Prijevremeni porođaj jedan je od vodećih svjetskih zdravstvenih problema i prioriteta. Iako postoje standardizirani globalni indikatori za optimizaciju sakupljanja i izvještavanja podataka, oni su ...još uvijek neprimjereni za međunarodnu usporedbu. Ovim kratkim preglednim člankom prikazane su aktualne spoznaje i kontroverze vezane uz definiciju, epidemiologiju te uzroke prijevremenog porođaja, utemeljene na najnovijim rezultatima opažajnih i pokusnih istraživanja te sustavnih pregleda i metaanaliza.
Preterm birth is a major public health issue and one of the most important clinical problems. Although standard global indicators for monitoring and reporting of the data exist, at the moment they are inadequate for international comparisons. This mini-review gives an overview of the current knowledge and controversies regarding the definition, epidemiology and causes of preterm birth, based on the most recent findings of observational and experimental studies, systematic reviews and meta-analyses.
Cilj: Utvrditi odnos indeksa tjelesne mase prije trudnoće i perinatalnog ishoda trudnica zaprimljenih na Kliniku za ginekologiju i porodništvo Kliničkog bolničkog centra (KBC) Rijeka u razdoblju od ...1. siječnja 2010. do 31. prosinca 2014. godine. Ispitanici i metode: Analizirana je skupina od 14 779 trudnica na temelju podataka prikupljenih iz baze podataka Klinike za ginekologiju i porodništvo KBC-a Rijeka. Rezultati: Trudnice s indeksom tjelesne mase (ITM) < 18 imaju statistički značajno veće izglede u odnosu na trudnice s ITM-om 18 – 24,99 za: intrauterino zaostajanje djeteta u razvoju (P < 0,001), rađanje prematurusa (P = 0,005), prijeteći pobačaj (P = 0,001), rađanje djeteta < 2 500 g (P = 0,022) te fetalnu smrt (P = 0,019). Trudnice s ITM-om 25 – 29,99 imaju veće izglede u odnosu na trudnice s ITM-om 18 – 24,99 za: gestacijski dijabetes melitus (P < 0,001), gestacijsku hipertenziju (P < 0,001), preeklampsiju (P = 0,007), acidozu djeteta u porodu (P = 0,029), rađanje djeteta s Apgar indeksom ≤ 7 (P = 0,001) te djeteta porodne težine < 2 500 g (P < 0,001) i ≥ 4 000 g (P < 0,001). Također, povećan je izgled za fetalnu smrt (P = 0,001), instrumentalni vaginalni porod (P = 0,041) te dovršenje poroda hitnim carskim rezom (P < 0,001). Trudnice s ITM-om ≥ 30 imaju veće izglede u odnosu na trudnice s ITM-om 18 – 24,99 za: gestacijski dijabetes melitus (P < 0,001), gestacijsku hipertenziju (P < 0,001), preeklampsiju (P < 0,001), rađanje prematurusa (P = 0,001), djeteta s Apgar indeksom ≤7 (P = 0,001) te djeteta porodne težine < 2 500 g (P < 0,001) i ≥ 4 000 g (P < 0,001). Povećan je izgled za febrilitet majki u puerperiju (P = 0,001), dojenačku smrt (P = 0,001) te dovršenje poroda hitnim (P < 0,001) i elektivnim carskim rezom (P = 0,001). Zaključak: Ovom retrospektivnom analizom pokazano je kako su trudnice s ITM-om < 18 (pothranjene) i one s ITM-om > 25 (preuhranjene i pretile) u povećanom riziku za razvoj perinatalnih komplikacija.
Aim: Pallister-Killian syndrome (PKS) is a rare chromosomal disorder, caused by tissue-limited mosaicism for an isochromosome 12p. Prenatal diagnosis of PKS is generally incidental. Although clinical ...presentation of PKS varies, cytogenetic findings are constant, and include a tetrasomy of chromosome 12p. We report a case of prenatally diagnosed PKS with unique dysmorphic feature: bifid cardiac apex, a type of morphology that has not been documented before. Case presentation: Our patient was the 38-year-old pregnant woman who underwent amniocentesis. Cytogenetic analysis of amniotic fluid detected a mosaic karyotype with a supernumerary chromosome (SMC) in 64 % of fetal amniocytes. To determine the chromosomal origin of SMC, fluorescence in situ hybridization was performed and tetrasomy 12p was confirmed: mos 47,XY,+mar18/46,XY10.ishi(12p)(8M16/SP6++,CEP12+,VIJyRM2196-). Ultrasound examination showed a fetus with cleft lip, echogenic focus in the left ventricle of the heart and shortened fetal long bones. After receiving a genetic counseling for PKS, the woman requested a termination of pregnancy. A postmortem inspection of the fetus revealed a complex heart anomaly that includes bifid cardiac apex and ventricular septal defect. Conclusions: This report expands the clinical manifestations of PKS with a unique feature of bifid cardiac apex, and highlights the targeted prenatal diagnosis of PKS if specific ultrasound markers are present.
Cilj: Sindrom Pallister-Killian (PKS) rijedak je kromosomski poremećaj uzrokovan tkivno ograničenim mozaicizmom za prekobrojni izokromosom 12p. Prenatalno se dijagnoza PKS-a postavlja uglavnom slučajno. Iako je težina kliničke slike različita i varira od vrlo blage do izrazito teške, citogenetički nalaz uvijek uključuje tetrasomiju 12p. Ovim radom prikazan je prenatalno dijagnosticirani PKS s jedinstvenim dismorfološkim obilježjem: bifidnim srcem, koje do sada nije opisano u literaturi, kao dio kliničke slike ovoga sindroma. Prikaz slučaja: Tridesetosmogodišnja trudnica upućena je na amniocentezu. GTG metodom oprugavanja kromosoma utvrđen je aberirani mozaični muški kariotip s malim prekobrojnim marker kromosomom (engl. small supernumerary marker chromosome, sSMC) u 64 % fetalnih amniocita. Za određivanje podrijetla marker kromosoma korištena je metoda fluorescentne in situ hibridizacije te je utvrđena tetrasomija 12p: mos 47,XY,+mar18/46,XY10.ishi(12p)(8M16/SP6++,CEP12+,VIJyRM2196-). Nalaz ultrazvuka ukazao je na fetus s rascjepom usne, ehogenim fokusom u lijevoj srčanoj klijetki te skraćenim dugim kostima. Po genetičkom savjetovanju, trudnica se odlučila za prekid trudnoće. Obdukcijom fetusa otkrivena je kompleksna srčana anomalija koja uključuje bifidno srce te ventrikularni septalni defekt. Zaključci: Ovaj prikaz slučaja prvi put opisuje jedinstveno dismorfološko obilježje bifidnog srca u PKS-u te naglašava važnost ciljanog pristupa u prenatalnoj dijagnostici PKS-a, ako postoje specifični ultrazvučni biljezi.
Abstract Objective To use amniotic fluid (AF) lamellar body count (LBC) to assess the influence of pre-eclampsia and associated pathologic conditions on fetal lung maturity (FLM). Methods A ...prospective study was conducted to analyze 378 AF samples containing 5 mL of AF from 306 singleton pregnancies at 26–39 weeks. Stratified by gestational age groups, pregnancies were categorized as follows: pre-eclampsia (n = 25); intrauterine growth restriction (IUGR) (n = 74); pre-eclampsia and IUGR (n = 63); and control (n = 144). Amniotic fluid LBC in each group was estimated and medians were compared for defined gestational age periods. Statistical analyses were performed via non-parametric tests. Results Between 31 and 33 weeks, significantly lower median LBCs were found in the pre-eclampsia group than in the IUGR group ( P = 0.022) and in pregnancies with both entities ( P = 0.031). Between 34 and 36 weeks, there were significantly lower median LBCs in the pre-eclampsia and the pre-eclampsia/IUGR groups than in the IUGR group ( P = 0.026 and P = 0.004, respectively), as well as in the pre-eclampsia/IUGR group compared with the control group ( P = 0.04). Conclusion Significantly lower LBCs in pre-eclamptic pregnancies between 31 and 36 weeks of gestation indicate delayed FLM associated with pre-eclampsia.
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BFBNIB, FZAB, GEOZS, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBJE, SBMB, UL, UM, UPUK
Abstract
Objective: To test if secular growth acceleration occurs during fetal life.
Methods: ANOVA Kruskal-Wallis and Mann-Whitney U-test have been used for the biometric characteristics comparison ...of nowadays fetal population with those three decades ago and to test the hypothesis about the existence of secular growth acceleration during fetal life. For this purpose, we first calculated mean values of particular biometric parameters for the whole pregnancy. During the period 2002-2009 biparietal diameter, fetal length and abdominal circumference measurements in singleton uncomplicated pregnancies between 22 and 41 gestational weeks were obtained. Gestational age was estimated according to Naegele's rule and confirmed with an early ultrasound examination. Pregnancies with fetal cromosomopathies and malformations were excluded as well as those resulting in perinatal death.
Results: There were no statistically significant differences of the examined fetal biometric parameters measured by ultrasound between contemporary fetal population and those from 35 years ago.
Conclusion: Our investigation did not undoubtedly prove that significant changes of fetal biometric parameters occurred in the last three decades. It is possible that secular growth acceleration does not exist in prenatal period but also the observed time period could have been short for this phenomenon to manifest.
Problem statement: There has been a notable shift to pregnancy at older maternal ages, which is generally agreed upon as age over 40 years. It is well recognized that women who delay childbearing are ...at increased risk of pregnancy complications. Our study aimed to compare the incidence of births to older women from 1 January 1995 to 31 December 1997 and from 1 January 2014 to 31 December 2016 and to evaluate the effects of advanced maternal age on pregnancy outcomes in Clinical Hospital Center Rijeka. Methods: Maternal and obstetrical data were collected from the Register of Clinical Hospital Center Rijeka. We compared the outcomes for women aged u226540 years with those of three younger subgroups stratified by maternal age (<20 years; 20-29 years (control group); 30-39 years). Statistical analyses were performed using Statistica 13.3.0. and MedCalc for Windows. In all analyses, P-values less than 0.05 were considered statistically significant.Results: Over the last two decades, the percentage of mothers aged u226540 years has increased from 2.1% to 3.8% (u03a72=46.25;P<0.001). A similar change has taken place in the rates of first-time mothers over 40, showing an increase of 64.1% compared to the 1990s. Moreover, our data revealed a notable rise in the frequency of both autosomal (61.1%) and sex chromosomal aneuploidies (68.2%), as a woman ages.Besides, we found a statistically significant association between pregnancy losses (ectopic pregnancies and abortions) and advanced maternal age. This association might reflect a decline in oocyte quality and/or changes in uterine and hormonal function. Finally, women u226540 years of age are more likely in the diagnosis of hypertensive disorders (OR=1.86;P=0.009), gestational diabetes mellitus (OR=3.81;P<0.001) and preterm birth (OR=2.09;P<0.001). Compared to the control group, both elective (OR=5.83;P<0.001) and emergency (OR=1.67;P<0.001) Caesarean section, as well as instrumental vaginal delivery (OR=3.19;P=0.002), occur more often in older women. However, their neonates do not show higher odds for Apgar u22647 and/or perinatal mortality.Conclusion: In conclusion, the results of our retrospective analysis indicate a significant increase in delayed childbearing and propose advanced maternal age as a risk factor for pregnancy and obstetrical complications.Conflicts of interest: none
Pregnancy induced hypertension (PIH) is major contributor to maternal death in developing countries. Endothelin-1 (ET-1) is the most potent vasoconstriction agent known and its serum levels are ...increased in PIH. Therefore it is important to elucidate maternal and neonatal factors which influence endothelin-1 serum levels. 100 pathological pregnancies and 88 controls were analyzed for blood endothelin-1 and their anthropometric and clinical data were collected. In maternal blood ET-1 levels were strongly predicted by diagnosis, therapy and BMI, while umbilical cord ET-1 levels were strongly predicted by gestational age, therapy and delivery termination. Positive correlation between BMI and ET-1 levels suggest that obese pregnant women have increased risk for cardiovascular diseases. Inverse relationship between Apgar and umbilical ET-1 indicates that ET-1 could be considered as a prognostic marker in cases of neonatal asphyxia.
Objectives. To observe a rate of fetal breathing and gross body movement appearance as physiologic reactions to the external vibroacoustic stimulation (VAS) and to establish a rapid and reliable ...antepartal method for accurate selecting of non-compromised fetuses in the low-risk population.
Methods. Actual condition of 742-term and near-term structurally normal and otherwise healthy singleton fetuses with favourable outcome was assessed by previously established combination of the modified fetal biophysical profile and VAS. Only inactive fetuses at the beginning of the testing were included in the study. The combined biophysical testing has been started by a transabdominal real-time ultrasound examination, followed by vibroacoustic stimulus applied over the fetal head for 5 s during fetal quiescence. Fetal breathing and gross body movements were observed with particular attention in each case at measured time intervals from the application of external VAS until the moment at which either the first 60-s episode of breathing movements or all three fetal gross body movements were detected. Obtained results have been presented numerically in 5-min periods and cumulative percentages.
Results. After the external VAS, 84.5% of studied fetuses successfully manifested their normal breathing or gross body movements in the first 5 min of the modified biophysical testing. Furthermore, approximately 96% of them were able to demonstrate at least one of these two biophysical activities after 6-7 min.
Discussion. Because of its simplicity, non-invasiveness, independence of precise gestational dating, reproducibility and immediate individual results, ultrasonographic observation of normal fetal breathing and or gross body movements after the external VAS stands a real chance to become a nearly optimal antenatal test for accurate and rapid information of actual non-compromised fetal condition. Authors strongly believe that the described antenatal method should represent a rather efficient assessment procedure of fetal well-being in late pregnancy, performed during regular antenatal visits.
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