INDUCTION OF LABOUR AFTER PREVIOUS CAESAREAN SECTION

34 Sažetak Stopa carskog reza, unatoč preporukama Svjetske zdravstvene organizacije i brojnih stručnih društava, kontinuirano raste u svim zemljama svijeta, a tome najviše doprinosi rastuća stopa ponovljenih carskih rezova. Vaginalni porod nakon prethodnog carskog reza (VBAC) sve se više promovira kao dobra opcija za drugorotkinje s prethodnim carskim rezom u svrhu izbjegavanja negativnih posljedica višestrukih carskih rezova, poglavito maternalnog morbiditeta i mortaliteta. Također, sve je veći interes za procjenu uspješnosti i sigurnosti indukcije poroda nakon prethodnog carskog reza. Svrha ovog istraživanja bila je odrediti i usporediti ishode VBAC-a. Za istraživanje su odabrane 682 ispitanice koje su podijeljene u dvije skupine – u skupinu sa spontanim VBAC-om uključeno je 610 ispitanica, a u skupina s induciranim VBAC-om 72 ispitanice. Uspješnost vaginalnog poroda u skupini sa spontanim VBAC-om bila je 60%, a u 40% slučajeva ishod je bio ponovljeni carski rez. U skupini s induciranim VBAC-om, uspješnost VBAC-a bila je 63,89%, a 36,11% trebalo je ponovljeni carski rez. Promatrane maternalne komplikacije javile su se kod 10,49% ispitanica u skupini sa spontanim VBAC-om te kod 8,33% ispitanica u skupini s induciranim VBAC-om. Najozbiljnija od njih – ruptura uterusa, javila se nešto češće u skupini s induciranim VBAC-om (4,17%) u odnosu na skupinu sa spontanim VBAC-om (2,46%). Vaginalni porod poslije carskog reza zasigurno je moguće ostvariti u visokom postotku spontanim putem te mu treba dati prednost spram ponovljenog carskog reza.Despite the recommendations of the World Health Organization and a number of professional societies, the Caesarean section rate is continuously increasing globally, mostly due to the increasing repeated Caesarean section rate. Vaginal birth after previous Caesarean section (VBAC) is being promoted as a good option for secundiparae because it avoids negative consequences of multiple Caesarean sections and increased maternal morbidity and mortality related to Caesarean sections. Also, there is an increasing interest in assessing the success and safety of induction of labour after previous Caesarean section. The purpose of this study was to determine and compare different VBAC outcomes. The study included 682 subjects divided into two groups – 610 subjects were included in the spontaneous VBAC group while 72 subjects were included in the induced VBAC group. The efficacy of vaginal delivery in the spontaneous VBAC group was 60%, and in 40% of cases the outcome was repeated Caesarean section. In the induced VBAC group, the VBAC rate was 63.89%, and 36.11% od subjects underwent repeated Caesarean section. Observed maternal complications occurred in 10.49% of subjects in spontaneous VBAC group and in 8.33% of subjects in induced VBAC group. The most serious of them - uterine rupture, occurred more frequently in the induced VBAC group (4.17%) than the spontaneous VBAC group (2.46%). Spontaneous Vaginal birth after Caesarean section is certainly possible in a high percentage and should be given priority over the repeated Caesarean section