Comparison of induced vs. spontaneous labor at the Department of Obstetrics and Gynecology at University hospital center Zagreb

Normalno trajanje trudnoće iznosi 280 dana ili 40 tjedana, a dovršenje trudnoće porođajem očekuje se između 38. i 40. tjedna. Porođaj spontano započinje fiziološkim promjenama u obliku dozrijevanja vrata maternice i nastankom materničnih kontrakcija. Ukoliko ne dođe do spontane inicijacije u očekivano vrijeme porođaja, nastavkom trudnoće postoji mogućnost nastanka komplikacija vezanih uz majku i novorođenče. Iz tog se razloga u slučaju termina trudnoće od 41. tjedna i više odlučuje za indukciju porođaja i dovršenje trudnoće. Ovo retrospektivno istraživanje provedeno je na Klinici za ženske bolesti i porode Kliničkog bolničkog centra Zagreb u razdoblju od 1. siječnja 2018. godine do 31. prosinca 2018. godine s ciljem da se utvrdi postoji li razlika u tijeku i ishodu porođaja koji su započeli spontano ili su inducirani. U promatranom je periodu na Klinici bilo 418 porođaja u terminu od 41. tjedna trudnoće i više, od čega je 59.5% započelo spontano, a 40.5% je inducirano. Parametri procjene tijeka i ishoda promatrani su kroz 3 kategorije: vezani uz majku, porođaj i novorođenče. Utvrđena je statistički značajna razlika u učestalosti ozljeda porođajnog kanala između istraživane i kontrolne skupine, tj. veći broj ozljeda zabilježen je kod induciranog početka porođaja (p = 0.0005). Statistički značajna razlika nije pronađena kod usporedbe duljine trajanja aktivne faze 1. porođajnog doba i 2. porođajnog doba, no ista je dokazana kod primjene epiduralne analgezije koja produljuje trajanje aktivne faze 1. porođajnog doba (p = 0.00026) i 2. porođajnog doba (p << 0.001). Broj dovršenja porođaja carskim rezom statistički se ne razlikuje u skupinama spontano započetih i induciranih porođaja kad se u obzir uzmu trudnoće od 41. tjedna i više. Nema statistički značajne razlike u potrebi za intenzivnim liječenjem novorođenčadi između istraživane i kontrolne skupine. Zaključno proizlazi kako u najvećem broju parametara koji opisuju tijek i ishod porođaja nema statistički značajne razlike između spontano započetih i induciranih porođaja. Obzirom na rizik većeg perinatalnog mortaliteta i morbiditeta povezanog s komplikacijama post-terminskih trudnoća, postoji tendencija da se porođaj inducira u trudnoća koje traju 41 tjedan i više.The usual duration of pregnancy is 280 days or 40 weeks and the termination of pregnancy with childbirth is expected between 38 and 40 weeks. Childbirth spontaneously begins with physiological changes in the form of maturation of the cervix and the occurrence of uterine contractions. If spontaneous initiation does not occur at the expected time of delivery, with the continuation of pregnancy there is a possibility of complications related to the mother and a newborn. For this reason, in the case of a gestational age of 41 weeks and older, it is decided to induce labour and complete the pregnancy. This retrospective study was conducted in Women's department at University hospital centre Zagreb in the period from 1 January, 2018 to 31 December, 2018 in order to determine whether there is a difference in the course and outcome of deliveries that began spontaneously or are induced. In the observed period, there were 418 deliveries at the Clinic in the period from the 41st week of pregnancy and more. 59.5% began spontaneously and 40.5% were induced. Outcome parameters were observed through 3 categories: maternal, childbirth and neonatal. The statistically significant difference was found in the frequency of birth canal injuries between the study and control groups (p = 0.0005). No statistically significant difference was found when comparing the duration of the active phase of the 1st childbirth period and the 2nd childbirth period but the difference was proved when applying epidural analgesia that prolongs the duration of the active phase of the 1st childbirth period (p = 0.00026) and the 2nd childbirth period (p << 0.001). The number of completed cesarean deliveries did not differ statistically in the groups of spontaneously initiated and induced births. There was no statistically significant difference in the need for intensive neonatal treatment between the study and control groups. In conclusion, it follows that in most of the parameters that describe the outcome of labour there is no statistically significant difference between spontaneously initiated and induced labor. The tendency is induction of labour at 41 weeks of gestation due to a decrease in perinatal mortality and morbidity associated with complications of post-term pregnancies