الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Childbirth, also known as labor and delivery, is the end of pregnancywhere one or more fetuses leave the uterus by passing through the vagina or by caesarean section. In 2015, there were about 135 million births globally. About 15 million were born before 37 weeks of gestation (Martin, 2017). Perineal tear is a serious health problem that leads to serious long term complications that negatively affect the women physical, psychological and social health. The use of lubricated massage or warm compresses to prevent or decrease the incidence and degree of perineal tear and pain is still controversial.Warm compresses is the application of hot agent, warmer than skin either in a moist or dry form on the surface of the body to relieve pain and congestion and to soften the exudates (Essa & Ismail, 2019). In this study it refers to applying pads soaked with warm sterile water (heated to 38c) during the uterine contractions once the fetal head distended the perineum Lubricated massage is the act of stretching and manipulating the perineal tissue using one or two fingers. Its goal is to prepare these tissues to stretch over the fetus‘s head and body during vaginal delivery by using personal lubricants,like K-Y Jelly (Ashley, 2019).In this study the massage and warm compresses were used for a pregnant woman‘s perineum, the intention is to attempt to prevent tearing of perineum during birth and reduce the need for an episiotomy.The purpose of the present study was to compare the effect of warm compresses versus lubricated massage during the second stage of labor on perineal integrity among primiparous women.The present study was carried out in the Obstetrics and Gynecology Department, Labor Unit at Menoufia University Hospital.A quasi experimental (comparative) research design was utilized in this study.A convenient sample of 150 primiparous women undergoing vaginal delivery was recruited and assigned to three groups:group 1: 50 primiparous women received warm compresses on the perineum during the 2nd stage of labor.group 2: 50 primiparous women received lubricated massage on perineum during the 2 nd stage of labor group 3: 50 primiparous women received routine hospital care during the 2nd stage of labor.Throughout the course of the present study, data were collected using two instruments which are revised by a jury of qualified experts and then tested for validity and reliability. Instruments were: Instrument I (Appendix A):A structured interviewing questionnaire. It involves two main parts:It was adapted from Ibrahim, et al., (2017) to match the purpose of the study and culture of the participants.Part 1: Demographic data of the primiparous women such as; age,occupation, education, residence and anthropometric measurements (height (cm),weight (kg), body mass index (BMI) weight (kg) / height (m2)Part 2: Current pregnancy profile such as; gestational age, fundal height,antenatal care and medical disorder during pregnancy.Instrument II (Appendix B):Instrument II:Assessment and observational birth outcome sheet: it was developed by the researcher guided by, Tanos & Toney, (2019). It included three parts:Part 1: Second stage characteristics, included the progress of labor,oxytocin stimulation, and duration of the second stage (min).
Part 2: Assessment of newborn birth outcomes and their characteristics such as newborn’s birth weight (kg) and newborn’s head circumference.Part 3: Assessment of perineal condition such as intact, episiotomy,perineal tear, and its degree. 1) First-degree tear: Injury includes the perineal skin and/or vaginal mucosa, 2) Second-degree tear: Injury involving perineal muscles but not involving the anal sphincter, 3) Third-degree tear: Injury involving the\\anal sphincter complex: Grade 3a tear: less than 50% of external anal sphincter(EAS) thickness torn. Grade 3b tear: more than 50% of EAS thickness torn. Grade 3c tear: both EAS and internal anal sphincter (IAS) torn and fourth-degree tear:injury of perineum involving the anal sphincter complex (EAS and IAS).An approval from the Committee of Hearing and Ethics was obtained from Faculty of Nursing, Menoufia University. Approaches ensuring the ethics were considered in the study regarding confidentiality and informed consent. The researcher introduced herself to the study participants and explained the purpose of the study in order to obtain their acceptance to be recruited in the study as well as to gain their cooperation.Confidentiality was achieved by the use of closed instrument with the names of the participants replaced by numbers. All women were informed that the information they provided during the study would be kept confidential and used only for statistical purpose and after finishing the study, the findings would be presented as a group data with no personal participant’s information remained.After explanation prior to enrollment in the study, informed consent was obtained verbally from all women. Each woman informed that participation in the study was voluntary, and that she could withdraw from the study whenever she decided to and each one was given the opportunity to freely refuse the participation. They were free to ask any questions about the study details.Upon completion of data collection, each answer was coded and scored.The researcher coded the data into a coding instrument so that the data could be prepared for computer use. Data was statistically analyzed using (Statistical Package for the Social Sciences, version 22, SPSS .Graphics were done using Excel program.The findings of the present study approved the study hypotheses:Parturient women who receive lubricated massage experience lower adverse perineal integrity during the 2nd stage of labor than parturient women who receivebr warm compresses.The findings of the present study showed that: There was a statistically significant difference between the three study groups in age, height, weight. There was a significant difference between the three studied groups regarding each item in the clinical information The medical history during current pregnancy among the three groups,concerning any heart disease, or diabetes, or anemia, or hypertension. All participants claimed the response ―no‖. There was no significant difference between the three studied groups regarding progress of labor. The difference was significant statistically regarding the mean fetal birth weight. There is relation between fetal head circumference and perineal condition among the three studied groups. The difference between the three groups about perineal condition was high statistically significant.Conclusions In the light of the present study results, it can be concluded that:The use of warm compresses was effective in reducing the degree of perineal tears and the degree of extension of episiotomy, when compared to the control group. This supports the first research hypothesis.Also, the lubricated massage was effective in reducing the degree of
perineal tears and the degree of extension of episiotomy, when compared to the control group. This supports the second research hypothesis.Lubricated massage was more effective than warm compresses in this respect and this supports the third research hypotheses.
Based on the present study findings, the research hypotheses are accepted.
Recommendations Based on the study findings the following were recommended:1. Advice using non-pharmacological methods for primiparous women as it reduce the complications of episiotomy and perineal tears.2. Perineal lubricated massage and perineal warm compresses should be incorporated during the second stage of labor as perineal protecting techniques.3. Further researches are also recommended : The effect of warm compresses on other pains encountered during the menstrual cycle. Assessment of laboring women’s satisfaction with the use of perineal warm compresses for management of second stage of labor. Replication of the present study at different sittings and among different subjects.