Effect Of Acupressure On Hypothermıa And Shıverıng After Cesarean Sectıon

Research Objective This research was planned to determine the effect of acupressure on hypothermia and shivering after cesarean section.

Hypotheses H01: There is no difference in hypothermia findings between women who received acupressure and women in the control group.

H02: There is no difference in shivering findings between women who received acupressure and women in the control group.

MATERIALS AND METHODS Research Design This research is a randomized controlled experimental study. Location and Time of Study The research will be conducted between July 15, 2025 and July 15, 2026 at the Ondokuz Mayıs University Health Application and Research Center in northern Turkey, with women who will undergo cesarean delivery in the obstetrics and gynecology department.

Study Population and Sample The study population will consist of women hospitalized in the obstetrics and gynecology ward for cesarean section at Ondokuz Mayıs University Health Application and Research Center. The sample size was calculated using the G*Power 3.1.9.2 program, taking into account the data from the study by Moysés et al. (2014). Using the mean and standard deviation values of the T120 min axillary body temperature of the experimental and control groups in that study, the effect size was calculated as 0.58. The minimum number of individuals to be included in the sample of this study was calculated using G*Power 3.1.9.2 with an effect size of 0.58, α= 0.05, and power: 0.80, and the sample size was determined as 96 women (acupressure group: 48, control group: 48). Considering possible data loss in the study, the sample size was increased by 10% to increase the analytical power, and it was determined that 106 women (acupressure group: 53, control group: 53) would be included in the study. The group assignments for each participant will be determined using a fully randomization technique via the website https://www.randomlists.com/team-generator.

The sample size for this study was calculated using the G*Power 3.1.9.2 program, taking into account the data from the study by Cantürk et al. (2019). The effect size was calculated as 0.82 using the mean and standard deviation of the postoperative tympanic temperature measurements of the experimental and control groups in that study. The minimum number of individuals required for this study's sample was calculated using G*Power 3.1.9.2 with an effect size of 0.82, α= 0.05, and power: 0.80, resulting in a sample size of 50 women (acupressure group: 25, control group: 25). Considering potential data loss, and to increase the analytical power, the sample size was increased by 20%, resulting in the inclusion of 60 women (acupressure group: 30, control group: 30).

Inclusion criteria for the study:

• Women aged 18-35 years,
• Women who underwent elective cesarean section,
• Women who received spinal anesthesia,
• Women who are classified as ASA I (Normal, healthy person without any disease or systemic problem other than surgical pathology causing a systemic disorder),
• Women whose body temperature is between 36-37.5 °C on the morning of cesarean section,
• Women who can speak and understand Turkish,
• Women who agree to participate in the study will be included.

Exclusion criteria for the study:

• Diagnosed with a high-risk pregnancy,
• Having a compromised body integrity or contagious skin disease at the acupressure application site,
• Using medications that affect thermoregulation, such as vasodilators,
• Developing intrapartum complications (such as placental abruption),
• Requiring intensive care after a cesarean section,
• Receiving more than 2500 mL of IV fluids or experiencing blood loss exceeding 20% during a cesarean section,
• Having a BMI below 18.5 or above 24.9,
• Women who wish to withdraw from the study at any stage will be excluded. Data Collection Tools The research data will be collected using the Pregnant Women Introduction Form, Vital Signs Monitoring Form, Temperature Comfort Perception Scale, and Shivering Level Assessment Form.

Pregnant Women Introduction Form: The form was created by the researcher after reviewing the literature. This form consists of a total of 30 questions: 9 questions covering the socio-demographic characteristics of women (age, education level, employment status, etc.) and 21 questions covering their obstetric characteristics (gestational week, number of pregnancies, etc.). While the socio-demographic and some obstetric characteristics (the first 12 questions in the obstetric characteristics section) included in this form will be completed face-to-face before cesarean section, other obstetric characteristics will be written by referring to the patient's file.

Vital Signs Monitoring Form: This form was created by the researcher after reviewing the literature. This form records fever, pulse rate, respiratory rate, blood pressure, and oxygen saturation. The women's vital signs will be monitored and recorded by the researcher before the surgery begins, at the start of the surgery, and at 0, 15, 30, 45, 60, 90, 120, 180, and 240 minutes post-surgery.

Temperature Comfort Perception Scale: The Temperature Comfort Perception Scale, is a visual analog scale designed to objectively assess individuals' comfort levels regarding temperature. This scale is scored from zero (too cold) to ten (too hot) based on the individual's own perception. A score of five represents ideal temperature comfort.The thermal comfort perception scale for women will be recorded by the researcher before the start of the surgery, at the beginning of the surgery, and at 0, 15, 30, 45, 60, 90, 120, 180, and 240 minutes post-surgery.

Tremor Level Assessment Form: The form, developed to assess individuals' tremor levels through observation, was prepared by the researcher as a questionnaire. This form allows for the objective determination of the individual's tremor severity and is evaluated as follows: 0 (no tremor), 1 (localized tremor in the abdomen and neck), 2 (tremor including the upper extremities), 3 (whole body tremor). The shivering assessment scale will be administered to the women before the surgery begins, at the start of the surgery, and at 0, 15, 30, 45, 60, 90, 120, 180, and 240 minutes post-surgery, and the results will be recorded by the researcher.

Acupressure Group: Half an hour before cesarean delivery, acupressure was applied to the Yong Quan point (Kd1), the Chongyang point (ST42), and the Zu San Li point (ST36) located under the patella on both feet (Figure 1, Figure 2, and Figure 3). The application was performed by applying pressure to both feet simultaneously, applying consecutive pressure with the index finger to points ST42 and Kd1, then to point ST36, for 3 minutes, followed by a 3-minute rest period, and repeated 3 times. The duration and intensity of acupressure were determined based on previous studies on the subject. The consecutive pressures were applied at a frequency that would not disturb the person or induce pain, and that would have a calming effect. After cesarean delivery, the Vital Signs Monitoring Form, the Temperature Comfort Perception Scale, and the Shivering Level Assessment Form were completed.

Yong Quan Point (Kd1) is one of the points located on the kidney meridian. On the body, it is situated on the sole of the foot, at the point where the front 1/3 and back 2/3 of the line connecting the base of the 2nd and 3rd toes to the heel intersect.

The Chongyang point (ST42) is located on the sole of the foot, at the point where the front 1/3 and back 2/3 of the line connecting the bases of the 2nd and 3rd toes to the heel meet.

The Zu San Li point (ST36) is located one finger width lateral to the anterior border of the tibia, 3 inches below the patella.

In the control group: Women who underwent routine postpartum care after cesarean delivery completed the Vital Signs Monitoring Form, the Temperature Comfort Perception Scale, and the Shivering Level Assessment Form.