University of Zagreb. School of Medicine. Department of Pediatrics.
Abstract
Prepoznavanje prijeteće asfiksije i procjena potrebe za terapijskom intervencijom najteže su zadaće perinatalne medicine. Razumijevanje utjecaja čimbenika koji dovode do asfiksije i poznavanje njihove međuovisnosti poboljšava ishode rizičnih trudnoća i poroda, a njihovo proučavanje vodi pronalasku preventivnih strategija. Cilj ovog rada bio je prikazati rizične čimbenike za asfiksiju te neonatalne ishode terminske novorođenčadi rođene s Apgar ocjenom jednakom ili manjom od 7 u prvoj minuti u Klinici za ženske bolesti i porode KBC-a Zagreb u trogodišnjem razdoblju. Ukupno je od 1. siječnja 2016. godine do 31. prosinca 2018. godine rođeno 108 takve djece, što odgovara incidenciji od 9,97 ‰. Glavne komponente etiopatogeneze su kronična hipoksemija fetusa - do koje dovode abnormalnosti posteljice povezane s kroničnim bolestima majke, akutna hipoksemija - koja prati intrapartalna hitna stanja, te kongenitalne bolesti novorođenčeta - koje mu otežavaju kardiorespiratornu prilagodbu na izvanmaternični život. Šećerna bolest majke, prijevremeno prsnuće plodovih ovoja i otežani, odnosno onemogućeni vaginalni porod najčešći su rizični čimbenici. Intrapartalni indikatori fetalne patnje, abnormalni nalaz CTG-a i mekonijska plodova voda prisutni su u tek 57,4% slučajeva. Najveći udio poroda dovršen je hitnim carskim rezom koji, glede Apgar ocjene, ima lošije ishode od elektivnog. Ovaj diplomski rad donosi pregled učestalosti rizičnih čimbenika i njihove povezanosti, te ističe probleme na koje bi, s ciljem potpunijeg razumijevanja etiopatogeneze perinatalne asfiksije, valjalo usmjeriti buduća istraživanja.Identifying threatening asphyxia and assessing the need for therapeutic intervention are the most difficult tasks of perinatal medicine. Understanding the factors leading to asphyxia and their interdependence improves the outcomes of risky pregnancies and childbirths, and studying them leads to discovering preventive strategies. The aim of this paper was to present risk factors for asphyxia and neonatal outcomes of term infants born with an Apgar score of equal to or less than 7 in the first minute at Department of Gynaecology and Obstetrics of UHC Zagreb in a three-year period. From January 1, 2016, to December 31, 2018, 108 such children were born, corresponding to an incidence of 9,97 ‰. Major components of etiopathogenesis are chronic foetal hypoxemia - caused by placental abnormalities associated with chronic maternal illnesses, acute hypoxemia - which accompanies intrapartal emergencies, and congenital illnesses - which impair neonates’ ability for cardiorespiratory adaptation to extrauterine life. Diabetes, premature rupture of the membranes and difficult vaginal delivery are the most common risk factors. Intrapartal signs of foetal distress, such as abnormal CTG findings and meconium stained liquor, are present in only 57.4% of cases. The highest share of deliveries is completed by an emergency caesarean section which, with regard to the Apgar score, has poorer outcomes than the elective one. This graduate thesis provides a review of the frequency of risk factors and their correlations, and highlights the problems that future research should focus on with the aim of a more complete understanding of the etiopathogenesis of perinatal asphyxia
