| Abstract | Cilj istraživanja: Ispitati povezanost anamnestičkih čimbenika (uključujući dob majke i paritet) sa stopom uspješno dovršenih trudnoća iz medicinski potpomognute oplodnje. Ispitati učestalost maternalnih, opstetričkih i perinatalnih komplikacija kod trudnoća iz medicinski potpomognutih oplodnji u odnosu na spontane trudnoće.
Materijali i metode: Retrospektivno je pregledana medicinska dokumentacija Klinike za ženske bolesti i porode u periodu od 1.1.2018. do 31.12.2018. godine te su izdvojene žene koje su rađale tehnikama MPO. Promatranu skupinu činila je 231 ispitanica, a 4168 žena činile su kontrolnu skupinu. U rad smo uključili i sve podatke o novorođenčadi izdvojenih ispitanica. Promatrane varijable su bile: način zanošenja, dob majke, paritet majke, broj plodova, vrijeme poroda, način dovršetka poroda, porođajna masa djece, trofičnost djece, APGAR indeks, pH vrijednost fetalne krvi, bolesti i stanja u trudnoći, potreba za korištenjem analgezije ili druge medikacije, nalaz plodove vode.
Rezultati: Među ispitivanim skupinama trudnoće iz MPO se češće dovršavaju kirurški (P<0,001). Programirani carski rez je češći oblik dovršetka poroda u skupini MPO od hitnog carsko reza (P=0,023). Ako gledamo živorođenost i spol novorođenčadi među skupinama nema razlike. Trudnice iz promatrane skupine češće su prijevremeno rađale (P<0,001). U skupini MPO češći je slučaj rađanja nedostaščadi (P<0,001). Stopa učestalosti višeplodnih trudnoća češća je u skupini MPO (P<0,001). Anamnestički čimbenici majke pokazuju da trudnice iz promatrane skupine rađaju u starijoj životnoj dobi, no to ne čini razliku među skupinama s obzirom na ishod trudnoće (P>0,05 za sve parametre). Pokazali smo da su trudnice iz skupine MPO znatno češće prvorotkinje od onih u kontrolnoj skupini (P<0,001). Sljedeće maternalne komplikacije češće se javljaju u skupini MPO: gestacijska hipertenzija (P<0,001), HELLP (P=0,002), kolestaza (P=0,014), trombofilija (P<0,001), hipotireoza (P<0,001). Od drugih komplikacija u trudnoći, kod MPO trudnica češći su oligohidramnij (P=0,019) i abrupcija placente (P=0,040). Trudnice iz skupine MPO su češće zahtijevale epiduralnu (P=0,020) i spinalnu (P<0,001) anesteziju. Ista skupina rjeđe je zahtjevala indukciju poroda amniotomijom (P<0,001) i dripom (P<0,001). Nalaz mekonijske plodove vode u promatranoj skupini je rjeđi (P<0,025). Ishodi trudnoće unutar skupine MPO ne ovise o tehnici izvođenja iste (P>0,05 za sve parametre). Trudnoće u podskupini 90 rodilja iz MPO postupaka KBC-a Split statistički značajno češće se dovršavaju vaginalno nego carskim rezom (P=0,047).
Zaključci: Majke koje rađaju iz MPO su starije životne dobi od ostalih. Trudnoće iz medicinski potpomognute oplodnje su pod većim rizikom i zahtijevaju intenzivniju antenatalnu i perinatalnu skrb. |
| Abstract (english) | Objective: To examine whether different anamnestic factors are more prevalent in pregnancies after assisted reproductive techniques (ART), to investigate whether pregnancies after ART increase the incidence of maternal and neonatal complications during pregnancy and childbirth and to compare it with a control (women who conceived naturally).
Materials and Methods: Medical documentation of Department of Gynecology and Obstetrics has been collected and retrospectively analyzed in one year period (from January 1st, 2018 to December 31st, 2018). A survey was conducted on 231 subjects who conceived after ART and 4168 subjects of the control group who conceived naturally. This survey also includes newborns of all subjects. The observed variables were: mode of conception, maternal age, parity, number of fetuses, week of delivery, mode of delivery, birth weight, newborn’s trophicity, Apgar score, pH value, pathological conditions during pregnancy, usage of anaesthesia or other medication, the incidence of meconium stained amniotic fluid.
Results: In the ART group pregnancy was mostly completed in a surgical way (P<0,001). In the same group planned cesarean deliveries were more often than emergency procedures (P=0,023). There is no difference concerning live-birth and sex of newborns between groups. Subjects of the ART group gave birth earlier than the control group (P<0,001), and consequently a greater number of SGA newborns belonged to that group (P<0,001). Majority of multiple pregnancies in this research were from the ART group (P<0,001). Subjects who conceived after ART were older than subjects who conceived naturally, but there is no difference in pregnancy outcomes concerning on maternal age (P>0,05 for all parameters). Women in ART group were mostly primiparae (P<0,001). These maternal complications are more often within ART group: gestational induced hypertension (P<0,001), HELLP (P=0,002), cholestasis (P=0,014), thrombophilias in pregnancy (P<0,001), hypothiroidism (P<0,001). Other complications which are more frequent in ART group are: oligohydramnios (P=0,019) and placental abruption (P=0,040). Women within ART group more often demanded epidural (P=0,020) and spinal (P<0,001) anaesthesia. Subjects from the same group less often needed labor induction, amniotomy (P<0,001) or drip (P<0,001). Incidence of meconium stained amniotic fluid was lower in ART group (P<0,025). Pregnancy outcomes in ART group don't depand on medical method (P>0,05 for all parameters). In subgroup consisted of 90 women vaginal delivery was more often than Caesarean section (P=0,047).
Conclusions: Mothers who give birth after ART are elder than others. Pregnancies after ART are more likely to have maternal complications during pregnancy and delivery. They demand more intensive antenatal and perinatal care. |
