TERM BREECH PRESENTATION: TRIAL VAGINAL DELIVERY OR ELECTIVE CAESAREAN SECTION

Cilj rada: Retrospektivna evaluacija perinatalnog ishoda poroda u stavu zatkom, uzevši u obzir način dovršetka poroda: vaginalnim putem, hitnim carskim rezom ili elektivnim carskim rezom. Materijali i metode: Analizirani su podatci Klinike za ginekologiju i porodništvo Kliničkog bolničkog centra Rijeka. Od ukupnog broja rođenih (N=34.867), ispitivana skupina uključivala je sve terminske jednoplodne porode (≥259 dana, 37 tjedana gestacije) u jednostavnom ili potpunom stavu zatkom, u rodilja koje su imale uredne trudnoće i živo dijete pri prijemu. U odnosu na to kako je dovršen porod, dobili smo 3 skupine: vaginalni porod u stavu zatkom (53%), hitni carski rez zatka (37%) i elektivni carski rez zatka (10%). Analizirali smo sljedeće parametre: rodnu masu, Apgar indeks ≤ 4 u 1. minuti i ≤ 7 u 5. minuti, acidozu, rane cerebralne znakove, intrakranijalna krvarenja, frakture klavikule, povrede živaca i mekih tkiva, ukupni neonatalni morbiditet i neonatalne smrti. Kod majki smo analizirali dob, paritet (nulipara/multipara), tjedne gestacije, indeks tjelesne mase (BMI) i ukupni postpartalni morbiditet. Statistička analiza provedena je u SPSS-u, primjenom Fisherovog i t-testa za usporedbu tri skupine uz statističku značajnost u razini P ≤0,05. Rezultati: U skupini u kojoj je porod dovršen vaginalno, rodna masa novorođenčadi bila je znakovito najmanja (3.251±422 grama). Ukupni neonatalni morbiditet u skupini vaginalnog poroda zatkom iznosio je 2,74%, u skupini novorođenčadi rođene hitnim carskim rezom 0,90%, dok u skupini elektivnog carskog reza nije bilo ispitivanih morbiditeta. Majke u skupini elektivnog carskog reza imale su najvišu srednju dob od 30,17±5,64 godina. Najviše nulipara bilo je u skupini hitnog carskog reza (70.90%), dok ih je u skupinama vaginalnog poroda zatka i skupini elektivnog carskog reza bilo po 55%. Novorođenčad rođena hitnim carskim rezom imala je najvišu srednju vrijednost gestacije od 39,63±1,20 tjedana. Najveći indeks tjelesne mase imale su žene u skupini elektivnog carskog reza (28,24±5,02). Postpartalni morbiditet majki bio je značajno veći u žena koje su rodile hitnim carskim rezom (20.60%), u odnosu na majke koje su rodile vaginalnim putem (2,11%). Zaključci: Rizični faktori za dovršenje poroda carskim rezom su: veća rodna masa djeteta, veća dob majke, nuliparitet, manja gestacija i veći indeks tjelesne mase. Ukupni perinatalni morbiditet djece signifikantno je veći u skupini vaginalnog poroda zatka, a u skupini elektivnog carskog reza morbiditeta nije bilo. Postpartalni morbiditet majki značajno je veći u skupinama elektivnog i hitnog carskog reza.Objective: Retrospective evaluation of the perinatal outcome of breech delivery, considering the technique of completing delivery: through vaginal birth, emergency caesarean section or elective caesarean section. Study design: The data of the Clinic for Gynecology and Obstetrics of the Clinical Hospital Center Rijeka have been analized. Out of the total number of births (N= 34.867), the study group included all term singleton deliveries (≥259 days, 37 weeks of gestation) in frank or complete breech presentation, women with regular pregnancies and alive child at admission. Considering the completion of delivery, we had three groups: vaginal breech delivery (53%), emergency caesarean section of breech presentation (37%), and elective caesarean section of breech presentation (10%). We analized the following parameters: birth weight, Apgar index ≤ 4 in 1. minute and ≤ 7 in 5. minute, acidosis, early cerebral signs, intracranial hemorrhage, clavicle fractures, nerve and soft tissue injuries, total neonatal morbidity and neonatal deaths. In mothers, we analized age, parity (nullipara/multipara), gestational age, body mass index (BMI) and total postpartal morbidity. Statistical analysis was performed in SPSS, using Fisher's and t-tests to compare three groups, with statistical significance at P ≤ 0,05. Results: In the group of vaginal breech delivery, birth weight was the smallest (3.251±422 grams). The total neonatal morbidity in the vaginal birth group was 2,74%, in the group of newborns delivered with an emergency caesarean section 0,90%, while the group of elective caesarean section had no observed morbidity. The mothers in the group of elective caesarean section had the highest mean age of 30,17±5,64 years. Most nulliparous women were in the group of emergency caesarean section (70,90%), while in the group of vaginal breech delivery and group of elective caesarean section their percentage was 55% in each group. Newborns delivered with an emergency caesarean section had the highest mean gestational age of 39,63±1,20 weeks. The highest body mass indexes were in women in the group of elective caesarean section (28,24±5,02). Postpartum maternal morbidity was significantly higher in women who had an emergency caesarean section (20,60%), compared to mothers who gave birth vaginally (2,11%). Conclusion: The risk factors for completing delivery with caesarean section are: higher birth weight of the baby, higher maternal age, nulliparity, lower gestational age and higher body mass index. The overall perinatal morbidity of the children was significantly higher in the group of vaginal births, and in the group of elective caesarean section was no morbidity. Postpartum maternal morbidity is significantly higher in the groups of elective and emergency caesarean sectio