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Izhodišča: Telemedicina lahko izboljša glikemične in porodne izide nosečnostne sladkorne bolezni (NSB), čeprav še ni jasno, za katere posameznice naj bi bila telemedicinska orodja najbolj primerna. Namen naše raziskave je bil preveriti povezavo nekaterih psiholoških dejavnikov z glikemičnimi parametri pri ženskah z NSB, ki smo jih spremljali s telemedicinsko obravnavo. Analizirati smo želeli zadovoljstvo nosečnic s telemedicinsko obravnavo in opredeliti osebnostne značilnosti žensk, ki jim telemedicinska obravnava bolj ustreza. Metode: Vključene nosečnice so izpolnile Vprašalnik Velikih pet (angl. Big Five Inventory, BFI) in Vprašalnik o opolnomočenju v zvezi z vodenjem sladkorne bolezni (angl. Diabetes Empowerment Scale, DES). Podatke o samomeritvah koncentracije glukoze v krvi smo pridobili iz glukometrov. Povezanost med spremenljivkami smo izračunali s Spearmanovim koeficientom korelacije (Spearman ρ). Rezultati: V raziskavo je bilo vključenih 50 žensk (starost 32,0 ± 4,3 let) z NSB, ki so bile vodene telemedicinsko. Od osebnostnih dimenzij sta bili sprejemljivost (Spearman ρ=0.422, p=0.003) in vestnost (Spearman ρ = 0.346, p = 0.016) pozitivno povezani s skupno realizacijo meritev glukoze v krvi. Ugotovili smo povezavo med povprečno koncentracijo glukoze v krvi po obrokih in skupnim dosežkom pri Vprašalniku DES (Spearman q = 0.324, p = 0.030) ter dvema podlestvicama, tj. Obvladovanjem psihosocialnih vidikov NSB (Spearman q = 0.326, p = 0.029) in Nezadovoljstvom in pripravljenostjo na spremembe (Spearman q = 0.363, p = 0.014). Zaključek: Naši rezultati predstavljajo korak k opredelitvi skupka psiholoških značilnosti žensk z NSB, ki bi lahko bil pomemben napovednik učinkovitosti telemedicinske obravnave. Potrebne so še nadaljnje raziskave, tudi o drugih psiholoških vidikih.

Nosečnost je za ženske občutljivo obdobje, ki ga spremljajo pomembne fiziološke in duševne spremembe tako na čustveni kot na biološki, tj. hormonski ravni. Anksioznost je v obdobju tako velikih sprememb do neke mere normalen in prilagoditveni odgovor na situacijo. Vendar pa nekatere nosečnice izkusijo visoko raven anksioznosti, ki doseže stopnjo klinično pomembne motnje. Anksiozne motnje, ki se v peripartalnem obdobju najpogosteje pojavljajo, so generalizirana anksiozna motnja, panična motnja, fobije, obsesivno-kompulzivna motnja in posttravmatska stresna motnja. Pretekla anamneza razpoloženjskih in/ali anksioznih motenj je med najmočnejšimi napovedovalci razvoja peripartalne anksioznosti. Čeprav raziskovalno zanimanje za anksiozne motnje v peripartalnem obdobju narašča in vemo več o značilnostih in diagnosticirani ravni, pa so dokazi o klinični obravnavi – tako farmakološki kot nefarmakološki – še vedno omejeni. Tveganje in korist uvedbe farmakološkega zdravljenja vedno individualno pretehtamo. Prepoznavanje in obravnava anksioznosti med nosečnostjo sta bistvenega pomena in delujeta preventivno za psihiatrične motnje po porodu. Poporodna anksioznost matere lahko tudi pomembno ovira proces navezovanja matere in otroka, kar posredno tudi vpliva na razvoj otroka. Pri nosečnicah, ki so v psihiatrično obravnavo že vključene zaradi obravnavane duševne motnje, pa je sledenje, podpora in dobro interdisciplinarno sodelovanje lečečega psihiatra in ginekološke službe nujno potrebno.

Slovenija se glede količine popitega alkohola uvršča v vrh evropskih držav. Pitje alkoholnih pijač je del slovenske kulture, družbeno vezivo, neobhodni sestavni del družabnih dogodkov in praznovanj. Uživanje alkohola pogosto preseže mejo manj tveganega pitja in tako predstavlja pomembno tveganje zdravstvenih težav in blagostanja posameznika, njegove družine ter ožje in širše okolice. Etanol deluje opojno, škodljivo in povzroča zasvojenost, vse več pa ga uživajo tudi mladi odrasli (25–34 let), pri katerih je najvišja tudi rodnost. Uživanje etanola med nosečnostjo škodljivo vpliva na otroka ter lahko povzroči resne in nepopravljive posledice, ki jih poznamo kot spekter fetalnih alkoholnih motenj. Varne količine alkoholnih pijač in obdobja v nosečnosti, ko uživanje alkohola ne bi pomenilo tveganja za otroka, ne poznamo, zato v Sloveniji velja priporočilo, da se nosečnice uživanja alkoholnih pijač povsem vzdržijo.

Sifilis je kronična sistemska okužba, ki jo povzroča spiroheta T. pallidum. Metoda izbire za postavitev diagnoze so serološki testi, in sicer testi za treponemska in testi za netreponemska protitelesa. Nezdravljena okužba v času nosečnosti lahko povzroči bolezen tudi pri otroku z možnimi dolgotrajnimi posledicami zanj. V Sloveniji je presejalno testiranje nosečnic na sifilis ob prvem pregledu v nosečnosti obvezno. S pravočasno postavitvijo diagnoze in z zdravljenjem nosečnice lahko v veliki večini primerov preprečimo prenos okužbe na plod. Diagnozo kongenitalni sifilis postavimo s primerjavo seroloških preiskav pri materi in otroku. Zdravljenje je odvisno od tveganja za prisotnost kongenitalnega sifilisa pri otroku. Predstavljamo klinični primer obravnave nosečnice s pozitivnim presejalnim testom v nosečnosti ter obravnavo novorojenčka s sumom na kongenitalni sifilis.

Ob koncu lanskega leta je Zdravstveni svet Republike Slovenije potrdil program preprečevanja zgodnjih invazivnih okužb novorojenčkov, povzročenih s streptokokom skupine B, ki vključuje univerzalno presejanje nosečnic v 35.–37. tednu nosečnosti. V prispevku smo pregledali različne diagnostične metode presejanja in dejavnike, ki pomembno vplivajo na njihovo uspešnost tako v ginekološki ambulanti kakor tudi v mikrobiološkem laboratoriju. Bralca opozarjamo na pravilnost odvzema kužnine, mu predstavimo izbrano strategijo testiranja s kombinacijo obogatene kulture in molekularnega testiranja ter mu ponujamo seznam registriranih molekularnih testov, primernih za testiranje. V zadnjem delu prispevka razpravljamo o pomenu hipervirulentnega klona CC-17, ki povzroča večino invazivnih okužb novorojenčkov v Sloveniji, in o metodah, s katerimi ga prepoznamo.

Izhodišče: Joga sodi med najbolj priporočljive oblike telesne dejavnosti nosečnic. Ni povsem jasno, ali so koristi vadbe joge v nosečnosti večje od koristi drugih oblik telesne dejavnosti. Namen članka je predstaviti sistematični pregled randomiziranih raziskav, ki so učinke vadbe joge primerjale z učinki drugih oblik telesne dejavnosti v nosečnosti. Metode: Pregledali smo zbirko Medline. Uporabili smo deskriptorja iz tezavra Medical subject headings (Mesh) joga (»yoga«) in nosečnost (»pregnancy«). Vključili smo randomizirane raziskave, objavljene med letoma 1996 in 2019, ki so vadbo joge primerjale z drugo obliko telesne dejavnosti v nosečnosti. Rezultati: Od leta 1996 je bilo objavljenih 20 randomiziranih raziskav, ki so preučevale učinke joge na perinatalne izide. Le pet raziskav je primerjalo učinke joge z učinki drugih, za nosečnice priporočenih oblik telesne dejavnosti. V primerjavi z vodeno telovadbo ali redno hojo je bila vadba joge v nosečnosti povezana z manjšim tveganjem za duševne motnje, bolezni zvišanega krvnega tlaka, nosečnostno sladkorno bolezen, zastoj plodove rasti in prezgodnji porod. Zaključek: Joga je varna oblika telesne dejavnosti v nosečnosti, ki ugodno vpliva na zdravje nosečnice in ploda. Do danes objavljeni podatki kažejo, da so koristi vadbe joge v nosečnosti lahko večje od koristi drugih oblik telesne dejavnosti.

Slabokrvnost je najbolj pogost simptom v nosečnosti. Zaradi razvoja zarodka in hitre rasti ploda se močno povečajo potrebe organizma po železu in vitaminih. Zato je slabokrvnost zaradi pomanjkanja železa daleč najbolj razširjena oblika slabokrvnosti v nosečnosti. Anemija v nosečnosti je opredeljena z ravnijo hemoglobina (Hb), ki je manjša od 110 g/L. V normalni nosečnosti se sestava krvi pomembno spremeni. Povečanje celokupnega volumna krvi in hemostatske spremembe so fiziološke spremembe, ki omogočajo, da porodnica brez posledic prenese normalno izgubo krvi med porodom. Plazemski volumen se v nosečnosti poveča za 50 %, masa eritrocitov pa za 18 – 25 %, odvisno od razpoložljivega železa. Te spremembe povzročijo razredčitev koncentracije hemoglobna, kar poznamo kot fiziološko slabokrvnost v nosečnosti. Fiziološka slabokrvnost doseže vrh v 32. tednu nosečnosti. Zaradi fizioloških sprememb odkrijemo s presejalnimi testi v nosečnosti mnogo slabokrvnosti, ki bi sicer ostale neodkrite. Povečane ali spremenjene prehranske in presnovne zahteve v nosečnosti povzročijo, da je slabokrvnost zaradi pomanjkanja železa (sideropenična anemija) bolj pogosta. Prva nepravilnost v biokemičnih izvidih, ki kaže na pomanjkanje železa v nosečnosti, je zmanjšana koncentracija feritina (na pomanjkanje železa lahko sklepamo že, ko je vrednost feritina manjša od 20–30 g/L). Feritin je stabilen in zadovoljivo zrcali zaloge železa, za razliko od vrednosti serumskega železa. Zato učinkovito dodajanje železovih pripravkov in s tem preprečevanje sideropeničnih anemij lahko pričnemo že zelo zgodaj. Tako na zelo enostaven način učinkovito preprečimo nastanek zapletov v nosečnosti, ob porodu in v poporodnem obdobju. Slabokrvnost v nosečnosti je povezana s višjo pogostnostjo za prezgodnji porod, nizko porodno težo, z nujnostjo uporabe transfuzije ob in po porodu ter s poporodno depresijo.

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.

Fetalna in neonatalna aloimunska trombocitopenija (FNAIT) je posledica transplacentarnega prenosa in vezave aloimunskih protiteles na trombocitne antigene otroka, ki jih je podedoval od očeta. Do aloimunizacije matere proti trombocitnim antigenom lahko pride tekom nosečnosti, kot tudi ob transfuziji trombocitov. FNAIT je redka bolezen, ki lahko poteka popolnoma brez bolezenskih znakov ali pa ima otrok znake hemoraške diateze. Njen najhujši zaplet je znotrajlobanjska krvavitev, zato sta zgodnja diagnostika in v primeru indikacije ustrezno zdravljenje zelo pomembna. Po podatkih iz literature je ocenjena pojavnost FNAIT 1 na 1000-2000 živorojenih. Pojavnost FNAIT v Sloveniji ni znana. Namen opravljene retrospektivne raziskave je bil ugotoviti pojavnost in etiologijo FNAIT v Sloveniji ter klinično sliko bolnikov s FNAIT. Rezultati raziskave, v kateri smo analizirali izvide transfuzijskih preiskav za dokaz trombocitnih protiteles pri novorojenčkih ali materah, so pokazali veliko nižjo pojavnost. V obdobju od leta 1996 do leta 2016 je bilo v Sloveniji potrjenih 39 primerov FNAIT, povprečno 2 na leto, medtem ko je bilo prošenj za dokaz trombocitnih protiteles pri novorojenčku ali materi povprečno 9 na leto. Pojavnost FNAIT je torej v Sloveniji 1 na 10.000 živorojenih. Kljub temu, da je ocena pojavnosti zaradi retrospektivne analize najverjetneje podcenjena, menimo, da omenjeni rezultati potrjujejo naša klinična opažanja, da je FNAIT poddiagnosticirana. Prispevek zato, poleg rezultatov retrospektivne raziskave o pojavnosti, etiologiji in klinični sliki FNAIT v Sloveniji, predstavlja pregled trenutnega znanja o FNAIT, saj želimo, da se na omenjeno bolezen, ki je lahko življenje ogrožajoča, pogosteje pomisli in ustrezno ukrepa.

Background: The purpose of the research was to determine the prevalence and location of diastasis recti abdominis muscle (DRA) during pregnancy and puerperium in women in the Ljubljana maternity hospital. Methods: The study sample included sixty randomly selected women; forty-five pregnant and postpartum women were recruited from the Ljubljana Maternity Hospital, and fifteen non-pregnant women from the larger Ljubljana area as a control group. All women were examined for the presence or absence of diastasis recti abdominis muscle along with the most and least likely location along the white lines. The measurements were performed by the finger-width method. Results: The findings indicate that the diastasis recti abdominis muscle increases with the progression of pregnancy. In the case of non-pregnant women, the diastasis is not present. The presence of DRA was first observed in the second trimester of pregnancy (9.5 %) and was most common in the third trimester (52.4 %). After birth, the incidence decreased (38.1 %). The majority of diastasis recti abdominis cases were observed in the umbilical area (52.6 %) in the third trimester. In the puerperium group three days after childbirth the diastasis below the umbilicus was most common (60.0 %) and slightly less common above the umbilicus (53.8 %). Conclusion: Diastasis recti abdominis muscle during pregnancy and after childbirth is a common condition. It is therefore recommended that all women should be timely examined for the presence of DRA before and after birth along the linea alba to start timely and adequate physiotherapy treatment. Health professionals as well as sports teachers and coaches who work with pregnant and puerperium women should be educated/trained in the field of testing and treatment of diastasis recti abdominis muscle.

Background. Multiple pregnancy can be prevented by an elective single blastocyst transfer. The aim of this prospective study was to evaluate the effect of blastocyst development and morphology on the outcome of single blastocyst transfer. Methods. In this study 157 women with single blastocyst transfer were included; their mean age was 33.6 years, range 20–42. Embryos were cultured to the blastocyst stage and evaluated using the Gardner’s classification. An elective single blastocyst transfer was performed in 83 women although 2 or more blastocysts developed (Group 1) and in 74 with only one developed blastocyst (Group 2). Results. In Group 1 (2 or more blastocysts) the pregnancy rate was a significantly higher than in Group 2 (1 blastocyst only) (39.8 % vs. 23.0 %; P < 0.05). After the transfer of a single expanded blastocyst no statistical difference in the pregnancy rate between the two groups was observed (45.5 % vs. 44.6 %). A significantly higher pregnancy rate was found after the transfer of one expanded blastocyst with a good embryoblast and trophoblast morphology compared to the transfer of a single early blastocyst (45.6 % vs. 7.1 %, P < 0.05). Conclusions. After single blastocyst transfer, the likelihood of achieving a pregnancy is higher in women with 2 or more blastocysts developed. And also the likelihood of achieving a pregnancy is higher with an expanded blastocyst transferred with good embryoblast and trophoblast morphology. The blastocyst development is the main predictor of pregnancy, which may reflect the embryonic genetic status.

Background. Sartans are commonly prescribed drugs for treatment of hypertension among general population. Data on their fetal toxicity are limited to small uncontrolled series and case reports; first such case was described in 2001. It is a well known that sartans therapy in the second and third trimesters of pregnancy is associated with nephrotoxic effect on fetus which results in oligohydramnios, fetal hypertension, renal insufficiency and fetal or neonatal death. Therapy with sartans is found only among pregnant women with diagnose of preexistent chronic hypertension and where sartans were prescribed as primary chosen therapy. Our aim is to describe samples of pregnant women who received sartans during their pregnancy. Methods. We looked over labour and delivery records of all pregnant women, who delivered during the year 2002 and 2006 at Department of Obstetrics and Gynecology, University Medical Center Ljubljana. We analyzed courses of pregnancy for those women who received sartans during pregnancy. Results. During the period we identified five hypertensive women who were exposed to sartans in pregnancy. Two of them were taking medications in the first trimester, course of their pregnancy was normal and the baby was delivered healthy and at term. Another pregnant woman who was also treated with sartans in the first trimester gave birth to a term baby with polydactyly. In our fourth case the therapy with irbesartan ceased in the second trimester of pregnancy when oligohydramnios was described. After stopping the drug, amniotic fluid volumes returned to normal. At 29 gestational weeks, a pathological cardiotocogram was noted and an emergency caesarean section was performed. The baby suffered from severe immaturity. The last case was a pregnant woman with chronic renal failure and arterial hypertension. Therapy with losartan and nifedipine was stopped at the end of second trimester. At the time oligohydramnios was also diagnosed. It persisted until spontaneous delivery at 27 gestational weeks. Aside from immaturity, the newborn suffered from transitional renal impairment. Conclusions. All three pregnancies, where sartans were administrated during the first trimester, ended favorably. From relatively adverse reports we gather that sartan therapy during first trimester of pregnancy probably does not present a higher risk for fetal malformations. Both other pregnancies, where therapy with sartans was stopped in the second trimester were complicated by oligohydramnios. In one of the two, oligohydramnios regressed spontaneously after the therapy had been stopped. In the last case reduced amniotic fluid persisted and it resulted in reversible renal insufficiency of the newborn. A literature review of recent articles reveal the risk of fetal nephrotoxicity due to sartans administered to the mother still during second half of the pregnancy. Renal insufficiency may be reversible or it may persist after cessation of sartan therapy. Based on data available from the literature and from our own five case reports, we can conclude that women who are treated with sartan at the childbearing age should be very well informed of possible teratogenic effects of the therapy. In case of unplanned pregnancy the therapy should be stopped as soon as the pregnancy is documented. However, additional studies are needed to better define the effect of sartans on the pregnancy.

Background: Pregnancy-related pelvic girdle pain (PGP) refers to the pain in the lumbosacral region, the sacroiliac joints and the symphysis pubis joint. The results of the high methodological quality studies indicate that the point prevalence of pregnant women suffering from PGP is about 20 %. Pregnancy-related PGP requires a comprehensive physiotherapy assessment in order to make or confirm a diagnosis, plan the treatment and evaluate the patient’s condi- tion. Physiotherapy assessment includes clinical diagnostic tests which should satisfy the criteria of safety, feasibility, reliability, sensitivity, specificity and validity. The aim of the present paper was to systematically review the literature on clinical diagnostic tests of PGP in order to determine which clinical tests meet the necessary criteria and are appropriate for clinical examination of PGP in pregnancy and postpartum. Methods: PubMed, Cinahl, Embase, Index Medicus databases and the Cochrane controlled trials reg- ister from 1980 to 2008 were searched using the key words, pregnancy/pelvic girdle pain, pregnancy/clinical tests/sacroiliac joint/symphysis pubis. Only the articles/texts in English and Slovene were reviewed unless translated abstract was available. Additional manual searches of the reference lists in books and review articles were undertaken. Along with the randomized clinical studies the literature search encompassed also the basic studies. Results: Nine studies evaluating the tests for clinical examination of the pregnancy-related PGP met the criteria for inclusion in this review. The studies evaluated and analysed six provocation tests for the sacroiliac joint, namely, the Posterior pelvic pain provocation test (P4), Patrick’s Faber test, palpation of the long dorsal ligament, compression test, separation test, Menell’s test as well as two provocation tests for the symphysis pubis joint (pain palpation and a modified Trendelenburg test) and one functional pelvic girdle test to assess the impairment (Active Straight Leg Raise –ASRL). The tests exemplifying the highest level of specificity and reliability to identify the pain in the sacroiliac joint proved to be the Posterior pelvic pain provocation test, Patrick’s Faber test and the palpation of the long dorsal ligament of the sacroiliac joint. According to the studies, the palpation and a modified Trendelenburg test are most appropriate to identify the pain, abnormalities and symphysis pubis asymmetries. The active straight leg raise is recommended as a functional test of the pelvic girdle. Conclusions: PGP can be diagnosed by pain provocation tests and pain palpation tests. Most of the evalu- ated tests have a very high specificity indicating that, if negative, it is likely that a patient does not suffer from pain in the pelvic girdle during pregnancy and in the postpartum period. The sensitivity is, however, lower. It is therefore recommended to perform all the tests, not to rule out PGP, if one test is negative. All the recommended tests are simple to carry out and appropriate for clinical examination of pregnancy-related PGP.

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. Preimplantation genetic diagnosis offers early investigation of embryos in couples with a high risk for offspring affected by a genetic disease. We report indications and results associated with the PGD program conducted at Gynecology Clinic Ljubljana from June 2004 to December 2008. Methods. The retrospective analysis includes sixty cycles performed in 34 couples enrolled in the PGD programe. Embryos were biopsied on the third day and the genetic analysis was performed using the FISH and PCR methods. Embryo transfers were carried out on the fifth day. Results. The main indications were chromosomal abnormalities (67 %), followed by recurrent miscarriages (16 %), autosomal dominant and recessive diseases (9 %), and X-linked diseases (6 %). Sixty cycles were performed and 48 embryo transfer procedures. There were 15 clinical pregnancies resulting in clinical pregnancy rate 25 % per cycle and 37.5 % per embryo transfer. A total of eight unaffected children were born, and two pregnancies are still ongoing. Conclusions. PGD is technically a very challenging procedure. Superior knowledge and communication between geneticists and reproductive medicine scientists is mandatory for successful PGD procedures. PGD has gained a place among the choices offered at Gynecology Clinic Ljubljana to couples at risk of transmission of genetic disease.