ROLE OF THE MIDWIFE IN THE SUPERVISION OF WOMAN IN LABOR AND CHILD DURING LABOR INDUCTION

Napretkom medicine inducirani porodi sve se više izvode. Indukcija se prema indikaciji dijeli na indiciranu, kada postoji patologija u trudnoći, i na elektivnu odnosno programsku kada se indukcija želi napraviti zbog određenih socijalnih razloga ili u cilju sprečavanja mogućih poteškoća. Indukcija, kao i svaka medicinska intervencija nosi određene rizike u koje se ubrajaju: RDS, ruptura uterusa, infekcija majke i djeteta, prolaps pupkovine, distocija i povećana stopa carskog reza. Indukcija se izvodi kada je rizik nastavka trudnoće veći od rizika indukcije. Metode indukcije mijenjale su se kroz prošlost. Danas su u upotrebi: intravenski oksitocin, prostaglandini koji se primjenjuju u obliku intracervikalnog gela, amniotomija, sweeping, Foleyev kateter, električna stimulacija uterusa te razne nefarmakološke metode. Metodu indukcije odabire liječnik pri čemu je jedan od najvažnijih faktora zrelost cerviksa koja se mjeri Bishopovim testom. Kada je rezultat Bishopovog testa manji od 6 preporuča se korištenje prostaglandina u cilju sazrijevanja grlića maternice. Primalja asistira liječniku pri izvođenju indukcije pripremajući potreban pribor i osiguravajući aseptične uvjete rada. Tijekom trajanja indukcije prati se stanje trudnice mjerenjem krvnog tlaka, temperature i praćenjem boje lica. Zbog ranog uočavanja mogućeg fetalnog distresa pri svakoj indukciji postavlja se kardiotokograf kojim se mjere otkucaji fetalnog srca. Osim lošeg kardiotografskog zapisa, indikator fetalnog distresa je mekonijska plodova voda. Inducirati se može i treće porodno doba u cilju skraćenja vremena trajanja primjenom uterotonika. Uloga primalje u trećem i četvrtom porodnom dobu je kontroliranje znakova koji upućuju na hemoragiju trudnice i praćenje visine fundusa uterusa. Prilikom uočavanja patologije primalja je dužna odmah obavijestiti liječnika. Primalja je prisutna uz trudnicu od trenutka ulaska u rađaonicu do odlaska na odjel babinjača. Stoga je osim stručne pomoći bitna i psihološka. Educirana trudnica je suradljivija i zadovoljnija. Ključne riječi: indukcija, metode indukcije, rizici indukcije, trudnica, primaljaFollowing the evolution of medicine the number of induced labor increased. Induced labor is divided by the indications on induced, when there's a pathology in pregnancy and elective also known as scheduled when there is a sociological reason of as a prevention of any complications. Like any other medical intervention, induced labor has it's risks such as: RDS, uterus rupture, mother or baby infection, umbilical cord prolapse, dystocia and increased rate of caesarean section. Induced labor is performed when there is a bigger risk of continuing the pregnancy then it is to induction itself. Methods of induction have changed in time. In todays usage there is: intravenous oxytocin, intracervical gel prostaglandin, amniotomy, sweeping, Foley's catheter, electrical uterus stimulation and various nonpharmacological methods. Method of induction is chosen by the doctor and the most important factor is cervical readiness for the delivery which is measured by Bishop score. Prostaglandin is recommended when the Bishop score is under 6 so that cervix can mature. The midwife assists doctor during the induction by preparing the equipment and insuring antiseptic working conditions. While performing induced labor midwife have to measure patient's blood pressure, temperature and look at face color. To prevent fetal distress during induction it's used cardiotocography that measures fetal heart rate. Besides bad cardiotocography results, meconium amniotic fluid is also an indicator of fetal distress. The third stage of labor can also be induced by using uterotonics. With induction, duration of the third stage is reduced. Activities of the midwife in third and fourth stage of labor are based on hemorrhage prevention. If irregularities are spotted, midwife's duty is to inform the doctor. Midwife is with the pregnant woman from the moment she enters the delivery room untill she leaves it. Because of that psychological support is very important. Educated woman in labor is calm and satisfied. Key words: induction, methods of induction, risks of induction, woman in labor, midwif