Nabassaites izkrišana un perinatālais iznākums
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Date
2021
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Volume Title
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Nabassaites izkrišana ir ārkārtas situācija dzemdniecībā, kad nabassaite nokrīt zem augļa esošās daļas, kas var izraisīt augļa asfiksiju. Incidence svārstās no 0,1% līdz 0,6%. Iespējamie riska faktori ir priekšlaikus dzimis bērns, augļa zems dzimšanas svars (<2500 g), ne – galviņas priekšguļa, polihidramnijs, amniotomijas pielietojums, daudzaugļu grūtniecība un gara nabassaite.
Pētījuma mērķis bija identificēt iespējamos nabassaites izkrišanas riska faktorus, taktiku un bērna perinatālo iznākumu.
Retrospektīvajā aprakstošajā pētījumā tika iekļauti visi nabassaites izkrišanas gadījumi Rīgas Dzemdību namā laika posmā no 2013. līdz 2017. gadam. Pēc nejaušības principa uz katru nabassaites izkrišanas gadījumu tika izvēlētas divas kontroles. Iegūtie dati tika analizēti, izmantojot MS Excel un IBM SPSS Statistics v24.
Rezultāti liecina, ka piecu gadu laikā no 33 296 dzemdībām tika identificēti 34 nabassaites izkrišanas gadījumi, kas bija 0,102% no visām dzemdībām. Iegūto datu statistiskā analīze starp grupām parādīja, ka jaundzimušo faktori, piemēram, ne – galviņas priekšguļa (p = 0,04), jaundzimušā svars zem 2500 g (p = 0,002) un polihidramnijs (p <0,0002), bija saistīti ar augstāku nabassaites izkrišanas risku, bet mātes vecumam (p = 0,248), grūtniecības nedēļai (p = 0,424), paritātei (p = 0,235) un nabassaites garumam (p = 0,601) nebija statistiski nozīmīgas saistības. Amniotomija bija uz statistiskas nozīmības robežas, lai to atzītu par riska faktoru (p = 0,052). Ķeizargrieziena operāciju veica 79,4% nabassaites izkrišanas gadījumu, savukārt kontroles grupā tikai 34,3% gadījumu (p = 0,00002). Apgares skalas rādītājs > 7 pirmajā minūtē tika konstatēts 76,5% jaundzimušo ar nabassaites izkrišanu, bet kontroles grupā - 97% (p = 0,002).
Šajā pētījumā tika secināts, ka zems dzimšanas svars, ne – galviņas priekšguļa un polihidramnijs ir statistiski nozīmīgi saistīts ar lielāku nabassaites izkrišanas risku. Citus faktorus kā riska faktorus nevar izslēgt nelielā gadījumu skaita dēļ. Nabassaites izkrišana ir saistīta ar zemākiem Apgares skalas rādītājiem pirmajā minūtē, un visbiežāk lietotā dzemdību atrisināšanas metode pie nabassaites izkrišanas ir ķeizargrieziena operācija.
Umbilical cord prolapse (UCP) is an obstetric emergency in which the umbilical cord drops below the presenting part of the fetus which can result in fetal asphyxia. The incidence varies between 0,1% and 0,6%. Possible risk factors include prematurity, low fetal birth weight (<2500 g), non-vertex presentation, polyhydramnios, amniotomy, multiparity and long umbilical cord. The aim of the study was to identify possible risk factors of UCP, management strategies and perinatal outcomes. The retrospective descriptive study included all cases of UCP in Riga Maternity Hospital in time period between 2013-2017. Two controls per case were randomly selected. The obtained data was analyzed using MS Excel and IBM SPSS Statistics v24. During a five year period, 34 cases of UCP were identified out of total 33 296 deliveries, which was 0,102% of all deliveries. Statistical analysis of the obtained data between groups showed that neonatal factors, such as non-vertex presentation (p=0,04), neonatal weight below 2500 g (p=0,002) and polyhydramnios (p<0,0002) were associated with higher risk of UCP, but maternal age (p=0,248), gestational week (p=0,424), parity (p=0,235) and umbilical cord length (p=0,601) had no significant association. Amniotomy was on the border of significance of being recognized as risk factor (p=0,052). The cesarean section was performed in 79,4% of UCP cases, whilst in control group just in 34,3% cases (p=0,00002). Apgar score of >7 in first minute was found in 76,5% of newborns with UCP, while in control group in 97% (p=0,002). Low birth weight, non-vertex presentation and polyhydramnios are associated with higher risk of UCP. Other factors cannot be excluded as risk factors because of the small number of cases. UCP is associated with lower Apgar scores in first minute and cesarean section is the most used management strategy of UCP.
Umbilical cord prolapse (UCP) is an obstetric emergency in which the umbilical cord drops below the presenting part of the fetus which can result in fetal asphyxia. The incidence varies between 0,1% and 0,6%. Possible risk factors include prematurity, low fetal birth weight (<2500 g), non-vertex presentation, polyhydramnios, amniotomy, multiparity and long umbilical cord. The aim of the study was to identify possible risk factors of UCP, management strategies and perinatal outcomes. The retrospective descriptive study included all cases of UCP in Riga Maternity Hospital in time period between 2013-2017. Two controls per case were randomly selected. The obtained data was analyzed using MS Excel and IBM SPSS Statistics v24. During a five year period, 34 cases of UCP were identified out of total 33 296 deliveries, which was 0,102% of all deliveries. Statistical analysis of the obtained data between groups showed that neonatal factors, such as non-vertex presentation (p=0,04), neonatal weight below 2500 g (p=0,002) and polyhydramnios (p<0,0002) were associated with higher risk of UCP, but maternal age (p=0,248), gestational week (p=0,424), parity (p=0,235) and umbilical cord length (p=0,601) had no significant association. Amniotomy was on the border of significance of being recognized as risk factor (p=0,052). The cesarean section was performed in 79,4% of UCP cases, whilst in control group just in 34,3% cases (p=0,00002). Apgar score of >7 in first minute was found in 76,5% of newborns with UCP, while in control group in 97% (p=0,002). Low birth weight, non-vertex presentation and polyhydramnios are associated with higher risk of UCP. Other factors cannot be excluded as risk factors because of the small number of cases. UCP is associated with lower Apgar scores in first minute and cesarean section is the most used management strategy of UCP.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Nabassaites izkrišana, perinatālais iznākums, Umbilical cord prolapse, perinatal outcomes