Vpliv načina poroda na tveganje za intrakranialne krvavitve pri novorojenčku
prospektivna populacijska kohortna raziskava
DOI:
https://doi.org/10.14528/snr.2019.53.3.751Ključne besede:
porod, carski rez, intrakranialna krvavitev, vakuumska ekstrakcijaPovzetek
Uvod: Namen raziskave je bil preučiti povezavo med načinom poroda in tveganjem za intrakranialno krvavitev pri novorojenčku.
Metode: Analizirali smo podatke iz Nacionalnega perinatalnega informacijskega sistema (NPIS) za obdobje od leta 2002 do leta 2016. Vključili smo prvorodnice, ki so rodile od 2500 do 4000 g težke enojčke v glavični vstavi. Za primerjavo deležev intrakranialne krvavitve pri vakuumski ekstrakciji in drugih načinih poroda smo uporabili Hi-kvadrat test (p < 0,05 signifikantno).
Rezultati: Vključili smo 125393 porodov: 5438 (4 %) načrtovanih carskih rezov, 97764 (78 %) spontanih vaginalnih porodov, 15577 (12 %) urgentnih carskih rezov in 6614 (5 %) vakuumskih ekstrakcij. Diagnosticiranih je bilo 17 (0.14 / 1000) intrakranialnih krvavitev: 12 po spontanem vaginalnem porodu, dve po urgentnem carskem rezu in tri po vakuumski ekstrakciji. Vakuumska ekstrakcija je bila povezana s statistično pomembno povečanim tveganjem za intrakranialno krvavitev v primerjavi s spontanim vaginalnim porodom (razmerje obetov (RO) 3,70; 95% interval zaupanja (IZ) 1,04−13,10), a ne v primerjavi z urgentnim carskim rezom (RO 3,54; 95% IZ 0,59−21,16).
Diskusija in zaključek: Vakuumska ekstrakcija je povezana s povečanim tveganjem za intrakranialno krvavitev v primerjavi s spontanim vaginalnim porodom, vendar je absolutno tveganje majhno. Tveganje za intrakranialno krvavitev se ne razlikuje pomembno glede na operativno dokončanje poroda z vakuumsko ekstrakcijo ali urgentni carski rez.
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