Possibilities in antenatal and itrapartal diagnostics of imperilled preterm born child

Ako želimo smanjiti broj prijevremenih poroda, potrebno je provoditi uspješnu antenatalnu i intrapartalnu dijagnostiku. Glavni načini dijagnostike su: pregledi tijekom trudnoće, utvrđivanje ranih znakova prijevremenog poroda, kardiotokografija, fetalna ph-metrija, analiza obriska cerviksa i urina, laboratorijskih nalaza, UZV, amniocenteza, te amnioskopija. Prilikom utvrđivanja ranih znakova prijevremenog poroda treba se služiti tokolitičkim indeksom, a pri analizi kardiotokografskog zapisa - kardiotokografskim indeksom. Utvrđivanje podudarnosti bakterija u obrisku vrata maternice, trudnica sa SIAI i ejakulata njihovih supružnika govori o mogućnosti prijenosa bakterija spolnim putem. Uspješna antenatalna i intrapartalna dijagnostika ugroženosti prijevremeno rođenog djeteta dovodi do smanjenja perinatalnog mortaliteta i neonatalnih komplikacija.If we want to reduce the number of preterm deliveries, we must make a successful antenatal and intrapartal diagnosis. The principle ways of diagnosing are: examinations during pregnancy, establishment of an early index measurement, analysis of the cervical smear and the urine, laboratory reports, echosonography, amniocentesis, amnioscopy. When we establish the early index of the preterm delivery, we must use tocolytical index, and when we analyse CTG, we must use the cardiotocographycal index. The determination of the same bacteria in the cervical smear of pregnant women with SIAI and in the ejaculate of their partners, proves that the bacteria can be sexually transmitted. The successful antenatal and intrapartal diagnosis of the imperilled preterm bom child can reduce the perinatal mortality and neonatal complications

Gynecological and obstetrical emergencies

Hitna stanja u ginekologiji i opstetriciji, prema izvješću Hrvatske liječničke komore, ubrajaju se među pet najurgentnijih stanja u medicini te je samim time naglašena važnost hitne intervencije. Ukoliko izostane hitan pristup, u opstetriciji nije ugrožen jedan život, kao u ginekologiji, nego dva, život majke i djeteta, pa je to daljnji razlog za urgentnost. U ginekologiji su najčešća hitna stanja izvanmaternična trudnoća, torkvirana cista kao i ruptura ciste corpusa haemorrhagicusa, a u opstetriciji abrupcija placente, placenta previja te postpartalno krvarenje. Uz ta stanja koja se većinom rješavaju operativnim putem, nadovezuje se i tromboembolijska bolest koja se danas najčešće liječi niskomolekularnim heparinom.According to the Croatian Medical Chamber report, gynecological emergencies and especially obstetrical emergencies are listed among five most urgent medical states, essential to act upon immediately. In obstetrics, if there is no immediate response, two lives, that of the mother as well of the child are in danger, which is an additional reason for urgent intervention. The most frequent gynecological emergencies are considered to be: ectopic pregnancy, torquated cyst as well as ruptured cyst of corpus haemorrhagicus and in obstetrics: placental abruption, placenta previa and postpartal hemorrhage. All of these conditions are in most cases managed surgically with exception of thromboembolic disease which is at present treated with low-molecular-weight heparin

Assessment of HPV DNA Test Value in Management Women with Cytological Findings of ASC-US, CIN1 and CIN2

The aim of this retrospective study was to answer the following questions: 1) is HPV DNA test for high-risk types able to predict lesion behaviour in women with cytological abnormalities lower than CIN3 (ASC-US, CIN1 and CIN2); 2) how to predict the histological diagnosis CIN3, and 3) is its use in diagnostic management in these patients justified or not? The study included 345 women (11 ASC-US, 312 CIN1 and 22 CIN2) that underwent conventional diagnostic management (repeat cytology and colposcopy with or without histology) and HPV testing for high-risk HPV types by PCR method. The value of HPV DNA test in predicting lesion regression/persistence was assessed in 275 subjects without histology. In 70 subjects, diagnostic accuracy (sensitivity, specificity, and positive and negative predictive value) of repeat cytology and HPV DNA test in predicting severe intraepithelial lesion (CIN3) was determined on the basis of colposcopy guided biopsy. The prevalence of persistent lesions was significantly higher in the group of HPV positive than in the group of HPV negative subjects (37.7% vs. 16.4%; p<0.001). Positive HPV test was associated with a 3.1-fold risk of lesion persistence [OR (95% CI) =3.095 (1.65–5.82)]. However, on screening to predict the outcome of cytologically diagnosed cervical lesion with sensitivity of 39.7% and positive predictive value of 37.7% showed that a positive test could not be considered a reliable indicator of lesion persistence. In contrast, the specificity of 82.5% and negative predictive value of 83.6% suggested that a negative test result could be taken as a good indicator of lesion regression. In comparison with repeat cytology, HPV test showed higher sensitivity (69.2% vs. 61.5%) but significantly lower specificity (63.2% vs. 93.0%) and positive predictive value (30.0% vs. 66.7%), and comparable negative predictive value (90.0% vs. 91.4%) in predicting histologically verified CIN3. In one patient with a histological diagnosis of squamous cell carcinoma with minimal invasion, repeat cytology indicated CIN3, whereas HPV test was negative. Due to authors experience in women with cytological abnormalities lower than CIN3, HPV testing is not a method to reliably predict lesion behaviour (regression, persistence) or presence of CIN3. HPV testing is of limited value in daily routine and should not be widely used until it is definitely demonstrated to be superior to conventional methods in improving the sensitivity, specificity and positive predictive value of CIN3 and invasive carcinoma detection

Pap Test – With or Without Vaginal Smear?

The aim of this study was to evaluate medical and economic justification of vaginal smears as a part of primary screening for cervical carcinoma and its precursors. Study included 245.048 participants whose VCE (vaginal, cervical, endocervical) smears were examined at Department of clinical cytology of University Hospital Center Osijek from 2003 till 2008. There were 12.639 (5.2%) abnormal findings, and they were divided into three groups: abnormal cells found only in vaginal smear (V), abnormal cells found in vaginal and in at least one other smear (V+) and abnormal cells not found in vaginal smear (C/E). These three groups were analysed in respect to cytological differential diagnosis and age of participants. It was estimated how many women could be additionally included in the screening, if vaginal smear would be included in the Pap test only after 50 years of age. In 6.9% of cytologically diagnosed lesions abnormal cells were found exclusively in vaginal smears (0.35% of all findings). As for squamous cell lesions, 91.2% were mild lesions (ASC and LSIL). Invasive squamous cell carcinoma was not diagnosed exclusively by vaginal smear in either woman under 50 years of age, while in women over 50 years of age it was diagnosed in 2.3% of cases. Exclusively by vaginal smear was diagnosed 3.9% of all AGC and 6.3% of adenocarcinoma, while in 85.0% of glandular epithelium lesions abnormal cells were not found in vaginal smears. Two thirds of adenocarcinoma diagnosed exclusively by vaginal smears were endometrial adenocarcinoma, but that is only 10.3% of all endometrial carcinoma diagnosed by Pap test. Obtained results show that taking of vaginal smears along with cervical and endocervical smears as a part of primary screening for cervical carcinoma and its precursors in women under 50 years of age is not justifiable, since vaginal smear only has a role in detection of endometrial carcinoma that are extremely rare in younger age groups. If vaginal smear would be taken only in women over 50 years of age, additional 37.7% of women under 50, or 25.1% women over 50 years of age could be included in the screening

Prevalence and Significance of Vaginal Group B Streptococcus olonization in Pregnant Women from Osijek, Croatia

The aim of the study was to determine the prevalence of vaginal group B streptococcus (GBS) colonization in pregnant women from Osijek area, the possible effect of GBS colonization on pregnancy outcome and neonatal complications and the role of intrapartum prophylaxis in this context. This retrospective case-control study took place at the Department of Gynecology and Obstetrics, Osijek University Hospital Center from December 2003 to June 2006. A total of 118 pregnant women was enrolled in study and divided into two groups: 59 women in 35th–37th week of gestation, free from risk factors for infection (control group); and 59 women in 25th–41st week of gestation with risk factors for infection. Low vaginal swab for GBS isolation and identification on selective and enriched medium was obtained from each woman. GBS colonization was recorded in 29 (24.6%) women: 12 (20.3%) control and 17 (28.8%) women at risk of infection, yielding a statistically non-significant difference (c 2=1.480489; p<0.48). Early neonatal infection was observed in six (20.7%) neonates born to 29 mothers with GBS colonization, pointing to a correlation between vaginal GBS colonization and early neonatal infection (rs=0.99). Early perinatal infection was found in 22 (18.6%) neonates, including 17 (28.8%) pregnancies with risk factors, pointing to a significant correlation between vaginal GBS colonization, risk factors and early perinatal infection (c 2=88.68; p<0.001); however, gestational age and pregnancy outcome were not influenced by GBS colonization. In eight (36.4%) newborns, early neonatal infection developed in spite of intrapartum administration of antibiotics; three of these children were born to GBS positive mothers, and perinatal GBS infection was demonstrated in one (0.84%) child. Study results revealed a relatively high rate of GBS colonization in the population of pregnant women in Croatia, occasionally leading to early neonatal infection. Large studies are needed to develop national strategy for the prevention of GBS infection in Croatia

Vascular Endothelial Growth Factor and Intratumoral Microvessel Density as Prognostic Factors in Endometrial Cancer

The aim of this research was to determine the VEGF A expression in tumor cells and the intratumoral microvessel density and their prognostic significance in the survival of the subjects. 87 subjects were monitored retrospectively for a period of 60 to 132 months. The subjects were treated at the Department of Obstetrics and Gynecology of Osijek University Hospital Center, Croatia. We analysed standard clinical, pathohistological and therapeutical prognostic factors, intratumoral microvessel density and expression of VEGF A. Five-year survival was calculated by the life chart method and presented graphically by Kaplan-Meier curves. Reaching conclusions on statistical hypotheses in this paper was done with a reliability level p<0.05. Of the analyzed clinical prognostic factors, those which proved to be statistically significant and independent prognostic factors were age and clinical stage of the disease, and of pathohistologic ones it was the depth of myometrial invasion and VEGF expression. An elevated VEGF expression is associated with deep myometrial invasion, poorly differentiated tumors, histologic type and intratumoral microvessel density to a statistically significant degree. Elevated VEGF expression, age, FIGO stage and depth of myometrial invasion play a significant prognostic role in patients with endometrial cancer. VEGF receptors could be a target for adjuvant therapy in VEGF positive endometrial cancer

Vascular endothelial growth factor and intratumoral microvessel density as prognostic factors in endometrial cancer [Vaskularni endotelni čimbenik rasta i gustoća tumorskih kapilara kao prognostički čimbenik u endometrijskom raku]

The aim of this research was to determine the VEGF A expression in tumor cells and the intratumoral microvessel density and their prognostic significance in the survival of the subjects. 87 subjects were monitored retrospectively for a period of 60 to 132 months. The subjects were treated at the Department of Obstetrics and Gynecology of Osijek University Hospital Center, Croatia. We analysed standard clinical, pathohistological and therapeutical prognostic factors, intratumoral microvessel density and expression of VEGF A. Five-year survival was calculated by the life chart method and presented graphically by Kaplan-Meier curves. Reaching conclusions on statistical hypotheses in this paper was done with a reliability level p < 0.05. Of the analyzed clinical prognostic factors, those which proved to be statistically significant and independent prognostic factors were age and clinical stage of the disease, and of pathohistologic ones it was the depth of myometrial invasion and VEGF expression. An elevated VEGF expression is associated with deep myometrial invasion, poorly differentiated tumors, histologic type and intratumoral microvessel density to a statistically significant degree. Elevated VEGF expression, age, FIGO stage and depth of myometrial invasion play a significant prognostic role in patients with endometrial cancer. VEGF receptors could be a target for adjuvant therapy in VEGF positive endometrial cancer