pH-metrija krvi fetalnog oglavka u intrapartalnom nadzoru fetusa u Kliničkoj bolnici Merkur

master's thesis

• Title (english): Intrapartum Foetal Scalp Blood Sampling for pH Measurment in Merkur Clinical Hospital
• Author: Martin Milić
• Mentor: Sandra Stasenko (mentor)
• Committee member: Doroteja Pavan-Jukić (predsjednik povjerenstva)
• Committee member: Željko Duić (član povjerenstva)
• Committee member: Sandra Stasenko (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Gynecology and Obstetrics); Zagreb
• Defense date and country: 2021-07-16, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

Dobrobit fetusa u porođaju je prioritet u porodničarstvu i perinatologiji. Kako bi omogućili siguran porođaj moraju se pratiti vitalni znaci ploda u porođaju. U nekim slučajevima je to zahtjevno jer je fetus izvan doticaja vanjskog svijeta. Cilj ovoga rada je prikazati ulogu fetalne pH-metrije u kontekstu dosadašnjih spoznaja te medicinske prakse u Kliničkoj bolnici Merkur. Zlatni standard u intrapartalnom nadzoru kardiotokografija. Najveći nedostatak ove metode u intrapartalnom nadzoru je visoka stopa lažno pozitivnih rezultata. To povećava stopu carskih rezova koji nose rizik od komplikacije i moguće dugoročne posljedice. Pokazalo se da je uporabom ove metode intrapartalnog nadzora stopa perinatalne smrtnosti pala dok se povećao broj dovršetka poroda carskim rezom u zadnjih nekoliko desetljeća. Fetalna pH-metrija je metoda kojom se prati oksigenacija fetusa. Glavni uzrok nepovoljnog perinatalnog ishoda je hipoksija fetusa koja posljedično dovodi do perinatalne asfiksije, a koja, kada dođe do ishemije mozga uzrokuje hipoksijsko ishemijsku encefalopatiju. Zbog relativno male prediktivne vrijednosti kardiotokografije na hipoksiju većina smjernica preporuča izvođenje fetalne pH-metrije prilikom suspektnog kardiotokografskog zapisa kako bi se vjernije prikazala fetalna ugroza te smanjio broj nepotrebnih carskih rezova. Osim navedenih postoje i druge metode u intrapartalnom nadzoru koje se nisu pokazale kao pouzdane te nisu zaživjele u medicinskoj praksi, osim stimulacije fetalnog oglavka, koja je zbog svoje jednostavnosti, ali i pouzdanosti široko rasprotranjena metoda u rodilištima. Intrapartalni nadzor ostaje tema za raspravljanje u svjetskim znanstvenomedicinskim krugovima zbog razvoja tehnologije i medicinske spoznaje te nepodudarajućih rezultata mnogih studija o prednosti određenih metoda intrapartalnog nadzora pa tako i u neusklađenosti mnogih svjetskih smjernica o intrapartalnom nadzoru. Unatoč tome, kardiotokografija uz fetalnu pH-metriju preporučena je metoda nadzora fetusa u porođaju zbog dobrih rezultata i smanjenja stope nepotrebnih carskih rezova.

Abstract (english)

Well-being of foetus in childbirth is priority in obstetrics practice. To ensure safe birth of a child, the obstetrician needs to monitor foetal vital signs. This can be difficult in some cases as there is little contact of foetus with the world outside the womb. The goal of this thesis is to review the advantages of foetal scalp blood sampling for pH in the context of new medical research and medical practice in Merkur Clinical Hospital. Today's golden standard in intrapartal foetal survaillance is cardiotocography. The biggest limitation of this method is high rate of false negative results. This leads to an increase of caeserean section rates which carries a risk of complications and possible long-term sequele. It has been found that using this method of intrapartum monitoring has reduced the rate of perinatal deaths but, in turn increased the rate of deliveries by caeserean sections in the last few decades. Foetal blood sampling for pH is a procedure that monitors foetal oxygenation. The main reason of poor perinatal outcome is foeatal hypoxia, which consequently leads to perinatal asphyxia which, when the brain ischaemia occours can cause hypoxic ischaemic encephalopathy. Because of relatively low predictive value of cardiotocography for hypoxia most guidelines suggests using foetal scalp blood sampling for pH in cases of suspicious cardiotocography finding as to reduce the number of unneeded caesarean deliveries and to give a better insight on foetal hypoxia. Besides mentioned, other methods of intrapartal monitoring exist but are mostly obsolete in medical practice, exception being foetal scalp stimulation which is, becase of simplicity and reliabilty, widespread across maternity wards. Intrapartal monitoring remains a theme of discussion in medical scientific world because of advances in technology and medical research, as well as inconsistencies in medial research results on advantages of certain methods of intrapartal monitoring and differences in clinical guidelines worldwide. In spite of mentioned, cardiotocography combined with foetal blood sampling for pH is the recommended method of foetal surveillance during delivery because of good results and low rate of unnecessary caesarean deliveries.

• Keywords: fetalna pH-metrija; intrapartalni nadzor; kardiotokografija; carski rez
• Keywords (english): foetal scalp blood sampling for pH; intrapartal foetal survaillance; cardiotocography; caesarean delivery
• Language: croatian
• URN:NBN: urn:nbn:hr:105:754278
• 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: 2022-03-16 11:39:12