Croatian Society of Gynaecology and Obstetrics, and Croatian Society of Perinatal Medicine of Croatian Medical Association
Abstract
U 2009. godini je u Hrvatskoj umrlo 7837 stanovnika više, nego se rodilo, stopa nataliteta je bila 10,1‰, mortaliteta 11,8‰, negativni priraštaj iznosi –1,7‰. Rođeno je 45 056 djece 500 grama (747 više nego 2008. godine), među njima 44853 djeteta 1000 grama. Učestalost nedonoščadi je 2009. godine bila 5,44%, a novorođenčadi niske porodne težine 5,55%. Perinatalni mortalitet za svu djecu 1000 g je bio 4,4‰, a za svu djecu 500 g 7,2‰. Fetalni mortalitet za djecu 1000 g je bio 3,0‰, a za djecu 500 g 4,2‰. Odgovarajući rani neonatalni mortalitet je bio 1,5‰ i 3,0‰. U porodu je umrlo 11 plodova, što je 0,24‰. Rani neonatalni mortalitet se smanjuje porastom težine novorođenčadi: za djecu 500–999 g je bio 483,0‰, za djecu 1000–1499 g 89,0‰, za 1500–1999 g 23,8‰, za 2000–2499 g 8,7‰ te za djecu 2500 g 0,6‰.U 15 od 35 rodilišta je standardni perinatalni mortalitet (djeca 1000 g) bio manji od 5,0‰, u 11 je bio 5,0–9,9‰, a u 4 bolnička i 5 izvanbolničkih rodilišta ni jedno dijete nije perinatalno umrlo. U trudnoći, porodu ili babinjama je umrlo 7 žena, pa je maternalna smrtnost u 2009. godini porasla od 6,9/100.000 živorođenih u 2008. godini na 15,6/100.000 živorođenih. Eklampsija je bilo 16 ili 0,36‰. Carskim rezom je dovršeno 8084 trudnoća, što je 18,2%, u blagom je porastu (za 0,45%) prema prethodnoj godini. Od svih SC bilo je 28,0% ponovljenih, a 69,95% od 3251 rodilje s ranijim carskim rezom je ponovno porođeno carskim rezom. Od 1614 jednoplodovih trudnoća u stavu zatkom njih 1232 (76.33%) je rođeno carskim rezom. Antenatalna skrb pokazuje stagnaciju prema prethodnoj 2008. godini: po trudnici je bilo prosječno 9,0±0,83 pregleda, 63,1% je pregledano 9 puta, od njih 28,1% više od 10 puta, ali još uvijek je 3,4% trudnica bilo bez pregleda ili s 1–2 pregleda, a 6,7% sa samo 3–5 pregleda. Prosječni broj pregleda ultrazvukom je bio 4,9±0,5, njih 70,0% je bilo pregledano 4 puta, od njih 46,1% 5 puta. U rodilištima III. razine s JINT, znakovito je niži fetalni mortalitet za djecu 500–1499 g. Organizacija perinatalne zaštite u Hrvatskoj u tri razine, s konačnim 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 in the year 2009 died 7837 inhabitants more than were born, natality rate was 10,1 mortality rate 11.8, the population increase was negativ –1,8. The 45 056 infants with birthweight 500 grams (747 more than in previous 2008), 44853 infants with birthweight 1000 grams have been born. In the year 2009 the incidence of preterm infants was 5.44% and of those LBW-s 5.55%. Perinatal mortality for infants 1000 grams was 4.4‰ and for those 500 g 7.2‰. Fetal mortality for infants 1000 g was 3.0‰ and for those 500 g 4.2‰. The corresponding early neonatal mortality was 1.5‰ and 3.0‰. Eleven fetuses died intra partum i.e. 0.24‰. The early neonatal mortality decreases with increase of body weight: for infants 500–999 grams was 483.0‰, for those 1000–1499 g 89.0‰, for 1500–1999 g 23.8‰, for 2000–2499 g 8.7‰, and for infants 2500 grams 0.6‰. In 15 out of 35 maternity wards the perinatal mortality was <5.0‰, in 11 between 5.0–9.9‰; in 4 hospital and in 5 out-hospital maternity wards no one infant died. During pregnancy, labor or puerperium died seven women and maternal mortality was 15.6/100.000. 16 ecclampsias were registered i.e. 0.36‰. By cesarean section were accomplished 8084 births i.e. 18.2%, there is mild increase (0.45%) in relation to the previous year 2008. The repeated CSs formed 28.0% of all sections. Out of 3251 gravidas with previous CS in 69.3% the pregnancy was again accomplished by repeated CS. Out of 1614 breech presentations the 1232 (74.3%) of them were accomplished by CS. The antenatal care showed an stagnation in relation to previous year: the mean number of antenatal visits per pregnant patient was 9.0±0.83, the 63.6% of pregnant patients had 9 visits, the 28.1% of them 10 visits; however 3.4% of pregnant woomen had no visit or 1–2 visits, 6.7% 5–6 visits. The mean value of ultrasound examination was 4.9±0.5, the 70.0% of patients had 4 US examinatios, the 46.1% of them 5 examinations. In the 3-rd level hospitals, in those with NICU, the early neonatal and perinatal mortality were significantly lower for infants 500–1499 grams. The primary task of the perinatal care in Croatia would be the institutional organization of the hospitals on the 3-rd and 2-nd level, with NICU units, along with additional supply of technology and human resources
