University of Split. School of Medicine. Gynecology and obstetrics.
Abstract
Cilj: Analizirati rezultate i ishode trudnoća koje su programom transporta in utero premještene u KBC Split u trogodišnjem razdoblju (2015. – 2017. godina).
Ispitanici i postupci: Analizirani su podatci 119 trudnica i njihove novorođenčadi koje su zaprimljene na Kliniku za ženske bolesti i porode KBC-a Split (Klinika) iz dalmatinskih rodilišta u sklopu projekta transport in utero u razdoblju od 2015. do 2017. godine. Podatci su dobiveni uvidom u medicinsku dokumentaciju (Rađaonski protokol, Protokol za transport in utero). Rezultati neonatalnog ishoda novorođenčadi su uspoređeni sa rezultatima istih trudnoća na nivou cijele Hrvatske.
Rezultati: U trogodišnjem periodu (2015.-2017.) u KBC Split je zaprimljeno 119 trudnica iz projekta transport in utero. Od toga je 14 vraćeno u matične ustanove, dok ih je 105 rodilo u KBC Split. Bilo je ukupno 112 živorođene djece. Boravak u Klinici do poroda je iznosio 1- 226 dana s medijanom od četiri dana. Trećina (38,1%) ispitanica je rodila unutar 24 sata od primitka u Kliniku. Evidentirano je 68 (64,8%) prijevremenih poroda, od čega je 26 (24,8%) nastupilo prije 30. tjedna. Većina poroda (58,1%) je dovršena carskim rezom. U intervalu 30- 37 tjedana je bilo 66,7% carskih rezova, a u terminskim porodima 62,2%. Vrlo niske porođajne mase je bilo 42 djece (36,8%). Hipotrofičnim je rast ocijenjen u 20,2% novorođenčadi. Bilo je 44 (39,3%) novorođenčadi ocjene vitalnosti po Apgaru sedam i manje te 13 (11,7%) s ocjenom manjom od pet. Perinatalni mortalitet u ispitivanoj skupini je bio 52,6‰ (6/114), fetalni mortalitet 17,5‰ (2/114), a rani neonatalni 35,7‰ (4/112). Oba slučaja fetalne smrti su nastupila u trudnoći prije dogovorenog transporta u KBC Split, gdje su trudnice upućena zbog mogućih komplikacija u majke. Sedam od deset (70%) svih smrti je zabilježeno u skupini novorođenčadi s manje od 1000g. RNM u skupini djece porođajne mase manje od 1500g (35,7‰; 4/112) u ovom je istraživanju gotovo pet puta manji od prosjeka RH gdje iznosi 173‰.
Zaključak: Rezultati ovog istraživanja potvrđuju opravdanost provedbe transporta in utero i regionalne organizacije perinatalne zaštite u cjelini.Goal: to analyse results and outcomes of pregnancies that are transported to University Hospital of Split with transport in utero programme in the period of three years (2015-2017).
Questioned participants and procedures: data analysed comes from 119 pregnant women and their newborns admitted to the Maternity and women's disease clinic from other Dalmatian maternity clinics as part of transport in utero programme from 2015 to 2017. Data is retrieved from the medical documentation (birth procedure protocols, transport in utero protocol). Results of neonatal outcomes of newborns are compared with the results of similar outcome pregnancies throughout Croatia.
Results: in the period of three years, 2015-2017, 119 pregnant women were admitted to University Hospital of Split through transport in utero programme. 14 women were returned to their original stationaries and the rest (105) gave birth at University Hospital of Split; in total, 112 children were liveborn. Hospitalisation period until child birth lasted between 1 and 226 days with median of four days. One third of the women in question, 38.1%, gave birth in the first 24 hours from admission to the hospital. Evidence shows 68 (64.8%) were premature births and 26 (24.8%) occured before the week 30. Most of the births ended with a caesarean section, 66.7% were pregnancies ranging from week 30-37, and 62.2% were on term pregnancies. Very low birth mass was noted in 42 children (36.8%). Hypotrophic growth was detected in 20.2% of the newborns. 44 (39.3%) of the newborns scored 7 or less on Apgar, and 13 (11.7%) scored less than 5. Perinatal mortality in the questioned group was 52.6‰ (6/114) , fetal mortality was 17.5‰ (2/114), and early neonatal was 35.7‰ (4/112). Both of the fetal death cases have occured in pregnancies before the arranged transport to University Hospital of Split, where pregnant women were referred to because of the possible pregnancy related complications. Seven out of 10 of all deaths of the newborns have occured in the group of newborns born with less than 1000g. Early neonatal mortality in the group of children with birth mass less than 1500g (35.7‰; 4/112) in this research is almost 5 times less than the average of 173% for the Republic of Croatia.
Conclusion: results of this research justify the implementation of the transport in utero programme and regional organisation of the perinatal protection in whole
