Opravdanost primjene heparina male molekulske mase u trudnica s nasljednom trombofilijom kao uzrokom opetovanih zadržanih pobačaja [Adequacy of low-molecural-weight heparin prophylaxis in pregnant women with hereditary trombophilia as a cause of recurrent pregnancy loss]

INTRODUCTION: Approximately 1% of women trying to conceive experience recurrent miscarriage. In 50% of the cases, the etiology of preceding miscarriages remains unknown. For this reason, the appropriate treatment and medical approach to these women are very challenging. Over the last 20 years, many studies have been analyzing the association between inherited thrombophilia and recurrent miscarriages. The main goals of this research were to investigate the perinatal outcome in hereditary thrombophilic patients with recurrent missed abortions after treatment with low molecular weight heparin. Nevertheless, this study evaluates the perinatal outcome in asymptomatic mutation carriers without LMWH prophylaxis. MATERIALS AND METHODS: The prospective study was conducted at the Department of Gynaecology and Obstetrics, University Hospital Centre Zagreb, from 2011 to January 2018. The research covered three groups of women: the first group (LMWH+) included 133 pregnant women with the history of two or more early recurrent pregnancy loss and hereditary trombophilia who were treated with a prophylactic dose of LMWH, the second group (LMWH-) enrolled 35 women with habitual abortions and hereditary thrombophilia who were not treated with a prophylactic dose of LMWH and, finally, the third (control) group covered 55 healthy pregnant women (with a negative personal venous thromboembolism and obstetric uteroplacental vascular insufficiency history) with hereditary thrombophilia who were not treated with a prophylactic dose of LMWH. The definition of inherited thrombophilia included the FVL, prothrombin G20210A mutation, antithrombin deficiency, protein C and protein S deficiency, MTHFR mutation and PAI-1 mutation. RESULTS: Pregnant women with inherited thrombophilia and habitual abortions who were treated with prophylactic doses of LMWH heparin showed a statistically significant reduction in miscarriages compared to women with inherited thrombophilia and two or more previous early pregnancy loss who were not administered the prophylactic dose of LMWH (P= 0,001). For a good perinatal outcome, it seems that application of LMWH is not necessary in the group of asymptomatic carriers of mutations with hereditary thrombophilia and negative personal and obstetric history. CONCLUSION: LMWH has a role in preventing further pregnancy losses in patients with hereditary thrombophilias and recurrent miscarriages. Nevertheless, the current findings show that LMWH is not required for a good perinatal outcome in asymptomatic carriers of a thrombophilic defect

Ultrazvučna dijagnostika i malformacije blizanačkih trudnoća

Broj blizanačkih trudnoća u konstantnom je porastu. Jedan od razloga tome je i odgođeno majčinstvo na kojeg se brojne žene zbog ritma i stila života odlučuju sve češće. Starija životna dob žene rezultira češćim zanošenjem uz pomoć medicinski potpomognute oplodnje i posljedično većim brojem višeplodnih trudnoća. Blizanačke trudnoće nose sa sobom veći rizik od perinatalnog i neonatalnog morbiditeta i mortaliteta. To se posebno odnosi na monokorionske trudnoće. Ultrazvuk kao dijagnostičko sredstvo, predstavlja najvažniju metodu za redovito praćenje takvih trudnoća. Njegova važnost očituje se u ranoj detekciji kongenitalnih malformacija, intrauterine smrti jednog od blizanaca, diskordantnog rasta gemina i otkrivanju žena rizičnih za prijevremeni porođaj ali i detekciji i praćenju težih patologija posebno specifi čnih za monokorionske trudnoće poput međublizanačkog transfuzijskog sindroma (TTTS-a), blizanačke sekvencije anemijje i policitemije (TAPS) i blizanačkog sindroma retrogradne arterijske perfuzije (TRAP). Svaka blizanačka trudnoća komplicirana patologijom trebala bi biti redovito kontrolirana u tercijarnom centru za ginekologiju i opstetriciju

Ultrazvučna dijagnostika i malformacije blizanačkih trudnoća

Broj blizanačkih trudnoća u konstantnom je porastu. Jedan od razloga tome je i odgođeno majčinstvo na kojeg se brojne žene zbog ritma i stila života odlučuju sve češće. Starija životna dob žene rezultira češćim zanošenjem uz pomoć medicinski potpomognute oplodnje i posljedično većim brojem višeplodnih trudnoća. Blizanačke trudnoće nose sa sobom veći rizik od perinatalnog i neonatalnog morbiditeta i mortaliteta. To se posebno odnosi na monokorionske trudnoće. Ultrazvuk kao dijagnostičko sredstvo, predstavlja najvažniju metodu za redovito praćenje takvih trudnoća. Njegova važnost očituje se u ranoj detekciji kongenitalnih malformacija, intrauterine smrti jednog od blizanaca, diskordantnog rasta gemina i otkrivanju žena rizičnih za prijevremeni porođaj ali i detekciji i praćenju težih patologija posebno specifi čnih za monokorionske trudnoće poput međublizanačkog transfuzijskog sindroma (TTTS-a), blizanačke sekvencije anemijje i policitemije (TAPS) i blizanačkog sindroma retrogradne arterijske perfuzije (TRAP). Svaka blizanačka trudnoća komplicirana patologijom trebala bi biti redovito kontrolirana u tercijarnom centru za ginekologiju i opstetriciju

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

ENDOMETRIOSIS, PAIN AND MENTAL HEALTH

Background: Endometriosis is a chronic and progressive disease which can significantly affect a woman\u27s personal, as well as intimate and professional aspects of life. The aim of this study was to asses health-related quality of life and mental health status in patients with endometriosis, investigating also their relationship with endometriosis-related comorbid symptoms and conditions, such as pain and infertility. Subjects and methods: An observational cross-sectional study involved 79 women with endometriosis. All patients filled the Endometriosis Health Profile (EHP-5), the Depression Anxiety Stress Scales (DASS-21) and the Visual Analogue Scale (VAS). Their medical data were retrieved from medical records. Data was analyzed using the SPSS 23.0 (IBM Corp., Armonk, NY). Results: Of all the patients evaluated in our study, 44.3% presented depressive symptoms and 25.3% presented anxiety, while 31.7% reported stress symptoms. Moderate correlations were found between results on EHP-5 and depression (r=0.515), stress (r=0.558) and VAS score (r=0.565). Furthermore, weak positive relationship was observed between EHP-5 and anxiety (r=0.295) and infertility (r=0.267). Additionally, moderate correlation was found between depression and infertility (r=0.519), while there was weak association between VAS score and stress (r=0.236). Conclusions: This study showed complex relationships between symptoms and conditions manifesting in patients with endometriosis. Due to diversity of symptoms, potentially including mental health issues, it is important to emphasize the need for combined personalized treatment for these patients, taking into account both physical and psychological aspect of the disease

Registar blizanaca i biobanka

U ovom preglednom članku autori prikazuju važnost osnivanja registra i biobanke za blizanačku trudnoću. Blizanačka trudnoća i blizanci su jedinstvena prilika za proučavanje fetalne fiziologije i patologije, majčine prilagodbe na dvoplodnu/višeplodnu trudnoću, razvoja komplikacija u trudnoći, porođaju i nakon njega, neonatalnog ishoda a kasnije blizanci predstavljaju jedinstvenu priliku za istraživanje uzročno-posljedičnih veza u promjenama ljudskog ponašanja, varijacijama u razvoju tijekom djetinjstva, adolescencije i odrasle dobi kao i u razvoju određenih bolesti

A retrospective investigation of preterm birt h in breech presentation during the period of 26 years

Breech presentation is childbirth, during which may be expected higher perinatal mortality and morbidity when compared to cephalic presentation. The breech presentation complicates 20–35 % of preterm delivery. This group of neonates is exposed to hypoxic damages, as well as birth injuries with consequent intracranial hemorrhages. The mortality rate of preterm infants is much higher than the mortality of full-term infants. A higher risk of perinatal asphyxia and birth trauma makes obstetricians decide for operative completion by Cesarean section. Research methods. We conducted a retrospective study and analyzed and compared perinatal categories: perinatal mortality and morbidity, the mode of pregnancy completion, and the incidence of Cesarean section and vaginal delivery in six periods. Patients and research methods. The studied material was collected for the period of the past 26 years from the archives in the Department of Obstetrics and Gynecology. All singleton pregnancies with the breech presentation were analyzed, delivered either vaginally or by Cesarean section. Results. The incidence of Cesarean sections in preterm births with breech presentation gradually grows through the studied period. Obstetricians were increasingly opting for a Cesarean section in the situation of preterm birth and breech presentation, to eliminate traumatic and hypoxic damage, and thus tried to reduce perinatal mortality. The perinatal mortality rate of premature fetuses in a breech presentation who were delivered vaginally, according to numerous authors was statistically significantly higher compared to the perinatal mortality of premature neonates who were delivered by Cesarean section. Conclusion. The research emphasizes the importance of the completion of the premature birth of a child in the breech presentation by Cesarean section if the child is alive and there are no identifiable development defects

Total antioxidant status of bitches before and after ovariectomy

Svaki kirurški zahvat narušava homeostazu organizma, koja se očituje u imunološkim, neuroendokrinim i metaboličkim promjenama u organizmu. Pretpostavlja se da jačina odgovora organizma ovisi i o jačini traume tijekom operativnih zahvata. Cilj istraživanja je bio utvrditi antioksidacijski status kuja prije i poslije ovarijektomije. U istraživanje je bilo uključeno petnaest kuja pacijenata Klinike za porodništvo i reprodukciju Veterinarskog fakulteta u Zagrebu u kojih je učinjena elektivna ovarijektomija u svrhu kastracije. Kujama je krv vađena prije operacije te poslije prvog, trećeg i sedmog postoperativnog dana kako bi se izmjerio ukupni antioksidacijski status. Svim kujama je učinjena i kompletna krvna slika, biokemija i C-reaktivni protein (CRP). Ukupan antioksidacijski status određivan je pomoću TAS test kitova. Proizvođač kitova preporučuje svakom laboratoriju standardiziranje referentnih vrijednosti. Zbog toga je učinjena analiza 30 seruma zdravih kuja koje nisu bile operirane te je kao referentna vrijednost korištena njihova srednja vrijednost +/- dvije standardne devijacije. Prosječna referentna vrijednost iznosila je 1,55 mmol/L. Vrijednosti ukupnog antioksidacijskog statusa nakon operacije u svim promatranim razdobljima nisu se statistički znatnije razlikovale. Uspoređujući minimalne i maksimalne vrijednosti u svim promatranim razdobljima, zaključili smo da nije bilo velikih razlika u vrijednostima ukupnog antiosksidacijskog statusa u operiranih kuja. Na temelju naših rezultata možemo zaključiti da ovarijektomija nije prouzročila oksidacijski stres.Surgery impairs homeostasis, which is manifested in immunological, neuroendocrine, and metabolic changes in the organism. It is assumed that the response of the organism is proportional to the extent of the operative injury. Accordingly, the aim of this study was to determine the antioxidant status of bitches before and after ovariectomy. Fifteen bitches were presented to the Clinic for Reproduction and Obstetrics, Faculty of Veterinary Medicine, Zagreb, for elective ovariectomy due to castration. Blood sampling was performed on Day 0 (before surgery) and on Days 1, 3 and 7 after surgery to measure total antioxidant status (TAS), complete blood count, biochemistry and CRP. Total antioxidant capacity was determined using TAS test kits. For the purpose of standardisation of reference values of TAS in laboratory, 30 serum samples of healthy, intact bitches were also analysed and the mean value +/- two standard deviations was used as the reference value. The average reference value was 1.55 mmol/L. The values of total antioxidant capacity after surgery on all sampling days did not differ significantly. Comparing the minimum and maximum values on all sampling days, there were no statistical differences in the values of the total antioxidant capacity in ovariectomised bitches. Based on these results, it can be concluded that ovariectomy did not cause oxidative stress