FREQUENCY AND TRENDS OF CESAREAN DELIVERY IN THE PERIOD FROM 2016 TO 2020. YEARS IN THE CLINICAL HOSPITAL CENTER SPLIT

Cilj ovog istraživanja bio je ispitati porast i trend carskih rezova u KBC-u Split u periodu od 2016. do 2020. godine, te podatke usporediti sa onima u gradu Zagrebu, Rijeci i Osijeku. Sukladno tome, predmet istraživanja bio je i istraživanje učestalosti poroda na carski rez s obzirom na patologiju tijekom trudnoće, dob majke, broj poroda majke i način prethodnih završetaka poroda. Za potrebe ovog istraživanja podatci su prikupljeni u knjigama poroda KBC-a Split gdje je otkriven podatak o ukupnom broja 5993 rodilja koje su se porodile carskim rezom, uključujući podatke o zdravstvenom stanju majke i novorođenčeta koji su doveli do carskog reza. Među ispitanicama utvrđeno je da rodilje starije od 35 godina češće trudnoću završavaju carskim rezom u odnosu na mlađe trudnice (62%). Patologije kod poroda carskim rezom prisutne su kod 474 rodilje (7,91%). Najčešća patologija je gestacijski dijabetes melitus (31,86%), druga najčešća je preeklampsija koja je prisutna kod 137 žena s patologijom (28,90%). Treća po redu najzastupljenija patologija je hipotireoza koja je zastupljena kod 63 rodilje s patologijom (13,29%). Patologija u obliku trombofilije je utvrđena kod 42 rodilje s patologijom (8,86%). S obzirom na navedeno, trudnice sa prisutnom patologijom češće su porod završile carskim rezom. Istraživanje je obuhvaćalo četiri hrvatska grada, Split, Zagreb, Rijeku i Osijek. U sva četiri promatrana grada od 2016. do 2020. godine je veći broj prirodnih poroda u odnosu na carski rez. Prema zastupljenosti carskog reza se može utvrditi da je najzastupljeniji kod rađanja u gradu Zagrebu (32-33%). Također je vidljivo da se u sva četiri grada broj poroda svake godine smanjuje. Uzmemo li obzir analizirani period po pitanju učestalosti i trendova carskog reza od 2016-2020 godine u KBC-u Split možemo zaključiti da je prisutan trend porasta carskog reza. Počevši od 2016 godine gdje je postotak carskog reza iznosio 26%, zatim 2017 godine 27%, 2018 godine 26%, 2019 godine 29% te 2020 godine 31%. U istraživanom periodu, najvećem broju rodilja (55,6%) riječ je o prvom porodu. U odnosu na višerotke, prvorotke su češće rađale carskim rezom. Kod trudnica koje su prethodno rodile carskim rezom, veća je vjerojatnost ponovljenog carskog reza (43,6%). Tome najčešće pridonosi opasnost od rupture maternice, želja trudnice ali i porodničara Bitno je raditi na edukaciji rodilja već pri prvim pregledima u trudnoći, gdje bi se na razini primarne zdravstvene zaštite trebalo objasniti rizike i dugoročne posljedice carskog reza te ukazati važnost vaginalnog porođaja koji je bolji za majku i dijete, ukoliko ne postoji nikakva patologija trudnoće.The aim of this study was to examine the increase and trend of cesarean sections in the Clinical Hospital Center (CHC) Split in the period from 2016 to 2020, and to compare the data with those in the city of Zagreb, Rijeka and Osijek. Accordingly, the subject of the study was to investigate the frequency of cesarean delivery with regard to pathology during pregnancy, maternal age, number of maternal births and previous endings of labor. For the purposes of this research, data were collected in the birth books of CHC Split where data on the total number of 5993 mothers who gave birth by caesarean section were revealed, including data on the health status of mothers and newborns that led to cesarean section. Among the respondents, it was found that mothers older than 35 years more often end their pregnancies by caesarean section compared to younger pregnant women (62%). Pathologies in cesarean delivery are present in 474 mothers (7.91%). The most common pathology is gestational diabetes mellitus (31.86%), the second most common is preeclampsia which is present in 137 women with pathology (28.90%). The third most common pathology is hypothyroidism, which is present in 63 mothers with pathology (13.29%). Pathology in the form of thrombophilia was found in 42 mothers with pathology (8.86%). Given the above, pregnant women with the present pathology more often completed the delivery by caesarean section. The research included four croatian cities, Split, Zagreb, Rijeka and Osijek. In all four observed cities from 2016 to 2020, there is a higher number of natural births compared to cesarean section. According to the prevalence of caesarean section, it can be determined that it is most prevalent at birth in the city of Zagreb (32-33%). It is also evident that in all four cities the number of births is decreasing every year. If we take into account the analyzed period in terms of frequency and trends of cesarean section from 2016-2020 in CHC Split, we can conclude that there is a trend of increasing cesarean section. Starting in 2016 where the percentage of cesarean section was 26%, then in 2017 27%, in 2018 26%, in 2019 29% and in 2020 31%. In the researched period, the largest number of mothers (55.6%) had their first childbirth. Compared to the mothers who already gave birth, mothers with first pregancy are more likely to have caserean section. Pregnant women who have previously given birth by caesarean section are more likely to have a repeated caesarean section (43.6%). The danger of uterine rupture, the wishes of the pregnant woman and the obstetrician usually contribute to this. It is important to work on educating mothers during the first examinations in pregnancy, where primary health care should explain the risks and long-term consequences of cesarean section and point out the importance of vaginal delivery, which is better for mother and child, if there is no pathology