Abstract | Carski rez je kirurški zahvat vađenja djeteta kroz trbušnu stijenku izvođenjem laparotomije i histerotomije. Kroz povijest se tehnika, uspješnost i učestalost izvršenja carskog reza značajno mijenjala. Na samim počecima, zbog visoke smrtnosti kako majki, tako i djece, tim putem uspješno rođenom djetetu su se pripisivale nadnaravne osobine. Kroz vrijeme se tehnika znatno mijenjala. Rez na maternici se prije vršio kroz gornji, mišićni dio stijenke, što je prepoznato kao rizični čimbenik za krvarenje i oslabljeno zarastanje. Zbog toga se uveo rez donjeg dijela maternice, gdje je stijenka tanja. Rez na trbušnoj stijenci je postajao sve umjereniji i estetski prihvatljiviji. Napretkom na području asepse, abdominalne kirurgije, anestezije i transfuzijske medicine carski rez postaje relativno siguran zahvat, zbog čega mu učestalost naglo raste krajem 20. i početkom 21. stoljeća. Medicinske indikacije za dovršavanje trudnoće kirurškim putem možemo podijeliti na apsolutne, kod kojih trudnoću nije moguće dovršiti ni na koji drugi način, zatim relativne, kod kojih je carski rez sigurnija opcija u odnosu na vaginalni porođaj, te konačno proširene, kad je život djeteta akutno ugrožen. Osim medicinskih, sve češće su i paramedicinske indikacije, od kojih je najčešća zahtijevanje trudnice da se trudnoća dovrši na taj način. Sve veći broj takvih, elektivnih zahvata je zabrinjavajuć, budući da izvođenje carskog reza u odnosu na vaginalni porođaj nosi veći rizik za razvoj komplikacija za majku, a prema nekim istraživanjima nepovoljno utječe i na dijete. Iz tog razloga su potrebni daljnji napreci na području kirurgije carskog reza, ali i bolje informiranje žena o opciji koja je za njih i njihovo dijete najprimjerenija. |
Abstract (english) | Caesarian section is a surgical procedure in which a child is extracted through the abdominal wall after performing laparotomy and hysterotomy. Throughout history the technique, efficacy and frequency of caesarean section was changing significantly. At the very beginning, due to high mortality of both mothers and children, when a live birth had been achieved, mythical characteristics were attributed to it. The technique went through major alterations. The incision of the uterine wall used to be performed on the upper, muscular part of the uterus, which has been recognized as a risk factor for haemorrhage and slowed healing. The abdominal wall incision has become less extensive and aesthetically more acceptable. With the advances in the areas of asepsis, abdominal surgery, anesthesia and transfusion medicine, caesarean section became a relatively safe procedure, which made its frequency skyrocket at the end of 20th and the beginning of 21st century. Absolute indications for surgically ending a pregnancy are those in which the pregnancy cannot be ended in any other way. Relative indications are those in which the operation carries a lower rick compared to vaginal birth. The third group of medical indications are those in which life of the fetus is acutely threatened. Apart from medical indications, there are paramedical indications, which are becoming more and more prominent. The most common paramedical indication is the future mother's ask to perform a caesarean section. The increasing number of these, elective operations is troubling, because performing a caesarean section, compared to vaginal birth, carries a greater risk of developing complications for the mother and, according to some research, for the child, too. For that reason, it is necessary to continue developing better and safer techniques and to inform the women about the optimal option for them and their child. |