Croatian Society of Gynaecology and Obstetrics, and Croatian Society of Perinatal Medicine of Croatian Medical Association
Abstract
U Hrvatskoj je od 1986. prirodni priraštaj nizak, a od 1991. postaje negativnim – više pučanstva umire, nego se rađa. U 2003. godini je umrlo 12.907 stanovnika više, nego se rodilo, negativni priraštaj iznosi –2,9. Učestalost nedonoščadi je 2002. godine bila 5,88%, a novorođenčadi niske porodne težine 5,79%. Perinatalni mortalitet za svu djecu 1000 g je bio 6,3‰, a za djecu 500 g 9,5‰. Fetalni mortalitet za djecu 1000 g je bio 4,1‰, a za djecu 500 g 4,4‰. Odgovarajući rani neonatalni mortalitet je bio 2,2‰ i 3,9‰. U porodu je umrlo 9 plodova, što je 0,23‰. Rani neonatalni mortalitet se smanjuje porastom težine novorođenčadi: za djecu 500–999 g je bio 632‰, za djecu 1000–1499 g 108‰, za 1500–1999 g 23,0‰, za 2000–2499 g 14,7‰ te za djecu 2500 g 1,0‰. U 25 od 36 rodilišta je perinatalni mortalitet bio manji od 7,0‰, a samo u 5 rodilišta veći od 10,0‰. Maternalna je smrtnost bila 5 žena, 12,7/100.000. Eklampsija je bila 21 ili 0,53‰. Carskim rezom je dovršeno 5.977 trudnoća, što je 15,1%, u neznatnom je porastu prema prethodnoj godini. Od svih SC bilo je 24,8% ponovljenih, a 62,9% od 2358 žena s ranijim carskim rezom je ponovno rodilo carskim rezom. Antenatalna skrb pokazuje istu razinu kao prethodne 2002. godine: po trudnici je bilo prosječno 8,10 pregleda, 52,3% je pregledano 9 puta, ali još uvijek je 12,4% trudnica bilo bez pregleda ili s manje od 6 pregleda. Prosječni broj pregleda ultrazvukom je bio 3,81, njih 54,1% je bilo pregledano 4 puta. U rodilištima III. razine, s JINT, niži je RNM za djecu 500–999 g, 1000–1499 g i za djecu 1500–1999 g, a za djecu 2000–2499 g i 2500 g se rani neonatalni mortalitet izjednačuje u rodilištima I., II. i III. razine. Organizacija perinatalne zaštite u Hrvatskoj u tri razine, s formiranjem jedinica intenzivne neonatalne terapije (JINT) i njege (JINNj), uz popunu tih jedinica opremom i uz odgovarajuću izobrazbu deficitarnih kadrova primarna¬ su zadaća perinatalne zdravstvene skrbi.In the Republic of Croatia since 1986 the natural increase is law. Since 1991 the natural increase is negative, in the year 2003 died 12.907 inhabitants more than were born, there is a decrease of –2.9%. In the year 2003 the incidence of preterm infants was 5.88% and of those LBW 5.77%. Perinatal mortality for infants 1000 grams was 6.3‰ and for those 500 g 9.5‰. Fetal mortality for infants 1000 g was 4.1‰ and for those 500 g 4.4‰. The corresponding early neonatal mortality was 2.2‰ and 3.9‰. During labor died only 9 fetuses, i.e. 0.23‰. The early neonatal mortality decreases¬ with increase of birth weight: for infants 500–999 grams was 632‰, for those 1000–1499 g 108‰, for 1500–1999 g 23.0‰, for 2000–2499 g 14.7‰, and for infants 2500 grams 1.0‰. In 25 out of 36 maternity wards the perinatal mortality was <7.0‰, in only 5 maternity wards 10.0‰. Maternal mortality was 12.7/100.000 (5 women). By cesarean section were accomplished 5977 births i.e. 15.1%, there is small increase in relation to the 2002. The repeated CSs formed 24.8% of all sections. Out of 2358 gravidas with previous CS in 62.9% the pregnancy was accomplished by repeated CS. The antenatal care did not remarkably changed in relation to previous year: the mean number of antenatal visits per pregnant patient was 8.10 and of ultrasound examinations 3.81; however 12.4% of pregnant patients had less than 6 visits. In the 3rd level hospitals, in those with NICU, the early neonatal mortality was significantly lower for infants 500–999, 1000–1499 and 1500–1999 grams whereas for infants 2000–2499 and for those 2500 grams the early neonatal mortality was equalized in hospitals of the 1-st, the 2-nd and of the 3-rd level. The primary task of the perinatal care in Croatia would be the institutional organization of the hospitals of the 3-rd and of the 2-nd level, with NICU departments, along with additional supply of technology and human resource
