Ozljede trbuha u trudnoći

master's thesis

• Title (english): Abdominal trauma in pregnancy
• Author: Sandra Jadranić
• Mentor: Goran Augustin (mentor)
• Committee member: Mate Majerović (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Goran Augustin (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2016-02-26, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

U suvremenom društvu ozljeda koja zahtijeva medicinsku skrb dogodi se u 3.7% svih trudnoća. Najčešći uzroci traume su cestovne prometne nesreće, padovi, fizički napadi i opekline, pri čemu najčešće dolazi do ozljede abdomena. Medicinsko osoblje treba imati na umu mogućnost trudnoće kod svake pacijentice u reproduktivnoj dobi kao i fiziološke i anatomske promjene koje ju prate. Sukladno tome treba modificirati postupke kardiopulmonalne resuscitacije i anesteziološke preoperativne skrbi.
CPN su najveći pojedinačni uzrok smrti trudnica i vodeći uzrok traumatske ozljede fetusa u SAD-u, a pravilno vezanje pojasom je najvažniji faktor u smanjenju maternalnog i fetalnog mortaliteta. Preko 70% smrti fetusa nakon tupe traume dogodi se zbog abrupcije placente, koja može nastati čak i kad nema drugih značajnih znakova traume. Ciljana ultrazvučna pretraga abdomena i biokemijski nalazi ključni su za dijagnozu pacijentica s unutarnjim krvarenjem. Trudnoća ne bi trebala isključiti mogućnost pristupanja principima kirurgije kontrole štete ukoliko je to potrebno.
Penetrirajuća trauma čini 9-16% svih abdominalnih trauma u trudnoći. Jedan od najvažnijih nalaza kod obrade trudnih traumatoloških pacijentica je fetus koji je vijabilan i stoga može biti spašen. Pri ozljedi vatrenim oružjem u abdomen radi se eksplorativna laparotomija zbog velike mogućnosti visceralne ozljede majke, poglavito kad je ozljeda u području gornjeg abdomena. Većina ubodnih ozljeda, ukoliko je majka hemodinamski stabilna, može biti zbrinuto neoperativno.
Mortalitet trudnica nakon ozljeda vatrenim i hladnim oružjem je niži nego kod pacijentica koje su pretrpjele iste ozljede a nisu trudne, budući da gravidni uterus ima zaštitni učinak. Obično fetus ima lošiju prognozu nego majka, sa stopom ozljeđivanja 59-80% i stopom perinatalnog mortaliteta od 41-71%.

Abstract (english)

Trauma requiring medical treatment occurs in 3.7% of all pregnancies. The most common causes are motor vehicle accidents, falls, physical attacks and burns. The most common site of injury of the pregnant patient is abdomen. There is a possibility of pregnancy in every female trauma patient of reproductive age and anatomical and physiological changes in pregnancy should be considered. Cardiopulmonary resuscitation and the following medical treatment should be modified accordingly.
Motor vehicle accidents are the most common single cause of death in pregnancy and the leading cause of traumatic injury of the fetus in USA. Proper seat belt use is the most important factor in decreasing maternal and fetal mortality. More than 70% of fetal deaths are caused by placental abruption which may happen even in the absence of visible signs of trauma. Abnormal abdominal sonography findings and biochemistry laboratory tests are crucial in making diagnosis of internal bleeding. Pregnancy should not be a contraindication for damage control surgery if one is necessary.
Penetrating trauma makes for 9-16% of all abdominal trauma in pregnancy. One of the most important findings when deciding on the treatment options is a viable fetus. Explorative laparotomy is the procedure of choice in abdominal injury caused by a firearm. Most of the stabbing injuries can be treated conservatively provided that the mother is hemodinamically stable.
Mortality following injuries caused by firearm and cold weapons in pregnacy is lower than mortality of non-pregnant patients suffering the same kind of injuries. That is due to the protective effect of gravid uterus. The fetus commonly has worse prognosis than the mother; fetal injury rate of 59-80% and perinatal mortality rate of 41-71%.

• Keywords: ozljede trbuha; trudnoća; prometne nesreće; strijelne ozljede
• Keywords (english): abdominal trauma; pregnancy; motor vehicle accidents; firearm injuries
• Language: croatian
• URN:NBN: urn:nbn:hr:105:271010
• 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: 2017-06-16 07:23:17