Vpliv epiduralne analgezije na obporodne izide : diplomsko delo

Olenik, Sandra (author), Lučovnik, Miha (mentor), Zupančič, Saša (co-mentor)

Uvod: Epiduralna analgezija je ena izmed najpogosteje uporabljenih farmakoloških metod za lajšanje obporodne bolečine po vsem svetu. Namen: Preučiti, ali epiduralna analgezija vpliva na pojavnost zapletov pri materi (zastoja ramen, raztrganin presredka tretje in četrte stopnje in poporodne krvavitve) ter zapletov pri novorojenčku (umrljivosti novorojenčkov, ocen po Apgarjevi lestvici <7 5 minut po rojstvu, obporodne asfiksije in Erbove pareze). Metode dela: Izvedena je prospektivna kohortna raziskava. Podatki so pridobljeni iz nacionalnega Perinatalnega informacijskega sistema Republike Slovenije za obdobje od leta 2007 do 2014. Vključili smo ženske, pri katerih se je porod začel spontano ali z indukcijo. Izključene so bile tiste, ki so imele načrtovan carski rez. Razvrščene so bile po Robsonovi klasifikaciji. Izvedena je bila primerjava med skupinama z epiduralno analgezijo in brez nje. Za analizo smo uporabili Hi-kvadrat test (p < 0,05 stopnja značilnosti). Rezultati: Analiziranih je bilo 207525 rojstev. Ob uporabi epiduralne analgezije je bila višja pojavnost zastoja ramen v eni izmed skupin (5b), poškodb 3. in 4. stopnje presredka v šestih skupinah (3, 4a, 5a, 5b, 6b, 10b), obporodne asfiksije v treh skupinah (1, 5a, 5b) in Erbove pareze v eni skupini (8b). Nasprotno se je ob uporabi epiduralne analgezije manjkrat pojavila poporodna krvavitev v dveh skupinah (1, 2a) in ocena po Apgarjevi lestvici <7 5 minut po rojstvu v treh skupinah (2a, 8b, 10a). Zgodnja umrljivost novorojenčkov se ni razlikovala med porodi z ali brez epiduralne analgezije. Razprava in zaključek: Ob uporabi epiduralne analgezije je bilo manj poporodnih krvavitev pri prvorodnicah, več raztrganin 3. in 4. stopnje pri mnogorodnicah, manj ocen po Apgarjevi lestvici <7 5 minut po rojstvu, vendar več obporodne asfiksije. Ni bilo opaznih bistvenih razlik pri pojavnosti zastoja ramen, umrljivosti novorojenčkov in Erbove pareze. Zaradi observacijske narave raziskave ni mogoče z gotovostjo govoriti o vzročni povezavi med epiduralno analgezijo in maternalnimi ter perinatalnimi izidi. Kljub temu lahko na podlagi te raziskave babice in ostali strokovni delavci lažje svetujejo pri uporabi epiduralne analgezije.

• Language: Slovenian
• Keywords: porodna analgezija, Apgar, raztrganine, poporodna krvavitev, asfiksija
• Work type: Bachelor thesis/paper
• Organization: ZF - Faculty of Health Sciences
• Year: 2019
• PID: 20.500.12556/RUL-111982
• COBISS.SI-ID: 5711979
• Publication date in RUL: 18.10.2019

Secondary language

• Language: English
• Title: Impact of epidural analgesia on perinatal outcomes : diploma work

Abstract

Introduction: One of the most commonly used pharmacological method for relieving labour pain is use of epidural analgesia. Purpose: To examine whether epidural analgesia affects the incidence of maternal outcomes (shoulder dystocia, third and fourth degree perineal tears and postpartum haemorrhage) and neonatal outcomes (neonatal mortality, Apgar scores <7 5 minutes after birth, perinatal asphyxia and Erb's palsy). Methods: A prospective cohort survey was conducted. Data was obtained from the National Perinatal Information System of the Republic Slovenia during the period from 2007 to 2014. We included women who started birth spontaneously or by induction. Women who had a planned caesarean section were excluded. Participants were classified according to the Ten Group Classification System. Comparison was made between groups with and without epidural analgesia. Hi-square test (p < 0,05 level of significance) was used for analysis. Results: 207525 births were analysed. With use of epidural analgesia, there was a higher incidence of: shoulder dystocia in one of the groups (5b), third and fourth degree perineal tears in six groups (3, 4a, 5a, 5b, 6b, 10b), perinatal asphyxia in three groups (1, 5a, 5b) and Erb’s palsy in one group (8b). In contrast, with the use of epidural analgesia, there was a lower incidence of: postpartum haemorrhage in the two groups (1, 2a) and Apgar score <7 5 minutes after birth in the three groups (2a, 8b, 10a). Early neonatal mortality did not differ between births with and without epidural analgesia. Discussion and conclusion: With epidural analgesia, there were fewer postpartum haemorrhages in primigravidas, more third and fourth degree perineal tears in multigravidas, less Apgar scores <7 after 5 minutes but more perinatal asphyxia. No important differences were observed in the incidence of shoulder dystocia, early neonatal mortality and Erb’s palsy. Due to observational nature of the study it is not possible to draw conclusions on causal relationship between epidural analgesia and observed outcomes. Nevertheless, midwifery and other practitioners can more accurately advise on the use of epidural analgesia based on this research.

• Keywords: birth analgesia, Apgar, lacerations, postpartum haemorrhage, asphyxia