Uvod: Število carskih rezov pri nas in v svetu narašča. Zapleti pri carskem rezu so pogostejši kot pri vaginalnih orodih. Telesna aktivnost v času nosečnosti ima številne prednosti za žensko in ...otroka ter izboljša izide poroda. Namen pregleda literature je predstaviti, kako telesna aktivnost med nosečnostjo vpliva na pojavnost carskega reza. Metode: Izveden je bil sistematični pregled znanstvene literature v podatkovnih bazah PubMed, SAGE in Web of Science z iskalnim nizom v angleškem jeziku. Iskanje je bilo omejeno na randomizirane raziskave, objavljene med letoma 2012 in 2022. Za prikaz iskanja, pregleda in izbire člankov je bil uporabljen diagram poteka PRISMA. Opravljeni sta bili kritična ocena člankov in vsebinska analiza podatkov. Rezultati: Od skupno 703 zadetkov je bilo v končno analizo vključenih 12 raziskav. Telesna aktivnost med nosečnostjo vpliva na pojavnost carskega reza in lahko prispeva k manjši možnosti za pojav slednjega. Nosečnicam se priporoča zmerna telesna aktivnost v trajanju od 30 do 60 minut, dva- do štirikrat tedensko. Diskusija in zaključek: Ugotovitve kažejo, da telesna aktivnost med nosečnostjo vpliva na zmanjšanje pojavnosti carskega reza. Pomembno je, da zdravstveni delavci vzpodbujajo in motivirajo nosečnice za vodeno, redno telesno aktivnost.
Analysis of the Beaucage model Hammouda, Boualem
Journal of applied crystallography,
December 2010, Volume:
43, Issue:
6
Journal Article
Peer reviewed
The Beaucage model is used to analyze small‐angle scattering (SAS) data from fractal and particulate systems. It models the Guinier and Porod regions with a smooth transition between them and yields ...a radius of gyration and a Porod exponent. This model is an approximate form of an earlier polymer fractal model that has been generalized to cover a wider scope. The practice of allowing both the Guinier and the Porod scale factors to vary independently during nonlinear least‐squares fits introduces undesired artefacts in the fitting of SAS data to this model. Such artefacts as well as an error in the original formulation of the model are discussed. This model is compared with other published models.
Cilj je ovoga preglednog rada ukazati na moguće rizike prijevremenoga poroda za daljnji razvoj djece te prikazati rezultate recentnih istraživanja psihofizičkoga zdravlja roditelja prijevremeno ...rođene djece. Istraživanja pokazuju da posljedice koje prijevremeno rođenje ima za djecu mogu biti ozbiljne, pri čemu rizik od neurorazvojnih poremećaja raste s nižom gestacijskom dobi djeteta i nižom porodnom težinom. Rizici prijevremenoga rođenja djeteta za roditelje mogu se očitovati neposredno i/ili dugoročno, od akutne stresne reakcije do poslijetraumatskoga stresnog sindroma, poteškoća u razvoju privrženosti, perzistirajuće intenzivne brige i straha za dijete, što je dodatno naglašeno prelaskom djeteta iz bolničkoga okruženja na kućnu njegu. Inicijalna emocionalna i informativna podrška medicinskoga osoblja, prakticiranje tzv. klokanske njege, dostupnost stručnjaka za mentalno zdravlje te neformalni izvori podrške izuzetno su važni čimbenici prilagodbe roditelja. Pregled suvremenih istraživanja upućuje na potrebu za daljnjim ispitivanjima čimbenika koji se dovode u vezu s (ne)uspješnom psihofizičkom prilagodbom roditelja na prijevremeno rođenje djeteta i skrb o nedonoščetu. Budući da je adekvatno suočavanje roditelja važan preduvjet razvojnih ishoda kod neurorizične djece, bitno je osigurati programe podrške roditeljima da bi se osnažila njihova znanja i kompetencije.
Uvod: V prispevku predstavljamo rezultate raziskave, s katero smo proučevali izvajanje preventivnih aktivnosti za varovanje reproduktivnega zdravja žensk v Sloveniji v predporodnem in poporodnem ...obdobju. Namen kvantitativne raziskave je bil proučiti pojavnost in vsebino predporodne in poporodne obravnave žensk v Sloveniji. Metode: Presečna raziskava je potekala od marca 2015 do marca 2022. Podatki so bili zbrani z anketnim vprašalnikom, na priložnostnem vzorcu 2.102 žensk. Analiza podatkov je vključevala osnovno deskriptivno statistiko z izračuni frekvenc in odstotkov. Za analizo razlik med ženskami prvorodnicami in ženskami mnogorodnicami smo uporabili Hi-kvadrat preizkus. Statistična značilnost je bila upoštevana na ravni petodstotnega tveganja. Rezultati: Raziskava je pokazala, da so v času nosečnosti obiski s strani medicinskih sester v patronažnem varstvu zelo redki (14 %). Po ocenah žensk je bila najpogosteje zastopana vsebina obiska poučevanje nosečnice o stanjih, v katerih mora ženska takoj v porodnišnico (61 %). Največ otročnic (22 %) in njihovih novorojenčkov je bilo po porodu deležnih štirih obiskov medicinskih sester v patronažnem varstvu. Ženske po porodu so bile najpogosteje deležne svetovanja s področja dojenja – prednosti dojenja in materinega mleka za otroka (79 %), medtem ko je bila obravnava novorojenčka največkrat namenjena kopanju (92 %). Diskusija in zaključek: Iz rezultatov je razvidno, da sta v slovenski praksi pojavnost in vsebina obiskov nosečnic in otročnic s strani medicinske sestre v patronažnem varstvu/babice različni. Pri pregledu otročnic so obravnave v večji meri bolj kot na otročnico osredotočene na novorojenčka, kar kaže seznam treh najpogosteje izvedenih intervencij na poporodnih obiskih: svetovanje o prednostih dojenja, položajih pri dojenju in prehrani med dojenjem.
Uvod: Namen raziskave je bil ugotoviti, ali lahko z uvedbo multimodalne analgezije po carskem rezu zmanjšamo odmerke opioidov in pospešimo pooperativno okrevanje. Metode: V retrospektivni kohortni ...raziskavi sta bili primerjani dve skupini: eksperimentalna (po uvedbi novega analgetičnega režima) in kontrolna skupina (pred uvedbo novega analgetičnega režima). Opazovana je bila sposobnost samostojne osebne higiene porodnice, skrb za novorojenčka po carskem rezu in čas od operacije do prvega podoja. Pri statistični analizi je bil uporabljen test hi-kvadrat in Mann-Whitneyjev U-test. Rezultati: V skupino z quadratus lumborum blokom in v kontrolno skupino smo vključili po 58 otročnic. Po uvedbi multimodalnega analgetičnega režima je večji delež otročnic samostojno skrbel za osebno higieno po šestih urah po carskem rezu (44 (76 %) otročnic v skupini quadratus lumborum blok in nobena v skupini opioidne analgezije). Po dvanajstih urah se je delež pri skrbi za osebno higieno v skupini, v kateri smo lajšali bolečino z opioidno analgezijo, nekoliko popravil 55 (95 %) v prvi skupini in v drugi skupini 28 (48 %, p < 0,001). Prvi podoj po carskem rezu je bil v prvi uri po operaciji pogostejši pri kontrolni skupini (19 otročnic pri quadratus lumborum bloku (33 %) in 32 otročnic z opioidno analgezijo (55 %, p = 0,02), po dveh urah razlik ga niso zaznali. Diskusija in zaključek: Z multimodalnim analgetičnim načinom pripomoremo k hitrejšemu samostojnemu izvajanju negovalnih aktivnosti otročnice, ki ji omogočajo hitrejšo prilagoditev na novo življenjsko vlogo.
Uvod: Vpliv porodnega položaja na tveganje za poškodbo presredka, ki je odvisen od lokalnih in regionalnih babiških praks, kot so ročna tehnika zaščite presredka, razne stopnje epiziotomije in ...operativnih porodov itd., še ni zadostno raziskan. Namen raziskave je bil v eni od slovenskih porodnišnic preučiti morebitno povezavo med porodnim položajem ob iztisu ploda in pojavnostjo poškodbe presredka.Metode: V retrospektivno kohortno raziskavo smo vključili 625 porodnic, ki so leta 2021 rodile v Splošni bolnišnici Jesenice. Izključili smo večplodne nosečnosti, prezgodnje porode, porode s plodom v medenični ali okcipito-posteriorni vstavi, vakuumske ekstrakcije ploda in epiziotomije. Z multiplo logistično regresijo smo preučili, ali je bil položaj porodnice ob iztisu ploda (leže na hrbtu (n = 66), leže na boku (n = 404) ali vsi ostali položaji (n = 155)) neodvisno povezan s pojavnostjo poškodbe presredka.Rezultati:Pri 363 porodnicah (58 %) ni prišlo do poškodbe presredka. Pri 192 (73 %) je prišlo do poškodbe prve stopnje, pri 59 (23 %) do poškodbe druge stopnje in pri 11 (4 %) do poškodbe presredka tretje ali četrte stopnje. Porodni položaj ob iztisu ploda ob upoštevanju drugih potencialnih dejavnikov tveganja ni bil statistično pomembno povezan s tveganjem za poškodbo presredka: razmerje obetov (RO) 0,691, 95% interval zaupanja (IZ) – 0,401–1,191 za položaj na boku; RO 0,710, 95% IZ – 0,386–1,306 za ostale položaje v primerjavi s porajanjem leže na hrbtu.Diskusija in zaključek: V slovenski porodnišnici z visokim odstotkom porodnic, ki ne rodijo leže na hrbtu, porodni položaj ob iztisu ploda ni neodvisni dejavnik tveganja za nastanek poškodbe presredka
Background. Postpartum haemorrhage from ruptured tissues can usually be diagnosed and managed properly. A problem exists with the occult haemorrhage without evident tissue trauma in which case a ...haematoma develops. Methods. After a normal delivery of the 41 years old secundipara after a previous caesarean in epidural analgesia a boy was born. Placenta was delivered spontaneously and perineal rupure sutured properly. About an hour after the delivery heavy pain was noted in the lower abdomen. Pelvic exam revealed a paravaginal haematoma and ultrasound scan coagulated and fresh blood behind the uterus. Rupture of the uterus was suspected and laparotomy revision performed. During the laparotomy there was no haemorrhage in the pelvic cavity, no uterine rupture but a large retroperitoneal haematoma extending to mesosigmoidal part of intestinum. Paravaginal heamatoma was evacuated vaginally and after half an hour the retroperitoneal haematoma diminished by 50 %. The patient received two blood transfusions. The blood loss was estimated as about 500 grams. The pulse and blood pressure were normal all the time. The laboratory values of haemoglobin was 96 g/l, haematocrit 0.30 before the operation and 93 g/l and 0.28 respectively 6 hours after. Beside anaemia the postoperative course was uneventful and the patient was dismissed from the hospital the 6th day postpartum. Conclusions. Although the laparotomy seems an excessive treatment it was the only way to exclude uterus rupture after a previous caesarean, heavy pain in the lower abdomen and blood behind the uterus noted on the ultrasound scan. In the non-urgent situation a CT scan could be performed to locate the blood accumulation and possibly exclude uterine rupture.
Background. The study presents the experience with epidural analgesia (EPA) for pain relief in Izola General Hospital from 2003 to 2006, the differences of labour between epidural analgesia and ...without it and the parturients’ satisfaction. Methods. A retrospective observational study was performed. Data were compared between 214 parturients with EPA matched by 214 parturients without. The control parturient was the equiipara with a term birth and the cephalic presentation of fetus that delivered just before the parturient of the EPA group. Maternal age, labor length, rate of oxitocin use, instrumental deliveries and cesarean sections, Apgar scores and birthweights were compared. The questionnaire was used to estimate the pain in 62 parturients. Results. In GH Izola in 214 parturients (10 %) EPA was applied for labour pain relief in the period from July 2003 till December 2006. In the EPA group there was a statistically significance compared with the control group: higher parturients’ mean age (30.5 vs 28.7 y.o.; p < 0.0005), longer labour length (278 vs 222 min; p < 0.0005), higher oxitocin use rate (93.4 % vs 72.9 %; p < 0.0001) and higher instrumental delivery rate (vacuum extraction 14 % vs 1.9 %; p < 0.0001). The cesarean section rates were equal in both groups. Despite the higher instrumental delivery rate and the longer labour length in the EPA group there were no worse perinatal outcomes, neither was statisticaly significant difference in Apgar scores compared with the control group. The mean intensity of pain was highest before the EPA application (VAS 7), lowest during the transition stage (VAS 1.5) and some higher during the second phase (VAS 2.7). Most of parturients in the EPA group were satisfied; 92 % of them evaluated the EPA as good or very good. Conclusions. EPA is a very effective method for pain control during labor. The parturients’ satisfaction with this pain control method is appropriate. Despite the higher instrumental delivery rate and the longer labour length EPA didn’t worsen the perinatal outcome.
Background: The purpose of this analysis was to find whether the quality indicators of perinatal care in Slovenia change. Methods: We used the same quality indicators which are used in the European ...project Europeristat1 to compare the quality of perinatal care among the countries of the European Union. We used two 5-year periods, from 1998 to 2002 (reference period) and from 2003 to 2008 (observed period). Data for perinatal quality were collected from the National Perinatal Information System of the Republic of Slovenia.2 Statistical significance was tested using the Pearson’s chi-square test. Results: Between 1998 and 2002, there were 87.679 labours ending in the delivery of 88.678 new- borns, and between 2003 and 2008, there were 90.662 labours ending in the delivery of 91.736 babies. In the observed period (2003 do 2008) mothers had statistically significantly higher educational level, a higher percentage came to their first pregnancy examination before the 12th week of gestation (84.0 % vs. 75.3 %), a higher percentage conceived after assisted reproductive techniques (2.0 % vs. 1.7 %), and the incidence of multiple pregnancies was higher (1.7 % vs. 1.6 %). Significantly lower were the percentages of labours without medical interventions (34.7 % vs. 41.9 %) and of spontaneous onset of labour (74.0 % vs. 92.6 %). The percentages of induced labours and of elective cesarean sections increased dramatically (20.1 % vs. 6.6 % and 6.0 % vs. 0.9 %). The increase in the overall percentage of cesarean sections (14.8 % vs. 11.0 %) is mainly due to increased incidence of elective cesarean sections, but the percentage of operative termination of vaginal labour increased as well (3.1 % vs. 2.6 %). The incidence of episiotomies was lower (48.7 % vs. 51.0 %) and so was the incidence of 2nd degree perineal lacerations (4.5 % vs. 5.4 %), while the incidence of 3rd–4th degree lacerations was higher (0.3 % vs. 0.2 %). Transfusion was required in a lower percentage (0.3 % vs. 1.0 %), but the percentage of hysterectomies increased (0.1 % vs. 0.03 %). The incidence of eclampsia was the same in the two time periods (0.1 %). Among preterm deliveries, the higher percentage occurred between 32 and 36 gestational weeks (5.9 % vs. 5.5 %), while there were no differences among the deliveries between the 22nd and 31st gestational week. Stillbirths after the 22nd gestational week was the same in both periods, 5 per 1000 of all newborns, whereas early (2 per 1000 vs. 3 per 1000) and late (0.04 per 1000 vs. 0.4 per 1000) neonatal mortality rates were lower. In both time periods lethal malformations were the cause of death in 1/3 of stillborn babies 1/3 of neonates. Conclusions: Over the last years, an increase in operative deliveries and a decrease in deliveries without medical interventions have been observed in Slovenia. Despite the fact that mothers come to their first prenatal examination earlier in pregnancy than before and that they are more educated, i.e. they have a better socio-economic status, the incidence of preterm deliveries increases, while the mother’s health and the incidence of stillbirths have not changed sig- nificantly. The decrease in neonatal mortality rate should be highlighted.
