Prevalence of congenital uterine anomalies at the University Hospital Sveti Duh in a ten-year period

Prirođene anomalije maternice nastaju kada u embrionalnom razvoju Müllerovih cijevi dođe do prekida ili pogrješaka u jednome od dinamičnih procesa diferencijacije, migracije, fuzije i kanalizacije. Povezuju se s mnogim ginekološkim i opstetričkim poteškoćama, a simptomi i znakovi uvelike variraju u ovisnosti o vrsti anomalije. Učestalost anomalija Müllerovih cijevi još uvijek nije poznata. U literaturi prevalencija u općoj populaciji varira od 0,16 do 10 %, u visokorizičnoj populaciji još je i viša, a najviša je među neplodnim ženama s habitualnim pobačajima i iznosi približno 25 %. Cilj istraživanja bio je prikazati učestalost prirođenih anomalija maternice u KB Sveti Duh u razdoblju od 1. siječnja 2007. do 31. prosinca 2016. godine. U istraživanju su korišteni podaci iz registara u kojima su evidentirani svi porođaji i ginekološke operacije u navedenom razdoblju. Obuhvaćeno je ukupno 40 618 pacijentica: 31 387 rodilja i 9 231 operirana žena. Operirane žene s anomalijama maternice većinom su bile podvrgnute histeroskopiji zbog lošeg reproduktivnog ishoda. Rezultati su prikazani prema CONUTA klasifikaciji. Dobiveni rezultati prikazuju ukupnu prevalenciju prirođenih anomalija maternice (1,23 %), prevalenciju među operiranim ženama (3,28 %) te prevalenciju među rodiljama (0,63 %). Nađeno je petnaest tipova anomalija, a kao najučestalije anomalije ističu se uterus septus partialis (75,2 %) i uterus bicorporalis partialis (13,8 %). Različiti klasifikacijski sustavi, raznolikost dijagnostičkih metoda i njihovih mogućnosti te različit odabir populacije žena glavni su čimbenici koji pridonose nepouzdanosti epidemioloških podataka u ovom području. Kao jedno od mogućih rješenja nameće se raširenija i primjerenija upotreba 3D ultrazvuka.Congenital uterine anomalies occur during embryonic development of müllerian ducts when an interruption or dysregulation occurs in any of the dynamic processes of differentiation, migration, fusion, and canalization. They are associated with many gynecological and obstetrical conditions, while signs and symptoms vary depending on the type of anomaly. The actual prevalence of müllerian anomalies is still unknown. In literature, the prevalence in the general population ranges from 0.16 to 10 %, while it is higher in the high-risk population and is the highest among infertile women with recurrent abortions where prevalence is approximately 25 %. The aim of the study was to present the prevalence of congenital uterine anomalies at the University Hospital Sveti Duh in the period from January 1, 2007 to December 31, 2016. In this study, data from surgical records and delivery records were used. A total of 40 618 patients were included: 31 387 women who gave birth and 9 231 operated women. Operated women with uterine anomalies were mostly hysteroscopically examined and/or treated due to poor reproductive outcome. The results are presented according to the CONUTA classification. Total prevalence of congenital anomalies (1.23%), prevalence among the operated women (3.28%), and prevalence among women who gave birth (0.63%) were obtained. Fifteen types of anomalies were reported, and the most common anomalies were partial septate uterus (75.2%) and partial bicorporal uterus (13.8%). Main factors contributing to the unreliability of epidemiological data in this area are: different classification systems, the variety of diagnostic methods and their capabilities, and various choice of women's population. One of the possible solutions to this issue is the widespread use of 3D ultrasound and more standardized diagnostic criteria

Prevalence of congenital uterine anomalies at the University Hospital Sveti Duh in a ten-year period

Prirođene anomalije maternice nastaju kada u embrionalnom razvoju Müllerovih cijevi dođe do prekida ili pogrješaka u jednome od dinamičnih procesa diferencijacije, migracije, fuzije i kanalizacije. Povezuju se s mnogim ginekološkim i opstetričkim poteškoćama, a simptomi i znakovi uvelike variraju u ovisnosti o vrsti anomalije. Učestalost anomalija Müllerovih cijevi još uvijek nije poznata. U literaturi prevalencija u općoj populaciji varira od 0,16 do 10 %, u visokorizičnoj populaciji još je i viša, a najviša je među neplodnim ženama s habitualnim pobačajima i iznosi približno 25 %. Cilj istraživanja bio je prikazati učestalost prirođenih anomalija maternice u KB Sveti Duh u razdoblju od 1. siječnja 2007. do 31. prosinca 2016. godine. U istraživanju su korišteni podaci iz registara u kojima su evidentirani svi porođaji i ginekološke operacije u navedenom razdoblju. Obuhvaćeno je ukupno 40 618 pacijentica: 31 387 rodilja i 9 231 operirana žena. Operirane žene s anomalijama maternice većinom su bile podvrgnute histeroskopiji zbog lošeg reproduktivnog ishoda. Rezultati su prikazani prema CONUTA klasifikaciji. Dobiveni rezultati prikazuju ukupnu prevalenciju prirođenih anomalija maternice (1,23 %), prevalenciju među operiranim ženama (3,28 %) te prevalenciju među rodiljama (0,63 %). Nađeno je petnaest tipova anomalija, a kao najučestalije anomalije ističu se uterus septus partialis (75,2 %) i uterus bicorporalis partialis (13,8 %). Različiti klasifikacijski sustavi, raznolikost dijagnostičkih metoda i njihovih mogućnosti te različit odabir populacije žena glavni su čimbenici koji pridonose nepouzdanosti epidemioloških podataka u ovom području. Kao jedno od mogućih rješenja nameće se raširenija i primjerenija upotreba 3D ultrazvuka.Congenital uterine anomalies occur during embryonic development of müllerian ducts when an interruption or dysregulation occurs in any of the dynamic processes of differentiation, migration, fusion, and canalization. They are associated with many gynecological and obstetrical conditions, while signs and symptoms vary depending on the type of anomaly. The actual prevalence of müllerian anomalies is still unknown. In literature, the prevalence in the general population ranges from 0.16 to 10 %, while it is higher in the high-risk population and is the highest among infertile women with recurrent abortions where prevalence is approximately 25 %. The aim of the study was to present the prevalence of congenital uterine anomalies at the University Hospital Sveti Duh in the period from January 1, 2007 to December 31, 2016. In this study, data from surgical records and delivery records were used. A total of 40 618 patients were included: 31 387 women who gave birth and 9 231 operated women. Operated women with uterine anomalies were mostly hysteroscopically examined and/or treated due to poor reproductive outcome. The results are presented according to the CONUTA classification. Total prevalence of congenital anomalies (1.23%), prevalence among the operated women (3.28%), and prevalence among women who gave birth (0.63%) were obtained. Fifteen types of anomalies were reported, and the most common anomalies were partial septate uterus (75.2%) and partial bicorporal uterus (13.8%). Main factors contributing to the unreliability of epidemiological data in this area are: different classification systems, the variety of diagnostic methods and their capabilities, and various choice of women's population. One of the possible solutions to this issue is the widespread use of 3D ultrasound and more standardized diagnostic criteria

Što povezuje ginekologa/opstetričara s dišnim putom?

Physiological changes in pregnancy as part of biohumoral and morphological changes (hyperemia, edema, hypersecretion) influence the possible problems in obstetric anesthesia. These changes by themselves, and particularly aggravated by acute or chronic gestational or non-gestational comorbidity, increase the risk of aspiration of gastric contents, failed intubation, esophageal intubation, inadequate ventilation, and respiratory failure. The types of premedication, anesthesia and techniques of anesthesia are evident from medical historiography. Almost obligatory promethazine and atropine was given intravenously either in the delivery room or on the operating table immediately before the induction of anesthesia in a dose of 0.5 mg in partuients of average body weight. Atropine has been a favorite premedicant for decades, given its pharmacological properties, especially its antisialogenic effect and absence of a depressant effect on the fetoplacental unit, but today it is rarely used. Nasal decongestants before surgery are not recommended but in cases of severe rhinitis, atropine, promethazine, or topical decongestants may be used.Fiziološke promjene u trudnoći u sklopu biohumoralnih i morfoloških promjena (hiperemija, edem, hipersekrecija) utječu na možebitne probleme u opstetričkoj anesteziji. Fiziološke promjene same po sebi, a osobito pogoršane akutnim ili kroničnim gestacijskim ili negestacijskim komorbiditetom, čimbenici su rizika za nastanak gastrične aspiracije, teške intubacije, ezofagusne intubacije, neadekvatne ventilacije i respiracijskih poremećaja. Vrste premedikacije, anestezija i tehnika anestezije razvidna su iz povijesti medicine. Tako su se prometazin i atropin obligatno rabili intravenski u rađaonici ili operacijskoj dvorani neposredno prije uvoda u anesteziju u dozi od 0,5 mg atropina kod rodilja prosječne težine. Atropin je desetljećima bio omiljen monopremedikant s obzirom na njegova farmakološka svojstva, napose antisijalogenog učinka i manjak medikamentne depresije na fetoplacentarnu jedinicu, no danas se rijetko rabi. Nazalni dekongestivi prije operacije se ne preporučuju, no u slučajevima teških oblika rinitisa, atropin, prometazin ili topikalni dekongestivi mogu se primijeniti

TRIDISKOIDNA POSTELJICA

Tridiscoidal placenta is a biontologically developing morphovascular placental anomaly that is divided from one homogeneous discoid structure into three symmetric or asymmetric parts due to complete or incomplete separation of the placental parenchyma with sufficient circulatory arborization. We present a rare case of tridiscoidal placenta for the first time after spontaneous preterm birth at 31 weeks of high-risk pregnancy.Tridiskoidna posteljica je biontološki razvojna morfovaskularna anomalija posteljice s homogenom strukturom parenhima podijeljenog u tri simetrična ili asimetrična dijela nastala zbog potpune ili nepotpune separacije posteljičnog parenhima sa sufi cijentnom cirkulacijskom arborizacijom. Prikazujemo vrlo rijedak slučaj trodiskoidne posteljice nakon prijevremenog porođaja u 31. tjednu visokorizične trudnoće

MOTHERS’ ANXIETY TO AGGRAVATED ACUTE FEAR OF EARTHQUAKES IN THE CITY OF ZAGREB IN THE COVID-19 PANDEMIC

Backround: Here we present the results of a psychometric investigation on current fear of COVID-19 infection aggravated by the earthquake-induced stress in the group of puerperal women. Subject and methods: A group of 16 hospitalized puerperal women that gave birth at Clinical Hospital Sveti Duh in Zagreb, Department of Obstetrics and Gynecology were enrolled in retrospective clinical investigation. All the patients delivered during COVID-19 pandemic and experienced devastating earthquake on March 22nd. The women were interviewed on the exact day of the earthquake, 4 hours after the main hit and 6 months after that during second pandemic wave on October of the same year. Women were also questioned about the breastfeeding. The participants provided written informed consent and were interviewed using Generalized Anxiety Disorder 7-item (GAD-7) scale for evaluation of generalized anxiety disorder. Results: Minimal level of anxiety after the earthquake was shown for 10 mothers with 6 of them having the highest level 4. Mild anxiety was proven for 3 patients, 2 exhibited moderate anxiety with one puerperal women with severe anxiety. One could say that 37.5% of enrolled patients exhibited some degree of anxiety after the earthquake (scoring >5). At second time point during COVID- 19 pandemic 13 participants had minimal anxiety score, 2 had mild, while 1 participant had moderate score evaluated by GAD-7 scale (18.8%). At the time of the earthquake 13 participants were breastfeeding (81.3%), while 3 were not due to the personal reasons. 6 months after the earthquake only 7 mothers were breastfeeding (43.8%), while 9 of the participants were feeding their children with adapted milk (56%). Main reason for breastfeeding discontinuation was the stop of milk secretion in the 6 months period after the delivery. Conclusions: To our knowledge, our study is the only national study dealing with mental health problems in a population of puerperal and breastfeeding mothers in a challenging time of COVID-19 pandemic aggravated by devastating earthquake

Prevalence of congenital uterine anomalies at the University Hospital Sveti Duh in a ten-year period

Prirođene anomalije maternice nastaju kada u embrionalnom razvoju Müllerovih cijevi dođe do prekida ili pogrješaka u jednome od dinamičnih procesa diferencijacije, migracije, fuzije i kanalizacije. Povezuju se s mnogim ginekološkim i opstetričkim poteškoćama, a simptomi i znakovi uvelike variraju u ovisnosti o vrsti anomalije. Učestalost anomalija Müllerovih cijevi još uvijek nije poznata. U literaturi prevalencija u općoj populaciji varira od 0,16 do 10 %, u visokorizičnoj populaciji još je i viša, a najviša je među neplodnim ženama s habitualnim pobačajima i iznosi približno 25 %. Cilj istraživanja bio je prikazati učestalost prirođenih anomalija maternice u KB Sveti Duh u razdoblju od 1. siječnja 2007. do 31. prosinca 2016. godine. U istraživanju su korišteni podaci iz registara u kojima su evidentirani svi porođaji i ginekološke operacije u navedenom razdoblju. Obuhvaćeno je ukupno 40 618 pacijentica: 31 387 rodilja i 9 231 operirana žena. Operirane žene s anomalijama maternice većinom su bile podvrgnute histeroskopiji zbog lošeg reproduktivnog ishoda. Rezultati su prikazani prema CONUTA klasifikaciji. Dobiveni rezultati prikazuju ukupnu prevalenciju prirođenih anomalija maternice (1,23 %), prevalenciju među operiranim ženama (3,28 %) te prevalenciju među rodiljama (0,63 %). Nađeno je petnaest tipova anomalija, a kao najučestalije anomalije ističu se uterus septus partialis (75,2 %) i uterus bicorporalis partialis (13,8 %). Različiti klasifikacijski sustavi, raznolikost dijagnostičkih metoda i njihovih mogućnosti te različit odabir populacije žena glavni su čimbenici koji pridonose nepouzdanosti epidemioloških podataka u ovom području. Kao jedno od mogućih rješenja nameće se raširenija i primjerenija upotreba 3D ultrazvuka.Congenital uterine anomalies occur during embryonic development of müllerian ducts when an interruption or dysregulation occurs in any of the dynamic processes of differentiation, migration, fusion, and canalization. They are associated with many gynecological and obstetrical conditions, while signs and symptoms vary depending on the type of anomaly. The actual prevalence of müllerian anomalies is still unknown. In literature, the prevalence in the general population ranges from 0.16 to 10 %, while it is higher in the high-risk population and is the highest among infertile women with recurrent abortions where prevalence is approximately 25 %. The aim of the study was to present the prevalence of congenital uterine anomalies at the University Hospital Sveti Duh in the period from January 1, 2007 to December 31, 2016. In this study, data from surgical records and delivery records were used. A total of 40 618 patients were included: 31 387 women who gave birth and 9 231 operated women. Operated women with uterine anomalies were mostly hysteroscopically examined and/or treated due to poor reproductive outcome. The results are presented according to the CONUTA classification. Total prevalence of congenital anomalies (1.23%), prevalence among the operated women (3.28%), and prevalence among women who gave birth (0.63%) were obtained. Fifteen types of anomalies were reported, and the most common anomalies were partial septate uterus (75.2%) and partial bicorporal uterus (13.8%). Main factors contributing to the unreliability of epidemiological data in this area are: different classification systems, the variety of diagnostic methods and their capabilities, and various choice of women's population. One of the possible solutions to this issue is the widespread use of 3D ultrasound and more standardized diagnostic criteria

TRIDISKOIDNA POSTELJICA

Tridiscoidal placenta is a biontologically developing morphovascular placental anomaly that is divided from one homogeneous discoid structure into three symmetric or asymmetric parts due to complete or incomplete separation of the placental parenchyma with sufficient circulatory arborization. We present a rare case of tridiscoidal placenta for the first time after spontaneous preterm birth at 31 weeks of high-risk pregnancy.Tridiskoidna posteljica je biontološki razvojna morfovaskularna anomalija posteljice s homogenom strukturom parenhima podijeljenog u tri simetrična ili asimetrična dijela nastala zbog potpune ili nepotpune separacije posteljičnog parenhima sa sufi cijentnom cirkulacijskom arborizacijom. Prikazujemo vrlo rijedak slučaj trodiskoidne posteljice nakon prijevremenog porođaja u 31. tjednu visokorizične trudnoće