Spontānu un inducētu vaginālu dzemdību iznākuma salīdzinājums sievietēm ar vienu dzemdes rētu.
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Date
2022
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Aktualitāte: Saskaņā ar Pasaules Veselības organizācijas datiem, pieaug ķeizargrieziena un inducētu vaginālu dzemdību biežums, tāpēc pētījuma mērķis ir novērtēt veiksmīgu vaginālu dzemdību biežumu pēc ķeizargrieziena un komplikāciju risku, kas atvieglotu ārsta lēmumu par piemērotāko dzemdību veidu.
Mērķis: Salīdzināt spontānu un inducētu vaginālu dzemdību iznākumu sievietēm ar vienu dzemdes rētu.
Metodes: Retrospektīvs pētījums, kurā tika izvērtēti Paula Stradiņa Klīniskās universitātes slimnīcas Dzemdību nodaļas arhīva dati no 2021. gada jūnija līdz 2021. gada decembrim ieskaitot. Tika iegūtas un analizētas 59 pacientu vēstures, kurām diagnosticētas vaginālas dzemdības pēc ķeizargrieziena (O75.7.) un dzemdības ar akūtu ķeizargriezienu (O82.1.).
Rezultāti: Lielākajai daļai jeb 76% pacienšu, dzemdības sākās spontāni (N=45), taču inducētas dzemdības bija 24% (N=14) gadījumu. Atkārtotu ķeizargriezienu nācās veikt 80% (N=47) sieviešu. Biežākās indikācijas atkārtotam ķeizargriezienam bija dzemdes disfunkcija (N=5), neefektīva dzemdību indukcija (N=5) un viena dzemdes rēta (N=5). Lielākajai daļai pacienšu nebija komplikāciju ne dzemdību laikā (N=54), ne pēcdzemdību periodā (N=56). Ķermeņa masas indekss (ĶMI) pieaugums bija saistīts ar lielāku risku neveiksmīgam vaginālu dzemdību mēģinājumam pēc ķeizargrieziena – sievietēm ar ĶMI 30 – 39 kg/m2 92,3% (N=12) gadījumu veica atkārtotu ķeizargriezienu. Makrosomijas, ĶMI, nepieredzētu vaginālu dzemdību un indukcijas veida saistība ar palielinātu risku dzemdes plīsumam netika viennozīmīgi konstatēta.
Secinājumi: Ar ķeizargriezienu anamnēzē pastāv liela veiksmīgu vaginālu dzemdību iespēja un dzemdību ierosināšana nepalielina komplikāciju biežumu un risku ne dzemdību, ne pēcdzemdību periodā.
Background: According to World Health Organisation the incidence of caesarean section and induced vaginal births is increasing, so the aim of the study is to evaluate the frequency of successful vaginal births after caesarean section and the risk of complications that would make it easier for the doctor to decide on the most appropriate type of birth. Aim: To compare the outcome of spontaneous and induced vaginal birth in women with a single uterine scar. Methods: A retrospective study evaluating data from the archives of the Maternity Department of Pauls Stradins Clinical University Hospital from June 2021 to December 2021. The histories of 59 patients diagnosed with vaginal delivery after caesarean section (O75.7) and delivery with acute caesarean section (O82.1). Results: In the majority or 76% of patients, labor was initiated spontaneously (N = 45), but induced labor was 24% (N = 14). Repeated caesarean section was performed in 80% (N = 47) of women. The most common indications for recurrent caesarean section were uterine dysfunction (N = 5), ineffective induction of labor (N = 5) and one uterine scar (N = 5). The majority of patients had no complications during childbirth (N = 54) or postpartum period (N = 56). The increase in body mass index (BMI) was associated with a higher risk of unsuccessful vaginal delivery after caesarean section - women with a BMI of 30-39 kg /m2 underwent repeated caesarean section in 92.3% (N = 12) of cases. The association of macrosomy, BMI, unprecedented vaginal birth and type of induction with an increased risk of uterine rupture has not been clearly established. Conclusion: With a history of caesarean section, there is a high chance of successful vaginal births, and the induction of labor does not increase the frequency and risk of complications during childbirth and the postpartum period.
Background: According to World Health Organisation the incidence of caesarean section and induced vaginal births is increasing, so the aim of the study is to evaluate the frequency of successful vaginal births after caesarean section and the risk of complications that would make it easier for the doctor to decide on the most appropriate type of birth. Aim: To compare the outcome of spontaneous and induced vaginal birth in women with a single uterine scar. Methods: A retrospective study evaluating data from the archives of the Maternity Department of Pauls Stradins Clinical University Hospital from June 2021 to December 2021. The histories of 59 patients diagnosed with vaginal delivery after caesarean section (O75.7) and delivery with acute caesarean section (O82.1). Results: In the majority or 76% of patients, labor was initiated spontaneously (N = 45), but induced labor was 24% (N = 14). Repeated caesarean section was performed in 80% (N = 47) of women. The most common indications for recurrent caesarean section were uterine dysfunction (N = 5), ineffective induction of labor (N = 5) and one uterine scar (N = 5). The majority of patients had no complications during childbirth (N = 54) or postpartum period (N = 56). The increase in body mass index (BMI) was associated with a higher risk of unsuccessful vaginal delivery after caesarean section - women with a BMI of 30-39 kg /m2 underwent repeated caesarean section in 92.3% (N = 12) of cases. The association of macrosomy, BMI, unprecedented vaginal birth and type of induction with an increased risk of uterine rupture has not been clearly established. Conclusion: With a history of caesarean section, there is a high chance of successful vaginal births, and the induction of labor does not increase the frequency and risk of complications during childbirth and the postpartum period.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Vaginālas dzemdības pēc ķeizargrieziena; spontānas dzemdības; inducētas dzemdības., Vaginal birth after cesarean section; spontaneous labor; labor induction.