| Abstract | Uvod: Metode analgezije(obezboljenja) porođaja su:inhalacijska analgezija(dušični oksidul i hlapivi anestetici), sistemska analgezija(opioidni analgetici i koanalgetici), lokalna i regionalna analgezija(epiduralna, spinalna i kombinirana) te komplementarne i alternativne metode(akupunktura, hipnoza). Sistemska i epiduralna analgezija najčešće su metode koja se koriste za ublažavanje boli kod porođaja. Korištenje farmakoloških sredstava za ublažavanje boli pri porođaju olakšavaju patnju majci, ali postoji bojazan da bi moglo imati štetne učinke na ishod dojenja. Svrha ovoga rada je ispitati moguću povezanost korištenih analgezija tijekom porođaja sa stavovima rodilja prema dojenju s posebnim naglaskom na epiduralnu analgeziju i analgeziju petidinom.
Cilj: Glavni cilj istraživanja je utvrditi postoji li statistički značajna razlika u učestalosti dojenja nakon porođaja između rodilja koje su dobile epiduralnu analgeziju i onih koje su dobile analgeziju petidinom. Sporedni ciljevi istraživanja su: ispitati jesu li rodilje koje su imale svoj prvi porođaj češće dobivale epiduralnu analgeziju, za razliku od rodilja koje su imale više od jednog porođaja; što su bili primarni izvori informacija rodiljama kada se radi o analgeziji; jesu li se rodilje koje su bile podvrgnute epiduralnoj analgeziji ili analgeziji petidinom više informirale kod osoblja u rodilištu ili iz drugih izvora; je li većina rodilja vlastitu odluku o dojenju donijela tijekom ili nakon trudnoće; jesu li rodilje zadovoljne analgezijom tijekom porođaja te postoji li statistički značajna razlika u zadovoljstvu analgezijom između rodilja koje su dobile epiduralnu analgeziju i onih koje su dobile analgeziju petidinom; što je bio glavni razlog prestanka dojenja rodilja te postoji li statistički značajna razlika u razlozima prestanka dojenja između sudionica koje su dobile epiduralnu analgeziju i onih koje su dobile analgeziju petidinom?
Ispitanici i metode: U istraživanju je sudjelovalo 130 rodilja poslije vaginalnog porođaja. Statistička analiza je napravljena pomoću hi-kvadrat testa s preciznim p-vrijednostima i dva miješana logistička modela. Istraživanje je provedeno na osnovu anketnog upitnika napravljenog za ovo istraživanje, na dobrovoljnoj osnovi i potpuno anonimno te telefonske ankete 4 tjedna po otpustu iz rodilišta.
Rezultati: Rodilje su pri prvom porođaju statistički značajno češće dobivale epiduralnu analgeziju(z = 4.74, p < .001), dok su rodilje pri drugom (z = 2.80, p = .005) i trećem (z = 2.92, p = .004) porođaju statistički značajno češće dobivale analgeziju petidinom.
Najvećem broju rodilja primarni izvor informacija o analgeziji bilo je osoblje u rodilištu (65, 50. 00%), otprilike četvrtini Internet (35, 26.92%), ginekolog (24, 18.46%), dok su forumi (5, 3.85%) i obiteljski liječnik (1, 0.77%) najslabije zastupljeni.
Rodilje su se statistički značajno razlikovale po primarnom izvoru informacija s obzirom na to kakvu su analgeziju dobile, uz malu veličinu afekta (χ2 (4) = 11.313, p = .013, V = .295). Kod osoblja u rodilištu češće su se informirale rodilje koje su primile analgeziju petidinom (z = 2.98, p = .003).
Nisu pronađene statistički značajne razlike u odluci o dojenju tijekom ili nakon trudnoće između rodilja koje su dobile epiduralnu analgeziju i onih koje su dobile analgeziju petidinom (χ2 (1) = 1. 359, p = .440, V = .102).
Dvije trećine rodilja zadovoljne su analgezijom tijekom porođaja (82, 63.08%), otprilike četvrtina je djelomično zadovoljna (34, 26.15%), dok je desetina nezadovoljna (14, 10.77%). Nisu pronađene statistički značajne razlike u zadovoljstvu analgezijom između rodilja koje su dobile epiduralnu analgeziju i onih koje su dobile analgeziju petidinom (χ2 (2) = 3.388, p = .197, V = .161).
Nisu pronađene statistički značajne razlike u razlozima prestanka dojenja između rodilja koje su dobile epiduralnu analgeziju i onih koje su dobile analgeziju petidinom (χ2 (1) = 0.112, p = 1, V = .079). Kao glavni razlog prestanka dojenja rodilje navode da nemaju mlijeka (12, 66,67%).
Zaključak: Istraživanje je pokazalo kako ne postoji statistički značajna razlika u učestalosti dojenja nakon porođaja između rodilja koje su dobile epiduralnu analgeziju i onih koje su dobile analgeziju petidinom. |
| Abstract (english) | Introduction: Methods of analgesia for pain relief during labor include: inhalational analgesia (nitrous oxide and volatile anesthetics), systemic analgesia (opioid analgesics and co-analgesics), local and regional analgesia (epidural, spinal and combined spinal epidural analgesia), as well as complementary and alternative techniques (acupuncture, hypnosis). Systemic and epidural analgesia are the most common methods for pain relief during vaginal delivery. Administration of drugs for pain relief reduces agony during birth, but also has a potential to affect breast-feeding. Goal of this research is to determine relationship between different methods of labor analgesia and attitudes of parturients towards breast-feeding, focusing on epidural analgesia and systemic administration of pethidine in particular.
Goals: Primary goal is to determine the difference in frequency of breast-feeding between parturients who received epidural analgesia and those who received pethidine for labor analgesia.
Secondary goals are: to determine if epidural analgesia is more common in primiparas or multiparas; to determine primary sources of informations on methods of labor analgesia ; to determine whether primary sources of informations, for parturients who received epidural analgesia and pethidine, came from delivery ward personell or from other sources; to determine whether parturients made decision on breast-feeding during pregnancy or after delivery; to determine parturients satisfaction with analgesia administered during labor and delivery and also to determine the difference in satisfaction between those who received epidural analgesia and those who received pethidine; to determine main causes of breast-feeding cessation and also to determine differences in causes of cessation of breast-feeding between parturients who received epidural analgesia and those who received pethidine.
Methods: Study included 130 parturients after vaginal delivery. In statistical analysis, Chi Square test with precise p-values and two logistic models were used. Research was conducted on the basis of voluntary and anonymous questionnaire and telephone survey which was done four weeks after discharge from the hospital.
Results: Epidural analgesia was more common method for labor analgesia in primiparas (z = 4.74, p < .001), while pethidine was more common method in parturients giving second (z = 2.80, p = .005) and third vaginal delivery (z = 2.92, p = .004).
Most parturients received informations on methods for analgesia from delivery ward personell (65, 50. 00%), around quarter of examinees received informations from the Internet (35, 26.92%), some received informations from gynecologist (24, 18.46%), as well as from Internet forums (5, 3.85%) and family practice specialist (1, 0.77%).
A difference was found for primary source of informations between parturients who received epidural analgesia and those who received pethidine (χ2 (4) = 11.313, p = .013, V = .295). Delivery ward personell was the most common source of informations for parturiens who received pethidine (z = 2.98, p = .003).
No difference was found for breast-feeding decision making between parturients who received epidural analgesia and those who received pethidine (χ2 (1) = 1. 359, p = .440, V = .102).
Around two thirds of parturients were satisfied with analgesia administered during labor and delivery (82, 63.08%), one quarter was partially satisfied (34, 26.15%), while one tenth of parturients were unsatisfied (14, 10.77%). No difference in satisfaction was found between parturients who received epidural analgesia and those who received pethidine (χ2 (2) = 3.388, p = .197, V = .161).
No difference was found for the reasons on breast-feeding cessation between parturients who received epidural analgesia and those who received pethidine (χ2 (1) = 0.112, p = 1, V = .079). Most common reason for cessation of breast-feeding was low milk quantity (12, 66,67%).
Conclusion: There is no difference in frequency of breast-feeding between parturients who received epidural analgesia and those who received pethidine during vaginal delivery |
