| Abstract | CILJ ISTRAŽIVANJA: Cilj istraživanja je istražiti učestalost dovršetka jednoplodovih
nedonošenih trudnoća između 28+6/7 i 31+6/7 tjedna gestacije carskim rezom te odrediti
povezanost modaliteta dovršetka trudnoće s osnovnim obilježjima majke i novorođenčadi.
MATERIJALI I METODE: Istraživanje uključuje sve trudnice i novorođenčad iz
prijevremenog porođaja niske gestacijske dobi (28 – 31+6/7 tjedna) u Klinici za ženske bolesti i
porode KBC – a Split u razdoblju od siječnja 2015. do prosinca 2021. godine. Uvidom u
Rađaonski protokol Klinike dobiveni su podaci o načinu dovršetka trudnoće, dobi trudnoće u
trenutku porođaja, paritetu, životnoj dobi majke i popratnim komorbiditetima, porođajnoj
duljini i masi novorođenčadi, spolu, APGAR ocjeni i pH vrijednosti arterijske krvi iz
pupkovine. Za procjenu statističke razlike se koristio hi-kvadrat test, Fisherov egzaktni test, ttest
nezavisnosti uzoraka i Mann-Whitney U test, ovisno o promatranim varijablama.
REZULTATI: Za vrijeme promatranog razdoblja zabilježeno je 241 prijevremeni porođaj
između 28. i 31. tjedna trudnoće. Dvije trećine prođaja je dovršeno carskim rezom (144 59,8
%). Nije pronađena statistički značajna razlika u učestalosti načina dovršetka trudnoće u
ispitivanom razdoblju (P=0,635). Modalitet dovršetka jednoplodovih prijevremenih porođaja
nije se značajno mijenjao s obzirom na gestacijsku dob (P=0,149). Starija životna dob majke je
povezana s većom učestalošću carskog reza u odnosu na vaginalni porođaj (31 ± 5,2 vs. 30,02
± 5,6). U žena koje su tijekom trudnoće razvile simptome hipertenzije (P=0,017), preeklampsije
(P<0,001) i HELLP sindroma (P=0,018), carski rez je češće birani način dovršetka porođaja.
U slučaju gestacijskog dijabetesa (P0,650), šećerne bolesti tip 1 (P=0,411), eklampsije
(P=0,244), kolestaze (P=0,223), trombofilije (P=0,622) i produljenog postporođajnog
krvarenja (P=0,063) nismo pronašli statistički značajnu razliku. Novorođenčad koja su
porođena vaginalno imaju značajno veću porođajnu masu (1633,39 ± 704,4 vs. 1373,75 ±
508,3; P=0,001) i duljinu (41,13 ± 4,69 vs. 38,88 ± 3,77; P0,001) u usporedbi s novorođenčadi
porođene carskim rezom. Nismo pronašli statistički značajnu razliku u modalitetu dovršetka
trudnoće s obzirom na spol (P=0,776).Kod novorođenčadi porođene vaginalnim putem pH
vrijednost pupkovine je veća nego kod novorođenčadi porođene carskim rezom (7,35 ± 0,1 vs.
7,30 ±0,11) kao i APGAR zbroj (7 vs. 6).
ZAKLJUČAK: Udio carskog reza kod teške nedonošenosti povećao se u posljednjoj godini u
odnosu na prethodne. ešće je birani način dovršetka trudnoće, ali se njegov udio neznačajno mijenja s obzirom na promatranu gestacijsku dob. Starija životna dob majke i popratni
komorbiditeti povezani su s većom učestalošću carskog reza u odnosu na vaginalni porođaj.
Porođajna masa i duljina novorođenčadi, pH vrijednost krvi pupkovine i APGAR zbroj
razlikuju se s obzirom na modalitet porođaja. |
| Abstract (english) | OBJECTIVES: The aim of the study is to investigate the frequency of the caesarean section
for singleton preterm birth between the 28th and 31th week of pregnancy and to determine the
relationship of the selected mode of birth with maternal and fetal features.
MATERIALS AND METHODS: The study includes all pregnant women and neonates with
gestation age of 28 – 31 weeks at University Hospital of Split (Clinic) in the period from January
1st, 2015, till December 31st, 2021. Clinical data about the mode of delivery, gestational age at
birth, parity, maternal age, diagnosis of pregnancy related diseases, birth length and weight of
newborns, sex, APGAR score and pH value of the umbilical arterial blood were obtained from
the medical documentation. The chi-squared test, Fisher’s exact test, t-sample independence
test and Mann-Whitney U test, depending on the analysed variables, were used to assess the
statistical difference.
RESULTS: During the observed period, 241 preterm births were recorded between the 28th
and 31st week of pregnancy. Caesarean delivery was completed in the 144 (59.8 %) cases. No
statistically significant difference was found in the mode of delivery during researched period
(P=0.635). The mode od delivery did not change significantly due to gestational age (P=0.149).
Older maternal age is associated with a higher frequency of caesarean section compared to
vaginal delivery (31 ± 5,2 vs. 30,02 ± 5,6). In the women who have developed symptoms od
hypertension (P=0.017), preeclampsia (P<0.001) and HELLP syndrome (P=0.018), caesarean
section is more comman mode of delivery. Different proportions in the mode of delivery were
not found in the case of gestational diabetes (P=0.650), type 1 diabetes (P=0.411), eclampsia
(P=0.244), cholestasis (P=0.223), thrombophilia (P=0.622) and prolonged postpartum
haemorrhage (P=0.063). Newborns delivered vaginally had higher birth weight (1633,39 ±
704,4 vs. 1373,75 ± 508,3) and birth length (41,13 ± 4,69 vs. 38,88 ± 3,77) compared with
neonates born by caesarean section. There was no statistically significant difference due to sex
(P=0.776). In newborns delivered vaginally, the pH value of the umbilical artery is higher than
in newborns delivered by caesarean section (7,35 ± 0,1 vs. 7,30 ±0,11), as is the APGAR score
(7 vs.6).
CONCLUSION: The incidence of caesarean section in the early preterm infant has increased
during the last year compared to the previous years. Caesarean section is more often chosen
mode of delivery versus vaginally delivery, but we did not find any difference in the incidence
of pregnancy caesarean section due to gestational age. Older maternal age and presence of
pregnancy related dieses are associated with higher incidence of caesarean section. The birth
weight and length, the pH value of the umbilical arterial blood and APGAR score have impact
on the mode of delivery. |
