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Episiotomy is obstetric procedure during which the incision extends the vestibule of the vagina during the second stage of labor. Episiotomy was extensively spread with gradual increase of rates in the first half of the 20th century and was performed medio-laterally in all nulliparous women with the idea to protect fetal head from trauma and pelvic floor from injuries. However, reports claiming that episiotomy had no such benefits were published. It was shown that routine medio-lateral episiotomy did not protect against the appearance of urinary incontinence after vaginal delivery, while the risk of anal incontinence could be increased. The role of episiotomy in development of pelvic floor dysfunction remains quite unclear. Due to the mentioned reason, restricted episiotomy approach should be accepted. The origin of stress incontinence during pregnancy is controversial and not definitely scientifically proven. Pregnancy per se and older age at first delivery may have impact on the onset of pelvic floor dysfunction. Urinary incontinence in pregnancy increases the risk of later urinary incontinence, both postpartum and later in life. Vaginal delivery is just one of the potential risk factors for development of urinary incontinence. Mechanical pressure by fetus on the pelvic floor structures, limited denervation of the pelvic floor and soft tissue damage during delivery are some of explanations for the onset of stress urinary incontinence. On the other hand, cesarean delivery might not be protective against emergence of urinary incontinence. Further research in this field is needed.

BACKGROUND:Ophthalmia neonatorum, or neonatal conjunctivitis, is an acute infection that occurs within the first 28 days of life. This aim of this survey was to evaluate the current methods of preventive treatment for ophthalmia neonatorum in maternity hospitals in Croatia. MATERIAL AND METHODS: The annual hospital birth rate in Croatia is approximately 40, 000. A clinical survey was undertaken with data collected using questionnaires sent to all 32 maternity hospitals in Croatia. There was a 100% response rate to the questionnaires. RESULTS: Preventive treatment for ophthalmia neonatorum was administrated to all newborns in 75% (24/32) of Croatian maternity hospitals. In 45.8% of maternity hospitals, (11/32) these procedures were performed within the first hour after birth. In 54.2% of maternity hospitals (13/32), preventive treatment for ophthalmia neonatorum was administrated to all newborns from one to three hours after birth. The main treatment agent was tobramycin (83.3%). Other topical prophylactic treatments included povidone- iodine (8.3%), erythromycin (4.2%), and silver nitrate (4.2%). In 25% of obstetric units, prophylaxis for ophthalmia neonatorum was not used routinely, but in cases of diagnosed neonatal conjunctivitis, antibiotic treatment with tobramycin was mainly used. CONCLUSIONS: A survey of all 32 maternity hospitals in Croatia showed variation in the prevalence of preventive treatment for ophthalmia neonatorum and the methods used. These findings support the need to implement standardized preventive measures that both conform to international clinical guidelines and recognize treatment availability in Croatia, where topical povidone-iodine is currently preferred for the prevention of ophthalmia neonatorum.

The aim of this study was to determine the efficacy and surgical outcome of the sling procedures in stress incontinent women in comparison to conventional anterior colporrhaphy. Total of 56 patients with stress urinary incontinence (SUI) were treated with sling procedure between November 2011 and March 2013, 39/56 (69.6%) with suprapubic arc (SPARC) and 17/56 (30.4%) with MiniArc method. During the same period total of 49 patients with SUI were treated with traditional anterior colporrhaphy according to Bagovid method as the control group. All patients were prospectively clinically assessed over aperiod of 3, 6 and l2 months after surgery. The objective cure rate after the follow-up was 92.9% (52/56) in observed group of patients and 79.6% (39/49) in control group and improvement was occurred in rest of 5.4% (3/56) and 18.4% (9/49), respectively (p0.05). The overall complications rate was significantly lower in the observed group of patients than in the control group, 12.5% (7/56) vs. 28.6% (14/49), (p0.05). In the sling group was postoperatively noticed slightly higher rate of urinary incontinence, but in the colporrhaphy group was emphasized rate of urinary retention. Only one from the each group of patients failed the surgical procedure and required additional correction for SUI. The mean operating time for SPARC and MiniArc procedure was 19 +/- 7 and 9 +/- 5 minutes, respectively (p0.0001). Mean duration of hospitalization was significantly shorter in the sling group of patients (2.6 +/- 1.0, range 2-7) days than in the control group of (9.6 +/- 1.8, range 6-18), (p0.0010.0001). According to presented results, sling is a highly effective method in patients with SUI with low incidence of perioperative complications, promising long-term results and high patient's satisfaction.

Analiziran je model prijevoza, cijene prijevoza i broj taksi vozila u urbanoj sredini. Naglašena je struktura taksi prijevoza unutar urbane sredine i udjela u ukupnom prijevozu, te dinamika potražnje promatrano u vremenskom presjeku.

Cilj rada. Ustanoviti način propisivanja antibiotika pri intrauterinim zahvatima. Materijal i metoda. Analizirano je propisivanje antibiotika u Zavodu za humanu reprodukciju, Klinike za ženske bolesti i porode KBC-a i MF-a u Zagrebu, u razdoblju od 1. siječnja 2007. do 1. travnja 2007. Promatran je način propisivanja antibiotske profilakse trinaestoro liječnika. Rezultat. U promatranom razdoblju učinjena su 144 intrauterina zahvata; histeroskopija i kiretaža. Propisivanje antibitske profilakse zavisilo je isključivo od stila rada pojedinih liječnika, a ne o kliničkoj slici. Učestalost primjene antibiotika je u rasponu od 0% pa do 100%. U liječenih pacijentica nije bilo komplikacija koje bi zahtijevale dodatnu antimikrobnu terapiju. Zaključak. Ne postoji standardni postupnik pri propisivanju antibiotske profilakse. Potrebno je iz temelja revidirati način antibiotske profilakse i time upoznati sve ginekologe koji izvode intrauterine zahvate., Aim of study. Observation of the prophylactic antibiotic use during intrauterine procedures. Method. From Jan. 1st, to Apr. 1st, 2007, in Fertility/Sterility Dept. of Gynecologic Clinic, Zagreb, use of antibiotics was analyzed. Thirteen gynecologists were observed. Results. The 144 intrauterine procedures were performed: hysteroscopies and D&C-s. Antibiotics were recommended between 0% and 100%, even in the same procedure performed by the specific gynecologist. Antibiotic use differed from doctor to doctor and was not related to clinical situation. There were no complications described, regardless of antibiotic use. Conclusion. The prophylactic use of antibiotics during intrauterine procedures has to be revised. All doctors performing such operations should be reeducated.

Vascular endothelial growth factor (VEGF) and placental growth factor (PlGF) are key factors in physiological and pathological conditions of pregnancy. We investigated whether serum levels of PlGF in mother’s and umbilical blood are different between healthy pregnant women and pregnant women suffering from type-1 diabetes mellitus. We performed a prospective study of 44 pregnant women with type 1 diabetes who did not have diabetic complications and of 34 healthy pregnant women of the adequate age and parity and the normal pregnancy course. Venous blood samples were collected from 8th weeks of pregnancy during the whole pregnancy, in distance from 4 weeks. Results are expressed as means±standard deviations. Statistical analysis was performed using ANOVA, Student t-test, linear regression, and non-parametrical Mann-Whitney U test. PlGF level in diabetic and healthy pregnant women from the 8th till the 15th week of pregnancy is comparatively low (23.16±4.94 pg/mL : 21.68 ±4.91 pg/mL), and after the 15th week of pregnancy it increases fast till the 31st week of pregnancy when the value is the highest (440.77±173.03 pg/ml : 390.41±138.07 pg/mL). After the 31st week of pregnancy there is a decrease of PlGF levels. Comparing PlGF values between the research groups in defined weeks of pregnancy no statistically significant difference was found. PlGF values in serum of healthy and diabetic pregnant women do not differ in same weeks of pregnancy. PlGF values in mother’s and fetal serum immediately after the birth are a bit lower (but not statistically significant) in diabetic pregnant women in relation to a control group. A statistically significant correlation coefficient was found between PlGF level and a newborns weight and between PlGF and placenta weight. A statistically significant correlation coefficient was found between PlGF level of mother’s blood and umbilical vein., Vaskularni endotelni čimbenik rasta (VEGF) i placentarni čimbenik rasta (PlGF) su ključni čimbenici u fiziološkim i patološkim trudnoćama. Cilj istraživanja je bio naći razliku razina PlGF-a u majčinoj i umbilikalnoj krvi između zdravih trudnica i onih koje boluju od dijabetsa tipa-1. Učinjeno je prospektivno istraživanje u 44 trudnice s dijabetesom tipa-1 i u 34 zdrave trudnice. Trudnice su bile istih dobnih skupina, pariteta i urednog tijeka trudnoće. Venska krv trudnica je skupljana od 8. tjedna trudnoće tijekom cijele trudnoće u vremenskim razmacima od 4 tjedna. Rezultati su prikazani srednjim vrijednostima ± standardne devijacije, a statistička analiza je učinjena sljedećim testovima: ANOVA, Student-t testom, linearnom regresijom i Mann-Whitneyevim U testom. Razina PlGF-a u dijabetičnih i zdravih trudnica je bila podjednako niska u vremenskom razdoblju od 8. do 15. tjedna trudnoće (23,16±4,94 pg/mL : 21,68±4,91 pg/mL), a nakon 15. tjedna dolazi do naglog povišenja razine sve do 31. tjedna trudnoće kada su vrijednosti bile i najviše (440,77±173,03 pg/ml : 390,41±138,07 pg/mL). Nakon 31. tjedna trudnoće dolazi do sniženja vrijednosti PlGF-a. Uspoređujući vrijednosti PlGF-a između istraživanih skupina u istim tjednima trudnoće nije nađena statistički znakovita razlika. Neposredno nakon poroda razina PlGF-a u majčinom i fetalnom serumu je bila nešto niža, ali ne i statistički znakovito niža u dijabetičnih trudnica u odnosu na zdrave trudnice. Nađene su statistički značajne korelacije između razina PlGF-a i porodne težine, između PlGF-a i težine placente i između razina PlGF-a seruma majke i seruma umbilikalne vene.

Invazivni rak vrata maternice po učestalosti zauzima četvrto mjesto svih zloćudnih bolesti ženskog reprodukcijskog sustava, a godišnje se u Hrvatskoj otkrije 14 novooboljelih na 100.000 žena. Materijali i metode. Prospektivno je praćeno 120 bolesnica, liječenih u Klinici za ženske bolesti i porode KBC-a Zagreb i Medicinskog fakulteta Sveučilišta u Zagrebu tijekom razdoblja 1996–2002. godine zbog raka vrata maternice kliničkog stadija IB-IIB.Cilj. Odrediti podtip HPV-a metodom PCR-om i Inno Lippa-om kod bolesnica liječenih zbog invazivnog karcinoma vrata maternice, s posebnim osvrtom na miješane infekcije te utvrditi povezanost podtipa HPV-a sa histološkim tipom karcinoma vrata maternice. Rezultati. Za analizu je preostalo 102 bolesnice, prosječne dobi 51,38 ±14,04 (26–83) godine. U vremenu praćenja (5–98 mjeseci) umrlo je 23 (22,5%) bolesnice zbog raka vrata maternice. Statistički je značajna razlika u preživljenju bolesnica u odnosu na: infekciju HPV tipom 16 (p=0,0008) i postojanju miješane infekcije HPV-om (p=0,0134). Coxovom regresijom analizirali smo sve čimbenike, statistički značajne univarijantnom analizom, i formirali model za preživljenje bolesnica s rakom vrata maternice visoke predikcije (2=74,222, df=7, p, Invasive cervical carcinoma is the fourth of all neoplasms of female genital reproductive system and 14/ 100 000 women would got ill in Croatia during a year. Material and method. 120 patients with cervical carcinoma clinical stage IB-IIB treated in Department of Obstetrics and Gynecology Medical School University of Zagreb, were examined prospectivly during period 1996–2002. The aim of the study was to detect the HPV-type using PCR and Inno Lippa method and compare their significance as prognostic factors. Results. 102 patients left for the analysis, an average age was 51.38±14.04 (26–83). During the folow up of 5–98 months 23 (22.5%) patients died from cervical carcinoma. HPV type 16 infection (p=0.0008) and mixed HPV infection (p=0.0134) are connected with poor surviving. Using Cox regression model we analysed all the significant factors by univariate method and formed a model of high prediction for poor surviving (2=74.222, df=7, p