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Objectives The aim of this study was to assess pregnant women’s knowledge and attitudes regarding maternal COVID-19 immunization during pregnancy. Methods A cross-sectional study was performed in two teaching hospitals between May and October 2021 in Zagreb, Croatia. During antenatal clinic visit pregnant women were approached and asked to fill out a predesigned questionnaire about their knowledge and attitudes towards COVID-19 vaccination. Collected data was later analyzed. Results A total of 430 women participated in the study. Only 16% of women expressed their willingness to be vaccinated against COVID-19 if offered, despite that 71% of them believe that COVID-19 might be a serious illness in pregnant women. The most important obstacle in having better acceptance of the vaccines is in the assumption that the vaccines are not safe for pregnant women (73%) or the fetus (75%), or that the vaccines are not effective (41%). The relationship exists between acceptance of vaccination in general and willingness to get other vaccines in pregnancy and readiness to be vaccinated against COVID-19 in pregnancy. Only one out of 55 women who were not adherent to the current vaccination recommendations in Croatia would accept the COVID-19 vaccine during pregnancy if offered. 21 (5%) women stated that vaccination against influenza and pertussis during pregnancy is necessary and 13 (62%) of them would get vaccinated against COVID-19 if offered. Conclusions This study showed that the crucial reasons for refusing vaccination against COVID-19 among pregnant women in Croatia are the concerns about the vaccines’ effectiveness and safety. All healthcare providers should put more effort into education of pregnant women on risks of COVID-19, as well as on the benefits and safety of the vaccines.

Objective. The aim of this study was to compare intracervical (IC) and intravaginal (IV) application of prostaglandin E2 (PGE2) for labor induction in term pregnancies with unfavorable cervix. Study design. This prospective randomized trial included 212 pregnant women with term pregnancy and unfavorable cervix randomly assigned for labor induction with either IC (0.5mg) or IV (2mg) PGE2 formulation. Main outcome measured was time interval from labor induction to delivery. Difference in mode of delivery and adverse perinatal outcomes between two studied groups was also investigated. Significance was set at p < 0.05. Results. Studied groups did not significantly differ regarding main characteristics such as age, parity, body mass index or Bishop score. Women in IV group compared to those in IC group had shorter induction to delivery time interval (p

Objective To assess primiparous and multiparous women, and singleton and multiple pregnancies in a recently published randomized trial. Study design Secondary analysis of a randomized clinical trial was performed. In total, 500 women with sacroiliac dysfunction diagnosed in pregnancy were randomized into a study group (who received expert advice about therapeutic exercise) and a control group (who continued with their normal lifestyle habits). The outcome measures assessed were: pain intensity [visual analogue scale (VAS)] and degree of functional disability (Quebec scale) at enrolment and after 3 and 6 weeks. Primiparous and multiparous women, and singleton and multiple pregnancies in the study and control groups were analysed separately. Results Sacroiliac dysfunction was more common in primiparous women compared with multiparous women (84.70% vs 77.16%), and in multiple pregnancies compared with singleton pregnancies (86.53% vs 80.07%). For all four subgroups analysed in this secondary analysis, the reduction in pain intensity (p = 0.001) and the degree of functional disability (p = 0.001) were better in the study group compared with the control group. Better results for the two outcome measures were found when comparing primiparous and multiparous women in the study group at follow-up, but the difference in functional disability disappeared 6 weeks after enrolment (p = 0.383). There was no difference in the two outcome measures between singleton and multiple pregnancies 3 and 6 weeks after enrolment (p = 0.061, p = 0.489 and p = 0.741, p = 0.353, respectively). Conclusion Expert advice about therapeutic exercise is effective for the reduction of symptoms of sacroiliac dysfunction in all four subgroups (primiparous and multiparous women, singleton and multiple pregnancies). Earlier reduction of pain intensity and degree of functional disability were obtained in primiparous women compared with multiparous women in the study group.

Objectives There are growing evidence that exercise improves sacroiliac dysfunction symptoms in pregnant women; but no data about the effect of expert advice regarding this matter. The aim of this study was to assess the effectiveness of expert advice about therapeutic exercise on sacroiliac dysfunction in pregnancy. Methods A total of 500 women with sacroiliac dysfunction diagnosed in pregnancy were randomized in study and control group. Study group has conducted expert advice on therapeutic exercise; while control group continued with their normal lifestyle. Pain intensity by Visual Analog Scale (VAS) and degree of functional disability by Quebec scale were assessed at enrolment and after 3 and 6 weeks. Results Significantly better reduction in pain intensity assessed by VAS (p=0.001) and degree of functional disability assessed by Quebec scale (p=0.001) was noted in study compared to control group. Better results for both outcome measures were obtained if intervention was implemented earlier i.e., in second (p=0.001; p=0.001) compared to third (p=0.005; p=0.001) trimester. Strong positive correlation was found between pain intensity and degree of functional disability in both groups. Conclusions Expert advice on therapeutic exercise is effective in reduction of sacroiliac dysfunction symptoms during pregnancy. Trial registration ACTRN12617000556347

Objectives Induction of labour (IOL) is of increasing prevalence worldwide and reliable prediction of its successful outcome is important. Traditional clinical methods for predicting successful IOL outcomes have been supplemented with newer technologies. The aim of this study was to compare transvaginal sonographic (TVS) cervical length measurement with Bishop score in predicting labour induction outcomes. Methods This study included pregnant women with term pregnancy, indication for IOL and unfavourable cervix (Bishop score >6) who had TVS performed prior to IOL. Exclusion critetia were regular contractions, ruptured membranes, non-cephalic presentation, uterine scar and pregnancy complications potentially influencing study outcomes. Outcomes measured were successful IOL defined as achievement of active phase of labour and vaginal delivery. Receiver operating characteristic (ROC) curves were used to determine diagnostic accuracy and sensitivity, specificity, positive and negative predictive values. Statistical significance was defined as p Results Among 112 studied participants, IOL was successful in 101 (90.2%) pregnant women. AUC for Bishop score >2 was 0.831 (95% CI, 0.744–0.917, p2 was 0.754 (95% CI 0.648–0.861, p Conclusions Bishop score >2 is a better predictor for both successful IOL and vaginal delivery among induced women with term pregnancy and unfavourable cervix compared to cervical length

Gestational diabetes mellitus (GDM) has become a major public health issue and one of the most discussed topics in contemporary obstetrics. Due to rising prevalence of GDM worldwide impact and importance of this medical condition in good quality antenatal care is growing. GDM is associated with serious adverse perinatal outcomes and unfavorable long-term health consequences for both, mother and her child. Despite a great amount of knowledge accumulated regarding GDM, medical community remains indecisive and still debates the most appropriate diagnostic strategy, screening policy, and treatment options for pregnancies complicated with GDM. These unresolved issues generate controversies, motivate further research and contribute to the growing interest surrounding GDM. In this review we will discuss and try to explain some of them.

The aim of this study was to determine the association of maternal pre-pregnancy body mass index (BMI) and pregnancy outcome among pregnant women in Croatia. Women who gave birth in Croatia in 2017 were categorized into four groups according to pre-pregnancy BMI and analysed regarding maternal characteristics and perinatal outcomes. Among 32051 pregnant women 5.3% were underweight, 65.5% had normal BMI, 20.4% were overweight and 8.8% were obese. Overweight and obese women had a higher prevalence of induction of labour and delivery by caesarean section compared to normal-BMI women (p

Introduction/Background Aberrant Hedgehog (Hh) pathway signaling has been implicated in pathogenesis of several human cancers. Recent studies have indicated its active role in serous ovarian carcinomas. Smoothened protein (SMO), a transmembrane co-receptor in Hh pathway signal transduction, is inhibited in non-dividing cells, thus its disinhibition might be a trigger for uncontrolled cell proliferation and growth. Very few studies have explored the role of SMO in serous ovarian cancers. The aim of the study was to assess the expression of SMO protein and to explore the Smoothened gene promoter methylation in a cohort of serous ovarian carcinomas. Methodology SMO protein expression was immunohistochemically quantified in 40 high-grade serous carcinomas (HGSC), 12 low-grade serous carcinomas (LGSC), 20 normal ovarian and 9 normal fallopian tube samples (controls). SMO gene promoter methylation status was analyzed using methylation-specific polymerase chain reaction (MSP) in randomly selected HGSCs (n=10), LGSCs (n=10), and normal fallopian tube (n=9) samples. Kaplan-Meier survival plots were used to estimate the impact of SMO expression on patients‘ overall survival (OS). Results SMO nuclear expression was significantly higher in HGSCs and LGSCs compared with the fallopian tube samples (p=0.010 and p=0.003, respectively). LGSCs, compared with normal ovarian tissue, exhibited higher total, cytoplasmic/membrane and nuclear expression (p=0.000, p=0.001 and p=0.000, respectively). Comparing HGSCs and LGSCs, significantly higher total and cytoplasmic/membrane expression was found in HGSC (p=0.026 and p=0.030, respectively). SMO gene promoter was unmethylated in both LGSCs and HGSCs as well as in fallopian tube. In addition, the SMO protein expression had no significant impact on patients‘ OS (p=0.07). Conclusion Our data indicate the lack of SMO gene promoter methylation while a significant overexpression (particularly nuclear) of SMO protein characterized a substantial proportion of serous ovarian carcinomas. Further functional studies should elucidate the clinical relevance of these findings. Disclosure Nothing to disclose.

There are numerous factors known to affect the course of pregnancy and adversely impact perinatal mortality and morbidity. Some of them are avoidable and some are not. Avoidable factors can be either under responsibility of medical staff, health care systems and communities; or under responsibility of pregnant women. By modifying and changing their lifestyle, pregnant women can influence some avoidable factors and improve their pregnancy outcome. However, by ignoring them, they can cause potential damage to themselves and to their unborn child. There is no well defined responsibility for women concerning ways they influence their pregnancy outcome; they have a full right to make decisions about themselves and their unborn children, whether right or wrong. Good communication, education and understanding are essential when dealing with these issues.

Aim: The aim of this study was to present methotrexate treatment results in ectopic pregnancy and gestational trophoblastic neoplasia (GTN) at a tertiary referral center. Methods: A retrospective case-series study was conducted using data from records of patients treated with methotrexate during a 4-year period at Merkur University Hospital in Zagreb, Croatia. The study included 11 patients divided into 2 groups: 6 patients with ectopic pregnancy (5 tubal and 1 cornual) and 5 patients with low-risk GTN. Patients with ectopic pregnancy were treated with single dose methotrexate protocol (1 mg/kg/day intramuscularly), whereas those with low-risk GTN were treated with 8-day single-agent methotrexate along with leucovorin rescue protocol. Results: Among 5 tubal pregnancies, methotrexate treatment was successful in 4 (80%) cases, while one patient required surgical treatment. One case of cornual pregnancy also required surgical treatment after ineffective methotrexate treatment. Of 5 GTN cases treated with methotrexate, 3 required further EMA-CO treatment and 1 required additional surgical treatment, yielding the overall success rate of methotrexate treatment of 20%. Conclusion: Methotrexate is a valuable medication for treatment of appropriately selected ectopic pregnancy cases, while its usefulness and effi ciency in the treatment of low-risk GTN diseases has not been confi rmed., Cilj: Cilj rada je prikazati rezultate liječenja metotreksatom dviju ginekoloških bolesti u tercijarnom referentnom centru. Metode: Provedena je retrospektivna studija uporabom podataka iz povijesti bolesti pacijentica liječenih metotreksatom tijekom četverogodišnjeg razdoblja u Kliničkoj bolnici Merkur, Zagreb, Hrvatska. U studiju je uključeno 11 pacijentica koje su podijeljene u 2 skupine: 6 pacijentica s ektopičnom trudnoćom (5 tubarnih i 1 kornualna) i 5 pacijentica s gestacijskom trofoblastičnom neoplazijom (GTN) niskog rizika. Pacijentice s ektopičnom trudnoćom liječene su jednokratnom dozom metotreksata (1 mg/kg/dan intramuskularno), dok su pacijentice s GTN niskog rizika liječene osmodnevnim protokolom metotreksatom i leukovorinom. Rezultati: Od 5 pacijentica s tubarnom trudnoćom liječenje metotreksatom bilo je uspješno u 4 (80%) slučaja, dok je u 1 slučaju bilo potrebno kirurško liječenje. U 1 zabilježenom slučaju kornualne trudnoće liječenje metotreksatom bilo je neuspješno te je pacijentica zbrinuta kirurški. Od 5 slučajeva GTN liječenih metotreksatom u 3 slučaja bio je potreban nastavak kemoterapije po EMA-CO protokolu, dok je u 1 slučaju bilo potrebno dodatno kirurško liječenje te je ukupna uspješnost liječenja metotreksatom iznosila 20 %. Zaključak: Metotreksat se može smatrati učinkovitom terapijom u liječenju pažljivo odabranih pacijentica s ektopičnom trudnoćom, dok njegova uspješnost u kemoterapijskom liječenju GTN niskog rizika nije potvrđena.

OBJECTIVES To determine the incidence of sacroiliac dysfunction in pregnancy and assess its progress during the course of the pregnancy. METHODS The present prospective cohort study, performed between April 1, 2013, and May 31, 2016, enrolled primigravidae aged 25-35 years before 13 weeks of pregnancies who were experiencing back pain and did not have prior symptoms of sacroiliac dysfunction. Participants attended regular follow-up over 6 months and clinical functional tests were used to diagnose sacroiliac dysfunction. Women with sacroiliac dysfunction were assessed at 3-week intervals with a numeric pain rating scale (NPRS) and the pregnancy mobility index (PMI). RESULTS Among 1500 women who fulfilled the inclusion criteria, 1181 (78.7%) were diagnosed with sacroiliac dysfunction and 1143 completed all follow-up. Pain assessed by the NPRS gradually worsened from the first toward the third trimester (P

Aims The aim of this study was to determine the prevalence of diabetes among women 5 years after having gestational diabetes during pregnancy. Also, we sought to determine whether women who develop diabetes after GD during pregnancy differ from women who do not develop diabetes after GD during pregnancy. Methods This longitudinal study was performed using data from medical birth certificates and CroDiab diabetes registry. Women burdened with gestational diabetes in Croatia in 2011 were followed up until year 2016. Those registered in CroDiab registry were recognised as new patients with diabetes. Results Among 40,641 deliveries in 2011, gestational diabetes was reported in 1181 (2.9%) women. Among them 853 (72.23%) were followed up in CroDiab diabetes registry and 32 (3.75%) were identified as new patients with diabetes. Median time from childbirth to onset of diabetes was 29.12 months. The diabetes group did not significantly differ to the group without diabetes according to age (p = 0.587), level of education (p = 0.549) or marital status (p = 0.849) except that the diabetes group was significantly more obese than the group without diabetes (p = 0.002). Conclusions Based on CroDiab diabetes registry data prevalence of diabetes 5 years after pregnancy complicated with gestational diabetes is 3.75% in Croatia. Women with gestational diabetes during pregnancy, and especially those with higher BMIs, are an important risk group for developing diabetes later in life so screening and preventive measures should be oriented toward them in primary care settings.

Introduction. Gestational diabetes is a very important obstetrical issue and one of the most frequent metabolic disorders with differing prevalence among various populations. Aim. To determine the prevalence of gestational diabetes in Croatia and to detect main risk factors and adverse pregnancy outcomes associated with gestational diabetes. Methods. This is a cross sectional study performed using data from medical birth certificates collected in 2014 in Croatia. All pregnant women who gave birth in year 2014 were included in the study, excluding those with known diabetes mellitus type I or type II. Results. Among 39.132 deliveries in 2014 incidence of gestational diabetes was 4.67%. Women with gestational diabetes were older, more overweight before pregnancy but gained less weight during pregnancy (all P’s < 0.001). Onset of labour among women with gestational diabetes was less often spontaneous and more often induced. Also, women with gestational diabetes had a signifi cantly lower incidence of vaginal delivery and concomitantly a higher incidence of delivery by caesarean section. Women with gestational diabetes gave birth to infants with higher birth weight, but other neonatal complications were not more often present among neonates of women with gestational diabetes compared to neonates of women without gestational diabetes. Conclusion. Prevalence of gestational diabetes in Croatia based on medical birth certificates is 4.67% and gestational diabetes in Croatia is associated with important risk factors and adverse perinatal outcomes.

Odrediti i usporediti učinkovitost vježba kao vrlo važne terapijske intervencije za stabilizaciju sakroilijakalnih zglobova i potpornog pojasa kod sakroilijakalne disfunkcije u trudnoći. Metode: Randomizirana kontrolna studija koja uključuje 240 trudnica sa sakroilijakalnom disfunkcijom u trudnoći. Ispitanice su metodom slučajnog izbora podijeljene u dvije skupine po 120 u svakoj te po 40 u svakome tromjesečju. Ispitivana skupina provodila je vježbe za stabilizaciju sakroilijakalnih zglobova 3 puta na tjedan po 45 minuta, dok je kontrolna skupina nosila potporni pojas tijekom svakodnevnih aktivnosti. Nakon dva tjedna procijenjen je intenzitet boli numeričkom skalom za procjenu boli, dok je za procjenu stupnja onesposobljenosti prilikom svakodnevnih aktivnosti upotrijebljena Kvibečka skala. Rezultati: Intenzitet boli i stupanj onesposobljenosti uzrokovani sakroilijakalnom disfunkcijom rastu od početka prema kraju trudnoće. Prisutna je statistička značajnost u smanjenju intenziteta boli (P < 0,01; P < 0,05) i stupnja onesposobljenosti (P < 0,01; P < 0,05) nakon obje primijenjene intervencije. Postoji povezanost intenziteta boli i stupnja onesposobljenosti u ispitivanoj skupini (r < 0,56). Ta je skupina imala statistički značajno veće smanjenje boli i stupnja onesposobljenosti od kontrolne skupine (P < 0,05). Zaključak: Rezultati upućuju na bolju učinkovitost vježba za stabilizaciju sakroilijakalnih zglobova od nošenja potpornog pojasa kod sakroilijakalne disfunkcije u trudnoći, što naglašava ulogu fizioterapeuta kod ovog poremećaja, To determine the effectiveness of exercise as a very important therapeutic intervention to stabilize the sacroiliac joints and the supporting belt in pregnant women with sacroiliac dysfunction. Methods: A randomized controlled study involving 240 patients with sacroiliac dysfunction in pregnancy. The subjects were randomly selected into two groups, 120 in each with 40 per each trimester. The study group carried out the exercise to stabilize the sacroiliac joints 3 times a week for 45 minutes while the control group was wearing a support belt during routine daily activities. After two weeks pain intensity by numerical rating scale and the level of disability during daily activities by Quebec scale were ­assessed. Results: Pain intensity and the degree of disability caused by sacroiliac dysfunction increases from the beginning to the end of pregnancy. There was a statistically significant reduction in pain intensity (P

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.

UVOD: Izvođenje aktivnosti u postpartalnom periodu često je otežano zbog boli u mišićno-koštanom sustavu. Pojavnost boli odraz je još uvijek prisutnih prilagodbi mišićno-koštanog sustava i hormonalnih promjena s jedne strane te nepravilnog položaja pri dojenju i izvođenja aktivnosti svakodnevnog života (poput podizanja, kupanja, prematanja djeteta i sl.). CILJ: Detektirati najčešća područja boli u kralježnici u postpartalnom periodu ovisno o načinu poroda te utvrditi utjecaj boli na aktivnosti svakodnevnog života. MATERIJALI I METODE: Uporedba parova na uzorku od 192 rodilje (96 poslije vaginalnog porođaja i 96 poslije carskog reza) s bolom u kralješnici. U radu je korištena karta boli za detekciju bolnih područja i Indeks za procjenu funkcionalnosti (eng. Functional rating index) za detekciju utjecaja boli na izvođenje aktivnosti svakodnevnog života. REZULTATI: Dobiveni rezultati upućuju na cervikalnu kralježnicu poslije vaginalnog porođaja odnosno lumbalnu kralježnicu poslije carskog reza kao područje najčešće boli 3. postpartalni dan te na torakalnu kralježnicu poslije vaginalnog porođaja odnosno lumbalnu kralježnicu poslije carskog reza kao područje najčešće boli 2 mjeseca postpartalno. Rezultati ukazuju na statističku značajnost (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.

The aetiology or pre-eclampsia remains unknown, but it is widely accepted that the disorder is placental in origin. Failed trophoblast invasion of the maternal spiral arteries is accepted to be a central pathogenetic mechanism. However, the concept of failed trophoblast invasion is based on an assumption rather than direct scientific observation and there are other likely explanations for this phenomenon. The criteria for disease causation, such as the Bradford-Hill criteria are central to the ascertainment of causal relationships in modern medicine and these criteria are used here to assess the relationship between the placenta and pre-eclampsia. There is a strong association between pre-eclampsia and small (rather than large) placentas and an appropriate dose-response relationship does not exist. Failed trophoblast invasion of the spiral arteries is not specific to pre-eclampsia and occurs in other pregnancy complications and in up to 40% of biopsies from normal pregnancies and the relationship between placental ischaemia and pre-eclampsia is very inconsistent. A placental cause for pre-eclampsia is not consistent with the pathogenesis of other pregnancy complications like gestational diabetes mellitus. If pre-eclampsia was a disease of trophoblast origin, the risk of the disease should be determined by trophoblast rather than maternal factors. However, evidence from assisted reproduction shows that the risk of a woman developing pre-eclampsia is almost entirely dependent on maternal factors and independent of the embryo from which the placenta develops. There is currently no plausible proven mechanism by which the placenta causes pre-eclampsia. The syndrome typically gets worse, and can arise de-novo after the placenta has been removed, calling into question the role of the placenta in its causation. Uterine artery ligation in humans, unlike in animal experiments, is not associated with an increased incidence of pre-eclampsia, calling into question the role of poor utero-placental perfusion in the cause of the disease in humans. The signals that initiate maternal adaptive responses during pregnancy come from or through the placenta into the maternal milieu but as is the case with gestational diabetes mellitus, are not necessarily the cause of maternal disease. Pre-eclampsia causes renal, hepatic, myocardial, cerebral and adrenal ischaemia--that is ischaemia in all highly vascular organs. Placental ischaemia, like ischaemia in all other organs, is a consequence rather than a causal factor in the development of the syndrome and this has profound consequences for research strategies.

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.

The terminal parts of the uteroplacental circulation include spiral arteries and intervillous space. In pregnancy, spiral arteries are invaded by trophoblast leading to their physiological change. This is a necessary adaptation of pre-existing vessels for ongoing pregnancy. Blood flow in the intervillous space is fully dependent on blood flow in the spiral arteries. In pregnancies complicated by pregnancy-induced hypertension and intrauterine growth restriction, the physiological change of the spiral arteries was found to be incomplete. In this review, we will present the complex circulation of the spiral arteries and intervillous space in normal pregnancy and pregnancies complicated by pregnancy-induced hypertension, assessed by ultrasound techniques.

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

Annular placenta is an extremely rare morphological type of human placenta. It is commonly related to placental vessel abnormalities frequently causing antenatal and postnatal hemorrhage and operative delivery. Gravida 4 para 1 had an uneventful course of pregnancy and normal vaginal delivery followed by moderate postpartum hemorrhage. Hemorrhage was found to be local in origin but the placenta was annular in shape and the newborn was delivered through one of the openings. Annular placenta was not recognized before delivery. Its implantation site was in the lower uterine segment but high enough to allow the passage of the fetus through its annular defect and vaginal birth. To our knowledge, this is a first report of annular placenta ending in normal vaginal delivery.

Hemolitička bolest fetusa i novorođenčeta (HBFN) je posljedica majčine aloimunizacije na eritrocitne antigene fetusa. Aloimunizacija na D antigen iz Rhesus (Rh) sustava krvnih grupa ima posebno značenje budući da se radi o najjačem eritrocitnom imunogenu. Otkako se unatrag četiri desetljeća rutinski provodi postnatalna profilaksa imunizacije davanjem anti-RhD imunoglobulina RhD negativnim ženama, drastično je smanjen mortalitet zbog HBFN. Uvođenjem antenatalne profilakse klinički značajna HBFN je postala izuzetno rijetka. Sporadični teški oblici bolesti su uglavnom posljedica nedosljednosti u provođenju profilakse. U slučaju koji opisujemo nije prepoznat rizik imunizacije tijekom prve majčine trudnoće, te je izostala antenatalna prevencija. Nakon primarne imunizacije, u drugoj je trudnoći s RhD pozitivnim djetetom došlo do žestokog sekundarnog imunološkog odgovora majke i ranog razvoja teške fetalne anemije. Intrauterine transfuzije su spasile vitalno ugroženi fetus, ali su istodobno uzrokovale snažnu eritroidnu supresiju. Anemija koja je trajala mjesecima nakon rođenja liječena je ponavljanim transfuzijama, te humanim rekombinantnim eritropoetinom. Unatoč teškoj kliničkoj slici, kratkoročni ishod bolesti je povoljan i dječak zasada ima uredan rast i razvoj. Ipak, rizici kasnih posljedica, a posebice neurorazvojnih odstupanja nalažu daljnje pomno praćenje djeteta. Opisani slučaj ukazuje na trajnu aktualnost problematike Rh imunizacije u nas. Provođenje antenatalne imunoprofilakse je prvi i ključni korak u kvalitetnoj prevenciji HBFN., Hemolytic disease of the fetus and newborn (HDFN) is a consequence of maternal alloimmunization against fetal red blood cell antigens. Alloimmunization against D antigen from Rhesus (Rh) blood group system is particularly important because of its strong immunogenicity. During the last few decades, the introduction of RhD prophylaxis by postpartum administration of anti-D immunoglobulin to RhD negative women, now improved with antenatal prophylaxis, has led to a dramatic decrease in perinatal mortality and morbidity from HDFN. However, severe cases have not disappeared, mostly due to prophylaxis failure. In our case, inappropriate prenatal care during the first pregnancy in an RhD negative mother resulted in primary immunization. In the next pregnancy with an RhD positive child, the mother’s secondary immune response was extremely strong and led to early development of severe fetal anemia. The fetus survived thanks to the treatment with intrauterine transfusions (IUT), but they caused suppression of erythropoiesis, which lasted for months after birth. The long lasting, late anemia was treated with repeated postnatal red cell transfusions and recombinant human erythropoietin (rHuEPO). Despite the severity of HDFN in our case, the short-term outcome is good. The boy has normal growth until now, but due to the possibility of an adverse long-term neurodevelopmental outcome, this case requires continuous follow up. It also reminds of the fact that RhD alloimmunization remains an actual problem in daily routine. Antenatal prophylaxis is a crucial step in quality care of those who are at a risk of HDFN.

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.

Rh imunizacija kroz hemolitičku bolest fetusa i novorođenčeta (HBFN) najčešći je uzrok fetalne anemije tijekom trudnoće. Amniocenteza je godinama korištena kao metoda probira kroz određivanje OD 450 uz pomoć Lileyeva dijagrama, no u novije je vrijeme zamijenjena neinvazivnim određivanjem maksimalne brzine protoka u središnjoj moždanoj arteriji fetusa. Napredak je postignut i u liječenju HBFN gdje je konzervativno liječenje zamijenjeno intrauterinom intravaskularnom fetalnom transfuzijom. Također, učinjene su brojne promjene u profilaksi bolesti, ponajviše kroz davanje profilaktičkih anti D imunoglobulina svim Rh negativnim trudnicama. Ta tri postupka smanjila su perinatalnu smrtnost i pobol vezan uz HBFN., Rh immunization and hemolytic disease of the fetus and newborn (HDFN) are one of the most common causes of fetal anemia in pregnancy. Traditionally used amniocentesis and determination of OD 450 using Liley diagram is nowadays replaced by measurements of the peak systolic velocity of the blood flow in the middle fetal cerebral artery. Further advances are obtained in the treatment of HDFN where conservative treatment is completely replaced by intrauterine intravascular blood transfusion. As well as that, there is a marked improvement obtained by adapting the prophylactic protocol, with the most important, administration of anti D immunoglobulin to all Rh negative women. These three procedures resulted in reduction of perinatal mortality and morbidity related to HDFN.

Beta hemolitični streptokok iz skupine B (BHSB) može izazvati vrlo tešku bolest u fetusa, novorođenčadi i dojenčadi. Aspiracija zaražene plodove vode može dovesti do smrti ploda, konatalne pnumonije ili sepse. Prolazak kroz zaraženi porodni kanal može izazvati kolonizaciju, ranu bolest tijekom prvih 7 dana života i kasnu bolest nakon prvoga tjedna pa sve do trećega mjeseca. Prevalencija bolesti bila je prije provođenja intrapartalne profilakse od 2 do 15 na 1000 živorođenih od čega je 80% otpadalo na ranu, a 20% na kasnu bolest novorođenčeta. U trudnoći je od 6,5% do 36% žena koje nemaju simptome bolesti kolonizirano BHSB-om. Od 2% do 4% trudnica ima bakteriuriju uzrokovanu BHSB. Primjenom intrapartalne profilakse smanjena je učestalost bolesti u novorođenčadi na 0,5 na 1000 živorođenih u Sjedinjenim Američkim Državama (SAD), a u Hrvatskoj je učestalost rane BHSB bolesti smanjena na 10 na 1000 živrođenih. Smanjena je smrtnost oboljele novorođenčadi od 50% na 4%. Prve preporuke o prevenciji neonatalne BHSB bolesti u SAD izdali su 1996. godine Američko društvo optetričara i porodničara, Središte za kontrolu bolesti, te 1997. Američka pedijatrijska akademija; preporuke su bile obnovljene i izmijenjene 2002. godine. Prema preporukama iz 1996. postojala su dva pristupa prevenciji: jedan koji se temeljio na traženju rizičnih činitelja i drugi koji se temeljio na probiru svih trudnica u kasnoj trudnoći. Prema preporukama iz 2002. preporučuje se samo drugi pristup, jer je za više od 50% učinkovitiji. U Hrvatskoj nema nacionalnih preporuka za prevenciju bolesti uzrokovane BHSB-om u novorođenčadi. Prema američkim preporukama, ukoliko je trudnica imala bakteriuriju u trudnoći uzrokovanu BHSB-om u bilo kojem broju, ako je između 35 i 37 tjedana trudnoće imala pozitivne nalaze kulture vagine i rektuma na BHSB, ako je dijete u prethodnoj trudnoći imalo tešku bolest uzrokovanu BHSB-om, te ako rezultati kulture između 35 i 37 tjedana nisu poznati a u trudnice se radilo o trudnoći < 37 tjedana, plodova voda je curila  18 sati, te je trudnica u porodu imala temperaturu iznad 38,0°C, preporučena je intrapartalna profilaksa. Penicilin G je ostao lijek izbora za prevenciju i liječenje bolesti uzrokovane BHSB-om u novorođenčadi, alternativa je ampicilin. U slučaju preosjetljivosti na penicilin, bez opasnosti od anafilaksije potrebno je primijeniti cefazolin, a u slučaju opasnosti od anafilaksije klindamicin i eritromicin, ako je klica osjetljiva na ta dva antibiotika. U slučaju rezistencije na klindamicin i eritromicin potrebno je dati vankomicin. Sve lijekove potrebno je primijeniti intravenozno., Group B streptococcus (GBS) could cause severe fetal, neonatal and infant infection. Fetal aspiration of infected amniotic fluid can lead to stillbirth, conatal pneumonia, or sepsis. Infants can also become infected with GBS during passage through the birth canal, although the majority of infants who are exposed to the organism through this route become colonized on skin or mucous membranes but remain asymptomatic, while some of them develop early onset GBS neonatal disease during the first 7 days of life, while late GBS disease can develop after 7 days till three months of life. It is estimated that prevalence rate of GBS disease in neonatal period before introduction of intrapartal prophylaxis was 2 to 15 per 1000 live-births of which 80% were early and 20% late onset GBS disease. Approximately 6,5% to 36% of pregnant women are colonizated with GBS, most of them asymptomatic. It is estimated that bacteriuria caused by GBS complicate 2%–4% of pregnancies. Due to intrapartal prophylaxis prevalence rate of GBS decreased to 0,5 per 1000 live-births, while case fatality rate declined from 50% before era of intrapartal prophylaxis to 4% after introduction of intrapartal prophylaxis in United States of America (USA). In Croatia after introduction of intrapartal prophylaxis prevalence of early neonatal GBS disease declined from 15 to 10 per 1000 live-births. Recommendations for intrapartum prophylaxis to prevent perinatal GBS disease in USA were issued in 1996 by the American College of Obstetricians and Gynecologists and Center for Disease Control, and in 1997 by the American Academy of Pediatrics, which were updated in 2002. The guidelines from 1996 recommended the use of one of two prevention methods, a risk-based approach or a culture-based screening approach. According to updated recommendations, culture-based screening approach is only appropriate, because it is over 50% more effective. Recommendations for the prevention of GBS neonatal disease do not exist in Croatia. According to the American recommendations, if there was bacteriuria in pregnancy, or vaginal and rectal cultures between 35 and 37 gestational weeks were GBS positive or infant from previous pregnancy suffered severe early onset GBS disease, or if screening results were not known in pregnant women with

Cilj rada. Subjektivna procjena zadovoljstva porodom višerotkinja ovisno o položaju pri rađanju. Metode. Prospektivno istraživanje koje je uključilo sve višerotkinje koje su zadovoljile kriterije od kojih je osnovni bio da su rodile u različitom položaju u prethodnoj te sadašnjoj trudnoći (sjedeći – ležeći). Rezultati. Od 689 višerotkinja 116 je zadovoljilo sve kriterije te je uključeno u analizu. Najveći broj ispitanica (37,9%) je ocijenio svoje zadovoljstvo rađanjem sjedeći ocjenom 10, najvišom ocjenom na vizualno-analognoj skali (VAS), dok je prosječna ocjena bila 8,4. Na zadovoljstvo porodom nisu utjecali paritet trudnice (Pearson, p=0,336, r=0,09) ni porodna masa djeteta (Pearson, p=0,691, r=0,04), kao ni vođenje poroda uz infuziju oksitocinom (t-test za neovisne uzorke, p=0,679). Također, najveći broj ispitanica (85,4%) je izjavio, uspoređujući porod sjedeći s porodom ležeći, da je porod sjedeći puno bolji ili malo bolji od poroda ležeći. Zaključak. Iz dobivenih rezultata možemo zaključiti da rodilje uključene u ovo ispitivanje preferiraju porod sjedeći, a kako nema značajne razlike u učestalosti komplikacija, perinatalnog mortaliteta te učestalosti dovršetka trudnoće carskim rezom, mišljenja smo da bi takav položaj rađanja trebalo omogućiti i drugima rodiljama koje to žele., Objective. To assess the satisfaction of multiparous women with sitting position during labor and to compare it to the supine (lying on the back) position. Methods. Prospective study including all multiparous women who had experience of different position in labor (lying flat on the back and sitting position). Among 689 multiparous women who gave the birth in predefined study period, 116 fulfilled the inclusion criteria and are included in final analysis. Results. Largest number of women included in this study graded their satisfaction with sitting position at birth by 10, the highest grade on visual analogue scale (VAS); while an average grade was 8.4. The birth satisfaction wasn’t related to parity (Pearson, p=0.336, r=0.09), baby’s birth weight (Pearson, p=0.691, r=0.04) as well as to oxytocin use (t-test for independent samples, p=0.679). The largest number of women found sitting position during labor much better or slightly better compared to supine position. Conclusion. Based on our results it can be concluded that laboring women included in this study prefer sitting position. As there is no significant difference in complications, perinatal mortality and caesarean section rate we believe the sitting position should be offered as a choice.

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.

During the placentation process, the expression of various glycoproteins plays an important role in embryonal development. Alterations in DNA methylation caused by 5-azacytidine (5azaC) can disturb normal glycoprotein expression as well as the proliferative ability of trophoblast cells. In order to assess this, a single dose of 5azaC was injected intraperitoneally into pregnant rats during days 1-19 of gestation. Animals were euthanised on day 20 and placental weight, as well as glycoprotein composition, was analysed together with immunohistological assessment of the degree of proliferation of the trophoblast cells. The placental weight was found to be significantly smaller in animals treated by 5azaC during days 4 to 14 of gestation (p

Problem infekcije humanim papiloma virusom (HPV) kroz njezinu rasprostranjenost, načine prenošenja te potencijalne dugoročne posljedice – karcinom cerviksa, poznat je već godinama. Sekundarna prevencija karcinoma cerviksa kroz programe probira citološkom analizom po Papanicolau, uspjela je u velikom dijelu svijeta smanjiti posljedice perzistirajuće HPV infekcije. Međutim, unatoč napretku u metodama probira i liječenja preinvazivnih oblika i dalje se javlja veliki broj novootkrivenih slučajeva karcinoma cerviksa svih stadija. Dosadašnje metode liječenja HPV infekcije nisu se pokazale učinkovitima te bi moguće rješenje smanjenja učestalosti karcinoma bilo u primarnoj prevenciji. Primarnom prevencijom, odnosno HPV imunizacijom, za očekivati je smanjenje učestalosti i posljedica HPV infekcije. Sa ciljem toga dvije su farmaceutske kompanije razvile profilaktičko cjepivo kao oblik imunizacije protiv HPV infekcije nekim od tipova virusa. Jedno od njih dostupno je u Europi, Americi i brojnim drugim zemljama. U ovome pregledu, prikazani su do sada objavljeni rezultati oba cjepiva s posebnim osvrtom na registrirano, kvadrivalentno cjepivo (tipovi 6, 11, 16 i 18). Cjepivo svojom učinkovitošću od 90% za perzistirajuću infekciju te učinkovitošću od 100% u prevenciji posljedice HPV infekcija na ciljne organe anogenitalne regije, u periodu od 5 godina, daje ohrabrujuće rezultate za rutinsku primjenu u općoj populaciji., Human papilloma virus (HPV) infection is well defined and well known problem all around the world, mostly through its easy spreadness, acquisition and potential long term effects related to cervical cancer. Secondary ¬prevention of cervical cancer is defined through routine cytology screening programmes, but despite all efforts, there are several thousands of cervical cancer new cases diagnosed annually worldwide. The relationship between cervical cancer and HPV infection is already well known. Presently available methods for HPV treatment are not satisfactory and the possible solution is in primary prevention. Primary prevention or immunization against HPV infection may reduce the incidence and consequences of HPV infection on the long terms. Today, two pharmaceutical companies developed prophylactic HPV vaccine. One of them is already readily available in USA, EU and numerous other countries. In this review, we present the results of their clinical efficacy with the point on already registered and available quadrivalent prophylactic HPV vaccine (types 6, 11, 16 and 18). With more than 90% effectiveness in the preventing persistent infection and 100% effectiveness in the prevention of HPV related genital disease over the 5 years period of time, it gives a promising results for the use in general population.

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.

Objective. To estimate the degree of risk of the echogenic intracardiac foci (IEF) for fetal chromosomopathies and to determine its association with structural anomalies of the fetus. Material and methods. During the period of two years 190 pregnant patients had been send for fetal echocardiography. Examination had been performed by transvaginal¬ (12–17 weeks of gestation) or transabdominal approach (18 weeks or more of gestation). Results. IEF was observed in 17 fetuses, multifocal appearance was found in 2 out of 17 fetuses. In 3 cases IEF had resolved during the 8 weeks period of time. Additional structural anomalies were detected in 11 fetuses. In 2 fetuses trisomy 21 had been confirmed. Conclusion. A single soft marker as IEF is commonly encountered during the second trimester among the fetuses with chromosomal aberation. As do many sonographic markers IEF can be resolved during the pregnancy and often can be found in normal fetuses., Cilj rada je bio na vlastitom uzorku utvrditi u kojoj mjeri ultrazvučni nalaz hiperehogenih intrakardijalnih žarišta (IEF) pridonosi dijagnostici kromosomopatija i strukturalnih anomalija. Uzorak i metode. Tijekom dvije godine 190 trudnica između 12. i 39. tjedna trudnoće je primljeno radi fetalne ehokardiografije. Pregled je obavljen vaginalnom sondom od 5 MHz pri trudnoćama 12.–17. tjedna ili zavinutom abdominalnom sondom od 3,5 MHz nakon 17. tjedna trudnoće. Rezultati. IEF su nađeni u 17 fetusa, multifokalni u 2 od njih. U 3 fetusa su IEF u roku od osam tjedana nestali. U 11 fetusa su nađene dodatne strukturalne anomalije. Trisomija 21 je potvrđena u 2 fetusa. Zaključak. IEF su »meki« ultrazvučni biljezi fetalne aneuploidije, često su prolazni, a nalaze se i u eukariotičnih fetusa.

OBJECTIVE: This study was performed in order to compare the performance of classical two dimensional (2D) and three dimensional (3D) ultrasound, both with power Doppler technology, in the visualization of the placental vascular network during ongoing pregnancy. METHODS: 15 pregnant volunteers in the third trimester of pregnancy were examined by 2D and 3D power Doppler ultrasound. The aim of the study was to follow the branching of the main stem vessel as far as possible distally in the placenta. In addition, we assessed the visualization rate of terminal parts of uteroplacental circulation, radial and spiral arteries. RESULTS: There was no difference in the visualization of primary placental stem vessels by 2D and 3D power Doppler. However, 3D power Doppler performs better distally, with statistically significant differences at the level of secondary stem (p = 0.03), and even more prominent differences at the level of tertiary stem vessels (p = 0.0008). There was no difference in the visualization rate of radial and spiral arteries (p > 0.05). CONCLUSION: We found 3D superior to 2D ultrasound with power Doppler technology in the determination of the distal vascular branches of the fetal placental blood vessels.

This retrospective case analysis is performed in order to analyze post-partum hysterectomies in St. Mary's Hospital, Manchester during the last thirteen years and to compare it with the published results twenty years ago. We wanted to determine any possible changes in trends as well as to discuss the place of post-partum hysterectomy in modern obstetric practice. The main outcome measurements were incidence, maternal mortality and morbidity, indications and risk factors for post-partum hysterectomy in our hospital today and twenty years ago. Obtained results were compared to the same data and trends world-wide. There has been a fall in the incidence of both, elective and emergency post-partum hysterectomies in St. Mary's Hospital. All together, 28 women underwent post-partum hysterectomy electively or as an emergency in the period between 1985 and 1997. Mortality rate was 1 in 28 cases and morbidity rate was 65% in emergency group and 37.5% in elective group. The most common indication for elective post-partum hysterectomy is cervical intraepithelial neoplasia. The most important risk factor for emergency post-partum hysterectomy is previous cesarean section especially related to placenta accreta. There was no significant changes in trends, maternal mortality and morbidity and indications related to emergency post-partum hysterectomies today and twenty years ago, while the indications for elective cases were changed.

OBJECTIVE This prospective case series was performed in order to assess pregnancy outcome of women with tentative diagnosis of cervical incompetence undergoing selective and emergency cervical cerclage. METHODS Women recruited in this case series were divided into two groups. The selective group (n = 13) was chosen among pregnant women with a history suggestive of cervical incompetence, but no clinical evidence of threatened miscarriage. The definition of cervical incompetence was dilatation of internal cervical os with shortening of the cervix less than 25 mm and "funnelling" of 25% and more, found on the ultrasound examination of the cervix. The emergency group (n = 12) had clinical symptoms of threatened miscarriage. After exclusion of infection and in the absence of uterine activity they were counseled and offered cerclage. RESULTS After cervical cerclage all women were treated in the same way as per our clinical protocol and monitored until delivery. The median gestational age at delivery was 36 weeks (19-39) in the selective group and 33 weeks (22-38) in the emergency group. This difference is not statistically significant. There was 1 miscarriage (8%), 5 pre-term deliveries (38%) and 7 term deliveries (54%) in the selective group; and 4 miscarriages (33%), 3 pre-term deliveries (25%) and 5 term deliveries (42%) in the emergency group. Total neonatal survival was 19/20 (95%) if pregnancy exceeded 24 weeks, making perinatal mortality 5%. There was no differences between selective and emergency groups (1 of 12 in selective vs. 0 of 8 in emergency). CONCLUSION Overall, it can be concluded that both selective and emergency cerclage may have some benefits in patients with cervical incompetence. However, in the absence of a randomized-controlled study, these beneficial effects described cannot be considered as proved.

First trimester fetal malformation screening still represents a diagnostic challenge in modern obstetrics. Being solely dependent on ultrasound instrumentation, and the skill and experience of the operator, recently improved by introducing high frequency transvaginal approach and digital image processing. This opens a new field of ultrasound in obstetrics called sonoembriology. Until now sonoembriology in routine clinical practice resulted in numerous reports about early detection of rare anomalies and uncommon syndromes. The reported sensitivity of sonoembriology with a respect to a final pregnancy outcome was more than 60% of all malformations in total, while in combination with ultrasound screening in second trimester, increases to in excess of 80%. The commonest anomalies detected by sonoembriology are anomalies of the head and brain, heart, abdominal wall, unbilical cord, urinary tract and skeleton. There is an important role of sonoembriology in the assessment of the nuchal translucency in the screening programme for chromosomal anomalies. This changes the well-known concept “fetus as a patient” to “embryo as a patient” and opens new frontiers in fetal diagnosis and therapy.