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Human umbilical vein (HUV) can be used as a substitute for small caliber blod vessels (

Study question: Altered adipose tissue secretion plays a central role in the meta- bolic abnormalities observed in PCOS. This study was conducted to determine the concentrations of adipokines in different phenotypes of PCOS women, hy- pothesizing that normal-weight, normoinsulinemic PCOS women, with mildest phenotype also present with changes in adipokine secretion compared to controls. Summary answer: There was no difference in adipokines serum levels be- tween different PCOS phenotypes. Lower levels of adiponectin and ghrelin, and higher levels of leptin and resistin were observed in all lean PCOS phenotypes without hyperinsulinemia compared to controls suggesting that other intrinsic PCOS factor is in the culprit of these abnormalities. What is known already: Women with PCOS have significantly elevated leptin and resistin, and lower adiponectin and ghrelin serum levels compared to healthy women. Whether these abnormalities are secondary to obesity/ab- dominal fat distribution/hyperandrogenism/hyperinsulinemia or represents the intrinsic PCOS abnormality is yet to be determined. There is a limited data on the adipokine serum levels in four main PCOS phe- notypes defined by the Rotterdam Criteria. The majority of them observed posi- tive association of serum adipokine concentrations and PCOS phenotype severity. Study design, size, duration: Observational, prospective study of 186 women with PCOS fulfilling Rotterdam criteria and 162 weight and age-matched women was conducted from 2009 to 2013. Five groups were created: A) O (Oligoovulation) + H (Hyperandrogenism) + P (Polycystic ovaries) (n = 102) ; B) O + H (n = 15), C) H + P (n = 27) ; D) O + P (n = 42) and E) (control group). Participants/materials, setting, methods: Body mass index (BMI), waist/ hip ratio (WHR) and hirsutism were evaluated. Serum concentrations of a leptin, adiponectin, resistin, ghrelin, androgens, sex hormone binding globulin (SHBG), glucose and insulin were measured. Free testosterone and homeostatic model assessment of insulin resistance (HOMA-IR) were calculated. Results were analyzed using SPSS 17 for Windows. Main results and the role of chance: No association was found between the leptin, resistin, adiponectin and ghrelin serum levels with severity of PCOS pheno- type (all p > 0.05). We observed higher levels of leptin and resistin and lower levels of adiponectin and ghrelin in all PCOS phenotypes compared to control group (all p < 0.001). The most prominent finding was the lower adiponectin (p < 0.001) and ghrelin (p < 0.001) serum levels and higher levels of leptin (p < 0.001) and resistin (p < 0.001) in lean PCOS patients without hyperandrogenemia and insulin resis- tency (phenotype D) compared to healthy controls (group E).Limitations, reason for caution: Small sample size in group B. HOMA-IR was used instead of more reliable but technically difficult hyperinsulinemic- euglycemic clamp technique. With significant variations in PCOS presentation seen in different ethnic populations, generalizing data obtained from any single ethnic group to other population groups should be approached with caution. Wider implications of the findings: Although the O + P phenotype itself is under dispute, our data show that the normal-weight, normoinsulinemic PCOS women, who share this phenotype present with alterations in adipokines metabolism, the finding that was previously observed in PCOS women in general. This may suggest that some other intrinsic PCOS factor other than obesity, hyperandrogenism or hyperinsulinemia modulates the adipose tissue dysfunction which merit further research.

The aim of this study was to calculate the relative prevalence of all phenotypes of polycystic ovary syndrome (PCOS) and to compare them for anthropometrical, hormonal and metabolic differences according to the Rotterdam Criteria. A total of 300 women with PCOS aged 26.7 +/- 5.6 years (mean +/- SD) and 100 women aged 28.3 +/- 4.1 years (mean +/- SD) were included in a control group. Anthropometrical, hormonal and metabolic parameters were compared between the groups. The most prevalent phenotype in our population was the most severe, phenotype A (56.7%), followed by phenotype D (26.7%) and phenotype C (14.3%). Phenotype B was present in only 2.3% of patients. The four main phenotypes did not differ in age, BMI and WHR. Women with phenotypes A and C had increased levels of LH and an increased LH/FSH ratio along with elevated androgen levels compared to the other groups. Serum glucose levels did not differ between the groups studied, however, higher levels of insulin, GIR and HOMA-IR were found between phenotype A and the control group. Phenotype C PCOS or ovulatory PCOS have the same characteristics as classic PCOS, however in a more mild form, which represents a transition between the classic form and the control group. Compared to the control group, phenotype D had higher mean levels of serum testosterone (still within normal range) along with elevated LH levels and LH/FSH ratio, similar to classic PCOS. However, compared with women diagnosed with PCOS based on hyperandrogenism, oligo-ovulation and polycystic ovaries, these patients demonstrated milder endocrine and metabolic abnormalities. Therefore, from an endocrine point of view, our study supports the inclusion of a normoandrogenic anovulatory phenotype in PCOS diagnostic criteria.

Polycystic ovary syndrome (PCOS) is a common endocrine condition affecting women of reproductive age. There are many typical signs and symptoms that allow for the diagnosis of PCOS depending on the criteria used. Interestingly, ethnicity influences the extent of these signs and symptoms; therefore, the frequency of symptoms varies between different countries and ethnic groups. The prevalence of this syndrome in Croatia is unknown, and it's clinical and biochemical characteristics have not yet been reported. During this study, we used the Rotterdam criteria to evaluate 365 Croatian women with PCOS, and compared them to 304 age matched controls to assess the clinical and biochemical abnormalities that occur in PCOS patients. The mean age of PCOS patients at presentation was 26.1 +/- 5.9 years and of controls were 28.0 +/- 4.2 years. Women with PCOS has significantly higher body mass index (BMI) than the control group, although in both groups most patients had normal weight (76.2% vs. 87.8%). Abdominal distribution of fat tissue was similar in both groups. Menstrual cycle abnormalities were observed in 90.7% of PCOS patients, and ultrasonographic appearance of polycystic ovaries was reported in 97.3% of PCOS cases. Nearly 75% of patients with PCOS had hirsutism and 49.6% had acne. We recorded significantly higher serum levels of luteinizing hormone (LH), total testosterone (TT), free testosterone (fT) and insulin, while the serum levels of sex hormone binding globuline (SHBG) and follicular stimulating hormone (FSH) were significantly lower than in the control group. Serum glucose values were not significantly different between the groups. In conclusion, chronic anovulation, hirsutism and ultrasound appearance of polycystic ovaries are the dominant features of PCOS in Croatian population. The majority of patients with PCOS had normal body weight. The incidence of insulin resistance in this group of patients is less than the previously described frequency in other populations of patients with PCOS and normal weight.

Cilj: Javna banka krvi iz pupkovine Ana Rukavina osnovana je u ožujku 2007. g. kako bi se povećala mogućnost pronalaženja transplantata za bolesnike, promicalo doniranje krvi pupkovine (KP) i pružila mogućnost svakoj trudnici da postane darivateljica. S tim zadatkom tim liječnika iz Banke, rodilišta i Hrvatskog registra dobrovoljnih darivatelja koštane srži, posjetio je gotovo sva hrvatska rodilišta i proveo edukaciju osoblja o informiranju i odabiru darivateljice, prikupljanju, pohranjivanju i terapijskoj primjeni KP. Metode: Banka surađuje s 22 rodilišta kojima pruža punu logističku potporu. KP se prikuplja u terminskom porodu i transportira u roku 24h. KP koje zadovolje kriterije obrađuju se separatorom Sepax, označavaju ISBT kodom i zamrzavaju u Bioarchive spremniku. Banka šalje kvartalna izvješća o broju uspješnih donacija, uočava probleme i provodi dodatne edukacije. Rezultati: U razdoblju 2007–2010 primljeno je 2879 KP a 1411 (49%) je pohranjeno. Razlozi odbijanja KP kod ulazne kontrole bili su mali TNC (97, 7%), vrijeme do obrade duže od 48h (0, 3%), administrativna greška (0, 1%), višeplodna trudnoća (0, 1%), validacija (1, 6%). Dodatnih 240 KP je odbijeno na završnoj kontroli zbog kvalitete KP (76, 7%), problema u transportu i obradi (14, 7%), zdravstvenog stanja novorođenčeta (0, 8%), majke (3, 3%), oca (2, 9%) ili nepotpune dokumentacije (0, 4%). Uzrok loše kvalitete KP bili su mali TNC nakon obrade (44%), mikrobiološko zagađenje (31, 1%) i izostanak rasta kolonija (1, 6%). U Svjetski Registar prijavljeno je 1171 KP (40, 6% donacija) a izdana jedna KP za bolesnika u Hrvatskoj i jedna u Francuski registar. Zaključak: Kako bi povećali mogućnosti izdavanja transplantata Banka će nastaviti s promocijom donacije KP, postaviti više kriterije ulaznog TNC u KP i nastaviti raditi na dobivanju akreditaciji FACT/Netcord.

Sindrom policističnih jajnika (PCOS) je multisistemski, endokrinološki, reprodukcijski i metabolički poremećaj, karakteriziran oligo/anovulacijama, hiperandrogenizmom i policističnim izgledom jajnika. Često je udružen s debljinom i inzulinskom rezistencijom. Žene s PCOS imaju povišen rizik za šećernu bolest tipa 2, dislipidemiju i kardiovaskularne bolesti. Sve je više studija koje govore u prilog da je lučenje hormona masnog tkiva – adipokina (leptina, adiponektina, grelina i rezistina) promijenjeno u bolesnica s PCOS te da bi promjene u lučenju adipokina kod žena s PCOS mogle biti važan pretskazatelj kliničkog tijeka bolesti uključujući nastanak dijabetesa i kardiovaskularnih bolesti. ----- ISPITANICE I METODE: U istraživanje smo uključili 151 ženu s dijagnozom PCOS postavljenu prema Rotterdamskim kriterijima i 95 zdravih žena usklađenih prema dobi i tjelesnoj težini. Usporedili smo razine leptina, rezistina, grelina i adiponektina te biokemijskih pokazatelja inzulinske rezistencije (inzulin i HOMA indeks) i kardiovaskularnog rizika (kolesterol, LDL, hsCRP) između ispitivanih skupina s ciljem utvrđivanja razlika u njihovim vrijednostima. Potom smo usporedili vrijednosti ovih adipokina između različitih fenotipa PCOS i pokušali utvrditi koji od ispitivanih čimbenika ima najveći utjecaj na njihove serumske razine. ----- REZULTATI: Utvrdili smo statistički značajne razlike u serumskim razinama svih adipokina između ispitivanih skupina ( p

Sindrom policističnih jajnika (PCOS) je multisistemski, endokrinološki, reprodukcijski i metabolički poremećaj, karakteriziran oligo/anovulacijama, hiperandrogenizmom i policističnim izgledom jajnika. Često je udružen s debljinom i inzulinskom rezistencijom. Žene s PCOS imaju povišen rizik za šećernu bolest tipa 2, dislipidemiju i kardiovaskularne bolesti. Sve je više studija koje govore u prilog da je lučenje hormona masnog tkiva – adipokina (leptina, adiponektina, grelina i rezistina) promijenjeno u bolesnica s PCOS te da bi promjene u lučenju adipokina kod žena s PCOS mogle biti važan pretskazatelj kliničkog tijeka bolesti uključujući nastanak dijabetesa i kardiovaskularnih bolesti. ----- ISPITANICE I METODE: U istraživanje smo uključili 151 ženu s dijagnozom PCOS postavljenu prema Rotterdamskim kriterijima i 95 zdravih žena usklađenih prema dobi i tjelesnoj težini. Usporedili smo razine leptina, rezistina, grelina i adiponektina te biokemijskih pokazatelja inzulinske rezistencije (inzulin i HOMA indeks) i kardiovaskularnog rizika (kolesterol, LDL, hsCRP) između ispitivanih skupina s ciljem utvrđivanja razlika u njihovim vrijednostima. Potom smo usporedili vrijednosti ovih adipokina između različitih fenotipa PCOS i pokušali utvrditi koji od ispitivanih čimbenika ima najveći utjecaj na njihove serumske razine. ----- REZULTATI: Utvrdili smo statistički značajne razlike u serumskim razinama svih adipokina između ispitivanih skupina ( p, Polycystic ovary syndrome (PCOS) is a multisystem endocrinological reproductive-metabolic disorder, characterised with oligo/anovulation, hyperandrogenism and polycystic ovaries. PCOS is often connected with obesity and insulin resistance. Patients with PCOS have increased risk for infertility, diabetes mellitus type 2, hypetension and cardiovascular diseases. ----- STUDY SUBJECTS AND METHODS: The study included 151 women diagnosed with PCOS set by the Rotterdam criteria and 95 healthy women matched by age and weight. We compared the levels of leptin, resistin, ghrelin, and adiponectin, and biochemical parameters of insulin resistance (insulin and HOMA index) and cardiovascular risk factors (cholesterol, LDL, hsCRP) between the two groups to determine differences in their values. Furthermore, we compared the values of these adipokines among different PCOS phenotypes and tried to determine which of the examined factors have the greatest impact on their serum levels. ----- RESULTS: We found statistically significant differences in all adipokines serum levels between PCOS patients and healthy controls (p

multiple pregnancy, outcome

Angiogenesis or neovascularization is a process of formation of blood vessels in adults, and experiments indicate the two pathways of formation: angiogenesis by endothelial progenitor cells from the bone marrow, and angiogenesis from already existing blood vessels. Tumor growth and metastatic potential depend on angiogenesis. Angiogenesis research can have both diagnostic and therapeutic use. Microvessel density (MVD) is an indicator of angiogenesis intensity-the number of blood vessels per surface unit. Immunohistochemical markers (antibodies) used for MVD determination are presented due to their specifi city. Numerous studies have shown a direct correlation between MVD and expression of factors that stimulate angiogenesis, tumor growth and metastatic potential in numerous solid tumors, i.e. MVD is an independent prognostic factor. Angiogenesis in tumor growth represents an attractive therapeutic goal consisting in the inhibition of factors that stimulate angiogenesis and the exogenic use of inhibitors. Anti- angiogenic therapy of cancer is presented, mostly drugs in various phases of investigation and the rare ones which are in widespread clinical use.

To determine the parameters for early detection of intrauterine infection and neonatal outcome in preterm labour complicated with pPROM.

Unatoč ranijem otkrivanju bolesti, te boljoj medikamentoznoj i kirurškoj terapiji, žene s klasičnim oblikom kongenitalne adrenalne hiperplazije (KAH) zbog manjka 21-hidroksilaze (21-OH) imaju niski fertilitet, osobito bolesnice koje su “ gubioci soli” (GS). Pratili smo ishod 4 trudnoće u dvije bolesnice s “ jednostavnom virilizirajućom” (JV) formom bolesti te jedne bolesnice koja je GS. Genotipizacija njihovih partnera pokazala da sva trojica imaju oba normalna CYP21 gena. U bolesnice koja je GS i u koje je došlo do razvoja preeklampsije tijekom trudnoće povećana je doza prednizolona i fludrokortizona. Tri bolesnice s KAH-om rodile su ukupno 4 zdrave djevojčice (3 carskim rezom, a 1 vaginalnim porodom), koje su sve heterozigoti za manjak 21-OH i imaju normalan izgled vanjskog genitala. Obradom članova obitelji otkriveno je da majka bolesnice koja je GS ima neklasičnu (NK) KAH. Niski fertilitet u žena koje su GS i dalje predstavlja značajan problem koji zahtijeva nove terapijske pristupe. Ukoliko majka ima manjak 21-OH (čak i ukoliko se radi o NKKAH-i) preporuča se provesti prekoncepcijsko savjetovanje i genotipizaciju oca. U slučaju da postoji mogućnost rađanja djeteta s KAH-om može se uvesti prenatalnu terapiju deksametazonom

The aim of this study was to check the validity of the biochemical screening of pregnancies with Down's syndrome during the second trimester of pregnancy, in order to reduce the incidence of invasive diagnostic procedures. We used the optimal balance between sensitivity and specificity to determine the "cut off" values to estimate the results of the biochemical screening. Between January 1995 and December 2000, 2000 pregnancies were checked by double (determining hCG and AFP serum levels) and triple test, (determining hCG, AFP and uE3 serum levels). Competitive radioimmunochemical procedures (2nd trimester Amerlax-M, Ortho Clinical Diagnostics, USA) were used. The risk of Down's syndrome was calculated by Prenata program (Ortho Clinical Diagnostics, USA). The "cut off" median MoM values in pregnancies with Down's syndrome were 0.73 (AFP) ; 2.02 (hCG) and 0.74 (nE3). The calculated risk was compared with possibility 1:300 to estimate the results of biochemical screening. Our results were checked in the cytogenetic laboratory where samples of amniotic fluid, that we also took, were sent. We observed lower AFP levels (0.96 +/- 0.09 MoM), uE3 levels (0.65 +/- 0.1 MoM) and higher levels of hCG (1.57 +/- 0.27 MoM) in pregnancies with Down's syndrome, in comparison with euploid pregnancies of the corresponding gestational age. With 1:200 risk, the sensitivity of triple test is 80%, with acceptable number of false-positive results. This cut-off value showed to be acceptable for separating positive from negative results. Invasive procedures should be performed in pregnancies with positive screening result, with the aim of getting the tissue sample of the fetus for further cytogenetic analysis.

Visoka učestalost prijevremenih poroda, kao i težina komplikacija koje oni nose sa sobom, jedan je od najznačajnijih problema suvremene medicine. Stoga je razumljivo da je smanjenje učestalosti prijevremenih poroda najvažnija zadaća modernih perinatologa. Međutim, nepoznavanje prave etiologije bilo prijevremeno započetih trudova, bilo prijevremenog prsnuća vodenjaka, čini taj cilj teško ostvarivim. Pravodobno započeta antenatalna skrb i pravilno primijenjene razne metode samopregleda, danas se još uvijek čine jedinim pouzdanim načinom spriječavanja prijevremenog poroda barem u dijelu trudnoća.Sitaciju i pravilne postupke dodatno otežava sumnja kako su simptomi prijevremenog poroda često samo znak poremetnje stanja djeteta ili majke što, još uvijek, ne uspjevamo prepoznati. U preglednom članku prikazujemo danas prihvaćena objašnjenja okolnosti koje pokreću prijevremenu materničnu aktivnost ili prijevremene procese sazrijevanja vrata maternice i prijevremeno prsnuće vodenjaka. Prikazane su mogućnosti probira trudnoća s rizikom i preporuke optimalnog odabira liječenja i postupka, u ovisnosti o trajanju trudnoće, zrelosti i stanju djeteta.

As pathological patterns of fetal blood flow distribution are often associated with various obstetrical complications per se, it is difficult to distinguish permanent neurologic disability independently predicted by various complications of pregnancy and/or early neonatal period and those somehow predicted by some circulatory abnormality. Positive neonatal cranial ultrasonography showed significant predictive value regarding both major and minor neurologic impairment later in life. Blood circulation in fetal aorta could be an important milestone in detection of fetuses at increased risk, perhaps irrespective of their gestational age at birth. We therefore recommend cranial ultrasonography examination to all neonates with absent or reversed blood flow in descending aorta. The combination of both positive findings, regardless of gestational age at birth, carries a significantly increased risk of permanent neurologic damage.

HELLP syndrome – relation to preeclampsia/ecclampsia (FI/EC).

Normalno trajanje trudnoće iznosi 280 dana ili 40 tjedana, a dovršenje trudnoće porođajem očekuje se između 38. i 40. tjedna. Porođaj spontano započinje fiziološkim promjenama u obliku dozrijevanja vrata maternice i nastankom materničnih kontrakcija. Ukoliko ne dođe do spontane inicijacije u očekivano vrijeme porođaja, nastavkom trudnoće postoji mogućnost nastanka komplikacija vezanih uz majku i novorođenče. Iz tog se razloga u slučaju termina trudnoće od 41. tjedna i više odlučuje za indukciju porođaja i dovršenje trudnoće. Ovo retrospektivno istraživanje provedeno je na Klinici za ženske bolesti i porode Kliničkog bolničkog centra Zagreb u razdoblju od 1. siječnja 2018. godine do 31. prosinca 2018. godine s ciljem da se utvrdi postoji li razlika u tijeku i ishodu porođaja koji su započeli spontano ili su inducirani. U promatranom je periodu na Klinici bilo 418 porođaja u terminu od 41. tjedna trudnoće i više, od čega je 59.5% započelo spontano, a 40.5% je inducirano. Parametri procjene tijeka i ishoda promatrani su kroz 3 kategorije: vezani uz majku, porođaj i novorođenče. Utvrđena je statistički značajna razlika u učestalosti ozljeda porođajnog kanala između istraživane i kontrolne skupine, tj. veći broj ozljeda zabilježen je kod induciranog početka porođaja (p = 0.0005). Statistički značajna razlika nije pronađena kod usporedbe duljine trajanja aktivne faze 1. porođajnog doba i 2. porođajnog doba, no ista je dokazana kod primjene epiduralne analgezije koja produljuje trajanje aktivne faze 1. porođajnog doba (p = 0.00026) i 2. porođajnog doba (p << 0.001). Broj dovršenja porođaja carskim rezom statistički se ne razlikuje u skupinama spontano započetih i induciranih porođaja kad se u obzir uzmu trudnoće od 41. tjedna i više. Nema statistički značajne razlike u potrebi za intenzivnim liječenjem novorođenčadi između istraživane i kontrolne skupine. Zaključno proizlazi kako u najvećem broju parametara koji opisuju tijek i ishod porođaja nema statistički značajne razlike između spontano započetih i induciranih porođaja. Obzirom na rizik većeg perinatalnog mortaliteta i morbiditeta povezanog s komplikacijama post-terminskih trudnoća, postoji tendencija da se porođaj inducira u trudnoća koje traju 41 tjedan i više., The usual duration of pregnancy is 280 days or 40 weeks and the termination of pregnancy with childbirth is expected between 38 and 40 weeks. Childbirth spontaneously begins with physiological changes in the form of maturation of the cervix and the occurrence of uterine contractions. If spontaneous initiation does not occur at the expected time of delivery, with the continuation of pregnancy there is a possibility of complications related to the mother and a newborn. For this reason, in the case of a gestational age of 41 weeks and older, it is decided to induce labour and complete the pregnancy. This retrospective study was conducted in Women's department at University hospital centre Zagreb in the period from 1 January, 2018 to 31 December, 2018 in order to determine whether there is a difference in the course and outcome of deliveries that began spontaneously or are induced. In the observed period, there were 418 deliveries at the Clinic in the period from the 41st week of pregnancy and more. 59.5% began spontaneously and 40.5% were induced. Outcome parameters were observed through 3 categories: maternal, childbirth and neonatal. The statistically significant difference was found in the frequency of birth canal injuries between the study and control groups (p = 0.0005). No statistically significant difference was found when comparing the duration of the active phase of the 1st childbirth period and the 2nd childbirth period but the difference was proved when applying epidural analgesia that prolongs the duration of the active phase of the 1st childbirth period (p = 0.00026) and the 2nd childbirth period (p << 0.001). The number of completed cesarean deliveries did not differ statistically in the groups of spontaneously initiated and induced births. There was no statistically significant difference in the need for intensive neonatal treatment between the study and control groups. In conclusion, it follows that in most of the parameters that describe the outcome of labour there is no statistically significant difference between spontaneously initiated and induced labor. The tendency is induction of labour at 41 weeks of gestation due to a decrease in perinatal mortality and morbidity associated with complications of post-term pregnancies.

Indukcija porođaja (engl. induction of labour – IOL) je jedan od najčešće izvođenih zahvata u porodništvu. Sveukupni porast incidencije IOL bilježi se diljem svijeta. Ovaj fenomen se objašnjava fiziološkim promjenama populacije trudnica, neujednačenim smjernicama i porastom incidencije elektivnih IOL. Točni mehanizmi inicijacije porođaja nisu razjašnjeni, no ključnim događajem smatra se razvoj upalnog procesa u prijeterminskim porođajima te brojni fizikalni i hormonalni signali zrelog fetusa u terminskim porođajima koji aktiviraju upalne transkripcijske faktore poput NF- kB te prekidaju vrijeme relaksacije mišićja maternice. Svjetska medicinska društva poput Američkog društva porodničara i ginekologa (engl. The American College of Obstetricians and Gynecologists - ACOG), Društva porodničara i ginekologa Kanade (engl. Society of Obstetricians and Gynaecologists of Canada - SOGC), Nacionalnog instituta za zdravlje i kliničku izvrsnost (engl. The National Institute for Health and Care Excellence - NICE) te Svjetske zdravstvene organizacije (engl. World Health Organization - WHO) izdaju smjernice na temelju najnovijih medicinskih istraživanja o valjanosti i točnom vremenu provedbe IOL u raznim stanjima trudnoće. U početku valja procijeniti stanje fetusa, trudnice i utvrditi zrelost vrata maternice. Najpouzdanija metoda procjene je utvrđivanje zrelosti materničnog vrata indeksom prema Bishopu. U slučaju nalaza nezrelog vrata maternice valja provesti preindukcijske postupke. U sazrijevanju vrata maternice najpotentniji su prostaglandini, dok se manje komplikacija očekuje primjenom mehaničkih metoda poput osmotskih dilatatora i balonskih katetera. Kod nalaza zrelog cerviksa kontrakcije maternice potaknu se intravenskom primjenom oksitocina i amniotomijom. Važno je u obzir uzeti angažiranost priležeće česti, te amniotomiju izvršiti u trenutku kada ona priliježe uz vrat maternice. Multiparitet i nalaz zrelog vrata maternice prema Bishopu povezuju se s većom uspješnosti indukcije. Najčešća komplikacija koje se opisuje primjenom indukcijskih metoda je tahisistolija s mogućim poremećajima srčanog ritma fetusa. Poseban oprez valja imati pri aplikaciji prostaglandina u obliku intravaginalnog gela/tablete i intravenskoj primjeni oksitocina., Induction of labour (IOL) is one of the most frequently performed obstetrical interventions. Overall increase in incidence of IOL is reported worldwide. This phenomenon is explained by physiological changes in the pregnant population, inconsistent guidelines and increase in incidence of elective labour induction. The exact mechanism that underlays the initiation of parturition isn't clear but inflammatory response has a critical role in pre-term labour. Mechanical and hormonal signals from growing fetus at term labour activate inflammatory transcription factors, such as NF kB and interrupt the uterine quiescence. World medical societies such as The American College of Obstetricians and Gynecologists (ACOG), Society of Obstetricians and Gynaecologists of Canada (SOGC), The National Institute for Health and Care Excellence (NICE) and World Health Organization (WHO) published evidence-based medicine guidelines about validity and exact time of IOL in many conditions of pregnancy. The condition of the fetus, the pregnant woman and the ripeness of the cervix should be assessed initially. The most reliable method to assess the ripeness of the cervix is Bishop score. In conditions of unfavourable cervix, the methods of cervical ripening should be done. It's important to consider the engagement of fetal presenting part and then amniotomy procedure performed when it is well applied to the cervix. Multiparity and favourable cervix findings in Bishop score are linked with the success of IOL. The most common complication of IOL is tachysystole with potential fetal heart rate changes. Special care should be taken when applying intravaginal prostaglandins in form of gel or a tablet as well as in intravenous application of oxytocin.

Fotopletizmografijom je moguće kvantificirati razliku u stupnju simpatektomije između lokalnih anestetika nakon aplikacije u epiduralni prostor. Postavljenjem fotopletizmografskog uređaja na ruku, moguće je mjeriti aktivnost simpatikusa iznad razine epiduralnog bloka. Hipoteza istraživanja je kako ropivakain izaziva manji stupanj simpatektomije u odnosu na levobupivakain nakon aplikacije u epiduralni prostor. U studiju je uključeno 60 trudnica kod kojih je indicirana epiduralna analgezija za porođaj. Ispitanice su randomizirane s obzirom na tip lokalnog anestetika: 10 ml 0.125% levobupivakaina ili 10 ml 0.125% ropivakaina. Fotopletizmografski signal na ruci i na nozi, krvni tlak te VAS ljestvica (VAS – visual analogue scale), zabilježeni su prije, te 5, 10 i 20 minuta nakon aplikacije epiduralne analgezije. Fotopletizmografski parametri mjereni na nozi pokazuju trend kontinuiranog porasta što odražava simpatektomiju te povećanje vaskularne popustljivosti u anatomskom području zahvaćenim epiduralnim blokom. Premda između levobupivakaina i ropivakaina postoji razlika za PTT (PTT – pulse transit time), nisu zabilježene razlike između skupina u smislu analgetskog učinka i hemodinamskih komplikacija te je za zaključiti kako su oba lijeka jednako sigurna i učinkovita za epiduralnu analgeziju. Temeljem promjena fotopletizmografskih parametara na ruci, za zaključiti je kako se aktivnost simpatikusa smanjuje i iznad razine epiduralnog bloka no potrebne se daljnje studije za konačne zaključke., By using photoplethysmography, it is possible to quantify the difference in sympathectomy between local anesthetics after epidural administration. By placing the photoplethysmographic probe on finger, it is possible to measure sympathetic activity above the level of block. Hypothesis of the study is that ropivacaine causes less sympathectomy than levobupivacaine after epidural administration. 60 parturients were included in the study. Parturients were randomised by the type of local anesthetic administered for epidural analgesia during labour: 10 ml of 0.125% levobupivacaine or 10 ml of 0.125% ropivacaine. Photoplethysmographic signal on toe and finger, blood pressure and VAS (VAS – visual analogue scale) were recorded before and 5, 10 and 20 minutes after administering epidural analgesia. Photoplethysmographic parameters measured on foot increased continuously, which reflects sympathectomy and increased vascular compliance in the level of epidural block. Although a difference was found for PTT (PTT – pulse transit time), no differences between groups were found regarding analgesic efficacy and hemodynamic complications which leaded to conclusion that both drugs are equally effective and safe for epidural administration. Based on photoplethysmographic changes measured on the finger, it is to conclude that sympathetic activity decreases above the level of the block but further studies are necessary for final conclusions.

Hiperreakcija žutog tijela je rijetko stanje s masivnim bilateralnim cističnim uvećanjem jajnika tijekom spontano postignute trudnoće. Točna prevalencija ovog stanja je nepoznata. Iako etiologija nije do kraja razjašnjena, smatra se da je ovo stanje učestalije u trudnoćama koje imaju povišenu koncentraciju hCG-a. Klinička slika može biti neupadljiva, ili se može komplicirati primjerice ascitesom, bolovima u abdomenu, torzijom janika. Dijagnoza se postavlja na temelju anamnestičkih podataka, ultrazvučnog nalaza cistično promijenjenih jajnika i laboratorijskih parametara povišenih androgena i hCG-a koji su ključan element za dijagnozu ovog stanja. Virilizacija majke u trudnoći također može upućivati na ovo stanje. Virilizacija novorođenčeta je rijedak ishod ovakvih trudnoća i svega su tri slučaja opisana u literaturi. Hiperreakcija žutog tijela se obično dijagnosticira u drugom ili trećem trimestru trudnoće. Pri postavljanju dijagnoze nužno je isključiti maligne bolesti koje ovo stanje može oponašati. Pacijentice koje boluju od sindroma policističnih jajnika, bolesti štitnjače, dijabetesa melitusa ili povišenog krvnog tlaka u većem su riziku od razvoja ove komplikacije tijekom trudnoće. Terapija je konzervativna te je potrebno pratiti bolesnicu dok ne dođe do rezolucije cista i normalizacije koncentracije androgena. Hiperreakcija žutog tijela nije kontraindikacija za vaginalni porod. Laktaciju je moguće uspostaviti nakon pada razine androgena u krvi., Hyperreactio luteinalis is a rare condition in which there is a massive cystic enlargement of the ovaries during spontaneous pregnancy. The exact prevalence of this condition is unknown. Although etiology of this condition is unknown, it is more common in pregnancies associated with elevated serum hCG levels. Patients may be asymptomatic, although complications such as ascites, abdominal pain, ovarian torsion can be developed. The diagnosis is made by history, ultrasound scans of enlarged multicystic ovaries and laboratory findings of elevated androgen and HCG levels that are key element in diagnosing this condition. The signs of virilisation of mother may lead to diagnosis. Virilisation of newborns is a rare outcome of the condition and only three cases are described in the literature. Diagnosis of luteal hyperreaction is made in second or in the third trimester of pregnancy. Malignancy which may mimic this condition must be excluded. Patients who are suffering from polycystic ovarian syndrome, thyroid diseases, diabetes mellitus or hypertension are at higher risk of developing this complication during pregnancy. Therapy is conservative and it is necessary to follow up patients until cysts resolution and normalization of androgen levels. Hyperreactio luteinalis is not contraindication for vaginal delivery. Lactation is established after normalization of serum androgen levels.

Mala rodna masa, često zbog intrauterinog zastoja u rastu, je uz prematuritet najčešći uzrok perinatalnog mortaliteta. Novorođenčad rodne mase manje od 1500 grama ima specifične potrebe u prvim danima života te posljedično zahtijeva velike financijske i medicinske resurse. Cilj ovog istraživanja bio je utvrditi broj hipotrofične novorođenčadi rodne mase manje od 1500 grama, rođene u Klinici za ženske bolesti i porode KBC-a Zagreb u 2018. godini, te opisati njihove osobitosti. Ovo istraživanje bilo je retrospektivno i deskriptivno. Uključivalo je 23 hipotrofične novorođenčadi rodne mase manje od 1500 grama, rođene u razdoblju između 1. siječnja i 31. prosinca 2018. godine. Nakon što su podaci skupno analizirani, novorođenčad je podijeljena u skupine prema rodnoj masi i gestacijskoj dobi. Analizirane su sljedeće karakteristike: spol, rodna masa i duljina, ponderalni indeks, način porođaja, stav ploda, graviditet i paritet majke, višeplodna trudnoća, Apgar ocjena u 5. minuti života, boravak u inkubatoru, parenteralna prehrana, reanimacija, intubacija, invazivna strojna ventilacija, korištenje nCPAP-a i smrtni ishod. Rezultati su pokazali da je incidencija hipotrofične novorođenčadi rodne mase manje od 1500 grama u ovom rodilištu iznosila 5,9‰. Ukupno je bilo 2,2% novorođenčadi vrlo male rodne mase, a hipotrofičnih je među njima bilo 26,7%. Što je rodna masa bila veća i gestacija dulja, to je bolji bio kratkoročni ishod novorođenčadi. Ovakvi rezultati naglašavaju važnost prenatalne skrbi jer povećanje tjelesne mase i produljenje gestacije smanjuju morbiditet i mortalitet. Zaključno, iako je preživljenje hipotrofične novorođenčadi vrlo male rodne mase povećano poboljšanjem neonatalne skrbi, ona još uvijek ima ozbiljne kratkoročne i dugoročne zdravstvene posljedice. Daljnja istraživanja trebala bi poboljšati razumijevanje specifičnih potreba ove visoko rizične populacije novorođenčadi., Small birth weight, often due to IUGR, and prematurity are the most common causes of perinatal mortality. Newborns weighing less than 1500 grams have specific needs in their earliest days of life, consequently requiring great financial and medical resources. The aim of this study was to determine the number of hypotrophic newborns weighing less than 1500 grams born at the Department of Gynecology and Obstetrics of the University Hospital Center Zagreb in 2018, as well as to describe their clinical features. This study was retrospective and descriptive. It included 23 hypotrophic newborns weighing less than 1500 grams, who were born between January 1st and December 31st 2018. After the data were analysed together, the newborns were divided into groups according to their birth weight and gestational age. The following characteristics were analysed: sex, birth weight and length, ponderal index, way of delivery, position in the womb, mother's gravidity and parity, multiple pregnancy, Apgar score in 5th minute, care in the incubator, parenteral feeding, reanimation, intubation, invasive mechanical ventilation, nCPAP and death outcome. The results showed that the incidence of hypotrophic newborns weighing less than 1500 grams in this hospital was 5.9‰. The incidence of very low birth weight newborns was 2.2%, among which 26.7% were hypotrophic. Newborns with higher weight and longer gestational age had better short-term outcomes than newborns with lower weight and shorter gestational age. These results stress the importance of prenatal care, as each gram and each day count. In conclusion, even though the survival rates of hypotrophic newborns with very low birth weight have increased, they still have serious short-term and long-term health consequences. Further research should improve the understanding of this high-risk population's needs.

Žene s prethodnim carskim rezom u anamnezi trudnoću mogu dovršiti ponovnim planiranim carskim rezom (PRCD) ili vaginalnim porođajem nakon prethodnog carskog reza (TOLAC/VBAC). Globalni porast incidencije carskog reza kao metode dovršenja trudnoće odnosi se djelomice i na češće izvođenje PRCD-a nego li je to objektivno potrebno. Iako je u proteklih desetak godina konstruirano više kliničkih sustava za procjenu vjerojatnosti uspješnog vaginalnog porođaja (VBAC kalkulator, MFMU Network kalkulator, modeli predviđanja), niti jedan od njih nije potvrđen (eksterno validiran) u prospektivnom kohortnom istraživanju. Potencijalni razlog zaziranja porodničara od TOLAC protokola mogao bi biti povećan rizik rupture maternice, međutim, na umu treba imati onaj postotak trudnice koje su mogle trudnoću dovršiti VBAC-om, ali to nisu učinile, što je najčešće posljedica propusta liječnika u antenatalnom savjetovanju i informiranju trudnice o njezinim izgledima za VBAC. Ruptura maternice potencijalno je fatalna komplikacija vaginalnog porođaja koja je češća u kontekstu TOLAC-a, a rizik raste korištenjem prostaglandina u indukciji porođaja. Iako je carski rez povezan sa značajno većim maternalnim negoli fetalnim morbiditetom i mortalitetom, mnoge će trudnice zanemariti svoje rizike, ako carski rez u konkretnom slučaju povećava šanse za preživljenje djeteta i bolji neonatalni status., Women with a previous cesarean section can choose either planned repeated cesarean delivery (PRCD) or vaginal birth after cesarean (VBAC) as a way to end their current preganancy. More frequent PRCDs, although not always with a reasonable indication, are partially accountable for a global raise of incidence of cesarean section. Although some prediction models of successful VBAC have been developed in the past decade (VBAC calculator, MFMU Network calculator, prediction models), none of them have been externally validated in a prospective cohort study. An increased risk of uterine rupture associated with TOLAC /VBAC arises as a possible reason for some clinicians to avoid TOLAC. One has to bear in mind the percentage of women who could have successfully completed VBAC, but haven't done so, mostly due to antenatal counsseling malpractice and not knowing their own chance of success. Uterine rupture is a potentially fatal complication of vaginal birth, which happens to be more common in the setting of TOLAC, and if prostaglandines are used for labor induction the risk becomes even higher. Although cesarean section bears more morbidity and moratality risks for the mother than for the child, many women will undergo cesarean section if they are told it would improve the survival rate and neonatal status of the newborn.

Prepoznavanje prijeteće asfiksije i procjena potrebe za terapijskom intervencijom najteže su zadaće perinatalne medicine. Razumijevanje utjecaja čimbenika koji dovode do asfiksije i poznavanje njihove međuovisnosti poboljšava ishode rizičnih trudnoća i poroda, a njihovo proučavanje vodi pronalasku preventivnih strategija. Cilj ovog rada bio je prikazati rizične čimbenike za asfiksiju te neonatalne ishode terminske novorođenčadi rođene s Apgar ocjenom jednakom ili manjom od 7 u prvoj minuti u Klinici za ženske bolesti i porode KBC-a Zagreb u trogodišnjem razdoblju. Ukupno je od 1. siječnja 2016. godine do 31. prosinca 2018. godine rođeno 108 takve djece, što odgovara incidenciji od 9,97 ‰. Glavne komponente etiopatogeneze su kronična hipoksemija fetusa - do koje dovode abnormalnosti posteljice povezane s kroničnim bolestima majke, akutna hipoksemija - koja prati intrapartalna hitna stanja, te kongenitalne bolesti novorođenčeta - koje mu otežavaju kardiorespiratornu prilagodbu na izvanmaternični život. Šećerna bolest majke, prijevremeno prsnuće plodovih ovoja i otežani, odnosno onemogućeni vaginalni porod najčešći su rizični čimbenici. Intrapartalni indikatori fetalne patnje, abnormalni nalaz CTG-a i mekonijska plodova voda prisutni su u tek 57,4% slučajeva. Najveći udio poroda dovršen je hitnim carskim rezom koji, glede Apgar ocjene, ima lošije ishode od elektivnog. Ovaj diplomski rad donosi pregled učestalosti rizičnih čimbenika i njihove povezanosti, te ističe probleme na koje bi, s ciljem potpunijeg razumijevanja etiopatogeneze perinatalne asfiksije, valjalo usmjeriti buduća istraživanja., Identifying threatening asphyxia and assessing the need for therapeutic intervention are the most difficult tasks of perinatal medicine. Understanding the factors leading to asphyxia and their interdependence improves the outcomes of risky pregnancies and childbirths, and studying them leads to discovering preventive strategies. The aim of this paper was to present risk factors for asphyxia and neonatal outcomes of term infants born with an Apgar score of equal to or less than 7 in the first minute at Department of Gynaecology and Obstetrics of UHC Zagreb in a three-year period. From January 1, 2016, to December 31, 2018, 108 such children were born, corresponding to an incidence of 9,97 ‰. Major components of etiopathogenesis are chronic foetal hypoxemia - caused by placental abnormalities associated with chronic maternal illnesses, acute hypoxemia - which accompanies intrapartal emergencies, and congenital illnesses - which impair neonates’ ability for cardiorespiratory adaptation to extrauterine life. Diabetes, premature rupture of the membranes and difficult vaginal delivery are the most common risk factors. Intrapartal signs of foetal distress, such as abnormal CTG findings and meconium stained liquor, are present in only 57.4% of cases. The highest share of deliveries is completed by an emergency caesarean section which, with regard to the Apgar score, has poorer outcomes than the elective one. This graduate thesis provides a review of the frequency of risk factors and their correlations, and highlights the problems that future research should focus on with the aim of a more complete understanding of the etiopathogenesis of perinatal asphyxia.

Prijevremeno puknuće plodovih ovoja nakon navršenog 37. tjedna gestacije (RVP) česta je, ali relativno neistražena pojava u trudnoći, a definirano je pucanjem više od jednog sata prije početka trudova. Postoji popularno vjerovanje da meteorološki uvjeti, osobito atmosferski tlak utječu na RVP. Za potrebe diplomskog rada, osmišljena je retrospektivna opservacijska studija koja uključuje trudnice s dijagnozom RVP-a koje su primljene u Kliniku za ženske bolesti i porode Kliničkog bolničkog centra Zagreb ili one s istom dijagnozom koje su ranije bile hospitalizirane u razdoblju od 1. siječnja do 31. prosinca 2016. godine. Cilj studije je dokazati postoji li statistički značajna povezanost između RVP-a i srednjih dnevnih vrijednosti atmosferskog tlaka, srednjih dnevnih vrijednosti relativne vlage u zraku i razlike između najviše i najniže dnevne temperature zraka. Podaci su osigurani od Državnog hidrometeorološkog zavoda za postaju Zagreb, Maksimir. U 2016. godini ukupno je bilo 3952 poroda, od kojih je 809 počelo prijevremenim puknućem plodovih ovoja bez obzira na duljinu gestacije. Kod 664 trudnice zabilježen je terminski RVP, od kojih je 489 bilo bez poznatih rizičnih čimbenika. Dokazana je značajna povezanost između RVP-a i srednjih dnevnih vrijednosti atmosferskog tlaka (P, Premature rupture of membranes after the 37th week of gestation (PROM) is a common, but not sufficiently studied condition that happens during pregnancy. It is defined as a rupture that occurs more that 1 hour before the onset of labour. In popular belief, it is associated with meteorological conditions, particularly with atmospheric pressure variations. This graduation thesis is a retrospective observational study of women admitted for PROM in the Clinic for Gynaecology and Obstetrics of the Clinical Hospital Centre Zagreb from 1 January to 31 December 2016. The aim of this study is to identify if there is a statistical significance in the correlation between PROM and atmospheric pressure, greater difference between maximal and minimal temperature and air humidity. The data was kindly provided by the Meteorological and Hydrological Service, for the station in Zagreb, Maksimir. In the year 2016, there were a total of 3952 deliveries. 809 started with a PROM or preterm premature rupture of membranes (PPROM), out of which 664 were with a PROM. Out of these 664, 489 were without known risk factors. This study observed significant association between PROM and atmospheric pressure variations (P

Rađanje djeteta jedan je od najljepših, ali i najbolnijih događaja koje žena može doživjeti. Porođajna bol je složen subjektivni fenomen, u kojem se bolni podražaj doživljava na individualnoj razini u skladu s emocionalnim, socijalnim i kulturološkim čimbenicima. Bol i anksioznost mogu uzrokovati aktivaciju simpatikusa, hiperventilaciju i hipokapniju s posljedično smanjenim uteroplacentalnim protokom i nekoordiniranom aktivnosti maternice te se preporuča ublažiti bol, posebice ako se radi o rodilji s komorbiditetom. Pri izboru analgezije mora se razmišljati o učinkovitosti i sigurnosti analgezije kao i o mogućim nepovoljnim učincima na majku i dijete te učincima na tijek i ishod porođaja. Epiduralna analgezija smatra se najboljom metodom ublažavanja porođajne boli jer osigurava učinkovitu analgeziju uz minimalne štetne učinke na majku i dijete. Kontroverze o primjeni i učinku epiduralne analgezije na tijek i ishod porođaja i dalje postoje i predmet su istraživanja brojnih radova. Epiduralna analgezija može utjecati na trajanje porođaja, blago skraćujući prvo te produžujući drugo porođajno doba. Primjena epiduralne analgezije tijekom porođaja može donekle povećati rizik dovršenja porođaja instrumentalnim putem, ali ne povećava vjerojatnost dovršenja porođaja carskim rezom. Smanjenjem koncentracije lokalnog anestetika dodatkom manjih količina opioida moguće je umanjiti navedene učinke. Ukoliko ne postoje kontraindikacije, epiduralna analgezija može se primijeniti na zahtjev rodilje bez obzira u kojem se stadiju porođaja rodilja nalazi te se preporuča nastaviti s njenom primjenom sve do samog kraja porođaja., Giving birth is an incredible, but also one of the most painful experiences in a woman’s life. Birth pain is a complex phenomenon, where painful stimulation is experienced on an individual level in accordance with emotional, social and cultural factors. Pain and anxiety can lead to adrenergic hyperactivity, hyperventilation and hypocapnia with reduced uteroplacental blood flow and uncoordinated uterine activity. Therefore, pain relief is recommended, especially in cases of maternal comorbidity. When thinking about labor analgesia, consideration should be given to the efficacy and safety of analgesia as well as possible adverse effects on mother and child and the effects on the course and outcome of labor. Epidural analgesia is considered the best method of alleviating labor pain, providing effective analgesia with minimal adverse effects. Despite the increased use and known benefits of epidural analgesia, there has been significant controversy regarding the impact of epidural analgesia on labor outcomes. Epidural analgesia can affect the duration of labor, slightly shortening first and prolonging the second stage of labor. The evidence indicates that effective labor analgesia does not increase the rate of Caesarean delivery, although it might be associated with an increased rate of instrumental vaginal delivery. It is possible to improve obstetric outcomes and reduce maternal side effects by reducing the concentration of local anesthetic. In the absence of a medical contraindication, maternal request is a sufficient medical indication for epidural analgesia in labor and it is recommended to continue with its application until the end of labor.

Adenomioza je bolest maternice kod koje se patohistološkom analizom tkiva maternice, unutar miometrija nalaze endometralne žlijezde i stroma. Ta invazija endometrija u miometrij rezultira morfološki promijenjenom maternicom te kliničkom slikom obilnih i bolnih menstruacijskih krvarenja, nepravilnih krvarenja, ali i neplodnosti kao posljedice ometanja procesa implantacije. Cilj ovog istraživanja bio je prikazati učestalost simptoma karakterističnih za adenomiozu i povezanost s drugim kliničkim i patohistološkim dijagnozama te prikazati reprodukcijske ishode kod bolesnica liječenih u Klinici za ženske bolesti i porode KBC-a Zagreb u razdoblju od 2011. do 2017. godine, kojima je patohistološkom analizom utvrđena adenomioza. Nađeno je da je medijan dobi u kojoj je dijagnosticirana adenomioza 55 godina. Bolesnicama je najčešće učinjena histerektomija (85,5%). Na adenomiozu se prije operacije posumnjalo u tek 5,5% bolesnica. Uputna dijagnoza je u 30% slučajeva bila sumnja na miom maternice, u 24,5% dokazan adenokarcinom endometrija. Kod 62,9% nađeni su simptomi karakteristični za adenomiozu. Čak 35% bolesnica imalo je jedan ili više spontanih pobačaja. Učestalost carskih rezova u ovoj skupini je bila 9,2%. Adenomioza je u našoj populaciji i dalje najčešće dijagnosticirana kod bolesnica kasne generativne ili postmenopauzalne dobi koje su histerektomirane. Često se, međutim, nalazi s drugim dijagnozama poput mioma ili adenokarcinoma endometrija. Sve su veći dokazi da je u skupini žena sa smanjenom plodnosti negativan utjecaj adenomioze značajan. Stoga je potrebno potaknuti sumnju na ovu bolest i kod mlađih bolesnica, pogotovo nakon čestih implantacijskih neuspjeha., Adenomyosis is uterine disease in which endometrial glands and stroma can be found within myometrium using histopathological analysis. This endometrial invasion results in morphologically altered uterus and can be a cause of abnormal uterine bleeding and infertility by hindering the process of implantation. The aim of this study was to detect the frequency and correlation of various diagnoses and symptoms that are otherwise associated with adenomyosis and to present problematic reproductive outcomes in patients treated at Clinical Center for Female Diseases and Births UHC Zagreb in the period from 2011 to 2017. Data analysis has showed that median age in which adenomyosis is diagnosed at UHC Zagreb is 55 years. Most common surgery was hysterectomy in 85.5% of cases. Before the surgery adenomyosis was suspected in only 5.5% of patients. The main indication for the surgery was myoma in 30% and endometrial adenocarcinoma was found in 24.5% of patients. 62.9% of women had symptoms related to adenomyosis. In women with adenomyosis percentage of spontaneous abortions was 35% which is significantly higher than in general population. Cesarean section was performed in 9.2% of patients. In our terms, adenomyosis is still considered as the disease of elderly women and it is diagnosed mostly after hysterectomy. It is important to keep in mind that adenomyosis is frequently associated with other diagnosis such as myoma or endometrial adenocarcinoma. Also, there is more and more evidence that the negative influence of adenomyosis in subfertile women is significant. Therefore, it is advisable to suspect on adenomyosis in younger women, especially after frequent implantation failures.