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Vol.20 No.4

Date: October 2011.

CONTENT:

GYNAECOLOGIA ET PERINATOLOGIA 50 years of the journal for gynaecology, obstetrics, neonatology, reproductive medicine and ultrasonic diagnostics (Vol.20 No.4, str.171-178)

Authors:

Ante Dražančić, Josip Đelmiš

Review

Summary:
The 50-years development of medicine publishing from the field of gynaecology and perinatology as well of ultrasonic diagnostics, in the years 1961–2010 in the journals »Ginekologija i opstetricija«, »Jugoslavenska ginekologija i opstetricija«, »Jugoslavenska ginekologija i perinatologija« and since 1992. in the journal »Gynaecologia et Perinatologia « is presented. In relation to single periods the names of editors-in-chief, of the members of editorial boards resp. of journal’s councils are designed. Alltogether through 50 years are printed 172 issues (+ 24 suplements), 1872 scientific or professional articles resp. reviews on 12.307 pages; during the last 19 years, since 1992, the 646 papers are printed on 3848 pages. To published scientific/professional articles/reviews, the 43 books reviews and 153 different reports from national and foreign meetings, social happenings, instructions to practice etc, have to be added. The papers published in 24 proceedings of congresses, conferences etc in this publication are not included.

Key words:
medicine publishing, history of medicine, gynaecology, obstetrics, neonatology, reproductive medicine, urogynaecology, oncology, ultrasonic diagnostics


THE INFLUENCE OF PREPREGNANCY WEIGHT AND WEIGHT GAIN DURING PREGNANCY ON PERINATAL OUTCOME (Vol.20 No.4, str.179-186)

Authors:

Josip Juras, Marina Ivanišević, Jozo Blajić, Danko Bljajić, Vito Starčević, Josip Đelmiš

Original paper

Summary:
Overweight and obese women develop gestational diabetes mellitus and hypertensive disorders during pregnancy more often, having worse perinatal outcome. Greater weight gain during pregnancy independently contributes to adverse perinatal outcome. The aim of this study was to explore the size of influence of prepregnancy body mass index and weight gain during pregnancy on perinatal outcome in healthy and diabetic pregnant women. During a period of ten years starting from 2000, 3741 pregnancies were analyzed in Department of obstetrics and gynecology at University hospital centre Zagreb. Women were classified according to their diagnosis and prepregnancy BMI. The worst perinatal outcome had diabetic women with BMI ³25 kg/m2. The aforementioned women had neonates with greater birth weight. They also had macrosomic infants and cesarean more often as well as preterm delivery. The complications of children such as congenital malformations, hyperbilirubinemia and perinatal asphyxia were also more often in diabetic group of patients with BMI ³25 kg/m2. Body mass index and weight gain during pregnancy have independent but cumulative effect on perinatal outcome. Overweight and obese women should lower their prepregnancy weight or follow the guidelines for weight gain during pregnancy in case of failure. This way the adverse influence of greater prepregnancy body mass index and weight gain on perinatal outcome could be reduced.

Key words:
obesity, weight gain, gestational diabetes mellitus, perinatal outcome


NEONATAL OUTCOMES IN PREGNANCIES COMPLICATED BY GESTATIONAL DIABETES MELLITUS (Vol.20 No.4, str.187-191)

Authors:

Marcela Ilijić Krpan, Emilja Juretić, Josip Juras, Vesna Vukelić, Dunja Anzulović, Iva Kulić, Iva Rukavina, Katarina Čima

Original paper

Summary:
High maternal blood glucose levels in pregnancies complicated by gestational diabetes mellitus are associated with a higher risk of accelerated fetal growth, cesarean delivery, birth trauma, asphyxia, low blood glucose levels and other biochemical and physiologic abnormalities in the newborn. Maternal management includes nutritional therapy but may require insulin or oral hypoglycemic drug. Objective. To determine the impact of maternal gestational diabetes on neonatal complications when compared with non-diabetic controls. To compare neonatal outcomes in diet-controlled gestational diabetes mellitus pregnancies (GDM A1) with neonatal outcomes in insulin-controlled gestational diabetes mellitus pregnancies (GDM A2). Methods. We retrospectively analyzed GDM pregnancies in our perinatal center during a 10-year period and compared these data with a similar number of non-diabetic pregnancies. A total of 3396 newborns from singleton pregnancies were included in the study. There were 1583 pregnancies complicated by gestational diabetes. The pregnancies were divided into two groups based on treatment and neonatal outcomes. Variables analyzed in newborns were: preterm birth, cesarean delivery rate, macrosomia, Apgar scores, birth injury, hypoglycemia, respiratory problems, perinatal infection, hyperbilirubinemia, and congenital anomalies. Results. GDM neonates compared with control are more often born preterm, macrosomic, large for gestational age (LGA), by cesarean section and with lower 1 Min. Apgar score. Neonatal hypoglycemia, hyperbilirubinemia, respiratory problems and congenital anomalies occurred more commonly in GDM infants. The incidence of birth trauma and infection did not differ between the two groups. GDM A2 neonates compared to GDM A1 are more often premature, LGA, delivered by cesarean section, with lower 1 Min. Apgar score. The incidence of neonatal hypoglycemia, hyperbilirubinemia, respiratory problems, and congenital anomalies as well as birth trauma and infection did not differ between the two groups. Conclusions. The risk of adverse neonatal outcomes is significant in pregnancies complicated by GDM and associated with the level of maternal glucose impairment. Therefore, strict glycemic control during pregnancy and special obstetric and pediatric management is important. Although the established diagnosis and treatment did not prevent neonatal complications in our study, the perinatal mortality was not increased. Modified screening strategies as well as diagnostic tests and even more strict blood sugar control may possibly further improve the neonatal outcomes.

Key words:
gestational diabetes mellitus, newborn, complications


NEW OPTIONS IN COMBINED HORMONAL CONTRACEPTION (Vol.20 No.4, str.192-200)

Authors:

Dinka Pavičić Baldani, Velimir Šimunić, Marina Šprem Goldštajn, Tomislav Čanić, Lana Škrgatić

Review:

Summary:
Although a variety of contraceptive options are available, the rate of unintended pregnancies in Croatia remains unacceptably high. Newer hormonal contraceptive options afford women more choices, less risks and better acceptance, which, we hope, will reduce the rate of unintended pregnancies. Health care providers need to be informed about these newer options, as all women requesting hormonal contraceptives need to be offered individual treatment. This article reviews the newest developments in the field of hormonal contraception.

Key words:
hormonal contraception, estrogen component, progestin component, regimens, mode of application


LAPAROSKOPSKA DISEKCIJA SAKROUTERINIH LIGAMENATA U LIJEČENJU KRONIČNOG BOLA U ZDJELICI: PREGLED I PRIKAZ TRI SLUČAJA (Vol.20 No.4, str.201-205)

Authors:

Tonči Visković, Rajko Fureš, Igor Maričić, Miroslav Kopjar, Mladen Zadro, Martina Bračun, Martin Gredičak

Review

Summary:
Approximately 10–15% of women in reproductive age have chronic pelvic pain of more than a year duration. The American College of Obstetricians and Gynecologists (ACOG,2004) defines chronic pelvic pain as pain of at least six months duration that appears in the pelvis and is serious enough to cause disability or lead to medical care. Although it is not known how, after 4–6 months duration pain itself can become an illnes. In other words, in such patients chronic pain is a disease, not a symptom. Endometriosis and pelvic inflammatory disease are the most common gynecological causes of chronic pelvic pain. Treatment for chronic pelvic pain depends on the underlying cause, severity of symptoms, the extent and location of disease, the wish for pregnancy, and the age of the patient. Conservative medical treatments for chronic pelvic pain include non-steroidal anti-inflammatory drugs and oral contraceptives. Surgery involves excision of endometriotic implants and removal of associated adhesions. Hysterectomy may be considered for patients with severe symptoms that do not respond to conservative treatment. The use of neuroablative procedures have been investigated for the treatment of chronic pelvic pain. Neurolytic therapies may be done by surgical transection or excision of nerves, injection of neurotoxic chemicals, or the use of energy sufficient to destroy neural tissue (heat, cold, laser). The most common of nerve transection procedures are laparoscopic uterosacral nerve ablation (LUNA) and presacral neurectomy (PSN). Laparoscopic uterosacral nerve ablation involves the destruction of the uterine nerve fibers that exit the uterus through the uterosacral ligaments. Presacral neurectomy refers to the interruption of the sympathetic inervation of the uterus at the level of the superior hypogastric plexus. Presacral neurectomy is technically more challenging than dissection of sacrouterine ligaments because of the presence of large vessels and the ureters near the field od dissection. In this paper we present our three cases of dissection of sacrouterine ligaments in treatment of the patients with chronic pelvic pain.

Key words:
chronic pelvic pain, dissection of sacrouterine ligaments, neuroablation


PREECLAMPSIA IN GRAVIDAS OLDER THAN 35 YEARS (Vol.20 No.4, str.206-210 )

Authors:

Marko Vulić, Damir Roje,Zoran Meštrović, Tomislav Strinić, Ivica Stipić, Marica Vladilo

Professional paper

Summary:
Objective. To compare perinatal outcome in gravida older than 35 years with and without preeclampsia. Materials and methods. We conducted a case control study that included 626 women older than 35 years who delivered in the University Hospital Split between 01. 01.–31. 12. 2007. Information was taken from the maternal delivery records. Out of 626 women, 48 had and 578 had not preeclampsia. Investigated variables were weeks of delivery, birth weight, Apgar score, parity and mode of delivery. For statistical analysis we used Chi square and Student T-test. Significance of differences was accepted at p<0,05. Results. In gravida older than 35 years with preeclampsia there were increased prevalence of preterm deliveries (Chi=11.486; p=<0.05), SGA (Chi=12.289; p<0.05) and LBW babies (Chi=19.635; p<0.05). Nuliparity was associated with occurence of preeclampsia in those gravida (Chi=7.984; p<0.050). Prevalence of Cesarean section was increased in study group (Chi=6.521; p<0.05). There were no differences in the Apgar score between two groups (Chi=0.449; p=NS). Conclusion. In gravida older than 35 years preeclampsia has negative impact on the perinatal outcome.

Key words:
preeclampsia, old primigravida


HETEROTOPIC PREGNANCY – CASE REPORT (Vol.20 No.4, str.211-212 )

Authors:

Marinko Marić, Ozren Mamula, Mirko Prodan, Oleg Petrović, Herman Haller

Case report

Summary:
Objective. To present diagnostics, treatment and outcome of heterotopic pregnancy. Case report. It was a thirty years old patient who was accepted into the Department in the fifth week of amenorrhea with severe pain in lower abdomen, which started that evening. She had no vaginal bleeding, a previously made home pregnancy test was positive. The exam showed that it was intrauterine pregnancy five weeks of gestation. On ultrasound the left ovary showed a heterogeneous formation of 6×5 cm, within which the ring shadow diameter of 15 mm. In the Douglas area the free liquid column of 30 mm was established. A patient at admission was hemodynamically stable. Clinically dominated the pain and signs of irritation of peritoneum and is done laparoscopic surgery. The left ruptured tubal pregnancy was found. Underwent left-salpingectomia. Early postoperative course was without accident. A patient on the third postoperative day was discharged from the department. Pregnancy which in the further course passed duly is completed by vaginal delivery of live, healthy infant in the 39th week of pregnancy..

Key words:
heterotopic pregnancy, laparoscopy in pregnancy, delivery


90 GODINA KLINIKE ZA ŽENSKE BOLESTI I PORODE U PETROVOJ ULICI (Vol.20 No.4, str.213-218)

Authors:

Slavko Orešković:

Book review

Summary:

*

Key words:

*


X. SVJETSKI KONGRES PERINATALNE MEDICINE (Vol.20 No.4, str.219-220)

Authors:

Meeting report

Summary:

*

Key words:

*


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