Indukcija vaginalnog porođaja

master's thesis

• Title (english): Induction of labour
• Author: Josipa Gudelj
• Mentor: Trpimir Goluža (mentor)
• Committee member: Vesna Elveđi-Gašparović (predsjednik povjerenstva)
• Committee member: Željko Duić (član povjerenstva)
• Committee member: Trpimir Goluža (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Gynecology and Obstetrics); Zagreb
• Defense date and country: 2024-09-11, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

Indukcija vaginalnog porođaja (IOL) čest je medicinski postupak u porodništvu, s rastućom učestalošću diljem svijeta. Razlozi za ovaj porast uključuju promjene u populaciji trudnica, neujednačene smjernice i rastuću primjenu elektivnih indukcija. Iako mehanizmi početka porođaja nisu potpuno razjašnjeni, znanstvenici smatraju da ključnu ulogu igraju fiziološki i hormonski signali zrelog fetusa, koji potiču upalne procese i kontrakcije maternice.
Indikacije za indukciju uključuju prenošenje trudnoće, hipertenziju, preeklampsiju, dijabetes, intrauterini zastoj rasta (IUGR) i intrauterinu smrt ploda.
Važan korak u procesu indukcije je pravilna preindukcijska procjena, koja uključuje ocjenu stanja fetusa i trudnice te zrelost cerviksa putem Bishopovog indeksa. Ako je cerviks nezreo, preindukcijski postupci poput primjene prostaglandina i mehaničkih metoda (osmotski dilatatori, balonski kateteri) mogu pomoći u sazrijevanju cerviksa. Kada je cerviks zreo, indukcija se često provodi primjenom oksitocina ili amniotomijom.
Odabir metode ovisi o specifičnim okolnostima i stanju trudnice. Oksitocin je brz, ali može povećati rizik od carskog reza i hiperstimulacije maternice. Prostaglandini, poput dinoprostona i mizoprostola, učinkoviti su u sazrijevanju cerviksa, dok mehaničke metode poput Foleyeva katetera i osmotskih dilatatora nude sigurnije alternative s manjim rizikom od komplikacija. Ključne komplikacije uključuju tahisistoliju i moguće poremećaje srčanog ritma fetusa, osobito kod primjene prostaglandina i oksitocina.

Abstract (english)

Induction of labour (IOL) is a common medical procedure in obstetrics, with increasing prevalence worldwide. This rise is attributed to changes in the population of pregnant women, inconsistent guidelines, and the growing use of elective inductions. Although the mechanisms of labour initiation are not fully understood, it is believed that physiological and hormonal signals from the mature fetus play a crucial role, stimulating inflammatory processes and uterine contractions.
Indications for induction include post-term pregnancy, hypertension, preeclampsia, diabetes, intrauterine growth restriction (IUGR), and intrauterine fetal demise.
A critical step in the induction process is a proper pre-induction assessment, which involves evaluating the fetal and maternal condition as well as cervical maturity using the Bishop score. If the cervix is immature, pre-induction methods such as prostaglandin application and mechanical methods (osmotic dilators, balloon catheters) can assist in cervical ripening. Once the cervix is mature, induction is often carried out using oxytocin or amniotomy.
The choice of method depends on specific circumstances and the condition of the pregnant woman. Oxytocin is fast-acting but may increase the risk of cesarean delivery and uterine hyperstimulation. Prostaglandins, such as dinoprostone and misoprostol, are effective in cervical ripening, while mechanical methods like Foley catheters and osmotic dilators offer safer alternatives with a lower risk of complications. Key complications include tachysystole and potential fetal heart rate abnormalities, particularly with the use of prostaglandins and oxytocin.

• Keywords: indukcija porođaja; indikacije za indukciju; Bishopov indeks; metode indukcije
• Keywords (english): induction of labour; indications for induction; Bishop score; induction methods
• Language: croatian
• URN:NBN: urn:nbn:hr:105:104558
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2024-09-08 18:49:33