| Abstract | Indukcija porođaja opstetriĉki je postupak izazivanja kontrakcija maternice prije spontanog porođaja. Programirana indukcija je terminska indukcija bez medicinske indikacije, dok je indicirana indukcija terapijsko završavanje trudnoće zbog fetalne, maternalne ili zajedničke patologije. Metode indukcije ovise o cervikalnoj zrelosti koja se definira prema Bishopovom indeksu. Farmakološki pripravci prostaglandina i balon kateteri učinkovita su sredstva za sazrijevanje cerviksa. Amniotomija i oksitocin metode su indukcije kod trudnica sa zrelim cerviksom. Uspjeh indukcije porođaja ponajprije ovisi o zrelosti cerviksa. Ostali prediktivni čimbenici uspjeha indukcije su paritet, ITM i visina majke te tjedan gestacije i teţina fetusa. Cilj svake indukcije je postići vaginalni porođaj unutar 24 sata, a neuspjeh indukcije se definira kao dovršenje porođaja carskim rezom. Cilj ovog rada bio je odrediti uspješnost indukcije porođaja kod prvorodilja na Klinici za ginekologiju i porodništvo KB „Sveti Duh― i prikazati najčešće indikacije za indukciju porođaja u periodu od početka 2013. do kraja 2017. godine. Kriterij za uključivanje bile su prvorodilje koje su inducirane. Na temelju medicinske dokumentacije dobiveni su podaci o dobi prvorodilja, spolu, duljini i težini čeda, zahvatu, anesteziji, tjednu gestacije, vrsti indukcije i dijagnozama. Od ukupno 1399 prvorodilja 73,8% je rodilo vaginalno, a 26,2% carskim rezom. Medicinski indiciranih indukcija bilo je 93,1%, a 6,9% programirano. Srednja dob pacijentica bila je 31 godinu. Najčešće medicinske indikacije za indukciju bile su: gestacijska dob veća od 41 tjedna (37,4%), oligohidramnion (27,8%) i GDM (20,9%). Porodničarima poseban izazov predstavlja indukcija prvorodilja budući da njihov nuliparitet i čest nalaz nezrelog cerviksa povećavaju rizik za carski rez. Postavlja se pitanje kada inducirati prvorodilju i koje su dijagnoze medicinski opravdane za taj postupak. Kada se odluka donese, potrebno je ostaviti dovoljno vremena za djelovanje sredstava za indukciju umjesto proglasiti neuspjeh. Ovaj pristup smanjuje učestalost carskih rezova nakon indukcije. |
| Abstract (english) | Induction of labor is an obstetric intervetion of stimulating uterine contraction before the spontaneus onset of labor. Elective induction is an induction on term in the absence of medical indication while indicated induction is a medical intervention indicated by fetal or maternal pathology. Methods of induction depend on cervical maturity which is defined by Bishop score. Pharmacological preparations of prostaglandins and baloon catheters are effective agents for cervical rippening. Amniotomy and oxytocin are methods for induction with a favourable cervix. The success of induction depends primarily on the maturity of the cervix. Other predictive factors of induction success are parity, BMI, and height of the mother, and week gestation and weight of the fetus. The goal of each induction is to achieve vaginal delivery within 24 hours, and induction failure is defined as the completion of delivery by Caesarean section. The aim of this study was to determine the success of induction in primiparous women at the Department of Gynecology Obstetrics at the Clinical Hospital ―Sveti Duh― and to show the most common indications for induction in the period from the beginning of 2013 to the end of 2017. Inclusion criteria were all primiparous women that were induced in that period. Based on medical documentation following data was obtained: patient age, obstetrical surgery, anesthesia, gestational age at delivery, induction type, diagnosis, sex, length and neonatal weight. Out of total 1399 births, 73.8% were vaginal deliveries, and 26.7% were Cesarean section. In 93.1% of cases induction was medically indicated and 6.9% was elective. The average patient age was 31. The most common indications for induction were: postterm pregnancy (37.4%), oligohydramnion (27.8%) and GDM (20.9%). For obstetricians, a special challenge is induction of primiparous women since their nulliparity and common finding of immature cervix increase the risk for the Cesarean section. The key objective is to define precise indications for induction of labor. The principle is to allow adequate time for the agents to act. This minimizes the number of cesarean deliveries performed for failed induction. |
