{"id":128,"date":"2023-07-29T19:56:58","date_gmt":"2023-07-29T19:56:58","guid":{"rendered":"https:\/\/painfreebirthing.com\/turk\/bilmek-istedikleriniz\/agrinin-giderilmesi-dogumu-nasil-etkiler\/more-details-on-the-effect-of-pain-relief-on-the-labor\/"},"modified":"2023-07-29T19:56:58","modified_gmt":"2023-07-29T19:56:58","slug":"more-details-on-the-effect-of-pain-relief-on-the-labor","status":"publish","type":"page","link":"https:\/\/painfreebirthing.com\/turk\/bilmek-istedikleriniz\/agrinin-giderilmesi-dogumu-nasil-etkiler\/more-details-on-the-effect-of-pain-relief-on-the-labor\/","title":{"rendered":"Epidural analjezi travay\u0131 az miktarda uzat\u0131r ve sezaryen riskini art\u0131rmaz."},"content":{"rendered":"\n\n\n\n
Epidural analjezi travay\u0131 az miktarda uzat\u0131r ve sezaryen riskini art\u0131rmaz.<\/font><\/p>\n

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    \n
  1. \n

    Gebe kad\u0131nlar genellikle \u201cEpidural travay\u0131 uzat\u0131r m\u0131?\u201d \u201cForsepsle do\u011fum olas\u0131l\u0131\u011f\u0131 artar m\u0131?\u201d gibi sorular sorarlar. Bu sorular karma\u015f\u0131k cevaplar\u0131 olan basit sorulard\u0131r. Hem anestezi camiyas\u0131nda, hem de d\u0131\u015far\u0131da epidural anestezinin travay seyirine etkisi tart\u0131\u015fma konusu olmaya devam etmektedir. Literat\u00fcr bu konuda ikiye ayr\u0131lmaktad\u0131r. Obstetrisyenler, ebeler, do\u011fum personelleri, hastalar, hastane y\u00f6neticileri, sigorta y\u00f6neticileri, gazeteciler ve sa\u011fl\u0131k bak\u0131m poli\u00e7e d\u00fczenleyicileri  hepsi bu tart\u0131\u015fmada yer al\u0131r. \u0130ddialar\u0131n\u0131 destekleyecek kan\u0131t bulunmad\u0131\u011f\u0131 halde, s\u00f6zl\u00fc bir az\u0131nl\u0131k \u00f6nemli bir sezaryen nedeni oldu\u011fu g\u00f6r\u00fc\u015f\u00fcyle epidural analjeziyi su\u00e7lamaktad\u0131r.  <\/span><\/font><\/p>\n

    Bilimsel grubun bu basit soruya ger\u00e7ek bir cevap belirlemesini engelleyen \u00e7e\u015fitli \u015fa\u015f\u0131rt\u0131c\u0131 fakt\u00f6rler vard\u0131r. Bunlardan baz\u0131lar\u0131 \u015f\u00f6yledir:<\/span><\/font><\/p>\n

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    • \n

      Etik nedenler:<\/span><\/b><\/font><\/p>\n<\/li>\n<\/ul>\n

       <\/b><\/p>\n

      En \u00f6nemli fakt\u00f6r etik nedenlerdir. \u0130deal bir \u00e7al\u0131\u015fma (prospektif \u00e7ift k\u00f6r randomize \u00e7al\u0131\u015fma) do\u011fum i\u00e7in gelen kad\u0131nlar\u0131 randomize olarak iki gruba ay\u0131rmay\u0131 gerektirir. Bir grup do\u011fum i\u00e7in epidural yap\u0131lan kad\u0131nlar, di\u011feri yap\u0131lmayanlardan olu\u015furdu. Ancak g\u00fcn\u00fcm\u00fczde epidural anestezi isteyen bir kad\u0131na bunu yapmamak etik de\u011fildir. Ayr\u0131ca, obstetrisyenler olas\u0131 bir zor do\u011fumla kar\u015f\u0131la\u015ft\u0131klar\u0131nda epidural analjezi isteyebilirler. Kad\u0131nlar rasgele iki gruba ayr\u0131ld\u0131\u011f\u0131 halde, travay seyri boyunca \u00e7al\u0131\u015fman\u0131n ba\u015f\u0131nda iv metod uygulana<\/span>n bir kad\u0131n yetersiz a\u011fr\u0131 kontrol\u00fc nedeniyle epidural  metoda ge\u00e7ebilir. \u00c7al\u0131\u015fma i\u00e7in, etik olarak hastan\u0131n bu talebi reddedilemez. <\/span><\/font><\/p>\n

       <\/p>\n

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      • \n

        K\u00f6r \u00e7al\u0131\u015fmalar\u0131n yap\u0131lamamas\u0131:<\/span><\/b><\/font><\/p>\n<\/li>\n<\/ul>\n

        \u0130deal olarak, e\u011filimi \u00f6nlemek i\u00e7in de\u011ferlendirmeyi yapanlar\u0131n metod i\u00e7in k\u00f6r olmalar\u0131 gerekmektedir. Pratik olarak hasta, obstetrisyen, hem\u015fire ve anestezi doktorlar\u0131 iyi \u00e7al\u0131\u015fan  bir epidural kateterin olup olmamas\u0131 konusunda k\u00f6r yapmak m\u00fcmk\u00fcn olamamaktad\u0131r.  Subjektif, klinik bir karar olan cerrahi do\u011fuma ge\u00e7i\u015f karar\u0131 eninde sonunda obstetrisyen taraf\u0131ndan verildi\u011fi i\u00e7in, maskelememek  \u00f6nemli olabilir. Obstetrisyenler ve ebeler, epidural analjezi uygulanan bir hastaya, uygulanmam\u0131\u015f olanla ayn\u0131 \u015fekilde yakla\u015fmayabilir. \u00d6rne\u011fin, epidural analjezi uygulanan hastalar aras\u0131nda forseps destekli do\u011fum, k\u0131smen obstetrisyenin hastan\u0131n daha rahat oldu\u011funu ve i\u015flem i\u00e7in gev\u015fek pelvik kaslar\u0131 bulundu\u011funu bilmesi nedeniyle daha s\u0131k olabilir.<\/span><\/font><\/p>\n

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        • \n

          Epidural isteyen kad\u0131nlarla istemeyenler aras\u0131nda g\u00f6r\u00fclen ki\u015filik farklar\u0131:<\/span><\/b><\/font><\/p>\n<\/li>\n<\/ul>\n

          Bu fakt\u00f6r de, bu konuyu karma\u015f\u0131k hale getiren ve retrospektif \u00e7al\u0131\u015fmalar\u0131 (rasgele  se\u00e7mek yerine, anestezi \u015feklini kendisi se\u00e7mi\u015f olan kad\u0131nlar\u0131n sonu\u00e7lar\u0131n\u0131 \u00e7al\u0131\u015fmak) belki de ge\u00e7ersiz k\u0131lan bir fakt\u00f6rd\u00fcr.  Epidural tercih eden kad\u0131nlarda tercih etmeyenlere g\u00f6re, kendilerine \u00f6zg\u00fc farklar bulunmaktad\u0131r.  Do\u011fum i\u00e7in epidural analjezi tercih eden kad\u0131nlar s\u0131kl\u0131kla nullipard\u0131r (ilk bebek sahibi), travay i\u00e7in hastaneye daha erken gelirler, bebekleri kar\u0131nlar\u0131nda daha y\u00fcksek seviyededir, bebekleri b\u00fcy\u00fckt\u00fcr ve travaylar\u0131 da yava\u015ft\u0131r. T\u00fcm bu fakt\u00f6rler epiduralli veya epiduralsiz, travay\u0131n uzamas\u0131na katk\u0131da bulunurlar.<\/span><\/font><\/p>\n

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          • \n

            \u00c7al\u0131\u015fmalar\u0131n g\u00fcc\u00fc:<\/span><\/b><\/font><\/p>\n<\/li>\n<\/ul>\n

            Baz\u0131 \u00e7al\u0131\u015fmalar ciddi olarak g\u00fc\u00e7s\u00fczd\u00fcr, yani her grupta yer alan hastalar\u0131n say\u0131s\u0131 \u00e7al\u0131\u015fmalar\u0131n sonucunu do\u011frulamak i\u00e7in yeterli de\u011fildir.<\/span><\/font><\/p>\n

            \u00c7e\u015fitli k\u0131s\u0131tlamalardan dolay\u0131 her bir \u00e7al\u0131\u015fman\u0131n sonucu detayl\u0131 olarak incelenmelidir. Her \u015feye ra\u011fmen, ger\u00e7ek g\u00fc\u00e7l\u00fc \u00e7ift k\u00f6r \u00e7al\u0131\u015fmalar olmasa da,  karma\u015f\u0131k istatistiksel y\u00f6ntemlerle (meta-analiz) baz\u0131 sonu\u00e7lar \u00e7\u0131kartmak m\u00fcmk\u00fcnd\u00fcr.  <\/span><\/font><\/p>\n

            Meta-analiz<\/span><\/u><\/b><\/font><\/p>\n

            D\u00fc\u015f\u00fck g\u00fc\u00e7teki bir \u00e7al\u0131\u015fman\u0131n (sonu\u00e7lar\u0131 g\u00fc\u00e7lendirecek kadar say\u0131da hasta olmayan \u00e7al\u0131\u015fma) zorluklar\u0131n\u0131n \u00fcstesinden gelmek i\u00e7in \u00e7e\u015fitli \u00e7al\u0131\u015fmalar\u0131n meta-analizi (benzer \u00e7al\u0131\u015fmalar\u0131n cevaplar\u0131n\u0131 elde eden) yap\u0131lm\u0131\u015f ve \u015fu sonu\u00e7lar elde edilmi\u015ftir (1):<\/span><\/font><\/p>\n

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            • \n

              Epidural analjezinin sezaryenle do\u011fuma etkisi: <\/span><\/b>2400 gebe kad\u0131n\u0131n deneyimini temsil eden be\u015f tane rasgele ve iki tane (bir \u00f6n \u00e7al\u0131\u015fma ve bir eski Avrupa \u00e7al\u0131\u015fmas\u0131) de ba\u015fka \u00e7al\u0131\u015fman\u0131n meta-analizi,  epidural veya opioid analjezi gruplar\u0131nda sezaryenle do\u011fum riski a\u00e7\u0131s\u0131ndan fark bulamam\u0131\u015ft\u0131r. Ayr\u0131ca, distosi (anormal servikal dilatasyon veya do\u011fum seyri) veya nullipar kad\u0131n (ilk gebeli\u011fi olan kad\u0131n) de\u011ferlendirildi\u011finde  sonu\u00e7lar de\u011fi\u015fmemektedir.<\/span><\/font><\/p>\n<\/li>\n

            • \n

              Epidural analjezinin travay s\u00fcresine etkisi:<\/span><\/b> Epidural analjezinin ba\u015flam\u0131\u015f bir travayda servikal dilatasyon \u00fczerine etkisi muhtemelen \u00e7ok d\u00fc\u015f\u00fckt\u00fcr. Epidural analjezi ve opioid analjezinin kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131 10 rasgele \u00e7al\u0131\u015fman\u0131n meta-analizi, do\u011fumun birinci evresinin yakla\u015f\u0131k 42 dakika uzad\u0131\u011f\u0131 (yakla\u015f\u0131k %8) sonucuna varm\u0131\u015ft\u0131r. 6 rasgele \u00e7al\u0131\u015fman\u0131n meta-analizinde, epidural analjezi uygulanan hastalarda do\u011fumun 2. evresinin ortalama s\u00fcresinde  14 dakikal\u0131k uzama  g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Epidural grupta iv gruba g\u00f6re do\u011fum ortalama 1 saat uzun bulunmu\u015ftur.<\/span><\/font><\/p>\n<\/li>\n

            • \n

              Epidural analjezi ve aletli do\u011fum (forseps): <\/span><\/b>Epidural analjezi ve forsepsle do\u011fum aras\u0131ndaki ili\u015fki karma\u015f\u0131kt\u0131r. Her ne kadar obstetrisyenler ve hastaneler aras\u0131nda bu tekni\u011fin uygulanmas\u0131 \u00e7ok de\u011fi\u015fse de , epidural analjezide aletli vajinal do\u011fum s\u0131kl\u0131\u011f\u0131 artm\u0131\u015f olabilir. Randomize \u00e7al\u0131\u015fmalar\u0131n meta-analizi, epidural analjezi uygulanan hastalarda toplam aletli do\u011fumun iki kat artt\u0131\u011f\u0131 sonucuna varm\u0131\u015ft\u0131r.  Ancak obstetrisyenlerin pratikte kullan\u0131m ve tercihlerine ba\u011fl\u0131 olarak \u00e7al\u0131\u015fmalar aras\u0131 b\u00fcy\u00fck de\u011fi\u015fiklikler ve geni\u015f g\u00fcvenlik aral\u0131\u011f\u0131 bulunmaktad\u0131r. \u00d6rne\u011fin, obstetrisyen epidural analjezi uygulanan hastalar\u0131na daha rahat olacaklar\u0131 i\u00e7in forseps e\u015fli\u011finde do\u011fum yapmay\u0131 tercih ediyor olabilir.<\/span><\/font><\/p>\n<\/li>\n

            • \n

              Oksitosin kullan\u0131m\u0131:<\/span><\/b> Epidural analjezi uygulanan kad\u0131nlarda iv gruba g\u00f6re oksitosin kulan\u0131m\u0131 daha fazlad\u0131r. \u00c7al\u0131\u015fmalar\u0131n meta-analizi epidural grupta 2 kat daha fazla oksitosin ihtiyac\u0131 oldu\u011funu g\u00f6stermi\u015ftir.<\/span><\/font><\/p>\n<\/li>\n

            • \n

              Hasta memnuniyeti ve yenido\u011fan\u0131n durumu: <\/span><\/b>A\u011fr\u0131s\u0131z do\u011fumda hasta memnuniyeti ve yenido\u011fan\u0131n durumu epidural grupta iv metoda g\u00f6re daha iyidir. \u00c7al\u0131\u015fmalar\u0131n meta-analizi opioid grupta a\u011fr\u0131n\u0131n daha k\u00f6t\u00fc ve memnuniyetsizli\u011fin daha fazla oldu\u011funu, 1. ve 5. Apgar skorlar\u0131n\u0131n ve umbilikal kord pH\u2019s\u0131n\u0131n daha d\u00fc\u015f\u00fck, yenido\u011fanda naloksan tedavisine olan ihtiyac\u0131n daha fazla oldu\u011funu g\u00f6stermi\u015ftir.<\/span><\/font><\/p>\n<\/li>\n<\/ul>\n

               Sonu\u00e7lar a\u015fa\u011f\u0131daki gibidir:<\/span><\/b><\/font><\/p>\n

              Baz\u0131 iyi y\u00fcr\u00fct\u00fclm\u00fc\u015f, prospektif, rasgele \u00e7al\u0131\u015fmalar, pek \u00e7ok anestezi doktorunun ve artan say\u0131da obstetrisyenin, epidural analjezinin do\u011fumu \u00e7ok az uzatt\u0131\u011f\u0131 ve sezaryenle do\u011fum riskini artt\u0131rmad\u0131\u011f\u0131 d\u00fc\u015f\u00fcncelerini desteklemeye yard\u0131mc\u0131 olmu\u015ftur.  <\/span><\/font><\/p>\n

              Epidural analjezi uygulanan hastalar\u0131n travaylar\u0131 daha uzundur. Travay s\u00fcresinde epidural grupta sistemik iv metodla kar\u015f\u0131la\u015ft\u0131rld\u0131\u011f\u0131nda yakla\u015f\u0131k 60 dakikal\u0131k bir uzama vard\u0131r. Ancak, hasta memnuniyeti ve yenido\u011fan\u0131n durumu epiduralde iv metoda g\u00f6re daha iyidir.<\/span><\/font><\/p>\n

              Tablo 1: Epidural ve opioid analjezide rasgele \u00e7al\u0131\u015fmalar<\/li>\n<\/ol>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
              \n

              First author and citation<\/p>\n<\/td>\n

              		\n

              Rate of C\/S for dystocia1<\/sup><\/p>\n<\/td>\n

              		\n

              P<\/p>\n<\/td>\n<\/tr>\n

               <\/td>\n\n

              Epidural group<\/p>\n<\/td>\n

              		\n

              Opioid group<\/p>\n<\/td>\n

              		 <\/td>\n<\/tr>\n
              \n

              Philipsen<\/p>\n

              Eur J Obstet Gynecol Reprod Biol 1989; 30:27-33<\/span><\/p>\n<\/td>\n

              		\n

              10\/57 (17%)<\/p>\n<\/td>\n

              		\n

              6\/54 (11%)<\/p>\n<\/td>\n

              		\n

              NS<\/p>\n<\/td>\n<\/tr>\n

              \n

              Thorp<\/p>\n

              Am J Obstet Gynecol 1993; 169:851-8<\/span><\/p>\n<\/td>\n

              		\n

              8\/48 (16.7%)<\/p>\n<\/td>\n

              		\n

              1\/45 (2.2%)<\/p>\n<\/td>\n

              		\n

              <.05<\/p>\n<\/td>\n<\/tr>\n

              \n

              Ramin2<\/sup><\/p>\n

              Obstet Gynecol 1995; 86:783-9<\/span><\/p>\n

              Current Anesth Rep 2000; 2:18-24<\/span><\/p>\n<\/td>\n

              		\n

              43\/664 (6%)<\/p>\n<\/td>\n

              		\n

              37\/666 (6%)<\/p>\n<\/td>\n

              		\n

              NS<\/p>\n<\/td>\n<\/tr>\n

              \n

              Sharma<\/p>\n

              Anesthesiology 1997; 87:487-94<\/span><\/p>\n<\/td>\n

              		\n

              13\/358 (4%)<\/p>\n<\/td>\n

              		\n

              16\/357 (5%)<\/p>\n<\/td>\n

              		\n

              NS<\/p>\n<\/td>\n<\/tr>\n

              \n

              Bofill<\/p>\n

              Am J Obstet Gynecol 1997; 177:1465-70<\/span><\/p>\n<\/td>\n

              		\n

              4\/49 (4%)<\/p>\n<\/td>\n

              		\n

              3\/51 (3%)<\/p>\n<\/td>\n

              		\n

              NS<\/p>\n<\/td>\n<\/tr>\n

              \n

              Clark<\/p>\n

              Am J Obstet Gynecol 1998; 179:1527-33<\/span><\/p>\n<\/td>\n

              		\n

              15\/156 (9.6%)<\/p>\n<\/td>\n

              		\n

              22\/162 (13.6%)<\/p>\n<\/td>\n

              		\n

              NS<\/p>\n<\/td>\n<\/tr>\n

              \n

              Gambling3<\/sup><\/p>\n

              Anesthesiology 1998; 89:1336-44<\/span><\/p>\n<\/td>\n

              		\n

              39\/616 (6%)<\/p>\n<\/td>\n

              		\n

              34\/607 (6%)<\/p>\n<\/td>\n

              		\n

              NS<\/p>\n<\/td>\n<\/tr>\n

              \n

              Loughnan<\/p>\n

              Br J Anaesth 2000; 84:715-9<\/span><\/p>\n<\/td>\n

              		\n

              36\/304 (12%)<\/p>\n<\/td>\n

              		\n

              40\/310 (13%)<\/p>\n<\/td>\n

              		\n

              NS<\/p>\n<\/td>\n<\/tr>\n

              \n

              Howell<\/p>\n

              Br J Obstet Gynaecol 2001; 108:27-33<\/span><\/p>\n<\/td>\n

              		\n

              13\/184 (7%)<\/p>\n<\/td>\n

              		\n

              17\/185 (9%)<\/p>\n<\/td>\n

              		\n

              NS<\/p>\n<\/td>\n<\/tr>\n

              \n

              Lucas4<\/sup><\/p>\n

              Am J Obstet Gynecol. 2001;185:970-5<\/span><\/p>\n<\/td>\n

              		\n

              46\/372 (12%)<\/p>\n<\/td>\n

              		\n

              54\/366 (15%)<\/p>\n<\/td>\n

              		\n

              NS<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

              Table 2:  Sentinel event studies comparing C\/S rate before and after a rapid change in epidural availiability<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
              \n

              First author and citation<\/p>\n<\/td>\n

              		\n

              Rate of C\/S (epidural rate)<\/p>\n<\/td>\n

              		\n

              P<\/p>\n<\/td>\n<\/tr>\n

               <\/td>\n\n

              Low epidural use period<\/p>\n<\/td>\n

              		\n

              High epidural use period<\/p>\n<\/td>\n

              		 <\/td>\n<\/tr>\n
              \n

              Bailey<\/p>\n

              Anaesthesia 1983; 38:282-5<\/span><\/p>\n<\/td>\n

              		\n

              7.1% (0%)<\/p>\n<\/td>\n

              		\n

              9.3% (27%)<\/p>\n<\/td>\n

              		\n

              NS<\/p>\n<\/td>\n<\/tr>\n

              \n

              Gribble<\/p>\n

              Obstet Gynecol 1991; 78: 231-34<\/span><\/p>\n<\/td>\n

              		\n

              9.0% (0%)<\/p>\n<\/td>\n

              		\n

              8.2% (47%)<\/p>\n<\/td>\n

              		\n

              NS<\/p>\n<\/td>\n<\/tr>\n

              \n

              Larson<\/p>\n

              SOAP1<\/sup> abstracts 1992: 13<\/span><\/p>\n<\/td>\n

              		\n

              27.5% (0%)<\/p>\n<\/td>\n

              		\n

              22.9% (32%)<\/p>\n<\/td>\n

              		\n

              NS<\/p>\n<\/td>\n<\/tr>\n

              \n

              Mancuso<\/p>\n

              SOAP1<\/sup> abstracts 1993: 13<\/span><\/p>\n<\/td>\n

              		\n

              14.9% (19%)<\/p>\n<\/td>\n

              		\n

              12.3% (67%)<\/p>\n<\/td>\n

              		\n

              NS<\/p>\n<\/td>\n<\/tr>\n

              \n

              Johnson<\/p>\n

              J Fam Pract 1995; 40:244-7<\/span><\/p>\n<\/td>\n

              		\n

              18.4% (21%)<\/p>\n<\/td>\n

              		\n

              17.2% (71%)<\/p>\n<\/td>\n

              		\n

              NS<\/p>\n<\/td>\n<\/tr>\n

              \n

              Lyon<\/p>\n

              Obstet Gynecol 1997; 90: 135-141<\/span><\/p>\n<\/td>\n

              		\n

              11.8% (13%)<\/p>\n<\/td>\n

              		\n

              10.0% (59%)<\/p>\n<\/td>\n

              		\n

              NS<\/p>\n<\/td>\n<\/tr>\n

              \n

              Fogel<\/p>\n

              Anesth Analg 1998; 87:119-23<\/span><\/p>\n<\/td>\n

              		\n

              9.1% (1%)<\/p>\n<\/td>\n

              		\n

              9.7% (29%)<\/p>\n<\/td>\n

              		\n

              NS<\/p>\n<\/td>\n<\/tr>\n

              \n

              Yancey<\/p>\n

              Am J Obstet Gynecol 1999; 180:353-9<\/span><\/p>\n<\/td>\n

              		\n

              19.4% (1%)<\/p>\n<\/td>\n

              		\n

              19.0% (59%)<\/p>\n<\/td>\n

              		\n

              NS<\/p>\n<\/td>\n<\/tr>\n

              \n

              Impey<\/p>\n

              Am J Obstet Gynecol 2000;182:358-63<\/span><\/p>\n<\/td>\n

              		\n

              3.8% (10%)<\/p>\n<\/td>\n

              		\n

              4.0% (57%)<\/p>\n<\/td>\n

              		\n

              NS<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/td>\n<\/tr>\n

              Okunabilecek di\u011fer kaynaklar:<\/span><\/font><\/p>\n

              1. Segal S, Birnbach D. Epidurals and cesarean deliveries: A new look to an old problem. Editorial. Anesthesia and Analgesia 2000;94:775.<\/span><\/font><\/p>\n

              2. Halpern SH, Leightonm BL, Ohisson A, Barrett JF, Rice A. Effect of epidural vs parenteral opioid analgesia on the progress of labor. JAMA 1996;280;2105.<\/span><\/font><\/p>\n

              3. Segal S. Epidrual analgesia and the progress and outcome of labor and delivery. Problems in Anesthesia. 1999;11:324.<\/span><\/font><\/p>\n

              4. Thorp JA, Hu DH, Albin RM, et al. The effect of intrapartum epidural analgesia on nulliparous labor: a randomized, controlled, prospective trial. Obstet Gynecol 1993;169:851-8.<\/span><\/font><\/p>\n

              5. Ramin SM, Gambling DR, Lucas MJ, Sharma SK et al. Randomized trial of epidural versus intravenous analgesia during labor. Obstet Gynecol 1995;86:783-9.<\/span><\/font><\/p>\n

              5. Philipsen T, Jensen NH. Epidural block or parenteral pethidine as analgesic in labor: a randomized study concerning progress in labor and instrumental deliveries. Eur J Obstet Gynecol Reprod Biol 1989;30:27-33.<\/span><\/font><\/p>\n

              6. Sharma SK, Sidawi JE, Ramin SM, Lucas MJ, Laveno KJ, et al. Cesarean delivery; a randomized trial of epidural versus patient-controlled meperidine analgesia during labor. Anesthesiology 1997;87:487-94.<\/span><\/font><\/p>\n

              7. Bofill JA, Vincent RD, Ross EL, et al. Nulliparous active labor, epidural analgesia, and cesarean delivery for dystocia. Am J Obstet Gynecol 1997;177:1465-70.<\/span><\/font><\/p>\n

              8. Clarke A. Carr D. Loyd G, Cook V, Spinnato J.  The influence of epidural analgesia on cesarean delivery rates: a randomized, prospective clinical trial. Am J Obstet Gynecol 1998;179:1527-33.<\/span><\/font><\/p>\n

              Bir sonraki b\u00f6l\u00fcm i\u00e7in t\u0131klay\u0131n\u0131z<\/span><\/font><\/p>\n

              Do\u011fum (travay) s\u0131ras\u0131nda yiyip i\u00e7ebilir miyim?<\/a><\/font><\/p>\n

              <\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n


              <\/span><\/p>\n

              <\/p>\n","protected":false},"excerpt":{"rendered":"

              Epidural analjezi travay\u0131 az miktarda uzat\u0131r ve sezaryen riskini art\u0131rmaz.   Gebe kad\u0131nlar genellikle \u201cEpidural travay\u0131 uzat\u0131r m\u0131?\u201d \u201cForsepsle do\u011fum olas\u0131l\u0131\u011f\u0131 artar m\u0131?\u201d gibi sorular sorarlar. Bu sorular karma\u015f\u0131k cevaplar\u0131 olan basit sorulard\u0131r. Hem anestezi camiyas\u0131nda, hem de d\u0131\u015far\u0131da epidural anestezinin travay seyirine etkisi tart\u0131\u015fma konusu olmaya devam etmektedir. Literat\u00fcr bu konuda ikiye ayr\u0131lmaktad\u0131r. Obstetrisyenler,…<\/p>\n

              Read More “Epidural analjezi travay\u0131 az miktarda uzat\u0131r ve sezaryen riskini art\u0131rmaz.”<\/span> »<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":127,"menu_order":38,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-128","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/painfreebirthing.com\/turk\/wp-json\/wp\/v2\/pages\/128","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/painfreebirthing.com\/turk\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/painfreebirthing.com\/turk\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/painfreebirthing.com\/turk\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/painfreebirthing.com\/turk\/wp-json\/wp\/v2\/comments?post=128"}],"version-history":[{"count":0,"href":"https:\/\/painfreebirthing.com\/turk\/wp-json\/wp\/v2\/pages\/128\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/painfreebirthing.com\/turk\/wp-json\/wp\/v2\/pages\/127"}],"wp:attachment":[{"href":"https:\/\/painfreebirthing.com\/turk\/wp-json\/wp\/v2\/media?parent=128"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}