Uvod: Zdravstveno osebje ima velik vpliv na doživljanje staršev ob rojstvu nedonošenega otroka. Namen raziskave je bil preučiti in predstaviti doživljanje mater ob rojstvu nedonošenega otroka.Metode: ...Uporabljena je bila deskriptivna fenomenološka analiza. Na namenskem vzorcu enajstih mater, ki so imele izkušnjo rojstva nedonošenega otroka, rojenega med 24. in 35. tednom gestacije, so bili izvedeni delno strukturirani intervjuji. Najmlajša intervjuvanka je bila ob porodu stara 24 let in najstarejša 36. Za osem izmed njih je bil porod nedonošenega otroka prvi porod. Raziskava je potekala med majem in junijem 2017. Podatki so bili analizirani s pomočjo Giorgijevega pristopa, značilnega za fenomenološko raziskavo.Rezultati: Strukturo opisa sestavljajo štiri tematske skupine, ki opredeljujejo doživljanje mater ob rojstvu nedonošenega otroka: (1) potek poroda: želje in pričakovanja; (2) reprezentacijo materinstva: čustvovanje, navezanost, empatijo, spomine; (3) čustvovanje in skrb za nedonošenega otroka v poporodnem obdobju ter (4) (ne)profesionalnost zdravstvenih delavcev.Diskusija in zaključek: Izsledki raziskave kažejo, da je večina mater iskala vzroke prezgodnjega poroda. Veliko jim je pomenila podpora svojcev, zdravstvenih delavcev ter »sotrpink« z oddelka. Večina mater se je med porodom in hospitalizacijo soočala z negativnimi občutki; empatičen odnos zaposlenih jih je spodbujal in navdajal z upanjem ter zaupanjem.
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NUK, ODKLJ, UL, UM, UPUK, VSZLJ
SHORT CERVIX – WHAT NOW? Faris Mujezinović
Zdravniški vestnik (Ljubljana, Slovenia : 1992),
02/2018, Volume:
78
Journal Article
Peer reviewed
Open access
Background: It is possible to predict preterm delivery (PD) before 34 weeks by ultrasound measurement of uterine cervical length (CL). This is the reason why this screening method is more frequently ...used in clinical practice. Methods: I extracted from PubMed database Crane’s sistematic review and articles about association of CL with PD and instructions what is necessary to take into consideration and what to do in case of a short cervix. Results: Majority of studies suggested CL of 25 mm as a cut-off point for selecting pregnancy as high risk for PD. Minority of studies also used 15 mm as a cut-off point. This inconsistency in selecting an unique cut-off point, as some authors showed, is a result of ignoring gestational age when measurement of CL is made. CL is usually measured until 24 weeks of pregnancy and value of US measurement of CL made later in pregnancy or role of follow-up measure- ments are still unclear. In cases with threatened preterm labour where CL is measured there was 66 % reduction of unnecessary tocolysis. US measurement of CL is of a little value if there is a progressive dilatation of cervix (Bishop score > 6). Shirodkar cerclage in women with short cervix does not reduce the risk for PD. Vaginal progesteron causes a 50 % decrease of incidence of PD in women with short cervix (CL < 15 mm). We do not know which form of vaginal progesteron is most effective. Progesteron is uneffective in women with PD in previous pregnancy and CL > 25 mm. Conclusions: US measurement of CL becomes reliable criteria for detecting pregnancies with increased risk for PD before 34 weeks of pregnancy. It enables individual risk calculation for PD with consideration of other risk factors.
Antibiotike v času poroda uporabljamo za preprečevanje in zdravljenje okužb pri materi ter za preprečevanje okužb pri novorojenčkih. Kratkotrajna terapija med porodom se uporablja za preprečevanje ...okužb s streptokokom skupine B (SSB) pri novorojenčkih, poporodnega endometritisa in za zdravljenje horioamnionitisa. Številne raziskave so dokazale, da z uporabo profilaktičnih odmerkov antibiotikov lahko podaljšamo nosečnost (in nato izboljšamo rezultate obolevnosti in umrljivosti novorojenčkov) po predčasnem prezgodnjem razpoku plodovih jajčnih ovojev (PPROM).
Pri nosečnicah z aktivnim prezgodnjim porodom priporočamo: penicilin G 3g (ali 5mE) intravensko nato 1,5 g (ali 2,5 mE) intravensko v 4-urnih intervalih do poroda.
Pri nosečnicah, ki so alergične na penicillin, priporočamo:
Pri ženski, ki je imela blago obliko alergije s kožnim izpuščajem, svetujemouporabo cefalosporina. V primeru zabeležene hujše oblike alergije na penicillin, svetujemo uporabo vankomicina. Terapija s klindamicinom, zaradi visoke rezistence SSB na klindamicin, ni več priporočljiva.
V primeru dolgotrajnega PPROM je potrebno v primeru aktivnega poroda predpisati široko spektalni intravenski antibiotiki, ki preprečuje tudi SSB okužbo novorojenca (priporočamo Cefazolin 2g i. v in nato 1g v 8-urnih intervalih do poroda). V primeru PPROM priporočamo čim prej po PPROM pričeti s terapijo s: ampicilinom (2 g i.v. vsake 6 ur) za 48 ur hkrati z azitromicinom (1g p.o. v enkratnem odmirku), nadaljujemo s amoksicilinom (500 mg p.o. vsakih 8 ur) za 5 dni ali do poroda novorojenca.
Background: Slovenian perinatal results are compared with European results: sometimes they are in the higher, sometimes in the lower range. Analysing trends and comparisons with other countries helps ...in planning changes in organisation and function so we are prepared for future challenges. Introduction of new technologies demands appropriate answers to challenges, including ethical ones. Methods: We compared perinatal results in Slovenia from 1987 to 1996, the PERISTAT project results from the year 2000 and the EURO-PERISTAT project with 2004 perinatal results including the Slovenian. Results: Some of the more prominent Slovenian perinatal results are shown. Cesarean section rate is the lowest among 26 countries in Europe. Deliveries after artificial reproductive techniques are second most frequent. Teenage pregnancies are very rare. Seemingly high maternal mortality mirrors also strict recording and cross checking with other data bases. Relatively high stillbirth rate may reflect the fact that all induced labours for fetal malformations are recorded. Conclusions: In Slovenia we do have tools for quality collection of perinatal results which should be used and audited. To have comparable results inside Slovenia, definitions should be written at http://www.obgyn-si.org/. When changing delivery record markers of prenatal care should be added – they could be easily obtained from maternity booklets (electronic or paper). In maternity booklet there is a place to write about grand dad prostate cancer; let us replace it with risk factors for preterm delivery (medical history and cervical length), 12 weeks screening for preeclampsia and intrauterine growth restriction (ultrasonic and biochemi- cal markers), gestational diabetes and obesity (body mass index, waist – hips ratio) and hypothyroidism; let us leave some free space for the future screening tests. Known and proven efficient management (e.g. progesterone for recurrent preterm delivery prevention) should be used.
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