LEOPOLDOVI HVATOVI: KOLIKO SU ČESTI U NAŠOJ SVAKODNEVNOJ PRAKSI

Objective. To determine how frequent obstetricians use Leopold’s maneuvers in their practice. Subjects and Methods. A questionnaire with numerical scale was distributed among practicing obstetricians. They examined how ­frequent the symphyseal fundal height (SFH) measurement, Leopold’s maneuvers and ultrasound examination for fetal orientation were performed. Results. A total of 165 obstetricians completed the questionnaire. Only 56 (33.9%) respondents indicated that they use SFH. The first and third Leopold’s maneuver were the most frequent abdominal grips ­performed. Only 36 (21.8%) respondents regularly perform all four maneuvers. Seventy seven (46.7%) respondents use ultrasound to determine fetal orientation. The use of ultrasound was significantly higher (p=0.02) in those practicing for less than 10 years (62.6%) compared to those practicing for 10 years or more (43.3%). Conclusion. Leopold’s maneuvers are still common in daily obstetrics practice. Abdominal palpation remains a common method to estimate the uterine size. The first and third Leopold’s maneuver were the most frequent abdominal grips performed. Ultrasound examination is commonly used to determine fetal orientation.Cilj rada je ustanoviti koliko često opstetričari u svojoj praksi rabe Leopold-Pavlikove hvatove. Materijal i metode. Upitnik s brojčanim podatcima je podijeljen opstetričarima iz prakse. Oni su pokazali koliko često izvode ­mjerenje udaljenosti fundus simfiza, Leoplodove hvatove i pregled ultrazvukom za prosudbu fetalnog položaja i stava. Rezultati. Ukupno je 165 opstetričara ispunilo upitnik. Samo 56 (33,9%) njih mjere udaljenost fundus simfiza. Prvi i treći Leopoldov hvat su najčešće rabljeni hvatovi. Samo 36 (21,8%) ispitanika redovito izvode sva četiri hvata. Sedamdeset ­sedam (47,7%) rabe ultrazvučni pregled da odrede položaj i stav djeteta. Uporaba ultrazvuka je bila signifikantno češća (p=0,02) u onih koji rade manje od 10 godina (62,6%) od onih koji rade dulje od 10 godina (43,3%). Zaključak. Leopoldovi hvatovi su još uvijek uobičajeni u svakodnevnoj opstetričnoj praksi. Palpacija trbuha trudnice je uobičajena metoda za prosudbu veličine maternice. Prvi i treći Leopoldov hvat su najčešće rabljeni hvatovi. Pregled ultrazvukom se obično rabi za prosudbu položaja i stava fetusa

Transplacental transfer of 2-naphthol in human placenta

Objective: To determine the transfer of 2-naphthol (2-NPH) in fullterm human placental tissues. Methods: Six placentas were studied. The ex-vivo dual closed-loop human placental cotyledon perfusion model was used. 2-NPH was added to the perfusate in the maternal compartment. Samples were obtained from the maternal and fetal up to 360 min measuring. Results: The mean fetal weight was 2880 ± 304.2 g. Mean perfused cotyledon weight was 26.3 (±5.5) g. All unperfused placental tissue samples contained NPH with a mean level of 7.98 (±1.73) μg\g compared to a mean of 15.58 (±4.53) μg\g after 360 min perfusion. A rapid drop in maternal 2-NPH concentration was observed; from 5.54 μg\g in the first 15 min and 13.8 μg\g in 360 min. The fetal side increased from 0.65 μg\g in the initial 15 min to 1.5 μg\g in 360 min. The transfer rate of NPH was much lower than that of antipyrine. Conclusion: 2-NPH has the ability to rapidly across the placenta from the maternal to the fetal compartment within 15 min. The placenta seems to play a role in limiting the passage of 2-NPH in the fetal compartment

Caesarean scar pregnancy: time to explore indications of the caesarean sections?

A retrospective study was conducted in women with history of a caesarean scar pregnancy (CSP) to explore the possible causative mechanisms. Over a period of 40 months, a total of 16,926 deliveries and 3554 caesarean sections (CS) occurred in our hospital. Nine cases of CSP were identified at an incidence of 1:1880 births and 0.25% of all CS. Analysis of the indications of the previous CS revealed that 88.8% of women with known indication had undergone CS without labour. Out of them, 75% underwent CS at preterm gestation and 25% had term elective procedure for breech presentation. Of the patients, 77.7% had multiple CS. Conservation of the uterus was possible in 77.7% of patients utilising non-radical forms of treatment. As most of the women underwent CS with a non-contractile uterus without labour, we believe that the risk of CSP may be related to the indications of the previous CS as the number of CS alone could not explain the occurrence of CSP. It is time to explore this area so that screening strategies can be developed to detect CSP at the earliest possible gestation and to prevent life-threatening complications such as uterine rupture and severe hemorrhage.Impact statement What is already known on this subject? A caesarean scar pregnancy (CSP) is a life-threatening condition that can result in uterine rupture and in severe haemorrhage. Although the diagnostic criteria for the CSP have been established, the risk factors that favour the condition are not well understood. We know that the incomplete healing of the lower uterine segment (LUS) from poor vascularisation can create a microscopic dehiscent tract through which the blastocyst enters the myometrium. Some have postulated that the healing processes following the elective procedures, such as for breech deliveries performed in a non-developed LUS, might facilitate this process. What do the results of this study add? In this study, analysis of the indications of the previous CS revealed that majority of women with a known indication had undergone CS without labour, either at preterm gestation or term elective procedure for breech presentation. We have postulated the possible causative mechanisms in relation to the physiology of LUS development. To the best of our knowledge, this is the first study that has looked specifically at the relationship between the indications of previous CS and CSP. What are the implications of these findings for clinical practice and/or further research? Further studies exploring the indications of the previous CS are recommended so that early first-trimester screening strategies can be generated towards this subgroup of patients to detect CSP at the earliest possible gestation

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially