THE ROLE OF INOSITOL, FOLIC ACID AND POLYUNSATURATED FATTY ACIDS IN PREGNANCY AND FETAL DEVELOPMENT

Historical reasons have led to knowledge that would not have been possible to obtain through research without gross violations of ethical norms. Quantification of macro- and micro-nutrient intake is hampered by a number of barriers. It has been observed that changes in fetal nutrition and its endocrine status can result in developmental adjustments that permanently alter the structure, physiology, and metabolism of children, thus exposing individuals to the risk of metabolic, endocrine, and cardiovascular diseases in adulthood. In research on the process better known as "fetal programming", the influence of the in utero environment on the epigenetic mechanisms of the fetus has been observed. Decreased or increased amounts of food intake may interfere with placental function and interfere with fetal growth. Altered placental function can lead to endothelial dysfunction, leading to changes in fetal growth and development. More recently, there has been increasing research on the impact of dietary supplementation on pregnant women and perinatal outcome. Among the more frequently examined variables are micronutrients such as folic acid, antioxidants, iron, magnesium and zinc, but also polyunsaturated fatty acids. The Covid-19 pandemic further highlighted the need to create disease registries and systematically monitor data, especially given the differences in health care availability on one hand and the incredible global differences in nutrient availability on the other

THE ROLE OF INOSITOL, FOLIC ACID AND POLYUNSATURATED FATTY ACIDS IN PREGNANCY AND FETAL DEVELOPMENT

Historical reasons have led to knowledge that would not have been possible to obtain through research without gross violations of ethical norms. Quantification of macro- and micro-nutrient intake is hampered by a number of barriers. It has been observed that changes in fetal nutrition and its endocrine status can result in developmental adjustments that permanently alter the structure, physiology, and metabolism of children, thus exposing individuals to the risk of metabolic, endocrine, and cardiovascular diseases in adulthood. In research on the process better known as "fetal programming", the influence of the in utero environment on the epigenetic mechanisms of the fetus has been observed. Decreased or increased amounts of food intake may interfere with placental function and interfere with fetal growth. Altered placental function can lead to endothelial dysfunction, leading to changes in fetal growth and development. More recently, there has been increasing research on the impact of dietary supplementation on pregnant women and perinatal outcome. Among the more frequently examined variables are micronutrients such as folic acid, antioxidants, iron, magnesium and zinc, but also polyunsaturated fatty acids. The Covid-19 pandemic further highlighted the need to create disease registries and systematically monitor data, especially given the differences in health care availability on one hand and the incredible global differences in nutrient availability on the other

Ultrazvučna dijagnostika makrosomije kod žena s gestacijskim dijabetesom - pregled literature

Pregnancies burdened with gestational diabetes (GDM) are more likely to end in birth of a macrosomic child, where the frequency of operative termination of pregnancy is more common, accompanied with more complications and injuries of both mother and child in comparison to the general population. The need to calculate fetal weight right before delivery has led to the development of numerous methods for greater estimation accuracy. We reviewed the related literature from 1980 to 2020, using the terms macrosomia, ultrasound assessment, gestational diabetes, and relevant articles were considered in preparation of this article. The most frequently used methods are based on two-dimensional ultrasound measurements of individual fetal biometric parameters and their combination in a mathematical regression model. Some methods involve the addition of other mother and child conditions to increase reliability of the method in recognizing macrosomia. In daily work, especially with pregnant women suffering from GDM, it is necessary to have reliable data on the estimated fetal weight before making the correct clinical decision on how to terminate the pregnancy. In this regard, we bring a review of the literature related to the assessment of fetal macrosomia, especially in women with GDM.Trudnoće opterećene gestacijskim dijabetesom (GDM) vjerojatnije će, u usporedbi s općom populacijom, završiti rođenjem makrosomskog djeteta, gdje je učestalost operativnog dovršenja trudnoće češća, popraćena s više komplikacija i oštećenja majke i djeteta. Potreba za izračunavanjem fetalne mase neposredno prije porođaja dovela je do razvoja brojnih metoda u svrhu veće preciznosti procjene. Pregledali smo literaturu od 1980. do 2020. godine rabeći izraze makrosomija, ultrazvučna procjena, gestacijski dijabetes, i upotrijebili smo relevantne članke u pripremi ovog članka. Najčešće primjenjivane metode temelje se na dvodimenzionalnim ultrazvučnim mjerenjima pojedinih fetalnih biometrijskih parametara i njihovoj kombinaciji u matematičkom regresijskom modelu. Neke su metode uključivale dodavanje drugih stanja majke i djeteta kako bi se povećala pouzdanost metode u prepoznavanju makrosomije. U svakodnevnom radu, osobito kod trudnica koje pate od GDM-a, potrebno je imati pouzdane podatke o procijenjenoj fetalnoj težini prije donošenja ispravne kliničke odluke o načinu dovršenja trudnoće. S tim u vezi donosimo pregled literature koja se odnosi na procjenu fetalne makrosomije, naročito u žena s GDM-om

DIETARY SALT INTAKE IN PREGNANCY AND HYPERTENSIVE PREGNANCY DISORDERS – NARRATIVE REVIEW

Salt is crucial for human health, but it`s excess is associated with the development of many diseases including arterial hypertension which is a major feature of hypertensive pregnancy disorders (HPDs). Maternal nutrition during pregnancy can affect cardiometabolic disease development during pregnancy and later in life, but it can also affect fetal growth and disease development in adulthood. Recent studies suggest that excessive salt intake often combined with low potassium intake throughout pregnancy, can suppress renin-angiotensin-aldosterone system (RAAS) with adverse effects on fetoplacental development and can increase the risk of HPDs. Although salt restriction has been considered potentially harmful in the non-pharmacological treatment of arterial hypertension in pregnancy and current guidelines do not recommend it during pregnancy to prevent HPDs, especially gestational hypertension and the development of preeclampsia, its role should be reconsidered in light of the recent evidence. However, one key question remains: How much salt, upper and lower limit of daily intake, in a balanced diet is not harmful in uncomplicated pregnancies as well as HPDs in general

DIETARY SALT INTAKE IN PREGNANCY AND HYPERTENSIVE PREGNANCY DISORDERS – NARRATIVE REVIEW

Salt is crucial for human health, but it`s excess is associated with the development of many diseases including arterial hypertension which is a major feature of hypertensive pregnancy disorders (HPDs). Maternal nutrition during pregnancy can affect cardiometabolic disease development during pregnancy and later in life, but it can also affect fetal growth and disease development in adulthood. Recent studies suggest that excessive salt intake often combined with low potassium intake throughout pregnancy, can suppress renin-angiotensin-aldosterone system (RAAS) with adverse effects on fetoplacental development and can increase the risk of HPDs. Although salt restriction has been considered potentially harmful in the non-pharmacological treatment of arterial hypertension in pregnancy and current guidelines do not recommend it during pregnancy to prevent HPDs, especially gestational hypertension and the development of preeclampsia, its role should be reconsidered in light of the recent evidence. However, one key question remains: How much salt, upper and lower limit of daily intake, in a balanced diet is not harmful in uncomplicated pregnancies as well as HPDs in general

DEPENDENCE OF CARRIAGEWAY CROSSFALL ON OPERATING SPEED

This paper describes a rational approach to improve the existing guidelines for road design in the regions of Slovenia, Croatia, Bosnia and Herzegovina, and Serbia in order to determine the carriageway crossfall in curves. In these guidelines there are certain shortcomings in determination of crosfall in comparison to some other European countries guidelines. During the last decades, worldwide and in Europe specifically, significant studies have been conducted on the issue of the operating speed and its implementation into the design process. Most European countries have been implementing this concept. The new German guidelines went a step further and introduced a new concept of a self-explaining class road. Using the results of research carried out in Croatia, this work focuses only on a determination of the carriageway crossfall based on operating speed, separately observing new and existing roads. Whereas the new road segments require implementing the principle of a consistent route, an existing road network can be safely improved only by introducing the criteria of the determination of crossfall in curves based on the operating speed

Pouzdanost urodinamske obrade u potvrdi stresne inkontinencije mokraće u odnosu na Bonney test

According to the International Continence Society, stress (static) urinary incontinence is defined as any involuntary loss of urine on effort or physical exertion, due to which intravesical pressure overcomes urethral pressure, with no detrusor activity. Urodynamic testing accurately assesses the function of the bladder and urethra. The urodynamic assessment includes three tests: cystometry, uroflowmetry and profilometry (determination of urethral pressure profile). Prior to urodynamic assessment, it is mandatory to rule out urinary tract infection since it is an invasive test. Urethral profilometry is a technique that measures pressure in the urethra and bladder at rest, during stressful actions, and during the act of miction. Its main purpose is to evaluate the sphincter mechanism. During the examination, a special catheter is used, which is being slowly pulled out from the bladder neck throughout the urethra, with continuous recording of intraurethral pressure. In addition to measuring urethral pressures, stress urinary incontinence is also very successfully proven by the cough test and Bonney test. If, on forced cough, the urine escapes uncontrollably, and continence is restored by finger lifting the neck of the bladder, the diagnosis of static incontinence is confirmed. At our urogynecologic clinic, urodynamic examination is being routinely performed. In the present study, we included patients previously treated for urinary stress incontinence and compared their results of urodynamic assessment to the results of Bonney test. Of the 43 subjects in whom stress incontinence was proven with Bonney test, we recorded an appropriate profilometry result in 13 cases.Stresna (statička) inkontinencija mokraće definira se prema ICS-u kao neželjeno otjecanje mokraće kroz uretru istodobno s porastom intraabdominalnog tlaka zbog kojeg intravezikalni tlak nadvlada tlak u uretri, uz odsutnu aktivnost detruzora. Urodinamskom obradom precizno se procjenjuje funkcija mokraćnog mjehura i mokraćne cijevi. U urodinamsku obadu ubrajajmo tri metode: cistometriju, mikciometriju (uroflow) i profilometriju (određivanje profila uretralnog tlaka). Prije urodinamske obrade moramo uvijek isključiti infekciju mokraćnih kanala, jer se radi o invazivnoj pretrazi. Profilometrija uretre je tehnika kojom mjerimo tlak u uretri kod mokraćnog mjehura u mirovanju, tijekom stresnih radnja i samog akta mokrenja. Osnovna joj je namjena ispitivanje sfinkterskoga mehanizma. Pri pregledu rabi se specijalni kateter koji se malom brzinom povlači od vrata mjehura prema distalno uz kontinuirano bilježenje intrauretralnoga tlaka. Uz mjerenje tlakova uretre stresna inkontinencija mokraće se vrlo uspješno dokazuje i testom kašlja, odnosno Bonney testom. Ako kod forsiranog kašlja mokraća nekontrolirano otječe, a podizanjem vrata mokraćnog mjehura prstima ispitanica uspijeva zadržati mokraću u mjehuru, radi se o statičkoj inkontinenciji. U OB “Dr Josip Benčević’’ pri uroginekološkoj ambulanti radi se urodinamsko ispitivanje. U ovo istraživanje uključili smo samo ispitanice s liječenom stresnom inkontinencijom mokraće te smo usporedili njihove rezultate na urodinamskoj obradi u odnosu na rezultate Bonney testa. Od 43 ispitanice kojima smo stresnu inkontinenciju dokazali Bonney testom u 13 slučajeva zabilježili smo uredan nalaz profilometrije

EXTRAUTERINE PREGNANCY IN A WOMAN USER OF ORAL CONTRACEPTIVE PILLS

Smatra se da oralna hormonska kontracepcija smanjuje rizik mnogih stanja u ginekologiji, na primjer zdjelične upalne bolesti, anemije i izvanmaternične trudnoće. U novije vrijeme nekoliko je autora preispitalo stav o manjem broju izvanmaterničnih trudnoća u korisnica oralne hormonske kontracepcije. Stav je moguće netočan te zato uz komentar prikazujemo slučaj izvanmaternične trudnoće koja je nastala uz redovitu uporabu oralnih kontracepcijskih tableta.Oral contraceptive pills are thought to lower the risk of numerous conditions in gynecology, for instance pelvic inflammatory disease, anemia and extrauterine pregnancy. Some of these standings are challenged nowadays, and therefore with the comment we present a case of a patient who became pregnant with an extrauterine pregnancy while regularly taking oral contraceptive pills

EXTRAUTERINE PREGNANCY IN A WOMAN USER OF ORAL CONTRACEPTIVE PILLS

Smatra se da oralna hormonska kontracepcija smanjuje rizik mnogih stanja u ginekologiji, na primjer zdjelične upalne bolesti, anemije i izvanmaternične trudnoće. U novije vrijeme nekoliko je autora preispitalo stav o manjem broju izvanmaterničnih trudnoća u korisnica oralne hormonske kontracepcije. Stav je moguće netočan te zato uz komentar prikazujemo slučaj izvanmaternične trudnoće koja je nastala uz redovitu uporabu oralnih kontracepcijskih tableta.Oral contraceptive pills are thought to lower the risk of numerous conditions in gynecology, for instance pelvic inflammatory disease, anemia and extrauterine pregnancy. Some of these standings are challenged nowadays, and therefore with the comment we present a case of a patient who became pregnant with an extrauterine pregnancy while regularly taking oral contraceptive pills

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