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Pubična bol najčešće je prisutna u urednim trudnoćama i čest je simptom u trudnoći. Ipak, katkad, a osobito ako uzrokuje tegobe pri kretanju, jaka je i/ili perzistentna te ako je povezana s upalom dokazanom laboratorijskim parametrima, trebala bi uputiti na pojačan oprez. Diferencijalna dijagnoza trebala bi uključiti osteitis pubis – nebakterijsku, samoograničavajuću upalu pubične simfize koja ne ostavlja trajne posljedice, ali i puno važnije, osteomijelitis pubis – bakterijsku infekciju pubične simfize koja se rijetko vidi u trudnoći, a zakasnjelo dijagnosticiranje te kasno i neodgovarajuće liječenje mogu ostaviti dugoročne komplikacije kao što su fistule koje nalažu dugotrajno, katkad i kirurško liječenje. Multidisciplinarni pristup obvezatan je radi isključivanja svih potencijalnih uzroka pubične boli i ranog postavljanja dijagnoze osteomijelitisa pubične simfize. Prikazujemo dvije trudnice s pubičnom boli u trudnoći, no s različitom dijagnozom i liječenjem te povoljnim ishodom koji je rezultat multidisciplinarnog pristupa., Pubic pain frequently accompanies uneventful pregnancies and is a common symptom in pregnancy. Still, in some cases, especially when it is associated with walking difficulties, persistent and/or severe pubic pain, and inflammation that can be confirmed by laboratory parameters, it should be taken with additional caution. Differential diagnosis should include osteitis pubis, a non-bacterial, self-limited inflammation that leaves no permanent consequences, but also, more importantly, osteomyelitis of the pubic symphysis. This is a rare bacterial infection in pregnancy, important to be diagnosed in time and treated early and properly since it can leave serious long-term complications such as fistulas that require prolonged treatment and sometimes even surgery. A multidisciplinary approach is mandatory to exclude all the other potential causes of pubic pain and make a timely diagnosis of osteomyelitis. We present two patients with pubic pain during pregnancy, with two different diagnoses and treatment options, and a favorable outcome that was the result of a multidisciplinary approach.

PURPOSE: To compare diagnostic accuracy of sonographic cervical length (CL) measurement and uterine electric activity assessed by electromyography (EMG) in second trimester regarding prediction of preterm delivery (PTD). ----- METHODS: Prospective study of 308 low-risk women. Shortened CL was defined as ≤25 mm (≤5th centile), while raised EMG activity was defined as the presence of ≥20 action potentials in 20 min of assessment (≥95th centile). Outcome measures were diagnostic accuracy of both tests alone or in combination for prediction of PTD and early PTD (≤34 weeks). ----- RESULTS: The incidence of PTD was 23/308 (7.4%) while the incidence of early PTD was 9/308 (2.9%). Shortened CL and raised EMG activity were significantly related to PTD [prevalence-weighted likelihood ratio (pw-LR) 1.9, 95% CI 1.0-3.5 vs. 9.5, 95% CI 2.5-35.7], but not to early PTD (pw-LR 0.4, 95% CI 0.2-0.8 vs. 0.6, 95% CI 0.3-1.7). Significant predictive value for early PTD was found only if both tests were combined (pw-LR 4, 95% CI 1.3-14.3). ----- CONCLUSION: Shortened CL and raised EMG activity in second trimester have significant diagnostic accuracy regarding prediction of PTD in a low-risk population. However, in order to be useful as a predictor for early PTD both tests must be positive.

In this study, 205 nulliparous parturients were enrolled to receive either intermittent (n = 101) or continuous (n = 104) type of epidural analgesia in labour. The primary outcome was rate of caesarean deliveries, whereas secondary outcomes included rate of fundal pressure manoeuvres, duration of labour from application of analgesia, dose of anaesthetic and short-term maternal and neonatal outcome between two groups. Rate of caesarean deliveries was significantly increased in the continuous group (15/104 vs 5/101, p = 0.02), as well as rate of fundal pressure manoeuvres (24/104 vs 11/101, p = 0.02) and dose of fentanyl (100 [100-300] vs 187.5 [125-450] μg, p

Objective: To compare cervical length (CL) measurement and qualitative glandular cervical score (QGCS), assessed by transvaginal ultrasound in mid trimester, regarding the prediction of preterm delivery (PTD) in low-risk population. Study design: Prospective cohort study of 278 low-risk, asymptomatic, nulliparous women with singleton pregnancies. Cervical length and QGCS were evaluated between 16 and completed 23 weeks. Cervical length 24 mm or less was defined as shortened. The parameters evaluated in QGCS were: cervical mucus area and deepest invasion of cervical glands. Qualitative glandular cervical score 1 or less was defined as low. Results: Shortened CL was found in 6.1% (17/278) whereas the low QGCS was found in 5.7% (16/278). The incidence of PTD before completed 34 weeks was 2.1% (6/278) and between 34 - 37 weeks 3.2% (9/278). Low QGCS in comparison with shortened CL had better sensitivity (83.3% vs. 66.6%) for PTD before completed 34 weeks as well as better sensitivity (55.5% vs. 22.2%) for PTD between 34 – 37 weeks. Positive predictive value was 31.2% vs. 23.5% for delivery before completed 34 weeks and 31.2% vs. 11.7% between 34 – 37 weeks. Conclusion: Qualitative Glandular Cervical Score has the same if not better accuracy in comparison with CL measurement regarding the prediction of PTD.

This review summarizes the current knowledge about ultrasound scanning values in monitoring the structural and functional changes of the uterus and ovaries during the menstrual cycle.The views that ovulation is more frequently right sided have been challenged, with recent data suggesting that ovulation occurs randomly. A 'follicular wave phenomenon', providing a new model for ovarian function during the menstrual cycle, has been described. Follicular development occurs in a wave-like fashion and women with two waves have earlier endometrial development due to earlier increase of the dominant follicle estrogen production. Myometrial contractions during menstrual cycle should be considered in the assessment of endometrial thickness. Uterine-ovarian arterial blood flow impedance is important in understanding the normal physiology of the menstrual cycle and may be of use in assisted conception protocols.At present, ultrasound scanning has an important role in noninvasive assessment of endometrial and ovarian cyclical changes and may be of particular importance in assisted conception procedures. Further work is likely to help in understanding its full diagnostic potential.

Objective: To determine whether a correlation exists between increased uterine electrical activity and cervical length (CL) in the midtrimester of pregnancy. Method: In this case-control study, 312 asymptomatic nulliparous women underwent both uterine electromyographic assessment and ultrasound CL measurement between the 16th and 23rd weeks of a singleton pregnancy. The outcome measure was the difference in ultrasound CL measurement between the women found to have uterine action potentials on electromyography and those who did not. Results: Action potentials were detected in 66 (21.1%) of the 312 women ; and compared with the remainder of the study population, cervical length was significantly shorter in these women (35.7+/-8.9 mm vs 38.8+/-7.9 mm ; P

OBJECTIVE: To assess the accuracy of a sign of bacterial vaginosis and a sign of cervical insufficiency in predicting preterm labor (PTL, occurring in the 37th week or earlier) and early PTL (occurring in the 34th week or earlier) in a low-risk cohort of 316 pregnant women. ----- METHOD: Vaginal pH was assessed using test gloves and cervical length (CL) was measured by transvaginal ultrasound. A pH value less than 5.0 (the 95th-percentile threshold) and a CL greater than 26 mm (the 5th-percentile threshold) were considered normal. ----- RESULTS: There were 14 participants (4.4%) with an elevated vaginal pH and 15 (4.7%) with a shortened CL. The incidence of PTL (

Objective. The purpose of this study was to assess the diagnostic accuracy of different parameters (clinical and sonographic) in the prediction and management of retained products of conception (RPOC) in the late postpartum period. Methods. This was a prospective cohort 3-year audit. Predefined data were collected and compared with histopathologic (HP) reports after uterine evacuation. The primary outcome measure was the diagnostic accuracy of different clinical and sonographic parameters, including color Doppler imaging in diagnosis of RPOC confirmed on HP reports. Secondary outcome measures were complication rates influencing maternal morbidity. Results. In total, 93 patients (0.92% of all deliveries) were selected. The presence of gestational tissue was confirmed on HP reports in 58% of cases. The likelihood ratio of sonography alone was 1.47 (95% confidence interval, 1.25–1.84), whereas that of sonography combined with color Doppler imaging was 2.16 (1.3–3.59), providing statistically significant accuracy regarding the prediction of RPOC. Conclusions. Sonography alone or combined with color Doppler imaging has better diagnostic accuracy than the usual clinical parameters used for the prediction of RPOC. Key words: cervical dilatation; color Doppler sonography; placenta; residua; sonography; vaginal bleeding.

The management of preterm and term delivery of fetus in breech presentation is one of the most disputable issues in modern obstetric practice. Several years ago, one of the biggest randomized controlled studies in obstetrics, Term Breech Trial (TBT), tried to set up guidelines and resolve the question of the best method to deliver the fetus at term in breech presentation. The results of this study have shown that the policy of planned cesarean section reduces the risk of short-term adverse perinatal outcome, compared with the policy of planned vaginal birth. Many perinatal centers have accepted the recommendations from this study and different obstetric associations have implemented these results in their guidelines. On the other hand, TBT had some limitations, especially those connected with the impossibility of regular and objective comparison of these two methods of delivery. In addition, the same group of authors did not find differences in long-term outcomes between the planned cesarean section and vaginal delivery. Although the rate of planned cesarean section has increased following the publication of TBT, selective vaginal breech delivery is still very successfully used in the centers where doctors have the possibility to obtain experience in vaginal breech deliveries. The most common method of reduce the noncephalic presentation is external cephalic version at term. It reduces the incidence of noncephalic presentations at labor, thus reducing the number of cesarean sections as well. At this moment, there is not enough evidence to support cesarean section as the method of choice for delivery of preterm and term breech, having in mind obstetric indications and criteria. The decision whether to deliver vaginally or by cesarean section should be individual for each pregnant woman.

OBJECTIVE: This study was performed in order to assess the potential influence of placental implantation site on transabdominal electromyographic (EMG) assessment of the uterine electrical activity in the middle trimester of pregnancy. - - - - - STUDY DESIGN: In this prospective study 251 unselected, nulliparous asymptomatic women with a singleton pregnancy underwent transabdominal uterine EMG. Uterine electrical activity was recorded using bipolar electrodes placed on the abdominal surface for 20min. Regarding the placental implantation site and presence of action potentials (AP) pregnant women were divided into two groups: the anterior placenta group (APG) and the posterior placenta group (PPG). Outcome measures were differences in the median frequency (MF) and median amplitude (MA) of AP between the two groups. - - - - - RESULTS: Action potentials were detected in 56 women: 33/56 in the APG versus 23/56 in the PPG. The parameters analyzed (MF, p=0.527, Fisher's exact test, and MA, p=0.255, Fisher's exact test) did not produce any statistical significant differences between the two groups. - - - - - CONCLUSION: Background uterine EMG activity measured from the abdominal surface in the middle trimester of pregnancy does not depend on the placental implantation site.

BACKGROUND: This randomized controlled trial compared the diagnostic accuracy of the sonographic assessment of cervical length and clinical digital examination of the cervix in the second trimester regarding the prediction of preterm delivery in a low-risk population. ----- METHODS: In total, 282 unselected, asymptomatic women with singleton pregnancy randomly underwent sonographic cervical length measurement (study group, n=138) or clinical digital examination (control group, n=144) in the second trimester. In the study group cervical length or=95th percentile (>or=4) for our population was defined as high. The primary outcome measure was the diagnostic accuracy of both tests regarding the prediction of preterm delivery (

Neonatal respiratory distress syndrome (RDS) is one of the biggest problems in modern obstetrics. The incidence of RDS is 1%-2%. RDS is a condition of insufficient surfactant production. Surfactant is a complex molecule which is responsible for maturation of fetal lungs. The most important factor for insufficient surfactant production and pulmonary immaturity is shortening of gestation, i.e. preterm delivery. Antenatal corticosteroids for maturation of fetal lungs are in use for over thirty years. Corticosteroids decrease the incidence and intensity of RDS, the severity of intracerebral hemorrhage, and overall neonatal morbidity and mortality. The mechanism of corticosteroid action is probably induction of fetal pulmonary enzyme complex that is responsible for adequate surfactant production and regulation of pulmonary interstitial fluids. In this literature review, we analyze long- and short-term benefits and risks of single and multiple antenatal corticosteroid administration.

Objective: To assess the current problem of alloimmunization in a tertiary referral center in Croatia. The results obtained were compared to data published worldwide. Methods: Retrospective case analysis included women with Rhesus (Rh) alloimmunization treated in our department from January 1997 to January 2003. Data of interest included the incidence, prevention, diagnosis and treatment, with the final point being perinatal mortality and morbidity. Results: 23 pregnant women with alloimmunization were identified. The incidence was 0.138% of deliveries in the same time period. The median gestational age at diagnosis/referral was 22 (range 9–37) weeks. Anti-D antigen, alone or in combination with the other antigens, was responsible for more than 90% of the alloimmunization cases included. A defined protocol for prevention of Rh D immunization after previous delivery was not followed properly in 9/19 cases. A particular problem was prophylaxis after previous pregnancy termination (TOP), whereby only 1/14 woman received adequate prophylaxis and only after 2 of 5 TOPs. Regarding fetal treatment, 9/23 women had a total of 24 intrauterine intravascular blood transfusions. Overall, perinatal mortality was 13%, and the median gestational age at delivery was 34 (range 31–40) weeks. In all there were 31 fetal exchange transfusions after delivery performed in 14/20 newborns. Conclusion: Despite precise diagnostic criteria and modern therapeutic options, alloimmunization remains a problem in Croatia. It is still related with a high perinatal mortality and morbidity. The main problem is inadequate prevention.

Cervical insufficiency is one of the risk factors for late spontaneous miscarriage and preterm labor. As cervical insufficiency can reoccur in the every subsequent pregnancy, there is a need for precise diagnostic modality and therapeutic procedure in order to reduce perinatal mortality and morbidity. Traditionally, the diagnosis of cervical insufficiency was made based on the patient's history. In this cases the intervention in the form of the cervical cerclage, was not found to be useful, i.e. perinatal mortality and morbidity remained unchanged. It is a similar situation in cervical insufficiency suspected based on hysterosalpingography and clinical examination. Recently, ultrasound, or more precisely transvaginal cervical assessment--cervicometry, was introduced in order to assess the morphological changes indicative for cervical insufficiency. In this literature review, we analyzed ultrasound based markers of cervical insufficiency, with their specificity, sensitivity, positive and negative predictive value, as well as usefulness of cervical cerclage in such cases.