| Abstract | UVOD: Epiziotomija je porodnička operacija u kojoj se urezom međice širi predvorje vagine tijekom drugog porođajnog doba s ciljem zaštite glave fetusa od traume i zdjeličnog dna od ozljeda. Svjetske udruge smatraju da postotak epiziotomija ne bi smio prelaziti 30% u tercijarnim perinatalnim centrima s većim brojem patoloških trudnoća i porođaja dok u sekundarnim i primarnim rodilištima taj postotak ne bi smio prelaziti 10-20%. Rizični faktori za nastanak porođajnih ozljeda su cefalopelvična disproporcija, makrosomija, abnormalna zdjelica majke, distocija ramena kod prethodnog poroda, kronična insuficijencija posteljice, preeklampsija, fetalne malformacije, instrumentalno dovršenje poroda, medijana epiziotomija, produljeno drugo porođajno doba. Ozljede rodnice se svrstavaju pod prednje i stražnje. Prednje perinealne ozljede – ozljede prednjeg zida vagine, labija, uretre ili klitorisa i najčešće ne predstavljaju rizik za komplikacije. Stražnje perinealne ozljede – ozljede stražnjeg zida vagine, perinealnih mišića ili opstetričke ozljede analnog sfinktera. CILJ: Cilj ovoga rada je utvrditi učestalost epiziotomija i ruptura mekih tkiva, u odnosu na rodnost žena i težinu novorođenčadi te primjenjuje li se epiziotomija restriktivno ili rutinski u usporedbi s preporukama Svjetske udruge. METODE: Istraživanje je provedeno u Klinici za ženske bolesti i porode KBC-Split, a istraživanje se provodilo za razdoblje od 1. siječnja 2020. godine do 31. prosinca 2020. godine. Kriteriji uključenja su bili sljedeći: vaginalni porodi jednoplodnih trudnoća, živo dijete u stavu glavom i porodi su koji uključivali epiziotomiju i/ili rupture perineuma. Ukupan broj porođaja u 2020. godini u KBC-Split bio je 4100, od toga 2789 vaginalnih porođaja. Za potrebe ovog istraživanja je analizirano 2146 vaginalnih porođaja koji su sadržavali zadane kriterije uključenja. REZULTATI: Od ukupno 2789 vaginalnih porođaja, 1628 (58,4%) je bilo s epiziotomijom, 518 (18,6%) bez epiziotomije, ali s rupturom, a 643 (23%) porođaja bez epiziotomije i bez ruptura. Od sveukupnih vaginalnih porođaja (n=2789), udio ruptura uz epiziotomiju je bio minimalan te iznosi 15% (n=235), dok udio ruptura bez epiziotomije iznosi 45% (n=518). ZAKLJUČCI: Prema rezultatima istraživanja, može se zaključiti kako se u Klinici za ženske bolesti i porode KBC-Split u 2020.godini nije koristila metoda restriktivne upotrebe epiziotomije. Udio ruptura kod vaginalnih porođaja iznosio je 27% (n=753). Dokazano je da je pojavnost ruptura veća kada epiziotomija nije primijenjena. Prema dobivenim podacima se može zaključiti da je niski udio ruptura, rezultat prekomjerne upotrebe epiziotomije. |
| Abstract (english) | INTRODUCTION: Episiotomy is an obstetric operation in which a perineal incision expands the vestibule of the vagina during the second postpartum period with the aim of protecting the fetal head from trauma and the pelvic floor from injury. World associations believe that the percentage of episiotomies should not exceed 30% in tertiary perinatal centers with a higher number of pathological pregnancies and births, while in secondary and primary maternity hospitals this percentage should not exceed 10-20%. Risk factors for the occurrence of birth injuries are cephalopelvic disproportion, macrosomia, abnormal maternal pelvis, shoulder dystocia in previous birth, chronic placental insufficiency, preeclampsia, fetal malformations, instrumental completion of labor, median episiotomy, prolonged second delivery. Vaginal injuries are classified as anterior and posterior. Anterior perineal injuries - injuries to the anterior wall of the vagina, labia, urethra, or clitoris and most often do not pose a risk for complications. Posterior perineal injuries - injuries to the back wall of the vagina, perineal muscles, or obstetric injuries of the anal sphincter. OBJECTIVE: The aim of this study is to determine the frequency of episiotomies and soft tissue ruptures, in relation to women's fertility and newborn weight, and whether episiotomy is applied restrictively or routinely compared to the recommendations of the World Association. METHODS: The research was conducted at the Clinic for Women's Diseases and Obstetrics KBC-Split, and the research was conducted for the period from January 1, 2020 to December 31, 2020. Inclusion criteria were as follows: vaginal births of singleton pregnancies, head-to-head pregnancies, and births that included episiotomy and / or perineal ruptures. The total number of births in 2020 in KBC-Split was 4,100, of which 2,789 were vaginal births. For the purposes of this study, 2146 vaginal deliveries were analyzed that contained the given inclusion criteria. RESULTS: Out of a total of 2789 vaginal births, 1628 (58.4%) were with episiotomy, 518 (18.6%) without episiotomy but with rupture, and 643 (23%) births without episiotomy and without rupture. Of the total vaginal deliveries (n=2789), the proportion of ruptures with episiotomy was minimal and amounted to 15% (n=235), while the proportion of ruptures without episiotomy was 45% (n = 518). CONCLUSIONS: According to the results of the research, it can be concluded that in 2020, the Clinic for Women's Diseases and Obstetrics KBC-Split did not use the method of restrictive use of episiotomy. The proportion of ruptures in vaginal births was 27% (n=753). Rupture has been shown to be higher when episiotomy is not performed. According to the obtained data, it can be concluded that the low proportion of ruptures is the result of excessive use of episiotomy. |
