The main etiological factor of precancerous lesion and invasive cervical cancer are oncogenic human papillomaviruses types (HPVs). The objective of this study was to establish the distribution of the ...most common HPVs in different cervical lesions and cancer prior to the implementation of organized population-based cervical screening and HPV vaccination in Croatia. In this study, 4,432 cervical specimens, collected through a 16-year period, were tested for the presence of HPV-DNA by polymerase chain reaction (PCR) with three sets of broad-spectrum primers and type-specific primers for most common low-risk (LR) types (HPV-6, 11) and the most common high-risk (HR) types (HPV-16, 18, 31, 33, 45, 52, 58). Additional 35 archival formalin-fixed, paraffin embedded tissue of cervical cancer specimens were analyzed using LiPA25 assay. The highest age-specific HPV-prevalence was in the group 18-24 years, which decreased continuously with age (P<0.0001) regardless of the cytological diagnosis. The prevalence of HR-HPV types significantly increased (P<0.0001) with the severity of cervical lesions. HPV-16 was the most common type found with a prevalence (with or without another HPV-type) of 6.9% in normal cytology, 15.5% in atypical squamous cells of undetermined significance, 14.4% in low-grade squamous intraepithelial lesions, 33.3% in high-grade squamous intraepithelial lesions, and 60.9% in cervical cancer specimens (P<0.0001). This study provides comprehensive and extensive data on the distribution of the most common HPV types among Croatian women, which will enable to predict and to monitor the impact of HPV-vaccination and to design effective screening strategies in Croatia.
Objective: Fetal growth in the first trimester is estimated by measuring the crown to rump length of the fetus (CRL). There are no data on the relation between fetal growth and fat distribution in ...pregnant women. The objective was to investigate the influence of fat distribution in pregnant women on fetal growth in the first trimester of pregnancy.
Methods: This was a controlled observation using a random sampling method. Newly registered pregnant women were included in the sample during a 12-18-month period. The study included 400 pregnant women from Bjelovarsko-bilogorska County, Croatia. Participants were divided into three groups according to their pregravid BMI values, normal weight (n = 254), overweight (n = 103), and obese (n = 43). In the 12th week of pregnancy, the CRL was measured by transvaginal ultrasound. The subcutaneous and preperitoneal fat was measured by transabdominal ultrasound, using the Suzuki method. The correlation was tested by the Pearson's coefficient, and a linear regression analysis was performed on the variables with good correlation.
Results: In normal weight pregnant women, there is no correlation between the adipose tissue and fetal length, but there is a significant correlation between overweight and obese ones.
Conclusion: The distribution of adipose tissue in obese and overweight pregnant women is associated with fetal length in the first trimester of pregnancy, with a stronger correlation between visceral fat and fetal length. The influence of this correlation on the overall fetal growth should be investigated by longitudinal monitoring of these variables during the entire pregnancy.
The aim of this article was a critical appraisal of current GDM screening and diagnosis status as well as a presentation of a potentially new approach to this perinatologic and public health problem ...of increasing clinical significance. Medline, EMBASE and Cochrane databases were searched. Most professional organisations recommend universal screening at 24-28 weeks of gestation, while some of them state that selective screening could also be recommended. Expert opinions regarding GDM diagnosis significantly differ throughout the world. Authors call for an open and broad professional and scientific discussion and suggest a combination of screening and diagnosis procedures in a form of one-step 1-h screening method, creation of regional GDM diagnostic criteria and standardisation of outcome-based randomised control trials. They also advise introduction of a conceptually new approach, where the risk of hyperglycaemia rather than insisting on GDM diagnosis itself should be detected.
To explore the relationship between histologic chorioamnionitis (HCA) and decidual macrophage (DM) polarization and their influence on outcomes of neonates born before the 32nd gestational week.
...Eighty-four neonates and their placentas were included in this retrospective case-control study and divided into two groups: with and without HCA present (HCA + and HCA-). Neonatal, maternal, and placental risk factors were explored and their influence on neonatal outcomes was examined. We used CD68 and iNOS as markers for polarized DMs type 1 (M1) and CD163, CD206 and arginase (Arg-1) for polarized DMs type 2 (M2).
HCA was present in 47 (56%) cases, and 37 (44%) cases were without the present HCA. There was no statistically significant difference in neonatal risk factors between the two groups (HCA + and HCA-). Higher rates of HCA (p = .042) were observed in mothers who received antepartum corticosteroid therapy. The frequency of vaginal deliveries in HCA + pregnancies was significantly higher than in HCA- pregnancies where deliveries by cesarean section were more frequently observed (p < .001). M2 DM were more abundant in the HCA + group (p = .035). Multiple regression model assessed the association between the presence of HCA, M1, and M2 DM with ROP stages. It has been observed that HCA is a risk factor for ROP stages (β coefficient = 0.34, r
partial
= 0.246, p = .024). With the logistic regression model, the association between the presence of HCA, M1, and M2 DM with neonatal nCPAP respiratory support and necrotizing enterocolitis (NEC) was assessed. The presence of M2 macrophages in decidua is an independent risk factor for neonatal nCPAP respiratory support (coefficient −0.07, OR = 0.928, 95% CI 0.87-0.99, p = .024) and the presence of M1 macrophages in decidua increases the risk for NEC (coefficient 0.010, OR = 1.0108, 95% CI 1.00-1.02, p = .032).
The significantly more abundant presence of M2 DM was detected in HCA + placentas and their association with the increased risk for neonatal nCPAP respiratory support was observed. On the contrary, the presence of M1 DM increases the risk for NEC. The presence of HCA is a risk factor for ROP stages.
•The ideal approach is to assess and treat iron deficiency before the onset of anemia.•Physicians should be aware of the stigma and normalization surrounding HMB.•It is recommended that all women ...have their hemoglobin and iron status checked prior to planning for pregnancy.•Postpartum hemorrhage is a greater risk in case of untreated IDA.•Intrapartum patient blood management include identifying risk factors for PPHs, minimizing blood loss and optimizing haemostasis.
Iron deficiency (ID) and iron deficiency anemia (IDA) are very common in women during their reproductive life, but often these conditions remain unrecognized and left untreated.
Heavy menstrual bleeding (HMB) and pregnancy are associated with ID/IDA, influencing health and the physical and social lives of these individuals. Cross discipline expertise has considered evidence presented here of the pathophysiological mechanisms, the symptoms, the diagnostic criteria and the therapeutic approaches to ID/IDA.
A call for action for IDA before and during pregnancy and in the postpartum period is discussed in this review. The uterine disorders causing HMB (which include, but are not limited to uterine fibroids, adenomyosis, endometrial polyps) not only contribute to IDA, but also to infertility and pregnancy complications. It is thus important to reveal and correct ID/IDA. During pregnancy iron requirement increases, thus ID/IDA are common, and these conditions may have a negative impact on pregnancy outcome. Hence, it is critical to early identify and treat ID/IDA during pregnancy with iron replacement therapy. Postpartum IDA may occur following blood loss and major hemorrhage at delivery. In this respect, patient blood management is the best approach for alleviating this critical situation.
Action to increase the awareness for women and physicians on the diagnosis and treatment of ID/IDA is essential to improve health outcomes for women across their life course and for their infants.
Peripartal hysterectomy (PPH) is a life saving surgical procedure that is performed when conservative measures fail to control bleeding. According to literature data there is an increase in incidence ...among developed countries.
To define the rate of PPH during two eight-year periods in five Croatian hospitals in respect to mode of delivery.
Patients data were collected retrospectively from the medical records of the five Croatian hospitals. We analyzed data from 1998 to 2013, and divided them in two eight-year periods.
In 70 cases out of 153,302 deliveries urgent PPH was performed. PPH after vaginal deliveries was found in 0.21%o and 0.16%o and PPH after caesarean section was 1.91 %o and 2.04%o in the first and second period, respectively.
There is no increase of PPH rate in the two analyzed periods, although there is a statistically significant increase of caesarean section rate. Caesarean section presents higher risk for PPH.
SAŽETAK. Objavljene smjernice vezane za follow-up pacijentica primarno liječenih od karcinoma jajnika, ali i drugih ginekoloških malignoma, temelje se na podacima samo nekoliko studija koje nisu ...randomizirane i koje ne prikazuju učinkovitost i utrošak/dobrobit pretraga što su korištene za dijagnozu recidiva bolesti. Te studije/preporuke nisu usuglašene po vrsti pretraga i vremenskoga intervala pregleda. Uz to kod detekcije recidiva u pacijentica primarno liječenih od karcinoma jajnika, ostaje još terapijska dilema s obzirom na to da će gotovo svaka pacijentica s recidivom bolesti umrijeti. Follow-up asimptomatskih pacijentica najčešće obuhvaća uvid u povijest bolesti, serumski CA 125, ginekološki fizikalni pregled i često ultrazvučni pregled, a koriste se i druge radiološke pretrage kada simptomi i znakovi ukazuju na mogući recidiv bolesti.
U literaturi nalazimo dvije oprečne tendencije. Prva koja vodi minimalističkome praćenju i druga koja, na osnovi novih procedura, lijekova i tehnologija, potiče kliničara da se koristi skupim pretragama koje još nisu znanstveno opravdane.
Potrebna su velika prospektivna randominizirana ispitivanja koja uspoređuju minimalistički follow-up s intenzivnim skupim pristupom pretraga. Studije moraju voditi računa o ciljevima liječnika (dobri i učinkoviti rezultati koji jamče najbolju kliničku praksu), potrebama pacijentica (percepcija da je liječenje vođeno na odgovarajući način) i realnim mogućnostima zdravstvenoga sustava. Te studije trebale bi jasnije usporediti objektivni klinički ishod (sveukupno preživljenje, vremenski interval bez bolesti i komplikacije) te subjektivni ishod (kvalitetu života i očekivanja pacijentica).
Ovarian cancer is the fourth most common gynecological malignancy in Croatia. Reasons for high fatality rates are the rapid growth of cancer and the late presentation of nonspecific symptoms in its ...advanced stage. Survival rates are significantly improved if cancer is detected early, while still in its localized stage. Screening the general population with the Ca-125 tumor marker and transvaginal ultrasound is not recommended at this time. Although there are no routine diagnostic techniques, early detection of ovarian carcinoma can be significantly improved with early recognition and objectivisation of nonspecific symptoms, analysis of potential biomarkers, as well as the use of multimodal tests.
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