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

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

Risk of sexual dysfunctions in breastfeeding females: protocol for a systematic review and meta-analysis

Background Epidemiological studies do not provide accurate statistics on the percentage of breastfeeding women experiencing sexual dysfunctions and restraining from sexual activity. The data vary between 40% and 83% in the first group and 20–50% in the second one. Despite excessive studies on contributors to intimacy changes, breast feeding received little attention from researchers. The relationship between lactation and postpartum sexual dysfunctions remains unclear. This systematic review and meta-analysis will synthesise available data and establish the link between breast feeding and sexuality problems.Methods and analysis A comprehensive literature search will be performed in biomedical databases PubMed/Medline, Scopus, Web of Science, EMBASE and CINAHL. We will extract peer-reviewed original studies written in English, Arabic or Polish from 2000 to June 2023. We will also search for reports from international health organisations and local health authorities. The preliminary search was performed on 04 April 2023. The studies must provide data on dysfunction prevalence/incidence and the strength of the relationship between breast feeding and sexuality in generally healthy women. The Covidence software will be used to perform literature screening, data extraction and quality assessment of individual studies. We will use a random-effects model meta-analysis to calculate pooled weighted frequency measures and effect size. Between-study heterogeneity will be assessed with the I2 test.Ethics and dissemination This meta-analysis does not require ethical approval because it synthesises data from previously published original studies. The final work will be published in a peer-reviewed journal and presented at scientific conferences.PROSPERO registration number CRD42023411053

The First United Arab Emirates National Representative Birth Cohort Study: Study Protocol.

BACKGROUND: In recent years, the prevalence of non-communicable diseases (NCDs) has escalated. Evidence suggests that there are strong associations between nutrition in early life and the risk of disease in adulthood. This manuscript describes the study protocol of the First United Arab Emirates National Representative Birth Cohort Study (UAE-BCS), with the objective of investigating nutrition and lifestyle factors in the first 1,000 days of life. The main aims of the study are (1) to address critical issues relating to mother and child nutrition and their effect on growth and development, (2) to profile maternal nutrition, child growth, health, and development outcomes in early life, and (3) to study the associations between these factors among the Emirati population in the UAE. METHODS/DESIGN: In this study, a multidisciplinary team of researchers was established including credible researchers from the UAE, Lebanon, Australia, and the United Kingdom to launch the First United Arab Emirates 3-year birth cohort study. We aim to recruit 260 pregnant Emirati women within their first trimester, which is defined by the study as from 8 to 12 weeks pregnant, from obstetrics and gynecology clinics in the UAE. Participants will be recruited via face-to-face interviews and will receive a total of 11 visits with 1 visit in each trimester of pregnancy and 8 visits after delivery. Maternal data collection includes, socio-demographic and lifestyle factors, dietary intake, anthropometric measurements, physical activity, maternal psychological state, and blood samples for biochemical analysis. Post-partum, visits will take place when the child is 0.5, 4, 6, 9, 12, 18, and 24 months old, with data collection including infant anthropometric measurements, young child feeding practices, dietary intake, supplement use and the eating environment at home, as well as all maternal data collection described above, apart from blood samples. Additional data collection for the child includes early child developmental assessments taking place at three timepoints: (1) within 2 weeks of birth, (2) at 10-14 months and (3) at 22-26 months of age. Early child developmental assessments for the infant include vision, hearing, cognition, motor skills, social-emotional reactivity, neurodevelopmental, and sleep assessments. DISCUSSION: The United Arab Emirates Birth Cohort study protocol provides a standardized model of data collection methods for collaboration among the multisectoral teams within the United Arab Emirates to enrich the quality and research efficiency in early nutrition, thereby enhancing the health of mothers, infants, and children