Nepravilne glavične vstave ploda in izidi poroda : diplomsko delo

Zupanič, Eva (author), Zakšek, Teja (mentor)

Uvod: Nepravilne glavične vstave ploda so vse glavične vstave, razen zatilne. Nastanejo z iztegovanjem plodove glavice. Delimo jih na temensko, čelno in obrazno vstavo. Povezane so s težjim porodom in večjo možnostjo izhodnih porodniških operacij. Babica igra pomembno vlogo pri postavljanju diagnoze in spremljanju poroda. Namen: Namen diplomskega dela je ugotoviti, kako pogosto se pojavljajo nepravilne glavične vstave, kakšni so izidi poroda, možne posledice za otroka in mater in kakšni so ukrepi babice pri porodu ploda v nepravilni glavični vstavi. Metode: V diplomskem delu smo uporabili deskriptivno metodo dela s sistematičnim pregledom literature. Pri iskanju smo uporabili časovni okvir od leta 2006 do 2017. Literatura je bila iskana v angleškem jeziku s ključnimi besedami malpresentation of fetal head AND sinciput presentation AND brow presentation AND face presentation AND cesarean section v podatkovnih bazah CINAHL, Cochraine Library, ScienceDirect, Springer Link ter COBIB.SI. V analizo smo vključili devet člankov. Pregledali smo tudi podatke rojstev za območje Slovenije za leto 2016 iz baze podatkov Perinatalnega informacijskega sistema. Rezultati: Incidenca obrazne vstave v Sloveniji za leto 2016 je bila 0,07 %, incidenca čelne vstave v Sloveniji za leto 2016 je bila 0,16 % in incidenca temenske vstave v Sloveniji za leto 2016 je bila 1,67 %. Nepravilne glavične vstave so bile pogosteje porojene s carskim rezom v primerjavi z zatilno vstavo ploda. Maternalne poporodne komplikacije so bile poporodna krvavitev v zvezi z atonijo maternice ali zaostalo posteljico. Novorojenčki, rojeni v nepravilni glavični vstavi ploda, so imeli pogosteje oceno po APGAR-ju po petih minutah <7, pogosteje so bili prezgodaj rojeni in imeli porodno težo <2500 g v primerjavi s tistimi, ki so bili rojeni v zatilni vstavi. Razprava in sklep: Nepravilne glavične vstave se pojavljajo redko, a lahko povzročijo obporodne in poporodne komplikacije pri materi in plodu. Spontan vaginalni porod je možen v veliko primerih, zato je pomembno, da po postavitvi diagnoze natančno spremljamo počutje matere in ploda. V primeru nenapredovanja poroda ali nepravilnih vzorcev plodovega srčnega utripa moramo takoj ukrepati in je potreben carski rez. Pomen znanja o vodenju poroda nepravilnih glavičnih vstav moramo poudariti že v času izobraževanja babic, saj z natančnim spremljanjem poroda in hitrim ukrepanjem pridemo do najbolj ugodnih rezultatov za mamo in novorojenčka.

• Language: Slovenian
• Keywords: nepravilne glavične vstave, pogostost, način poroda, maternalne in neonatalne komplikacije, babica
• Work type: Bachelor thesis/paper
• Organization: ZF - Faculty of Health Sciences
• Year: 2018
• PID: 20.500.12556/RUL-101802
• COBISS.SI-ID: 5454955
• Publication date in RUL: 06.07.2018

Secondary language

• Language: English
• Title: Malpresentations of the fetal head and outcomes of labour : diploma work

Abstract

Introduction: Malpresentations of the fetal head are all head presentations other than vertex. They occur due to extension of the fetal head. There are sinciput, brow and face presentation. They are associated with a difficult labour and an increased risk of operative intervention. A midwive has an important role in determining a presentation and recording labour. Purpose: The purpose of diploma work was to determine, how often malpresentations of the fetal head occur in labour, what are the outcomes of labour and possible complications of labour for mother and child. Methods: In this diploma work desciptive method with systematic literature review was used. We searched for a time frame from 2006 to 2017. Literature was searched in English language with keywords malpresentation of the fetal head AND sinciput presentation AND brow presentation AND face presentation AND cesarean section, in the databases CINAHL, Cochraine Library, ScienceDirect, Springer Link and COBIB.SI. We included 9 articles in the analysis. We also rewieved the birth data for the area of Slovenia in year 2016 from the database Perinatalnega informacijskega sistema. Results: The incidence of face presentation in Slovenia for 2016 was 0,07 %, the incidence of brow presentation in Slovenia for 2016 was 0,16 % and the incidence of sinciput presentation in Slovenia in 2016 was 1,67 %. The frequency of cesarean section during labour was higher for infants born in malpresentations of the fetal head compared with vertex presentation. Maternal complication was postpartum haemorrhage in relation to atonic uterus or retained placenta. The incidence of Apgar score at five minutes <7, prematurity and low birth weight <2500 g was higher for infants born in malpresentation of the fetal head compared with those born in vertex presentation. Discussion and conclusion: Malpresentations of the fetal head are rare but can occur maternal and neonatal morbidity. Vaginal delivery is possible in many cases, but intervention or operative birth become necessary when malpresentation persist and labour fails to progress.

• Keywords: malpresentations of the fetal head, incidence, mode of delivery, maternal and fetal complications, midwife