Title Primaljska skrb kod višeplodne trudnoće Title (english) MIDWIFE CARE DURING MULTIPLE PREGNANCY Author Josipa Roso Mentor Jelena Marušić (mentor)Committee member Zdeslav Benzon (predsjednik povjerenstva) Committee member Deana Švaljug (član povjerenstva)Committee member Jelena Marušić (član povjerenstva)Granter University of Split Defense date and country 2015-09-30, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Višeplodnom trudnoćom se smatra svaka trudnoća koja u maternici sadrži više od jednog ploda. Najčešće višeplodne trudnoće su blizanačke, no zbog sve većeg liječenja neplodnosti raste učestalost višeplodnijih trudnoća. Blizanačke trudnoće se dijele na monozigotne te dizigotne. Razlikuju se po tome što se monozigotni blizanci razvijaju iz jedne oplođene jajne stanice koju oplodi jedan spermij te je DNK tih blizanaca identičan. Dok se dizigotni razvijaju iz dvije oplođene jajne stanice koje
... More oplođuju dva spremija te je DNK u tih blizanaca različit.
Dijagnoza višeplodne trudnoće se dijagnosticira anamnezom, kliničkim pregledom te ultrazvučnim pregledom. Jako je bitno saznati da li je majka sama blizanka ili ih ima u obitelji te da li je liječila neplodnost. Najsigurnija potvrda je ultrazvučnim pregledom.
Višeplodne trudnoće imaju jedinstvene komplikacije. Najčešće su prijeteći spontani pobačaji, anastomoze, diskordantni rast te prijevremeno rađanje.
Ono što produžuje višeplodne trudnoće i potvrđuje povoljne učinke su mirovanje tijekom većeg dijela trudnoće, serklaže vrata maternice i tokolitičko liječenje. Najčešće se to odvija pri profilaktičkoj hospitalizaciji ili ambulantnom liječenju.
Zdravstvena zaštita trudnice s višeplodnom trudnoćom je slična zaštiti trudnice s jednoplodnom trudnoćom, ali ipak s malo više nadzora. Antenatalne metode skrbi su iste kao kod jednoplodnih, možda su malo češće amniocenteze. U perinatalnoj zaštiti primalja ima ulogu edukatora najčešće. Savjetuje se trudnici pravilna i zdrava prehrana bogata željezom, vitaminima. Ako ne postoje kontraindikacije savjetuju se laganije aktivnosti poput šetnje, ali u određenim razdobljima.
Jako je bitno imati redoviti i pravilni nadzor djece tijekom cijele trudnoće. Naglasak se daje na praćenje rasta i oksigenaciju plodova. Pri tome je najbitnije znati točno trajanje trudnoće. U ovom nadzoru zlatni standard je karditokografija. Višeplodne trudnoće kraću traju od jednoplodnih trudnoća. Blizanačke trudnoće se mogu spontano dovršiti ili carskim rezom. Dok kod višeplodnijih trudnoća se češće odmah kreće s carskim rezom kako bi se odmah spriječile moguće komplikacije. Ovakve trudnoće je bolje dovršavati u tercijarnim perinatalnim centrima.
Primalja ima jednu od glavnih uloga tijekom samog poroda te zato mora biti stručna i u pitanju teorije, ali i prakse. A još važniju ulogu ima u periodu puerperija kada je glavni savjetnik „novopečene“ majke. Majka koja rodi blizance ili veći broj djece treba posebno ohrabrivanje i savjete. Primalja je posrednik između nje i okoline te daje do znanja obitelji, a posebice partneru kako rodilji treba potpora i pomoć prilikom nove uloge. Rodilju treba educirati o pravilnom dojenju / izdajanju, izvršavanju osobne higijene te joj treba naglasiti zašto treba paziti kada će početi sa svakodnevnim aktivnostima. Treba je educirati kako će provoditi njegu djece, osobito toaletu pupka prvih dana te joj naglasiti dobrobit majčina mlijeka za njenu djecu kao i za nju samu.
6. SUMMARY Less Abstract (english) Every pregnancy where there is more than one fetus in the uterus is called the multiple pregnancy. The most frequent multiple pregnancies are twin pregnancies, but because of more infertility treatment there is a higher frequency of pregnancies with more than one fetus. Twin pregnancies can be monozygotic and dizygotic. Monozygotic twins are developed from one fertilized egg that is fertilized by one sperm and therefore the DNA of those twins is identical. Dizygotic are developed from
... More two fertilized eggs that are fertilized by two sperms and therefore the DNA in those twins is different.
The diagnosis of multiple pregnancy is made with anamnesis, clinical and ultrasound examination. It is very important to know whether the mother is a twin or if there are twins in the family or if the mother was treated because of infertility. The safest confirmation is that of ultrasound examination.
Health care of a woman with multiple pregnancy is similar to the care of a woman with single pregnancy, but with more supervision. Prenatal care is the same as in single fetus pregnancy, but amniocentesis is more frequent. During the perinatal care midwife has the role of an educator. She advises to the pregnant woman proper healthy nutrition rich with iron and vitamins. If there are no contraindications, pregnant woman is advised to do leisure activities like walking, but in certain periods.
It is very important to have regular and proper supervision of the children during pregnancy. Emphasis is put on the tracking of the growth and oxygenation of the fetuses. It is very important during this to know the exact duration of the pregnancy. During this supervision the golden standard is the cardiotocography.
Multiple pregnancies are shorter than other pregnancies. Twin pregnancies can end spontaneously or with a caesarean section. To prevent possible complications, in multiple pregnancies we often immediately move with the caesarean. It is better that these pregnancies are ended in tertiary perinatal centres.
The midwife has one of the main roles during the birth and therefore she must be an expert in both theory and practice. But she has the more important role during the period of puerperium –when she is the main consultor of the new mother. The midwife is the mediator between the mother and her environment and makes it clear to the family, and especially to the partner, that the woman in labour is in need of support and help in her new role. The midwife needs to educate the new mother about correct breastfeeding/expressing breast milk, doing personal hygiene and underline what about she needs to be careful when doing everyday activities. She should educate the new mother how to care for the children, especially cleaning the navel during the first days and, moreover, the benefits of mother’s milk for the children and the mother herself.
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10. Škrablin S, Kuvačić I, Pavičić D, i sur. Maternal and neonatal outcome in Less Keywords
višeplodna trudnoća
ultrazvučni pregled
uloga primalje
Keywords (english)
the multiple pregnancy
ultrasound examination
the midwife role
Language croatian URN:NBN urn:nbn:hr:176:258737 Study programme Title: Midwifery (university/undergraduate) Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2019-12-13 08:28:14
