Abstract
Background
Spontaneous liver rupture in pregnancy is often unrecognized, highly lethal, and not completely understood. The goal was to summarize and define the etiology, risk factors, ...clinical presentation, appropriate diagnostic methods, and therapeutic options for spontaneous hepatic rupture during pregnancy/puerperium (SHRP) complicated by the hypertensive disorder.
Methods
Literature search of all full-text articles included PubMed (1946–2021), PubMed Central (1900–2021), and Google Scholar. Case reports of a spontaneous hepatic rupture or liver hematoma during pregnancy or puerperium as a complication of hypertensive disorders (preeclampsia, eclampsia, HELLP syndrome) were searched. There was no restriction of language to collect the cases. Additional cases were identified by reviewing references of retrieved studies. PRISMA guidelines for the data extraction and quality assessment were applied.
Results
Three hundred and ninety-one cases were collected. The median maternal age was 31 (range 17–48) years; 36.6% were nulliparous. Most (83.4%) occurred in the third trimester. Maternal and fetal mortality was 22.1% and 37.2%, respectively. Maternal and fetal mortality was significantly higher 1) before the year 1990, 2) with maternal hemodynamic instability, and 3) eclampsia. The most important risk factors for SHRP were preeclampsia and HELLP syndrome. Most women had right lobe affected (70.9%), followed by both lobes in 22.1% and left lobe in 6.9%. The most common surgical procedure was liver packing. Liver transplantation was performed in 4.7% with 100% survival. Maternal mortality with liver embolization was 3.0%. Higher gestational age increases fetal survival.
Conclusion
The diagnosis and treatment of SHRP are often delayed, leading to high maternal and fetal mortality. SHRP should be excluded in hemodynamically unstable patients with preeclampsia/eclampsia or HELLP syndrome and right upper abdominal pain. Liver embolization and liver transplantation contribute to maternal survival. Maternal and fetal mortality was significantly higher before the year 1990. Hemodynamic instability, preeclampsia, and eclampsia have a significant negative influence on maternal survival.
Level of evidence
Level V
Pregnancies burdened with gestational diabetes (GDM) are more likely to end in birth of a macrosomic child, where the frequency of operative termination of pregnancy is more common, accompanied with ...more complications and injuries of both mother and child in comparison to the general population. The need to calculate fetal weight right before delivery has led to the development of numerous methods for greater estimation accuracy. We reviewed the related literature from 1980 to 2020, using the terms macrosomia, ultrasound assessment, gestational diabetes, and relevant articles were considered in preparation of this article. The most frequently used methods are based on two-dimensional ultrasound measurements of individual fetal biometric parameters and their combination in a mathematical regression model. Some methods involve the addition of other mother and child conditions to increase reliability of the method in recognizing macrosomia. In daily work, especially with pregnant women suffering from GDM, it is necessary to have reliable data on the estimated fetal weight before making the correct clinical decision on how to terminate the pregnancy. In this regard, we bring a review of the literature related to the assessment of fetal macrosomia, especially in women with GDM. Key words: Gestational diabetes mellitus; Fetal weight; Ultrasound; Assessment; Macrosomia
INFLUENCE OF MALE OBESITY ON FERTILITY Kasum, Miro; Anić-Jurica, Sonja; Čehić, Ermin ...
Acta clinica Croatica,
06/2016, Letnik:
55, Številka:
2
Journal Article
Recenzirano
Odprti dostop
The aim of this review is to analyze current diagnostic approaches to obesity in
adult men, the potential mechanisms linking obesity to infertility, and treatment options aimed at
improving ...reproductive health. Obesity has become a worldwide epidemic with the estimated prevalence
increasing from 28.8% to 36.9% between 1980 and 2013. In terms of diagnosis, numerous
simple techniques have been developed including body mass index, waist to hip ratio, waist circumference,
bioelectrical impedance analysis, ultrasound and skinfold measurements. Additionally, several
other less available but more accurate techniques have been suggested, such as air displacement plethysmography,
dual energy x-ray absorptiometry, computed tomography and magnetic resonance imaging.
In addition to cardiovascular and other disorders, male obesity can negatively affect the male reproductive
potential through abnormal reproductive hormone levels, reduced semen quality, increased
release of adipose-derived hormones and adipokines, as well as thermal, genetic and sexual mechanisms.
In the management of obesity related male infertility, natural weight loss is the cornerstone and
regular exercise the first-line treatment. Although bariatric surgery results in greater improvements in
weight loss outcomes when compared to non-surgical interventions, further research is required to
clarify its overall influence on male fertility.
The purpose of this review is to present contemporary measures for preventing the
increase in preovulatory progesterone (P) and its adverse effects on ovarian stimulation in in vitro
fertilization ...(IVF). For the last 20 years, the increase of preovulatory P has been a topic of numerous
discussions because its role is not fully understood in terms of its impact on pregnancy outcome after
IVF. Some studies failed to establish a connection between the preovulatory P increase and successful
IVF outcome regardless of the level of P, while, conversely, most other studies have reported on adverse
effects of elevated P concentrations. Current strategies to prevent the increase in preovulatory P include
an individualized approach with the use of mild stimulation protocols and early application of
human chorionic gonadotropin for ovulation induction among good responders, delay in the transfer
of fresh embryos from 3rd to 5th day, and cryopreservation of all embryos with the thawed embryo
transfer in the natural cycle. Nevertheless, further studies are needed to confirm the current preventive
methods or enable the application of new strategies in order to lower or eliminate the detrimental
effects of preovulatory P rise during ovarian stimulation in IVF.
Purpose
To determine clinical and radiographic risk factors for the vertical subsidence of modular fluted tapered stems implanted using the transfemoral Wagner approach in a cohort of revision hip ...arthroplasties.
Methods
A retrospective review of a single-centre surgical registry was performed. Patients who underwent a revision total hip arthroplasty, in which the uncemented modular fluted tapered stem (REVISION Hip/Anca-Ti6Al4V, LimaCorporate, Udine, Italy) was implanted using the transfemoral Wagner approach, were identified. Patient’s demographic data, clinical and radiographic outcomes and post-operative complications were assessed. As a significant subsidence, a 5-mm cut-off was chosen.
Results
We identified 278 revision hip arthroplasties with a mean follow-up of 35 months. The median of subsidence in the group of 5 mm and less was 2 mm, and 17 mm in the group of subsidence of 5 mm and more. A negative correlation was found between the stem subsidence and the length of good contact between the medial and lateral cortical bone and the stem (medial, − 0.248;
P
< 0.001, lateral, 0.284; P < 0.001). For 200 mm stems, the percentage of good contact between femoral parts of stem and bone on medial side was 40.5% (81.0 mm) for patients with subsidence of five or less mm, and 30% (60.0 mm) for lateral side. For 140 mm stems, the percentage was 52.86% (74.0 mm) for medial side and 40.36% (56.5 mm) for lateral side. A neck length was shown to correlate significantly with the stem subsidence (
P
= 0.004).
Conclusion
It is crucial to provide good contact between the bilateral cortical bone and stem, and, if possible, to select implant constructs with shorter femoral necks, in order to reduce subsidence and to ensure longer implant survivorship.
A common practice in meteorological drought monitoring is to transform the observed precipitation amounts to the standardised precipitation index (SPI). Though the gamma distribution is usually ...employed for this purpose, some other distribution may be used, particularly in regions where zero precipitation amounts are recorded frequently. In this study, two distributions are considered alongside with the gamma distribution: the compound Poisson exponential distribution (CPE) and the square root normal distribution (SRN). They are fitted to monthly precipitation amounts measured at 24 stations in Croatia in the 55-year-long period (1961–2015). At five stations, long-term series (1901–2015) are available and they have been used for a more detailed investigation. The accommodation of the theoretical distributions to empirical ones is tested by comparison of the corresponding empirical and theoretical ratios of the skewness and the coefficient of variation. Furthermore, following the common approach to precipitation monitoring (CLIMAT reports), the comparison of the empirical and theoretical quintiles in the two periods (1961–1990 and 1991–2015) is examined. The results from the present study reveal that it would be more appropriate to implement theoretical distributions in such climate reports, since they provide better evaluation for monitoring purposes than the current empirical distribution. Nevertheless, deciding on an optimal theoretical distribution for different climate regimes and for different time periods is not easy to accomplish. With regard to Croatian stations (covering different climate regimes), the CPE or SRN distribution could also be the right choice in the climatological practice, in addition to the gamma distribution.
Trudnoće opterećene gestacijskim dijabetesom (GDM) vjerojatnije će, u usporedbi s općom populacijom,
završiti rođenjem makrosomskog djeteta, gdje je učestalost operativnog dovršenja trudnoće češća, ...popraćena s
više komplikacija i oštećenja majke i djeteta. Potreba za izračunavanjem fetalne mase neposredno prije porođaja
dovela je do razvoja brojnih metoda u svrhu veće preciznosti procjene. Pregledali smo literaturu od 1980. do 2020.
godine rabeći izraze makrosomija, ultrazvučna procjena, gestacijski dijabetes, i upotrijebili smo relevantne članke u
pripremi ovog članka. Najčešće primjenjivane metode temelje se na dvodimenzionalnim ultrazvučnim mjerenjima
pojedinih fetalnih biometrijskih parametara i njihovoj kombinaciji u matematičkom regresijskom modelu. Neke su
metode uključivale dodavanje drugih stanja majke i djeteta kako bi se povećala pouzdanost metode u prepoznavanju
makrosomije. U svakodnevnom radu, osobito kod trudnica koje pate od GDM-a, potrebno je imati pouzdane
podatke o procijenjenoj fetalnoj težini prije donošenja ispravne kliničke odluke o načinu dovršenja trudnoće. S tim
u vezi donosimo pregled literature koja se odnosi na procjenu fetalne makrosomije, naročito u žena s GDM-om.
Women with gestational diabetes (GDM) and weight gain during pregnancy above recommended more often give birth to macrosomic children. The goal of this study was to evaluate the diagnostic accuracy ...of the modified formula for ultrasound assessment of fetal weight created in a pilot study using a similar specimen in comparison to the Hadlock-2 formula.
This is a prospective, cohort, applicative, observational, quantitative, and analytical study, which included 213 pregnant women with a singleton pregnancy, GDM, and pregnancy weight gain above recommended. Participants were consecutively followed in the time period between July 1st, 2016, and August 31st, 2020. Ultrasound estimations were made within three days before the delivery. Fetal weights estimated using both formulas were compared to the newborns' weights.
A total of 133 fetal weight estimations were made. In comparison to the newborns' weight modified formula had significantly smaller deviation in weight estimation compared to the Hadlock-2 formula, higher frequency of deviation within 5% of newborns weights (78.2% 95% CI=0.74-0.83 vs. 60.2%), smaller frequency of deviations from 5 to 10% (19.5 vs. 33.8%) and above 10%, which was even more significant among macrosomic children. There were 36/50 (72%) correctly diagnosed cases of macrosomia by modified and 33/50 (66%) by Hadlock-2 formula. Area under the curve (AUC) for the modified formula was 0.854 (95% CI=0.776-0.932), and for the Hadlock-2 formula 0.824 (95% CI=0.740-0.908). The positive predictive value of the modified formula was 81.81%, the negative 97.91%.
In cases of greater fetal weights, the modified formula showed greater precision.
Preterm premature rupture of membranes (PPROM) occurs in 3% of all pregnancies and is responsible for approximately one-third of all preterm births, causing significant perinatal morbidity and fetal ...death. In a significant number of PPROM cases an infection is present although it is sometimes difficult to determine clinically. Our knowledge of pathophysiology of intrauterine infection/inflammation and impact of antibiotic therapy on its clinical course is elementary. It is known that intrauterine infection/inflammation is a significant risk factor for developing neurological impairment in children. Prophylactic administration of antibiotics might eradicate infection in women with PPROM and improve neonatal outcomes, on the other hand, it could only increase the period of latency and suppress infection to a subclinical level without eradicating the underlying infection, leaving the fetus in an unfavorable intrauterine environment. Still, the European and the American guidelines recommend routine administration of antibiotic therapy in women presenting with PPROM. Studies have shown that administration of antibiotics increases the period of latency and improves certain short-term neurological outcomes such as reducing the rate of abnormal cerebral ultrasound scan prior to the discharge from hospital, but it does not reduce perinatal mortality, the rate of preterm births and does not have an effect on long-term neurological outcomes. Furthermore, guidelines for antibiotics administration on PPROM are largely based on deficient, low quality and possibly outdated evidence. Optimal regimen and duration of antibiotic therapy are not clear and new studies estimating changes in bacterial resistance and more common clinical use of cephalosporines in the clinical management of PPROM are necessary.
Prerano prijevremeno prsnuće vodenjaka (PRVP) javlja se u 3% svih trudnoća i odgovorno je za trećinuprijevremenih porođaja, uzrokujući značajni perinatalni morbiditet i smrt fetusa. U značajnom brojuslučajeva PRVP-a prisutna je infekcija koja predstavlja klinički dijagnostički problem, a znanje opatofiziologiji intrauterine infekcije/upale, te utjecaju antibiotika na istu je predmet istraživanja. Poznato jeda je intrauterina infekcija/upala značajan čimbenik rizika za razvoj neuroloških oštećenja u djece.Preventivna primjena antibiotika mogla bi eradicirati infekciju i djelovati pozitivno na ishode djece trudnicas PRVP-om, dok bi, s druge strane, mogla samo produljiti vrijeme latencije, te suprimirati infekciju dosubkliničke razine bez eradiciranja infekcije, što ostavlja fetus u nepovoljnom intrauterinom „okolišu“.Ipak, europske i američke smjernice preporučuju rutinsku primjenu antibiotika pri PRVP-u. Istraživanjapokazuju kako primjena antibiotika produljuje vrijeme latencije i poboljšava određene kratkoročneneurološke ishode, poput smanjenja učestalosti abnormalnog ultrazvučnog nalaza mozga novorođenčetapri otpustu iz bolnice, ali ne utječe značajno na perinatalni mortalitet, ne dovodi do smanjenja učestalostiprijevremenih porođaja, te nema utjecaja na dugoročne neurološke posljedice kod djece. Također,smjernice za upotrebu antibiotika kod PRVP-a su u velikoj mjeri bazirane na oskudnim niskokvalitetnim i,moguće, zastarjelim dokazima. Optimalni antibiotski režimi duljine trajanja primjene antibiotika još uvijeknisu ustanovljeni, te su potrebna daljnja istraživanja koja bi uzela u obzir promjenu u bakterijskojrezistenciji, te učestalije korištenje cefalosporina u kliničkom liječenju PRVP-a.
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