Vaginalni porođaj nakon prethodnog carskog reza

master's thesis

• Title (english): Vaginal birth after cesarean delivery
• Author: Marin Trkulja
• Mentor: Gordan Zlopaša (mentor)
• Committee member: Vesna Elveđi Gašparović (predsjednik povjerenstva)
• Committee member: Dinka Pavičić Baldani (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: 2019-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

Žene s prethodnim carskim rezom u anamnezi trudnoću mogu dovršiti ponovnim planiranim carskim rezom (PRCD) ili vaginalnim porođajem nakon prethodnog carskog reza (TOLAC/VBAC). Globalni porast incidencije carskog reza kao metode dovršenja trudnoće odnosi se djelomice i na češće izvođenje PRCD-a nego li je to objektivno potrebno. Iako je u proteklih desetak godina konstruirano više kliničkih sustava za procjenu vjerojatnosti uspješnog vaginalnog porođaja (VBAC kalkulator, MFMU Network kalkulator, modeli predviđanja), niti jedan od njih nije potvrđen (eksterno validiran) u prospektivnom kohortnom istraživanju. Potencijalni razlog zaziranja porodničara od TOLAC protokola mogao bi biti povećan rizik rupture maternice, međutim, na umu treba imati onaj postotak trudnice koje su mogle trudnoću dovršiti VBAC-om, ali to nisu učinile, što je najčešće posljedica propusta liječnika u antenatalnom savjetovanju i informiranju trudnice o njezinim izgledima za VBAC.
Ruptura maternice potencijalno je fatalna komplikacija vaginalnog porođaja koja je češća u kontekstu TOLAC-a, a rizik raste korištenjem prostaglandina u indukciji porođaja.
Iako je carski rez povezan sa značajno većim maternalnim negoli fetalnim morbiditetom i mortalitetom, mnoge će trudnice zanemariti svoje rizike, ako carski rez u konkretnom slučaju povećava šanse za preživljenje djeteta i bolji neonatalni status.

Abstract (english)

Women with a previous cesarean section can choose either planned repeated cesarean delivery (PRCD) or vaginal birth after cesarean (VBAC) as a way to end their current preganancy. More frequent PRCDs, although not always with a reasonable indication, are partially accountable for a global raise of incidence of cesarean section. Although some prediction models of successful VBAC have been developed in the past decade (VBAC calculator, MFMU Network calculator, prediction models), none of them have been externally validated in a prospective cohort study. An increased risk of uterine rupture associated with TOLAC /VBAC arises as a possible reason for some clinicians to avoid TOLAC. One has to bear in mind the percentage of women who could have successfully completed VBAC, but haven't done so, mostly due to antenatal counsseling malpractice and not knowing their own chance of success.
Uterine rupture is a potentially fatal complication of vaginal birth, which happens to be more common in the setting of TOLAC, and if prostaglandines are used for labor induction the risk becomes even higher. Although cesarean section bears more morbidity and moratality risks for the mother than for the child, many women will undergo cesarean section if they are told it would improve the survival rate and neonatal status of the newborn.

• Keywords: vaginalni porođaj; carski rez; TOLAC; VBAC; PRCD; antenatalno savjetovanje; ruptura maternice; indukcija porođaja; prostaglandini
• Keywords (english): vaginal birth; cesarean section; TOLAC; VBAC; PRCD; antenatal counselling; uterine rupture; labor induction; prostaglandines
• Language: croatian
• URN:NBN: urn:nbn:hr:105:954696
• 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: 2019-11-27 14:41:19