COVID-19 vaccination intention at the beginning of COVID-19 pandemic in Slovenia

Background: With the successful development and introduction of vaccines to protect against COVID-19 disease, the pandemic is expected to end. The success of a vaccination programme depends on the uptake rates in the Slovenian population and especially among healthcare workers (HCWs), who are at higher risk of infection. Recently, several studies have examined the readiness of different population groups worldwide to be vaccinated. This study compares COVID-19 vaccination intentions between lay people and HCWs, and relationships between socio-demographic characteristics, attitudes and beliefs about COVID-19 vaccination, and vaccination intentions reported in the early stages of epidemics. Methods: A cross-sectional study based on an online survey was performed in Slovenia between 13 and 14 March 2020, when the epidemic was officially announced in the country. Data from 2,494 eligible respondents were analysed. Results: The study has shown that 33.2% of all respondents expressed the intention to get vaccinated against COVID-19 disease. This intention was expressed slightly more frequently among HCWs (38.9%) than among lay respondents (30.3%). Men compared to women, older and younger HCWs compared to middle-aged adults, and university graduates compared to HCWs with lower levels of education were more likely to get vaccinated against the disease. More HCWs than lay respondents believed that the COVID-19 vaccine would be safe and effective, and they were also more in favour to support vaccination of high-risk groups than mandatory vaccination of the general population. Conclusion: It is critical to communicate the importance of vaccination against COVID-19 appropriately and on a sound scientific basis through various health education programmes and the media, as only one-third of respondents and less than a half of HCWs indicated that they would be willing to get vaccinated once a vaccine is available

Variations in Multiple Birth Rates and Impact on Perinatal Outcomes in Europe

Objective Infants from multiple pregnancies have higher rates of preterm birth, stillbirth and neonatal death and differences in multiple birth rates (MBR) exist between countries. We aimed to describe differences in MBR in Europe and to investigate the impact of these differences on adverse perinatal outcomes at a population level. Methods We used national aggregate birth data on multiple pregnancies, maternal age, gestational age (GA), stillbirth and neonatal death collected in the Euro-Peristat project (29 countries in 2010, N = 5 074 643 births). We also used European Society of Human Reproduction and Embryology (ESHRE) data on assisted conception and single embryo transfer (SET). The impact of MBR on outcomes was studied using meta-analysis techniques with random-effects models to derive pooled risk ratios (pRR) overall and for four groups of country defined by their MBR. We computed population attributable risks (PAR) for these groups. Results In 2010, the average MBR was 16.8 per 1000 women giving birth, ranging from 9.1 (Romania) to 26.5 (Cyprus). Compared to singletons, multiples had a nine-fold increased risk (pRR 9.4, 95% Cl 9.1–9.8) of preterm birth (<37 weeks GA), an almost 12-fold increased risk (pRR 11.7, 95% CI 11.0–12.4) of very preterm birth (<32 weeks GA). Pooled RR were 2.4 (95% Cl 1.5–3.6) for fetal mortality at or after 28 weeks GA and 7.0 (95% Cl 6.1–8.0) for neonatal mortality. PAR of neonatal death and very preterm birth were higher in countries with high MBR compared to low MBR (17.1% (95% CI 13.8–20.2) versus 9.8% (95% Cl 9.6–11.0) for neonatal death and 29.6% (96% CI 28.5–30.6) versus 17.5% (95% CI 15.7–18.3) for very preterm births, respectively). Conclusions Wide variations in MBR and their impact on population outcomes imply that efforts by countries to reduce MBR could improve perinatal outcomes, enabling better long-term child health

THE COMPARISON OF SLOVENIAN AND EUROPEAN PERINATAL DATA OR AS MORE BACK WE LOOK FURTHER INTO THE FUTURE WE WILL SEE

Background: Slovenian perinatal results are compared with European results: sometimes they are in the higher, sometimes in the lower range. Analysing trends and comparisons with other countries helps in planning changes in organisation and function so we are prepared for future challenges. Introduction of new technologies demands appropriate answers to challenges, including ethical ones. Methods: We compared perinatal results in Slovenia from 1987 to 1996, the PERISTAT project results from the year 2000 and the EURO-PERISTAT project with 2004 perinatal results including the Slovenian. Results: Some of the more prominent Slovenian perinatal results are shown. Cesarean section rate is the lowest among 26 countries in Europe. Deliveries after artificial reproductive techniques are second most frequent. Teenage pregnancies are very rare. Seemingly high maternal mortality mirrors also strict recording and cross checking with other data bases. Relatively high stillbirth rate may reflect the fact that all induced labours for fetal malformations are recorded. Conclusions: In Slovenia we do have tools for quality collection of perinatal results which should be used and audited. To have comparable results inside Slovenia, definitions should be written at http://www.obgyn-si.org/. When changing delivery record markers of prenatal care should be added – they could be easily obtained from maternity booklets (electronic or paper). In maternity booklet there is a place to write about grand dad prostate cancer; let us replace it with risk factors for preterm delivery (medical history and cervical length), 12 weeks screening for preeclampsia and intrauterine growth restriction (ultrasonic and biochemi- cal markers), gestational diabetes and obesity (body mass index, waist – hips ratio) and hypothyroidism; let us leave some free space for the future screening tests. Known and proven efficient management (e.g. progesterone for recurrent preterm delivery prevention) should be used

Risk factors for osteoporosis in postmenopausal women – from the point of view of primary care gynecologist

Osteoporosis is a highly prevalent public health problem with osteoporosis-related fractures that account for high morbidity and mortality. Therefore, prevention strategies and early detection of osteoporosis should be carried out in primary gynaecological care units, so as to substantially reduce the risk of fractures and allow the best treatment option for a particular woman

QUALITY OF PERINATAL CARE IN SLOVENIA 2003–2008

Background: The purpose of this analysis was to find whether the quality indicators of perinatal care in Slovenia change. Methods: We used the same quality indicators which are used in the European project Europeristat1 to compare the quality of perinatal care among the countries of the European Union. We used two 5-year periods, from 1998 to 2002 (reference period) and from 2003 to 2008 (observed period). Data for perinatal quality were collected from the National Perinatal Information System of the Republic of Slovenia.2 Statistical significance was tested using the Pearson’s chi-square test. Results: Between 1998 and 2002, there were 87.679 labours ending in the delivery of 88.678 new- borns, and between 2003 and 2008, there were 90.662 labours ending in the delivery of 91.736 babies. In the observed period (2003 do 2008) mothers had statistically significantly higher educational level, a higher percentage came to their first pregnancy examination before the 12th week of gestation (84.0 % vs. 75.3 %), a higher percentage conceived after assisted reproductive techniques (2.0 % vs. 1.7 %), and the incidence of multiple pregnancies was higher (1.7 % vs. 1.6 %). Significantly lower were the percentages of labours without medical interventions (34.7 % vs. 41.9 %) and of spontaneous onset of labour (74.0 % vs. 92.6 %). The percentages of induced labours and of elective cesarean sections increased dramatically (20.1 % vs. 6.6 % and 6.0 % vs. 0.9 %). The increase in the overall percentage of cesarean sections (14.8 % vs. 11.0 %) is mainly due to increased incidence of elective cesarean sections, but the percentage of operative termination of vaginal labour increased as well (3.1 % vs. 2.6 %). The incidence of episiotomies was lower (48.7 % vs. 51.0 %) and so was the incidence of 2nd degree perineal lacerations (4.5 % vs. 5.4 %), while the incidence of 3rd–4th degree lacerations was higher (0.3 % vs. 0.2 %). Transfusion was required in a lower percentage (0.3 % vs. 1.0 %), but the percentage of hysterectomies increased (0.1 % vs. 0.03 %). The incidence of eclampsia was the same in the two time periods (0.1 %). Among preterm deliveries, the higher percentage occurred between 32 and 36 gestational weeks (5.9 % vs. 5.5 %), while there were no differences among the deliveries between the 22nd and 31st gestational week. Stillbirths after the 22nd gestational week was the same in both periods, 5 per 1000 of all newborns, whereas early (2 per 1000 vs. 3 per 1000) and late (0.04 per 1000 vs. 0.4 per 1000) neonatal mortality rates were lower. In both time periods lethal malformations were the cause of death in 1/3 of stillborn babies 1/3 of neonates. Conclusions: Over the last years, an increase in operative deliveries and a decrease in deliveries without medical interventions have been observed in Slovenia. Despite the fact that mothers come to their first prenatal examination earlier in pregnancy than before and that they are more educated, i.e. they have a better socio-economic status, the incidence of preterm deliveries increases, while the mother’s health and the incidence of stillbirths have not changed sig- nificantly. The decrease in neonatal mortality rate should be highlighted

The Effect of Von Willebrand Disease on Pregnancy, Delivery, and Postpartum Period: A Retrospective Observational Study

Background and Objectives Several reports indicate that women with von Willebrand disease (VWD) are at an increased risk of bleeding and other complications during pregnancy and childbirth. The aim of this study was to investigate the effect of VWD on the course of pregnancy, childbirth, and the postpartum period. Materials and Methods This was a retrospective study that compared many variables between women with VWD (n = 26) and women without VWD (n = 297,111) who gave birth between 2002 and 2016 in Slovenia. Data were obtained from the Slovenian National Perinatal Information System. Results Women with VWD were not more likely to have a miscarriage, vaginal bleeding during pregnancy, anemia, intrauterine growth restriction, or imminent premature labor. However, women with VWD were more likely to experience childbirth trauma-related bleeding (OR, 10.7; 95% CI: 1.4, 78.9), primary postpartum hemorrhage (OR, 3.7; 95% CI: 0.9, 15.8), and require blood transfusion after childbirth (OR, 16.3; 95% CI: 2.2, 120.3). No cases of stillbirth or early neonatal death were observed in women with VWD. Conclusion Although women with VWD did not demonstrate an increased risk of vaginal bleeding during pregnancy or poor fetal outcomes, they had a higher risk of primary postpartum hemorrhage and requiring blood transfusion

Analiza vodenja poterminske nosečnosti v Sloveniji v letu 2012

Uvod: V literaturi je poterminska nosečnost različno opredeljena, prav tako tudi ukrepi v zvezi z njo. Podaljšanje nosečnosti preko 41. tedna nosečnosti prinaša dodatna tveganja za plod, zato se v tem primeru pogosto sprejme odločitev o indukciji poroda. Tudi slednja prinaša za žensko in plod določena tveganja, predvsem v smislu povečane potrebe po izhodnih porodniških operacijah. Metode: Uporabljen je bil kvantitativni pristop; raziskava je bila zasnovana na podatkih iz nacionalnega perinatalnega informacijskega sistema za leto 2012. V analizo je bilo vključenih 10.163 porodov s poterminsko nosečnostjo. Analiza je bila narejena s pomočjo statističnega programa SPSS verzija 18.0, pri čemer je bila uporabljena opisna statistika. Rezultati: Ugotovljeno je bilo, da delež induciranih porodov z višjo gestacijsko starostjo narašča (po 42. tednu gestacijske starosti znaša 41,8 %), s čimer narašča tudi delež operativno dokončanih porodov (po 42. tednu gestacijske starosti se 24,9 % porodov dokonča s carskim rezom ali vakuumsko ekstrakcijo). Diskusija in zaključek: Rezultati o načinu dokončanja poroda po predvidenem datumu poroda v Sloveniji v proučevanem obdobju so primerljivi rezultatom tuje strokovne in znanstvene literature. V nadaljnjem raziskovanju bi bilo smiselno zajeti tudi podatke o kondiciji novorojenčkov, saj zgolj način dokončanja poroda ni kazalec zdravstvenega stanja novorojenca. Smiselno bi bilo proučevati oceno novorojenčka po Apgarjevi, sprejem novorojenca na enoto intenzivne nege in terapije, vrednosti pH krvi in potrebne ukrepe reanimacije novorojenčka