Vplyv drenáže pupočníka po spontánnom pôrode na tretiu dobu pôrodnú


Authors: Erik Dosedla 1 ;  Petra Gašparová 1 ;  Zuzana Ballová 1 ;  M. Sitáš 1 ;  P. Calda 2
Authors‘ workplace: Department of Gynaecology and Obstetrics, Faculty of Medicine, Pavol Jozef Safarik University in Kosice and Hospital Agel Košice-Šaca Inc., Košice-Šaca, Slovak Republic 1;  Department of Gynaecology, Obstetrics and Neonatology, First Faculty of Medicine Charles University and General Teaching Hospital, Prague, Czech Republic 2
Published in: Ceska Gynekol 2023; 88(4): 260-263
Category: Original Article
doi: https://doi.org/10.48095/cccg2023260

Overview

Drenáž pupočníka zahŕňa uvoľnenie Peánových klieští z pupočníka po oddelení novorodenca z maternálneho konca pupočníka. Následne dochádza k vyprázdňovaniu krvi z placenty. Tento postup je súčasťou aktívneho vedenia III. doby pôrodnej (TSL – third stage of labor). Cieľ: Táto štúdia je určená na poskytnutie poznatkov o dĺžke trvania tretej doby pôrodnej a riziku retencie placenty pri použití drenáže pupočníka, a pri postupe bez drenáže pupočníka. Materiál a metodika: Prospektívnej randomizovanej štúdie manažmentu TSL sa zúčastnilo 600 pacientiek. Pacientky boli rovnomerne rozdelené do dvoch skupín s drenážou pupočníka (300) a bez drenáže pupočníka (300). TSL bola aktívne vedená odporúčaniami FIGO (the International Federation of Gynecology and Obstetrics). Sledovali sme trvanie TSL a retenciu placenty po 30 min. Výsledky: Priemerné trvanie TSL bolo 6,8 ± 0,4 min v skupine s drenážou a 11,6 ± 0,8 min v kontrolnej skupine. Dospeli sme k záveru, že drenáž pupočníka významne skracuje trvanie TSL (p = 0,026), ako aj znižuje riziko retencie placenty. V skupine, s použitou drenážou pupočníka sa retencia placenty 30 min po pôrode plodu vyskytla v čtyroch prípadoch, kým v druhom súbore sa vyskytla v 14 prípadoch (RR 3,62; 95% CI 1.18–11.14). Záver: Predpokladáme, že pri drenáži pupočníka dochádza ku kolabovaniu tenkostenných uteroplacentárnych ciev skôr, čo spôsobuje krvácanie z týchto ciev medzi placentu a stenu maternice, a týmto mechanizmom dochádza k včasnejšiemu odlúčeniu placenty. Samozrejme, že drenáž pupočníka je len jedným z krokov algoritmu aktívneho vedenia tretej doby pôrodnej podľa FIGO.

Klíčová slova:

III. doba pôrodná – drenáž placenty – manuálne vybavenie placenty – popôrodné krvácanie – retinovaná placenta


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Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine

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Czech Gynaecology

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2023 Issue 4

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