Učinci epiduralne analgezije na tijek i ishod porođaja

master's thesis

• Title (english): Effects of epidural analgesia on the course and outcome of labor
• Author: Dora Perinčić
• Mentor: Gordan Zlopaša (mentor)
• Committee member: Vesna Elveđi Gašparović (predsjednik povjerenstva)
• Committee member: Željko Duić (član povjerenstva)
• Committee member: Gordan Zlopaša (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Gynecology and Obstetrics); Zagreb
• Defense date and country: 2018-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

Rađanje djeteta jedan je od najljepših, ali i najbolnijih događaja koje žena može doživjeti. Porođajna bol je složen subjektivni fenomen, u kojem se bolni podražaj doživljava na individualnoj razini u skladu s emocionalnim, socijalnim i kulturološkim čimbenicima. Bol i anksioznost mogu uzrokovati aktivaciju simpatikusa, hiperventilaciju i hipokapniju s posljedično smanjenim uteroplacentalnim protokom i nekoordiniranom aktivnosti maternice te se preporuča ublažiti bol, posebice ako se radi o rodilji s komorbiditetom. Pri izboru analgezije mora se razmišljati o učinkovitosti i sigurnosti analgezije kao i o mogućim nepovoljnim učincima na majku i dijete te učincima na tijek i ishod porođaja. Epiduralna analgezija smatra se najboljom metodom ublažavanja porođajne boli jer osigurava učinkovitu analgeziju uz minimalne štetne učinke na majku i dijete. Kontroverze o primjeni i učinku epiduralne analgezije na tijek i ishod porođaja i dalje postoje i predmet su istraživanja brojnih radova. Epiduralna analgezija može utjecati na trajanje porođaja, blago skraćujući prvo te produžujući drugo porođajno doba. Primjena epiduralne analgezije tijekom porođaja može donekle povećati rizik dovršenja porođaja instrumentalnim putem, ali ne povećava vjerojatnost dovršenja porođaja carskim rezom. Smanjenjem koncentracije lokalnog anestetika dodatkom manjih količina opioida moguće je umanjiti navedene učinke. Ukoliko ne postoje kontraindikacije, epiduralna analgezija može se primijeniti na zahtjev rodilje bez obzira u kojem se stadiju porođaja rodilja nalazi te se preporuča nastaviti s njenom primjenom sve do samog kraja porođaja.

Abstract (english)

Giving birth is an incredible, but also one of the most painful experiences in a woman’s life. Birth pain is a complex phenomenon, where painful stimulation is experienced on an individual level in accordance with emotional, social and cultural factors. Pain and anxiety can lead to adrenergic hyperactivity, hyperventilation and hypocapnia with reduced uteroplacental blood flow and uncoordinated uterine activity. Therefore, pain relief is recommended, especially in cases of maternal comorbidity. When thinking about labor analgesia, consideration should be given to the efficacy and safety of analgesia as well as possible adverse effects on mother and child and the effects on the course and outcome of labor. Epidural analgesia is considered the best method of alleviating labor pain, providing effective analgesia with minimal adverse effects. Despite the increased use and known benefits of epidural analgesia, there has been significant controversy regarding the impact of epidural analgesia on labor outcomes. Epidural analgesia can affect the duration of labor, slightly shortening first and prolonging the second stage of labor. The evidence indicates that effective labor analgesia does not increase the rate of Caesarean delivery, although it might be associated with an increased rate of instrumental vaginal delivery. It is possible to improve obstetric outcomes and reduce maternal side effects by reducing the concentration of local anesthetic. In the absence of a medical contraindication, maternal request is a sufficient medical indication for epidural analgesia in labor and it is recommended to continue with its application until the end of labor.

• Keywords: porođajna bol; epiduralna analgezija; porođaj
• Keywords (english): labor pain; epidural analgesia; labor
• Language: croatian
• URN:NBN: urn:nbn:hr:105:203721
• 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: 2018-12-20 09:02:48