| Abstract | Ciljevi: Analiza porođaja nakon prethodna dva carska reza u Klinici za ženske bolesti i porode
KBC-a Split (Klinika). Analiza učestalosti kirurške sterilizacije u sklopu porođaja trećim
carskim rezom (CR).
Ispitanice i postupci: U istraživanje su bile uključene sve trudnice koje su rodile carskim
rezom u Klinici u periodu 1.1.2019. – 31.12.2022., s prethodna minimalno dva CR-a. Podaci
su prikupljeni iz Dnevnih programa, Rađaonskih i Operacijskih protokola Klinike. Ispitivana
su obilježja trudnica i novorođenčadi.
Rezultati: Zabilježena su 242 porođaja opetovanim (trećim ili više) CR-om što iznosi 1,42%
od svih porođaja te 4,61% od porođaja CR-om. Između godine s najmanjim (2019.) i s najvećim
(2021.) zabilježenim brojem ovih porođaja evidentiran je porast od 76,74% (P=0,004). Porođaji
su najčešće obavljeni s navršenih 38 tjedana trudnoće (75,21%). Period od drugog do trećeg
CR-a (medijan =4) prosječno je bio dulji nego period od prvog do drugog CR-a (medijan =3)
(P=0,001). Kiruršku sterilizaciju u sklopu opetovanog carskog reza zatražile su 132 (54,55%)
ispitanice te je graničnom značajnosti (P=0,05) pokazan pad u udjelu između prve i posljednje
promatrane godine. Novorođenačka hipotrofija (4,13%) i hipertrofija (7,44%) evidentirane su
u značajno manjem udjelu od pretpostavljene frekvencije od 10% (P=0,021, P=0,001). Od
ukupno šest ispitanica s potvrđenim poremećajima sijela i/ili implantacije posteljice, njih četiri
(66,67%) moralo je biti histerektomirano.
Zaključci: U ispitivanom periodu evidentiran je porast opetovanih carskih rezova koji prati
porast učestalosti porođaja CR-om u Klinici. Evidentirano je graničnom statističkom
značajnosti smanjenje broja ispitanica koje su zatražile kiruršku sterilizaciju u sklopu
opetovanog CR-a u ispitivanom periodu. Razmak između drugog i trećeg carskog reza
statistički je bio značajno duži od perioda između prvog i drugog carskog reza. Dugoročne
komplikacije nakon carskog reza evidentirane su u naših ispitanica (placenta previja, PAS
poremećaji, nepotpun razdor maternice). Histerektomija je učinjena u 66,67% trudnica s
potvrđenim poremećajem sijela ili implantacije posteljice. |
| Abstract (english) | Objectives: Analysis of childbirth after previous two caesarean deliveries at the University
Hospital of Split (Clinic). Analysis of the frequency of surgical sterilization at the time of the
third caesarean section.
Subjects and methods: The study included all pregnant women who gave birth by caesarean
section in the Clinic (2019 – 2022), with at least two previous caesarean sections. The data was
obtained from the Daily programs, Birth and Operating protocols of the Clinic. Characteristics
of pregnant women and newborns were examined.
Results: In the observed period 242 deliveries by repeated (third or more) cesarean section
were recorded, which is 1.42% of all deliveries and 4.61% of deliveries by cesarean section.
An increase of 76.74 % was recorded between the year with the lowest (2019) and the highest
(2021) recorded number of these deliveries (P=0.004). Cesarean sections were most oftenly
performed at 38 weeks of pregnancy (75.21%). The period between second and third cesarean
delivery (median 4) was on average longer than the period from the first to the second (median
3) (P=0.001). In our study 132 (54.55%) respondents requested surgical sterilization as a part
of a repeated caesarean section. Borderline significance (P=0.05) showed a decrease in the
proportion between the first and last observed year. Neonatal hypotrophy (4.13%) and
hypertrophy (7.44%) were recorded in a significantly lower proportion than the assumed
frequency of 10% (P=0.021, P=0.001). Out of a total of six respondents with confirmed
disorders of the placenta, four of them (66.67%) had to have a hysterectomy.
Conclusions: An increase in number of repeated caesarean sections was recorded and it follows
an increase in the frequency of cesarean deliveries in the Clinic. A decrease in the number of
respondents who requested surgical sterilization as part of a caesarean section in the examined
period was recorded with borderline statistical significance. The interval between the second
and third cesarean section is significantly longer than the period between the first and second.
Long-term complications after cesarean section were recorded in our subjects (placenta previa,
placenta accreta spectrum disorders, incomplete uterine rupture). Hysterectomy was performed
in 66.67% respondents with a confirmed placental disorders. |
