Breech birth

Uvod: Proti koncu nosečnosti natančno opredelimo, kako plod leži v maternici da se nosečnica s pomočjo porodničarja odloči za način poroda. Ugotavljamo lego, položaj, vstavo in držo ploda. O medenični vstavi govorimo, kadar se v medenični vhod matere vstavi spodnji del plodovega telesa oziroma plodova zadnjica. Za razliko od poroda v glavični vstavi v Sloveniji porod v medenični vstavi vodi porodničar. Babice imajo kljub temu pomembno vlogo pri spremljanju poroda. Porod pri medenični vstavi lahko poteka vaginalno ali z carskim rezom. Da bi zmanjšali verjetnost poroda v medenični vstavi in s tem povezanega večjega tveganja za mater in plod se ob koncu nosečnosti poslužujemo zunanjega obrata. Namen: Namen diplomskega dela je s pomočjo uporabe statističnih podatkov Nacionalnega inštituta za javno zdravje predstaviti izide medeničnega poroda v Sloveniji, povzeti glavne ugotovitve o izidih medeničnega poroda in podati predloge za izboljšavo babiške prakse v Sloveniji. Cilji diplomskega dela so predstaviti medenični porod, vlogo babice pri medeničnem porodu in povzeti glavne ugotovitve o medeničnem porodu. Metode dela: V diplomskem delu je uporabljena opisna oziroma deskriptivna metoda dela. V empiričnem delu so uporabljeni statistični podatki Nacionalnega inštituta za javno zdravje. Pri iskanju literature smo si pomagali s pomočjo domačih (COBISS) in tujih (Pubmed, Cochrane) podatkovnih baz. Poudarek je predvsem na interpretaciji ugotovitev tujih in domačih avtorjev. Ključne besede, ki so uporabljene so: medenični porod, zunanji obrat, medenična vstava. Rezultati: Medenična vstava je najpogostejša od nepravilnih vstav. Po podatkih Nacionalnega inštituta za javno zdravje je bilo leta 2016 v medenični vstavi rojenih 4,9 % otrok od tega jih je bilo 83,5 % rojenih z carskim rezom. Razprava in sklep: Na podlagi pregleda literature je bilo ugotovljeno, da se večina otrok rodi v glavični vstavi, le nekaj odstotkov je rojenih v medenični vstavi. V Sloveniji število carskih rezov pri medenični vstavi zelo hitro narašča. Mnenja glede načina poroda v medenični vstavi so od porodnišnice do porodnišnice različna. Nekateri zagovarjajo vaginalni medenični porod drugi ne. V porodnišnicah, kjer je manj medeničnih porodov, je posledično tudi več zapletov pri vaginalnem porodu v medenični vstavi. V današnjem času se v Sloveniji večina porodničarjev zaradi pomanjkanja izkušenj pri vaginalnem porodu v medenični vstavi odloči za carski rez. S tem se izognejo zapletom, ki jih prinaša vaginalni medenični porod.Introduction: Towards the end of pregnancy, we precisely define how fetus lies in uterus so that mother can choose the type of childbirth with help from her obstetrician. We monitor location, position, insertion and pose of fetus. We discuss breech birth when fetus’s buttocks or feet are in the pelvic region. Unlike vertex presentation, breech birth is led by obstetrician in Slovenia. Midwives nevertheless play an important role in the monitoring of childbirth. Breech birth can be performed vaginally or with caesarean section. To lower the risk of breech birth and related maternal risk and risk of fetus we apply process called External cephalic version. Purpose: the purpose of this thesis is to summarize major findings on results of breech birth, to summarize the main findings of breech birth and make suggestions for improvement of midwifery practice in Slovenia with use of statistics data from National institute of public health. The goal is to present breech birth, role of midwife and to summarize main findings on breech birth. Work methods: To write the thesis we studied existing domestic and foreign literature from this field. Descriptive work method was used. In the empirical part we use statistical data from National institute of public health. Domestic (COBISS) and foreign (Pubmed, Cochrane) databases were used to find literature. The emphasis is mainly on interpreting the findings of foreign and domestic authors. Results: Breech presentation is the most common of incorrect presentation. According to the National institute of public health, in 2016, 4.9% of children were born in the breech presentation and 83,5 % were born with caesarean section. Discussion and conclusion: Based on the literature review, that most children were born in cephalic presentation only a few percent were born in the breech presentation. In Slovenia the number of caesarean sections in breech presentation is very rapidly increasing. Opinions regarding the kind of delivery of breech infant differ from one maternity clinic to another. Some advocate vaginal birth more than others. In maternity clinics where there are fewer breech births, there are also several more complications with vaginal delivery of a breech infant. Nowadays most obstetricians in Slovenia, due to the lack of experience with vaginal delivery of a breech infant, opt for caesarean section. This avoids the complications of vaginal delivery