TERAPIJA METOTREKSATOM GINEKOLOŠKIH PACIJENTICA: ČETVEROGODIŠNJE ISKUSTVO U TERCIJARNOJ ZDRAVSTVENOJ USTANOVI

Aim: The aim of this study was to present methotrexate treatment results in ectopic pregnancy and gestational trophoblastic neoplasia (GTN) at a tertiary referral center. Methods: A retrospective case-series study was conducted using data from records of patients treated with methotrexate during a 4-year period at Merkur University Hospital in Zagreb, Croatia. The study included 11 patients divided into 2 groups: 6 patients with ectopic pregnancy (5 tubal and 1 cornual) and 5 patients with low-risk GTN. Patients with ectopic pregnancy were treated with single dose methotrexate protocol (1 mg/kg/day intramuscularly), whereas those with low-risk GTN were treated with 8-day single-agent methotrexate along with leucovorin rescue protocol. Results: Among 5 tubal pregnancies, methotrexate treatment was successful in 4 (80%) cases, while one patient required surgical treatment. One case of cornual pregnancy also required surgical treatment after ineffective methotrexate treatment. Of 5 GTN cases treated with methotrexate, 3 required further EMA-CO treatment and 1 required additional surgical treatment, yielding the overall success rate of methotrexate treatment of 20%. Conclusion: Methotrexate is a valuable medication for treatment of appropriately selected ectopic pregnancy cases, while its usefulness and effi ciency in the treatment of low-risk GTN diseases has not been confi rmed.Cilj: Cilj rada je prikazati rezultate liječenja metotreksatom dviju ginekoloških bolesti u tercijarnom referentnom centru. Metode: Provedena je retrospektivna studija uporabom podataka iz povijesti bolesti pacijentica liječenih metotreksatom tijekom četverogodišnjeg razdoblja u Kliničkoj bolnici Merkur, Zagreb, Hrvatska. U studiju je uključeno 11 pacijentica koje su podijeljene u 2 skupine: 6 pacijentica s ektopičnom trudnoćom (5 tubarnih i 1 kornualna) i 5 pacijentica s gestacijskom trofoblastičnom neoplazijom (GTN) niskog rizika. Pacijentice s ektopičnom trudnoćom liječene su jednokratnom dozom metotreksata (1 mg/kg/dan intramuskularno), dok su pacijentice s GTN niskog rizika liječene osmodnevnim protokolom metotreksatom i leukovorinom. Rezultati: Od 5 pacijentica s tubarnom trudnoćom liječenje metotreksatom bilo je uspješno u 4 (80%) slučaja, dok je u 1 slučaju bilo potrebno kirurško liječenje. U 1 zabilježenom slučaju kornualne trudnoće liječenje metotreksatom bilo je neuspješno te je pacijentica zbrinuta kirurški. Od 5 slučajeva GTN liječenih metotreksatom u 3 slučaja bio je potreban nastavak kemoterapije po EMA-CO protokolu, dok je u 1 slučaju bilo potrebno dodatno kirurško liječenje te je ukupna uspješnost liječenja metotreksatom iznosila 20 %. Zaključak: Metotreksat se može smatrati učinkovitom terapijom u liječenju pažljivo odabranih pacijentica s ektopičnom trudnoćom, dok njegova uspješnost u kemoterapijskom liječenju GTN niskog rizika nije potvrđena

Doppler assessment of uteroplacental blood flow in screening for preeclampsia

Preeclampsia complicates between 4–5 percent of pregnancies and it is one of the leading causes of maternal and perinatal mortality and morbidity worldwide. One potential screening tool for identifying pregnant women at risk for developing pre-eclampsia is Doppler assessment of blood flow in uterine arteries (UtA) and some other parts of uteroplacental circulation. Studies suggest that abnormal UtA waveforms (abnormal resistance index (RI), pulsatility index (PI) or diastolic notching) reflects impaired uteroplacental blood flow due to failed second wave of trophoblastic invasion of spiral arteries, and identify women at high risk of developing preeclampsia. Still, due to high false-positive rates, low sensitivity and low positive predictive values the majority of international guidelines do not recommend the use of UtA Doppler in clinical practice. Until more evidence, perinatal care should still focus on taking a detailed medical history, assessing for risk factors and measuring blood pressure at each prenatal visit and if classified as high risk, to use some other screening methods. Also, a growing amount of evidence suggests that pregnant women presenting with one recognized high risk factors or two or more moderate risk factors for developing pre-eclampsia should be offered low-dose aspirin from 12 weeks gestation in order to reduce the risk of developing preeclampsia

TERAPIJA METOTREKSATOM GINEKOLOŠKIH PACIJENTICA: ČETVEROGODIŠNJE ISKUSTVO U TERCIJARNOJ ZDRAVSTVENOJ USTANOVI

Aim: The aim of this study was to present methotrexate treatment results in ectopic pregnancy and gestational trophoblastic neoplasia (GTN) at a tertiary referral center. Methods: A retrospective case-series study was conducted using data from records of patients treated with methotrexate during a 4-year period at Merkur University Hospital in Zagreb, Croatia. The study included 11 patients divided into 2 groups: 6 patients with ectopic pregnancy (5 tubal and 1 cornual) and 5 patients with low-risk GTN. Patients with ectopic pregnancy were treated with single dose methotrexate protocol (1 mg/kg/day intramuscularly), whereas those with low-risk GTN were treated with 8-day single-agent methotrexate along with leucovorin rescue protocol. Results: Among 5 tubal pregnancies, methotrexate treatment was successful in 4 (80%) cases, while one patient required surgical treatment. One case of cornual pregnancy also required surgical treatment after ineffective methotrexate treatment. Of 5 GTN cases treated with methotrexate, 3 required further EMA-CO treatment and 1 required additional surgical treatment, yielding the overall success rate of methotrexate treatment of 20%. Conclusion: Methotrexate is a valuable medication for treatment of appropriately selected ectopic pregnancy cases, while its usefulness and effi ciency in the treatment of low-risk GTN diseases has not been confi rmed.Cilj: Cilj rada je prikazati rezultate liječenja metotreksatom dviju ginekoloških bolesti u tercijarnom referentnom centru. Metode: Provedena je retrospektivna studija uporabom podataka iz povijesti bolesti pacijentica liječenih metotreksatom tijekom četverogodišnjeg razdoblja u Kliničkoj bolnici Merkur, Zagreb, Hrvatska. U studiju je uključeno 11 pacijentica koje su podijeljene u 2 skupine: 6 pacijentica s ektopičnom trudnoćom (5 tubarnih i 1 kornualna) i 5 pacijentica s gestacijskom trofoblastičnom neoplazijom (GTN) niskog rizika. Pacijentice s ektopičnom trudnoćom liječene su jednokratnom dozom metotreksata (1 mg/kg/dan intramuskularno), dok su pacijentice s GTN niskog rizika liječene osmodnevnim protokolom metotreksatom i leukovorinom. Rezultati: Od 5 pacijentica s tubarnom trudnoćom liječenje metotreksatom bilo je uspješno u 4 (80%) slučaja, dok je u 1 slučaju bilo potrebno kirurško liječenje. U 1 zabilježenom slučaju kornualne trudnoće liječenje metotreksatom bilo je neuspješno te je pacijentica zbrinuta kirurški. Od 5 slučajeva GTN liječenih metotreksatom u 3 slučaja bio je potreban nastavak kemoterapije po EMA-CO protokolu, dok je u 1 slučaju bilo potrebno dodatno kirurško liječenje te je ukupna uspješnost liječenja metotreksatom iznosila 20 %. Zaključak: Metotreksat se može smatrati učinkovitom terapijom u liječenju pažljivo odabranih pacijentica s ektopičnom trudnoćom, dok njegova uspješnost u kemoterapijskom liječenju GTN niskog rizika nije potvrđena

Prevalence, risk factors and pregnancy outcomes of women with gestational diabetes in Croatia – a national study

Introduction. Gestational diabetes is a very important obstetrical issue and one of the most frequent metabolic disorders with differing prevalence among various populations. Aim. To determine the prevalence of gestational diabetes in Croatia and to detect main risk factors and adverse pregnancy outcomes associated with gestational diabetes. Methods. This is a cross sectional study performed using data from medical birth certificates collected in 2014 in Croatia. All pregnant women who gave birth in year 2014 were included in the study, excluding those with known diabetes mellitus type I or type II. Results. Among 39.132 deliveries in 2014 incidence of gestational diabetes was 4.67%. Women with gestational diabetes were older, more overweight before pregnancy but gained less weight during pregnancy (all P’s < 0.001). Onset of labour among women with gestational diabetes was less often spontaneous and more often induced. Also, women with gestational diabetes had a signifi cantly lower incidence of vaginal delivery and concomitantly a higher incidence of delivery by caesarean section. Women with gestational diabetes gave birth to infants with higher birth weight, but other neonatal complications were not more often present among neonates of women with gestational diabetes compared to neonates of women without gestational diabetes. Conclusion. Prevalence of gestational diabetes in Croatia based on medical birth certificates is 4.67% and gestational diabetes in Croatia is associated with important risk factors and adverse perinatal outcomes

UČESTALOST, RIZIČNI ČIMBENICI I ISHODI TRUDNOĆA KOD INDUKCIJE POROĐAJA U HRVATSKOJ – NACIONALNO JEDNOGODIŠNJE ISTRAŽIVANJE

The aim of this study was to determine the prevalence of labor induction in Croatia, as well as the main risk factors and adverse pregnancy outcomes associated with labor induction. Materials and methods: A cross-sectional study was performed using data from medical birth certificates collected in 2019 in Croatia. Results: Among 36,603 deliveries in 2019, the prevalence of labor induction was 14.1%. Women whose labor was induced were older, had a higher body mass index (BMI), and more frequent gestational weight gain above recommendations compared to women with spontaneous onset of labor (p<0.001). Induced labors were more frequent in pregnancies with gestational diabetes, gestational hypertension, preeclampsia, and fetal growth restriction (p<0.001 all). Women with induced labor had a higher incidence of cesarean section, vacuum extraction, postpartum hemorrhage, shoulder dystocia, and more frequently delivered infants above 4000 g (p<0.05 all). Logistic regression showed that maternal age, pre-pregnancy BMI, gestational diabetes, gestational hypertension, preeclampsia, fetal growth restriction, and gestational age at delivery were significant predictors of labor induction (p<0.001 all). Conclusions. The prevalence of labor induction in Croatia is 14.1%. Labor induction is associated with important risk factors and adverse perinatal outcomes, which can partially be attributed to the mode of labor onset. All of these should be taken into account when performing this obstetric procedure.Indukcija porođaja važan je opstetrički zahvat koji se provodi u sve većem broju porođaja diljem svijeta s ciljem smanjenja perinatalnog pobola i smrtnosti. Cilj ovog istraživanja bio je utvrditi učestalost indukcije porođaja u Hrvatskoj te glavne rizične čimbenike i nepoželjne ishode povezane s indukcijom porođaja. Materijali i metode: Provedeno je presječno istraživanje pomoću podataka sakupljenih pri prijavi porođaja u Hrvatskom zavodu za javno zdravstvo u 2019. godini u Republici Hrvatskoj. Rezultati: Na ukupno 36.603 porođaja u 2019. godini u Republici Hrvatskoj učestalost indukcije porođaja bila je 14,1 %. Trudnice kod kojih je porođaj bio induciran bile su starije, imale su veći indeks tjelesne mase i češće prirast tjelesne težine u trudnoći iznad preporučenog u usporedbi s trudnicama koje su imale spontani početak porođaja (p<0,001 sve). Porođaj je češće induciran kod trudnoća s komplikacijama poput gestacijskog dijabetesa, gestacijske hipertenzije, preeklampsije i intrauterinog zastoja u rastu ploda (p<0,001 sve). Trudnice kojima je porođaj induciran češće su rodile carskim rezom, vakuum-ekstrakcijom, češće su imale postpartalno krvarenje, distociju fetalnih ramena te su češće rađale novorođenčad iznad 4000 g u usporedbi s trudnicama u kojih je porođaj započeo spontano (p<0,05). Logistička regresija pokazala je kako su dob trudnice i indeks tjelesne mase prije trudnoće, gestacijski dijabetes, gestacijska hipertenzija, preeklampsija, intrauterini zastoj u rastu ploda i gestacijska dob kod porođaja značajni prediktori indukcije porođaja (p<0,001 sve). Zaključak: Učestalost indukcije porođaja u Hrvatskoj je 14,1%. Indukcija porođaja povezana je s važnim rizičnim čimbenicima i nepoželjnim perinatalnim ishodima koji se djelomice mogu pripisati načinu početka porođaja. O svemu navedenom treba voditi računa kada se savjetuje i planira navedeni opstetrički zahvat

Prevalence of diabetes five years after having gestational diabetes during pregnancy — Croatian national study

AIMS: The aim of this study was to determine the prevalence of diabetes among women 5 years after having gestational diabetes during pregnancy. Also, we sought to determine whether women who develop diabetes after GD during pregnancy differ from women who do not develop diabetes after GD during pregnancy. ----- METHODS: This longitudinal study was performed using data from medical birth certificates and CroDiab diabetes registry. Women burdened with gestational diabetes in Croatia in 2011 were followed up until year 2016. Those registered in CroDiab registry were recognised as new patients with diabetes. ----- RESULTS: Among 40,641 deliveries in 2011, gestational diabetes was reported in 1181 (2.9%) women. Among them 853 (72.23%) were followed up in CroDiab diabetes registry and 32 (3.75%) were identified as new patients with diabetes. Median time from childbirth to onset of diabetes was 29.12 months. The diabetes group did not significantly differ to the group without diabetes according to age (p=0.587), level of education (p=0.549) or marital status (p=0.849) except that the diabetes group was significantly more obese than the group without diabetes (p=0.002). ----- CONCLUSIONS: Based on CroDiab diabetes registry data prevalence of diabetes 5 years after pregnancy complicated with gestational diabetes is 3.75% in Croatia. Women with gestational diabetes during pregnancy, and especially those with higher BMIs, are an important risk group for developing diabetes later in life so screening and preventive measures should be oriented toward them in primary care settings

Microstructural plasticity in nociceptive pathways after spinal cord injury.

OBJECTIVE To track the interplay between (micro-) structural changes along the trajectories of nociceptive pathways and its relation to the presence and intensity of neuropathic pain (NP) after spinal cord injury (SCI). METHODS A quantitative neuroimaging approach employing a multiparametric mapping protocol was used, providing indirect measures of myelination (via contrasts such as magnetisation transfer (MT) saturation, longitudinal relaxation (R1)) and iron content (via effective transverse relaxation rate (R2*)) was used to track microstructural changes within nociceptive pathways. In order to characterise concurrent changes along the entire neuroaxis, a combined brain and spinal cord template embedded in the statistical parametric mapping framework was used. Multivariate source-based morphometry was performed to identify naturally grouped patterns of structural variation between individuals with and without NP after SCI. RESULTS In individuals with NP, lower R1 and MT values are evident in the primary motor cortex and dorsolateral prefrontal cortex, while increases in R2* are evident in the cervical cord, periaqueductal grey (PAG), thalamus and anterior cingulate cortex when compared with pain-free individuals. Lower R1 values in the PAG and greater R2* values in the cervical cord are associated with NP intensity. CONCLUSIONS The degree of microstructural changes across ascending and descending nociceptive pathways is critically implicated in the maintenance of NP. Tracking maladaptive plasticity unravels the intimate relationships between neurodegenerative and compensatory processes in NP states and may facilitate patient monitoring during therapeutic trials related to pain and neuroregeneration

Prikazi / Book Reviews

Digitalna humanistika i digitalizacija etnografske baštine. Godišnji znanstveno-stručni skup Hrvatskog etnološkog društva i 8. znanstveni seminar u čast Branimiru Brataniću, Etnografski muzej Zagreb, 1. lipnja 2017. godine (Janja Kovač); Stranputice humanistike, Petar Bagarić, Ozren Biti i Tea Škokić, ur., Institut za etnologiju i folkloristiku, Zagreb, 2017., 215 str. (Ljiljana Gavrilović); Sensitive Objects. Affect and Material Culture, Jonas Frykman and Maja Povrzanović Frykman, eds., Nordic Academic Press, Lund, 2016, 285 pp. (Meglena Zlatkova); Emanuela Guano, Creative Urbanity. An Italian Middle Class in the Shade of Revitalization, University of Pennsylvania Press, Philadelphia, 2017., 242 str. (Valentina Gulin Zrnić); Mjesto izvedbe i stvaranje grada, Valentina Gulin Zrnić, Nevena Škrbić Alempijević i Josip Zanki, ur. Hrvatsko društvo likovnih umjetnika, Institut za etnologiju i folkloristiku, Zagreb, 2016., 203 str. (Iva Grubiša); Novi Travnik: između utopije i nostalgije, Mario Katić i Velimir Bugarin, ur., Sveučilište u Zadru, Udruga "Baština" Novi Travnik, HKD "Napredak" Sarajevo, Zadar, 2016., 172 str. (Luka Šešo); Mune i Žejane Maksu Pelozi. Zbornik radova sa znanstvenoga skupa Mune Maksu Pelozi, Vele Mune, 24. listopada 2015., Robert Doričić, Helena Doričić, Igor Eterović, Ivana Eterović i Nevena Škrbić Alempijević, ur. Udruga "Žejane", Žejane, 2016., 281 str. (Sara Mikelić); Osama(e). Život naselja do tri stanovnika u Istri. / L\u27ermo(i). La vita nei villagi con fino a tre abitanti in Istria, autorica izložbe i kataloga Ivona Orlić, Etnografski muzej Istre / Museo Etnografico dell\u27Istria, 25. 12. 2016. – 5. 4. 2017. (Ana-Marija Vukušić); Sandi Blagonić, Istrijani protiv Istrana. Diskurzivna konstrukcija identiteta i simbolička natjecanja, Naklada Jesenski i Turk, Zagreb, 2016., 183 str. (Katja Sirotić); Reana Senjković, Svaki dan pobjeda. Kultura omladinskih radnih akcija, Institut za etnologiju i folkloristiku, Srednja Europa, Zagreb, 2016., 350 str. (Matea Korda); Duško Petrović, Izbjeglištvo u suvremenom svijetu. Od političkoteorijskih utemeljenja do biopolitičkih ishoda, Naklada Ljevak, Zagreb, 2016., 440 str. (Tomislav Pletenac); Tijana Trako Poljak, Hrvatski simbolički identitet. Značenja nacionalnih simbola iz perspektive hrvatskih građana, Tim press, Zagreb, 2016., 313 str. (Marijeta Rajković Iveta); Milana Černelić, Bunjevci. Ishodišta, sudbine, identiteti, Filozofski fakultet, Odsjek za etnologiju i kulturnu antropologiju, FF-press, Zavod za kulturu vojvođanskih Hrvata, Zagreb, Subotica, 2016., 264 str. (Petra Kelemen); Balázs Borsos, The Regional Structure of Hungarian Folk Culture, Waxmann, Münster, New York, 2017., 436 str. (Jelka Vince Pallua); Christine A. Jones, Mother Goose Refigured. A Critical Translation of Charles Perrault’s Fairy Tales, Wayne State University Press, Detroit, 2016., 216 str. (Nada Kujundžić)Digitalna humanistika i digitalizacija etnografske baštine. Godišnji znanstveno-stručni skup Hrvatskog etnološkog društva i 8. znanstveni seminar u čast Branimiru Brataniću, Etnografski muzej Zagreb, 1. lipnja 2017. godine (Janja Kovač); Stranputice humanistike, Petar Bagarić, Ozren Biti i Tea Škokić, ur., Institut za etnologiju i folkloristiku, Zagreb, 2017., 215 str. (Ljiljana Gavrilović); Sensitive Objects. Affect and Material Culture, Jonas Frykman and Maja Povrzanović Frykman, eds., Nordic Academic Press, Lund, 2016, 285 pp. (Meglena Zlatkova); Emanuela Guano, Creative Urbanity. An Italian Middle Class in the Shade of Revitalization, University of Pennsylvania Press, Philadelphia, 2017., 242 str. (Valentina Gulin Zrnić); Mjesto izvedbe i stvaranje grada, Valentina Gulin Zrnić, Nevena Škrbić Alempijević i Josip Zanki, ur. Hrvatsko društvo likovnih umjetnika, Institut za etnologiju i folkloristiku, Zagreb, 2016., 203 str. (Iva Grubiša); Novi Travnik: između utopije i nostalgije, Mario Katić i Velimir Bugarin, ur., Sveučilište u Zadru, Udruga "Baština" Novi Travnik, HKD "Napredak" Sarajevo, Zadar, 2016., 172 str. (Luka Šešo); Mune i Žejane Maksu Pelozi. Zbornik radova sa znanstvenoga skupa Mune Maksu Pelozi, Vele Mune, 24. listopada 2015., Robert Doričić, Helena Doričić, Igor Eterović, Ivana Eterović i Nevena Škrbić Alempijević, ur. Udruga "Žejane", Žejane, 2016., 281 str. (Sara Mikelić); Osama(e). Život naselja do tri stanovnika u Istri. / L\u27ermo(i). La vita nei villagi con fino a tre abitanti in Istria, autorica izložbe i kataloga Ivona Orlić, Etnografski muzej Istre / Museo Etnografico dell\u27Istria, 25. 12. 2016. – 5. 4. 2017. (Ana-Marija Vukušić); Sandi Blagonić, Istrijani protiv Istrana. Diskurzivna konstrukcija identiteta i simbolička natjecanja, Naklada Jesenski i Turk, Zagreb, 2016., 183 str. (Katja Sirotić); Reana Senjković, Svaki dan pobjeda. Kultura omladinskih radnih akcija, Institut za etnologiju i folkloristiku, Srednja Europa, Zagreb, 2016., 350 str. (Matea Korda); Duško Petrović, Izbjeglištvo u suvremenom svijetu. Od političkoteorijskih utemeljenja do biopolitičkih ishoda, Naklada Ljevak, Zagreb, 2016., 440 str. (Tomislav Pletenac); Tijana Trako Poljak, Hrvatski simbolički identitet. Značenja nacionalnih simbola iz perspektive hrvatskih građana, Tim press, Zagreb, 2016., 313 str. (Marijeta Rajković Iveta); Milana Černelić, Bunjevci. Ishodišta, sudbine, identiteti, Filozofski fakultet, Odsjek za etnologiju i kulturnu antropologiju, FF-press, Zavod za kulturu vojvođanskih Hrvata, Zagreb, Subotica, 2016., 264 str. (Petra Kelemen); Balázs Borsos, The Regional Structure of Hungarian Folk Culture, Waxmann, Münster, New York, 2017., 436 str. (Jelka Vince Pallua); Christine A. Jones, Mother Goose Refigured. A Critical Translation of Charles Perrault’s Fairy Tales, Wayne State University Press, Detroit, 2016., 216 str. (Nada Kujundžić

Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements

Comparison of intracervical and intravaginal application of prostaglandin E2 for induction of labour in term pregnancies with unfavourable cervix

Uvod. Indukcija porođaja je postupak poticanja porođaja prije njegovog spontanog početka koji se provodi u svakom četvrtom porođaju u razvijenim zemljama svijeta. Jedan od najčešće korištenih preparata za indukciju porođaja kod nepovoljnog genitalnog nalaza je prostaglandin E2 (PGE2, dinoproston), koji se može aplicirati u obliku intracervikalnog (IC) i intravaginalnog (IV) preparata te su istraživanja i dalje nekonzistentna koji je način aplikacije učinkovitiji i sigurniji. Cilj ovog istraživanja bio je usporediti IC i IV primjenu PGE2 preparata za indukciju porođaja terminskih trudnoća s nepovoljnim genitalnim nalazom te utvrditi postoji li razlika u vremenskom intervalu od početka indukcije do porođaja i u učestalosti uspješne indukcije između navedenih preparata. ----- Ispitanice i metode. Provedeno je prospektivno randomizirano kontrolirano istraživanje koje je uključivalo trudnice s nepovoljnim genitalnim nalazom randomizirane za indukciju porođaja primjenom IC (0,5 mg) ili IV (2mg) preparata PGE2. Ukupno je 212 ispitanica randomizirano, 106 u svaku skupinu. Statistička analiza provedena je u paketu SPSS v21, razina značajnosti postavljena je na p<0,05. ----- Rezultati. Ispitanice u IV skupini u usporedbi s ispitanicama u IC skupini imale su kraći interval od početka indukcije do porođaja (p<0,001) i od početka indukcije do početka aktivne faze porođaja (p=0,001), veću učestalost vaginalnog porođaja unutar 24 sata od početka indukcije (63,3 % naspram 40,6 %, p=0,002) i veću učestalost uspješne indukcije (95,9 % naspram 86,5 %, p=0,020). Srednja vrijednost intervala od početka indukcije do porođaja iznosila je 28 sati u IC skupini i 15 sati u IV skupini. Ispitanice u skupinama nisu se značajno razlikovale prema dobi, paritetu, indeksu tjelesne mase, Bishop zbroju i ultrazvučnoj (UZV) duljini vrata maternice. Nije utvrđena razlika između skupina prema načinu dovršetka trudnoće (p=0,453) niti prema neželjenim perinatalnim ishodima. Bishop zbroj > 2 pokazao se kao dobar prediktor uspješne indukcije dok UZV duljina vrata maternice < 29 mm ima lošiju predikciju. Multivarijatna logistička regresija pokazala je da IV preparat povećava šansu porođaja unutar 24 sata od početka indukcije te smanjuje šansu neuspješne indukcije u usporedbi s IC preparatom. Povećanje Bishop zbroja povisuje šansu dovršetka porođaja unutar 24 sata od početka indukcije te smanjuje šansu dovršetka porođaja carskim rezom i neuspješne indukcije. Trošak indukcije porođaja manji je kod IV nego IC primjene preparata PGE2. ----- Zaključak. IV primjena PGE2 naspram IC primjene učinkovitija je i jeftinija metoda indukcije porođaja uz usporedivu sigurnost kod terminskih trudnoća s nepovoljnim genitalnim nalazom te bi trebala biti metoda izbora za ovaj postupak. Bishop zbroj bolji je prediktor uspješne indukcije od UZV duljina vrata maternice.Introduction. One of the most often used formulations for induction of labour in women with unfavourable cervix is prostaglandin E2 (PGE2, dinoprostone) which can be applied as an intracervical (IC) or intravaginal (IV) formulation and studies remain indecisive which formulation is more efficient and safe. The aim of this study was to compare IC and IV application of PGE2 for labour induction in term pregnancies with unfavourable cervix. ----- Materials and methods. This is a prospective randomised controlled trial including 212 pregnant women with unfavourable cervix who were randomly assigned for labour induction with either IC (0.5mg) or IV (2mg) PGE2 formulation. ----- Results. Women in IV group compared to those in IC group had shorter induction to delivery time (p<0.001), higher prevalence of vaginal delivery within 24 hours of labour induction (p=0.002) and higher prevalence of successful labour induction (p=0.020). Median interval from induction to delivery was 28 hours in IC group and 15 hours in IV group. The studied groups did not significantly differ regarding main clinical characteristics, mode of delivery or adverse perinatal outcomes. Bishop score > 2 was shown to be a good predictor of successful labour induction while cervical lenght < 29mm had poorer predictive value. ----- Conclusion. IV application of PGE2 is more effective and less costly than IC application for induction of labour in term pregnancies with unfavourable cervix with a comparable safety profile and should be the method of choice for this procedure