Date: January 2011.
PERINATAL FACTORS AND DEVELOPMENTAL DISPLACEMENT OF THE HIP (Vol.20 No.1, str.1-5)
Jadranko Šegregur*, Kornelija Koši-Šantić **, Zlatko Hrgović***
Objective. The aim of this study was to evaluate the relationship of perinatal factors and developmental displacement of the hip in our setting. Methods. The study inculuded 140 mothers and children with developmental displacement of the hip and 420 mothers and healthy children, as a control group. Ultrasound was applied with a 6.2 MHz linear scanner and results were classified according to Graf. The following factors were analyzed: age and maternal parity, complications in pregnancy, during and after delivery, fetal posture, type of delivery, gestational age, newborn sex, birth weight, birth length, ponderal index, Apgar score and neonatal complications. ANOVA, Chi-square and Student t-test were used for statistical analysis. Results. From a total 2511 newborns, 140 (6.9%) children were diagnosed with developmental displacement of the hip, which incidence where significantly higher in females (72.9%), in breech presentation (10.7%), cesarean section (25.7 %), higher maternal age and parity, birth weight >4000 g, ponderal index >2.85 and bilateral (49.3%) cases. Conclusion. Female sex, breech presentation, high birthweight and ponderal index were confirmed as risk factors for developmental displacement of the hip, which connects to intrauterine mechanical and hormonal risk factors.
perinatal factors, developmental displacement of the hip, ultrasound
OUT-OF-HOSPITAL MATERNITIES Medically survived or useful? (Vol.20 No.1, str.6-15)
Ante Dražančić,* Urelija Rodin**
Through 10-years period 2000–2009, the fetal, early neonatal and perinatal mortality in six out-of-hospital maternities of Republic of Croatia are analyzed. All stillborns and early neonatally (0–6 days) died infants, registered on the Perinatal Death Certificate were analyzed with regard to gestational age, birth weight and length, maternal disease and a day of life succombed infant. During the 10 years period in six out-of-hospital maternities were born 13023 infants with a birth weight ³500 grams resp. ³22 weeks of pregnancy. Alltogether were 9 stillborns (0.64‰) and 9 (0.69‰) early neonatally died infants, the perinatal mortality was 1.38‰. Ten years avarage perinatal mortality (for international comparison, infants ³1000 grams) was 4,4 times lower than overall perinatal mortality in the country (6.05‰); the mortality for national comparison (infants ³500 grams) was 6.4 times lower than overall mortality in the country (8.85‰). The incidence all of pre-term births (22–36 wks) during 10 years period was 0.94%, of infants with 22–27 wks was 0.04%, of those 27–31 weeks 0.02% and of those with 32–36 weeks 0.88%, manyfold significantly lower than overall values. The data demonstrate that the out-of-hospital maternities have successfuly accomplished its duty in the modern regional organization of perinatal care, i.e. the screening of pregnancies/fetuses and their sending to the higher level hospitals.
out-of-hospital maternities, small maternities, perinatal mortality, pre-term childbirths
SUSPECTED APPENDICITIS DURING PREGNANCY: PREVALENCE AND MANAGEMENT (Vol.20 No.1, str.16-20)
Hasan S. Dahamsheh
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.
PHARMACOLOGICAL COST-BENEFIT ANALYSIS OF VACCINATION OF ADOLESCENTS BY CERVARIX (Vol.20 No.1, str.21-29)
Ante Ćorušić*, Magdalena Karadža*, Pavo Planinić*, Lana Škrgatić,* Dragana Ljubojević-Grgec**, Josip Juras,* Jozo Blajić*
Cervical carcinoma is the second most fequent female carcinoma in the world. In Croatia it took the 8th place. Cervical intraepithelial neoplasms and cervical carcinoma are related to permanent infection caused by high oncogenic type of HPV. The cost of treatment and therapy depends on grade of disease. In multinational double blinded randomised studies Cervarix vaccine has demonstrated its high efficiency in production of circulating serum antibodies, and the decrement of prevalence of HPV infection, preinvasive lesions and cervical carcinoma when applied in sexually not active adolescents. Cervarix vaccine also decreases the prevalence of permanent infections caused by HPV in sexually active women. Using mathematical models and considering high vaccine efficiency, it is predicted decrease of morbidity and mortality due to cervical carcinoma by 60–75%. When direct and indirect costs of therapy of cervical carcinoma and life quality were compared to cost of vaccination by Cervarix, it could be saved more than 50 milions of kunas in Croatia annually.
uterine cervix dysplasias, prophylaxis, vaccination
MULTI-MODAL ANALGESIA AFTER HYSTERECTOMY AND ADNEXECTOMY (Vol.20 No.1, str.30-33)
Renata Marohnić, Dunja Anzulović, Sandra Fudurić, Slobodan Mihaljević, Jozo Blajić, Ljiljana Mihaljević
Postoperative pain is the most common form of an acute pain and inadequate analgesia can lead to numerous complications. Our goal was to compare two different methods of analgesia by multimodal approach and to optimize pain control in both groups. During the first operative day, 50 randomly chosen patients undergoing abdominal hysterectomy with bilateral adnexectomy were analyzed. According to the American Society of Anesthesiologists (ASA) they were classified to Class I-III. In the first group of 25 patients, metamizol and tramadol were administered in continuous intravenous infusion and in the second group of 25 patients ketoprofen and tramadol were administered. Pain was registered during the first, third, sixth and ninth postoperative hour using visual analogue scale (VAS). In both groups the adequate level of analgesia was achieved, although the patients in the second group have reached moderate level of pain earlier than the second group did. Therefore, as the non-steriod antiiflammatory drug adjuvant to opioid drug we prefer ketoprofen to metamizole.
postoperative pain, multimodal analgesia, VAS
DAVYDOV’S LAPAROSCOPY ASSISTED NEOVAGINOPLASTY (Vol.20 No.1, str.35-39)
Dubravko Habek, Boris Ujević, Tatjana Pavelić Turudić, Renato Bauman, Gordana Horvat, Ingrid Marton
Presentation is made of three cases of the Mayer-von Rokitansky-Küster-Hauser syndrome, operated after complete work-up by the laparoscopy assisted method of neovaginoplasty according to Davydov. In all three cases, the postoperative course was uneventful, with satisfactory cosmetic effect, functional cohabitation and sexual satisfaction in both partners, as the main goals of neovagina creation.
Ključne riječKey words:
Syndroma Mayer-von Rokitansky-Küster-Hauser, neovaginoplasty, Davydov, laparoscopy
SIRENOMELIA AND CAUDAL REGRESSION SYNDROME – THE RARE CONGENITAL ANOMALIES (Vol.20 No.1, str.40-43)
Žana Žegarac,* Željko Duić,* Jasenka Zmijanac Partl,* Sandra Stasenko,* Danka Mirić-Tešanić,* Ivan Fistonić**
Sirenomelia and caudal regression syndrome present a rare congenital malformation. Although sirenomelia was thought to be severe type of the caudal regression syndrome in the previous years, it is known today that the sirenomelia and the caudal regression syndrome are, in fact, two mutually diverse states. Both states appear during the early embryogenic development of the fetus due to the different pathogenic mechanisms. The sirenomelia is considered to appear due to the vascular steal theory, whereas the caudal regression syndrome appears due to the disorder of the mesoderm differentiation. The sirenomelia and caudal regression syndrome come into existence in the early embryologic development of the fetus during the fourth postconceptional week at the period of gastrulation. The two reported case studies show the distinction between the pathogenesis, as well as the associated anomalies based upon the antenatally diagnosed malformations. The antenatal diagnostics and prognosis are discussed, especially emphasizing the antenatal screening of the malformations which enables the early diagnosis, as well as the indications for the early and less traumatic pregnancy termination.
sirenomelia, caudal regresion syndrome, congenital malformations
DIGOXIN AND AMIODARON IN FETAL SUSTAINED SUPRAVENTRICULAR TACHYCARDIA AND NONIMMUNE HYDROPS (Vol.20 No.1, str.44-47)
Vesna Sokol,** Josip Juras,* Ivan Malčić,*** Jozo Blajić,** Marina Ivanišević**
Supraventricular tachycardia is the most common and clinically significant form of sustained fetal tachyarrhythmia in pregnancy; depending on duration and high rate variability heart failure and nonimmune hydrops may develop which are associated with a high incidence of perinatal mortality. Doppler/echo diagnosis is usually accidental during second and third trimester of pregnancy. Therapeutic goals are cardioconversion to sinus rhythm and recovery of heart failure. We present a case of fetal supraventricualr tachycardia diagnosed at 29 weeks of gestation with nonimmune hydrops. Treatment with digoxin and amiodarone was successful. The heart rate restored to sinus rhythm and nonimmune hydrops resolved within three weeks of treatment. Therapy with two drugs that act synergistically may be more efficient than monotherapy in blocking likely atrio-ventricular reentry mechanism by accessory pathway in sustained supraventricular tachycardia, thus allowing resolution of hydrops with favorable management outcome.
fetalus, tachycardia supraventricular, fetal hydrops, digoxin, amiodarone
More about Tubal Carcinoma (Vol.20 No.1, str.48-52)
Letter to the editor