Pathological pregnancy and psychological symptoms in women [Patološka trudnoća i psihički simptomi u žena]

Pregnancy is followed by many physiologic, organic and psychological changes and disorders, which can become more serious in pregnancy followed by complications, especially in women with pathological conditions during pregnancy. The purpose of this study was to find out and analyze the prevalence and intensity of psychological disorders in women with pathological conditions during pregnancy and compare it with conditions in pregnant women who had normal development of pregnancy. The research is approved by the Ethical committee of the Mostar University Hospital Center, and it was made in accordance with Helsinki declaration and good clinical practices. The research conducted section for pathology of pregnancy of Department for gynecology and obstetrics of the Mostar University Hospital Center. It included 82 pregnant women with disorders in pregnancy developement and control group consisted of pregnant women who had normal development of pregnancy. The research work was conducted from September 2007 to August 2008 in Mostar University Hospital Center. Pregnant women had Standard and laboratory tests, Ultrasound. CTG examinations were done for all pregnant women and additional tests for those women with complications during pregnancy. Pregnant women completed sociobiographical, obstetrical-clinical and psychological SCL 90-R questionnaire. Pregnant women with pathological pregnancy exibited significantly more psychological symptoms in comparison to pregnant women with normal pregnancy (p < 0.001 to p = 0.004). Frequency and intensity of psychical symptoms and disorders statisticly are more characteristic in pathological pregnancy (61%/40.6%). The statistical data indicate a significantly higher score of psychological disorders in those pregnant women with primary school education (p = 0.050), those who take more than 60% carbohydrates (p = 0.001), those with pathological CTG records (p < 0.001), those with pathological ultrasound results (p < 0.001 to 0.216) and those pregnant women with medium obesity and obesity (p = 0.046). Body mass index (BMI) during normal pregnancy development is lower (p = 0.002) but the levels of glucose, triglycerides, cholesterol, HDL and LDL in blood are higher Blood pressure in pregnant women with pathological pregnancy was statistically significantly higher (p < 0.001). Diagnostic criteria for the metabolic syndrome were found in 19 pregnant women with the pathological pregnancy. Statistically, in those women, a significantly higher appearance of psychological symptoms and disorders was observed in comparison to the pregnant women without metabolic syndrome (p < 0.001). The research has shown that 87.8% from all pregnant women included in this study have been hospitalized due to premature birth, hypertensive disorders, and diabetes in pregnancy, and also due to bleeding in the second and third trimester of pregnancy

High-density cervical ureaplasma urealyticum colonization in pregnant women

Background/aim: Ureaplasma urealyticum, a common commensal of the female lower genital tract, has been observed as an important opportunistic pathogen during pregnancy. The aims of this study were to determine the degree of cervical colonization with U. urealyticum in pregnant women with risk pregnancy and in pregnant women with normal term delivery and to evaluate the correlation between high-density cervical U. urealyticum colonization and premature rupture of membranes (PROM) as well. Methods. This research was conducted on the samples comprising 130 hospitalized pregnant women with threatening preterm delivery and premature rupture of membranes. The control group consisted of 39 pregnant women with term delivery without PROM. In addition to standard bacteriological examination and performing direct immunofluorescence test to detect Chlamydia trachomatis, cervical swabs were also examined for the presence of U. urealyticum and Mycoplasma hominis by commercially available Mycofast Evolution 2 test (International Microbio, France). Results. The number of findings with isolated high-density U. urealyticum in the target group was 69 (53.08%), while in the control group was 14 (35.90%). Premature rupture of membranes (PROM) occurred in 43 (33.08%) examinees: 29 were pPROM, and 14 were PROM. The finding of U.urealyticum ≥104 was determined in 25 (58.14%) pregnant women with rupture, 17 were pPROM, and 8 were PROM. There was statistically significant difference in the finding of high-density U. urealyticum between the pregnant women with PROM and the control group (χ² = 4.06, p &lt; 0.05). U. urealyticum was predominant bacterial species found in 62.79% of isolates in the PROM cases, while in 32.56% it was isolated alone. Among the 49 pregnant women with preterm delivery, pPROM occurred in 29 (59.18%) examinees, and in 70.83% of pregnant women with findings of high-density U. urealyticum pPROM was observed. Conclusion. Cervical colonization with U. urealyticum ≥ 104 is more frequent in pregnant women with risk pregnancy than in pregnant women with normal term delivery. High-density cervical U. urealyticum colonization should be observed as a possible etiological factor for PROM

Lyme borreliosis and pregnancy

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Effect of lipide profile in healthy physiological pregnancy on fetal growth and development

Novouspostavljena kohortna populacija srednje Dalmacije CRIBS (Kohortna studija rođenih na istočnojadranskim otocima) uključuje Split i okolicu, otoke Brač i Hvar te je osmišljena tako da omogućuje longitudinalno praćenje tijeka trudnoće, prikupljanje podataka o zdravlju majke prije i za vrijeme trudnoće, o čimbenicima okoliša koji utječu na zdravlje majke i fetusa te podatke s poroda. U ovdje prikazanu analizu bio je uključen 171 par majka-novorođenče. U odnosu na WHO (engl. World Health Organisation) i CDC/NCHS (engl. Centers for Disease Control and Prevention/National Center for Health Statistics) populacije, CRIBS novorođenčad je u prosjeku teža i veća. Pronađene su razlike u visini srednjih vrijednosti ukupnog i HDL (engl. high density lipoproteins) kolesterola u krvi trudnica ovisno o tome žive li na kopnu ili otocima; češće su povišene kod ispitanica s kopna kao i učestalost HDL kolesterola iznad referentnih vrijednosti. Majke s nižim vrijednostima HDL kolesterola od referentnih u drugom tromjesečju trudnoće, rađale su djecu statistički značajno veće porođajne duljine, a one s povišenim ukupnim i LDL (engl. low density lipoprotein) kolesterolom novorođenčad manje porođajne duljine. S obzirom na mali broj ispitanica s komplikacijama u trudnoći, nije bilo moguće utvrditi utječu li vrijednosti lipidnog profila na preeklampsiju, hipertenziju, fetalni zastoj rasta i/ili pretilost.Cohort study CRIBS (Croatian Islands` Birth Cohort Study) includes middle Dalmatian population; city of Split and surroundings and the islands of Brač and Hvar, and was designed to enable tracking the pregnancy longitudinally; collecting data on mother's health before and during the pregnancy, data on environmental factors that can influence mother's and fetal health, and birth data. Analysis included 171 mother-newborn pairs. In relation to WHO (World Health Organisation) and CDC/NCHS (Centers for Disease Control and Prevention/National Center for Health Statistics) referent populations, CRIBS newborns were on average heavier and longer. Differences in mean levels of total and HDL (high density lipoprotein) cholesterol were found depending on whether the mothers were living on the mainland or on the islands; higher level were found in mainland's mothers as well as the higher prevalence of elevated HDL. Pregnant women with lower mean HDL cholesterol in their second trimester gave birth to longer newborns, while those with normal or elevated LDL (low density lipoprotein) had newborns of smaller lenght. Considering small number of participants with pregnancy complications, it was not possible to determine whether lipid profile values associated with preeclampsia, hypertension, fetal growth retardation and/or obesity

PERINATAL MORTALITY IN REPUBLIC OF CROATIA IN THE YEAR 2009

U 2009. godini je u Hrvatskoj umrlo 7837 stanovnika više, nego se rodilo, stopa nataliteta je bila 10,1‰, mortaliteta 11,8‰, negativni priraštaj iznosi –1,7‰. Rođeno je 45 056 djece 500 grama (747 više nego 2008. godine), među njima 44853 djeteta 1000 grama. Učestalost nedonoščadi je 2009. godine bila 5,44%, a novorođenčadi niske porodne težine 5,55%. Perinatalni mortalitet za svu djecu 1000 g je bio 4,4‰, a za svu djecu 500 g 7,2‰. Fetalni mortalitet za djecu 1000 g je bio 3,0‰, a za djecu 500 g 4,2‰. Odgovarajući rani neonatalni mortalitet je bio 1,5‰ i 3,0‰. U porodu je umrlo 11 plodova, što je 0,24‰. Rani neonatalni mortalitet se smanjuje porastom težine novorođenčadi: za djecu 500–999 g je bio 483,0‰, za djecu 1000–1499 g 89,0‰, za 1500–1999 g 23,8‰, za 2000–2499 g 8,7‰ te za djecu 2500 g 0,6‰.U 15 od 35 rodilišta je standardni perinatalni mortalitet (djeca 1000 g) bio manji od 5,0‰, u 11 je bio 5,0–9,9‰, a u 4 bolnička i 5 izvanbolničkih rodilišta ni jedno dijete nije perinatalno umrlo. U trudnoći, porodu ili babinjama je umrlo 7 žena, pa je maternalna smrtnost u 2009. godini porasla od 6,9/100.000 živorođenih u 2008. godini na 15,6/100.000 živorođenih. Eklampsija je bilo 16 ili 0,36‰. Carskim rezom je dovršeno 8084 trudnoća, što je 18,2%, u blagom je porastu (za 0,45%) prema prethodnoj godini. Od svih SC bilo je 28,0% ponovljenih, a 69,95% od 3251 rodilje s ranijim carskim rezom je ponovno porođeno carskim rezom. Od 1614 jednoplodovih trudnoća u stavu zatkom njih 1232 (76.33%) je rođeno carskim rezom. Antenatalna skrb pokazuje stagnaciju prema prethodnoj 2008. godini: po trudnici je bilo prosječno 9,0±0,83 pregleda, 63,1% je pregledano 9 puta, od njih 28,1% više od 10 puta, ali još uvijek je 3,4% trudnica bilo bez pregleda ili s 1–2 pregleda, a 6,7% sa samo 3–5 pregleda. Prosječni broj pregleda ultrazvukom je bio 4,9±0,5, njih 70,0% je bilo pregledano 4 puta, od njih 46,1% 5 puta. U rodilištima III. razine s JINT, znakovito je niži fetalni mortalitet za djecu 500–1499 g. Organizacija perinatalne zaštite u Hrvatskoj u tri razine, s konačnim formiranjem jedinica intenzivne neonatalne terapije (JINT) i njege (JINNj), uz popunu tih jedinica opremom i uz odgovarajuću izobrazbu deficitarnih kadrova primarna su zadaća perinatalne zdravstvene skrbi.In the Republic of Croatia in the year 2009 died 7837 inhabitants more than were born, natality rate was 10,1 mortality rate 11.8, the population increase was negativ –1,8. The 45 056 infants with birthweight 500 grams (747 more than in previous 2008), 44853 infants with birthweight 1000 grams have been born. In the year 2009 the incidence of preterm infants was 5.44% and of those LBW-s 5.55%. Perinatal mortality for infants 1000 grams was 4.4‰ and for those 500 g 7.2‰. Fetal mortality for infants 1000 g was 3.0‰ and for those 500 g 4.2‰. The corresponding early neonatal mortality was 1.5‰ and 3.0‰. Eleven fetuses died intra partum i.e. 0.24‰. The early neonatal mortality decreases with increase of body weight: for infants 500–999 grams was 483.0‰, for those 1000–1499 g 89.0‰, for 1500–1999 g 23.8‰, for 2000–2499 g 8.7‰, and for infants 2500 grams 0.6‰. In 15 out of 35 maternity wards the perinatal mortality was <5.0‰, in 11 between 5.0–9.9‰; in 4 hospital and in 5 out-hospital maternity wards no one infant died. During pregnancy, labor or puerperium died seven women and maternal mortality was 15.6/100.000. 16 ecclampsias were registered i.e. 0.36‰. By cesarean section were accomplished 8084 births i.e. 18.2%, there is mild increase (0.45%) in relation to the previous year 2008. The repeated CSs formed 28.0% of all sections. Out of 3251 gravidas with previous CS in 69.3% the pregnancy was again accomplished by repeated CS. Out of 1614 breech presentations the 1232 (74.3%) of them were accomplished by CS. The antenatal care showed an stagnation in relation to previous year: the mean number of antenatal visits per pregnant patient was 9.0±0.83, the 63.6% of pregnant patients had 9 visits, the 28.1% of them 10 visits; however 3.4% of pregnant woomen had no visit or 1–2 visits, 6.7% 5–6 visits. The mean value of ultrasound examination was 4.9±0.5, the 70.0% of patients had 4 US examinatios, the 46.1% of them 5 examinations. In the 3-rd level hospitals, in those with NICU, the early neonatal and perinatal mortality were significantly lower for infants 500–1499 grams. The primary task of the perinatal care in Croatia would be the institutional organization of the hospitals on the 3-rd and 2-nd level, with NICU units, along with additional supply of technology and human resources

SUMNJA NA APENDICITIS U TRUDNOĆI: POJAVNOST I POSTUPAK

Objective. An evaluation of the the clinical picture, diagnostic procedures and outcome of appendicitis in pregnant women. Method. Retrospective analytic study of 28 appendectomies performed during pregnancy for suspected appendicitis in our hospital at period April 2004 to September 2006. All files and medical records of these patients were analyzed and studied. The including variables (demographic, clinical, laboratory and surgical outcomes data) were collected retrospectively. The number of correct and wrong diagnosis were reported and comparison of perinatal outcome, maternal morbidity and different variables in negative and positive laparotomy performed. Results. The prevalence of suspected appendicitis in pregnancy is 0.29%. Incidence of negative laparotomies was 36%. The most correct diagnostic findings for acute appendicitis were history of periumbilical pain, anorexia and iliac fossa findings. Delayed surgical intervention significantly increased maternal morbidity (p=0.003), rate of premature labor (p=0.031) and rate of abortion but not significantly (p=0.28). Conclusion. The prevalence of suspected appendicitis during pregnancy in our environment during this period was higher than the reported incidence; the rate of wrong diagnosis is still high. Good clinical assessment with adjunct ultrasonic examination could reduce the incidence of negative laparotomies and prevent late complications. Delay in operation is leading to higher rate of maternal morbidity and adversely affect the obstetric outcome.Cilj rada. Vrednovanje kliničke slike, dijagnostičkih postupaka i ishoda apendicitisa u trudnica. Metode. Retrospektivno je analizirano 28 trudnica s apendektomijom tijekom trudnoće zbog sumnje na appendicitis. U bolnici u Zarqua-i u Jordanu u razoblju od travnja 2004. do rujna 2006. učinjeno je 28 apendektomija tijekom trudnoće. Analizirane su povijesti bolesti tih 28 trudnica. Istraživane su razne varijable: demografske karakteristike pacijentica, kliničke, laboratirijske i kirurški ishod. Ustanovljen je broj točnih i pogrešnih dijagnoza te uspoređen perinatalni ishod i maternalni morbiditet u pacijentica s pozitivnim i negativnim laparotomijskim nalazom. Rezultati. Pojavnost sumnje na apendicitis u trudnoći je bila 0,29% svih registriranih trudnoća. U 36% sumnji je laparotomijom nađen normalni apendiks. Najtočniji dijagnostički nalaz za akutni apendicitis je bio periumbilikalni bol, anoreksija i osjetljivost ilijačnih šupljina. Odgađanje kirurške intervencije je znakovito povisilo majčin morbiditet (p=0,003), stopu preranog poroda (p=0,031) te neznakovito stopu pobačaja (p=0,28). Zaključak. Pojavnost sumnje na apendicitis u trudnoći je u našim prostorima bila viša nego se uobičajeno spominje; stopa krivih dijagnoza je još visoka. Dobra klinička psosudba uz dodatak ultrazvučnog pregleda mogla bi smanjiti učestalost negativnih laparotomija i spriječiti kasnije komplikacije. Odgoda operacije povećava maternalni morbiditet i obrnuto pridonosi opstetričkom ishodu

Association of Angiotensin-Converting Enzyme Insertion-Deletion Polymorphism with Preeclampsia

The aim of this study was to determine if insertion-deletion polymorphism of angiotensin-converting enzyme is a risk factor for the development of preeclampsia. Sixty women with preeclampsia and 50 normotensive pregnant women were included in this study. Preeclampsia was defined as blood pressure > 140/90 mmHg in a previously normotensive women with proteinuria >300 mg/L in a 24-hours. Twelve women also had preeclampsia in previous pregnancy. The genotyping of polymorphism in the intron 16 of the angiotensin-converting enzyme was performed by the polymerase chain reaction followed by the agarose electrophoresis. The patients were divided into three groups according to the presence (I) or absence (D) of insertional polymorphism (II, ID, and DD). Genotype distribution and allele frequencies were compared by Mantel-Haenszel c 2 testing. The frequency of DD genotype was not significantly higher in women with preeclampsia (26/60)than in the control group (14/50, p=0.096). The D allele frequency was significantly higher in 17 women with preeclampsias who required delivery before 34 weeks of pregnancy (0.735), than in 43 women in whom obstetric complications took place after 34 weeks of pregnancy (0.56, p=0.036). The D allele frequency was 0.83 in women having recurrent preeclampsia, i.e. significantly higher compared with women, who were for the first time, experienced preeclampsia (0.57, p=0.013). This study showed a significantly positive association between D allele frequency and risk of recurrent preeclampsia and preterm delivery before 34 weeks of pregnancy. The deletion genotype could be an important contributing factor for an early onset and recurrent preeclampsia

Sestrinska skrb u zajednici kod maloljetničke trudnoće

Reproduktivno zdravlje je stanje potpunog psihičkog, fizičkog, mentalnog i socijalnog blagostanja u svemu što se odnosi na reproduktivni sistem, a ne samo odsutstvo bolesti i nesposobnosti. Planiranje obitelji je svjesno i slobodno odlučivanje žene i muškarca o najpovoljnijem vremenu za roditeljstvo, o rađanju željenog broja djece, te o vremenu i razmaku između porođaja. Spriječavanje zanošenja tj. kontracepcija je bitna mjera u planiranju obitelji i zaštiti reprodukcijskog zdravlja. To su svi oni postupci kojima se, primjenom raznih metoda i sredstava sprječava trudnoća. Pubertet je fiziološko razdoblje čovjekova života, vrijeme fizičkog sazrijevanja u kojem dječaci i djevojčice prolaze promjene čiji je rezultat tijelo sposobno za reprodukciju. Pubertet završava stjecanjem spolne zrelosti i sposobnosti reprodukcije. Adolescencija je za razliku od puberteta vrijeme kognitivnih, intelektualnih, socijalnih i emocionalnih promjena. Ovo je vrijeme formiranja mentalnog života, razvijanje osobnosti, kristalizacija stavova, razvijanja apstraktnog mišljenja. Posljednjih godina zabilježava se ranija spolna zrelost i sekundarne spolne osobine, te zbog toga današnje mlade djevojke već poprimaju dimenzije odraslih žena prije nego prijašnjih godina. Maloljetničke trudnoće najčešće su neplanirane i neželjene, te kao takve zahtijevaju poseban tretman. Kao prvo, veliku važnost ima psihička priprema adolescentne trudnice, a pošto su maloljetničke trudnoće i visokorizične potreban je i visok stupanj kontrole kako bi se takva trudnoća održala. Maloljetne trudnice se dijele na tri skupine, a to su : infantilne, mlađe maloljetne trudnice i starije maloljetne trudnice. Prema podacima Svjetske zdravstvene organizacije (WHO) godišnje se porodi oko šesnaest milijuna djevojaka u dobi od 15 do 19 godina, te oko dva milijuna djevojaka mlađih od 15 godina. Tijekom posljednje tri godine u Hrvatskoj je rodilo 5237 djevojaka u dobi od 14 do 19 godina

Treatment of the pregnancy hypertensive disorders

Liječenje hipertenzivne bolesti u trudnoći uključuje antihipertenzivnu terapiju, antikonvulzivnu profilaksu, kontroliranu ekspanziju volumena (onkotsku terapiju), liječenje poremećaja koagulacije, te dovršenje trudnoće. Ciljevi antihipertenzivne terapije jesu: smanjiti povišeni periferni otpor, povećati perfuziju tkiva, uključujući uteroplacentarnu i fetalnu perfuziju, te spriječiti eklamptični napad, razvoj progresije bolesti i HELLP sindroma. Preporučljivi antihipertenzivi jesu urapidil, nifedipin, labetalol, metildopa, dihidralazin i magnezijev sulfat. Oprezno onkotsko liječenje 6% hidroksietilškrobom ili dekstranima ima za cilj poboljš nje reducirane mikroperfuzije uteroplacentarnog bazena, izovolemičnu hemodiluciju, te tromboprofilaksu. Liječenje aspirinom nije pokazalo poboljšanje u perinatalnom ishodu. Niskomolekularni heparin se profilaktički preporučuje kod teške preeklampsije, teške kronične hipertenzije, nefropatije, transplantacije bubrega i antifosfolipidnih protutijela. Liječenje zahtijeva praćenje hemodinamskog i koagulacijskog statusa, te statusa fetoplacentarne jedinice biofizikalnim profilom i doplersonografskim nadzorom.The management of preeclampsia includes antihypertensive therapy, anticonvulsant prophylaxis, controlled volume expansion (oncotic therapy), treatment of coagulation disorders and termination of pregnancy. Antihypertensives include nifedipin, urapidil, labetalol, methyldopa, dihydralazine and magnesiumsulfat. Oncotic treatment with 6% hydroxyethyl starch or dextrans is used to improve the reduced microperfusion of the uteroplacental unit, isovolemic hemodilution, and thromboprophylaxis. Aspirin therapy failed to show any perinatal outcome improvement. Low molecular heparin is recommended as prophylaxis in severe preeclampsia, severe chronic hypertension, nephropathy, kidney transplantation, and antiphospholipid antibodies. The treatment requires monitoring of the maternal hemodynamic and coagulation status, and of the fetoplacental unit status by biophysical profile and doppler sonography control

Liječenje i ishod trudnoća kompliciranih infekcijom COVID-19: deskriptivna studija jednog centra

This study aims to describe the clinical characteristics, radiological and laboratory results, therapy and outcome of pregnancies complicated by COVID-19 infection. Methodology. A retrospective descriptive study included all pregnant women with COVID-19 who gave birth in our hospital from April 2020 to January 2022. Exclusion criteria were: incomplete or unclear medical documentation, suspected COVID-19 infection without confirmation by PCR or rapid Ag test, previously diagnosed autoimmune diseases, positive history of malignant diseases, and started oxygen support in another institution before admission to our hospital. Results. Our study included 186 pregnant women who gave birth at KBC “Dr. Dragiša Mišović – Dedinje” in the mentioned period. Of these, 69 had no symptoms of COVID-19 infection, and 67 developed a milder clinical picture. In comparison, 41 pregnant women were diagnosed with bilateral pneumonia. A total of 38 pregnant women were admitted to the intensive care unit, of which 32 pregnant women needed oxygen support, 20 pregnant women were on an oxygen mask, 2 of them on a high-flow nasal canal, four pregnant women on non-invasive mechanical ventilation and six pregnant women on invasive mechanical ventilation. Of the total number of patients, 111 had a natural vaginal delivery, while 75 underwent cesarean section. Of 111 pregnant women who had a vaginal delivery, 92 (83%) received epidural analgesia, while 19 (17%) did not. Among pregnant women undergoing cesarean section, nine pregnant women (12%) received epidural anesthesia, 51 of them (68) received spinal anesthesia, while a cesarean section in 15 pregnant women (20%) was performed under general balanced anesthesia. Of 186 hospitalized and delivered pregnant women, 183 (98.4%) were discharged home in good general condition, while three (1.6%) had a fatal outcome. Conclusion. The clinical manifestations of pregnant women suffering from COVID-19 infection corresponded to the symptoms of the general population to the greatest extent. In contrast, the excessive use of antibiotics, even for asymptomatic patients, is very worrying.Ovo istraživanje ima za cilj opisati kliničke karakteristike, radiološke i laboratorijske nalaze, terapiju i ishod trudnoća kompliciranih infekcijom COVID-19. Metodologija. Retrospektivna deskriptivna studija obuhvatila je sve trudnice s COVID-19 koje su rodile u našoj bolnici od travnja 2020. do siječnja 2022. Kriteriji za isključenje bili su: nepotpuna ili nejasna medicinska dokumentacija, sumnja na infekciju COVID-19 bez potvrde PCR-om ili brzim Ag testom, prethodno dijagnosticirane autoimune bolesti, pozitivna anamneza malignih bolesti, te započeta potpora kisikom u drugoj ustanovi prije prijema u našu bolnicu. Rezultati. Našim istraživanjem obuhvaćeno je 186 trudnica koje su se u navedenom periodu porodile u KBC “Dr. Dragiša Mišović – Dedinje”. Od toga 69 nije imalo simptome infekcije COVID-19, a 67 je razvilo blažu kliničku sliku. Za usporedbu, kod 41 trudnice dijagnosticirana je obostrana upala pluća. Ukupno 38 trudnica primljeno je na jedinicu intenzivne njege, od čega su 32 trudnice trebale kisikovu potporu, 20 trudnica je bilo na kisikovoj maski, od toga 2 na visokoprotočnoj nazalnoj njezi, četiri trudnice na neinvazivnoj. mehaničkom ventilacijom i šest trudnica na invazivnoj mehaničkoj ventilaciji. Od ukupnog broja pacijentica, 111 je imalo prirodni vaginalni porod, a 75 je podvrgnuto carskom rezu. Od 111 trudnica koje su imale vaginalni porod, 92 (83%) dobile su epiduralnu analgeziju, a 19 (17%) nije. Od trudnica podvrgnutih carskom rezu, devet trudnica (12%) dobilo je epiduralnu anesteziju, njih 51 (68) spinalnu anesteziju, dok je carski rez u 15 trudnica (20%) obavljen u općoj uravnoteženoj anesteziji. Od 186 hospitaliziranih i porodilja, 183 (98,4%) otpuštene su kući u dobrom općem stanju, dok su tri (1,6%) imale smrtni ishod. Zaključak. Kliničke manifestacije trudnica oboljelih od infekcije COVID-19 u najvećoj su mjeri odgovarale simptomima opće populacije. Nasuprot tome, pretjerana uporaba antibiotika, čak i kod asimptomatskih pacijenata, vrlo je zabrinjavajuća