Epizyotomi
Özet
Epizyotomi, doğum çıkışını genişletmek ve fetüsün doğumunu kolaylaştırmak amacıyla perineye yapılan cerrahi bir kesidir. Dünya Sağlık Örgütü'nün %10'luk tavsiyesinin ardından küresel epizyotomi oranları genel olarak düşüş göstermektedir. Kesin bir endikasyonu olmamakla birlikte; fetüsün hızlı doğumu, operatif vajinal doğum, omuz distosisi ve kadın sünneti öyküsü gibi durumlarda klinisyen takdiriyle tercih edilebilir. Geçmişte pelvik tabanı koruma ve anal sfinkter laserasyonunu önleme gibi faydaları olduğuna inanılsa da güncel çalışmalar rutin epizyotomi kullanımını desteklememektedir. Aksine rutin uygulama; artan kan kaybı, enfeksiyon, yara yerinde ayrılma ve sonraki doğumlarda şiddetli yırtık riski gibi istenmeyen sonuçlarla ilişkilidir. Epizyotomi çeşitleri arasında en sık median ve mediolateral teknikler kullanılır. Median epizyotomi anal sfinkter yaralanması riskini yaklaşık dört kat artırdığından, epizyotomi yapılması gereken durumlarda daha düşük risk profiline sahip olan mediolateral veya lateral insizyon tercih edilmelidir. Uygulama için en uygun zaman, üç ila dört kasılma içinde doğumun beklendiği andır. İşlem öncesinde hastadan onam alınmalı, lokal anestezi gibi uygun bir yöntemle yeterli analjezi sağlanmalı ve fetal kafa derisi korunmalıdır.
Episiotomy is a surgical incision made to the perineum to widen the birth outlet and facilitate the delivery of the fetus. Following the World Health Organization's recommendation of a ten percent rate, global episiotomy rates have generally been declining. Although there are no absolute indications, it can be performed at the clinician's discretion in specific clinical scenarios such as expedited vaginal delivery, operative vaginal delivery, shoulder dystocia, and a history of female genital mutilation. While it was historically believed to provide benefits like preserving pelvic floor strength and preventing anal sphincter lacerations, current studies do not support routine use. On the contrary, routine episiotomy is associated with adverse outcomes, including increased blood loss, infection, wound dehiscence, and a higher risk of severe perineal tears in subsequent deliveries. Among the various types of episiotomy, median and mediolateral techniques are most frequently preferred. Since median episiotomy increases the risk of anal sphincter injury approximately fourfold, a mediolateral or lateral incision, which is associated with a lower risk profile, is recommended when an episiotomy is necessary. The optimal timing for execution is when delivery is expected within three to four contractions. Prior to the procedure, informed consent must be obtained from the patient, adequate analgesia should be ensured through appropriate methods such as local anesthesia, and the fetal scalp must be carefully protected during the incision.
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