Small for gestational age in mild and moderate preterm delivery at Split University Hospital Centre: effect of delivery mode on neonatal outcome a three year retrospective study

In the present study, we aim to assess whether there is a difference in cesarean delivery incidence in moderate and mild preterm birth. This retrospective study included singleton pregnancies with moderate and mild preterm birth in the period from January 1, 2015 to December 31, 2017. The following variables were investigated: maternal age (years), parity, week of pregnancy (≤32-33+6/7 and 34-36+6/7 ), and mode of delivery (vaginal and cesarean section), birth weight (grams) and 5 min Apgar score (≤7, 8-10). Five hundred and eighty six women had preterm delivery in that period and 521 met inclusion criteria. Sixty-nine were born from 32-33+6/7 and 452 from 34-36+6/7 weeks of pregnancy. There was not a statistically significant difference in the age and parity between groups (p=0.6406). There was a statistically significant difference in delivery mode (χ2=21.5634; p<0.001), the rate of small for gestational age (SGA) neonates (χ2=22.6002; p<0.001) and Apgar score (χ2=77.8317; p<0.01) between the study groups. Statistical analysis revealed the difference in APGAR score according to delivery mode between moderate and mild SGA newborns (χ2=16.2398; p<0.0001). We found a difference in incidence of cesarean delivery according to the relation of newborn weight with gestational age between the investigated groups. (χ2=43.8247; p<0.0001). We found a correlation of APGAR score and mode of delivery in mild (χ2=24.3262; p<0.0004) but not in moderate (χ2=5.8245; p<0.4413) newborns. There was a statistical difference in APGAR score according to mode of delivery in mild and moderate SGA newborns (χ2=16.2398; p<0.001). In conclusion, we found that the delivery mode has no impact on perinatal outcome according to APGAR score in the 5th minute. There is increased incidence of SGA and cesarean delivery in moderate preterm group. There is a difference in APGAR score in 5th minute between mild and moderate preterm infants. In subgroup of SGA newborns, delivery mode has an impact on APGAR score in the 5th minute. Increased incidence of SGA babies in moderate preterm birth group could be an indicator of hostile intrauterine environment and preterm birth could be seen as a protective mechanism

Severe preterm preeclampsia - associated posterior reversible encephalopathy syndrome

Posterior reversible encephalopathy syndrome (PRES) is a clinical syndrome which causes non-specific neurological symptoms such as visual impairment (cortical blindness, diplopia, hemianopia), acute headaches, seizures (focal or general tonic-clonic), vomiting, altered mental status, focal neurologic deficit as a complication of preeclampsia. Preeclampsia is a serious complication specific for pregnancy, characterized by hypertension (systolic > 140 mm Hg and/or diastolic > 90 mm Hg) and proteinuria (> 300 mg u 24-h urine sample , > 1 +) at or after 20th week of gestation. It is one of the leading causes of perinatal morbidity and mortality. We present a 38-year-old pregnant woman, gravida 1 para 0 with PRES which was manifested on the second day after delivery by Cesarean section at 32 weeks of gestation with aphasia and blindness caused by severe preeclampsia. We confirmed the diagnosis by MRI which revealed white matter edema in the posterior cerebral area in a symmetric fashion, hyper intense cortical foci in the right occipital lobe and punctiform lesions in the bilateral occipital lobe. We treated her promptly in the intensive care unit (ICU) with antihypertensive and anticonvulsant therapy after which she fully recovered. PRES should always be kept in mind when a patient in the postpartum period develops one of the above symptoms. If timely recognized and promptly treated, full recover usually follows

Cesarean section in singleton preterm deliveries at KBC Split

Cilj istraživanja: Istražiti učestalost dovršetka jednoplodovih nedonošenih trudnoća carskim rezom. Ispitanici i metode: Istraživano razdoblje obuhvaća period od 01.01.2015.-31.12.2018. Podaci su prikupljeni su popisnom metodom iz pisanih rađaoničkih protokola Klinike za ženske bolesti i porođaje KBC-a Split. Rezultati: U promatranom razdoblju je bilo 1124 prijevremena porođaja, a od toga 922 jednoplodovih trudnoća. U istraživanom razdoblju nije bilo razlike u učestalosti prijevremenog porođaja između istraživanih godina (χ2=12,44; P=0,053).U promatranom razdoblju nismo našli razlike u učestalosti raznih stupnjeva nednonošenosti (χ2=4,03; P=0,903 ) kao ni u načinu dovršetka trudnoće; ekstremna nedonošenost (χ2=0,65: P=0,885), teška nedonešenost (χ2=1,07; P=0,783), umjerena nedonošenost (χ2=6,05; P=0,109), i blaga nedonošenost (χ2=0,49; P=0,919). Uočili smo razliku u načinu dovršetka trudnoće s obzirom na porođajnu masu djece (χ2=70,85; P<0,001). Nismo vidjeli razliku u dobi majki koje su rađale vaginalno i carskim rezom (t=-1,14:p=0,13), kao ni u razliku u porođajnoj masi (t=-1,125; P=0,08 ) i duljini djece (t=0,6; p=0,548). Pronašli smo razliku u paritetu majki (χ2 test=44,91; P<0,001) te vodećoj česti u porođaju (χ2=60,55; P<0,050). Dokazali smo razliku u kategorijama pH vrijednosti krvi iz pupčane arterije novorođenčadi djece rođene vaginalno i carskim rezom (χ2=19,17; p<0,050) te u APGAR zbroju djece između istraživanih skupina (χ2=104,22; P<0,001). U žena koje su tijekom trudnoće razvile kliničke simptome preeklampsije (χ2= 6,02; P=0,014) i HELLP sindroma (χ2=6,42; P=0,011) pronašli smo statistički značajnu razliku u načinu završetka trudnoće. U žena koje su tijekom trudnoće razvile kliničke simptome GDM (χ2=0,11; P=0,745), IDDM (χ2=0,08; P=0,782), te kolestaze (χ2=0,03; P=0,862) nismo pronašli statistički značajnu razliku u načinu porođaja. Zaključci: Naše istraživanje pokazalo je da u promatranom razdoblju nema razlike u učestalosti svih prijevremenih porođaja. Učestalost jednoplodnih nedonošenih trudnoća je u promatranom razdoblju stalna, kao i njihova razdioba po stupnju nedonošenosti. Nismo pronašli razlike u učestalosti dovršetka trudnoće carskim rezom s obzirom na stupanj nedonošenosti, ali smo pronašli razliku u odnosu na porođajnu masu djece. Način porođaja ima utjecaja na vrijednost zbroja po Apgarovoj te pH vrijednost iz pupčane arterijeAim: The aim of the study was to investigate does delivery mode has impact on perinatal outcome in singleton preterm birth. Material and methods: This retrospective study included singleton preterm deliveries in the period from January 1, 2015 to December 31, 2018. Data were collected from the official delivery book of University Hospital of Split. Results: In investigate period there was 1124 preterm births, and 922 singletons. There was no statistically significant difference in the preterm delivery rate (χ2=12.44; P=0.053). Also there were no differnce in degree of prematurity (χ2=4.03; P=0.903), and in cesarean delivery rate in differentnt degrees of prematurity; extreme (χ2=0.65: P=0.885), very (χ2=1.07; P=0.783), moderate (χ2=6.05; P=0.109), and mild (χ2=0.49; P=0.919). We found difference in birth weight (χ2=70.85; P<0.001) between investigated groups. There was a statistically significant differenca in maternal age (t=-1,14:P=0.13), birth weight (t=-1.125; P=0.08) and legth of newborns (t=0.6; P=0.548). We find difference in parity and (χ2 test=44,91; P<0.001) and presentation (χ2=60.55; P<0.050) between investigated groups. There was a statistically significant difference in the APGAR score (χ2=104.22; P<0.001) and umbilical artery pH (χ2=19.17; P<0.050) between study groups. In women with preeclampsia (χ2= 6.02; P=0.014) and HELLP (χ2=6.42; P=0.011) we find difference in delivery mode between study groups. Conclusion: Our research has shown that there is no difference in the incidence of all premature deliveries in the observed period. The frequency of uncommon premature pregnancies is constant in the observed period, as well as their distribution by degree of non-obesity. We did not find any differences in the incidence of pregnancy completion with Caesarean section due to the degree of inadequacy, but we found a difference in relation to the birth weight of children. The method of delivery has an effect on the value of the sum of Apgarus and the pH of the umbilical artery

Diskordantni rast u dikorionskih blizanaca i rizik prijevremenog porođaja

The aim was to determine whether discordant twin growth has an impact on preterm birth in dichorionic pregnancies. This retrospective study included dichorionic twin pregnancies in the period from January 1, 2013 to December 31, 2015. The following variables were investigated: maternal age (years), parity, body mass index (kg/m2), week (≤366/7 and ≥37) and mode of delivery (vaginal and cesarean section), birth weight (grams) and Apgar score (≤7, 8-10). Discordant twin growth in dichorionic pregnancies was found to be associated with preterm birth (χ2=4.74; p=0.03) but had no impact on the mode of delivery (χ2=0.119; p=0.73). There was a statistically significant difference in the rate of small for gestational age (SGA) neonates (χ2=16.4556; p=0.000267) and Apgar score (χ2=7.9931; p<0.05) between the study groups. Mode of conception in dichorionic pregnancies was not a risk factor for preterm delivery (χ2=1.417; p=0.23). In conclusion, discordant twin growth in dichorionic pregnancies is a risk factor for preterm delivery and has no impact on the mode of delivery but has an impact on the rate of SGA and Apgar score.Cilj istraživanja je bio ustanoviti ima li diskordantni rast blizanaca u dikorionskim blizanačkim trudnoćama utjecaja na pojavnost prijevremenog porođaja. U studiju su uključene dikorionske blizanačke trudnoće u razdoblju od 1. siječnja 2013. do 31. prosinca 2015. Istraživane varijable su bile majčinska dob (godine), paritet, indeks tjelesne mase (kg/m2), način po-rođaja (vaginalno i carski rez), porođajna masa (grami) i zbroj APGAR (≤7, 8-10). U blizanačkim trudnoćama s diskordantnim rastom bila je veća učestalost prijevremenog porođaja (χ2=4,74; p=0,03), ali nije bilo razlike u načinu dovršetka trudnoće ­između istraživanih skupina (χ2=0,119; p=0,73). Utvrđena je statistički značajna razlika u pojavnosti hipotrofične djece (χ2=16,4556; p=0,000267) i zbroju APGAR (χ2=7,9931; p<0,05) između istraživanih skupina. Način zanošenja u dikorionskim trudnoćama nije bio činitelj rizika za prijevremeni porođaj u istraživanim skupinama (χ2=1,417; p=0,23). Zaključno, diskordantni rast blizanaca u dikorionskim trudnoćama predstavlja činitelj rizika za prijevremeni porođaj, hipotrofiju novorođenčadi i niži zbroj APGAR, ali nema utjecaja na način dovršetka trudnoće

Liječenje pneumotoraksa

Pluća oblaže tanka ovojnica koja se naziva pleura, a građena je od dva sloja, parijetalnog i visceralnog. Između dva lista pleure nalazi se mala količina surfaktanta koja olakšava proces disanja. U patološkom stanju taj potencijalni prostor može biti ispunjen zrakom, razvija se pneumotoraks i pluće kolabira. Količina zraka u pleuralnom prostoru određuje veličinu pneumotoraksa i njegovu malignost. Od posve malih i asimptomatskih, do velikih koji pritišću kolabirano pluće, te dovode do razvoja dispneje i nagle boli u grudima. Prema mehanizmu nastanka pneumotoraks djelimo na spontani i traumatski. Kada spontano nastane u potpuno zdrave osobe nazivamo ga primarni spontani pneumotoraks. Ukoliko je osoba ranije bolovala od neke plućne bolesti govorimo o sekundarnom spontanom pneumotoraksu, koji je najčešće i komplikacija te iste bolesti. Traumatski pneumotoraks nastaje kod penetrantnih ozljeda pluća i zatvorenih povreda plućnog parenhima ili traheobronhalnog stabla. Posebnu pozornost treba obratiti na tenzijski pneumotoraks kao stanje koje može dovesti do kardiopulmonalne insuficijencije, te posljedično smrti pacijenta u svega nekoliko minuta. U ovoj situaciji nalaže se hitna dekompresija iglom ili kateterom. Pneumotoraks dijagnosticiramo temeljem anamneze i fizikalnog nalaza uz pomoć RTG snimaka i CT-a. Liječenje ima za cilj evakuaciju zraka iz pleuralnog prostora i sprječavanje njegovog povratka. Svaki pneumotoraks iziskuje zasebni pristup i odabir najbolje metode liječenja. Terapijske mogućnosti variraju od opservacije, drenaže pa sve do kiruških zahvata. U svrhu sprječavanja recidiva resekcijske tehnike kombiniraju se sa metodama trajne obliteracije, pleurodezama.Lungs are covered with thin invaginated sac called pleura, which is built from two layers, parietal and visceral. Between those two layers we can find small amount of liquid which facilitates the process of breathing. In pathological condition this potential space can be fulfilled with air, which cause pneumothorax and lung collapse. Amount of air in pleural space determinates largeness of pneumothorax and it´s malignancy. From very little and asymptomatic, till severely large which puts pressure on collapsed lung and cause dyspnea and sudden chest pain. According to mechanism of genesis we can divide pneumothorax on spontaneous and traumatic. When it occurs spontaneously in absolutely healthy person we call it primary spontaneous pneumothorax. If person before suffered from any lung disease we talk about secondary spontaneous pneumothorax, which is mostly a complication of that same disease. Traumatic pneumothorax occurs in penetrating injuries and closed trauma of lungs parenchyma or tracheobronchial tree. Special attention must be referred when it comes to tension pneumothorax, because this condition can lead to cardiopulmonary arrest and consequently to death of patient in only few minutes. In this situation it´s required to promptly decompress the lung with needle or catheter. We can diagnose pneumothorax based on anamnesis and physical findings with the help of an RTG scanning and CT. Treatment for the tasks has to evacuate the air from pleural space and to prevent it´s recidivism. Each pneumothorax requires individual access and best choice of method to cure it. Therapical possibilities vary from observation, aspiration to surgical operation. In purpose to prevent recidives we combine resection surgery with methods of permanent obliteration, pleurodesis

Liječenje pneumotoraksa

Pluća oblaže tanka ovojnica koja se naziva pleura, a građena je od dva sloja, parijetalnog i visceralnog. Između dva lista pleure nalazi se mala količina surfaktanta koja olakšava proces disanja. U patološkom stanju taj potencijalni prostor može biti ispunjen zrakom, razvija se pneumotoraks i pluće kolabira. Količina zraka u pleuralnom prostoru određuje veličinu pneumotoraksa i njegovu malignost. Od posve malih i asimptomatskih, do velikih koji pritišću kolabirano pluće, te dovode do razvoja dispneje i nagle boli u grudima. Prema mehanizmu nastanka pneumotoraks djelimo na spontani i traumatski. Kada spontano nastane u potpuno zdrave osobe nazivamo ga primarni spontani pneumotoraks. Ukoliko je osoba ranije bolovala od neke plućne bolesti govorimo o sekundarnom spontanom pneumotoraksu, koji je najčešće i komplikacija te iste bolesti. Traumatski pneumotoraks nastaje kod penetrantnih ozljeda pluća i zatvorenih povreda plućnog parenhima ili traheobronhalnog stabla. Posebnu pozornost treba obratiti na tenzijski pneumotoraks kao stanje koje može dovesti do kardiopulmonalne insuficijencije, te posljedično smrti pacijenta u svega nekoliko minuta. U ovoj situaciji nalaže se hitna dekompresija iglom ili kateterom. Pneumotoraks dijagnosticiramo temeljem anamneze i fizikalnog nalaza uz pomoć RTG snimaka i CT-a. Liječenje ima za cilj evakuaciju zraka iz pleuralnog prostora i sprječavanje njegovog povratka. Svaki pneumotoraks iziskuje zasebni pristup i odabir najbolje metode liječenja. Terapijske mogućnosti variraju od opservacije, drenaže pa sve do kiruških zahvata. U svrhu sprječavanja recidiva resekcijske tehnike kombiniraju se sa metodama trajne obliteracije, pleurodezama.Lungs are covered with thin invaginated sac called pleura, which is built from two layers, parietal and visceral. Between those two layers we can find small amount of liquid which facilitates the process of breathing. In pathological condition this potential space can be fulfilled with air, which cause pneumothorax and lung collapse. Amount of air in pleural space determinates largeness of pneumothorax and it´s malignancy. From very little and asymptomatic, till severely large which puts pressure on collapsed lung and cause dyspnea and sudden chest pain. According to mechanism of genesis we can divide pneumothorax on spontaneous and traumatic. When it occurs spontaneously in absolutely healthy person we call it primary spontaneous pneumothorax. If person before suffered from any lung disease we talk about secondary spontaneous pneumothorax, which is mostly a complication of that same disease. Traumatic pneumothorax occurs in penetrating injuries and closed trauma of lungs parenchyma or tracheobronchial tree. Special attention must be referred when it comes to tension pneumothorax, because this condition can lead to cardiopulmonary arrest and consequently to death of patient in only few minutes. In this situation it´s required to promptly decompress the lung with needle or catheter. We can diagnose pneumothorax based on anamnesis and physical findings with the help of an RTG scanning and CT. Treatment for the tasks has to evacuate the air from pleural space and to prevent it´s recidivism. Each pneumothorax requires individual access and best choice of method to cure it. Therapical possibilities vary from observation, aspiration to surgical operation. In purpose to prevent recidives we combine resection surgery with methods of permanent obliteration, pleurodesis

Liječenje pneumotoraksa

Pluća oblaže tanka ovojnica koja se naziva pleura, a građena je od dva sloja, parijetalnog i visceralnog. Između dva lista pleure nalazi se mala količina surfaktanta koja olakšava proces disanja. U patološkom stanju taj potencijalni prostor može biti ispunjen zrakom, razvija se pneumotoraks i pluće kolabira. Količina zraka u pleuralnom prostoru određuje veličinu pneumotoraksa i njegovu malignost. Od posve malih i asimptomatskih, do velikih koji pritišću kolabirano pluće, te dovode do razvoja dispneje i nagle boli u grudima. Prema mehanizmu nastanka pneumotoraks djelimo na spontani i traumatski. Kada spontano nastane u potpuno zdrave osobe nazivamo ga primarni spontani pneumotoraks. Ukoliko je osoba ranije bolovala od neke plućne bolesti govorimo o sekundarnom spontanom pneumotoraksu, koji je najčešće i komplikacija te iste bolesti. Traumatski pneumotoraks nastaje kod penetrantnih ozljeda pluća i zatvorenih povreda plućnog parenhima ili traheobronhalnog stabla. Posebnu pozornost treba obratiti na tenzijski pneumotoraks kao stanje koje može dovesti do kardiopulmonalne insuficijencije, te posljedično smrti pacijenta u svega nekoliko minuta. U ovoj situaciji nalaže se hitna dekompresija iglom ili kateterom. Pneumotoraks dijagnosticiramo temeljem anamneze i fizikalnog nalaza uz pomoć RTG snimaka i CT-a. Liječenje ima za cilj evakuaciju zraka iz pleuralnog prostora i sprječavanje njegovog povratka. Svaki pneumotoraks iziskuje zasebni pristup i odabir najbolje metode liječenja. Terapijske mogućnosti variraju od opservacije, drenaže pa sve do kiruških zahvata. U svrhu sprječavanja recidiva resekcijske tehnike kombiniraju se sa metodama trajne obliteracije, pleurodezama.Lungs are covered with thin invaginated sac called pleura, which is built from two layers, parietal and visceral. Between those two layers we can find small amount of liquid which facilitates the process of breathing. In pathological condition this potential space can be fulfilled with air, which cause pneumothorax and lung collapse. Amount of air in pleural space determinates largeness of pneumothorax and it´s malignancy. From very little and asymptomatic, till severely large which puts pressure on collapsed lung and cause dyspnea and sudden chest pain. According to mechanism of genesis we can divide pneumothorax on spontaneous and traumatic. When it occurs spontaneously in absolutely healthy person we call it primary spontaneous pneumothorax. If person before suffered from any lung disease we talk about secondary spontaneous pneumothorax, which is mostly a complication of that same disease. Traumatic pneumothorax occurs in penetrating injuries and closed trauma of lungs parenchyma or tracheobronchial tree. Special attention must be referred when it comes to tension pneumothorax, because this condition can lead to cardiopulmonary arrest and consequently to death of patient in only few minutes. In this situation it´s required to promptly decompress the lung with needle or catheter. We can diagnose pneumothorax based on anamnesis and physical findings with the help of an RTG scanning and CT. Treatment for the tasks has to evacuate the air from pleural space and to prevent it´s recidivism. Each pneumothorax requires individual access and best choice of method to cure it. Therapical possibilities vary from observation, aspiration to surgical operation. In purpose to prevent recidives we combine resection surgery with methods of permanent obliteration, pleurodesis

Severe preterm preeclampsia - associated posterior reversible encephalopathy syndrome

Posterior reversible encephalopathy syndrome (PRES) is a clinical syndrome which causes non-specific neurological symptoms such as visual impairment (cortical blindness, diplopia, hemianopia), acute headaches, seizures (focal or general tonic-clonic), vomiting, altered mental status, focal neurologic deficit as a complication of preeclampsia. Preeclampsia is a serious complication specific for pregnancy, characterized by hypertension (systolic > 140 mm Hg and/or diastolic > 90 mm Hg) and proteinuria (> 300 mg u 24-h urine sample , > 1 +) at or after 20th week of gestation. It is one of the leading causes of perinatal morbidity and mortality. We present a 38-year-old pregnant woman, gravida 1 para 0 with PRES which was manifested on the second day after delivery by Cesarean section at 32 weeks of gestation with aphasia and blindness caused by severe preeclampsia. We confirmed the diagnosis by MRI which revealed white matter edema in the posterior cerebral area in a symmetric fashion, hyper intense cortical foci in the right occipital lobe and punctiform lesions in the bilateral occipital lobe. We treated her promptly in the intensive care unit (ICU) with antihypertensive and anticonvulsant therapy after which she fully recovered. PRES should always be kept in mind when a patient in the postpartum period develops one of the above symptoms. If timely recognized and promptly treated, full recover usually follows