Croatian Society of Gynaecology and Obstetrics, and Croatian Society of Perinatal Medicine of Croatian Medical Association
Abstract
Cilj rada. Ispitati porode u trudnica-rodilja s prethodnim carskim rezom. Metode. Ispitanice su trudnice-ro¬dilje s obzirom na indikacije za carski rez, životnu dob, interval između poroda, gestacijsku dob, početak poroda i dovršenje poroda, zatim komplikacije u porodu i perinatalnu smrtnost. Obrađene su trudnoće od 23. tjedna i novorođenčad porodne težine 500 g i veće. Statistička obrada učinjena je 2-testom, 2×2 tablicama kontingencije. Razlika je značajna ako je p manji od 0,05. Rezultati. U razdoblju od 1. siječnja 1983. do 31. prosinca 2002. godine bilo je 20766 poroda s jednim plodom, od kojih je 1175 (5,66%) dovršeno carskim rezom. Od 1175 rodilja s carskim rezom 516 (43,8%) je ponovno rađalo. Od 516 trudnica-rodilja s prethodnim carskim rezom u 152 (29,5%) je učinjen elektivni carski rez, a u 142 (27,5%) carski rez u porodu. U 364 trudnice-rodilje pokušano je vaginalno rađanje: spontani početak (289 – 79,4%), programirani porod (53 – 14,6%) i inducirani porod (22 – 6,0%). Od 289 spontano započetih poroda carskim rezom je dovršen 121 (41,9%), od 53 programirana 6 (11,3%), a od 22 inducirana 15 (68,2%) (p<0,00l). U dvije rodilje poslije vaginalnog poroda nađena je ruptura uterusa i u jedne je ruptura uterusa utvrđena u porodu. Najmanje je komplikacija kod vaginalnog poroda (5,8%), zatim kod elektivnog carskog reza (12,5%), a najviše kod carskog reza u porodu (20,4%) (p<0,001). Kasna je fetalna smrtnost bila 1,16%, rana neonatalna u 1,74%, tako da je ukupna perinatalna smrtnost 2,91%. Smrtnosti u rodilja nema. Zaključak. U odabranih trudnica-rodilja s prethodnim carskim rezom treba pokušati vaginalno rađanje uz liberalan stav za dovršenje poroda carskim rezom.Objective. To examine deliveries of pregnant women with a previous cesarean delivery. Methods. Pregnant women were studied according to indications for cesarean section, age, interpregnancy interval, gestational age, trial of labor, delivery completion and perinatal mortality. Deliveries at 23 weeks’ gestation and newborn infants weighing 500 g were analyzed. Statistical analysis was performed using the 2-test with 2×2 contingency tables. The difference was considered to be significant at p<0.05. Results. Among 20766 singleton deliveries between January 1, 1983, and December 31, 2002, 1175 (5.66%) were cesareans. Of those 1175 women with cesarean section, 516 (43.8%) have had a previous cesarean delivery. In actual pregnancy 152 (29.5%) had elective repeat cesarean delivery, and 142 (27.5%) had emergency cesarean delivery. Vaginal delivery was attempted in 364 women: 289 (79.4%) had spontaneous onset of labor, 53 (14.6%) planned delivery, and 22 (6.0%) induced labor. Delivery was completed by cesarean section in 121 (41.9%) of 289 with spontaneous onset of labor, in 6 (11.3%) of 53 with planned delivery, and in 15 (68.2%) of 22 with induced labor (p<0.001) respectively. Uterine rupture was found in two women after delivery, whereas in one woman it was identified during delivery. Complication rates were lowest in women with attempted vaginal delivery (5.8%), then in women with elective repeat cesarean delivery (12.5%), whereas they were highest in women with emergency cesarean delivery (20.4%) (p<0.001). Late fetal death occurred in 1.16%, and early neonatal death in 1.74%, resulting in a 2.91% total perinatal death rate. There was no maternal death. Conclusion. Pregnant women with a previous cesarean delivery should attempt vaginal birth, however, with a liberal obstetrician’s attitude for eventual cesarean delivery
