Doğum İndüksiyonu
Özet
Doğum indüksiyonu, gebeliğin anne veya fetüs açısından devamının risk oluşturduğu durumlarda uterin kontraksiyonların başlatılması ve servikal olgunlaşmanın sağlanması amacıyla uygulanan bir obstetrik girişimdir. Günümüzde indüksiyon oranları giderek artmakta olup, gebeliklerin yaklaşık %20’sinde doğum indüksiyonu uygulanmaktadır. İndüksiyon endikasyonları arasında postterm gebelik, preeklampsi, gestasyonel diyabet (GDM), intrauterin gelişme geriliği (IUGR), oligohidramniyos, erken membran rüptürü (EMR) ve intrauterin fetal ölüm yer almaktadır. Endikasyonsuz indüksiyon ise anne ve bebek açısından ciddi riskler barındırmaktadır. Başarılı bir indüksiyon için servikal olgunluk büyük önem taşımaktadır. Bishop skoru, serviksin açıklık, silinme, kıvam, pozisyon ve başın seviyesi parametrelerini değerlendirerek indüksiyon başarısını öngörmede en yaygın kullanılan skorlama sistemidir. Bishop skoru düşük olan olgularda prostaglandin preparatları ile servikal olgunlaştırma yapılması önerilmektedir. Oksitosin, indüksiyonun temel ajanıdır ve uterin kasılmaları uyararak doğumu başlatır. Mekanik yöntemler (Foley kateteri, laminaria) de özellikle serviks olgunlaşmamış olgularda kullanılabilir. Doğum indüksiyonu sırasında anne ve fetusun yakın takibi gereklidir. Uygunsuz veya aşırı indüksiyon, uterin hiperstimülasyon, fetal distres, sezaryen oranlarında artış ve uterin rüptür gibi komplikasyonlara yol açabilmektedir. Bu nedenle indüksiyon kararı, endikasyon, servikal durum ve fetal iyilik hali dikkate alınarak bireyselleştirilmelidir.
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