Ishodi trudnoća nakon indukcije porođaja zbog medicinske indikacije

master's thesis

• Title (english): Pregnancy outcome in medically indicated induction of labor
• Author: Deborah Olayinka Bankole
• Mentor: Berivoj Mišković (mentor)
• Committee member: Vesna Elveđi Gašparović (predsjednik povjerenstva)
• Committee member: Željko Duić (član povjerenstva)
• Committee member: Berivoj Mišković (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

Indukcija porođaja obuhvaća metode stimulacije kontrakcija prije nastupa spontanog porođaja. Dijeli se na medicinski indiciranu i programiranu. Indukcija je medicinski indicirana kada postoji stanje majke i/ili djeteta koje nosi veći rizik za nepoželjnim ishodom od same indukcije. Indukcija se postiže različitim metodama, a odabir ponajviše ovisi o nalazu cervikalne zrelosti koja se definira Bishopovim indeksom. Cilj svake indukcije je vaginalan porod unutar 24 sata. U slučaju da se vaginalni porod ne može ostvariti, dijete se porađa carskim rezom što se kvalificira kao neuspjela indukcija.
Ovo retrospektivno istraživanje provedeno je u KB „Sveti Duh“ u razdoblju od 1. siječnja do 31. prosinca 2017. godine s ciljem da se analiziraju ishodi trudnoća u kojima je porođaj induciran radi postojanja medicinske indikacije. U promatranom je periodu inducirano 468 porođaja, što čini 17,2% od ukupnog broja porođaja. Dodatnih 468 žena sustavnim je uzorkovanjem odabrano za kontrolnu skupinu. Prilikom indukcije porođaja najčešće su korišteni prostaglandinski preparati (57,7%). 148 poroda inducirano je radi oligohidramnija, 102 zbog gestacijskog dijabetesa te 95 radi dosegnute gestacijske dobi. 16,5% induciranih poroda završilo je carskim rezom dok taj udio u skupini trudnica koje su spontano ušle u porođaj iznosio 13,2%. Dobivena razlika nije statistički značajna. Nadalje su evaluirani i ostali pokazatelji ishoda pa je tako dobiveno da među promatranim skupinama nema statistički značajne razlike u udjelima djece Apgar indeksa ≤7. Stanje majke prosuđeno je na osnovi povreda mekog dijela porođajnog kanala. Lakih je ozljeda mekog dijela porođajnog kanala pronađeno značajno manje u žena kojima je porod induciran. Epiduralna analgezija je korištena u 45,5% induciranih i 32,3% spontano započetih porođaja, što čini statistički značajnu razliku (p<0,05). Izostanak razlika u ishodu među induciranim i spontanim porođajima govori nam da je indukcija sigurna i korisna metoda koja može osigurati dobar ishod unatoč riziku koji nosi medicinska indikacija.

Abstract (english)

Induction of labor implies stimulation of uterine contractions before the spontaneous onset of labor. It can be medically indicated or elective. Induction is medically indicated when the state of the mother and / or fetus carries a higher risk than induction alone. Induction can be achieved with various methods while the choice of method depends on cervical maturity defined by Bishop score. The goal of each induction is to achieve vaginal delivery within 24 hours. If vaginal delivery is not possible, Cesarean section should be performed, which qualifies as unsuccessful induction. This study was performed retrospectively at the University Hospital “Sveti Duh” for the period from January 1, 2017 to December 31, 2017. The aim was to evaluate the outcome of pregnancies after medically indicated induction of labors. In the observed period, 468 births were induced, which represents 17.2% of the total amount of births. Another 468 pregnant women who had spontaneous onset of labor were systematically sampled into the control group. Prostaglandins were the most commonly used induction method. 148 births were induced because of oligohydramnios, 102 because of gestational diabetes, and 95 because of prolonged pregnancy. From the total of 468 births in the induced group, 16.5% were Cesarean section. When compared to the control group, where 13.2% of births were performed by Cesarean section, the difference isn't statistically significant. No statistically significant difference is found in proportion to children who had an Apgar score ≤7. Maternal morbidity was also evaluated. It is found that women whose labor is induced are less likely to suffer from perineal tear and labial laceration. Further results show that epidural analgesia is used more frequently in the induced group (45.5% vs. 32.3%, p<0.05). The absence of difference in outcome between two observed groups leads to the conclusion that induction of labor is a safe and useful method which can ensure a good outcome despite the risk medical induction includes.

• Keywords: indukcija porođaja; carski rez; metoda indukcije; medicinska indikacija
• Keywords (english): induction of labor; Cesarean section; induction methods; medical indication
• Language: croatian
• URN:NBN: urn:nbn:hr:105:447049
• 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: 2020-02-17 14:19:19