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Background: In addition to its neuroprotective effect, Brain-derived neurotrophic factor (BDNF) also plays a role in glucose and lipid metabolism. This study aims: a) to find changes in the BDNF concentration during pregnancy in type 1 diabetes. b) to prove the effect of DHA and EPA supplementation on changes in BDNF concentrations c) to investigate the impact of hypoglycemia on BDNF concentration. Subjects and methods: The data from this study were from the PRE-HYPO cohort study. Twenty-one of them were on a standard diabetic diet enriched with EPA and DHA (EPA 120 mg/day and DHA 616 mg/day ; Exposed group), and nineteen pregnant diabetic women were on the standard diabetic diet without EPA and DHA supplementation (Non-exposed group). In the first trimester of pregnancy, fiftHHQ SUHJQDQW ZRPHQ GHYHORSHG K\SRJO\FHPLD HSLVRGHV .9 mmol/L ; HYPO+ group), and twenty-five pregnant women did not have hypoglycemia episodes (HYPO- group). Results: BDNF concentration significantly decreased during pregnancy from the first to the third trimester, in Non-exposed from 25.1 (22.0-30.2) to 22.1 (16.3-28.2), P

The effort to reach the ideal glycemic control in type 1 diabetic pregnancy (T1DM) is often linked with increased risk of hypoglycemia. The aim of the study was to find the effect of C- peptide concentration on severe hypoglycemia prevalence in diabetic pregnancy and its impact on insulin doses and fetal macrosomia. Study participants. 90 women with T1DM and singleton pregnancy, who received insulin treatment for ≥ 24 months, were included in the study. The HbA1c was ≤ 8% at pregnancy confirmation. The study was conducted in Department of Obstetrics and Gynecology, School of Medicine University of Zagreb, as a part of scientific project PRE-HYPO No IP-2018-01-1284. Participants were divided into three groups according to duration of diabetes: 1. group 2-10 years (n=36) ; 2. group 11-20 years (n=36), and 3. group ≥ 20 years (n=18). Severe hypoglycemia was defined as glucose concentration below 3 mmol / L. Results. The percentage of severe hypoglycemia in the first trimester according the groups was 41.7%, 66.7% and 77.8%, respectively, and it declined in third trimester in all three groups (19.4% ; 38.9% and 66.7%, respectively). The C- peptide concentration in group 1 was significantly higher throughout pregnancy when compared with group 2 and 3 (P=0.011 ; P=0.015 ; P

Summary. Breech presentation is a baby birth, in which we can expect higher perinatal mortality and morbidity in relation to cephalic presentations. The incidence of preterm delivery in breech presentation ranges from 20-35%. So early engendered children are exposed to hypoxic damages, as well as traumatic injuries with consequent intracranial hemorrhages. The mortality rate of preterm infants is much higher than the mortalityod full-term infants. A higher risk of perinatal asphyxia and birth trauma makes obstertricians decide for operational completion of caesarean birth. Research methods. We conducted a retrospective study of five major periods where we compared perinatal mortality and morbidity, the way of completion of the pregnancy, and the incidence of caesarean sections and vaginal deliveries. Examinees and research method conducted through a period of 21 year were all singleton pregnancy with a baby in breech presentation, completed by caesarean section. Results. The incidence of caesarean sections at preterm births with breech presentation gradually grows through the period studied. Obstetricians were increasingly opting for a caesarean section at preterm births of children in breech presentation, in order to eliminate traumatic and hypoxic damage, and thus tried to reduce perinatal mortality. The perinatal mortality rate of premature children who were labored in breech presentation by vaginal birth, according to numerous authors was statistically significantly higher compared to perinatal mortality of children women delivered prematurely by caesarean section. Conclusion. The research leads us to the importance of the completion of the premature birth of a child in breech presentation by caesarean section, if the child is alive and there is no identifiable development defects.

Summary. Peripartum hysterectomy can be defined as a hysterectomy performed at the time, or within 24 hours, of delivery. Another definition is a hysterectomy performed any time from delivery to discharge from the same hospitalization. Aim. The aim of the study was to determine the incidence, indications and complications associated with peripartal hysterectomies in 5 year period. Patients and methods. In this retrospective study we analyzed 20 peripartal hysterectomies in Clinical Hospital Center Zagreb, Department of Obstetrics and Gynecology, during the period from January 2010 to December 2015. Peripartal hysterectomies after both, vaginal deliveries and Caesarean sections were included in our research. We studied patients who underwent peripartal hysterectomy of any age and at any time during pregnancy. Procedures were performed by surgeons of different gynecological subspecialties. Results. The age of our patients was in the range between 23 and 45 years. Total number of deliveries in that period was 25565 and the incidence of the peripartal hysterectomies was 0.8/1000 deliveries. Main indication was uterine hypotony (35%) followed by placenta previa (25%). There were no postoperative complications or maternal deaths in the analyzed group. Of 20 peripartal hysterectomies, 19 were after Cesarean sections. Conclusion. Cesarean section induces higher peripartal hysterectomy incidence in women due to its relation to atonic and placenatal disorders that increases maternal morbidity.

Summary. According to the World Health Organization criteria, underweight, normal weight, overweight and obesity are defined by body mass index (BMI). Underweight, overweight and obesity in pregnancy increase the risk of unfavorable maternal and perinatal outcome. The aim of the study was to analyze the impact of maternal BMI before and during pregnancy, and the impact of gestational weight gain on the occurrence of maternal and neonatal morbidity. Subjects and methods. This retrospective study included 4646 pregnant women that underwent oral glucose tolerance test between 24th and 32nd week of gestation and gave birth to their children at Clinical Department of Gynecology and Obstetrics, Zagreb University Hospital Center during the 2013-2015 period. There were 136 (2.9%) underweight, 3066 (66%) normal weight, 949 (20.4%) overweight and 467 (10.01%) obese women. The following data were analyzed: maternal age, BMI, gestational weight gain, parity, prevalence of preeclampsia, method of delivery termination (cesarean section, vaginal delivery or vacuum extraction), and neonatal birth weight, ponderal index, fetal macrosomia, and Apgar index at 1 min and 5 min. Results were expressed as mean value and standard deviation. The SPSS ver. 17 statistical software was used on data analysis. The χ2-test and ANOVA were calculated. Study parameters were compared between study groups and control group. The level of statistical significance was set at p

Diagnosing early stage of fallopian tube carcinoma poses great diffi culties. In our patient, fallopian tube carcinoma was suspected because of the incidental fi nding of malignant glandular cells in VCE smear and patient history of surgery for breast carcinoma. Upon laparotomy, a small, macroscopically normal uterus and bilaterally normal ovaries, oviducts, fi mbriae, omentum, bowel and peritoneum were revealed. On cytology, papillary formations and individual malignant cells of columnar epithelium were detected in peritoneal washing. Because of the cytology fi nding of malignant cells in peritoneal washing, we decided to perform hysterectomy, bilateral salpingo-oophorectomy, omentectomy, appendectomy, and pelvic peritoneum ablation. Histopathologic diagnoses: adenocarcinoma serosum tubae in situ utriusque, carcinoma metastaticum ovarii utriusque. The case presented demonstrates that fallopian tube is the origin of ovarian carcinoma.

Obesity affects mental, physical and emotional health, increases the prevalence of hypertension, diabetes, sexual dysfunction and cardiovascular disease, and reduces the quality of life. Every woman with body mass index greater than 30 kg/m2 is considered obese, which has negative sequels on her general and reproductive health. A higher prevalence of early habitual abortion, congenital anomalies, preterm delivery, preeclampsia, gestational diabetes, cesarean section, fetal growth retardation and thromboembolism has been reported in obese women. Obesity is associated with worse maternal and perinatal outcomes. Children born to obese mothers more frequently develop cardiovascular disease, type 2 diabetes and metabolic syndrome later in life. This review gives recommendations for preconception work- up, and antenatal, intrapartum and postpartum care of obese pregnant women and their newborns.

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 ad 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.

Objective was to compare perinatal outcome in pregnant women with type-2 DM vs. type-1 DM. Patients and methods. In the period (2000.– 2012.) 557 pregnant women with type-1 DM and 149 with type-2 DM were delivered. Following data were analyzed: age, body mass index (BMI), weight gain, HbA1c level in each trimester of pregnancy, complications of labor and delivery, new born weight and ponderal index, perinatal mortality and morbidity. All women with type- 2DM received insulin. Results. 557 type-1 DM women delivered 563 newborn children (4 pregnancies with twins and 1 pregnancy with triplets). 149 type-2 DM women delivered 154 newborn children (5 pregnancies with twins). No shoulder dystocia occurred.

Hyperthyroidism of any cause can complicate pregnancy, but Graves’ hyperthyroidism is the most common cause of overt hyperthyroidism. Human chorionic gonadotropin-mediated hyperthyroidism is a common cause of subclinical hyperthyroidism. It may occur transiently in the fi rst half of gestation and is typically less severe than Graves’ disease. The diagnosis of hyperthyroidism during pregnancy should be based primarily on suppressed (

Inherited and acquired thrombophilias are associated with a tendency to thromboembolic disease development (deep vein thrombosis and pulmonary embolism). There is evidence that, besides an increased proneness to develop venous thromboembolic disease, women with thrombophilia are at an increased risk of pregnancy complications such as preeclampsia, intrauterine growth restriction, abruptio placentae, habitual abortion and stillbirth. Intraplacental clot formation is considered to be responsible for these pregnancy complications ; therefore medication preventing thrombosis may prove useful to prevent these complications.

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.

Aims. The aim of this study was to relate the levels of glucose, insulin, C-peptide, leptin and adiponectin in the maternal and umbilical vein serum to the birth weight in T1DM and healthy pregnancies. Methods. The study included 120 pregnant women divided into 4 groups: 30 suffering from type 1 diabetic pregnancy (T1DM) who gave birth to eutrophic and 30 who gave birth to macrosomic infants ; 30 from Control group (CTRL) who gave birth to eutrophic and 30 who gave birth to macrosomic infants. Serum insulin, C-peptide, leptin and adiponectin levels were quantified by ELISA. Results. Fetal macrosomia is associated with higher level of leptin in the fetal serum in both groups (T1DM: p=0.049 ; CTRL: p=0.031). Fetal levels of glucose and insulin have an influence on birth weight in the Control group (glucose: p=0.002 ; insulin: p=0.015). Adiponectin levels are higher in the maternal (p=0.001) and fetal serum (p

Introduction. Due to the stressful and sedentary lifestyle with the plenty of calorie-rich food obesity reaches pandemic proportions. It is increased interest of scientist to discovery previously unknown metabolic-endocrine effects on obesity. Aims. The aim of this study was to determine the influence of obesity of the mother and GDM as individual and combined factors on the levels of glucose, C-peptide, adiponectin and leptin in umbilical serum, and on insulin resistance in the child. Methods. This case control study included 160 pregnant women divided into four groups according to BMI and GDM. The concentration of C-peptide, adiponectin and leptin were determined using the ELISA method. Results. Obese women in both diabetic and healthy groups had higher concentrations of C-peptide. The concentration of adiponectin was positively correlated to newborn’s weight among women with normal BMI values in both diabetic and healthy groups and leptin concentrations and newborn’s weight only among obese diabetic women. Conclusion. This study has shown that the activities of increasingly common pathogenic factors in the mother - weight and increased insulin resistance - either independent or combined, alter the in utero metabolism of the child.

INTRODUCTION Diabetes-induced changes and poorly regulated glycemia in diabetic pregnant women are reflected on placental tissue and metabolism, and consequently induce a series of complications in both the embryo and later fetus, and the pregnant woman. For normal growth and development of the fetal central nervous system of particular importance is the availability and supplementation of essential long-chain polyunsaturated fatty acids. The purpose of this study was to determine how changes in carbohydrate metabolism can affect the lipid content of the placenta in pregnant women with type 1 diabetes mellitus (DM 1). MATERIALS AND METHODS Pregnant women (38 with DM 1, and 34 healthy) were recruited for the study at the Reference Center for Diabetes in Pregnancy, Department of Gynecology and Obstetrics, Clinical Hospital Center Zagreb. All pregnancies were finished by caesarean section at the expected term of birth. Samples were collected from placental tissue, homogenized and total lipids were extracted by solvent mixtures. Free fatty acids were separated by thin layer chromatography, trans-esterified to methyl esters and analyzed by gas chromatography. RESULTS The amounts of free fatty acids were significantly reduced in placental tissue of the pregnant women with DM1 than in the control group. In DM1 group the ratio of lauric acid (C12:0) was significantly lower and the ratios of miristoleic (14:1), palmitic (16:0), stearic (18:0), oleic (18:1), linoleic (18:2) and docosahexaenoic (22:6) fatty acids were significantly higher than in the control group. CONCLUSION Decreased amounts of free fatty acids in the placenta of pregnant women with DM1 might indicate an increased lipolytic activity. Well regulated DM1 results with stable metabolism of carbohydrates and lipids, and with the appropriate fatty acid composition.

A pregnant woman with inherited thrombophilia (factor II mutation – 20210A) had two late pregnancy losses. The first pregnancy was not well documented, but the second pregnancy was complicated by fetal thrombophilia and umbili- cal artery thrombosis, proven after fetal death. During the third pregnancy enoxaparine was introduced in the therapy and early amniocentesis was performed. Fetal thrombophilia was proven again. Early delivery was induced and per- formed with no complications, resulting in a live healthy infant. A history of miscarriages or recurrent fetal loss should raise suspicion of thrombophilia as a potential cause. It is debatable whether amniocentesis in pursuit of fetal thrombo- philia should be performed and whether this will lead to a better perinatal outcome. When fetal thrombophilia is diag- nosed, an earlier induction of delivery should be considered, taking into account the fetal extrauterine viability. The aforementioned approach of early delivery in cases of inherited fetal thrombophilia could be a possible solution for better perinatal outcomes.

Objective was to compare perinatal outcome in pregnant women with type-2 DM vs. type-1 DM. Patients and methods: In the period (2000.-2012.) 557 pregnant women with type-1 DM and 149 with type-2 DM were delivered. Following data were analyzed: age, body mass index (BMI), weight gain, HbA1c level in each trimester of pregnancy, complications of labor and delivery, new born weight and ponderal index, perinatal mortality and morbidity. All women with type-2DM received insulin. Results: 557 type-1 DM women delivered 563 newborn children (4 pregnancies with twins and 1 pregnancy with triplets). 149 type-2 DM women delivered 154 newborn children (5 pregnancies with twins). No shoulder dystocia occurred. Conclusion: Despite a milder glycemia disturbances and better HbA1c level in first trimester women with type-2 DM had higher perinatal mortaliy than type -1DM group, but fetal macrosomia and CS rate was siginificantly lower in type-2 DM group what can be the result of introduced insulin treatment during pregnancy.

Diabetic nephropathy increases risk developing hypertension/ preeclampsia in diabetic mothers and increase perinatal morbidity and mortality rate. The aim of the study was to investigate: 1) incidence of diabetic nephropathy in pregnant women with type-1 diabetes mellitus, 2) frequency of hypertension/preeclampsia in mothers with diabetic nephropathy, 3) perinatal outcome in mothers with diabetic nephropathy. Patients and methods. During the period 2004 to 2011 retrospective analyses of 396 pregnant women with type-1 DM was performed. All patients were divided in five groups: I. pregnancies with type-1 DM without complications (309 ; 78%), II. pregnancies with type-1 DM and non proliferative retinopathy (n=29 ; 7.3%), III. pregnancies with type-1 DM and proliferative retinopathy (n=23 ; 5, 8%), IV. pregnancies with type-1 DM and peripheral neuropathy (n=5 ; 1, 3%), and V. pregnancies with type-1 DM and diabetic nephropathy (n=30 ; 7, 6%). Results. Incidence of diabetic nephropathy was 7.6%. Hypertension/ preeclampsia was developed in 14 (47%) of all pregnant type-1 DM patients with diabetic nephropathy, and only in 12% of type-1 DM patients without any complications of diabetes. When the groups were compared for age, height, body weight, gained weight during pregnancy, body mass index, HbA1c values and acid base status of umbilical vein after statistical analyses was found no significant difference. The significant statistical difference was found among diabetic mothers without complications of diabetes and those with diabetic nephropathy when compared to gestational age at delivery, new borns weight and ponderal index. In the group of mothers with diabetic nephropathy preterm delivery rate was significantly higher than in mothers without complications of type-1 DM (p=9.035). Among the mothers with type-1 DM without complications perinatal mortality was 2.8%, and in type-1 DM mothers with diabetic nephropathy perinatal mortality was 0%. Conclusion. Diabetic nephropathy is a serious complication of DM and pregnancies of mothers with such complications have to be closely monitored in order to achieve such good perinatal outcome.

Objective. Perinatal and neonatal hypoxic/ischemic (H/I) brain injury is a leading cause of perinatal mortality and morbidity [1]. Prolonged neuronal apoptosis plays an important role in the processes contributing to neuronal degeneration. The essential long-chain polyunsaturated fatty acid (LCPUFA) docosahexaenoic acid (DHA), a major component of brain membrane phospholipids, prevents neuronal cell apoptosis and plays an important role as an anti-oxidant agent [2]. Some research has shown that omega-3 FAs protect against ischemic brain damage in adult stroke models [3]. One recent study has suggested the beneficial effect of DHA pretreatment on brain damage and functional outcomes at 7 days after H/I in neonatal rats [4]. In this study, it was found that dietary supplementation of omega-3 FAs to pregnant female rats resulted in robust and prolonged neuroprotection in the neonatal brain after H/I. Fetal concentration of DHA depends on the mother’s concentration, i.e. on their ingestion by food. During the pregnancy the maternal EFA status declines steadily. Therefore, it is recommended that this fatty acid must be added in food [5]. Previous studies showed that type 1 diabetes is associated with low DHA level of pregnant women [6, 7]. The aims of the study were: 1. To determine total FAs concentration (mg/L) in the maternal vein serum and in the serum of the umbilical vein in pregnant women suffering from Type 1 diabetes (T1DM) and in healthy pregnant women (Control group) and ; 2. To determine and analyze omega-3 FAs (ALA, EPA, DHA) concentrations (mg/L) in relation to the total FAs concentration in the mother’s vein serum and the serum of the umbilical vein in pregnant women suffering from T1DM compared to the Control group. Methods. The study included 63 pregnant women, 32 suffering from T1DM and 31 from Control group who gave birth to eutrophic children. Samples of a mother’s vein blood and the umbilical vein blood were taken immediately after the birth. The total lipid extraction was carried out by the mixture of chloroform: methanol solvent: a method of increasing polarity according to Folch [8]. Heptadecanoic acid (C17) was used as internal standard in order to determine the exact proportion of total lipids. Fatty acids from lipid extracts were converted to methyl esters by transesterification with methanolic HCl (ref: ISO standard) and their composition analyzed by GC-MS on Varian 3400 (Varian, USA) equipped with Saturn II ion trap mass spectrometer operating in the electron impact (EI) mode. Results. There was statistically significant difference in the total FAs concentration in the maternal vein serum and the umbilical vein serum between the two groups (p0.001 ; EPA: p>0.001 ; DHA: p

Cilj ispitivanja: Procjena učinkovitosti perinatalne skrbi, korištene terapije i praćenja uobičajenih laboratorijskih parametara jetrene disfunkcije. Usporedba sa svjetskim podacima. Metode: Proveli smo retrospektivnu analizu podataka 88 trudnica koje su u posljednjih 11 godina liječene u Klinici za ženske bolesti i porode u Zagrebu. Rezultati: U 11 godišnjem periodu na ukupno 58.109 porođaja 88 rodilja prosječne starosti 28, 6 godina bolovalo je od intrahepatičke kolestaze u trudnoći, što čini incidenciju od 0, 15%. Dvije trudnice isključili smo iz studije zbog kronične opstruktivne bolesti jetre. Nije bilo slučajeva akutnih virusnih bolesti jetre i dermatoloških bolesti. 100% ispitivanih trudnica imalo je svrbež kao dominantan simptom koji se pojavljivao uglavnom u trećem trimestru (91%). Vrijednosti alkalne fosfataze jednake ili veće od 200 imalo je 57 žena (64, 7%).Prijevremeno je rodilo 29% trudnica. Nije bilo statistički značajne povezanosti između povišenih vrijednosti alkalne fosfataze i prijevremenih poroda. Jedna trudnoća završila je intrauterinom fetalnom smrću (1, 1%). Nije zabilježen niti jedan slučaj neonatalne smrti. Perinatalni mortalitet u 88 trudnica s kolestazom iznosio je 11, 36‰ . CTG zapis u 9% žena bio je prepatološki (sužena undulacija, gubitak reaktivnosti). Mekonijsku plodnu vodu imalo je 38% rodilja, a amniocenteza je rađena u 8 trudnica. Samo dvije (2, 3%) su imale pozitvna mekonijska tjelešca u amnijskoj tekućini. Obje trudnoće su odmah dovršene ; kod trudnice u terminu induciranim vaginalnim porodom te hitnim carskim rezom (s obzirom i na prepatološki CTG) kod trudnice u 35. tjednu gestacije. U terapiji su uglavnom podjednako bili zastupljeni sedativi (diazepam 27, 3%) i kortikosteroidi (pronizon 23, 9%), dok je 10, 2% trudnica uzimalo oba lijeka. Trudnoća je u 79% slučajeva dovršena vaginalnim porodom, 11% slučajeva elektivnim carskim rezom nakon dokazane fetalne zrelosti, a u 8% žena bilo je potrebno učiniti hitan carski rez .Prosječna težina terminske novorođenčadi iznosila je 3.322, 9&plusmn ; ; 556, 5 grama (95%CI 3180, 4-3465, 4). Kod 46% terminske novorođenčadi bio je proveden neki oblik terapije hiperbilirubinemije (infuzija glukoze 21%, fototerapija 5%, infuzija+fototerapija 10%). Transfuziju krvi u drugom danu babinja primilo je 6% babinjača. Istovremeno nije nađen niti jedan slučaj povišenog PV-a. Zaključak: Incidencija intrahepatičke kolestaze u trudnoći u našoj populaciji vrlo je niska. Studija sugerira da se radi o stanju relativno benignom za majku, ali s povećanim rizicima za dijete (prijevremeni porod, intrauterina smrt, neonatalni distres). Postoji statistički značajna povezanost između vrijednosti pojedinih laboratorijskih parametara (alkalne fosfataze i ukupnog bilirubina) i simptoma bolesti, ali ne i između tih istih parametara i fetalne odnosno neonatalne prognoze tj. krajnjeg ishoda trudnoće. Među laboratorijskim parametrima koji se određuju svakako bi se trebao naći i nivo žučnih kiselina u majčinoj cirkulaciji. Iako se pojava mekonija u amnijskoj tekućini, u trudnoći opterećenoj kolestazom, u svjetskoj literaturi opisuje kao moguća opasnost za dijete, kasna amniocenteza kod nas se radi rijetko, čak i u svrhu procjene zrelosti fetalnih pluća. Naši rezultati ukazuju i na veću učestalost prijevremenih poroda, dvojbenu vrijednost uobičajenog CTG nadzora te korištenu terapiju koja je samo simptomatska ; olakšava tegobe majci, ali ne poboljšava perinatalni ishod.

In normal pregnancy, physiological insulin resistance (IR) is present as the result from placental hormones. In women with gestational diabetes (GDM), IR is more severe and leads to elevated concentration of glucose and other nutrients such as lipids and amino acids with increased transfer to the fetus. We aimed to determine the concentration of adiponectin, leptin and C-peptide in maternal vein serum (MVS) and umbilical vein serum (UVS) of newborns born from mother with GDM and healthy mothers at term and to investigate their associations with offspring outcome. Further, the aim was also to assess the associations between adiponectin, leptin and C-peptide in MVS /UVS at delivery and to examine whether or not there are correlations between those hormonal levels and birth weight, maternal body weights and body mass indexes. To examine the influence of GDM on cord blood lipids at birth and relationship to body composition, cord blood iC-peptide, leptin and adiponectin. Evaluate metabolic profile GDM and healthy pregnancies. Material and Methods: Pregnant women included in this prospective study underwent routine physical examination and performed 2-h 75- g oral glucose tolerance test (OGTT). Diagnosis of GDM was defined according WHO criteria. The serum sample was taken from 37 GDM and 46 healthy pregnant women. Maternal characteristics were analyzed: age, weight, height, BMI, parity, mode of delivery, and gestational age at delivery. Newborn characteristics were gender, cranial perimeter, weight, and length and ponderal index. All were delivered by cesarean section. We measured in maternal and in umbilical vein serum: glucose, HbA1c, triglycerides (TG), cholesterol, HDL and LDL cholesterol, C-peptide, adiponectine, leptine, HOMA-IR. RESULTS: Mothers with GDM and healthy ones were primiparous and there was no significant difference in age. Women with GDM had a significantly higher mean BMI than mothers in control group (29.6±3.2:23.3±2.3 ; p

Poster je prikaz istraživanja o učestalosti pretilosti, poremećaja metabolizma ugljikohidrata i povišenog kardiometaboličkog rizika u žena s gestacijskim dijabetesom.

Background. For the fetal growth and development, and especially for the fetal nervous system, arachidonic acid (AA) and docosahexaenoic acid (DHA) are of an essential importance. Due to certain evidence of lack of EFA during pregnancy, some authors emphasise need for nutritional supplementation. Objective. The aim of our research was to determine the total amount of the fatty acids (FA) in maternal venous plasma and plasma of umbilical veins and arteries in pregnant women suffering from type 1 diabetes versus healthy pregnant women. Likewise, we wanted to determine the concentration (%) of AA and DHA in relation to the total amount of FA in venous plasma of mothers, plasma of umbilical veins and arteries in diabetic and healthy pregnant women. Methods. The study included 35 pregnant women, 24 with diabetes mellitus type 1 (study group) and 11 healthy women (control group) who gave birth to eutrophic children. Diabetic mothers were on intensive insulin therapy and healthy women were verified as healthy by 75g oral glucose tolerance test (WHO, 1999.) . Extraction of total lipids from the samples was carried out according to the method of Folch. The identification procedure of FA content was performed by gas chromatography and mass spectrometry. Results. Age, BMI, weight gain during pregnancy, weeks of gestation, neonatal birthweigt, Apgar scores and pH were analised and no significant difference was found. There was no statistically significant difference comparing the total amount of FA in venous plasma of mothers between groups. The total amount of FA in the venous serum of diabetic mothers was 6410.7 ± 2204.1 mg/L, and in the control group 6881.6 ± 2569.8 mg/L. Concentration of AA in maternal venous plasma of diabetic pregnant women was significantly lower concentration in comparison to control group. Neither statistically significant difference in DHA concentrations was found between the two groups. It was found significantly higher total amount of FA in the umbilical vein of diabetic mothers (2653 ± 979.9 mg/L) compared to the control group (1873.1 ± 814.1 mg/L). There was no statistical difference of the concentration of AA and DHA in umbilical vein plasma between the two studied groups. There was no significant difference comparing the total amount of FA in the plasma of umbilical artery between the two studied groups (investigated group 2834.4±636.8, control group 2076.9±858.6). Also there was no difference of the concentrations of AA and DHA in the total amount of umbilical artery plasma FA between the two studied groups. Conclusion. Good metabolic control of diabetic pregnant women results in only by minor changes in concentrations of lipids in diabetic compared to healthy pregnant women and their newborns.

Objective. The goal of this study was to define the influence of type 1 DM on levels of glucose, insulin, c-peptide, leptin, adiponectin, total free fatty aids (FFA), and essential fatty acids (EFA) in maternal and umbilical vein blood. Methods. Research included (58) pregnant women divided into two groups as follows: 28 healthy pregnant women (CTRL) and 30 pregnant women with type 1 DM. Maternal vein blood samples and umbilical vein and artery blood samples during delivery were taken and glucose concentration along with insulin, C-peptide, leptin, adiponectin, and FFA were meas¬ured. Extraction of total lipids was performed according Folch method. For extraction of the fatty acids, gas chromatography was used. Results. Mean values in maternal blood of the CTRL were: glu¬cose 4.1 ±1.6 mmol/L, insulin 12.8±1.7U/mL, C-peptide 315.2±201.1 ng/mL, leptin 1003.9±621.8 ng/ mL, adiponectin 17.3±4.55 |jg/mL. Values measured from umbilical vein blood in CTRL group were: glucose 3.3±1.3 mmol/L, insulin 3.47 U/L, C-peptide 105.7±87.9 ng/mL, leptin 400.3±354.6 ng/mL, adiponectin 4.8±3.5 pg/mL, In maternal blood of type 1 DM values were: glucose 5.4±4.8, insulin 21.1 ±8.7 U/mL, C-peptid 319± 230 ng/mL, leptin 720.4 ± 952.0 ng/mL, adiponectin 9.3±7.9 yg/mL. In umbilical vein of mothers with type 1 DM we measured: glucose 3.1 ± 2.1 mmol/L, insulin 11.0±4.2 U/mL, C-peptide 257.0±234.8 ng/mL, leptin 1240.8±989.7 ng/mL, adiponectin 40.6±55.2 |jg/mL. Fetal macrosomia is associated with higher concentration of leptin. C peptide correlates very well with birthweight of the newborns and shows increased values among newborns of diabetic mothers even when they are eutrophic compared to the eutrophic newborns of the controls. The statistical significant difference was found in total lipid content in pregnant women between the studied groups (CTRL 6881.7±2311.3 mg/L: type 1 DM 7553.8±4822.9 mg/L). In the umbilical vein the concentra¬tion of the total lipd contents was lower in both groups 1899±862.6 vs. 2636.1 ±904.8 mg/L com¬pared to the respective artery 2588.91 ±892.63 vs. 2728.7±1327.4 mg/L) what suggests that fetus of the diabetic mother synthesizes additional lipids. We did not find any statistical significant difference between maternal and umbilical vein plasma concentration of EFA between two groups. The con¬centration of docosahexaenoic (DHA) acid in umbilical artery plasma was higher in CTRL group compared to type 1 DM group (3.17% : 2.43%). The relative concentrations of arachidonic acid (AA) and DHA in umbilical vein plasma in both groups were higher when compared with maternal venous plasma in both groups. There were found statistically significant higher relative concentrations of AA in umbilical vein plasma in CTRL and in type 1 DM groups (11.7% ; 13.6%) when compared with maternal vein plasma in both groups ( CTRL=1.6% ; type 1 DM =1.9%).

Objectives: Increased reactive oxygen species (ROS) production in diabetes causes increased oxidative stress. Consequently, gestational diabetes (GDM) increases expression of antioxidant enzymes in the placenta in the 3rd trimester. Whether the placenta compensates diabetes-induced oxidative stress also in the 1st trimester is unknown. Therefore, we determined expression of antioxidant enzymes as well as of ROS producing enzymes xanthine oxidase (XO) and NADPH oxidases 4 and 5 (NOX4, 5) in 1st trimester placentas from Type 1 diabetic (T1D) pregnancies compared to healthy pregnancies. Methods: 1st trimester placentas from normal (n=14) vs. T1D (n=16) pregnancies between gesta-tional week 6-12 were obtained after pregnancy interruption for psychosocial reasons and immediately frozen in liquid nitrogen. Total RNA was isolated, and mRNA expression of superoxide dismutases 1-3 (SOD1-3), glutathione peroxidases 1, 3, and 4 (GPX1, 3, 4), catalase (CAT) and glutathione reductase (GSR) measured by real time PCR. Also, expression of enzymes producing ROS ie, NOX4, 5 and XO was determined. Data were normalized to expression of the housekeeping gene HPRT1. Results: Expression of SOD2 was decreased by 38% (p=0.036) in T1D placentas from week 8-12, but not from week 6-7. GPX3 was reduced by 63% (p=0.006) in ali investigated gestational weeks. GPX1, GPX4 and CAT showed also lower expression in T1D placentas between weeks 8-12 but did not reach significance. Expression of the ROS producing enzymes NOX4, 5 and XO was unchanged. Conclusion: This is the first study measuring diabetes associated changes in placental antioxidant enzyme expression in early pregnancy. In contrast to GDM in the 3rd trimester, we found a down-regulation of placental antioxidant enzymes in the 1st trimester. This suggests that either 1) oxidative stress is reduced in T1D 1st trimester placentas causing reduced antioxidant enzyme expression, or 2) because of their lower expression, oxidative stress in T1D cannot be compensated by antioxidant enzymes. This would lead to even higher oxygen toxicity of T1D in the 1st trimester placenta.

The goal of this study is to define the influence of maternal obesity and GDM as separate and associated factors on levels of adipokines in maternal and umbilical vein blood. Research included 160 pregnant women divided into four groups as follows: group of pregnant women without GDM and with BMI25, group of pregnant women with GDM and with BMI25. Pregnant women that had any other disease or pathological condition were excluded from study. Maternal and umbilical vein blood samples during delivery were taken and glucose concentration along with insulin, C-peptide, leptin, adiponectin, resistin andTNF-a were measured.Valuesof insulin resistance were calculated using HOMA-IRformula. Within our group of pregnant women without GDM and with BMI

Results: In the first trimester of pregnancy placental trophoblast cells invade the maternal uterine wall in order to anchor the placenta and to establish adequate utero-placental blood flow by remodelling of the uterine arteries. Therefore, trophoblasts are well equipped with matrix degrading enzymes i.e. matrix metalloproteinases (MMPs). Maternal T1D is associated with a higher risk for early pregnancy loss, pre-eclampsia and fetal growth restriction. As underlying reason we hypothesise impaired trophoblast invasion. Because placental changes in early gestation are difficult to determine, indirect evidence is needed to demonstrate changes in trophoblast invasion. The aim of the present study was to identify changes in MMP expression in first trimester placentas from healthy vs. T1D pregnancies. Additionally, the effect of low oxygen on MMP expression was determined in a first trimester trophoblast cell line (ACH-3P). First trimester placentas from normal (n=15) vs. T1D (n=12) pregnancies between gestational week 6 and 10 were obtained after pregnancy interruption for psycho-social reasons and immediately frozen in liquid nitrogen. Total RNA was isolated and mRNA expression of all 23 human MMPs was measured using sqRT-PCR and analyzed according to the gestational weeks. Expression signals were normalized to the trophoblast marker cytokeratin 7. ACH-3P cells were cultured under various oxygen concentrations (2.5, 5, 12, 21) for seven days and expression of MMPs was measured similarly. In the first trimester, the placenta expresses 14 MMPs. T1D was associated with a reduced expression of 11 MMPs in weeks 8-10. Hypoxia reduced expression of various MMPs in ACH-3P cells. This is the first study to demonstrate altered placental MMP expression during early human pregnancy as a result of maternal T1D. T1D is associated with a decrease of MMP expression which may hence impair the process of trophoblast invasion. Lower uterine oxygen concentrations as a result of diabetes may be involved in the impaired MMP expression. These results may explain the higher incidence of spontaneous abortions in T1D women and their higher risk for pre-eclampsia and IUGR in late pregnancy.

Obesity represents a significant medical problem in modern world, especially in developed and developing countries. Due to its destructive impact on health, great efforts are being made in order to reduce the number of obese people. Approximately 25% of women in their reproductive age are overweight. These women are obese when they enter pregnancy, which increases the risk of giving birth to a macrosomic newborn. On the other hand, the risk for a person to become obese adult increases if that person was born with increased birth weight. Obesity is defined as excess of adipose tissue which occurs due to imbalance between energy input and consumption, leading to multiple adverse pathophysiological mechanisms which endanger health. In 95% of cases, the etiology of obesity is unknown, but most people become obese simply due to eating habits. After a person becomes obese, all the other factors (reduced physical activity, changes in metabolic and hormonal mechanisms) are more and more expressed and are contributing to preservation and advancement of obesity. Due to alterations in target-organ sensitivity to insulin and pancreas’ ability to respond to increased need for insulin, obese people are more often affected by diabetes. Obese people have elevated triglycerides and cholesterol blood levels which, along with hypertension, leads to atherosclerosis. Due to hyperestrogenism, obese women are more often affected by breast and endometrial cancer and also by oligomenorrhea, amenorrhea and anovulatory cycles. In extremely obese people, upper-airway obstruction during sleep causes hypoxia and hypercapnia, which can lead to development of policytemia, pulmonary hypertension and chronic pulmonary heart. The body weight of obese people is 20-30% above average for a given height, age and sex. Different laboratory techniques have been used for estimating obesity and amount of adipose tissue, but due to their complexity they are not used in routine practice. Nowadays, mostly criteria based on height and weight are being used for estimating obesity. Index known as Body Mass Index (BMI) is generally accepted. It is calculated using formula W/H, where W stands for body weight in kilograms and H stands for height in meters. Based on BMI, women are grouped in 4 categories: 1. Thin = BMI < 19.9 kg/m², 2. Normal = BMI 20.0-24.9 kg/m², 3. Obese = BMI 25.0-29.9 kg/m², 4. Very obese = BMI > 30.0 kg/m². This classification was used in our study. Main advantage of BMI index is its simple calculation, but its limitation is absence of differentiation between obesity and increased muscle mass as the cause of increased body weight. BMI is well correlated with mortality – people with BMI in range 20 to 25 kg/m² have low risk, and those people with BMI higher than 30kg/m² have high risk of premature death. Women can enter pregnancy already overweight or they can experience significant increase in body weight, resulting in obesity. Those pregnancies are more often characterized by antepartal, intrapartal and postpartal complications. Among antepartal complications, authors describe hypertension, preeclampsia, gestational diabetes and urinary infections ; among intrapartal complications - umbilical cord complications, meconium stained amniotic fluid and prolonged second phase of delivery ; and among pospartal complications – hemorrhage and puerperal infections. All authors agree that women which have high body weight prior to delivery, more frequently give birth to macrosomic newborns, which increases the use of oxytocin and the need for cesarean sections. There is higher occurrence of perinatal mortality in obese pregnant women, related to premature deliveries and twin-pregnancies which lead to increased number of premature deliveries. On the other hand, high increase in body weight of pregnant women who had high BMI before pregnancy, can lead to more frequent deliveries of newborns with low birth weight. Newborns born by obese mothers have higher risk for congenital malformations. Newborns of extremely obese pregnant women (BMI>31kg/m²) more often manifest neural tube defects along with other anomalies of central nervous system, anomalies of the great vessels and frontal abdominal wall defects. Pregnant women that had high increase in body weight during pregnancy usually enter next pregnancy with increased body weight.

In a retrospective study we analyzed the influence of obesity on pregnancy outcome. Maternal BMI (kg/m2) was calculated at the first obstetrical visit and defined as 30 kg/m2. Maternal outcomes included caesarean deliveries, gestational hypertension, and preeclampsia. Fetal/neonatal outcomes included newborns weight, macrosomia, major congenital malformations, stillbirth, neonatal death, and perinatal mortality. Women with normoglycemia were included. Maternal and infant outcomes correlated with BMI. A total of 1377 women fulfilled the criteria. Caesarean deliveries increased in overweight (27.8 %) and obese (30.5%). The incidence CS in women in normal BMI was 15.7%. Hypertensive disorders (gestational hypertension and preeclampsia) increased in overweight (9.2%) and in obese women (13.6%). Mean birth weight was 3268 ±760.4 g in normal BMI, 3470±715 g in overweight, and 3535±873g in obese (p < 0.05) mothers. Macrosomia occurred in 11.3%, 18.9%, and 23.5% of newborns of normal BMI, overweight, and obese mothers, respectively (p < 0.001). Congenital malformations occurred in 1.7%, 2.8% and 3.2% in normal BMI, overweight and obese women. Perinatal mortality was 0.5%, 1.2%, and 1.1% in normal BMI, overweight and obese mothers. Overweight and obese women have greater adverse pregnancy outcomes.

The prevalence of diabetes and overweight is increasing worldwide and hence strategies are needed to stop this increase. Women with prior gestational diabetes mellitus (GDM) are obvious target for this intervention as they have already been indentified at their young age as high-risk group. In Our study group the prevalence of the metabolic syndrome was 42, 2% in the previous GDM. Necessity for this group is to offer regular control of glucose metabolism, examination of lipid profile and plan how to modify and sustain their lifestyle to lower insulin resistance - central obesity, dyslipidemia and hypertension. These measures can reduce cardiovascular morbidity and the risk of progressing to overt diabetes.

Background. Pregnant vvomen vvith type 1 and type 2 diabetes mellitus are associated vvith an increased risk of congenital malformations, perinatal mortality, obstetric complications, and neonatal morbidity. Methods. We analyzed perinatal outcomes and the incidence of congenital malformations in offspring of type 1 and type 2 diabetic mothers from 1993 until 2008 years divided in the two periods. The aim of the study vvas to examine the cases of type 1 and type 2 diabetic mothers during the tvvo periods 1993. - 2000 (the first period) and 2001- 2008 (the second period) recorded by EUROCAT of Congenital Malformations. Results. In the first period there were 228 births after vvhere the mother had type 1 diabetes and 12 births vvhere the mother had type- 2 diabetes. In the second period there were 277 births after a pregnancy vvhere the mother had type 1 diabetes and 69 births vvhere the mother had type-2 diabetes. In the second period there were statistically significant higher number of deliveries by type 2 diabetic mothers (p

Background. In recent years, the basal insulin analogue Detemir has been introduced. It is developed to improve upon the limitations of Neutral Protamine Hagedorn insulin (NPH) and other conventional basal insulins, which have an inadequate duration of action, a marked peak glucose-lowering effect and variability in response from one injection to another. Detemir might help to overcome some of the barriers to insulin initiation and optimization, including concerns over hypoglycemia and weight gain. The efficacy and safety of insulin Detemir (Levemir®), a long-acting human insulin analogue plus insulin aspartat, were compared with NPH plus insulin aspartat for pregnant women with type-i diabetes mellitus (DM-i). Methods. In a randomized, parallel-group, open-labeled trial, 28 women with uncomplicated DM-1 (age 30.3 ± 4.6 years, HbA1c < 7%) were randomized to receive Detemir (2X daily) plus insulin aspartat (I. group ; n=14) and NPH (2X daily) plus insulin aspartat (II. group ; n=14). The trial period extended from first trimester (from 6-10 weeks) to 6 weeks postpartum. Results. Both treatment groups maintained good overall glycemic control during the study. At beginning of the study HbA1c did not differ between two groups: 6.56 ± 0.83:6.82 ± 0.58 ; n.s.). At the end of the study we found statistically significant decrease in HbA1c in I. group of patients (5.8 ± 0.74 : 6.4 ± 0.96 ; p 38th weeks of pregnancy), and newborns were healthy. Conclusion. Detemir was more effective than NPH in decreasing postprandial glucose concentrations. Overall safety and effectiveness of Detemir were comparable to NPH in pregnant women with DM-1.

Vascular endothelial growth (VEGF) factor and placental growth factor (PlGF) are key factors in physiological and pathological conditions of pregnancy. The aim of the study was to analyze whether serum levels of PlGF in mother’ s and umbilical blood are differentiated between healthy pregnant women and pregnant women suffering from type-1 diabetes mellitus. We performed a prospective study of 44 pregnant women with type 1 diabetes mellitus who did not have diabetes complications and of 34 healthy pregnant women of the adequate age and parity and the normal pregnancy course. Statistical analysis was performed using ANOVA, Student t-test, linear regression, and non-parametrical Man-Whitney U test. PlGF level in diabetic and healthy pregnant women from the 8th till the 15th week of pregnancy is comparatively low, and after the 15th week of pregnancy it increases fast till the 31st week of pregnancy when the value is the highest. After the 31st week of pregnancy there is a decrease of PlGF level. Comparing PlGF values between the research groups in certain weeks of pregnancy no statistically significant difference was found. PlGF values in serum of pregnant healthy women and pregnant women with type 1 diabetes mellitus do not differ in certain weeks of pregnancy.

Telemedicine in perinatology in Croatia is recent issue and the ways of major breakthrough are carried out. Numerous studies show benefits in perinatal care but the question of cost brings up consideration of true needs for telemedical interventions. Despite the telemedical network that exists for other specialities, due to a good road connections, there are no currently programmes that could help to develop single use of it in perinatology.

The placenta is a complex organ which plays the central metabolic role in pregnancy. This study was designed to investigate the effect of type 1 DM on the content of lipids in deciduas free placental tissue. It was realized by comparing fatty acid contents in placentae from normal term pregnancies with those from pregnancies complicated with type-1 DM. All pregnancies were terminated by cesarean section. 72 decidua free placental semples from term pregnancies were analyzed for fatty acid content. Group I consisted of 34 normal pregnancies. Group II consisted of 38 term pregnancies with type 1 DM. The placentae were cooled and washed immediately after delivery with Lactated Ringer’ s solution at less than 4º ; ; ; C. Decidua was cut away from the cotyledons and villous tissue was obtained from multiple cotyledons. The tissue was teased of blood vessels and minced into fine pieces. Extraction of lipids was performed (Folch). Thin-layer chromatography was performed on silicic acid impregnated paper. Gas chromatography of the fatty acid methyl esters was carried on a SRI 8610C GAS CHROMATOGRAPH, („ SRI Instruments Chromatography Systems, Torrance, CA, USA). Results. Demographic data from the two groups are shown that there is no statistically significant difference between the two groups in maternal age, gestational age and birthweight. The highest amount of PL in placental tissue in both groups were found. In type 1 DM were found decrease of FFA and CE (table 1). It was found higher levels of laurinic (12:0), myristinic (14:0) and lignocerinic (24:0) fatty acids in placentae of type 1 DM in total lipids.

It is about vein thrombosis due to ovarian hyperstimulation syndrome in diabetic pregnant women

Perinatal outcomes in insulin versus diet treatment for gestational diabetes mellitus

Trudnoća Tip 1 dijabetičnih majki bi morala biti shvaćena kao vrlo rizična i dvršena u bolničkoj jedinici koja omogućava dobru optetričku njegu.

IT is about angiogenic placental growth factors in mothers blood and umbilical cord in pregnant women suffering from type-1 diabetes mellitus

This paper reviews perinatal problems of autoimmune etiology of systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), immune thrombocytopenic purpura (ITP) and myasthenia gravis (MG) which are particularly associated with pregnancy loss and obstetric complications. SLE is disease of unknown etiology in which tissues and cells are damaged by deposition of pathogenic autoantibodies and immune complexis. Since SLE is predominantly a disease of young women, pregnancy is a frequent occurrence. Fertility rates are normal in patients with SLE, but the rate of spontaneous abortion and stillbirths is high (30-40 percent), especially in women with antiphospholipid antibodies. If severe renal or cardiac disease is absent and SLE is controlled, many patients complete pregnancy safely and deliver normal infants. Neonatal lupus occurs in infants but is rare, two syndromes are seen: a transient rash and congenital heart AV block. APS refers to the occurrence of thrombosis, recurrent miscarriage, or both in association with laboratory evidence of persistent antiphospholipid antibodies, either lupus anticoagulants (LAC) and/or anticardiolipin antibodies (ACA). It is designated as "primary" when it occurs in isolation, and "secondary" when it arises in association with other diseases such as SLE. Recurrent pregnancy loss is one of the defining diagnostic criteria of APS. ITP is an autoimmune disorder manifested by immune mediated thrombocytopenia. Neonatal alloimmune thrombocytopenia caused by movement of maternal alloantibodies directed against fetal platelet antigens across the placenta that is the most common cause of severe neonatal thrombocytopenia. These antibodies cause thrombocytopenia, which may result in intracranial hemorrhages. Myasthenia gravis (MG) often affects women in the second and third decade of life, overlapping with the childbearing years. The course of the disease is unpredictable during pregnancy ; however, worsening of symptoms occurs more likely during the first trimester and postpartum. MG can be well managed during pregnancy with relatively safe and effective therapies.

Information on the predictive value in normal and pregnancy complicated with type-1 diabetes mellitus outcome, of yolk sac (YS) measurement and YS morphology has been scanned. During first trimester, peripherally placed (within gestational sac) YS measuring 5 mm or less is likely to be normal. YS maybe smaller or larger of 5 mm in abnormal pregnancies, than in intact pregnancies of equal size. Aim: To compare the size and shape at transvaginal sonography (TVS) of YS in normal and type 1 diabetic pregnancies and to correlate these characteristics with perinatal outcome. Patient and methods: 60 healthy pregnancies and 60 pregnancies with type 1 DM underwent TVS in the first trimester to establish the normal size and shape: TVS was performed at least 2 times between 6-12 weeks of menstrual age (MA), and HCG was measured at he same day of TVS as well. We calculated the correlation coefficient between YS and MA, YS and crown-rump length, YS and gestational sac diameter, and YS and HCG. Student-t test and Mann-Whitney test were used for statistical analysis with SPSS 10 software. Results: The high statistical positive correlation was found between YS diameter and MA, crown-rump length and diameter of YS for both studied groups. The YS diameter in type-1 DM pregnancies was statistically significantly larger for MA, than that of healthy pregnant women. YS in type-1 DM showed slower regression after 10 weeks of MA than in healthy pregnancies. The unfavorable perinatal outcome in healthy pregnant women was connected with YS measuring 5 mm and less with hypoechogenic sonographic characteristics. YS measuring more than 6 mm were found in 30/60 of type-1 DM group. Perinatal outcome was favorable in 20/30 cytogenetic malformation occurred in type-1 DM group. It is unknown if abnormalities of YS are related primarily to YS or secondarily to embryonic maldevelopment. Gross change in its size and/or shape may indicate or reflect significant dysfunction of the maternal-fetal transport system in early pregnancy. The larger size of YS could be of maternal hyperglycemia and accumulation of nutritive secretions not used by embryo, resulting more frequently in diabetic embryopathy.

OBJECTIVE: The results of studies in type-1 diabetes mellitus pregnant patients (type-1 DM) for mid-trimester distribution of serum multiple of the median (MoM) concentrations of alpha-fetoprotein (AFP), unconjugated estriol (uE3) and human chorionic gonadothropin (hCG) are often conflicting. THE AIM OF THE STUDY: This study investigated the relationship between type-1 DM and maternal serum levels of AFP, uE3, and hCG. STUDY DESIGN: The serum markers AFP, uE3 and hCG during second trimester in 25 pregnant women with uncomplicated and well controlled type-1 DM have been compared with 327 healthy controls . METHODS: Competitive radio immunochemical procedures (2nd trimester Amerlax-M, Ortho Clinical Diagnostics, USA) were used. Serum markers were expressed as MoM concentration derived from the control samples, corrected for maternal weight. Gestational age was calculated by the last menstrual period (LMP) and verified by ultrasound not later than 10 weeks after LMP. Regression functions were used for adjustment of serum levels for weight . Mann Whitney test was used to calculate the statistical significance between two studied groups. RESULTS: Mean maternal weight in controls was 68.25± 10.31 kg, and in type-1DM group 72.16± 13.12 kg (p=0.3). There were no significant differences in the distribution of hCG, AFP and uE3 between these two cohorts. All three markers AFP, uE3 and hCG levels in well controlled type-1 DM pregnant patients were lower but not statistical significant when compared to the healthy controls. All pregnancies had favourable perinatal outcome. CONCLUSIONS In centres which offer appropirate medical facilities to their type-1 DM pregnant patients and reach optimal preconceptional and during pregnancy blood glucose surveillance, general adjustment of AFP, uE3 and hCG except for weight are no longer necessary.

Diabetes in pregnancy causes many problems both for a mother and a child. Patients and methods. In ten years period (1995 - 2004) 396 pregnant patients with type-1 diabetes mellitus were delivered. Following data were analyzed: age of patients, body mass index, weight gain during pregnancy, number and outcome of previous pregnancies, levels of HbA1c in each trimester of pregnancy, complications of labor and delivery, new born weight and height, perinatal mortality and morbidity, placental weight and patohistologycal findings. For statistical analyses we used statistical program SPSS vr. 10. The aim of the study was to analyze the mode of delivery, perinatal outcome in relation to gestational weeks, complications of diabetes mellitus and complications of pregnancy. Results. 396 type-I diabetic patients delivered 398 new born children (2 pregnancies with twins). 309 pregnant type-I patients were without diabetic complications, 29 pregnant patients with non proliferative retinopathy, 23 patients with proliferative retinopathy, 5 patients with peripheral neuropathy and 30 patients with clinically manifest nephropathy. Premature labor occurred in 81 out of 396 deliveries (21.5%) of type-1 diabetic women. Among premature delivered patients the rate of elective preterm delivery was 16.6% what is explained with increased incidence of other complications of pregnancy like fetal in compromise (n=35 ; 43.2%) and super-imposed pre eclampsia (n=31 ; 38.3%). In 15 (18.5%) out of 81 prematurely delivered pregnant diabetic patients pregnancy was terminated earlier than 37 week of gestation because of contractions. The incidence of respiratory distress syndrome in premature new born children was 14.8% (n=12). There were 93 (23.6%) spontaneous vaginal deliveries, 7 (1.8%) deliveries finished by vacuum extraction, and by cesarean section delivered 296 (74.7%) type-1 diabetic patients. There were 23 (5.8%) SGA newborns, 269 (67.6%) AGA newborns, and 106 (26.6%) LGA newborns. Perinatal mortality was 3.3% (n=13 ; 8 stillbirth and 5 neonatal death). Congenital malformations occurred in 10 (2.5%) newborns: one child with Potter' syndrome, 6 children with congenital heart malformation, one child with prosencephaly, and two children with multiple malformations. Four children with congenital malformations died in early neonatal period. During labor and delivery two complications were diagnosed: placental abruption and silent uterus [scare] rupture after previous cesarean section. In postpartum period 16% patients developed endometritis, and one patient developed deep venous thrombosis. Conclusion. The type-I diabetic pregnant patients must be considered a high risk obstetric patients and delivered in the unit that can provide experienced obstetric care, continuous fetal monitoring, and neonatal intensive care.

The aim of this study was to reassess the standards for birth weight of healthy newborns from Zagreb area, Croatia. We investigated the changes in birth weight since the last published data in 1982 in view of secular trend and recent changes in population demographic structure caused by the war. Our sample included all children born in 2001 at the Department of Gynecology and Obstetrics of the Zagreb Faculty of Medicine. To produce growth charts with percentile curves that show reliable correlation between weeks of gestation and birth weight, small number of data points in 28th - 37th week of gestation was supplemented with the data from the years 2000, 2002 and 2003. After exclusion of stillbirths, multiple pregnancies and high impact malformations, final sample consisted of 5, 036 deliveries. Four growth charts were constructed, separately by gender (male or female) and mother's parity (primiparous or mutiparous). In comparison to previously published standards, our study showed lower weight of newborns in 5th, 10th and 25th percentiles. The values of newborn weight in the 50th percentile were similar, while the birth weight of contemporary sample in 75th, 90th and 95th percentile values was greater. The heaviest newborns were found in male child - multiparous sub-sample (50th percentile for 40th gestational week was 3620 g), while the smallest weights were recorded in female child - primiparous sub-sample (50th percentile for 40th gestational week was 3350 g). The average increase of birth weight for all newborns between the present study and previous data was 57 g. Decrease in weight in children delivered after shorter gestation is likely explained with improvements in survival of preterm newborns of smaller weight. The increased weight in upper end of percentile curves is attributed to secular trend.

Splenic rupture in pregnancy or postpartum is a rare and frequently misdiagnosed occurrence. Failure to recognise it is common, and can be fatal for both mother and child. With all our highly developed diagnostic methods and equipment, aetiology of splenic ruptures in pregnancy remains a dilemma in many cases.

Placental sVEGFR-1, an antagonist of VEGF and PlGF, is upregulated in preeclampsia, leading to increased systemic levels of sVEGFR-1. Increased circulating sVEGFR-1 in patients with preeclamsia is associated with decreased circulating levels of free VEGF and PlGF.

Aim. To evaluate potential risk factors and perinatal outcome of pregnancies complicated with placenta previa in Croatian population of pregnant women recruited from the largest tertiary care perinatal center in Croatia. Methods. This retrospective case-control study included a total of 202 singleton pregnancies with placenta previa during a 10-year study period and 1, 004 randomly selected simple singleton controls. Data on potential risk factors for placenta previa development were carefully extracted from medical records, reviewed, and compared with a control group of women. Data were statistically analyzed with chi-square test and Mann-Whitney U test, and crude odds ratio (OR) with 95% confidence interval (95% CI) were provided. Results. The incidence of placenta previa was 0.4%. Factors significantly associated with a placenta previa development were advanced maternal age (especially >34 years, even after adjustment for high parity), gravidity of 3 and more (OR, 4 ; 95% CI, 2.5-6.6), more than one previous delivery (OR, 2.76 ; 95% CI, 1.7-4.3), history of previous cesarean sections (OR, 2.0 ; 95% CI, 1.17-3.44), abortions (OR, 2.8 ; 95% CI, 2.04-3.83), and presence of various uterine abnormalities (OR, 8.5 ; 95% CI, 1.75-44.5). The risk was significantly increased after two previous cesarean sections (OR, 7.32 ; 95% CI, 2.1-25) and after one previous abortion (OR, 4.8 ; 95% CI, 2.7-8.3). No difference between the groups was found regarding the history of previous placenta previa, drug abuse, and male sex at birth. Smoking history was significantly less frequent in women with placenta previa than controls (16.3% vs 25.6%, chi-square=7.9, p=0.007). The main perinatal complication was preterm birth, with 14-fold higher risk in women with placenta previa. Preterm infants of mothers with placenta previa were more likely to have lower first- (6 vs 10, p34 years, 3 or more previous pregnancies, parity of 2 and more, rising number of previous abortions, and history of previous cesarean section, but not child sex at birth, history of drug abuse and previous placenta previa. Smoking cigarettes was significantly less frequent in women with placenta previa. Preterm delivery still remains the greatest problem in pregnancies complicated with placenta previa.