org/10.1007/s00192-017-3334-3
- Cornelisse S, Arendsen LP, van Kuijk SMJ, Kluivers, KB, van Dillen J, Weemhoff M. Obstetric anal sphincter injury: a followup questionnaire study on longer-term outcomes. International Urogynecology Journal 2016;27, 1591-1596. doi.org/10.1007/s00192-016-3017-5
- Bidwell P, Sevdalis N, Silverton L, Harris J, Gurol-Urganci I, Hellyer A, Freeman R, van der Meulen J, Thakar R. Women's experiences of the OASI Care Bundle; a package of care to reduce severe perineal trauma. International Urogynecology Journal 2021;32(7), 1807-1816. doi: 10.1007/s00192-020-04653-2
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Kadın Hastalıkları ve Doğum |
| Bölüm | Olgu Sunumu |
| Yazarlar | |
| Yayımlanma Tarihi | 25 Ağustos 2025 |
| Gönderilme Tarihi | 26 Mart 2025 |
| Kabul Tarihi | 5 Ağustos 2025 |
| Yayımlandığı Sayı | Yıl 2025Cilt: 64 Sayı: Özel Sayı: 1 (11. Ulusal Ürojinekoloji Kongresi Bildiri Kitapçığı) |
