Ishod trudnoće uz gestacijski dijabetes u usporedbi s indeksom tjelesne mase

Gestational diabetes involves disorder of glucose metabolism first diagnosed in pregnancy. Obese women undoubtedly have more often complications in reproductive age, such as fertility difficulties, spontaneous and recurrent miscarriages, premature births, and various obstetric and surgical complications related to the course of pregnancy, delivery and puerperium. Children of obese pregnant women are more likely to develop obesity in childhood and adulthood. We analyzed the outcome of 51 pregnancies in obese pregnant women and 50 pregnant women with normal body mass index. All women in both groups were diagnosed with gestational diabetes by the IADPSG criteria. We analyzed gestational age at delivery and mode of delivery, gestational weight gain, presence of concomitant diagnosis of gestational or chronic hypertension, difference in birth weight, and prevalence of hypertrophic newborns. There was no significant difference in gestational age at pregnancy termination and in the mode of delivery. There was a significant difference in gestational weight gain, number of pregnant women with hypertension, neonatal birth weight and number of hypertrophic children. Based on the data presented, we conclude that obesity is an unfavorable factor for pregnancy outcome. It also influences birth weight and fetal hypertrophy, as well as gestational weight gain.Gestacijski dijabetes podrazumijeva poremećaj metabolizma glukoze koji se prvi puta dijagnosticira u trudnoći, a njegova incidencija je u porastu. Pretile žene nedvojbeno imaju češće probleme i komplikacije u reproduktivnim godinama, što podrazumijeva teškoće pri zanošenju, spontane i habitualne pobačaje, prijevremene porođaje i različite opstetričke i kirurške komplikacije vezane za tijek trudnoće, porođaja i babinja. Djeca iz takvih trudnoća češće razvijaju pretilost u djetinjstvu kao i u odrasloj dobi. S obzirom na navedeno analizirali smo ishod trudnoća u 51 pretile trudnice i 50 trudnica s urednim indeksom tjelesne mase, pri čemu su sve trudnice (u objema skupinama) imale dijagnozu gestacijskog dijabetesa prema kriterijima IADPSG. Analizirali smo gestacijsku dob, način dovršenja trudnoće, prirast na težini trudnica, prisutnost istodobnih dijagnoza gestacijske ili kronične hipertenzije, razliku u težini novorođenčadi te učestalost hipertrofične novorođenčadi. Rezultati su pokazali da ne postoji statistički značajna razlika u gestacijskoj dobi kad je završena trudnoća niti u načinu dovršenja porođaja. Utvrđena je statistički značajna razlika u dobivenim kilogramima tijekom trudnoće, broju trudnica s hipertenzijom, porođajnoj masi novorođenčadi i broju hipertrofične djece. U zaključku, pretilost u trudnoći s gestacijskim dijabetesom je nepovoljan čimbenik za ishod trudnoće, porođajnu masu i prekomjeran rast novorođenčadi, kao i za prirast tjelesne mase trudnice tijekom trudnoće

Perinatalne značajke infekcije virusom SARS-CoV-2 u trudnoći: moguć razlog za zabrinutost

Ever since the beginning of COVID-19 pandemic, uncertainty regarding clinical presentation and differences among various subpopulations exist. With more than 209,870,000 confirmed cases and more than 4,400,000 deaths worldwide, we are facing the new era of health crisis which will undoubtedly impair global health, economic and social circumstances. In the past year, numerous genetic mutations which code SARS-CoV-2 proteins led to the occurrence of new viral strains, with higher transmission rates. Apart from the implementation of vaccination, the effect of SARS-CoV-2 on pregnancy outcome and maternal fetal transmission remains an important concern. Although neonates diagnosed with COVID-19 were mostly asymptomatic or presented with mild disease, the effect on early pregnancy is yet to be evident. While positive finding of SARS-CoV-2 RNA in some samples such as amniotic fluid, placental tissue, cord blood and breast milk exists, additional research should confirm its association with transplacental transmission.Od početka pandemije COVID-19 do danas tijek bolesti među različitim subpopulacijama ljudi nije do kraja poznat. Diljem svijeta potvrđeno je više od 209.870.000 oboljelih, ali i više od 4.400.000 smrtnih slučajeva. Nalazimo se u vremenu globalne krize, suočeni s njezinim posljedicama na zdravlje ljudi, ekonomiju i društvo. Protekle godine su brojne genske mutacije koje dovode do strukturnih promjena proteina SARS-CoV-2 dovele do pojave novih sojeva virusa s većom transmisijom. Bez obzira na uvođenje cijepljenja učinak SARS-CoV-2 na ishod trudnoće i prijenos virusa s majke na dijete i dalje su važan predmet interesa. Zasad je poznato da je novorođenčad s COVID-19 najčešće asimptomatska ili s blagom kliničkom slikom, a utjecaj infekcije na ranu trudnoću bit će tek vidljiv. Iako je RNK SARS-CoV-2 potvrđena u uzorcima plodove vode, posteljičnog tkiva, krvi pupkovine i u majčinu mlijeku potrebna su dodatna istraživanja koja će potvrditi njezinu povezanost s transplacentnim prijenosom

Utječu li novi dijagnostički kriteriji za gestacijski dijabetes na ishod trudnoća?

The incidence of pregnancy related diabetes has been steadily increasing during the past decade. The aim of this retrospective study was to evaluate the type and prevalence of gestational diabetes complications after implementing new diagnostic criteria for gestational diabetes. The incidence of gestational diabetes, maternal age, mode of delivery and birth weight were analyzed. Study patients were divided into three groups. The first group consisted of patients who gave birth during 2005, the second group during 2011 and the third group during 2012. In 2005, the World Health Organization criteria were used on diagnosing gestational diabetes, whereas in 2011 and 2012 the criteria issued by the International Association of Diabetes and Pregnancy Study Groups were considered. Th ere was no statistically significant difference among the groups according to maternal age, birth weight (p=0.203) and mode of delivery (p=0.883). Cesarean section was performed in about 30% of deliveries in all groups combined. There was no significant difference in the number of neonatal hypertrophy (p=0.348), although the distribution of hypertrophy showed a tendency towards higher values in 2005. Th e incidence of gestational diabetes was 2.2% in 2005, 6.6% in 2011 and 12% in 2012. In conclusion, difference in the incidence of pregnancy related diabetes appeared to have resulted directly from using different diagnostic criteria. The new criteria contributed to a relatively higher incidence of gestational diabetes but also achieved better gestational glycemic control and consequently better fetal growth regulation.Incidencija gestacijskog dijabetesa je u stalnom porastu u proteklom desetljeću. Cilj ove retrospektivne studije bio je utvrditi komplikacije gestacijskog dijabetesa i ishode trudnoća nakon promjene kriterija za dijagnozu gestacijskog dijebetesa. Analizirana je incidencija dijabetesa u trudnoći, dob majki, način dovršenja porođaja i težina novorođenčadi. Ispitanice su bile podijeljene u tri skupine. U prvoj skupini su bile žene koje su rodile u 2005. godini, u drugoj skupini one koje su rodile 2011. godine, a u trećoj skupini one koje su rodile 2012. godine. Za dijagnozu gestacijskog dijabetesa 2005. godine korišteni su kriteriji Svjetske zdravstvene organizacije, a 2011. i 2012. godine kriteriji IADPSG (International Association of Diabetes and Pregnancy Study Groups). U ispitivanim skupinama nije nađena statistički značajna razlika s obzirom na dob rodilja. Nije bilo statistički značajne razlike u prosječnoj težini novorođenčadi (p=0,203) među ispitivanim skupinama. Također nije nađena statistički značajna razlika niti u načinu dovršenja porođaja (p=0,883). U ispitivanom uzorku carskim rezom rodilo je oko 30% trudnica. Nije bilo statistički značajne razlike u pojavnosti fetalne hipertrofije (p=0,348), ali je 2005. godine rođeno više djece u skupinama s većom porođajnom masom. Godine 2005. incidencija gestacijskog dijabetesa bila je 2,2%, 2011. godine 6,6%, a 2012. godine 12%. Razlika u incidenciji gestacijskog dijabetesa posljedica je primjene različitih dijagnostičkih kriterija. Novi kriteriji su doprinijeli porastu incidencije gestacijskog dijabetesa, ali i boljoj regulaciji glikemije te posljedično boljoj regulaciji fetalnoga rasta

Secular Changes in Growth and Obesity in Perinatal Population

The survey was conducted during the last 25 years and included 2414 healthy women who delivered in »Sestre milosrdnice« University Hospital Center in Zagreb, Croatia and their newborns. The aim was to establish the secular trend of some anthropological factors through two generations. Anthropological features such as pre-pregnancy weight, body mass index before pregnancy, height, age, place of residence, educational level, parity and the newborn weight were registered. The study was randomized. The mothers from the city of Zagreb and the surrounding villages, rural areas are examined. The women age was different and also different levels of education and socioeconomic status. The study included women who had not given birth yet, who had delivered once, twice, and three or more times. Maternal height in 25 years increased by 3.1cm. and increases with education. The pre-pregnancy weight increased 2.8 kg and increases with age, parity and rural life. The body mass index (BMI) which the women had before pregnancy was calculated, and according to its value the participants were divided in three groups: with normal weight, overweight and fat. Among the studied periods BMI does not differ significantly, but does differ significantly with respect to the ordinal number of births, parity, age and living environment. Higher BMI was associated with deliveries to heavier children

Dijastaza simfize u blizanačkoj trudnoći

Pubic symphysis diastasis is a rare pregnancy complication whose exact incidence is still not known, but it is estimated to be in the range of 1:300 to 1:30,000 pregnancies. It is defined as a distance between the two pubic bones or an interpubic gap greater than 10 mm with typical presentation. Typical symptoms of diastasis symphysis are pain in the symphyseal region that radiates to the lower back and thighs, waddling gait, painful movement, reduced mobility, and, rarely, urinary retention. In this case report we present a case of antepartum pubic symphysis diastasis diagnosed by palpation during a pelvic exam in a multiparous woman with a twin pregnancy. The patient had an uneventful previous antenatal period; at a routine follow-up she reported symphyseal pain over a longer period with exacerbatio in the previous three weeks, in addition to difficulty walking and staying in an upright position. On manual palpation a 10-mm interpubic gap was found and the patient was hospitalized. In view of the twin pregnancy and pubic symphysis diastasis it was decided that a cesarean section was the appropriate mode of delivery. A postoperative pelvic X-ray showed an interpubic gap of 14 mm. With regard to the simplicity and reliability of manual palpation in cases of suspected pubic symphysis diastasis, implementing palpation of the pubis in regular obstetrical practice would enable early recognition, immediate treatment, and a better outcome in the long term. Also, as there are no evidence-based guidelines considering antepartum pubic symphysis diastasis and each case is approached individually, a comprehensive investigation of this condition is needed in order to achieve standardization of practice.Dijastaza simfize rijetka je komplikacija trudnoće čija točna incidencija još nije poznata, a procijenjena incidencija kreće se u rasponu od 1 : 300 do 1 : 30.000 trudnoća. Definira se kao udaljenost između dvije pubične kosti odnosno kao interpubični razmak veći od 10 mm s tipičnom kliničkom slikom. Tipični simptomi dijastaze simfize jesu bol u području simfize koja se širi u donji dio leđa i bedro, gegavi hod, bolno kretanje, smanjena pokretljivost i, rijetko, urinarna retencija. U ovom radu prikazujemo bolesnicu s antepartalnom dijastazom simfize, koja je dijagnosticirana manualnom palpacijom za vrijeme redovitoga ginekološkog pregleda. Višerotkinja s blizanačkom trudnoćom, koja dotad nije imala kompliciran tijek trudnoće, pri redovitom je pregledu navela da dulje osjeća bol u području simfize, uz pogoršanje tegoba u posljednja 3 tjedna te otežano hodanje i stajanje. Manualnom palpacijom otkriven je interpubični razmak od 10 mm te je trudnica hospitalizirana. S obzirom na blizanačku trudnoću i dijastazu simfize, odlučeno je da trudnoća bude dovršena elektivnim carskim rezom. Postoperativni rendgenogram (RDG) zdjelice pokazao je interpubični razmak od 14 mm. Manualna palpacija jednostavna je i pouzdana metoda pa bi njezino uvođenje u svakodnevnu opstetričku praksu omogućilo rano otkrivanje dijastaze simfize, brži početak terapije i dugoročno bolji ishod. Također, budući da ne postoje znanstveno dokazane smjernice o zbrinjavanju antepartalne dijastaze simfize, nego se svakoj bolesnici pristupa individualizirano, potrebno je sveobuhvatno istraživanje ove patologije koje bi dovelo do standardiziranja prakse

THE IMPORTANCE OF ANTENATAL ULTRASOUND SCREENING FOR CONGENITAL OSTEOCHONDRODYSPLASIA – TWO CASE REPORTS

Osteohondrodisplazije velika su skupina rijetkih genskih bolesti karakterizirana poremećajem rasta i razvoja hrskavice i kosti. Često su povezane s malformacijama drugih organskih sustava. Mogu se podijeliti na letalne i neletalne skeletne displazije. Tanatoforična displazija jedna je od najčešćih letalnih skeletnih displazija s učestalošću pojavljivanja od 0,69 na 10.000 porođaja, dok je heterozigotna ahondrodisplazija među najčešćim neletalnim displazijama s učestalošću od 0,15 na 10.000 porođaja. Prikazat ćemo dva novorođenčeta s osteohondrodisplazijom. Prvi je prikaz letalne osteohondrodisplazije kod novorođenčeta 41-godišnje višerotkinje koja je u 33. tjednu nekontrolirane trudnoće došla u našu Kliniku zbog započetog porođaja. Drugi je prikaz neletalne osteohondrodisplazije u novorođenčeta 31-godišnje višerotkinje kod kojeg se od 30. tjedna trudnoće prate kraće kosti udova.Osteochondrodysplasias comprise a large, genetically heterogeneous group of disorders characterized by abnormalities of cartilage and bone growth. They are often associated with abnormalities in other organ systems. They are classified as lethal or non-lethal skeletal dysplasias. Thanatophoric dysplasia is the most common form of lethal skeletal dysplasia with an incidence of 0.69 per 10.000 births. Heterozygous achondroplasia is the most common non-lethal dysplasia with an incidence of 0.15 per 10.000 births. We will present two cases of skeletal dysplasia. The first case is the case of lethal osteochondrodysplasia in the fetus of a 41-year-old multiparous woman, who came to our hospital in active preterm labor, in the 33th week of uncontrolled pregnancy. The second case is the case of non-lethal osteochondrodysplasia in the fetus of a 31-year-old multiparous woman. The fetal short femur length was detected in the 30th week of pregnancy

SECULAR CHANGES IN EDUCATION, URBAN-RURAL LIVING, MENARCHE AND ABORTION RATES IN PERINATAL POPULATION

Over a 25-year period we examined the anthropological characteristics of mothers and their partners, such as the place of living: urban vs. rural, the degree of education, parity, the time of menarche, and the frequency of intentional abortions. We examined 2 414 mothers and their partners in four periods of time extending from 1985 to 2009 in order to establish changes in the said anthropological characteristics over a period of 25 years. The degree of education of mothers and their partners is on the rise. In the period from 1985 to 1994, the percentage of mothers from the country was on the rise. Women with less education have on average more children, and those with better education the least children. Women from rural areas have on average more children than women from urban areas. The time of menarche dropped by 9 months over the period of 25 years. Girls from urban areas have their first menstrual cycle earlier. Women with higher professional qualifications had their first period earlier. The number of intentional abortions over the 25-year period dropped