Title Distocija ramena u porođaju Title (english) Shoulder dystocia in childbirth Author Porin Mašić Mentor Željko Duić (mentor)Committee member Berivoj Mišković (predsjednik povjerenstva)Committee member Dinka Pavičić Baldani (član povjerenstva)Committee member Željko Duić (član povjerenstva)Granter University of Zagreb Defense date and country 2020-07-17, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Distocija ili zastoj fetalnih ramena nepredvidivo je hitno stanje u porodništvu koje nastaje zbog uklještenja fetalnih ramena u porođajnom kanalu zbog čega je normalni porođajni mehanizam onemogućen. Brojni faktori rizika povezani su s nastankom distocije ramena no prediktivna vrijednost bilo kojeg od njih ili njihove kombinacije je niska. Cilj hvatova koji se primjenjuju u slučaju distocije ramena je sigurno porađanje novorođenčeta prije pojave asfiksije zbog kompresije pupkovine uz izbjegavanje nastanka fetalnih i maternalnih ozljeda. Ovaj rad je retrospektivno istraživanje provedeno na Klinici za ženske bolesti i porode KB „Merkur“ s ciljem da se odredi učestalost distocije ramena te njezina povezanost s faktorima rizika, pojedinim pomoćnim opstetričkim hvatovima te ozljedama novorođenčadi i majki u razdoblju od početka 2011. do kraja 2019. godine. Istraživanje je obuhvatilo 31 rodilju s dijagnosticiranom distocijom ramena te njihovu novorođenčad. Učestalost distocije ramena u tom devetogodišnjem periodu na Klinici iznosila je 0,25% (31/12456 vaginalnih porođaja). Najčešće se javila u terminskim trudnoćama rodilja s BMI ≥30 (19/31, 61%), tjelesne visine <170cm (23/31, 71%) te u slučaju porasta tjelesne težine >15kg tijekom trudnoće (18/28, 64%). Gestacijski dijabetes zabilježen je u trećine ispitanica (8/26), a uz pomoć vakuum ekstrakcije rodilo je 26% (8/31) rodilja. Porođajna težina fetusa ≥4000g bila je u 48% (15/31) porođaja kompliciranih distocijom ramena, češće u rodilja s BMI ≥30 (12/19, 63%) i s gestacijskim dijabetesom (5/8, 63%). Primjena McRobertsova hvata s ili bez suprapubičnog pritiska dovela je do oslobađanja fetalnih ramena u 50% (15/30) svih slučajeva, dok je u preostalih 50% slučajeva (15/30) bilo potrebno upotrijebiti neki od unutarnjih hvatova. Najčešće ozljede novorođenčeta bile su ozljede brahijalnog pleksusa (8/31, 26%) i prijelom klavikule (7/31, 23%) dok 16 novorođenčadi (52%) kod DR nije imalo ozljede. Smrtni ishod je bio kod 1 ploda (3%). Distocija ramena i danas predstavlja veliki nepredvidiv izazov za svakog porodničara. Pažljivim probirom rodilja s povećanim rizikom za distociju ramena, stalnom edukacijom osoblja koje skrbi za rodilju u prepoznavanju i postupanju kod zastoja ramena u porođaju kao i adekvatnom vođenju dokumentacije o zbivanju u porođaju mogu se smanjiti na najmanju moguću mjeru nepovoljni ishodi distocije ramena kako za plod tako i za majku.
Abstract (english) Shoulder dystocia is an unpredictable emergency in obstetric caused by the entrapment of the fetal shoulders in the birth canal, which renders the mechanism of normal delivery impossible. Numerous risk factors are associated with the onset of shoulder dystocia but the predictive value of either or a combination of these is low. The aim of the maneuvers used in the case of shoulder dystocia is to safely birth the newborn before the onset of asphyxia due to umbilical cord compression while avoiding fetal and maternal injury. This paper is a retrospective study conducted at the Clinic for Women's Diseases and Births KB "Merkur" with the aim of determining the incidence of shoulder dystocia and association with risk factors, additional obstetric maneuvers, and newborn and maternal injuries between early 2011 and the end of 2019.The study included 31 pregnant women diagnosed with shoulder dystocia and their newborns. In the nine-year period the incidence of shoulder dystocia at the Clinic was 0.25% (31/12456 vaginal deliveries). It most commonly occurred in term pregnancies with a BMI ≥30 (19/31, 61%), body height <170cm (23/31, 71%), and in the case of weight gain >15kg during pregnancy (18/28, 64%). Gestational diabetes was reported in one third (8/26) of the patients, and with the help of vacuum extraction only 26% (8/31) of women gave birth. Fetal birth weight ≥4000g was observed in 48% (15/31) of cases, more often in women with BMI ≥30 (12/19, 63%) and gestational diabetes (5/8, 63%). McRoberts maneuver and suprapubic pressure resulted in the release of fetal shoulders in 50% (15/30) of all cases, while in the remaining 50% of cases (15/30) it was necessary to use some of the internal maneuvers. The most commonly newborn injuries were brachial plexus injuries (8/31, 26%) and clavicle fracture (7/31, 23%), while 16 neonates (52%) in shoulder dystocia had no injuries. Fatal outcome was in one fetus (3%). Shoulder dystocia is still a major and unpredictable challenge for any obstetrician today. With a careful screening of high-risk mothers for shoulder dystocia, continuous education of maternity care staff in recognizing and treating shoulder obstruction in childbirth and adequate management of birth documentation can minimize the adverse outcomes of shoulder dystocia for fetus but also for the mother.
Keywords
distocija ramena
faktori rizika
hvatovi
ozljeda brahijalnog pleksusa
Keywords (english)
shoulder dystocia
risk factors
maneuvers
brachial plexus injury
Language croatian URN:NBN urn:nbn:hr:105:470904 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2021-09-02 10:37:40
