| Sažetak | Cilj istraživanja: Cilj istraživanja bio je ispitati razinu utjecaja raznih čimbenika na način završetka vaginalnih poroda s naglaskom na epiziotomiju i rupture međice te prikazati učestalost i opravdanosti prakse izvođenja epiziotomije na Klinici za ženske bolesti i porode KBC-a Split.
Ispitanici i metode: U istraživanje je uključen slučajan uzorak od 804 poroda uzet iz populacije svih 3514 vaginalnih poroda obavljenih na Klinici za ženske bolesti i porode KBC-a Split u razdoblju od siječnja 2016. godine do prosinca 2016. godine. Što čini uzorak od 22.88% populacije. Istraživanje je po ustroju opažajna retrospektivna studija s deskriptivnom i inferencijalnom statističkom analizom podataka.
Rezultati: Prema provedenom istraživanju dobiveni su sljedeći rezultati. Od svih poroda u uzorku 53% su epiziotomije, 12% su rupture, a preostalih 35% su normalni vaginalni porodi. U uzorku je jednaka zastupljenost ženske (49%) i muške (51%) novorođenčadi, što je potvrđeno hikvadrat testom uz p-vrijednost = 0.6472. Najveći broj novorođenčadi rođen je u 1. lijevom uzdužnom zatiljačnom položaju (81%), zatim u 2. desnom uzdužnom zatiljačnom položaju (16%), pa u obrnutom zatiljačnom položaju (3%), a samo jedno novorođenče je rođeno na nožni zadak. Od ukupnog broja poroda 40% je poroda prvorotki, dok je preostalih 60% poroda višerotki. Prosječna dob rodilje je 30.19 godina. Velika većina poroda je bila u terminu (96%), 4% ih je prijevremenih, a samo jedan porod je prenesen. Prosječno vrijeme trajanja trudnoće je 275.9 dana. Prosječna duljina i težina novorođenčadi je 50.85 cm i 3570. 54 g, a prosječno trajanje poroda iznosi 5.8 h. Gornji kvartil podataka za Apgar score iznosi 10, što znači da barem 75% uzorka ima vrijednost Apgar scora jednaku 10.
Nadalje, u prosjeku najkraće traju normali vaginalni porodi. Porodi koji završavaju rupturama traju nešto duže, dok najduže traju porodi u kojima je primjenjena epiziotomija. Što je i potvrđeno t- testovima. Rezultati su pokazali da način završetka poroda nije neovisan o tome radi li se o prvorotki ili višerotki na statistički značajnoj razini. Kod višerotki prevladavaju vaginalni porodi, dok se kod prvorotki češće primjenjuje epiziotomija. Pokazalo se kako su rupture češće kod duljeg trajanja trudnoće, što ptvrđuje i t- test. Također kod muške novorođenčadi očekujemo kako će porod češće završiti rupturom ili će biti potrebna epiziotomija, s obzirom da su statistički značajno dulja
Zaključak: Većina dobivenih rezultata u ovom istraživanju je pretpostavljena, s obzirom na ostale studije, ali uz nekoliko iznimaka. Razina epiziotomija je previsoka za tercijarni bolnički centar, s obzirom na svjetske smjernice. S druge strane udio ruptura je posljedično nizak.
Istaknili smo zanimljiv podatak o utjecaju duljine trajanja trudnoće na način završetka poroda. Koji navodi da se rupture češće događaju pri duljem trajanju trudnoće.
Međutim jedna od bitnijih stvari koju bi htjeli istaknuti je nedovoljna uloga primaljske struke u zdravstvenom sustavu. Primalje moraju i trebaju provoditi pozitivnu primaljsku praksu s psljedičnim ishodom bolje kliničke njege za trudnice i novorođenčad. |
| Sažetak (engleski) | Objectives: The aim of the study was to examine how various factors influence the way vaginal births are completed, with emphasis on episiotomy and perineum rupture, and to show the frequency and justification of the practice of performing episiotomy at the Clinical Center for Female Diseases and Births of KBC Split.
Subjects and methods: The study was conducted on a random sample of 804 births taken from the population of all 3514 vaginal births carried out at the Clinical Center for Female Diseases and Births of KBC Split in the period from January 2016 to December 2016. What makes a sample of 22.88% of the population. Research is organized as a observational retrospective study with a descriptive and inferential statistical analysis of data.
Results: According to the conducted study, the following results were obtained. Of all the births in the sample, 53% ended with a episiotomy, 12% with a rupture, and the remaining 35% are normal vaginal births. Female (49%) and male (51%) newborns are equally represented in the sample, which was confirmed by a hi-square test at p = 0.6472. The highest number of newborns was born in the left occiput anterior presentation (81%), then in the right occiput anterior presentation (16%) and in the left occiput posterior presentation (3%), and only one newborn was born in the incomplete/footling breech presentation. Out of the total number of births, 40% are of primipara mothers, while the remaining 60% of the births are of multipara mothers. The average age of mother is 30.19 years. The vast majority of births were carried out in term (96%), 4% were premature, and only one birth was overdue. The average duration of pregnancy is 275.9 days. The average length and weight of newborns is 50.85 cm and 3570. 54 g, and the average duration of birth is 5.8 h. The upper quartile data for the Apgar score is 10, which means that at least 75% of the sample has an Apgar score of 10.
Furthermore, on average, normal vaginal births are the shortest. The births ending in ruptures last a little longer, while the longest lasting births are the ones in which episiotomy has been applied. This is confirmed by t-tests. The results have shown that the way vaginal births are completed is not independent of whether the mother is a primapara or a multipara, at a statistically significant level. In multipara mothers vaginal births are more prevalent, while episiotomy is more commonly used in primapara mothers. It has been shown that ruptures are more frequent in longer pregnancies, which was once again confirmed by t-tests. Also, in male newborns, we expect that the birth will more often end with a rapture or an episiotomy will be necessary, since they are longer on a statistically significant level.
Conclusion: Most of the results obtained in this study were assumed, given the other studies, but with a few exceptions. Such that the level of episiotomy usage is too high for a tertiary hospital center, given the worldwide guidelines. Subsequently, the rate of rupture is low.
We highlight an interesting data regarding the effect of pregnancy lenght on the way vaginal births are completed, which states that ruptures occur more often during longer pregnancy.
However, one of the most important things we would like to point out is the inadequate role of the midwifery profession in the health care system. Midwifes must and should implement a positive midwife practice which will consequently end in a better clinical care for both pregnant women and newborns. |
