Date: December 2002.
FIRST TRIMESTER MICROBIOLOGY OF THE CERVIX AND THE OUTCOME OF PREGNANCIES AT HIGH RISK FOR PREMATURITY (Vol.11 No.4, str.143-149)
Authors:Snježana Škrablin, Trpimir Goluža, Ivan Kuvačić, Držislav Kalafatić, Andrea Plavec, Vesna Grajščan, Leo Žagar, Lidija Žele-Starčević, Vladimir Banović
Objective. To examine and compare the course and outcome of pregnancies with microbiologically positive versus microbiologically negative cervical smears in the first trimester of pregnancy and particularly to determine the impact of chlamydial and ureaplasma colonization on perinatal outcome. Methods. In a group of 155 pregnancies at high risk for spontaneous abortion or preterm delivery, cared for at the Department of Gynecology and Obstetrics, University of Zagreb School of Medicine, cervical swabs collected during the first trimester were microbiologically analysed. Aerobes, anaerobes, and mycoplasmas were searched for by cultivation of agents, while Chlamydia trachomatis was analysed by ligase chain reaction. Antibiotic treatment was introduced immediately after receiving the results of analysis. Pregnant women were divided in two groups, among whom the Group I consisted of 55 women with a positive microbiological result of cervical smear, and Group II consisted of 100 women with microbiologically negative results. Additionally, as no one case of other mycoplasmas but Ureaplasma urealyticum was found, the infections due to Chlamydia trachomatis and Ureaplasma urealyticum were analysed separately. Student’s t-test, Fisher exact test and chi-square test were used for statistical analysis, considering p value of <0.05 as statistically significant. Results. No difference in proportion of term deliveries and gestational age at the delivery was observed between the groups. In the Group I an increase in preterm rupture of membranes (two times) and intra-amniotic infection (p<0.006) was observed, and perinatal asphyxia and connatal infection in newborns was detected more often (18.7% Vs 2.3%, and 16.6% Vs 6.9%, respectively; p<0.001 for asphyxia). Three out of 50 liveborns in the Group I (6.0%) and 2 out of 88 liveborns in the Group II (2.3%) died early neonatally (p=n.s.). The most frequently isolated agents were Chlamydia trachomatis, isolated in 18, and Ureaplasma urealyticum in 17 pregnancies. The course of pregnancies with Chlamydia trachomatis, when compared to those with negative smear, was more frequently complicated with preterm contractions (6 out of 18 or 33,3%), mean gestational age at the delivery was 37.2 weeks, only 31% of infants were healthy (p=0.027). Neonatal death rate was 5.5%. Ureaplasma urealyticum colonization, when compared to pregnancies with sterile smear, was connected to significantly higher frequency of intra- -amniotic infection (7 out of 17 or 41%), premature rupture of membranes before term was three times more frequent (3 out of 17 or 17,6%), gestational age at the delivery was shorter (35.1 weeks), only 25% of newborns were regarded as being healthy (p=0.029). No one child died early neonatally. Conclusion. Cervical colonization with aerobes, anaerobes and both Ureaplasma urealyticum and Chlamydia trachomatis, identified during the first trimester of pregnancy, complicated the pregnancy and had impact on frequent neonatal complications, irrespective of immediate cure.
first trimester cervical colonisation, Chlamydia trachomatis, Ureaplasma urealyticum, perinatal outcome
HUMAN PAPILLOMAVIRUS (HPV) INFECTION OF UTERINE CERVIX IN POŽEGA REGION (Vol.11 No.4, str.150-158)
Damir Hodžić, Rastislav Navratil, Renata Rališ, Damir Eljuga
Objective. The prevalence of HPV infection is unknown, but HPV infection, as most common sexually transmitted disease, occurs in 20–40% sexually active women. It is the fact that HPV, up to now, cannot be completely eradicated by any known therapy. According to recent literature reports, the HPV infection obviously correlates with developing of cervical cancer. Knowing these facts, the importance of the prevention of infections of lower genital tract is easily understandable as well as proper treatment. Methods. Between May 2001 and May 2002 at Gynecological Polyclinic of Po`ega County General Hospital 66 women with HPV suspect Pap smear or with chronic and peristent inflammation of lower genital tract were treated. In all of them endocervical smear for microbiological analysis was taken, as well as endocervical cyto-brush for HPV DNA identification by PCR method. Results. From all 66 patients, 37 (56.06%) were HPV positive. In 19 (51.35%) of them HPV-16 was found, in 15 (40.54%) there was HPV of undetermined type, in 2 (5.41%) HPV-33, and in 1 (2.70%) HPV-6. Among all patients, only in 15 (22.73%) of them no microbiological agent was isolated; out of these, 11 (73.33%) were HPV positive. All other patients with proven infection of lower genital tract were specifically treated with antibiotics. Recurrent infection occurred in 3 (5.88%) patients, and treatment was repeated with other suitable antibiotics. Nulliparae were 24 (36.36%), out of which 16 (66.67%) were HPV positive. The youngest patient was 19, and the oldest 75 years old. In the group to 19 years old there were 2 patients and 1 (50.00%) was HPV positive. In the 20–29 years old group there were 26 patients, out of them 15 (57.69%) were HPV positive. In the 30–39 years old group there were 22 patients, out of them 13 (59.09%) were HPV positive. In the 40–49 years old group there were 10 patients, out of them 5 (50.00%) were HPV positive. In the group 50 and older, there were 6 patients, out of them 3 (50.00%) were HPV positive. Conclusion. The detection and a treatment of cervico-vaginal infections, especially of those with HPV, may prevent the development of the neoplasia of uterine cervix.
HPV typing, female genital infection, cervical cancer prevention
DELIVERIES AFTER PREVIOUS CESAREAN SECTION (Vol.11 No.4, str.159-162)
Željko Mladinić, Tibor Toth, Alen Šelović, Marija Hiđa-Čohar, Vladimir Bartoš
Research results of deliveries performed by cesarean section during the period of 1991 to 2000 are presented in this study. Out of a total of 10,750 deliveries, 806 (7.5%) were performed by cesarean section. Out of a total of 387 parturients who had undergone a previous cesarean section, 178 (46%) deliveries were vaginal and 209 (54%) were performed by a repeated cesarean section. Indications for a repeated cesarean section were: 79 (37.8%) elective, 35 (16.7%) uterine inertia, 21 (10%) possible fetal asphyxia and 15 (7.2%) small pelvis. After a previous cesarean section, 146 (82%) parturients had vaginal delivery for the first time, 24 (13.5%) for the second, 7 (3.9%) for the third time and 1 (0.6%) for the fifth time. Manual uterine exploration was done 51 (28.7%) times, placental lysis 4 (2.2%) times and vacuum extraction 16 (9%) times. For the parturients who had undergone a repeated cesarean section mean hospitalization time was 10.3 days and for those who had vaginal delivery after cesarean section it was 4.3 days. During pregnancy 15.9% women were examined twice, 28.8% 3 to 5 times, 11.6% 6 to 8 times and 22.8% more than 9 times. Mean ultrasonographic examination per woman was 3.6 times. 55.8% parturients gained weight up to 13 kg, 34.6% up to 14 to 20 kg and 9.6% more than 20 kg. The tendency of increase in the total number of cesarean sections is shown in our study.
cesarean section, indications
CURE OF TOTAL UTEROVAGINAL AND PARTIAL RECTAL PROLAPSE(Vol.11 No.4, str.163-164)
The aim. A successful operative therapy of an old woman with total uterovaginal eversion and rectal mucous membrane prolapse is presented. Methods and results. An 82-year old woman was admitted because of low abdominal pains and relative urine and stool retention caused by uterovaginal and rectal mucous membrane prolapse. The uterovaginal total prolapse was successfully operated by Neugebauer LeFort procedure and the Kelly’s suture. The treatment of the rectal mucous membrane prolapse involved the performance of pararectal tissue sutures, levatororaphy, and kolpoperineoplasty. The polypropylene mash was also used to correct the rectovaginal septum rupture and to support the rectum itself. Conclusion. The highly successful operation was performed under local anesthesia because the humpbacked patient was an onld person suffering of asthenia.
uterovaginal total prolapse, rectal prolapse, operative therapy
Dr. DRAGO OREŠIĆ(Vol.11 No.4, str.165-165)
Dr. FRANKA RUŽIĆ(Vol.11 No.4, str.166-166)
M. LAZAREVSKI: BIOMEHANIKA GENITALNOG PROLAPSA I URINARNA STRES INKONTINENCIJA(Vol.11 No.4, str.167-167)