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Uvod: V slovenskem prostoru zadnja leta narašča zanimanje po porod v domačem okolju, zato nas je zanimalo, kako poteka in kako uspešno je oživljanje novorojenčka v izvenbolnišničnem okolju. Nujna medicinska pomoč ni na voljo v tako kratkem času kot v porodnišnici, zato so pri intervencijah kot je stabilizacija in oživljanje potrebne prilagoditve. Namen: Namen diplomskega dela je predstaviti prve ukrepe oživljanja ob odsotnosti dihanja in srčne akcije pri novorojenčku v izvenbolnišničnem okolju in ugotoviti, kateri so možni zapleti med porodom, ki lahko vodijo do potrebe po intervenciji oživljanja ter kompetence diplomirane babice za oživljanje novorojenčka. Metode dela: Pri izdelavi diplomskega dela je bila uporabljena deskriptivna metoda dela. Pregledana je bila strokovna domača in tuja literatura v podatkovnih bazah in spletnih straneh PubMed, Medline, Google scholar, American Journal of Obstetrics and Gynecology, American Academy of Pediatrics, Kobo Deskop in GOV.si. Rezultati: Vsakega novorojenčka po rojstvu najprej stimuliramo s sušenjem in segrevanjem. V kolikor ob čistih dihalnih poteh ugotovimo odsotnosti dihanja, po prvi minuti začnemo z začetnimi petimi vpihi. Če po prvih vpihih otrok ne diha redno, nadaljujemo s predihavanjem 1 minuto. Če ponovno ocenimo, da otrok ne diha, srčna frekvenca pa je nad 60 utripov na minuto, nadaljujemo z ventilacijo. Če novorojenček še vedno ne diha in ima srčni utrip pod 60 udarcev na minuto, je potrebna masaža srca. V nizkorizični skupini žensk, med katero spadajo kandidatke za porod na domu, je najpogostejši razlog za potrebo po oživljanju distocija ramen in aspiracija mekonijske plodovnice. Pri slednji dihalne poti čistimo z aspiracijo, v primeru distocije pa zaplet rešujemo s prijemi od manj k bolj agresivnim. Diplomirana babica je za oživljanje novorojenčka kompetentna in usposobljena ter k ukrepom zavezana s Kodeksom etike za babice Slovenije. Znanje in veščine mora redno obnavljati kot to predpisuje Pravilnik o licencah izvajalcev v dejavnosti zdravstvene in babiške nege Slovenije. Razprava in zaključek: Da lahko ženska rodi v domačem okolju, mora ustrezati določenim kriterijem. To zmanjša možnosti za zaplete, ki bi vodili v potrebo po nujni intervenciji oživljanja novorojenčka. V Sloveniji študij, ki bi kazale stopnjo mortalitete novorojenčkov pri porodih v izvenbolnišničnem okolju še nimamo. Menimo, da bi taka raziskava pripomogla k oblikovanju jasnejših smernic za oživljanje novorojenčka pri porodu doma. Introduction: In recent years, there has been a growing interest in home birth in Slovenia, so we were interested in how it was possible to revive a newborn in a non-hospital environment. Emergency medical care is not available in such a short time as in a maternity hospital, so interventions such as stabilization require adjustments. Purpose: The purpose is to present the resuscitation in the absence of breathing in cardiac actions in a newborn in an outpatient setting and find out, what are possible complications during labour that may lead to resuscitation and the competence of a graduate midwife to resuscitate a newborn. Methods: A descriptive method of work was used in the preparation of the gradution thesis. Slovenian and English literature was searched in databases on the websites PubMed, Medline, Google Scholar, American Journal of Obstetrics and Gynecology, American Academy of Pediatrics, Kobo Deskop and GOV.si. Results: Afret birth we stimutale every newborn with drying and worming up. If the newborn is not breathing and has clean airways, after 1 minute we start with the initail five rescue breaths. If the baby is not breathing after the first five rescue breaths, we continue ventilation for 1 minute. If we again estimate that the child is not breathing, and the heart rate is above 60 beats per minute, we continue with ventilation. If the newborn is still not breathing and has a heart rate below 60 beats per minute, a heart massage is required. In a low risk groups of women, among whom are candidates for home birth, the most common reasons for resucitation are shoulder dystocia and meconium aspiration. In the latter, the airway is cleaned by aspiration, in case of shoulder dystocia we are using manevers from lass to more invasive. A graduate midwife is competente and trained for the revival of a newborn, which is dictated by the »Kodeks etike za babice Slovenije« and the rulebook on licenses of providers in the field of health care in midwifery care in Slovenia. Discussion in conclusion: In order for a woman to give birth in a home environment, she must meet certain criteria, which reduces the possibility of a complication that would lead to the need for urgent intervention to resuscitate the newborn. We do not yet have studies in Slovenia that would show the infant mortality rate. We believe that such research would help to continue the development of deliveries in the outpatient environment in our country. |
