Acupuncture as treatment option for dysmenorrhea and acute pelvic pain in patient with endometriosis: a case report

Endometriosis is a common chronic gynaecologic disorder of still unknown origin. It affects up to 10% of women of child-bearing age. Although the condition may be asymptomatic, common symptoms include dysmenorrhoea, dyspareunia, non-cycle pelvic and abdominal pain, and subfertility. Endometriosis has great impact on well-being and quality of life with diminished physical, emotional and social aspects of women’s life. There is an increased interest in use of acupuncture treatment as noninvasive, efficient and safe therapeutic option in the management of patients with pelvic pain and dysmenorrhea due to endometriosis. Acupuncture can provide relief from the pain by local and central stimulation of the nervous system. This results in the release of endorphins and other neurohumoral factors in the hypothalamus and during transmission of the impulse through the neural axis, to change the threshold and experience of pain in the spinal cord and various parts of the brain, including emotional limb nucleus and reverse inhibitory sensory pathways, and further to regulate the inflmmation process by promoting immunomodulatory effects with secretion of different biochemical factors. The aim of the article is to present patient with severe acute pelvic pain and chronic dysmenorrhoe due to endometriosis who was successfully treated with acupuncture

CARDIOTOCOGRAPHY: FROM THE FIRST DETECTION OF FETAL HEART RATE TO FIGO GUIDELINES

Gotovo punih 150 godina bilo je potrebno da bi se od otkrića kucaja čedinjeg srca stvorili tehnički preduvjeti za razvitak kardiotokografije – kontinuiranog i istodobnog bilježenja fetalne srčane frekvencije i trudova. Daljnje sazrijevanje znanstvene misli i razumijevanje CTG zapisa rezultiralo je nastankom različitih shema, indeksa i zbrojeva za ¬procjenu nalaza. FIGO smjernice objavljene koncem 80-ih godina prošlog stoljeća, omogućuju objektivnu procjenu CTG zapisa, uporabu jedinstvenih definicija, smanjenje razlika u »inter- i intraobserver« tumačenjima nalaza, te upućuju na daljnje dijagnostičke i terapeutske postupke. Ove smjernice u redovitoj su primjeni i u svim našim klinikama i bolnicama, ali nažalost o tome nije zadnjih 15 godina objavljivano. Smatramo da rastuća prava pacijenata, kao i povećana pravna ¬odgovornost liječnika prioritetnom nameću i Hrvatskom društvu za perinatologiju izradu jedinstvenih pismenih smjernica za ante- i intrapartalnu kardiotokografiju.It has taken almost 150 years from the first detection of fetal heart rate to the creation of technical prerequisites for the development of cardiotocography – continuous and simultaneous registration of fetal heart rate and uterine contractions. Further reopening of scientific idea and understanding of cardiotocography has resulted in the development of different schemes and scores to assess the fetal heart rate recording patterns. FIGO guidelines, which were reported at the end of 1980, enable the objective assessment of fetal heart rate recording patterns. It also enables the use of uniformed definitions, decrease in different »inter- and intraobserver« interpretations during CTG analysis and gives directions ¬towards further diagnostic and therapeutic procedures. These guidelines are being regularly applied throughout our ¬hospitals and clinics, but unfortunately nothing has been published about them in the past fifteen years. Therefore we strongly believe that the growing rights of the patients as well as the doctors’ growing legal responsibilities are requiring from the Croatian Society for Perinatology as its priority the establishment of the unique written guidelines for the ante- and intrapartum cardiotocography

CONTRACEPTIVE IMPLANT First experiencies

Cilj ispitivanja. Određivanje kontraceptivne učinkovitosti, raščlamba učestalosti i vrste nuspojava te utjecaja na obrazac menstruacijskih krvarenja i dismenoreju. Materijal i metode. Tijekom četiri godine je postavljeno 30 kontraceptivnih implantata s etonogestrelom. Po završetku praćenja je izvršeno ispitivanje pacijentica u pismenoj formi, a ¬podatci statistički obrađeni. Rezultati. Ukupno je ostvareno 673 mjeseci kontraceptivne zaštite i zabilježena jedna trudnoća. Kod polovice pacijentica je registrirano smanjenje duljine i obilnosti menstruacijskih krvarenja. Učestalost amenoreje iznosi 22,7%. Simptomi dismenoreje se poboljšavaju kod svih pacijentica. Najčešće neželjene pojave su nepravilno krvarenje, akne, dobitak na težini i glavobolja. Implantat je u osam slučajeva odstranjen prije vremena. Zaključak. ¬Kontraceptivni implantat je veoma pouzdano kontraceptivno sredstvo. Nuspojave koje zahtijevaju prekid metode se ¬javljaju u trećine korisnica. Naša preporuka je prije odluke o primjeni kontraceptivnog implantata ordinirati mini-pilule s dezogestrelom, a potom u slučaju dobre podnošljivosti samo gestagenske kontracepcije razmotriti prijelaz na kontraceptivni implantat s etonogestrelom.Aims of the study were to determine the contraceptive effectiveness and the analysis of the pattern of ¬frequency and types of common adverse effects, the influence on menstrual bleeding and dysmenorrhoea as well as the acceptability of the idea of new contraceptive method. Material and methods. During four years of our study we ¬implanted 30 contraceptive implants with etonogestrel. After the following time the patients were asked to complete questionnairy.The data were statistically evaluated. Results. Throughout our study we followed 673 contraceptive months and registered one pregnancy. The length and the abundance of menstrual bleeding decreasead in about half of the participants. The frequency of amenorrhoea was 22.7%, whereas symptoms of dysmenorrhoea improved in all patients. As regards the most common adverse effects were vaginal bleeding disturbances, acne, weight gain and headache. ¬Implant had to be removed earlier in eight cases. Conclusion. Contraceptive implant is very effective contraceptive method. Common adverse effects, which require discontinuation of the contraception, are present in about 1/3 of users. Our recommendation however is the prescription of progestogen-only-pills with desogestrel, before the decision for ¬contraceptive implant with etonogestrel

COMBINED ULTRASOUND-BIOCHEMICAL SCREENING OF FETAL TRISOMIA IN THE FIRST TRIMESTER AND DOUBLE BIOCHEMICAL SCREENING IN THE SECOND TRIMESTER AT NONRISK PREGNANCIES

Cilj rada: Usporediti uspješnost primjene probirnih testova aneuploidija u prvom i drugom tromjesečju trudnoće. Ispitanice i metode: Istraživanu skupinu činilo je 374 trudnica s kombiniranim ultrazvučno-biokemijskim testom u prvom, odnosno dvostrukim biokemijskim testom u drugom tromjesečju. Sve su trudnoće bile jednoplodne i urednog ishoda. U probiru prvog tromjesečja korišteni su biokemijski biljezi u serumu trudnica: plazmatski protein pridružen trudnoći (PAPP-A) i slobodna B-podjedinica humanog korionskog gonadotropina (slobodni B-hCG), uz ultrazvukom izmjerenu debljinu nuhalnog nabora (NT) i dužinu tjeme-trtica (CRL) u ploda. U dvostrukom biokemijskom probiru drugog tromjesečja korišteni su biokemijski biljezi: alfa-fetoprotein (AFP) i slobodni B-hCG, a gestacija je procijenjena prema ultrazvučnoj biometriji. Rezultati: Povećani ultrazvučno-biokemijski rizik trisomije 21 u 1. tromjesečju trudnoće ustanovili smo u 30 trudnica (8.0%). Od ukupnog broja, 70 ispitanica (18.7%) imalo je povećani rizik obzirom na biokemijske biljege u ¬prvom, odnosno njih 56 (15.0%) obzirom na biokemijske biljege u drugom tromjesečju trudnoće. Izvršeno je ukupno 30 postupaka amniocenteze. Od toga je u 19 trudnica (63.3%) indikacija postavljena na osnovi kombiniranog probirnog testa. Nadalje, amniocenteza je izvršena u 11 trudnica (28.2%) zbog povećanog rizika u dvostrukom biokemijskom probiru drugog tromjesečja. Udjel lažno-pozitivnih razultata u kombiniranom probiru prvog tromjesečja bio je statistički značajno niži, nego u biokemijskom probiru drugog tromjesečja (B2=12.02, p=0.0005). Ustanovili smo značajnu pozi¬tivnu povezanost log10 MoM slobodnog B-hCG između prvog i drugog tromjesečja (r2=0.403, p<0.0001). Nismo ustanovili značajnu povezanost između ostalih biokemijskih biljega u prvom, odnosno, drugom tromjesečju. Zaključak: Rezultati našeg istraživanja su pokazali značajno veću specifičnost ranog kombiniranog probirnog testa aneuploidija u odnosu na biokemijski probirni test u prvom, kao i u drugom tromjesečju. Mogućnosti izbora pojedinih probirnih testova trebale bi biti usklađene sa stavovima i potrebama samih trudnica, kao i sa smjernicama koje su preporučile nadležne institucije za fetalnu medicinuObjective: To evaluate the performance of screening tests for aneuploidy in the first and second trimesters of pregnancy in Croatian pregnant women. Study Design and Methods: Study population comprised 374 pregnant women who underwent the combined ultrasound-biochemical in the first and double-test in the second trimester of pregnancy, respectively. All were singleton pregnancies with normal outcomes. The first-trimester screening was performed combining serum markers, pregnancy associated plasma protein-A (PAPP-A) and free B-subunit of human chorionic gonado¬tropin (free B-hCG) with fetal nuchal translucency thickness (NT) and crown-rump length (CRL), measured by ultrasound. For the second-trimester screening, maternal serum alpha-fetoprotein and free B-hCG were used as biochemical markers in relation to fetal biometry diagnosed by ultrasound. Results: In 30 pregnant women (8.0%) elevated risk for trisomy 21 was found after combined ultrasound-biochemical screening. Out of total, 70 pregnant women (18.7%) were classified ’at risk’ on the basis of biochemical markers in the first and 56 (15.0%) in the second trimester. In 30 pregnant women amniocentesis was performed. In 19 cases (63.3%) the indication was elevated risk in the first-trimester combined test. In 11 women (28.2%) amniocentesis is recommended because of the elevated second-trimester biochemical risk. The proportion of false-positive results in combined first-trimester screening test was significantly lower than with second-trimester biochemical markers (B2=12.02, p=0.0005). We found the significant positive relationship between log10 MoM F B-hCG in the first and second trimester (r2=0.403, p<0.0001). There was no significant relationship between PAPP-A and second-trimester biochemical markers. Conclusion: Results of this preliminary study confirmed better specificity of the combined first-trimester screening in relation to biochemical screening in the second trimester of pregnancy. The decision and choice of the most appropriate screening test should consider woman’s personal attitude and preferences, as well as follow the guidelines recommended by the competent associations for the fetal medicine

Acupuncture as treatment option for dysmenorrhea and acute pelvic pain in patient with endometriosis: a case report

Endometriosis is a common chronic gynaecologic disorder of still unknown origin. It affects up to 10% of women of child-bearing age. Although the condition may be asymptomatic, common symptoms include dysmenorrhoea, dyspareunia, non-cycle pelvic and abdominal pain, and subfertility. Endometriosis has great impact on well-being and quality of life with diminished physical, emotional and social aspects of women’s life. There is an increased interest in use of acupuncture treatment as noninvasive, efficient and safe therapeutic option in the management of patients with pelvic pain and dysmenorrhea due to endometriosis. Acupuncture can provide relief from the pain by local and central stimulation of the nervous system. This results in the release of endorphins and other neurohumoral factors in the hypothalamus and during transmission of the impulse through the neural axis, to change the threshold and experience of pain in the spinal cord and various parts of the brain, including emotional limb nucleus and reverse inhibitory sensory pathways, and further to regulate the inflmmation process by promoting immunomodulatory effects with secretion of different biochemical factors. The aim of the article is to present patient with severe acute pelvic pain and chronic dysmenorrhoe due to endometriosis who was successfully treated with acupuncture