JJAM25_149
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- けいざぶろう すみい
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1 J. Jpn. Acad. Midwif., Vol. 25, No. 2, , 2011 総 説 分娩第 2 期の分娩体位が会陰裂傷 会陰切開に及ぼす影響 : 文献レビュー The influence of maternal position in the second stage of labor on perineal lacerations and episiotomy: A review Katsuko SHINOZAKI 1 Shigeko HORIUCHI 2 抄 録 目的 2 対象と方法 2 結果 21 intact 2intact 3 結論 2 キーワード :2 1 St.Luke's College of Nursing,Graduate School, Doctoral Course 2 St.Luke's College of Nursing Abstract Purpose The purpose of this study was to analyze various maternal positions in the second stage of labor and the associated occurrence of perineal lacerations and episiotomy. Methods The literature search focused on the areas of nursing, midwifery and physiology. Analyzed quantitatively was
2 the association between various maternal positions and outcomes of perineal laceration and episiotomy were then analyzed quantitatively. Results The findings related to maternal positions in the second stage of labor associated with perineal lacerations and episiotomies were the sitting position with mixed results of intact perineums and perineal lacerations. This was a major characteristic of using the birthing chair. Maternal positions, which were more likely to be associated with intact perineums and less with perineal lacerations, were: lateral, hands and knees and squatting. The maternal position, which was most likely to be associated with episiotomies, was the recumbent position, which included lithotomy and, semi-recumbent. Conclusion The numerically highest incidence of episiotomies was in the recumbent position, which may reflect the ease of performing an incision in that position. Key words: maternal position, perineal laceration, episiotomy, second stage of labor, alternative labor position Ⅰ. 緒言 Francois Mauriceau Caldeyro-Barcia International Federation of Gynecology and ObstetricsFIGO 1983 Janet Balaskas GardosiSylvester & B-Lynch Scott & Kerr, 1963Humphrey, Chang & Wood, Mendez-Bauer, Arroyo & Garcia Ramos, 19754Gold, Borrel & Fernstrom, 1957Russell, outcomes outcomes Ⅱ. 用語の操作的定義 Intact Ⅲ. 方法 1. 対象 2 2. 方法 1 research question
3 2 2 2 key words 1 2 maternal position, maternal posture, patient positioning, posture, Knee-Chest position, kneeling, "hands and knees", "all fours", squatting, sitting, lateral position, standing, upright position, "alternative position", supine position, dorsal position, recumbent position, "horizontal position", "lithotomy position". perineum, "perineal lacerations", perineal tears, "perineal trauma", "perineal outcomes", lacerations. 3 PubMed Cochrane Library CINAHL plus PsycINFO Soc INDEX Maternity and Infant Care Ver PubMed 218Cochrane Library 79CINAHL plus 301PsycINFO 12SocINDEX 7Maternity and Infant Care Randomized controlled trial17 non Systematic Review SR SR Outcomeintact WHOICD non 1 9 1SR U.S.A 5U.S.A outcomeintact 3 χ 2 χ 2 p0.05 ITT χ 2 Ⅳ. 結果 1. 座位群と仰臥位群の比較 1 9 8SR1 151
4 intact intact75 1Hillan, 19842Turner, Romney & Webb, 1986Altman, Ragnar & Ekstrm, 2007 intact2 87 3Crowly, Elbourne & Ashurst, 1991 Turner, Romney & Webb, 1986Gupta, Hofmeyr & Smyth, Crowly, Elbourne & Ashurst, 1991Stewart & Spiby, 1989Stewart, Hillan & Calder, 1983Turner, Romney & Webb, 1986Gupta, Hofmeyr & Smyth, Crowly, Elbourne & Ashurst, 1991Stewart, Hillan & Calder, 1983Hillan, 1984Gupta, Hofmeyr & Smyth, Altman, Ragnar & Ekstrm, 蹲踞位群と仰臥位群の比較 2 521SR2 intact intact22gardosi, 表 1 座位群 vs 仰臥位群の比較研究の一覧 結 果 著 者 対象者 デザイン 座位の種類 intact( 無傷 ) 会陰裂傷 会陰切開 Crowley P. Elbourne D. & The Birth EZchair / / * 350/ * Ashurst H. et al. 111/596 62/ /634 (1991) Ireland ,230 Stewart P & Spiby H. (1989) 304 obstetric chair / / / / / / Stewart P. Hillan E. & Calder AA. (1983) Turner MJ. Romney ML. & Webb JB. et al. (1986) Hillan EM. (1984) Waldenstrom U & Gottvall K. (1991) Sweden Bomfim- Hyppolito S. (1998) Brazil Altman D. Ragnar I. & Ekstrm A. et al. (2007) Sweden Gupta JK. Hofmeyr GJ. & Smyth RMD. (2009) ,500g 4,000g The Birth EZ chair The Birth EZchair / % 15/ % 14/ / / / / / * 110/ / * 111/ / SR (metaanalysis) /250 * / / / / / / / * 57/ / / / /1, /1, *p 0.05p0.01 (No Significant Difference) 136/ / / / / / /112 * 10 2/ /1, /1,
5 2 表 2 Gardosi J. Hutson N. & B-Lynch C 蹲踞位群 vs 仰臥位群の比較研究の一覧 結 果 著 者 対象者 デザイン 体位の種類 intact( 無傷 ) 会陰裂傷 会陰切開 その他 /199 64/173 51/173 * /173 52/199 55/ Allahbadia GN & Vaidya PR. (1993) India Golay J. Vedam S. & Sorger L. (1993) Gupta JK. Hofmeyr GJ. & Smyth RMD. (2009) Gupta JK. Hofmeyr GJ. & Smyth RMD. (2009) SR (metaanalysis) SR (metaanalysis) / / / / / *p 0.05p0.01 (No Significant Difference) / * 81/ / / / /100 * 13 4/ / / / / /405 * / Hutson & B-Lynch, 1989Golay, Vedam & Sorger, Allahbadia & Vaidya, 1993Gupta, Hofmeyr & Smyth, Gardosi, Hutson & B-Lynch, 1989Golay, Vedam & Sorger, 1993Gupta, Hofmeyr & Smyth, Allahbadia & Vaidya, 1993Gupta, Hofmeyr & Smyth, 膝手位群と仰臥位群の比較 intact 3Roberts & Kriz, 1984 Rooks, Weatherby & Ernst, 1992Shorten, Donsante & Shorten, 2002intact 53 1Gottvall, Allebeck & Ekeus, Rooks, Weatherby & Ernst, 1992Shorten, Donsante & Shorten, Rooks, Weatherby & Ernst, 1992Shorten, Donsante & Shorten, 側臥位群と仰臥位群の比較 4 6 5SR1 intactintact 331 Shorten, Donsante & Shorten, Shorten, Donsante & Shorten, 2002 Gottvall, Allebeck & Ekeus, Rooks, Weatherby & Ernst, Rooks, Weatherby & Ernst, 1992Shorten, Donsante & Shorten, Gupta, Hofmeyr 153
6 表 3 膝手位群 vs 仰臥位群の比較研究の一覧 著者対象者デザイン Roberts JE & Kriz DM. (1984) Rooks JP. Weatherby NL. & Ernst EKM. (1992) Shorten A. Donsante J. & Shorten B. (2002) Australia 2006 Gottvall K. Allebeck P. & Ekeus C. (2007) Sweden 表 NBC NBC ,021 2,164 介入結果 体位の種類 intact( 無傷 ) 会陰裂傷 会陰切開 / ,690 5,276 側臥位群 vs 仰臥位群の比較研究の一覧 著者対象者デザイン Rooks JP. Weatherby NL. & Ernst EKM. (1992) NBC NBC , , , ,701 1,488 28/ / / / / /1, / / / / * 592/1, *p 0.05p0.01 (No Significant Difference) Albers LL. Anderson D. & Cragin L. et al. (1996) Mexico& Shorten A. Donsante J. & Shorten B. (2002) Australia 2006 Gottvall K. Allebeck P. & Ekeus C. (2007) Sweden Gupta JK. Hofmeyr GJ. & Smyth RMD. (2009) 695 8/1, / /2, /1, / / / / /1, / /1, / 介 入 結 果 体位の種類 intact ( 無傷 ) 会陰裂傷 会陰切開 /2, /682 2,897 1,972 2,406 5,153 1 SR (metaanalysis) , , ,701 1,018 1,005/2, / / / / /1, / /1, / *p 0.05p0.01 (No Significant Difference) 8/1, / /2, /1, /2, /1, / * 788/1, / / /
7 2 & Smyth, あらゆる体位の比較 non 181 1SR 2 intact intact87intact 1intact 7 2Terry, Westcott & O'Shea, 2006Roberts & Kriz, 19845Olson, Olson & Cox, 1990 ; Rooks, Weatherby & Ernst, 1992Albers, Anderson & Cragin et al., 1996 ; Shorten, Donsante & Shorten, 2002 ; de Jonge, van Diem & Scheepers et al., intact 73Terry, Westcott & O'Shea, 2006 ; Olson, Olson & Smith, 1990 ; Albers, Anderson & Cragin, Terry, Westcott & O'Shea, Gupta, Hofmeyr & Smyth, de Jong, Johanson & Baxen, 1997 ; Olson, Olson & Cox, 1990 ; Shorten, Donsante & Shorten, Gupta, Hofmeyr & Smyth, 2009 ; De Jonge, Teunissen 表 5 あらゆる体位の比較研究の一覧 著者対象者デザイン dejong PR. Johanson RB. & Baxen P. et al. (1997) South Africa. Terry RR. Westcott J. & O' Shea L. et al Roberts JE. & Kriz DM. (1984) Olson R. Olson C. & Cox. (1990) U.S.A Rooks JP. Weatherby NL. & Ernst EKM. (1992) Albers LL. Anderson D. & Cragin L. et al. (1996) Mexico & NBC, NBC ,980 2,595 non 介 入 結 果 体位の種類 intact( 無傷 ) 会陰裂傷 会陰切開 /260 * 24/ /257 13/ / / / / / / / / ,442 2,897 3, , / /1, ,005/2, / ,228/3, / / / / /1, / / / / / / /75 51 * 34/ / / / / / /2, ,164/3, /1, / / / / / /65 6 2/ / / / / /1, /3, /2, / / / /
8 Shorten A. Donsante J. & Shorten B. (2002) Australia Gottvall K. Allebeck P. & Ekeus C. (2007) Sweden dejonge A. vandiem MT. & Scheeoers PLH. et al. (2007) Netherland Gupta JK. Hofmeyr GJ. & Smyth RMD. (2009) DeJonge A. Teunissen TAM. & Lagro-Janssen ALM Netherland 2,891 2, ,782 1, , , ,366 2,701 1, ,018 1, Missing 202 SR (metaanalysis) SR (metaanalysis) / / / / / / /1, / / / / / / / / /1, / /1, / / / / / _ 3742 *p 0.05p0.01 (No Significant Difference) 186/2, / / / / /5, /1, /1, /1, / / / /2, % 369/2, % 139/ % 111/ % 154/1, / / / / /38 0 * 788/1, / / / / / * 967/2, % 802/2, % 394/1, % 252/1, % * & Lagro-Janssen, 2004 Ⅴ. 考察 1.intactについて intact intact intact intact 33intact intact 2. 会陰裂傷について Crowly, Elbourne & Ashurst, 1991 ; Stewart, Hillan & Calder, 1983 ; Turner, Romney & Webb, 1986 The Birth E-Z chaircentury Manufacturing Co, Aurora Nebraska
9 intact intact 154mmHg Thomson, 1988 Bonica, 1967 intact 5 The Birth E-Z chair 2 22 intact5 3 intact X Russell, intact 134mmHgThomson, 1988Bonica, mmHgThomson, 1988Bonica, 会陰切開について intact
10 Ⅵ. 結語 1 intact 2 intact 3 謝辞 引用文献 Albers, L.L., Anderson, D. Cragin, L., Daniels, S.M., Hunter, C. & Sedler, K.D., et al. (1996). Factores related to paerineal trauma in childbirth, Journal of Nurse-Midwifery, 41 (4), Allahbadia, G.N.& Vaidya, P.R. (1993). Squatting position for delivery. Journal of Indian Medical Assiciation, 91, Altman, D., Ragnar, I., Ekstrm, A., Tyden, T. & Olsson, S.E. (2007). Anal sphincter lacerations and upright delivery postures - a risk analysis from a randomized controlled trial, Int Urogynecol J Pelvic Floor Dysfunct, 18 (2), Bomfim-Hyppolito S. (1998). Influence of the position of mother at delivery over some maternal and neonatal outcomes, Int J Gynaecol Obstet, 63 Suppl 1, S Bonica, J.J. (1967). Principles and practice of obstetric analgesia and anesthesia. F A Davis Co., Philadelphia. Borrel, V. & Fermstrom, I. (1957). The movements at the sacro-iliac joints and their importance to changes in the pelvic dimensions during parturition. Acta Obstet Gynecol Scand, 36, Caldeyro-Barcia, R, (1979). The influence of maternal position on time of spontaneous rupture of the membranes, progress of labor, and fetal head compression, Birth and the Family Journal, 6 (1), (8) Crowley, P., Elbourne, D., Ashurst, H., Garcia, J., Murphy, D. & Duignan, N. (1991). Delivery in an obstetric birth chair: a randomized controlled trial. British Journal of Obstetrics and Gynaecology, 98, de Jonge, A., van, Diem, M.T., Scheepers, P.L.H., van, der, Pal-de Bruin, K.M. & Lagro-Janssen, A.L.M. (2007). Increased blood loss in upright birthing positions originates from perineal damage, British Journal of Obstetrics and Gynaecology, 114 (3), De Jonge, A., Teunissen, T.A.M. & Lagro-Janssen, A.L.M. (2004). Supine position compared to other positions during the second stage of labor: A meta-analytic review, J Psychosom Obstet Gynecol, 25, de Jong, P.R., Johanson, R.B., Baxen, P., Adrians, V.D., Westhuisen, S. Van der.& Jones, P.W. (1997). Randomised trial comparing the upright and supine posiitons for the second stage of labour, British Journal of Obstetrics and Gynaecology, 104, Gardosi, J., Hutson, N. & B-Lynch, C. (1989). Randomised, controlled trial of squatting in the second stage of labour, Lancet, 2 (8654), Gardosi, J., Sylvester, S. & B-Lynch, C. (1989). Alternative position in the second stage of labour: a randomized controlled trial, British journal of Obstetrics and Gynaecology, 96, Golay, J., Vedam, S. & Sorger, L. (1993).The squatting position for the second stage of labor : Effects on labor and on maternal and fetal well-being, Birth, 20 (2), Gold, E.M. (1950). Pelvic drive in obstetrics: an X-ray study of 100 cases, Am J Obstet Gynecol, 59, Gottvall, K., Allebeck, P. & Ekeus, C. (2007). Risk factors for anal sphincter tears: the importance of maternal position at birth, British Journal of Obstetrics and Gynaecology, 114 (10), Gupta, J.K., Hofmeyr, G.J. & Smyth, R.M.D. (2009). Position in the second stage of labour for women without epidural anaesthesia, Cochrane Library, Issue 4. Hillan, E.M. (1984). The birthing chair trial, Research and the Midwife Conference, Humphrey, M. D., Chang, A., Wood, E. C., Morgan, S. & Hounslow, D. (1974). A decrease in fetal ph during the
11 2 second stage of labour when conducted in the dosal position, J Obstet Gynaecol, 6, (2) (5) (11) Mendez-Bauer, C., Arroyo, J., Garcia, Ramos C., Menendez, A., Lavilla, M. & Izquierdo, F. et al. (1975). Effects of standing position on spontaneous uterine contractility and other aspects of labour, J Perinat Med, 3 (2), Olson, R., Olson, C. & Cox, N.S. (1990). Maternal birthing positions and perineal injury, The Journal of Family Practice, 30 (5), Roberts, J.E. & Kriz, D.M. (1984). Delivery positions and perineal outcome, Journal of Nurse-Midwifery, 29 (3), Rooks, J.P., Weatherby, N.L., & Ernst, E.K.M. (1992). The National birth center study Part II- Intrapartum and immediate postpartum and neonatal care, Journal of Nurse- Midwifery, 37 (5), Russell, J.G.B. (1969). Moulding of the pelvic outlet, The Journal of Obstetrics and Gynaecology of the British Commonwealth, 76 (9), Scott, D.B. & Kerr, M.G. (1963). Inferior vena caval compression in late pregnancy. J Obstet Gynaecol Br Emp. 70, Shorten, A., Donsante, J. & Shorten, B. (2002). Birth position, accoucheru, and perineal outcomes: Informing women about choices for vaginal birth, Birth, 29 (1), Stewart, P., Hillan, E. & Calder, A.A. (1983). A randomised trial to evaluate the use of a birth chair for delivery, The Lancet, 11, Stewart, P. & Spiby, H. (1989). A randomized study of the sitting position for delivery using a newly designed obstetirc chair, British Journal of Obstetrics and Gynaecology, 96, Terry, R.R., Westcott, J., O Shea, L. & Kelly, F. (2006). Postpartum outcomes in supine delivery by physicians vs nonsupine delivery by midwives, J Am Osteopath Assoc, 106, Thomson, A.M. (1988). Management of the woman in normal second stage of labour: a review, Midwifery, 4, Turner, M.J., Romney, M.L., Webb, J.B. & Gordon, H. (1986). The birthing chair: an obstetric hazard? Journal of Obstetrics and Gynaecology, 6, Waldenstrom, U. & Gottvall, K. (1991). A randomized trial of birthing stool or conventional semirecumbent position for second-stage labor, Birth, 18 (1),
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