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Vol.21 No.3

Date: August 2012.

CONTENT:

IS THERE A NEED FOR THE INTRODUCTION OF »SCREENING« FOR CHLAMYDIA TRACHOMATIS IN WOMEN YOUNGER THAN 25 YEARS? (Vol.21 No.3, str.96-99)

Authors:

Vanja Kaliterna*, Mariano Kaliterna**, Lidija Pejković***, Zvonimir Barišić*, Željka Karin*

Original paper

Summary:
Introduction. Chlamydia trachomatis is an obligate intracellular bacterium that attacks columnar squamous epithelium of the urinary tract, reproductive tract, respiratory tract and conjunctiva. Infections caused by Chlamydia are among the most common sexually transmitted diseases. The most important problem of chlamydial infections is that they are generally asymptomatic, and they are often unrecognized and untreated. The diagnosis of Chlamydial infections is often established only when completing a detailed analysis of medical complications related to pregnancy or infertility. The recent studies suggest a need to introduce »screening« for Chlamydia for the most vulnerable populations (younger than 25 years). Some countries had already implemented the screening for Chlamydia as a standard preventive procedure. Screening a young and sexually active population under age of 25 years for C.trachomatis would identify a significant number of subjects in whom a timed treatment could prevent serious complications. The aim of this study was to determine the prevalence of C.trachomatis in women younger than 25 years in Split-Dalmatia County, and on the basis of the results to conclude whether there is a need for the introduction of »screening« for young people for Chlamydia. Patients and methods. The study involved a total of 500 women referred by their gynecologists as part of regular gynecological exam, with a request for C. trachomatis testing in the Educational Public Health Institute of Split-Dalmatia county, as a survey of general population. Endocervical samples were analyzed by molecular test Abbott Real Time CT assay (Abbott, Germany). Results. Of the total number of tested cervical samples (N = 500), 7 of them were positive for C.trachomatis (1.4%). The subjects were divided according to age. In the first group of women younger than 25 years out of total of 39 tested samples 4 (10.3%) were positive for C.trachomatis, while in the group of women older than 25 years out of total of 461 tested, only 3 (0.7%) were diagnosed with C.trachomatis infection (p<0.05). Conclusion. Our findings suggest that »screening« for C.trachomatis should be introduced in Croatia. This preventive measure should target a population of sexually active women younger than 25 years. The early identification of person positive for C. trachomatis, through routine »screening« and treatment, reduces the incidence of long-term complications.

Key words:
Chlamydia trachomatis, screening, Croatia


OVULATION STIMULATION TODAY– INDICATIONS, MEDICATIONS AND PROTOCOLS (Vol.21 No.3, str.100-105)

Authors:

Marina Šprem Goldštajn, Dinka Pavičić Baldani, Tomislav Čanić

Review

Summary:
Ovulation stimulation is one of the basic points of assisted reproduction. Choice of method, medication and stimulation protocol must be individualized, strictly aimed for that patient and based on medical findings, patient’s age, previous treatments and diagnoses of infertile couple. Different protocols are proposed for different groups of infertility and we are obliged to keep in mind guidelines by World health organisation (WHO), European society for human reproduction and embriology (ESHRE) and American society for reproductive medicine (ASRM). For appropriate individualization we must obtain thorough preparation, workup and strategy to choose a method of stimulation, which are different for amenorrhoe and anovulation (WHO I and II) group or aimed at ovulation stimulation for assisted reproductive techniques – IUI, IVF or ISCI. Aim of every individualization is acquierement of optimal number oocytes of best quality for choosen strategy and method. Supranumerous oocytes and embryos do not necessary mean better results – more pregnancies. Thereby today’s strategy is mild or minimal stimulation, less medications, less oocytes and single or double embryo transfer. In the future we anticipate new tools devised to optimize one embryo for one singleton live birth.

Key words:
ovulation induction, asisted reproduction


NON-CONTRACEPTIVE BENEFITS OF PROGESTIN-RELEASING INTRAUTERINE DEVICE (LNG-IUS) (Vol.21 No.3, str.106-111)

Authors:

Tomislav Čanić, Dinka Pavičić Baldani, Marina Šprem Goldštajn, Velimir Šimunić, Mihajlo Strelec

Review:

Summary:
The levonorgestrel-releasing intrauterine system (LNG-IUS; Mirena®) is the reversible contraceptive method with efficacy similar to that achieved with sterilization. LNG-IUS has a strong local effect on the endometrium which enables unique opportunities for treatment of variety of gynecologic conditions in symptomatic patients with or without contraceptive needs. In several countries LNG-IUS is licensed for use in menorrhagia and to provide endometrial protection to perimenopausal and postmenopausal women on estrogen replacement therapy. There are evidences which suggest that LNG-IUS may also be beneficial in women with endometriosis, adenomyosis, fibroids, endometrial hyperplasia and early stage endometrial cancer (where the patient is deemed unsuitable for primary surgical therapy). Despite numerous contraceptive and non-contraceptive benefits the use of LNG-IUS in Croatia is underestimating. This review evaluates the quality of evidence relating to the non-contraceptive therapeutic uses of LNG-IUS in gynecology..

Key words:
levonorgestrel-releasing intrauterine system, non-contraceptive benefit

 


OVARIAN RESIDUAL SYNDROME: INCIDENCE IN ZABOK GENERAL HOSPITAL (Vol.21 No.3, str.112-114)

Authors:

Tonči Visković, Rajko Fureš, Igor Maričić, Miroslav Kopjar, Mladen Zadro, Nikša Knezović, Marin Šimić, Jadanka Šanjug, Martin Gredičak

Professional papers

Summary:
Residual or retained ovary sindrome (ROS) is presenting with dyspareunia, chronic pelvic pain and adnexal masses in women who underwent hysterectomy with preservation of ovaries. Probably it is the most common iatrogenic couse of chronic pelvic pain. Incidence of this syndrome is between 0,9 and 5%. In our hospital in period between 2001. and 2005., 73 women underwent hysterectomy with ovarian presevation. Out of these 73, in 11 was diagnosed residual ovary syndrome, i.e. 14%. We explain this significant differece with the fact that data about incidence of ROS in literature dates from 1980, when laparoscopy was not so often used. Also chronic palvic pain is registered more siriously in last 20 years.

Key words:
residual/retained ovary sindrome, chronic pelvic pain, hysterectomy


BREECH DELIVERY – MODE OF DELIVERY AND EARLY NEONATAL OUTCOME (Vol.21 No.3, str.115-118)

Authors:

Marinko Marić, Oleg Petrović, Nebojša Sindik, Herman Haller

Professional paper

Summary:
A breech presentation is a presentation abnormality, in which the breech of the fetus in a longitudinal lie is the presenting part in the birth canal, whereas its head is situated in the fundus of the uterus. In 3–4% of all single pregnancies the fetus will be in breech presentation at term. Objectives. This clinical research was conducted in order to establish the existence of differences in early neonatal outcomes in newborns. Patients and methods. A total of 998 parturient/ pregnant women were monitored and gave birth of the fetus in breech presentation during the mentioned clinical research at the Clinic for Gynaecology and Obstetrics of the Clinical Hospital Centre in Rijeka, between January 1, 2000 and December 31, 2010. In order to achieve the consistency of data and results as well as the objectivity of clinical deductions, all the multiple pregnancies, all the deliveries before the 37 weeks gestation and all the late fetal deaths were excluded from the research. All parturient/pregnant women were, based on the mode of delivery, divided into three groups (vaginal birth, elective caesarean section, and urgent caesarean section). The evaluation of perinatal outcome was based on the analysis of the fetal sex, its weight, length and head circumference, Apgar score at 5 minutes after birth, admission to and length of stay in the intensive care unit, and early neonatal morbidity. All data for each of three groups were compared and statistically analyzed by the statistic data processing program Statistica 7.1 (Stat.Soft.Inc.) Results. From altogether 998 breech deliveries 595 (59,6%) were assigned to vaginal birth, 296 (29,7%) were assigned to urgent caesarean section and 107 (10.7%) to elective caesarean section. Within the selected group of 998 single pregnancies the frequency of vaginal birth was rising during eleven years of research and reached its peak in the year 2007 (74,2%). The age and the parity of women had no influence on the choice of delivery mode. Regardless the mode of delivery in cases of breech presentation – vaginal birth, urgent or elective caesarean section birth, no statistically significant differences were established regarding the perinatal outcome and early neonatal morbidity (birth trauma, frequency of reanimation procedures, neurological damages, and duration of stay in the NICU). Conclusions. No significant differences were shown in the early neonatal outcome, although newborns after elective caesarean section had best neonatal outcome. During the observation period appeared no cases of neonatal or maternal mortality in any of three analysed groups of pregnancies/deliveries.

Key words:
caesarean section. neonatal outcome, breech presentation, vaginal birth


EXTRAUTERINE PREGNANCY WITH GESTAGEN-RELEASING INTRAUTERINE DEVICE (LNG-IUS) IN SITU (Vol.21 No.3, str.119-122)

Authors:

Dinka Pavičić Baldani, Tomislav Čanić, Marina Šprem Goldštajn,Mihajlo Strelec, Velimir Šimunić

Case report

Summary:
The levonorgestrel-releasing intrauterine system (LNG-IUS, Mirena®) is one of the most effective methods of contraception, with a Pearl index of 0.1. Ectopic pregnancy rate is extremelly low with 0.02 per 100 women-years. We describe a woman, a year and half ago fitted with Mirena®, presented with a right lower abdominal pain, elevated body temperature and change in casual vaginal bleeding. Inflammatory parameters were in normal range, b-hCG level was raised at 2779,40 IU/L and a vaginal ultrasound scan showed a normal empty uterus with IUS in situ and a suspicious finding resembling right tubal pregnancy. At laparoscopy, an ectopic pregnancy in the right Fallopian tube was discovered. The LNG-US was left in situ, because indication for Mirena® use in decribed patient, abait of contraception, was treating of heavy menstrual bleedings. To our knowledge, this is a first report of extrauterine pregnancy with gestagenreleasing intrauterine device in situ in Croatia. This case illustrates an extremely rare event and a possible note of caution.

Key words:
levonorgestrel-releasing intrauterine system, ectopic pregnancy


ADDENDUM TO NEW COLPOSCOPIC CLASSIFICATION »RIO DE JANEIRO 2011« (Vol.21 No.3, str.123-126)

Authors:

Goran Grubičić

Letther to the editor


INFEKCIJE U GINEKOLOGIJI I PERINATOLOGIJI (Vol.21 No.3, str.127-129)

Authors:

Deni Karelović i suradnici

Book review

 

 

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