Ob koncu lanskega leta je Zdravstveni svet Republike Slovenije potrdil program preprečevanja zgodnjih invazivnih okužb novorojenčkov, povzročenih s streptokokom skupine B, ki vključuje univerzalno ...presejanje nosečnic v 35.–37. tednu nosečnosti. V prispevku smo pregledali različne diagnostične metode presejanja in dejavnike, ki pomembno vplivajo na njihovo uspešnost tako v ginekološki ambulanti kakor tudi v mikrobiološkem laboratoriju. Bralca opozarjamo na pravilnost odvzema kužnine, mu predstavimo izbrano strategijo testiranja s kombinacijo obogatene kulture in molekularnega testiranja ter mu ponujamo seznam registriranih molekularnih testov, primernih za testiranje. V zadnjem delu prispevka razpravljamo o pomenu hipervirulentnega klona CC-17, ki povzroča večino invazivnih okužb novorojenčkov v Sloveniji, in o metodah, s katerimi ga prepoznamo.
Optimalne zdravstvene izide v nosečnosti povezujemo s stopnjo zdravstvene pismenosti, ki je danes prepoznana kot ključna socialna determinanta zdravja. Namen integrativnega pregleda literature je bil ...preučiti, kateri sodobni pristopi (intervencije) zdravstvene vzgoje za dvig zdravstvene pismenosti nosečnic so razviti v svetu ter kakšna je vključenost strokovnjakov drugih disciplin v intervencije zdravstvene vzgoje. Pregledani so bili članki, objavljeni med letoma 2010 in 2021, iz naslednjih elektronskih podatkovnih zbirk: Cinahl in Medline (prek baze EBSCOhost), PubMed in ScienceDirect. V končno vsebinsko integrativno analizo je bilo umeščenih pet kvantitativnih raziskav. Zbrani podatki so bili analizirani z metodo tematske analize. Raziskave poročajo o vplivu zdravstvene pismenosti na prepričanja/stališča, znanje in življenjski slog med nosečnostjo, obenem pa tudi kažejo na to, da je vključevanje drugih, nezdravstvenih strokovnjakov v zdravstvenovzgojne intervencije zelo omejeno. Vidne so spremembe v pristopu sodobne zdravstvene vzgoje, a hkrati tudi to, da je ta proces prepočasen in nezadostno progresiven.
Fetalna in neonatalna aloimunska trombocitopenija (FNAIT) je posledica transplacentarnega prenosa in vezave aloimunskih protiteles na trombocitne antigene otroka, ki jih je podedoval od očeta. Do ...aloimunizacije matere proti trombocitnim antigenom lahko pride tekom nosečnosti, kot tudi ob transfuziji trombocitov. FNAIT je redka bolezen, ki lahko poteka popolnoma brez bolezenskih znakov ali pa ima otrok znake hemoraške diateze. Njen najhujši zaplet je znotrajlobanjska krvavitev, zato sta zgodnja diagnostika in v primeru indikacije ustrezno zdravljenje zelo pomembna. Po podatkih iz literature je ocenjena pojavnost FNAIT 1 na 1000-2000 živorojenih. Pojavnost FNAIT v Sloveniji ni znana. Namen opravljene retrospektivne raziskave je bil ugotoviti pojavnost in etiologijo FNAIT v Sloveniji ter klinično sliko bolnikov s FNAIT. Rezultati raziskave, v kateri smo analizirali izvide transfuzijskih preiskav za dokaz trombocitnih protiteles pri novorojenčkih ali materah, so pokazali veliko nižjo pojavnost. V obdobju od leta 1996 do leta 2016 je bilo v Sloveniji potrjenih 39 primerov FNAIT, povprečno 2 na leto, medtem ko je bilo prošenj za dokaz trombocitnih protiteles pri novorojenčku ali materi povprečno 9 na leto. Pojavnost FNAIT je torej v Sloveniji 1 na 10.000 živorojenih. Kljub temu, da je ocena pojavnosti zaradi retrospektivne analize najverjetneje podcenjena, menimo, da omenjeni rezultati potrjujejo naša klinična opažanja, da je FNAIT poddiagnosticirana. Prispevek zato, poleg rezultatov retrospektivne raziskave o pojavnosti, etiologiji in klinični sliki FNAIT v Sloveniji, predstavlja pregled trenutnega znanja o FNAIT, saj želimo, da se na omenjeno bolezen, ki je lahko življenje ogrožajoča, pogosteje pomisli in ustrezno ukrepa.
Background. Preimplantation genetic diagnosis offers early investigation of embryos in couples with a high risk for offspring affected by a genetic disease. We report indications and results ...associated with the PGD program conducted at Gynecology Clinic Ljubljana from June 2004 to December 2008. Methods. The retrospective analysis includes sixty cycles performed in 34 couples enrolled in the PGD programe. Embryos were biopsied on the third day and the genetic analysis was performed using the FISH and PCR methods. Embryo transfers were carried out on the fifth day. Results. The main indications were chromosomal abnormalities (67 %), followed by recurrent miscarriages (16 %), autosomal dominant and recessive diseases (9 %), and X-linked diseases (6 %). Sixty cycles were performed and 48 embryo transfer procedures. There were 15 clinical pregnancies resulting in clinical pregnancy rate 25 % per cycle and 37.5 % per embryo transfer. A total of eight unaffected children were born, and two pregnancies are still ongoing. Conclusions. PGD is technically a very challenging procedure. Superior knowledge and communication between geneticists and reproductive medicine scientists is mandatory for successful PGD procedures. PGD has gained a place among the choices offered at Gynecology Clinic Ljubljana to couples at risk of transmission of genetic disease.
Background: Pregnancy-related pelvic girdle pain (PGP) refers to the pain in the lumbosacral region, the sacroiliac joints and the symphysis pubis joint. The results of the high methodological ...quality studies indicate that the point prevalence of pregnant women suffering from PGP is about 20 %. Pregnancy-related PGP requires a comprehensive physiotherapy assessment in order to make or confirm a diagnosis, plan the treatment and evaluate the patient’s condi- tion. Physiotherapy assessment includes clinical diagnostic tests which should satisfy the criteria of safety, feasibility, reliability, sensitivity, specificity and validity. The aim of the present paper was to systematically review the literature on clinical diagnostic tests of PGP in order to determine which clinical tests meet the necessary criteria and are appropriate for clinical examination of PGP in pregnancy and postpartum. Methods: PubMed, Cinahl, Embase, Index Medicus databases and the Cochrane controlled trials reg- ister from 1980 to 2008 were searched using the key words, pregnancy/pelvic girdle pain, pregnancy/clinical tests/sacroiliac joint/symphysis pubis. Only the articles/texts in English and Slovene were reviewed unless translated abstract was available. Additional manual searches of the reference lists in books and review articles were undertaken. Along with the randomized clinical studies the literature search encompassed also the basic studies. Results: Nine studies evaluating the tests for clinical examination of the pregnancy-related PGP met the criteria for inclusion in this review. The studies evaluated and analysed six provocation tests for the sacroiliac joint, namely, the Posterior pelvic pain provocation test (P4), Patrick’s Faber test, palpation of the long dorsal ligament, compression test, separation test, Menell’s test as well as two provocation tests for the symphysis pubis joint (pain palpation and a modified Trendelenburg test) and one functional pelvic girdle test to assess the impairment (Active Straight Leg Raise –ASRL). The tests exemplifying the highest level of specificity and reliability to identify the pain in the sacroiliac joint proved to be the Posterior pelvic pain provocation test, Patrick’s Faber test and the palpation of the long dorsal ligament of the sacroiliac joint. According to the studies, the palpation and a modified Trendelenburg test are most appropriate to identify the pain, abnormalities and symphysis pubis asymmetries. The active straight leg raise is recommended as a functional test of the pelvic girdle. Conclusions: PGP can be diagnosed by pain provocation tests and pain palpation tests. Most of the evalu- ated tests have a very high specificity indicating that, if negative, it is likely that a patient does not suffer from pain in the pelvic girdle during pregnancy and in the postpartum period. The sensitivity is, however, lower. It is therefore recommended to perform all the tests, not to rule out PGP, if one test is negative. All the recommended tests are simple to carry out and appropriate for clinical examination of pregnancy-related PGP.
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.
Namen prispevka je razjasnitev dilem pri napotitvi bolnika s sumom na bolezen ščitnice k tirologu. Zaradi omejitev zdravstvenega sistema pomoč pri specialistu ni vedno dosegljiva takoj. Stopnje ...nujnosti, opredeljene v »Pravilniku o naročanju in upravljanju čakalnih seznamov ter najdaljših dopustnih čakalnih dobah«, naj bi omogočale bolnikom, da dobijo pomoč takrat, ko jo potrebujejo. Sistem eNaročanja z eNapotnico zahteva razvrščanje napotnic glede na stopnjo nujnosti. Menimo, da mora to zahtevno strokovno opravilo izvajati zdravnik specialist, ne pa drugo medicinsko osebje ali administrativni kader. Ustrezno razvrščanje napotnic je možno samo, če je informacij na napotnici dovolj, sicer jo je treba dopolniti. Stopnje nujnosti pri bolnikih z motnjo v delovanju ščitnice ne opredelimo samo na podlagi laboratorijskih izvidov, čeprav so ti zelo pomembni in morajo biti navedeni na napotnici. Pomagamo si tudi z drugimi informacijami o bolniku, kot so na primer starost, pridružene bolezni, zdravila, ki jih bolnik prejema, morebitna nosečnost ali postopek oploditve z biomedicinsko pomočjo. Pri bolniku s sumom na golšo oziroma nodus v ščitnici so zelo pomembne informacije o klinični oceni velikosti ščitnice, prisotnost morebitnih sumljivih bezgavk na vratu in izvidi opravljenih slikovnih preiskav. Čeprav so ščitnične bolezni zelo pogoste in ne morejo vsi bolniki dobiti pomoči specialista takoj, pa lahko pravilno izpolnjena ter natančno razvrščena eNapotnica zagotovi ustrezen rok obravnave večini bolnikov.
Background. Multiple pregnancy can be prevented by an elective single blastocyst transfer. The aim of this prospective study was to evaluate the effect of blastocyst development and morphology on the ...outcome of single blastocyst transfer. Methods. In this study 157 women with single blastocyst transfer were included; their mean age was 33.6 years, range 20–42. Embryos were cultured to the blastocyst stage and evaluated using the Gardner’s classification. An elective single blastocyst transfer was performed in 83 women although 2 or more blastocysts developed (Group 1) and in 74 with only one developed blastocyst (Group 2). Results. In Group 1 (2 or more blastocysts) the pregnancy rate was a significantly higher than in Group 2 (1 blastocyst only) (39.8 % vs. 23.0 %; P < 0.05). After the transfer of a single expanded blastocyst no statistical difference in the pregnancy rate between the two groups was observed (45.5 % vs. 44.6 %). A significantly higher pregnancy rate was found after the transfer of one expanded blastocyst with a good embryoblast and trophoblast morphology compared to the transfer of a single early blastocyst (45.6 % vs. 7.1 %, P < 0.05). Conclusions. After single blastocyst transfer, the likelihood of achieving a pregnancy is higher in women with 2 or more blastocysts developed. And also the likelihood of achieving a pregnancy is higher with an expanded blastocyst transferred with good embryoblast and trophoblast morphology. The blastocyst development is the main predictor of pregnancy, which may reflect the embryonic genetic status.
Introduction: To estimate the procedure-related risks of pregnancy loss following chorionic villus sampling (CVS) and amniocentesis (AC) compared to pregnancies without procedure.
This cohort study ...enrolled all women who underwent CVS or AC at the Department of Perinatology, University Medical Centre, Ljubljana, Slovenia (from January 2013 to June 2015). For each group we obtained a maternal age and gestational age (11-14 weeks for CVS and >15 weeks for AC) for a matched control group without invasive procedures from the national database. The data was obtained from hospital records and telephone surveys concerning pregnancy outcomes. Pregnancy loss rates in intervention vs. control groups were compared by generating relative risk (RR) with a 95% confidence interval.
During the study period, 828 women underwent CVS and 2,164 women underwent AC. Complete outcome data was available in 2,798 cases (93.5%, 770 CVS, 2,028 AC). Pregnancy loss occurred in 8/770 (1.04%, 95% CI 0.4-2.0%) after CVS vs. 15/1130 (1.33%, 95% CI 0.8-2.2%) in matched control (RR 0.8, 95% CI 0.33-1.8, p=0.6). It occurred in 16/2028 (0.79%, 95% CI 0.5-1.3%) after AC vs. 14/395 (3.29%, 95% CI 2.1-5.8%) in matched control (RR 0.2, 95% CI 0.11-0.45, p<0.0001).
The pregnancy loss rates after CVS and AC were comparable to losses in pregnancies without these procedures. With the increasing use of non-invasive prenatal testing, information that the invasive procedures are safe when indicated is essential.
Rak dojke pri mladih bolnicah je redek pojav. Uspešno zdravljenje te bolezni omogoča večini mladih bolnic dolgo preživetje. Pomemben vidik kakovosti življenja je nedvomno ohranjanje plodnosti, ...posebno ob zavedanju, da je starost žensk ob prvem otroku vse višja. Mlade bolnice je zato treba že ob postavitvi diagnoze seznaniti z možnimi negativnimi vplivi zdravljenja na plodno sposobnost in jim ponuditi možnost svetovanja. Na ginekološko-onkološkem konziliju bolnicam ali paru med drugim predstavimo postopke za shranjevanje genetskega materiala pred pričetkom zdravljenja. V pričujočem prispevku predstavljamo in razpravljamo o novejših spoznanjih, ki povezujejo rak dojke ter nosečnost. Predstavljamo tudi zbrane podatke o nosečnostih pri zelo mladih bolnicah po zdravljenju raka dojke v Sloveniji.
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