Citomegalovirus (CMV) je najpogostejši virusni vzrok okužbe ploda v maternici. Virus je nevrotropen, zato povzroča predvsem nevrološke zaplete. Je najpogostejši negenetski vzrok senzorinevralne ...naglušnosti, nevroloških nepravilnosti in umske zaostalosti, hkrati je vzrok tudi za nedonošenost, smrt ploda v maternici in umrljivost novorojenčkov. Okužbo s CMV potrjujemo z dokazom za CMV specifičnih protiteles IgM in IgG. Prisotnost virusa dokazujemo s PCR. Za časovno opredelitev okužbe s CMV določamo avidnost protiteles IgG. Prirojena okužba je posledica viremije ob primarni ali sekundarni okužbi nosečnice. Ob znotrajmaternični okužbi so lahko prisotni značilni ultrazvočni znaki. Prenatalna diagnoza prirojene okužbe s CMV se postavi z amniocentezo. Simptome ob rojstvu ima do 15 % otrok mater s potrjeno okužbo v nosečnosti. Pri novorojenčkih s simptomi pride v 40–60 % do trajnih posledic, od katerih je najpogostejša senzorinevralna naglušnost. Svetovanje nosečnici s primarno okužbo s CMV je težavno, saj po doslej razpoložljivih podatkih in izsledkih raziskav izida za plod še ne znamo natančno napovedati. Ocene resnosti okužbe in možnih posledic temeljijo predvsem na časovni opredelitvi okužbe nosečnice, prisotnosti in vrsti nepravilnosti pri plodu in laboratorijskih parametrih. Rutinsko zdravljenje nosečnic s potrjeno okužbo s CMV z virostatikom valaciklovirjem ali s hiperimunimi globulini se zaradi pomanjkanja zadostnih dokazov o učinkovitosti ne priporoča. Vse nosečnice bi morale biti seznanjene o nevarnostih okužbe s CMV in preventivnih ukrepih za zaščito pred okužbo s CMV v nosečnosti. Pregledni članek povzema znana dejstva glede presejanja, diagnosticiranja in zdravljenja okužbe s CMV v nosečnosti z navajanjem najnovejših spoznanj in dokazov ter predstavlja prilagoditev tujih priporočil za dobro klinično prakso v Sloveniji.
Slabokrvnost je najbolj pogost simptom v nosečnosti. Zaradi razvoja zarodka in hitre rasti ploda se močno povečajo potrebe organizma po železu in vitaminih. Zato je slabokrvnost zaradi pomanjkanja ...železa daleč najbolj razširjena oblika slabokrvnosti v nosečnosti. Anemija v nosečnosti je opredeljena z ravnijo hemoglobina (Hb), ki je manjša od 110 g/L. V normalni nosečnosti se sestava krvi pomembno spremeni. Povečanje celokupnega volumna krvi in hemostatske spremembe so fiziološke spremembe, ki omogočajo, da porodnica brez posledic prenese normalno izgubo krvi med porodom. Plazemski volumen se v nosečnosti poveča za 50 %, masa eritrocitov pa za 18 – 25 %, odvisno od razpoložljivega železa. Te spremembe povzročijo razredčitev koncentracije hemoglobna, kar poznamo kot fiziološko slabokrvnost v nosečnosti. Fiziološka slabokrvnost doseže vrh v 32. tednu nosečnosti. Zaradi fizioloških sprememb odkrijemo s presejalnimi testi v nosečnosti mnogo slabokrvnosti, ki bi sicer ostale neodkrite. Povečane ali spremenjene prehranske in presnovne zahteve v nosečnosti povzročijo, da je slabokrvnost zaradi pomanjkanja železa (sideropenična anemija) bolj pogosta. Prva nepravilnost v biokemičnih izvidih, ki kaže na pomanjkanje železa v nosečnosti, je zmanjšana koncentracija feritina (na pomanjkanje železa lahko sklepamo že, ko je vrednost feritina manjša od 20–30 g/L). Feritin je stabilen in zadovoljivo zrcali zaloge železa, za razliko od vrednosti serumskega železa. Zato učinkovito dodajanje železovih pripravkov in s tem preprečevanje sideropeničnih anemij lahko pričnemo že zelo zgodaj. Tako na zelo enostaven način učinkovito preprečimo nastanek zapletov v nosečnosti, ob porodu in v poporodnem obdobju. Slabokrvnost v nosečnosti je povezana s višjo pogostnostjo za prezgodnji porod, nizko porodno težo, z nujnostjo uporabe transfuzije ob in po porodu ter s poporodno depresijo.
Gestational diabetes (GDM) is one of the most common complications in pregnancy, with a prevalence that continues to rise. At the time of the COVID-19 epidemic, immediate reorganisation and ...adjustment of the system was needed. Telemedicine support was offered in order to provide high-quality treatment to pregnant women. However, the success of the treatment is unknown. We therefore aimed to evaluate COVID-19 epidemic effects on pregnancy outcomes in GDM.
The maternal outcomes (insulin treatment, gestational weight gain, caesarean section, hypertensive disorders) and perinatal outcomes (rates of large and small for gestational age, preterm birth and a composite child outcome) of women visiting a university hospital diabetes clinic from March to December 2020 were compared with those treated in the same period in 2019.
Women diagnosed with GDM during the COVID-19 epidemic (n=417), were diagnosed earlier (23.9 11.7-26.0 vs. 25.1 21.8-26.7 gestational week), had higher fasting glucose (5.2 5.0-5.4 vs. 5.1 4.8-5.3 mmol/l) and earlier pharmacological therapy initiation, and had achieved lower HbA1c by the end of followup (5.1% (32.2 mmol/mol) 4.9% (30.1 mmol/mol)-5.4% (35.0 mmol/mol) vs. 5.2% (33.3 mmol/mol) 5.0% (31.1 mmol/mol) - 5.4%·(35.5 mmol/mol), p<0.001) compared to a year before (n=430). No significant differences in perinatal outcomes were found.
Although GDM was diagnosed at an earlier gestational age and higher fasting glucose concentration was present at the time of diagnosis, the COVID-19 epidemic did not result in worse glucose control during pregnancy or worse pregnancy outcomes in Slovenia.
Decembra 2019 se je v Wuhanu na Kitajskem pojavil novi sev koronavirusa SARS-CoV-2, ki povzroča bolezen covid-19. Ta se kaže s simptomi in znaki prizadetosti zgornjih dihal: s kašljem, dispnejo, ...povišano telesno temperaturo, prisotne pa so lahko bolečine v mišicah, prebavne težave, izguba vonja in okusa. Znanje, pridobljeno na podlagi izbruhov ostalih človeških koronavirusov (angl. Severe Acute Respiratory Syndrome Coronavirus - SARS-CoV in Middle East Respiratory Syndrome Coronavirus - MERS-CoV), uvršča nosečnice in njihove plodove v ranljivo skupino, vendar pa trenutno velja, da nosečnice niso bolj ogrožene za težak potek bolezni covid-19. Po razglasitvi pandemije so sledili ostri ukrepi, katerih cilj je bil omejiti širjenje virusa. Zato se je življenje na vseh področjih korenito spremenilo. Tudi delovanje bolnišnic se je moralo prilagoditi na obstoječe razmere. V Porodnišnici Ljubljana smo se po razglasitvi pandemije covida-19 zavedali, da bo treba za optimalno oskrbo vseh nosečnic oblikovati smernice oz. kliničnih poti za vse zaposlene. Zaradi narave dela obsega dejavnosti ni bilo mogoče bistveno zmanjšati, zato smo se na sprejem morebitno ali potrjeno okuženih nosečnic morali pripraviti v izjemno kratkem času. Porodnišnico smo razdelili na tri območja po zgledu urgentnega bloka Univerzitetnega kliničnega centra Ljubljana: belo območje za zdrave nosečnice, sivo območje za nosečnice, pri katerih smo sumili na okužbo s SARS-CoV-2, vendar ta še ni bila potrjena, in rdeče območje, kjer smo obravnavali dokazano pozitivne nosečnice. Do konca maja 2020 sta v Ljubljanski porodnišnici rodili dve porodnici z dokazano okužbo z virusom SARS-CoV-2 in tri porodnice po preboleli okužbi z virusom SARS-CoV-2. Nobena od njih ni imela hujših simptomov bolezni covid-19, zato tudi intenzivno zdravljenje ni bilo potrebno.
Pregnancy after kidney transplantation is an uncommon event. In addition to the risk to the child and the mother, pregnancy has a certain risk for the transplanted kidney.
We made a retrospective ...analysis of pregnancy and kidney function over a 49-year period in women with transplanted kidneys monitored at the National Transplant Centre, University Medical Centre Ljubljana, Ljubljana, Slovenia.
We analyzed 22 pregnancies in 18 women (26-39 years old) 78 ± 37 months after transplantation. Serum creatinine before conception was 92 ± 26 μmol/L; 3 years after delivery, it was 117 ± 67 μmol/L. There were no rejections during pregnancy. Three rejections occurred in the first 9 months after delivery. The median duration of pregnancies was 37 weeks. Preeclampsia occurred in 4 women and severe eclampsia occurred in 2 women. In 19 cases, delivery was by caesarean section. One child was born with trisomy of chromosome 21 and 3 children were born with minor congenital anomalies.
Renal function and proteinuria did not deteriorate 3 years after pregnancy, even after 2 pregnancies. Rejections in the early post-pregnancy period were common. Preeclampsia was more frequent than in the average population. The incidence of major congenital anomalies was comparable to that seen in pregnant women without immunosuppression.
Objective
To compare perinatal outcomes before and after implementation of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria for testing of gestational diabetes ...mellitus (GDM).
Methods
A national, perinatal, registry‐based cohort study of prospectively collected data was conducted. Patients with diabetes type 1 or 2 were excluded. Outcomes of 135 786 pregnancies before (January 1, 2004 to May 31, 2010) and 140 524 after (June 1, 2011 to December 31, 2017) the introduction of IADPSG criteria were compared using Student t test and χ2 test (P<0.05 was significant). Multivariable logistic regression was used to compare outcomes controlling for potential confounders.
Results
Prevalence of GDM increased from 2.6% to 9.7% (adjusted odds ratio 3.92; 95% confidence interval 3.78–4.08). Incidence of large‐for‐gestational age (LGA), macrosomia (birth weight >4500 g), Erb's palsy, and hypertensive disorders in pregnancy decreased despite increasing maternal age and pre‐pregnancy obesity. Rates of cesarean delivery increased in both GDM and non‐GDM groups, with a less pronounced increase in GDM mothers. Incidence of small‐for‐gestational age (SGA) increased in GDM but not in non‐GDM group.
Conclusion
Implementation of IADPSG criteria in a country with a relatively low prevalence of GDM did not result in higher rates of cesarean delivery and was associated with reductions in LGA and hypertensive disorders in pregnancy.
Implementation of IADPSG criteria resulted in higher prevalence of gestational diabetes and was associated with reductions in macrosomia and hypertensive disorders in rates of pregnancy.
The aim of this study was to evaluate the usability of preoperative autologous blood donation (PAD) in pregnant women with placenta previa.
We retrospectively reviewed 142 pregnancies with placenta ...previa from completed 32 weeks of gestation who underwent a caesarean delivery in University clinical centre Ljubljana, over a five-year period.
Although more than two thirds of pregnant women met the criteria for PAD, it was justified for approximately 13.6% of them. The decrease in haemoglobin level after PAD was only 4.5 ± 6.7 g/l on average and did not induce anaemia.
Although our study shows that PAD is not reasonable for the majority of all pregnant women with placenta previa who met the criteria for PAD from our study, we believe that with the implementation of Patient Blood Management it still has its prospects of clinical application. However, further prospective studies are needed to find risk factors for increased surgical bleeding to make a proper patient selection for PAD.
Ectopic decidual transformation is a well-documented phenomenon that occurs most often in the ovary and cervix but can also be present on the serosal surfaces of the abdominal organs. Although ...generally asymptomatic, ectopic decidua sometimes mimics acute appendicitis or causes intraabdominal bleeding. We report a case of ectopic decidual transformation and present a review of the literature.
PDF
