| Abstract | Inducirani programirani porođaj označava dovršenje trudnoće zbog medicinsko-preventivnih i socijalnih indikacija u odsustvu terapijskih indikacija. Cilj ovoga retrospektivnog istraživanja provedenog u Klinici za ginekologiju i porodništvo KB „Sveti Duh” u razdoblju od 1. siječnja 2016. do 31. prosinca 2018. godine bio je usporediti ishode trudnoća induciranih programiranih porođaja sa spontano započetim porođajima. U tom razdoblju bilo je 8230 porođaja, od čega je u 265 (3,22 %) trudnica porođaj dovršen induciranim programiranim porođajem. Za kontrolnu skupinu sustavno je odabran uzorak od 265 trudnica. Kao metoda indukcije induciranih programiranih porođaja najčešće je korištena kombinacija amniotomije i oksitocina (80,75 %), a potom amniotomija (9,81 %) te prostaglandini (5,66 %). U 85,28 % trudnica s programiranom indukcijom porođaj je dovršen unutar 12 sati. Programirani inducirani porođaj češće je bio metoda izbora kod višerotki u odnosu na prvorotke (84,15 % vs. 15,85 %). Medijan trajanja trudnoće u trudnica s induciranim programiranim porođajem iznosio je 40 + 1 tjedan, a u kontrolnoj skupini 39 + 5 tjedana. Nađen je statistički značajno manji udio intrapartalnog carskog reza (3,02 % vs. 7,92 %) te veći udio vaginalnog porođaja (95,82 % vs. 89,43 %) u istraživanoj u odnosu na kontrolnu skupinu. Nije uočena razlika u udjelu vakuum ekstrakcija (1,13 % vs. 2,64 %) među skupinama. Nije bilo razlike u udjelu zastoja fetalnih ramena u istraživanoj i kontrolnoj skupini (3,02 % vs. 0,75 %). Epiduralna anestezija bila je češća u trudnica s programiranom indukcijom porođaja nego u onih sa spontanim početkom porođaja (48,46 % vs. 30,3 %). Udio lakih ozljeda mekog dijela porođajnoga kanala među promatranim skupinama bio je gotovo jednak (35,16 % vs. 36,89 %). Nije nađena razlika u udjelu teških ozljeda mekog porođajnog kanala (ruptura međice 3. i 4. stupnja) između istraživane i kontrolne skupine (<0,01 % vs. 0 %). Nije dobivena statistički značajna razlika u udjelu postpartalnog krvarenja u istraživanoj skupini u odnosu na kontrolnu (2,26 % vs. 0,75 %). Povećana porođajna težina novorođenčadi (3709 vs. 3454 g) te veći udio hipertrofične novorođenčadi (17,74 % vs. 7,55 %) istraživane skupini bili su statistički značajni. Uočen je manji udio hipoksije fetusa u istraživanoj nego u kontrolnoj skupini (0,75 % vs. 4,15 %). Razlika u Apgar indeksima istraživane i kontrolne skupine nije nađena. Prema dobivenim rezultatima smatramo kako je dobro odabrani inducirani programirani porođaj koristan i siguran postupak u KB „Sveti Duh” te treba biti dio dobre kliničke prakse. |
| Abstract (english) | Elective induction is the induction of labor for social indications in the absence of acceptable fetal or maternal indications. The aim of this retrospective study was to determine pregnancy outcome of elective induction of labor compared with spontaneous onset of labor. The study was performed at the Department of Obstetrics and Gynecology, University Hospital "Sveti Duh" for the period from January 1, 2016 to December 31, 2018. There were 8230 births during that period, of which 265 (3,22%) births were electively induced. The control group consisted of 265 systematically sampled pregnant women. As a method of elective labor induction, the most frequently used combination was amniotomy and oxytocin (80,75%) followed by amniotomy (9,81%) and prostaglandins (5,66%). In 85,28% of pregnant women with elective induction of labor, delivery was completed within 12 hours. Elective induction of labor was more often a method of choice for multiparous than for nulliparous women (84,15% vs. 15,85%). The median duration of pregnancy in women with electively induced labor was 40+1 weeks and in control group 39+5 weeks. There was a statistically significant lower proportion of cesarean deliveries (3,02% vs. 7,92%) and higher proportion of vaginal deliveries (95,82% vs. 89,43%) in the elective induction group compared to the control group. There was no difference in vacuum extraction (1,13% vs. 2,64%) among these groups. Statistically significant difference in the proportion of fetal shoulder dystocia in the investigated and control group was not found (3,02% vs. 0,75%). Epidural anesthesia was more common in pregnant women with electively induced labor than in those with spontaneous onset of labor (48,46% vs. 30,3%). The share of light tears of lower genital tract among observed groups was almost equal (35,16% vs. 36,89%). There was no difference in proportion of severe tears (3rd and 4th-degree perineal laceration) between the investigated and the control group (<0,01% vs 0%). Statistically significant difference in the proportion of postpartum hemorrhage in the investigated group compared to the control group (2,26% vs. 0,75%) was not found. The increased birth weight of newborns (3709 vs. 3454 g) and the higher proportion oh hypertrophic newborns (17,74% vs. 7,55%) of the investigated group were statistically significant. A smaller proportion of fetal hypoxia was observed in the investigated than in the control group (0,75% vs. 4,15%). The difference in Apgar indexes among these groups was not found. Based on these results we belive that well-chosen elective labor induction is a useful and safe procedure at the University Hospital "Sveti Duh" and should be part of good clinical practice. |
