Umbilical cord wrapping and enlargement in monochorionic monoamniotic twins with letal outcome

We present the case of tapered umbilical cords in monoamniotic monocorial twins with late abortion as an outcome. A pregnant woman at the age of 38 had healthy course of her second pregnancy. In the 9th week of gestation, an monoamniotic monocorionic pregnancy was diagnosed by ultrasound. Early amniocentesis was done due to the older age of a mother. During the procedure an enlargement of the umbilical cord was discovered, and the wrapping of the two umbilical cords. Mosaic trisomy of the 21st chromosome was proved. In the 19 w + 3 d gest., negative heart beats were detected for both of fetuses. The induction of abortion was initiated by prostaglandin vaginal gel (dinoprost). There were no signs of maceration, the weights were 230 and 190 grams, with increased and wrapped umbilical cords. The pathohistological fi nding confi rmed monochorionic-monoamniotic twin pregnancy with a long and tightly knit umbilical cord with complete blood fl ow obstruction and no signs of fetal malformalities. Also, there were no clinical signs of fetal transfusion syndrome. It is probably that the umbilical cord of the second twin was hypoplastic and with more complications

Correlation between biometeorological forecast and the incidence of obstetric admissions in perinatal center during five years: A retrospective study of one center

Background and purpose: The aim of this study was to correlate obstetric admissions at a tertiary perinatal center with biometeorological forecast and weather conditions. Materials and methods: This retrospective study was conducted at the Department of Gynaecology and Obstetrics Clinical Hospital “Sveti Duh” over five years, from January 1, 2014 to December 31, 2018. The hospital’s emergency data was used for record of obstetric admissions on each day. The selected days were sorted in 4 groups based on biometeorological forecast. Results: In the observed period, there were a total of 18,072 obstetric admissions. There were 216 days with fifteen or more admissions. The results showed no significant difference between obstetric admission based on the biometeorological forecast one day before or three days before. Most hospitalization were on days with a favorable biometeorological forecast in the observed period, 68 days with more than fifteen admissions per day. The day before, the biometeorological forecast was mostly favorable or relatively favorable. Conclusion: Our retrospective single-center study did not show a significant difference between obstetric hospital admissions depending on biometeorological conditions, but the higher number of admissions during days with a favorable forecast is definitely the basis for future studies with larger dataset

Association of weather conditions and the day with extreme number of deliveries with spontaneous onset in a tertiary referral perinatal center

Background and purpose: The effect of weather on people’s well-being and health has been previously noticed and has been a subject of interest for medical professionals and laypeople throughout human history. There are many studies connecting gynecology and obstetrics with weather, some of them investigating the weather and physiological processes such as onset of labor.Materials and methods: In this paper we tried to find relationship between weather conditions and the day with extreme number of deliveries with spontaneous onset (contractions and/or rupture of membranes) in a tertiary referral perinatal center. It is still debatable whether we could connect the weather conditions with actual childbirth.Results: A case analysis shows that there could be a connection between the development of the weather situation and the extreme number of deliveries with spontaneous onset.Conclusion: Unfavorable biometeorological conditions were the result of weather conditions that affect people. In our case there was strong cold advection during the analyzed period, especially on the day with an extreme number of deliveries with spontaneous onset, and significant drop of barometric pressure

INFLUENCE OF HYSTEROSCOPIC METROPLASTY ON APPEARANCE, ONGOING AND OUTCOME OF PREGNANCY

Cilj rada. Usavršavanjem dijagnostike, posebice ultrazvučnih i endoskopskih metoda, omogućeno je uspješno otkrivanje poremećaja u spajanju Müllerovih cijevi s posljedičnim stvaranjem septuma uterusa različite dužine i lokalizacije. Ovi poremećaji su združeni s lošim reprodukcijskim ishodom i povećanim rizikom za majku. Cilj rada je bio analizirati¬ uspješnost histeroskopske metroplastike u nastanku, tijeku i ishodu trudnoće. Ispitanice i metode rada. Skupina od 410 ispitanica s trudnoćom nastalom poslije histeroskopske metroplastike, sa srednjom vrijednosti životne dobi od 31,4 godine i srednjom vrijednosti trajanja neplodnosti 5,3 godine, podijeljena je u dvije podskupine: 1) s primarnom neplodnošću 178 i 2) sa sekundarnom neplodnošću 232 bolesnice. Rezultati. Prije histeroskopske metroplastike stopa rađanja je bila 7,6% (31 porod), sa stopom preživljenja 5,4% i perinatalnim mortalitetom 32,3%. Stopa spontanih pobačaja je bila 72,8% (169 bolesnica), od 1 do 9 po bolesnici. Ukupni broj spontanih pobačaja iznosio je 360, odnosno 86,1% od ukupnog broja 418 trudnoća ili 2,1 pobačaj po bolesnici. Stopa izvanmaternične trudnoće je bila 10,8% (25 bolesnica). U 178 ispitanica nije došlo do trudnoće unatoč poduzetom višegodišnjem liječenju neplodnosti. Poslije histeroskopske metroplastike stopa po¬roda je signifikatno porasla i dostigla 75,8%. S druge strane, stopa spontanih pobačaja je signifikantno pala na 10,4%. Stopa perinatalnog mortaliteta je pala na 2,2%, dok je stopa izvanmaternične trudnoće pala na 3,9%. Trudnoća u tijeku je 8,5%. Zaključak. Incizijom septuma kavuma uterusa postiže se poboljšanje uvjeta za implantaciju i razvoj trudnoće. Nakon histeroskopske metroplastike signifikantno raste stopa poroda, od 7,6% prije na 75,8% poslije operacije. U isto vrijeme, stopa spontanih pobačaja pala je od 72,8% prije histeroskopske metroplastike na 10,4% poslije operacije.Objective. Ultrasound diagnostics and hysteroscopic technique made a hughe progress in accurate detection of failure of fusion of the Müllerian ducts and failure of resorption of the intervening septum, which are occuring during embryologic development from 6 to 20 weeks and result in formation of uterine septa of variable lengths and positions. These congenital uterine malformations are associated with poor reproductive outome and an increased risk for mother. Hysteroscopic metroplasty is minimally invasive procedure allowing safe technique for incision of the septum. The objective was to analyze the successfulness of the hysteroscopic metroplasty in the appearance, ongoing and outcome of the pregnancy. Material and methods. The group of 410 patients with pregnancy after hysteroscopic metroplasty was evaluated.¬ The mean age of patients was 31.4 years. The mean infertile interval was 5.3 years. Before hysteroscopic metroplasty 232 patients were referred with history of pregnancy loss or complications of pregnancy. Infertility was the main complaint in 178 patients. Results. Before hysteroscopic metroplasty delivery rate in the group of 232 patients with secondary infertility¬ was 7.6%, perinatal mortality rate 32.3% and spontaneous abortion rate 72.8%; total number of miscarriagies was 360, its number ranged 1–9 in studied 169 patients. Ectopic pregnancy rate was 10.8% (25 patients). In spite of the treatment lasting several years there were no pregnancies in the group of 178 patients. After hysteroscopic metroplasty, delivery rate increased significantly and reached 75.8%. Ongoing pregnancy rate is 8.5%. On the other hand, spontaneous abortion rate decreased significantly and dropped to 10.4%. Ectopic pregnancy rate decreased to 3.9%. Perinatal mortality decreased to 2.2%. Conclusion. Pregnancy capacity of the uterine cavity is enlarged by hysteroscopic incision of the septum. Conditions for implantation and embryo development are improved. Hysteroscopic metroplasty significantly increased delivery rate, from 7.6% before to 75.8% after the procedure. Rate od spontaneous abortions decreased¬ from 72.8% before operation to 10.4% and ectopic pregnancy rate from 10.8% to 3.9%

Šezdeset godina primjene modificirane manualne perinealne zaštite po Ritgenu

The aim is to present the 60-year experience in modified Ritgen maneuver according to perineal injuries. This retrospective clinical observational study (1950-2010) analyzed the impact of modified Ritgen maneuver delivery technique (controlled fetal head deflexion with left hand and synchronous reduction of perineal strain with extended right hand thumb along the right side of the vulva and perineum without pushing) on peripartum perineal tears at the Maternity Ward, Bjelovar General Hospital in Bjelovar, Croatia, divided into five-year intervals. The rate of perineal tear in general was less than 5% until 2000. The rate of perineal tear grade I was very low until 1995, then increased to 8.6% in 2010, yet never exceeding 10%. The rate of perineal tear grade II never exceeded 2%, whereas perineal tear grade III was a sporadic event never exceeding 0.4% of the study material with a single case of grade IV tear. The rate of intact perineum in vaginal deliveries without episiotomy ranged from 96.2% to 100% in the 1950-1960 period, with a decrease to 46% in 2010. The study revealed the modification of Ritgen maneuver described to have resulted in significant reduction of all grades of perineal tear over decades.Cilj istraživanja bio je prikazati 60-godišnje iskustvo u modificiranoj manualnoj perinealnoj zaštiti po Ritgenu u odnosu na razdore međice. Retrospektivna opservacijska klinička studija (1950.-2010.) analizirala je petogodišnje intervale učinka modificirane Ritgenove tehnike perinealne zaštite (kontrolirana fetalna defleksija lijevom rukom uz sinkronu redukciju napetosti međice desnom rukom koja je ispružena s desne strane međice i vulve, bez tiskanja rodilje) na peripartalne razdore međice u rodilištu Opće bolnice u Bjelovaru, Hrvatska. Ukupna stopa razdora međice bila je manja od 5% do 2000. godine. Stopa razdora I. stupnja bila je vrlo niska do godine 1995., zatim se povećala na 8,6% u 2010. godini, ali nikada iznad 10%. Razdori međice II. stupnja nisu prelazili stopu od 2%, dok su razdori međice III. stupnja bili sporadični i nisu prelazili 0,4% u ispitivanom materijalu, uz jedan slučaj razdora IV. stupnja. Netaknuta međica bez epiziotomije bila je u rasponu od 96,2% do 100% u razdoblju od 1950. do 1960. godine, sa smanjenjem od 46% u 2010. godini. Ovo istraživanje dokazalo je značajno smanjenje razdora međice svih stupnjeva uporabom modificirane manualne zaštite po Ritgenu

Postoji li povezanost komplikacija rane trudnoće s biometeorološkom prognozom?

The aim of our study was to connect the possible complications of early pregnancy (miscarriage and symptomatic ectopic pregnancy) up to the 12th week of gestation with biometeorological conditions while assuming a greater number of incidents with an unfavorable biometeorological forecast. We performed a retrospective observational study using medical data of a single medical center of Department of Gynecology and Obstetrics, Sveti Duh University Hospital and meteorological data from the Croatian Meteorological and Hydrometeorological Service in Zagreb. We tracked the number of visits to the gynecology and obstetrics emergency unit on a daily basis during 2017. Days with five or more visits were selected and underwent further analysis, during which the number of miscarriages and symptomatic ectopic pregnancies was noted. The information from the biometeorological forecast was then extracted and added to the database. Our results did not show a statistically significant difference between the groups determined by biometeorological forecast in the number of spontaneous abortions or ectopic pregnancy. Also, statistically significant results did not follow the expected trend of the increasing number of complications related to worse biometeorological forecast, or vice versa, a decreased number of complications with better forecast. Our single-center retrospective analysis of emergency unit visits related to weather conditions did not show a connection between the complications of early pregnancy and biometeorological conditions. However, different results could emerge in future studies. Considering the large and high-quality database collected for this study, efforts in researching the connection between other gynecologic pathologies and weather conditions will be feasible.Cilj ovoga istraživanja bio je povezati komplikacije rane trudnoće (spontani pobačaj i izvanmaternična trudnoća) do 12. tjedna gestacije s biometeorološkim uvjetima, očekujući veći broj incidenata u uvjetima nepovoljne biometeorološke prognoze. Proveli smo retrospektivno opservacijsko istraživanje koristeći medicinske podatke Klinike za ginekologiju i porodništvo Kliničke bolnice Sveti Duh i meteorološke podatke Državnoga hidrometeorološkog zavoda u Zagrebu. Zabilježili smo broj hitnih pregleda na Klinici za ginekologiju i porodništvo tijekom 2017. godine. Dani s pet ili više pregleda su zabilježeni, a zabilježen je i broj spontanih pobačaja i izvanmaterničnih trudnoća. Informacije o biometeorološkoj prognozi za obrađene dane su dodane prikupljenoj bazi podataka. Naši rezultati nisu pokazali statistički značajnu razliku između skupina određenih biometeorološkom prognozom u broju spontanih pobačaja i izvanmaterničnih trudnoća. Statistički značajne rezultate nisu pokazali ni očekivani porast broja komplikacija s lošijom biometeorološkom prognozom ili smanjen broj komplikacija povezanih s boljom biometeorološkom prognozom. Naša retrospektivna analiza nije pokazala povezanost posjeta hitnom prijmu s vremenskim prilikama, stoga ni povezenost komplikacija rane trudnoće s vremenskim uvjetima. Međutim, drugačiji rezultati se mogu dobiti u budućim istraživanjima. S obzirom na veliku i kvalitetnu bazu podataka prikupljenu u ovom istraživanju daljnja nastojanja u istraživanju povezanosti ginekološke patologije i vremenskih uvjeta uvelike su olakšana

THIRD- AND FOURTH-DEGREE PERINEAL TEARS AND RESTRICTIVE USE OF EPISIOTOMY

Cilj: Utvrditi ukupan broj i učestalost razdora međice III. i IV. stupnja u uporabi restriktivne epiziotomije te učestalost opstetričkih ozljeda analnog sfi nktera (OASIS) u odnosu na paritet, način dovršenja porođaja, trajanje porođaja, epiduralnu analgeziju, iskustvo porodničkog tima, porođajnu težinu i opseg glave novorođenčeta. Ispitanice i metode: U retrospektivno kliničko istraživanje uključena je 51 rodilja koje su rodile na Klinici za ginekologiju i porodništvo KB-a Sveti Duh u razdoblju od 1. siječnja 2010 do 31. prosinca 2014. s dijagnozom OASIS. Rezultati: Od ukupno 12858 vaginalnih porođaja, 77 % (n=9887) žena nije imalo epiziotomiju, dok je 23% (n=2971) imalo epiziotomiju. Ukupna učestalost OASIS-a u promatranom razdoblju iznosila je 0,4%, s mediolateralnom epiziotomijom (0,7%) u odnosu na žene bez epiziotomije (0,3 %; p0,05). Zaključak: Kao rizični čimbenici za nastanak OASIS-a pokazali su se prvorodnost, duljina trajanja porođaja više od deset sati te primjena epiziotomije. U trećini slučajeva s OASIS-om bili su prisutni ostali opstetrički rizični čimbenici za nastanak OASIS-a. Restriktivna uporaba epiziotomije i manualna perinealna protekcija smanjuju incidenciju razdora III. i IV. stupnja.Aim: To determine the number and prevalence of third- and fourth-grade perineal tears with restrictive use of episiotomy, and the prevalence of obstetric anal sphincter injuries (OASIS) according to parity, mode of labor termination, delivery duration, epidural analgesia, obstetric team experience, and neonatal birth weight and head circumference. Subjects and Methods: This retrospective clinical study included 51 women diagnosed with OASIS, having delivered their newborns at Department of Gynecology and Obstetrics, Sveti Duh University Hospital from January 1, 2010 until December 31, 2014. Results: Out of 12858 vaginal deliveries, episiotomy was not used in 77% (n=9887), whereas it was used in 23% (n=2971) of women. The overall prevalence of OASIS during the study period was 0.4%, with 0.7% for mediolateral episiotomy versus 0.3% in women without episiotomy (p10 hours (p4000 g (21.6%), maternal body mass index, and second stage of labor >1 hour (43.6%) versus 0.05 both). Conclusion: Primiparity, delivery duration >10 hours, and use of episiotomy were identifi ed as risk factors for OASIS. Other obstetric risk factors for OASIS were present in one-third of OASIS cases. The prevalence of third- and fourth-degree perineal tears can be reduced with restrictive use of episiotomy and manual perineal protection