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

Hrvatski model integrativne prospektivne skrbi trudnoća u žena s epilepsijom

Epilepsy is the most common neurological complication in pregnancy. Women with epilepsy have a higher risk of complications in pregnancy. In Croatia, women with epilepsy are treated by neurologists at tertiary centers according to the place of residence. We prospectively followed-up pregnancies in women with epilepsy and healthy controls, and analyzed the factors responsible for their delivery outcomes and development of their babies. Healthy pregnant women had a higher level of education and economic status, but pregnant women with epilepsy took folic acid in a higher proportion than controls, possibly due to timely preconception counseling. Complications during pregnancy depended on the number of antiepileptic drugs and epilepsy control. We noticed some behavioral and cognitive aspects in children exposed in utero to valproic acid, which required follow up. The rate of congenital malformations was not increased. In conclusion, women with epilepsy should receive preconception counseling about the risk for pregnancy, but also about the possibilities to minimize that risk. We have introduced a model of integrative management of pregnancy and epilepsy based on close collaboration among different clinical experts in Croatia, in order to provide prompt counseling and timely intervention.Epilepsija je najčešća neurološka komplikacija u trudnoći. Žene s epilepsijom imaju veći rizik za komplikacije u trudnoći. U Hrvatskoj žene s epilepsijom obično prate neurolozi u tercijarnim centrima prema mjestu njihova boravka. Mi smo prospektivno pratili trudnoće u žena s epilepsijom i u zdravih kontrolnih trudnica te analizirali čimbenike odgovorne za ishode trudnoća i razvoj njihove djece. Zdrave trudnice su imale višu razinu obrazovanja i ekonomskog statusa, ali su žene s epilepsijom uzimale folnu kiselinu u višem postotku nego zdrave trudnice zahvaljujući pravodobnom predkoncepcijskom savjetovanju. Komplikacije za vrijeme trudnoće ovisile su o broju antiepileptičnih lijekova i kontroli epilepsije. Zamijetili smo određene bihevijoralne i kognitivne aspekte u djece izložene in utero valproičnoj kiselini, što zahtijeva daljnje praćenje. Stopa kongenitalnih malformacija nije bila povišena. U zaključku, ženama s epilepsijom trebali bismo omogućiti predkoncepcijsko savjetovanje o rizicima u trudnoći, ali i o mogućnostima kako značajno smanjiti taj rizik. Predstavili smo model integrativne prospektivne skrbi trudnica s epilepsijom koji se temelji na bliskoj suradnji različitih kliničkih eksperata u Hrvatskoj, u cilju osiguranja promptnog savjetovanja i pravodobne intervencije

Kardiovaskularni rizik kod žena s preeklampsijom

In this study, possible biochemical and functional cardiovascular markers were assessed in women with preeclampsia. Fifty-five pregnant women with manifest moderate (mild) preeclampsia (PE) and fifty healthy women as a control group were included in this prospective study. Laboratory tests including lipid panel, C-reactive protein (CRP), and homocysteine levels as biohumoral markers of atherogenesis, as well as ergometry and the main cardiovascular risk factor markers were performed in all women during pregnancy and six months after delivery. In our study, cholesterol and LDL levels in the PE group did not differ from those in the control group. Triglyceride levels in the PE group were higher than the corresponding values found in normal pregnancies, while HDL levels were significantly lower in the PE group than in the normal pregnancy group (p<0.001). The values of total cholesterol, LDL, HDL, and triglycerides in the PE group were higher compared to those in the same group six months after delivery (p<0.001). The effect of PE as an inflammatory disease could be confirmed to a certain extent by elevated CRP levels (p<0.001). A very high percentage of negative exercise stress tests indicated a good cardiovascular response to the current PE in the otherwise healthy pregestational women. It could be concluded that the development of possible cardiovascular comorbidities in preeclamptic pregnant women is a long process, but also due to etiologic factors of coexistent metabolic disorders such as dyslipidemia, as well as elevated inflammatory markers and homocysteine, PE can be considered even an early predictor of cardiovascular disease.U ovom članku prikazani su mogući biokemijski i funkcionalni kardiovaskularni pokazatelji kod žena s preeklampsijom. U ovu prospektivnu studiju uključeno je pedeset i pet trudnica s umjerenom (blagom) preeklampsijom (PE) te pedeset zdravih žena u kontrolnoj skupini inicijalno tijekom trudnoće te šest mjeseci nakon porođaja. Laboratorijska analiza je uključivala određivanje lipidograma, C-reaktivnog proteina (CRP) i razine homocisteina kao biohumoralnog pokazatelja aterogeneze, kao i test opterećenja na pokretnom sagu uz izdvajanje osnovnih poznatih kardiovaskularnih čimbenika rizika. U našoj studiji razina ukupnog kolesterola i LDL kolesterola u skupini s PE nije se razlikovala od onih u kontrolnoj skupini. Razine triglicerida u skupini s PE bile su više od odgovarajućih vrijednosti u normalnim trudnoćama, dok su razine HDL u skupini s PE bile značajno niže nego u kontrolnoj skupini (p<0,001). Vrijednosti ukupnog kolesterola, LDL-a, HDL-a i triglicerida u skupini s PE bile su značajno više u trudnoći u usporedbi s onima u istoj skupini šest mjeseci nakon porođaja (p<0,001). Učinak PE kao upalne bolesti može se u određenoj mjeri potvrditi povišenim razinama CRP-a (p<0,001). Vrlo visok postotak negativnih testova na testu opterećenja pokazao je dobru kardiovaskularnu funkcionalnu sposobnost naspram PE u inače pregestacijski zdravih žena. Može se zaključiti da je razvoj mogućih kardiovaskularnih supostojećih bolesti kod trudnica s PE dug proces, ali svakako zbog etiologije metaboličkih poremećaja kao što je dislipidemija, kao i povišenih upalnih pokazatelja i homocisteina, ujedno i rani prediktor kardiovaskularnih bolesti

Patohistološki nalazi kod žena podvrgnutih histeroskopskoj resekciji endometralnih polipa i mioma maternice

The aim of our study was to determine the prevalence of endometrial premalignant and malignant lesions in women undergoing hysteroscopy and to identify anthropologic factors related to the presence of malignancy. Data on 3470 women with submucosal myomas or endometrial polyps suspected on ultrasound were retrospectively analyzed. Hysteroscopy was performed in all these women in order to make a more precise diagnosis. Histologic analysis of endometrial samples obtained during hysteroscopy was used to confirm the diagnosis. Statistical analysis was performed using the SPSS 20.0.0 software. The mean age of study women was 49.1±13.3 years. The number of procedures performed due to the referral diagnosis of endometrial or submucosal myoma significantly increased over the 16-year study period. A significantly higher number of women had a benign histopathologic diagnosis. Histologic analysis revealed malignancy in 67 women. The youngest woman and oldest woman with malignant findings was aged 32 and 75, respectively. A significantly higher number of women with atypical hyperplasia and malignancy were in menopause. A comparable number of women with different histologic findings lived in urban and rural areas. There were a significantly larger proportion of widows among women with the histologic diagnosis of atypical hyperplasia or malignancy. The prevalence rate of malignancy in women having undergone hysteroscopy for polyps and myoma found by ultrasound was 1.93%. Postmenopausal status and older age were associated with an increased risk of malignancies, but premalignant changes and malignancies were also found in young and premenopausal women. Therefore, diagnostic hysteroscopy can be recommended in women of all age groups.Cilj ove studije bio je odrediti učestalost endometralnih premalignih i malignih lezija nakon histeroskopije te identificirati antropološke čimbenike povezane s malignitetom. Retrospektivno su analizirani podaci za 3470 žena s ultrazvučnom sumnjom na submukozni miom ili endometralni polip. Svim ženama je učinjena histeroskopija kako bi se dobila precizna dijagnoza. Uzorci iz endometrija dobiveni histeroskopijom poslani su na histološku analizu. Statistička analiza učinjena je primjenom programa SPSS 20.0.0. Prosječna dob žena u studiji bila je 49,1±13,3 godine. Broj zahvata zbog uputne dijagnoze endometralnog ili submukoznog mioma značajno je porastao u šesnaestogodišnjem razdoblju trajanja studije. Značajno veći broj žena imao je benignu histopatološku dijagnozu. Histološka analiza pokazala je malignitet u 67 žena. Najmlađa i najstarija žena s malignitetom imale su 32 i 75 godina. Značajno veći broj žena s atipičnom hiperplazijom i malignitetom bio je u menopauzi. Usporediv broj žena s različitim histološkim nalazima živio je u urbanim i ruralnim sredinama. Bio je značajnije viši udio udovica s dijagnozom atipične hiperplazije ili maligne bolesti. Učestalost malignosti kod žena kojima je učinjena histeroskopija zbog ultrazvučnog nalaza mioma ili polipa bila je 1,93%. Menopauza i starija dob bile su povezane s povišenim rizikom za zloćudne bolesti, ali premaligne i maligne promjene nađene su i kod mladih i premenopauzalnih žena. Stoga se dijagnostička histeroskopija preporuča u svim dobnim skupinama

Family Planning, Natural Family Planning, and Abortion Use among U. S. Hispanic Women

Hispanics are the largest minority group in the U. S. and they contribute to over 50 percent of Catholics under the age of 25. The purpose of this study was to determine the patterns of contraceptive use (current and ever), natural family planning (NFP), and abortion among U. S. Hispanic women between the ages of 15 and 44 years and to compare their patterns of use to non-Hispanic women of the same age range. A particular interest was to determine the influence of faith on the choice of family-planning methods among the sexually active U. S. Catholic Hispanic women. Data for this study came from the National Survey of Family Growth 2006– 2008, which included 1,613 Hispanic and 5,743 non-Hispanic women between the ages of 15 and 44. Approximately 57 percent of the Hispanic women are Catholic. In general, U. S. Hispanic women had significantly less frequent use of the hormonal pill, male condom, withdrawal, and vasectomy (of male partner) but more frequent use of the IUD and Depo-Provera compared to non-Hispanic women. There was little use of NFP and no difference in the frequency of reported abortion. Catholic Hispanic women had significantly less frequent use of the male condom, the Pill, vasectomy, and abortion and more use of NFP compared to non-Catholic Hispanic women. Although there is some positive influence of faith among the sexually active Hispanic women of reproductive age, overall, the amount of ever use of sterilization (21 percent), condom use (80 percent), Pill use (66 percent), and Depo-Provera (30 percent) is remarkable. The more frequent use of Depo-Provera and the IUD might reflect the economic level of the participants and the use of federally funded family-planning services

Ishod trudnoće uz gestacijski dijabetes u usporedbi s indeksom tjelesne mase

Gestational diabetes involves disorder of glucose metabolism first diagnosed in pregnancy. Obese women undoubtedly have more often complications in reproductive age, such as fertility difficulties, spontaneous and recurrent miscarriages, premature births, and various obstetric and surgical complications related to the course of pregnancy, delivery and puerperium. Children of obese pregnant women are more likely to develop obesity in childhood and adulthood. We analyzed the outcome of 51 pregnancies in obese pregnant women and 50 pregnant women with normal body mass index. All women in both groups were diagnosed with gestational diabetes by the IADPSG criteria. We analyzed gestational age at delivery and mode of delivery, gestational weight gain, presence of concomitant diagnosis of gestational or chronic hypertension, difference in birth weight, and prevalence of hypertrophic newborns. There was no significant difference in gestational age at pregnancy termination and in the mode of delivery. There was a significant difference in gestational weight gain, number of pregnant women with hypertension, neonatal birth weight and number of hypertrophic children. Based on the data presented, we conclude that obesity is an unfavorable factor for pregnancy outcome. It also influences birth weight and fetal hypertrophy, as well as gestational weight gain.Gestacijski dijabetes podrazumijeva poremećaj metabolizma glukoze koji se prvi puta dijagnosticira u trudnoći, a njegova incidencija je u porastu. Pretile žene nedvojbeno imaju češće probleme i komplikacije u reproduktivnim godinama, što podrazumijeva teškoće pri zanošenju, spontane i habitualne pobačaje, prijevremene porođaje i različite opstetričke i kirurške komplikacije vezane za tijek trudnoće, porođaja i babinja. Djeca iz takvih trudnoća češće razvijaju pretilost u djetinjstvu kao i u odrasloj dobi. S obzirom na navedeno analizirali smo ishod trudnoća u 51 pretile trudnice i 50 trudnica s urednim indeksom tjelesne mase, pri čemu su sve trudnice (u objema skupinama) imale dijagnozu gestacijskog dijabetesa prema kriterijima IADPSG. Analizirali smo gestacijsku dob, način dovršenja trudnoće, prirast na težini trudnica, prisutnost istodobnih dijagnoza gestacijske ili kronične hipertenzije, razliku u težini novorođenčadi te učestalost hipertrofične novorođenčadi. Rezultati su pokazali da ne postoji statistički značajna razlika u gestacijskoj dobi kad je završena trudnoća niti u načinu dovršenja porođaja. Utvrđena je statistički značajna razlika u dobivenim kilogramima tijekom trudnoće, broju trudnica s hipertenzijom, porođajnoj masi novorođenčadi i broju hipertrofične djece. U zaključku, pretilost u trudnoći s gestacijskim dijabetesom je nepovoljan čimbenik za ishod trudnoće, porođajnu masu i prekomjeran rast novorođenčadi, kao i za prirast tjelesne mase trudnice tijekom trudnoće

Odrednice stavova prema ženama u vojsci

In recent decades, an increasing number of women are joining the military, which has been historically a male-dominated institution. This study examined attitudes toward women in the military and the factors associated with them. The study was conducted on a random sample of 895 active service members from the Croatian Armed Forces (445 men and 450 women). The study findings indicate a moderately high approval of women in the military, but with the existence of significant gender differences. Men expressed more negative attitudes toward women in the military when compared to women. In addition, the results of the regression analyses indicated that, among men, hostile sexism, satisfaction with professional contacts with women in the military, and professional status were significantly associated with their attitudes toward women in the military. The results also showed that, among women, hostile sexism, frequency of professional contacts with other women, and educational level were significantly associated with their attitudes toward women in the military. The study findings reveal insights into gender relations in the previously unexplored socio-cultural military context, and have implications for research and practice in the Croatian military. However, this study could also contribute to a better understanding of the complexity of gender issues within NATO, and could encourage the development of new theoretical models and cross-cultural research.Posljednjih se desetljeća sve veći broj žena priključuje vojsci, instituciji kojom su povijesno gledano dominirali muškarci. Ovim su istraživanjem ispitane odrednice stavova prema ženama u vojsci, a istraživanje je provedeno na slučajnom uzorku 895 pripadnika djelatnog sastava Hrvatske vojske (445 muškaraca i 450 žena). Nalazi istraživanja ukazuju na umjereno visok stupanj odobravanja žena u vojsci, ali uz postojanje značajnih rodnih razlika. Muškarci su u usporedbi sa ženama izražavali negativnije stavove prema ženama u vojsci. Rezultati regresijskih analiza pokazali su da su među muškarcima hostilni seksizam, zadovoljstvo profesionalnim kontaktima sa ženama u vojsci te profesionalni status značajno povezani s njihovim stavovima prema ženama u vojsci. Rezultati su također pokazali da su kod žena hostilni seksizam, učestalost profesionalnih kontakata s drugim ženama te razina obrazovanja značajno povezani s njihovim stavovima prema ženama u vojsci. Nalazi istraživanja donose uvide u rodne odnose unutar ranije neistraživanog sociokulturnog vojnog konteksta te imaju implikacije za istraživanje i praksu u Hrvatskoj vojsci. Ujedno, mogli bi doprinijeti i boljem razumijevanju složenosti rodnih pitanja unutar NATO-a te potaknuti razvoj novih teorijskih modela i budućih međukulturnih istraživanja

Women's Rules in the University 1930's-1970

I choose to do my research on the history of women???s rules within the university system. I tried to stick within the time line of the early 1930???s and beyond. As I was looking at the rules and regulations from different universities around the country I decided it was a great idea to do a compare and contrast to those from U of I. In doing so I found that majority of the colleges including our university had similar if not the same rules spread across this time period. I used the first part of my research discussing rules I found at other universities via scholarly journals and books. I then used our archives library to research rules and regulations from the university of Illinois and compared it to the rules that I found at other universities. I also found interviews from women students who attended the university during the 1930???s through the 40???s and gained insight to how they felt about the rules and regulations they had to deal with during those times. In doing this research I found a lot of interesting, strict, and peculiar rules. I also found ways that women went about to get around the rules and still do their own things. Overall I decided to do my research project on this to bring about awareness that this was something women in previous generations had to go through as college students. When my class took a visit to the archives earlier in the semester and we came across these rules I became very intrigued by them because it was something that I had no idea ever existed. I chose to do my paper on this topic because not only do I find it interesting but also I think other students should be made aware that there were rules in place once upon a time and they were just for women

Hormonal abnormalities in first-degree relatives of women with polycystic ovary syndrome (PCOS)

Wstęp: Liczne dane wskazują na rodzinne występowanie zaburzeń hormonalnych u krewnych pierwszego stopnia kobiet z zespołem policystycznych jajników (PCOS, polycystic ovary syndrome). Celem pracy była ocena czy u rodzeństwa kobiet z PCOS występują zaburzenia hormonalne typowe dla tego zespołu. Materiał i metody: Zbadano 88 krewnych pierwszego stopnia kobiet z zespołem wielotorbielowatych jajników (44 siostry i 42 braci). Grupy kontrolne stanowiło 70 zdrowych kobiet i 30 zdrowych mężczyzn. U wszystkich osób oceniono parametry antropometryczne i hormonalne (stężenia testosteronu, androstendionu, DHEA-S, LH, FSH) oraz stężenie SHBG. Wyniki: Średnie stężenia testosteronu i DHEA-S były większe u sióstr kobiet z PCOS niż u kobiet z grupy kontrolnej. U 8 z 44 sióstr (18,2%) postawiono rozpoznanie PCOS. Średnie stężenia testosteronu, androstendionu oraz indeks wolnych androgenów były istotnie większe u sióstr z PCOS w porównaniu z siostrami bez tego zespołu. Bracia kobiet z PCOS w porównaniu z mężczyznami z grupy kontrolnej mieli większe stężenia DHEA-S. Przedwczesne łysienie cechowało 11 z 42 braci (26,2%), które wystąpiło przed 30. rokiem życia. Przedwcześnie łysiejący bracia nie różnili się od braci bez łysienia pod względem ocenianych parametrów hormonalnych. Wnioski: Rodzeństwo pacjentek z PCOS jest predysponowane do występowania zaburzeń hormonalnych typowych dla tego zespołu. Przedwczesne łysienie u mężczyzn przed 30. rokiem życia nie powinno być uznawane za męski fenotypowy odpowiednik PCOS. (Endokrynol Pol 2011; 62 (2): 129&#8211;133)Introduction: A body of evidence points to a familial aggregation of hormonal abnormalities in first-degree relatives of women with polycystic ovary syndrome (PCOS). The aim of this study was to determine whether siblings of women with PCOS had evidence of hormonal abnormalities typical of PCOS. Material and methods: Eighty-six siblings of women with PCOS (44 sisters, 42 brothers) were recruited. Two control groups consisted of 70 healthy women and 30 healthy men. Anthropometric, hormonal (testosterone, androstenedione, DHEA-S, LH, FSH) parameters and SHBG were assessed in all subjects. Results: Mean testosterone and DHEA-S levels were higher in sisters of women with PCOS than in the control women. In eight of the 44 (18.2%) sisters, a diagnosis of PCOS was made. Mean testosterone and androstenedione levels, and free androgen index (FAI) were significantly higher in sisters with PCOS compared to the sisters without PCOS. Brothers of women with PCOS had higher DHEA-S level than the control men. Eleven of the 42 (26.2%) brothers had alopecia occurring before the age of 30. Prematurely balding brothers did not differ from the non-balding brothers in hormonal parameters. Conclusions: Siblings of women with PCOS are predisposed to hormonal abnormalities typical of PCOS. The symptom of premature balding under the age of 30 in brothers of women with PCOS should not be considered as a male PCOS equivalent. (Pol J Endocrinol 2011; 62 (2): 129&#8211;133