Indukcija porođaja

master's thesis

• Title (english): Induction of labor
• Author: Ema Mjeda
• Mentor: Gordan Zlopaša (mentor)
• Committee member: Trpimir Goluža (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: 2020-07-17, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

Indukcija porođaja (engl. induction of labour – IOL) je jedan od najčešće izvođenih zahvata u porodništvu. Sveukupni porast incidencije IOL bilježi se diljem svijeta. Ovaj fenomen se objašnjava fiziološkim promjenama populacije trudnica, neujednačenim
smjernicama i porastom incidencije elektivnih IOL. Točni mehanizmi inicijacije porođaja nisu razjašnjeni, no ključnim događajem smatra se razvoj upalnog procesa u prijeterminskim porođajima te brojni fizikalni i hormonalni signali zrelog fetusa u terminskim porođajima koji aktiviraju upalne transkripcijske faktore poput NF- kB te prekidaju vrijeme relaksacije mišićja maternice. Svjetska medicinska društva poput Američkog društva porodničara i ginekologa (engl. The American College of Obstetricians and Gynecologists - ACOG), Društva porodničara i ginekologa Kanade (engl. Society of Obstetricians and Gynaecologists of Canada - SOGC), Nacionalnog instituta za zdravlje i kliničku izvrsnost (engl. The National Institute for Health and Care Excellence - NICE) te Svjetske zdravstvene organizacije (engl. World Health Organization - WHO) izdaju smjernice na temelju najnovijih medicinskih istraživanja o valjanosti i točnom vremenu provedbe IOL u raznim stanjima trudnoće. U početku valja procijeniti stanje fetusa, trudnice i utvrditi zrelost vrata maternice. Najpouzdanija metoda procjene je utvrđivanje zrelosti materničnog vrata indeksom prema Bishopu. U slučaju nalaza nezrelog vrata maternice valja provesti preindukcijske postupke. U sazrijevanju vrata maternice najpotentniji su prostaglandini, dok se manje komplikacija očekuje primjenom mehaničkih metoda poput osmotskih dilatatora i balonskih katetera. Kod nalaza zrelog cerviksa kontrakcije maternice potaknu se intravenskom primjenom oksitocina i amniotomijom. Važno je u obzir uzeti angažiranost priležeće česti, te amniotomiju izvršiti u trenutku kada ona priliježe uz vrat maternice. Multiparitet i nalaz zrelog vrata maternice prema Bishopu povezuju se s većom uspješnosti indukcije. Najčešća komplikacija koje se opisuje primjenom indukcijskih metoda je tahisistolija s mogućim poremećajima srčanog ritma fetusa. Poseban oprez valja imati pri aplikaciji prostaglandina u obliku intravaginalnog gela/tablete i intravenskoj primjeni oksitocina.

Abstract (english)

Induction of labour (IOL) is one of the most frequently performed obstetrical interventions. Overall increase in incidence of IOL is reported worldwide. This phenomenon is explained by physiological changes in the pregnant population, inconsistent guidelines and increase in incidence of elective labour induction. The exact mechanism that underlays the initiation of parturition isn't clear but inflammatory response has a critical role in pre-term labour. Mechanical and hormonal signals from
growing fetus at term labour activate inflammatory transcription factors, such as NF kB and interrupt the uterine quiescence.
World medical societies such as The American College of Obstetricians and Gynecologists (ACOG), Society of Obstetricians and Gynaecologists of Canada (SOGC), The National Institute for Health and Care Excellence (NICE) and World Health Organization (WHO) published evidence-based medicine guidelines about validity and exact time of IOL in many conditions of pregnancy. The condition of the fetus, the pregnant woman and the ripeness of the cervix should be assessed initially. The most reliable method to assess the ripeness of the cervix is Bishop score. In conditions of unfavourable cervix, the methods of cervical ripening should be done. It's important to consider the engagement of fetal presenting part and then amniotomy procedure performed when it is well applied to the cervix. Multiparity and favourable cervix findings in Bishop score are linked with the success of IOL. The most common complication of IOL is tachysystole
with potential fetal heart rate changes. Special care should be taken when applying intravaginal prostaglandins in form of gel or a tablet as well as in intravenous application of oxytocin.

• Keywords: indukcija porođaja; Bishopov indeks; metode indukcije; tahisistolija
• Keywords (english): induction of labour; Bishop score; methods of induction; tachysystole
• Language: croatian
• URN:NBN: urn:nbn:hr:105:543004
• 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: 2021-03-26 12:05:04