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Decembra 2019 se je v Wuhanu na Kitajskem pojavil novi sev koronavirusa SARS-CoV-2, ki povzroča bolezen covid-19. Ta se kaže s simptomi in znaki prizadetosti zgornjih dihal: s kašljem, dispnejo, povišano telesno temperaturo, prisotne pa so lahko bolečine v mišicah, prebavne težave, izguba vonja in okusa. Znanje, pridobljeno na podlagi izbruhov ostalih človeških koronavirusov (angl. Severe Acute Respiratory Syndrome Coronavirus - SARS-CoV in Middle East Respiratory Syndrome Coronavirus - MERS-CoV), uvršča nosečnice in njihove plodove v ranljivo skupino, vendar pa trenutno velja, da nosečnice niso bolj ogrožene za težak potek bolezni covid-19. Po razglasitvi pandemije so sledili ostri ukrepi, katerih cilj je bil omejiti širjenje virusa. Zato se je življenje na vseh področjih korenito spremenilo. Tudi delovanje bolnišnic se je moralo prilagoditi na obstoječe razmere. V Porodnišnici Ljubljana smo se po razglasitvi pandemije covida-19 zavedali, da bo treba za optimalno oskrbo vseh nosečnic oblikovati smernice oz. kliničnih poti za vse zaposlene. Zaradi narave dela obsega dejavnosti ni bilo mogoče bistveno zmanjšati, zato smo se na sprejem morebitno ali potrjeno okuženih nosečnic morali pripraviti v izjemno kratkem času. Porodnišnico smo razdelili na tri območja po zgledu urgentnega bloka Univerzitetnega kliničnega centra Ljubljana: belo območje za zdrave nosečnice, sivo območje za nosečnice, pri katerih smo sumili na okužbo s SARS-CoV-2, vendar ta še ni bila potrjena, in rdeče območje, kjer smo obravnavali dokazano pozitivne nosečnice. Do konca maja 2020 sta v Ljubljanski porodnišnici rodili dve porodnici z dokazano okužbo z virusom SARS-CoV-2 in tri porodnice po preboleli okužbi z virusom SARS-CoV-2. Nobena od njih ni imela hujših simptomov bolezni covid-19, zato tudi intenzivno zdravljenje ni bilo potrebno.

Background. Postpartum haemorrhage from ruptured tissues can usually be diagnosed and managed properly. A problem exists with the occult haemorrhage without evident tissue trauma in which case a haematoma develops. Methods. After a normal delivery of the 41 years old secundipara after a previous caesarean in epidural analgesia a boy was born. Placenta was delivered spontaneously and perineal rupure sutured properly. About an hour after the delivery heavy pain was noted in the lower abdomen. Pelvic exam revealed a paravaginal haematoma and ultrasound scan coagulated and fresh blood behind the uterus. Rupture of the uterus was suspected and laparotomy revision performed. During the laparotomy there was no haemorrhage in the pelvic cavity, no uterine rupture but a large retroperitoneal haematoma extending to mesosigmoidal part of intestinum. Paravaginal heamatoma was evacuated vaginally and after half an hour the retroperitoneal haematoma diminished by 50 %. The patient received two blood transfusions. The blood loss was estimated as about 500 grams. The pulse and blood pressure were normal all the time. The laboratory values of haemoglobin was 96 g/l, haematocrit 0.30 before the operation and 93 g/l and 0.28 respectively 6 hours after. Beside anaemia the postoperative course was uneventful and the patient was dismissed from the hospital the 6th day postpartum. Conclusions. Although the laparotomy seems an excessive treatment it was the only way to exclude uterus rupture after a previous caesarean, heavy pain in the lower abdomen and blood behind the uterus noted on the ultrasound scan. In the non-urgent situation a CT scan could be performed to locate the blood accumulation and possibly exclude uterine rupture.

Background: The purpose of this analysis was to find whether the quality indicators of perinatal care in Slovenia change. Methods: We used the same quality indicators which are used in the European project Europeristat1 to compare the quality of perinatal care among the countries of the European Union. We used two 5-year periods, from 1998 to 2002 (reference period) and from 2003 to 2008 (observed period). Data for perinatal quality were collected from the National Perinatal Information System of the Republic of Slovenia.2 Statistical significance was tested using the Pearson’s chi-square test. Results: Between 1998 and 2002, there were 87.679 labours ending in the delivery of 88.678 new- borns, and between 2003 and 2008, there were 90.662 labours ending in the delivery of 91.736 babies. In the observed period (2003 do 2008) mothers had statistically significantly higher educational level, a higher percentage came to their first pregnancy examination before the 12th week of gestation (84.0 % vs. 75.3 %), a higher percentage conceived after assisted reproductive techniques (2.0 % vs. 1.7 %), and the incidence of multiple pregnancies was higher (1.7 % vs. 1.6 %). Significantly lower were the percentages of labours without medical interventions (34.7 % vs. 41.9 %) and of spontaneous onset of labour (74.0 % vs. 92.6 %). The percentages of induced labours and of elective cesarean sections increased dramatically (20.1 % vs. 6.6 % and 6.0 % vs. 0.9 %). The increase in the overall percentage of cesarean sections (14.8 % vs. 11.0 %) is mainly due to increased incidence of elective cesarean sections, but the percentage of operative termination of vaginal labour increased as well (3.1 % vs. 2.6 %). The incidence of episiotomies was lower (48.7 % vs. 51.0 %) and so was the incidence of 2nd degree perineal lacerations (4.5 % vs. 5.4 %), while the incidence of 3rd–4th degree lacerations was higher (0.3 % vs. 0.2 %). Transfusion was required in a lower percentage (0.3 % vs. 1.0 %), but the percentage of hysterectomies increased (0.1 % vs. 0.03 %). The incidence of eclampsia was the same in the two time periods (0.1 %). Among preterm deliveries, the higher percentage occurred between 32 and 36 gestational weeks (5.9 % vs. 5.5 %), while there were no differences among the deliveries between the 22nd and 31st gestational week. Stillbirths after the 22nd gestational week was the same in both periods, 5 per 1000 of all newborns, whereas early (2 per 1000 vs. 3 per 1000) and late (0.04 per 1000 vs. 0.4 per 1000) neonatal mortality rates were lower. In both time periods lethal malformations were the cause of death in 1/3 of stillborn babies 1/3 of neonates. Conclusions: Over the last years, an increase in operative deliveries and a decrease in deliveries without medical interventions have been observed in Slovenia. Despite the fact that mothers come to their first prenatal examination earlier in pregnancy than before and that they are more educated, i.e. they have a better socio-economic status, the incidence of preterm deliveries increases, while the mother’s health and the incidence of stillbirths have not changed sig- nificantly. The decrease in neonatal mortality rate should be highlighted.

Background. The study presents the experience with epidural analgesia (EPA) for pain relief in Izola General Hospital from 2003 to 2006, the differences of labour between epidural analgesia and without it and the parturients’ satisfaction. Methods. A retrospective observational study was performed. Data were compared between 214 parturients with EPA matched by 214 parturients without. The control parturient was the equiipara with a term birth and the cephalic presentation of fetus that delivered just before the parturient of the EPA group. Maternal age, labor length, rate of oxitocin use, instrumental deliveries and cesarean sections, Apgar scores and birthweights were compared. The questionnaire was used to estimate the pain in 62 parturients. Results. In GH Izola in 214 parturients (10 %) EPA was applied for labour pain relief in the period from July 2003 till December 2006. In the EPA group there was a statistically significance compared with the control group: higher parturients’ mean age (30.5 vs 28.7 y.o.; p < 0.0005), longer labour length (278 vs 222 min; p < 0.0005), higher oxitocin use rate (93.4 % vs 72.9 %; p < 0.0001) and higher instrumental delivery rate (vacuum extraction 14 % vs 1.9 %; p < 0.0001). The cesarean section rates were equal in both groups. Despite the higher instrumental delivery rate and the longer labour length in the EPA group there were no worse perinatal outcomes, neither was statisticaly significant difference in Apgar scores compared with the control group. The mean intensity of pain was highest before the EPA application (VAS 7), lowest during the transition stage (VAS 1.5) and some higher during the second phase (VAS 2.7). Most of parturients in the EPA group were satisfied; 92 % of them evaluated the EPA as good or very good. Conclusions. EPA is a very effective method for pain control during labor. The parturients’ satisfaction with this pain control method is appropriate. Despite the higher instrumental delivery rate and the longer labour length EPA didn’t worsen the perinatal outcome.