Prevencija preeklampsije

Preeklampsija je sindrom uzrokovan trudnoćom koji je jedinstven za humanu populaciju. Manifestira se složenim poremećajem brojnih organskih sustava trudnice. Uzrok je značajno povišenog mortaliteta i morbiditeta majki i djece širom svijeta. Predvidjeti ili prevenirati nastanak preeklampsije i dalje nije moguće u opsegu koju bi mogli nazvati zadovoljavajućim. U idealnim uvjetima, trudnice s visokim rizikom od razvoja poremećaja bile bi prepoznate u prvom tromjesečju trudnoće što bi nam ostavilo dovoljno vremena da učinkovitim mjerama omogućimo adekvatnu placentaciju i na taj način spriječimo ili barem ublažimo razvoj sindroma. U preglednom članku potanko su opisane neke od danas najčešće primjenjivanih preventivnih mjera: niske doze acetilsalicilne kiseline (aspirin), niskomolekularni heparin, nadomjesno liječenje kalcijem i nadomjesno liječenje n-3 (omega-3) masnim kiselinama

Važnost primjene niskomolekularnog heparina kod trudnica s nasljednom trombofilijom za dobar perinatalni ishod

The aim of the study was to establish the importance of low molecular weight heparin (LMWH) treatment for good pregnancy outcome in patients with hereditary thrombophilia. This retrospective study included 70 patients with inherited thrombophilia who gave birth at Zagreb University Hospital Center in the period from January 2014 to January 2015. Fifty-seven women were treated and 13 women were not treated with LMWH. Perinatal outcome was significantly better in women with hereditary thrombophilia who were treated with heparin during pregnancy as compared with women without LMWH (p=0.006). Regardless of heparin therapy, patients with hereditary thrombophilia alone had a significantly better perinatal outcome as compared with women who, along with hereditary thrombophilia, had a history of habitual abortions (p=0.035) or intrauterine fetal death (p=0.033). Women treated with heparin had better perinatal outcome if they were without a history of recurrent or non-recurrent fetal loss (p=0.088). In the group without LMWH, perinatal outcome was significantly better in women with no history of habitual abortions as compared with women with recurrent miscarriages (p=0.047). Administration of LMWH is justified in women with hereditary thrombophilia and a history of adverse perinatal outcome.Cilj ove studije bio je ustanoviti komplikacije trudnoće i važnost primjene niskomolekularnog heparina za poboljšanje perinatalnog ishoda kod trudnica s nasljednom trombofilijom. Retrospektivno su analizirani podatci 70 trudnica s dokazanom hereditarnom trombofilijom i urednom ili opterećenom opstetričkom anamnezom koje su porođene u Klinici za ženske bolesti i porođaje u razdoblju od siječnja 2014. do siječnja 2015. Njih 57 liječeno je niskomolekularnim heparinom, dok kod ostalih 13 žena nije provedena antikoagulantna terapija. Ispitanice s nasljednom trombofilijom koje su tijekom trudnoće uzimale heparinsku terapiju imale su statistički značajno bolji perinatalni ishod u odnosu na ispitanice s nasljednom trombofilijom bez antikoagulantne terapije (p=0,006). Ispitanice s hereditarnom trombofilijom i urednom opstetričkom anamnezom imale su statistički značajno bolji perinatalni ishod u odnosu na ispitanice s trombofilijom i prethodnim habitualnim pobačajima (p=0,035) ili intrauterinom smrti čeda (p=0,033). Ispitanice s hereditarnom trombofilijom i urednim prethodnim trudnoćama koje su liječene heparinom imale su nešto bolji perinatalni ishod u odnosu na skupinu s trombofilijom i prethodnim mors fetus in utero kod kojih je također primjenjivana antikoagulantna terapija (p=0,088). U skupini ispitanica s hereditarnom trombofilijom a bez heparinske terapije, ispitanice bez habitualnih pobačaja u anamnezi imale su statistički značajno bolji perinatalni ishod u odnosu na trudnice s habitualnim pobačajima (p=0,047). Primjena niskomolekularnog heparina za bolji perinatalni ishod opravdana je kod trudnica s nasljednom trombofilijom i opterećenom opstetričkom anamnezom

Antenatalna skrb blizanačke i višeplodne trudnoće

Blizanačke i višeplodne trudnoće opterećene su povećanom učestalošću gotovo svih poznatih komplikacija, izuzev prenošenja i makrosomije. Najveća opasnost krije se u povećanoj učestalosti prijevremenog porođaja uz značajno viši perinatalni mortalitet i kratkoročni i dugoročni morbiditet u rođene djece. Tijek i ishod višeplodnih trudnoća značajno opterećuju intrauterini zastoj u rastu jednog ili više plodova te kongenitalne anomalije uz dodatno povećanje perinatalnog mortaliteta i morbiditeta. U monokorionskih blizanačkih trudnoća nalazimo i specifične patološke entitete: međublizanački transfuzijski sindrom, međublizanačku anemiju-policitemiju, međublizanačka obrnuta arterijska perfuzija na koje tijekom antenatalne skrbi treba misliti i pravovremeno ih prepoznati i dijagnosticirati

Antenatalna skrb blizanačke i višeplodne trudnoće

Blizanačke i višeplodne trudnoće opterećene su povećanom učestalošću gotovo svih poznatih komplikacija, izuzev prenošenja i makrosomije. Najveća opasnost krije se u povećanoj učestalosti prijevremenog porođaja uz značajno viši perinatalni mortalitet i kratkoročni i dugoročni morbiditet u rođene djece. Tijek i ishod višeplodnih trudnoća značajno opterećuju intrauterini zastoj u rastu jednog ili više plodova te kongenitalne anomalije uz dodatno povećanje perinatalnog mortaliteta i morbiditeta. U monokorionskih blizanačkih trudnoća nalazimo i specifične patološke entitete: međublizanački transfuzijski sindrom, međublizanačku anemiju-policitemiju, međublizanačka obrnuta arterijska perfuzija na koje tijekom antenatalne skrbi treba misliti i pravovremeno ih prepoznati i dijagnosticirati

Tubal factor infertility: which is the possible role of tubal microbiota? A fresh look to a busy corner focusing on the potential role of hysteroscopy.

There is a growing body of evidence regarding the importance of the urogenital microbiota associated to reproductive outcomes, both for achieving pregnancy naturally or with the use of assisted reproductive technology (ART). The role of the vaginal and endometrial microbiota in potential infertility can be applied to the tubal milieu, which is currently a hot topic in clinical research. Given that the incidence of tubal infertility factor is constantly increasing, and the incidence of previously known infectious causes is declining, it is extremely important to encourage research to identify the real composition of the tubal microbiota. On the other hand, the potential importance of the role of hysteroscopy in elucidating tubal infertility factor is currently underestimated and not completely clarified. This short review article presents the most recent evidence on the possible role of tubal microbiota on female infertility, focusing on the role of its potential diagnostic effectiveness and, in particular, on the role of hysteroscopy

Silent spontaneous uterine rupture after previous cesarean section and myomectomy with delivery of a healthy newborn

Introduction. Silent spontaneous rupture of the uterus before labor with delivery of a healthy newborn and with no maternal or neonatal morbidity or mortality is very rare. Very few cases have been reported in literature. Case report. We report a case of silent spontaneous uterine rupture. Rupture was found during an elective repeat cesarean section. Patient had history of one prior cesarean myomectomy. At 38 weeks of gestation, before labour has started and before any symptoms, the patient underwent elective caesarean section with delivery of a healthy and eutrophic female infant. Uterine rupture in previous myomectomy scar and intact amniotic sac with fetus inside was found as soon as peritoneum was opened. The patient was discharged on postoperative day 5 with healthy newborn. Conclusion. Though silent spontaneous rupture of the uterus before term is very rare condition, all pregnant women with previous hysterotomy should be warned about possibility of spontaneous uterine rupture even before labour has started

Pregnancy outcome and liraglutide levels in serum and umbilical vein blood of a woman with type 2 diabetes. A case report

Background: According to FDA guidelines, liraglutide should be used on the basis of careful consideration in pregnant women with Type 2 diabetes mellitus. The aim of the present study was to record the concentration of liraglutide in maternal and umbilical vein serum from a pregnant woman treated with liraglutide. Case report: The pregnant woman we present in this case report is a 28-year-old diagnosed with Type 2 diabetes mellitus for 7 years. In spite of high insulin dose her glycaemia was poorly controlled, she developed dyslipidaemia and her body weight increased; thus, her diabetologist prescribed liraglutide injections and metformin. At booking, obstetrical ultrasound confirmed intrauterine pregnancy of 8 gestational weeks. The patient was informed about all possible consequences for her foetus that might be caused by liraglutide therapy during pregnancy. She continued her treatment with liraglutide and metformin medication throughout pregnancy. Her pregnancy was terminated by elective Caesarean section at 39 gestational weeks; a healthy newborn male was delivered. The concentration of liraglutide was measured in maternal and umbilical vein serum. Conclusion: There was no significant transfer of liraglutide from the circulation of the treated mother to her fetus, at least 3.5 h after the drug application

EQUIPMENT OF MATERNITY HOSPITALS IN REPUBLIC OF CROATIA IN THE YEAR 2003 Obstetrics

Prikazan je broj opstetričkih kreveta za 2003. godinu, u 29 bolničkih i 7 izvanbolničkih rodilišta u Republici Hrvatskoj, broj liječnika specijalista iz ginekologije i porodništva te broj kardiotokografskih i ultrazvučnih aparata. Podaci su uspoređeni s brojem žitelja u cjelini i po osam regija u Republici Hrvatskoj. Postoji manjak kreveta za babinjače i trudnice u regiji Zagreba i manjak trudničkih kreveta u regiji Dalmacije. U Hrvatskoj ima 563 aktivnih ginekologa, što je 12,6 na 100000 žitelja: ima 285 bolničkih, 170 ugovornih i 108 ginekologa s privatnom praksom. Zadovoljavajuća je opremljenost rodilišta CTG i UZV aparatima, ali trebalo bi poduzeti mjere u cilju redovitog obnavljanja postojeće opreme.The number of beds in 29 hospital and 7 out-hospital maternity wards, regional distribution of Ob/Gyn specialists and the number of CTG and US machines were analyzed. The data were analyzed according to the number of inhabitants in total and in 8 regions of the country. There is evident lack of beds for puerperal and pregnant patients in the Zagreb region, and lack of beds for pregnant patients in Dalmatia region. In Croatia there are 563 active Ob/Gyn specialists¬, i.e. 12.6 per 100000 of population; there are 285 Ob/Gyn hospital specialists, 170 out-hospital specialists with a contract with Croatian Institute for Health Insurance and 108 private Ob/Gyn specialists. At the moment the equipment of maternity¬ wards satisfies, but it should be renewed regularly