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Vol.24 No.1

Date: January 2015.

CONTENT:

EFFICACY OF SLING AND MESH PROCEDURES FOR STRESS URINARY INCONTINENCE AND PELVIC FLOOR REPAIR IN FEMALES (Vol.24 No.1, p.1-8)

Authors:

Damir Hodžić, Tomislav Župić, Irina Jurić, Željko Štajcer, Vjekoslav Mandić, Slavko Orešković

Original Paper

Summary:

Stress urinary incontinence (SUI) and pelvic organ prolapse occur as a common problem, especially in postmenopausal women. The aim of this study was to determine the effi cacy and surgical outcome of the sling procedures in stress incontinent women in comparison to conventional anterior colporrhaphy, as well as the Apogee procedure in women with rectocele or enterocele in comparison to conventional posterior colporrhaphy. A total of 56 patients with SUI were treated with sling procedure between November 2011 and March 2013, including 39/56 (69.6%) with suprapubic arc (SPARC) and 17/56 (30.4%) with MiniArc method. During the same period, a total of 49 patients with SUI were treated with traditional anterior colporrhaphy according to Bagović method as the control group. In the period from January 2008 to December 2011, the study also included a total of 126 respondents with a central and posterior vaginal wall compartment defect of the vagina, divided into two groups according to surgical technique of treatment (Apogee and colporrhaphy). The research was entirely conducted at University of Zagreb, School of Medicine, Clinical Department of Gynecology and Obstetrics, Department of Gynecologic Surgery and Urology. The objective cure rate at follow
up was 92.9% (52/56) in the observed group of patients and 79.6% (39/49) in the control group; improvement was recorded in the remaining 5.4% (3/56) and 18.4% (9/49) of patients, respectively (p<0.05). The overall complication rate was signifi cantly lower in the observed group of patients than in the control group, i.e. 12.5% (7/56) vs. 28.6% (14/49),
(p<0.05). A slightly higher rate of urinary incontinence was found postoperatively in the sling group, while the rate of urinary retention was greater in the colporrhaphy group. Surgical procedure failed in only one patient from each group; they required additional correction for SUI. The mean operating time for SPARC and MiniArc procedure was 19±7 and
9±5 minutes, respectively (p<0.0001). The mean length of hospital stay was signifi cantly shorter in the sling group (2.6±1.0, range 2–7 days) than in the control group of (9.6±1.8, range 6–18 days; p<0.001<0.0001). The results showed the polypropylene sling and mesh surgery to be minimally invasive, with a low recurrence rate and signifi cantly improving
the patient quality of life.
 
Key words:
 
females, stress urinary incontinence, sling, pelvic fl oor repair, Apogee

 


ACCURACY OF FETAL WEIGHT ULTRASOUND ASSESSMENT IN TERM PREGNANCIES (Vol.24 No.1, p.9-13)

Authors:

Katja Erjavec, Ratko Matijević

Original scientific paper

Summary:

Fetal weight assessment is of great value for appropriate management of advanced pregnancies. Ultrasound assessment is considered the most accurate and often used method, but it is still unclear which of the many formulas used for ultrasound assessment is best and most accurate. The aim of this study was to determine whether there is a signifi cant difference between birth weight and fetal weight assessed using the ultrasound and two different formulas; Hadlock II and Campbell Wilkin. We also sough to recognise determinants that enable more accurate
fetal weight assessment as well as the determinants that disenable it. Methods. A prospective study was conducted at Clinical Hospital ”Sveti Duh” in Zagreb from December 2013 until March 2014. The study included 342 pregnant women who gave birth and who had fetal weight ultrasound assessment done within three days prior to delivery. The difference between actual and estimated fetal weight was tested using Wilcoxon Matched Pairs Test. Logistic regression analysis was performed to analyse the correlation between birth weight and the determinants that infl uence the accuracy of fetal weight ultrasound assessment. Results. There is no signifi cant difference between birth weight and fetal weight assessed using Hadlock II formula, while a signifi cant difference exists when Campbell Wilkin formula in used. Also, fetal weight assessment is less accurate when used for extreme values of fetal weight. Conclusion. Fetal weight ultrasound assessment using Hadlock II formula is an accurate and reliable method and should be used routinely in everyday clinical practice, while Campbell Wilkin formula should be used with caution. Also, clinicians should be aware of the limited values of fetal weight assessment when dealing with extreme values of fetal weight.

Key words:

ultrasound, fetal weight assessment, Hadlock II, Campbell Wilkin

 


CEREBRO-PLACENTAL RATIO IN PREGNANCIES WITH PREECLAMSIA AND INTRAUTERINE GROWTH RESTRICTION (Vol.24 No.1, p.14-18)

Authors:

Gordana Grgić, Gordana Bogdanović, Igor Hudić, Elvira Brkičević, Ismihana Hadžipašić

Original scientific paper

Summary:

Fetal CPR (cerebro-placental ratio) hemodynamic ratio obtained by semi quantitative analysis of vascular resistance in the middle cerebral artery (MCA) and the umbilical artery (UA) is a reliable parameter in the evaluation of fetal condition. The aim was to: 1. Determinate the mean resistance index of UA and MCA in pregnant women with preeclampsia and intrauterine growth restriction (IUGR). 2. Determinate the mean CPR in pregnant women with preeclampsia and IUGR. 3. Determinate the mean Apgar score at fi rst and fi fth minute in pregnant women with preeclampsia and IUGR. 4. Correlate the value of RI umbilical artery, CPR and Apgar score at fi rst and fi fth minute. 5. What is the more common method of labor in pregnant women with preeclampsia and IUGR? Patients and methods: One hundred singlton pregnancies from 28 to 40 gestational weeks were included in the study. Fifthy pregnancies with a diagnosis preeclampsia (control group) and fi fthy pregnancies with ultrasound diagnosis of fetal growth restriction (experimental group) and preeclampsia have been prospectively evaluated. Results: RI of UA shows statistical differences between control and experimental group (p<0,0001)., RI of MCA is signifi cantly smaller in control group, CPR is signifi cantly
smaller in experimental group. Preterm labor is 9, 33 more often in the experimental group than in the control group. Vaginal labor is more often in control group. The chance for vaginal labor 8, 81 is more often in control group. Apgar score after fi rst and fi fth minute in the experimental group was signifi cantly lower than in the control group. CPR ratio in the experimental group signifi cantly correlates with Apgar score at the fi rst and fi fth minute. Conclusions: 1. The  index of resistance in the UA is higher in pregnant women with preeclampsia and IUGR compared to pregnant women who have only preeclampsia, while the index of resistance of MCA is higher in the group of women who developed preeclampsia only. 2. CPR was lower in the group of pregnant women with preeclampsia and IUGR also. 3. Apgar score after the fi rst and fi fth minute was lower in the group of pregnant women that have both preeclampsia and IUGR. 4. In the group of women with preeclampsia and IUGR increase of CPR leads to an increase Apgar score of newborns. 5. Vaginal labor is more common in the control group, while the C-section is more common in the experimental group.

Key words:

cerebro-placental ratio, preeclamsia, intrauterine growth retardation

 


CAUSES AND TREATMENT OF HABITUAL ABORTION (Vol.24 No.1, p.19-30)

Authors:

Josip Đelmiš, Vesna Sokol, Marina Ivanišević, Slavko Orešković, Mislav Herman, Josip Juras

Review article

Summary:

Spontaneous abortion is undesired pregnancy loss of a fetus weighing less than 500 g before the 22nd week of gestation, classifi ed into sporadic and recurrent according to its occurrence. In case of two or more consecutive pregnancy losses, it is referred to as habitual abortion. Habitual abortions cause a serious problem in women who fail to carry their pregnancies to the term necessary for the fetus to survive. Habitual abortions generally occur in the same period of gestation. There are numerous causes of habitual abortions, including genetic factors, uterine anomalies, thrombophilias, endocrinopathies (corpus luteum insuffi ciency, diabetes mellitus, thyroid diseases, etc.), immune disorders, male factor, and environmental factors. The basic clinical workup in couples with a history of habitual abortion includes thorough personal and family history, maternal complete blood count and thyroid function tests, laboratory
testing for antiphospholipid antibodies and gynecologic examination, and karyotyping in both partners. Habitual abortions are recorded in 1% of reproductive couples, while the cause of miscarriage remains unknown in about 50% of cases. In case of identifi ed pathology, treatment is only possible in the group of non-genetic etiology. This review article presents current diagnostic options to identify the cause and to treat patients with habitual abortions.

Key words:

habitual abortion, cause, treatment

 


DIETARY EFFECT ON C-PEPTIDE PRESERVATION IN TYPE 1 DIABETIC PREGNANT WOMEN (Vol.24 No.1, p.31-36)

Authors:

Josip Đelmiš, Erden Radončić, Marina Horvatiček, Marina Ivanišević

Review article

Summary:

Insulin is the main hormone in the regulation of glucose metabolism. Insulin is synthesized in the Langerhans islet β-cells as the proinsulin precursor, from which C-peptide and insulin are formed by proteolytic cleavage. In patients with type 1 diabetes mellitus (DM-1), complex interplay of genetic, exogenous and autonomic factors leads to selective destruction of pancreatic β-cells, thus compromising insulin synthesis and secretion. Patients with DM-1 can produce exogenous insulin to a certain extent, however, insulin secretion undergoes gradual reduction due to selective destruction of β-cell function. Both C-peptide and insulin are secreted to portal circulation in equimolar amounts. There is an association of elevated C-peptide concentration with great reduction of hypoglycemic episodes, HbA1c values and microvascular complications. Studies have demonstrated that vitamins D and E, nicotinamide and polyunsaturated fatty
acids (omega-3 fatty acids) may have protective effects in DM-1. Our investigations showed C-peptide to increase in both healthy and DM-1 pregnant women. This review article describes the impact of pregnancy and diet on β-cell function
in women with DM-1.

Key words:

pregnancy, type 1 diabetes mellitus, C-peptide, nicotinamide, omega-3 fatty acids, vitamins D and E

 


”THREE RINGS VULVOSCOPY” – A NEW APPROACH TO THE VULVA (Vol.2 No.1, p.37-45)

Authors:

Vesna Harni, Damir Babic, Dubravko Barisic

Professional paper

Summary:

Objective. To test a new approach to vulvar discomfort adapted to vulvar anatomy and specifi city of vulvar lesions. Methods. In a retrospective observational study, we analyzed the results of the original vulvoscopy technique called ”Three Rings Vulvoscopy”, in a total of 216 gynecological patients with or without vulvar discomfort, in which colposcopic changes of the vulva were documented according to their specifi city and localization using ISSVD Vulvodynia Pattern Questionnaire. Results. Analysis of vulvoscopy results revealed four groups of respondents: asymptomatic patients without vulvoscopy fi ndings and asymptomatic patients with non–specifi c lesions; symptomatic patients with non–specifi c lesions and symptomatic patients with specifi c vulvoscopy fi ndings. Absence of any vulvar complaints and vulvoscopy fi ndings in all three vulvar rings were found in the patients with a ”normal vulva”. Vulvar discomfort with a signifi cantly frequent presence of both, specifi c and non–specifi c lesions, in all three vulvar rings were found in the patients with ”vulvar dermatosis”. Absence of specifi c lesions in any of the vulvar rings and a signifi cantly higher incidence of non–specifi c lesions in the inner vulvar ring (non–relevant to the diagnosis of vulvodynia), were common
characteristics of patients with vulvodynia and impaired vulvar skin. The fundamental difference between these subjects was the presence of vulvar complaints in patients with vulvodynia. There weren’t diagnosed symptomatic patients without any vulvoscopy lesion in all three vulvar rings or asymptomatic patients with specifi c lesion in any of the vulvar rings. Conclusion. ”Three Rings Vulvoscopy”, with the assessment of the specifi city of vulvar lesions, seems to be promising in the differential diagnosis of vulvar discomfort. The new vulvoscopy technique is being proposed in order to encourage others to adopt it and prove it in clinical practice.

Key words:

vulvoscopy; three vulvar rings; vulvar diseases; vulvar dermatosis; vulvodynia; impaired vulvar skin

 


CASE REPORT: EMERGENCY CESAREAN SECTION IN A PARTURIENT WITH TUBEROUS SCLEROSIS AND THREATENING RETROPERITONEAL HEMORRHAGE (Vol.24 No.1, p.46-48)

Authors:

Slobodan Mihaljević, Vlatka Marijić, Ivan Vasilj, Marko Ćaćić

Case report

Summary:

Tuberous sclerosis is a autosomal-dominant multisystem genetic disorder characterised by the growth of benign tumors called hamartomas throughout the body. It is most commonly presented by epileptic seizures, possibly combined with mental retardation, cutaneous angiofi bromas, renal, cardiac and pulmonary involvement. We present a case of anesthesia procedure for an emergency cesarean section and unilateral nephrectomy performed in a 32 year old parutient with tuberous sclerosis and threatening retroperitoneal hemorrhage.

Key words:

emergency cesarean section tuberous sclerosis retroperitoneal hemorrhage

 

 

Mjesto održavanja kongresa: Hotel President****, Split, Starčevićeva 1, www.hotelpresident.hr/split
Vrijeme održavanja kongresa: 22.- 24. listopad 2015.