Vpliv operativnega dokončanja vaginalnega poroda na tveganje za intrakranialne krvavitve pri novorojenčku : diplomsko delo

Buh, Nika (author), Lučovnik, Miha (mentor)

Uvod: Približno 3% porodov v Sloveniji se konča z vakuumsko ekstrakcijo. Pojavnost neonatalnih intrakranialnih krvavitev pri porodih dokončanih z vakuumom pri nas ni znana. Namen: Namen raziskave je bil preučiti povezavo med načinom poroda in tveganjem za intrakranialno krvavitev pri novorojenčku. Metode: Analizirali smo podatke iz Nacionalnega Perinatalnega Informacijskega Sistema za obdobje 2002 do 2016. Vključili smo prvorodnice, ki so rodile 2500 do 4000g težke enojčke v glavični vstavi. Za primerjavo deležev intrakranialne krvavitve pri vakuumski ekstrakciji in drugih načinih poroda smo uporabili Hi-kvadrat test (p < 0,05 signifikantno). Rezultati: Vključili smo 125393 porodov: 5438 (4 %) načrtovanih carskih rezov, 97764 (78 %) spontanih vaginalnih porodov, 15577 (12 %) urgentnih carskih rezov in 6614 (5 %) vakuumskih ekstrakcij. Diagnosticiranih je bilo 17 (0.14/1000) intrakranialnih krvavitev: 12 po spontanem vaginalnem porodu, dve po urgentnem carskem rezu in tri po vakuumski ekstrakciji. Vakuumska ekstrakcija je bila povezana s statistično pomembno povečanim tveganjem za intrakranialno krvavitev v primerjavi s spontanim vaginalnim porodom (razmerje obetov (RO) 3,70; 95% interval zaupanja (IZ) 1,04-13,10), a ne v primerjavi z urgentnim carskim rezom (RO 3,54; 95% IZ 0,59-21,16). Razprava in zaključek: Vakuumska ekstrakcija je povezana s povečanim tveganjem za intrakranialno krvavitev v primerjavi s spontanim vaginalnim porodom, vendar je absolutno tveganje majhno. Tveganje za intrakranialno krvavitev se ne razlikuje pomembno med operativnim dokončanjem poroda z vakuumsko ekstrakcijo v primerjavi z urgentnim carskim rezom.

• Language: Slovenian
• Keywords: carski rez, intrakranialna krvavitev, porod, vakuumska ekstrakcija
• Work type: Bachelor thesis/paper
• Organization: ZF - Faculty of Health Sciences
• Year: 2019
• PID: 20.500.12556/RUL-106047
• COBISS.SI-ID: 5572459
• Publication date in RUL: 19.01.2019

Secondary language

• Language: English
• Title: Effects of operative vaginal delivery on neonatal intracranial haemmorhage : diploma work

Abstract

Introduction: Approximately 3% of deliveries in Slovenia end with vacuum extraction. The incidence of neonatal intracranial haemorrhages in vacuum-complete deliveries is not known in Slovenia. Purpose: The objective was to examine association between mode of delivery and incidence of neonatal intracranial haemorrhage. Methods: Slovenian National Perinatal Information System (NPIS) data for the period 2002 through 2016 were analysed. Nulliparous women delivering singleton neonates in cephalic presentation weighting 2500 to 4000g were included. Incidence of neonatal intracranial haemorrhage in vacuum delivery vs. other modes of delivery was compared using Chi-square test (p< 0.05 significant). Results: 125393 deliveries were included: 5438 (4 %) planned caesarean deliveries, 97764 (78 %) spontaneous vaginal deliveries, 15577 (12 %) emergency caesarean deliveries, and 6614 (5 %) vacuum extractions. 17 (0.14/1000) neonatal intracranial haemorrhages were recorded: 12 occurred in spontaneous vaginal deliveries, two in emergency caesarean deliveries, and three in vacuum extractions. As compared with infants born by spontaneous vaginal delivery, those delivered by vacuum extraction had higher rates of intracranial haemorrhage (odds ratio (OR) 3.70; 95% confidence interval (CI) 1.04-13.10). Risk estimates did not reach statistical significance when comparing infants born by vacuum extraction and those born by emergency caesarean delivery (OR 3.54; 95% CI 0.59-21.16). Discussion and conclusions: Infants born by vacuum extraction have significantly higher rates of intracranial haemorrhage than those born by spontaneous vaginal delivery, though absolute risk is small. There are no significant differences in rates of intracranial haemorrhage in vacuum extraction vs. emergency caesarean delivery.

• Keywords: caesarean delivery, intracranial haemorrhage, labour, vacuum extraction