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Bacground/Aim. Preterm birth is defined as a delivery prior to the completed 37th week of gestation. Literature data suggested that periodontal processes may influence to the feto-placental unit and induce preterm delivery. The degree of the periodontal disease is influenced by secretor status. Pro-inflammatory cytokines are involved in periodontitis as well as in delivery. The combined influence of these factors on the risk of preterm birth has not been explored. The aim of our study was to investigate the associations between periodontal diseases, secretor status, and interleukin-1-β (IL1-ß) and prostaglandine E2 (PGE2) levels in women delivered preterm. Methods. The study included 56 preterm delivery women and 56 women delivered at term as a control group, aged between 17 and 41 years. Periodontal examination, blood and saliva sampling were performed within 48 hours following delivery. Secretor phenotype was determined by hemagglutination inhibition method. The concentrations of IL1-ß and PGE2 were measured by high sensitivity Enzyme-linked Immunosorbent Assay (ELISA). Results. In the pre-term birth group there were 66.1% of women with periodontitis, while in the control one there were 12.5% (p < 0.01). Concentrations of IL1-ß and PGE2 in plasma were significantly higher in the non-secretor group of women who gave birth pre-term and had periodontitis comparing to other groups. There was a significant correlation between salivary and plasma levels of PGE2 and IL1-ß in the preterm birth group (R = 0.416, p = 0.017 and R = -0.592, p < 0.001, respectively). There were no such correlations in women who delivered at term. Conclusion. Our results support the hypothesis that non-secretor phenotype and periodontitis are at least in part responsible for pathogenesis of preterm birth. This probability of negative impact of non-secretor status cannot be ignored. These findings support the need for additional research into the biology of human parturition. © 2020 Inst. Sci. i, Uvod/Cilj. Prevremeni porođaj se definiše kao porođaj pre navršene 37 nedelje gestacije. Podaci iz literature govore u prilog tome da periodontalni procesi mogu uticati na fetoplacentalnu jedinicu i indukovati preterminski porođaj. Sekretorni status može uticati na stepen periodontalne bolesti. Proinflamatorni citokini imaju uticaj na periodontitis kao i na porođaj. Kombinovani uticaj ovih faktora rizika za prevremeni porođaj nije dovoljno istražen. Cilj ove studije je bio da istraži povezanost između periodontalne bolesti, sekretornog statusa, nivoa interleukina 1-b (IL1-b) i prostaglandina E2 (PGE2) kod žena koje su imale prevremeni porođaj. Metode. Studijom je bilo obuhvaćeno 56 žena, koje su imale prevremen porođaj i 56 žena u kontrolnoj grupi koje su se porodile u terminu, starosti između 17 i 41 godine. Periodontalni pregled, uzorkovanje krvi i salive je izvršeno u prvih 48 sati po porođaju. Sekretorni status je određen metodom inhibicije hemaglutinacije. Koncentracije IL1-b i PGE2 su merene visoko senzitivnim Enzyme-linked Immunosorbent Assay (ELISA) testom. Rezultati. U grupi prevremenih porođaja bilo je 66,1% žena sa periodontitisom, a u kontrolnoj grupi 12,5% (p < 0.01). Prevremeno porođene žena, nesekretori sa periodontitisom imale su u plazmi značajno više vrednosti IL 1-b i PGE 2 u odnosu na ostale grupe (p < 0,01). U grupi prevremeno porođenih žena postojala je značajna korelacija između salivarnih i plazmatskih koncentracija PGE2 i IL1-b (R = 0.416, p = 0.017 i R = -0,592, p < 0,001, redom). Ove korelacije nisu postojale kod žena koje su imale terminski porođaj. Zaključak. Naši rezultati podržavaju hipotezu da su sekretorni status i periodontitis, bar delimično, odgovorni za patogenezu preterminskog porođaja. Verovatnoća negativnog uticaja nesekretornog statusa se ne sme ignorisati. Ovi zaključci ukazuju na potrebu za dodatnim istraživanjima porođaja.

Background/Aim. Preterm birth is defined as a delivery prior to the completed 37th week of gestation. Literature data suggested that periodontal processes may influence to the feto-placental unit and induce preterm delivery. The degree of the periodontal disease is influenced by secretor status. Pro-inflammatory cytokines are involved in periodontitis as well as in delivery. The combined influence of these factors on the risk of preterm birth has not been explored. The aim of our study was to investigate the associations between periodontal diseases, secretor status, and interleukin1-b (IL1-ß) and prostaglandine E2 (PGE2) levels in women delivered preterm. Methods. The study included 56 preterm delivery women and 56 women delivered at term as a control group, aged between 17 and 41 years. Periodontal examination, blood and saliva sampling were performed within 48 hours following delivery. Secretor phenotype was determined by hemagglutination inhibition method. The concentrations of IL1-ß and PGE2 were measured by high sensitivity Enzyme-linked Immunosorbent Assay (ELISA). Results. In the pre-term birth group there were 66.1% of women with periodontitis, while in the control one there were 12.5% (p lt 0.01). Concentrations of IL1-ß and PGE2 in plasma were significantly higher in the non-secretor group of women who gave birth pre-term and had periodontitis comparing to other groups. There was a significant correlation between salivary and plasma levels of PGE2 and IL1-ß in the preterm birth group (R = 0.416, p = 0.017 and R = -0.592, p lt 0.001, respectively). There were no such correlations in women who delivered at term. Conclusion. Our results support the hypothesis that non-secretor phenotype and periodontitis are at least in part responsible for pathogenesis of preterm birth. This probability of negative impact of non-secretor status cannot be ignored. These findings support the need for additional research into the biology of human parturition., Uvod/Cilj. Prevremeni porođaj se definiše kao porođaj pre navršene 37 nedelje gestacije. Podaci iz literature govore u prilog tome da periodontalni procesi mogu uticati na fetoplacentalnu jedinicu i indukovati preterminski porođaj. Sekretorni status može uticati na stepen periodontalne bolesti. Proinflamatorni citokini imaju uticaj na periodontitis kao i na porođaj. Kombinovani uticaj ovih faktora rizika za prevremeni porođaj nije dovoljno istražen. Cilj ove studije je bio da istraži povezanost između periodontalne bolesti, sekretornog statusa, nivoa interleukina 1-b (IL1-b) i prostaglandina E2 (PGE2) kod žena koje su imale prevremeni porođaj. Metode. Studijom je bilo obuhvaćeno 56 žena, koje su imale prevremen porođaj i 56 žena u kontrolnoj grupi koje su se porodile u terminu, starosti između 17 i 41 godine. Periodontalni pregled, uzorkovanje krvi i salive je izvršeno u prvih 48 sati po porođaju. Sekretorni status je određen metodom inhibicije hemaglutinacije. Koncentracije IL1-b i PGE2 su merene visoko senzitivnim Enzyme-linked Immunosorbent Assay (ELISA) testom. Rezultati. U grupi prevremenih porođaja bilo je 66,1% žena sa periodontitisom, a u kontrolnoj grupi 12,5% (p lt 0.01). Prevremeno porođene žena, nesekretori sa periodontitisom imale su u plazmi značajno više vrednosti IL 1-b i PGE 2 u odnosu na ostale grupe (p lt 0,01). U grupi prevremeno porođenih žena postojala je značajna korelacija između salivarnih i plazmatskih koncentracija PGE2 i IL1-b (R = 0.416, p = 0.017 i R = -0,592, p lt 0,001, redom). Ove korelacije nisu postojale kod žena koje su imale terminski porođaj. Zaključak. Naši rezultati podržavaju hipotezu da su sekretorni status i periodontitis, bar delimično, odgovorni za patogenezu preterminskog porođaja. Verovatnoća negativnog uticaja nesekretornog statusa se ne sme ignorisati. Ovi zaključci ukazuju na potrebu za dodatnim istraživanjima porođaja.

Rh aloimunizacija je veoma retko oboljenje, ali i dalje veoma komplikovano za dijagnostiku i lečenje. Predstavlja veliki izazov za kliničara perinatologa. Dopler sonografsko merenje maksimalnog protoka kroz sistolu u fetalnoj arteriji cerebri mediji ( middle cerebral artery peak systolic volume- MCA PSV) je neinvazivna metoda i smatra se da je dobar dijagnostički test za procenu stepena fetalne anemije, kao i za određivanje potrebe za in-utero transfuzijom (IUT) kod pacijentkinja sa Rhesus ( Rh) aloimunizacijom. Cilj: Cilj studije je pokazati da li dopler merenje MCA PSV fetusa sa Rh aloimunizacijom korelira sa stepenom ugroženosti fetusa određenom spektrofotometrijskom analizom plodove vode po Lileyu, kao i sa vrednostima hematokrita ( Hct) fetusa koji su dobijeni kordocentezom, koja važi za metodu zlatnog standarda u određivanju fetalne anemije. Metode: Ova prospektivna studija obuhvatila je 36 trudnica koje su ispitivane i lečene zbog Rh aloimunizacije u tercijarnom centru ( Klinika za Ginekologiju i Akušerstvo, Klinički Centar Srbije) tokom perioda od 5 godina ( 2012.-2017.). Dopler merenje MCA PSV i amniocentezu radili smo kod svih fetusa koji su bili u riziku za pojavu fetalne anemije. Određivanje hematokrita ( Hct) radili smo kod svih fetusa koji su zahtevali IUT, kao i kod svih neonatusa. Kod pacijentkinja kod kojih je bilo neophodno primeniti IUT u cilju korekcije anemije poredili smo vrednosti MCA PSV i hematokrita pre i posle svake transfuzije. Rezultati: MCA PSV i Hct su u negativnoj korelaciji, pri čemu je senzitivnost merenja MCA PSV 83%, specifičnost 40%, PPV 56%, NPV 71%. Spektrofotometrijsko određivanje ugroženosti fetusa po Liley-u i Hct su u negativnoj korelaciji, pri čemu je senzitivnost metode po Liley-u 70%, specifičnost 46%, PPV 55%, NPV 61%. Hct i MCA PSV su u negativnoj korelaciji pre terapije inutero transfuzijom (p=0.035) i pre i posle druge transfuzije (p=0.046). Obratno, posle prve (p=0.954), pre druge (p=0.738), kao i pre (p=0.092) i po, Introduction: Rhesus alloimmunization is a rare condition, but still very challenging for assessment. Doppler sonography of fetal middle cerebral artery peak systolic velocity (MCA PSV) is noninvasive procedure and it could be used in the prediction of fetal anemia and the need for in-utero intravascular transfusion (IUT) in red blood cell (RBC) alloimmunization pregnancies. Objective: The aim of this study was to evaluate whether measurement of MCA PSV is in correlation with spectrophotometric measurement by amniocentesis, as well as with hematocrit values achieved by cordocentesis, which is a gold standard for assessment of severity of fetal anemia. Methods: Study included 36 pregnancies treated due to RBC alloimmunization in our tertiary referral center during the 5 year period (2012–2017). We measured MCA PSV and spectrophotometric values in all patients. We measured Hct in all patients where there was a need to perform IUT for correction of fetal anemia, and in all neonates upon birth. In patients with IUT we compared MCA PSV and Hct values before and after every transfusion. Results: MCA PSV and Hct correlated negatively, with sensitivity for MCA PSV test of 83%, specificity 40%, PPV 56%, NPV 71%. Spectrophotometric measurement by Liley negatively correlated with Hct values, with sensitivity of 70%, specificity of 46%, PPV 55%, NPV 61%. MCA PSV and Hct correlated negatively before transfusion therapy (p=0.035) and after the second transfusion (p=0.046). Contrary, after the first (p=0.954), before the second (p=0.738), as well as before (p=0.092) and after (p=0,741) the third transfusions there were no significant correlations between Hct and MCA-PSV values. Conclusion: Doppler sonography can be used in assessment of fetal anemia in pregnancies with Rh alloimmunization, as non-invasive and fast procedure. It is more accurate than invasive procedure, amniocentesis. There is a reduction in MCA PSV accuracy for assessing fetal anemia in previously transfused fetus

Праћење трудноће је могуће од самог зачећа, захваљујући великом напретку на пољу дијагностичких метода и средстава. Од тренутка имплантације ембриона у ендометријуму мајке, отвара се огромно поље могућности и потреба за анализом тока трудноће све до финалног исхода, порођаја. Биохемијски скрининг у првом и другом триместру омогућава увид у статистички ризик од појаве посматраних аномалија фетуса, као и ризике од превременог порођаја и развоја хипертензивног синдрома. На располагању су и визуелизационе методе: ултразвук, магнетна резонанца и фетоскпија. Са друге стране доступна је анализа феталног генетског материјала. Циљ је обезбеђивање нормалног тока трудноће и рођења здравог детета. Зато је неопходно да се утврди евентуално одступање од нормалног, било у здравственом стању труднице, стању фетоплацентне јединице или могуће аномалије плода. Урођене аномалије фетуса су поремећаји грађе, понашања, функције и метаболизма, који су настали пре рођења. У преко 50% спонтаних побачаја се код фетуса дијагностикује нека аномалија у развоју. Са великим малформацијама се рађа 2-3% деце, а у првих пет година живота открије се још толико деце са урођеном аномалијом. Ове аномалије су значајан узрок смрти у неонаталном периоду, као и у каснијем животу. Било да су развојне аномалије настале током органогенезе, или да су се поремећаји појединих органа и органских система плода јавили након њиховог нормалног формирања, правовремена дијагностика феталних аномалија нам омогућава доношење адекватне одлуке о даљем вођењу трудноће. Неопходно је на време открити и прекинути трудноћу са аномалијом плода инкомпатибилном са животом, а у осталим случајевима започети што пре одговарајуће лечење дијагностиковане малформације. Материјал и методе Спроведена је кохортна студија свих трудница које су упућене на Клинику за Гинекологију и акушерство Клиничког центра Србије (КГА КЦС) у Београду због пренатално постављене сумње на постојање конгениталних аномалија фетуса. Пацијенткиње су укључиване у ст

Biohemijski markeri prvog i drugog trimestra, osim u skriningu hromozomopatija, pokazuju vaţnu i nesumnjivu povezanost sa maternalnim i fetalnim ishodom trudnoće kod pacijentkinja gde se radi o fetusu sa euplodnim brojem hromozoma. Smatra se da u osnovi najozbiljnijih komplikacija trudnoće, kao što su hipertenzija, abrupcija placente, intrauterusna restrikcija rasta ploda, mala telesna masa za gestacijsku dob i intrauterusna smrt ploda, osim sliĉnih faktora rizika, postoji i ishemijska bolest placente. Morfološke promene u graĊi placente direktno utiĉu na promenu u nivoima sekrecije biohemijskih markera:βHCG-a(beta humanog horionskog gonadotropina), PAPP-a (plasma protein A u vezi sa trudnoćom) u periodima od 11.do 14. nedelje, kao i HCG-a, AFP (alfa feto proteina), uE3 (nekonjugovanog estriola) i inhibina A u periodu od 16.do 19. nedelje gestacije. Raznolikost biohemijskih markera je velika, ali se prednost daje onima koji se rutinski rade u kliniĉkoj praksi, ranije detektuju nego što je pojava prvih kliniĉkih manifestacija bolesti, kao i to da su u dobroj korelaciji sa ozbiljnošću komplikacija, uz što veću senzitivnost i specifiĉnost i manje troškove analize. Cilj:Cilj rada je bio utvrditi korelaciju vrednosti biohemijskih markera skrininga prvog i drugog trimestra sa razliĉitim komplikacijama trudnoće, analizirati period trudnoće kada se komplikacije javljaju, ispitati maternalni i fetalni morbiditet u vezi sa markerima, kao i neonatalni ishod trudnoća gde su pacijentkinje imale razliĉite kategorije vrednosti navedenih markera. Materijal i metod: Studija je bila kliniĉka i prospektivna, sprovedena u periodu od 1.1.2013. do 01.07.2014.godine na Klinici za ginekologiju i akušerstvo (KGA) Kliniĉkog centra Srbije. U studiju su bile ukljuĉene 104 trudnice, sa monofetalnom trudnoćom nastalom prirodnim putem. U prvoj studijskoj grupi su bile 54 ispitanice kod kojih su jedan ili više fetalnih biohemijskih markera prvog ili drugog trimestra imali vrednosti ispod 0,5 i pre, Biochemical markers of the first and second trimester of pregnancy, show an important and indisputable correlation with the maternal and fetal outcome of pregnancy in patients with euploid chromosomic fetuses. It is believed that, in the basis of the most severe complications of pregnancy, such as hypertension, placental abruption, intrauterine restriction of fetal growth, low birth weight for gestational age and intrauterine fetal death, besides similar risk factors, there is also ischemic placental disease. Morphological changes of placental structure directly affect the changes in the secretion levels of the biochemical markers: βHCG (beta human chorionic gonadotrophin), PAPP-A(pregnancy associated plasma protein A) in the period of 11.th-14.th gestational weeks, and HCG, AFP (alpha-feto protein), uE3 (unconjugated estriol) and inhibin A in the period from 16.th to 19.th weeks of gestation. The diversity of biochemical markers is high, but the advantage is given to those who are routinely being done in clinical practice, those who are previously detected than the onset of the first clinical manifestations of the disease, and which correlate with the seriousness of complications, with greater sensitivity and specificity and less analysis costs. Objective: The aim of this study was to determine the correlation of the biochemical markers values of the first and second trimester screening with different complications of pregnancy, to analyze the period of pregnancy when complications occurred, to examine maternal and fetal morbidity related to markers, as well as the neonatal outcome of pregnancy, where the patients had different categories of markers values. Material and method: The study was clinical and prospective, conducted in the period from 01.01.2013.th until 01.07.2014.th at the Clinic for Gynecology and Obstetrics of the Clinical Center of Serbia...

Ishod postupka savremenih tehnika asistirane reprodukcije, a pre svega in vitro fertilizacije i intracitoplazmatske injekcije spermatozoida (ICSI) predstavlja, u velikom broju slučajeva, multifetalna trudnoća sa dva i više embriona. Multifetalne trudnoće sa dva fetusa su povezane sa visokim perinatalnim morbiditetom i mortalitetom, jer je verovatnoća povoljnog ishoda multiple trudnoće (ţivo i zdravo novoroĎenče), trajanje gestacije i telesna masa novoroĎenčeta obrnuto proporcionalna broju fetusa1. Kod blizanačkih trudnoća je daleko veći procenat prevremenog poroĎaja, spontanog pobačaja, komplikacija u vidu pojave gestacijske hipertenzije, gestacijskog dijabetes melitusa, krvarenja u drugom, a posebno trećem trimestru (veća incidenca placente previje i abrupcije posteljice), kao i pojave antepartalne i postpartalne hemoragije, intrauterusne smrti jednog ili oba ploda (FMU - 17%). Prenatalni neinvazivni fetalni skrining kod pacijentkinja sa blizanačkim trudnoćama nastalim postupkom vantelesne oplodnje vrši se putem ultrasonografskog pregleda oba fetusa i analizom vrednosti hormona u serumu pacijentkinje izraţenih u MoM ima, ustanovljenih prilikom standardnog biohemijskog skrininga hromozomopatija fetusa putem Double, Triple ili Quadriple testa. Biohemijski markeri su povezani sa različitim spoljašnjim faktorima, kao što su ţivotna dob pacijentkinje i partnera, demografski podaci, tok i ishod prethodnih trudnoća, posebno prevremenih poroĎaja, spontanih pobačaja, perinatalnog morbiditeta i mortaliteta, podaci o vantelesnom oploĎenju, vrstu vantelesnog oploĎenja (IVF, ICSI), broj prethodnih neuspelih pokušaja, (eventualna donacija oocita), tok aktuelne trudnoće, kao i prisustva simptoma koji ukazuju na preteći pobačaj ili poroĎaj. I dalje su veoma aktuelna istraţivanja koja ispituju korelaciju izmeĎu vrednosti hormona u krvi pacijentkinja sa navedenim entitetima. Prenatalni neinvazivni fetalni skrining ima značajnu ulogu u predikciji kongenitalnih anomalija fetusa, kao i, The outcome of the process of modern techniques of assisted reproduction, and above all in vitro fertilization and intracytoplasmic injections of spermatozoids (ICSI), is in many cases multifetal pregnancy with two or more embryos. Multifetal pregnancies with two fetuses are associated with high perinatal morbidity and mortality, as the probability of a favorable outcome for multiple pregnancies (live and healthy newborns), the duration of gestation and the body weight of the newborn are reversely proportional to the number of fetuses. In twin pregnancies, the percentage of premature birth, spontaneous abortion, complications in the form of gestational hypertension, gestational diabetes mellitus, bleeding in the second, and especially in the third trimester (higher incidence of placenta and abruption of the placenta), and the occurrence of antepartum and postpartum haemorrhage, intrauterine deaths of one or both fetuses (FMU - 17%). Prenatal non-invasive fetal screening in patients with twin pregnancies resulting from under-fertilization is performed by ultrasonographic examination of both fetuses and the analysis of the hormone value in the serum of the patient expressed in MoM has been established during the standard biochemical screening of fetus chromosome analysis through the Double, Triple or Quadriple test. Biochemical markers are associated with a variety of external factors, such as the patient's and partner's lifespan, demographic data, the flow and outcome of previous pregnancies, especially premature births, spontaneous abortion, perinatal morbidity and mortality, fertilization data, insemination (IVF, ICSI), the number of previous unsuccessful attempts, (possible donation of the oocyte), the current pregnancy, and the presence of symptoms that indicate a predominant abortion or birth. There are still very current research that examines the correlation between the hormone values in the patient's blood with the indicated entities. Prenatal non-invasive fe

Prema sadašnjim stavovima i preporukama, ultrasonografska fetalna merenja u prvom i drugom trimestru imaju najveću moć za predikciju daljih komplikacija kao i samih ishoda monohorionskih trudnoća, ali su rezultati prethodnih studija nekonzistentni ili nedovoljno pouzdani zbog male incidence monohorionskih blizanaca, pa su dalja istraživanja na ovu temu još uvek potrebna. Cilj: Ciljevi studije su bili analizirati tok i ishod monohorionskih blizanačkih trudnoća, a zatim ispitati povezanost i potencijalnu prediktivnu vrednost ultrasonografskih parametara koji se određuju u prvom i drugom trimestru trudnoće na tok i ishod monohorionskih blizanačkih trudnoća. Materijal i metod: Sprovedena je prospektivna kohortna studija svih trudnica sa monohorionskim blizanačkim trudnoćama koje su kontrolisane i porođene u Klinici za ginekologiju i akušerstvo Kliničkog centra Srbije u Beogradu, u periodu od 01. januara 2010. godine do 31. decembra 2015. godine. Svakoj pacijentkinji je već tokom prvog pregleda uzeta kompletna anamneza sa podacima o godinama života, komorbiditetima, paritetu, kao i načinu nastanka trudnoće. U prvom trimestru, između 11 i 14 nedelje trudnoće za svakog blizanca su ultrazvučno izmereni dužina teme-trtica (crown-rump lenght CRL) i debljina nuhalne translucence (NT). U periodu od 16 do 18 nedelje trudnoće, ultrazvučnim pregledom za oba blizanca, određeni su biometrijski parametri: biparijetalni dijametar (biparietal diameter BPD), obim trbuha (abdominal circumference AC) i dužina butne kosti (femur length FL). Redovno su registrovane sve komplikacije trudnoće. Naročita pažnja se obraćala na pojavu intrauterinog zastoja u rastu jednog ili oba blizanca (intrauterine growth restriction IUGR), interblizanačkog transfuzionog sindroma (twin-to-twin transfusion syndrome TTTS), spontanog pobačaja (pre 24. nedelje gestacije) ili prevremenog porođaja (pre 35. nedelje gestacije) i smrti jednog ili oba blizanca..., According to current positions and recommendations, ultrasonographic fetal measurements in the first and second trimesters have the greatest power to predict further complications as well as the outcomes of monochorionic pregnancies, but the results of previous studies are inconsistent or insufficiently reliable due to the small incidence of monochorion twins, so further research on this matter is always necessary. Objective: The aims of the study were to analyze the course and outcome of monochorionic twin pregnancies, and then examine the connection and potential predictive value of ultrasonographic parameters that are assessed in the first and second trimester of pregnancy on the cource and outcome of monochorion twin pregnancies. Material and Method: We conducted a prospective cohort study of all pregnant women with monochorionic twin pregnancies checked-up and delivered at the Clinic for Gynecology and Obstetrics Clinical Center of Serbia in Belgrade, in the period from January 1, 2010 to December 31.2015. Already during the first examination, a complete history was taken from every patient with data on age, comorbidity, parity, and the way of pregnancy commencement. In the first trimester, between 11 and 14 weeks of pregnancy for each twin, the crown-rump lenght (CRL) and the thickness of nuchal translucency (NT) were measured ultrasonically. In the period from 16 to 18 weeks of pregnancy, ultrasound examination for both twins determined biometric parameters: biparietal diameter (BPD), abdominal circumference (AC) and femur length (FL). All complications of pregnancy were registered regularly. Particular attention was paid to the occurrence of intrauterine growth restriction (IUGR) in one or both twins, twin-totwin transfusion syndrome (TTTS), spontaneous abortion (before 24 weeks of gestation) or premature labor (before 35 weeks of gestation) and the death of one or both twins...

Prevremeni porođaj je onaj porođaj koji se dogodi pre navršene 37. nedelje trudnoće. Prevalenca prevremenog porođaja u svetu se kreće od 5% do 13.3%. Prevremeni porođaj može biti uzrokovan mnogobrojnim patološkim procesima kao i bolestima majke ili fetusa. Jedan od prepoznatih uzroka prevremenog porođaja je intraamnionska infekcija. Intraamnionska infekcija indukuje produkciju proinflamatornih citokina karakterističnih za terminski porođaj uključujući factor nekroze tumora alfa (TNF)-α, IL-8, IL-6, IL-1β i PGE2. U nekim slučajevima prevremenog porođaja u amnionskoj tečnosti se ne mogu detektovati mikrobiološki agensi ni gajenjem u kulturi ni drugim osetljivijim mikrobiološkim tehnikama uprkos povećanim nivoima citokina u amnionskoj tečnosti. Literaturni podaci ukazuju da se, u slučajevima prevremenog porođaja sa sterilnom antramnionskom inflamacijom, citokini produkuju u procesu infekcije ili inflamacije na udaljenom mestu u organizmu. Na taj način stvoreni citokini cirkulacijom dospevaju do feto-placentarne jedinice, prolaze placentarnu barijeru i u momentu kada dostižu kritičnu koncentraciju stimulišu porođaj. Ova zapažanja su u skladu sa Miller-ovom (Miller) teorijom žarišta iz 1891. Godine. Mikrobiološka i imunološka istraživanja kao i studije na animalnom modelu ukazuju da periodontalni procesi mogu uticati na fetoplacentarnu jedinicu I indukovati prevremeni porođaj. Perodontalna oboljenja su infektivna oboljenja čiji je ishod inflamacija specifičnih tkiva koja okružuju zub i predstavljaju njegovu potporu. Postoje dve glavne kategorije periodalnog oboljenja: a) gingivitis-nedestruktivna i reverzibilna inflamacija gingival i b) periodontitis-destruktivna inflamacija potpornog tkiva zuba. Gingivitis je reverzibilna i nedestruktivna inflamacija gingiva prouzrokovana nespecifičnim bakterijama. Ako gingivitis perzistira kasnije može dovesti do periodontitisa..., Preterm birth (PTB) is defined as a delivery prior to the completed 37th week of gestation. The global prevalence rate of preterm birth is ranging from 5% to 13.3%. PTB is associated with multiple pathological processes such as medical conditions of the mother or fetus.Intra-amniotic infection has been causally linked to PTB. Intra-amniotic infection induces the production of pro-inflammatory cytokines, involved in term delivery, including tumor necrosis factor (TNF)-α, IL-8, IL-6, IL-1β, and PGE2. In some cases of PTB microorganisms cannot be detected by cultivation and other microbiology techniques despite high levels of cytokines in amniotic fluid. Literature data suggest that in cases of PTB with sterile intra-amniotic inflammation, cytokines are produced in distant part of the body due to infection and inflammation, cross the placental barrier, and when they reach appropriate quantities stimulate labor. This statement is in accordance with Miller’s focal infection theory published in 1891. Microbiological, immunological and animal model studies suggested that periodontal processes may influence to the feto-placental unit and induce preterm delivery. Periodontal diseases are infectious diseases that result in the inflammation of the specialized tissues that both surround and support the teeth. There are two major categories of periodontal diseases: a) Gingivitis – non-destructive and reversible gingival inflammation and b) Periodontitis – destructive inflammation of teeth supporting tissues. Gingivitis is a mainly reversible and nondestructive gingival inflammation related to a non-specific bacterial challenge. When gingivitis is persistent, it can further lead to periodontitis. Periodontitis is a destructive inflammatory disease of the supporting tissues of the teeth. Pro-inflammatory cytokines (IL-1β, IL-6, and TNF-α) and prostaglandins (PGE1 and PGE2) are produced in response to infection. Vascular permeability is also increased – allowing the diffusion of cy

Rh aloimunizacija je veoma retko oboljenje, ali i dalje veoma komplikovano za dijagnostiku i lečenje. Predstavlja veliki izazov za kliničara perinatologa. Dopler sonografsko merenje maksimalnog protoka kroz sistolu u fetalnoj arteriji cerebri mediji ( middle cerebral artery peak systolic volume- MCA PSV) je neinvazivna metoda i smatra se da je dobar dijagnostički test za procenu stepena fetalne anemije, kao i za određivanje potrebe za in-utero transfuzijom (IUT) kod pacijentkinja sa Rhesus ( Rh) aloimunizacijom. Cilj: Cilj studije je pokazati da li dopler merenje MCA PSV fetusa sa Rh aloimunizacijom korelira sa stepenom ugroženosti fetusa određenom spektrofotometrijskom analizom plodove vode po Lileyu, kao i sa vrednostima hematokrita ( Hct) fetusa koji su dobijeni kordocentezom, koja važi za metodu zlatnog standarda u određivanju fetalne anemije. Metode: Ova prospektivna studija obuhvatila je 36 trudnica koje su ispitivane i lečene zbog Rh aloimunizacije u tercijarnom centru ( Klinika za Ginekologiju i Akušerstvo, Klinički Centar Srbije) tokom perioda od 5 godina ( 2012.-2017.). Dopler merenje MCA PSV i amniocentezu radili smo kod svih fetusa koji su bili u riziku za pojavu fetalne anemije. Određivanje hematokrita ( Hct) radili smo kod svih fetusa koji su zahtevali IUT, kao i kod svih neonatusa. Kod pacijentkinja kod kojih je bilo neophodno primeniti IUT u cilju korekcije anemije poredili smo vrednosti MCA PSV i hematokrita pre i posle svake transfuzije. Rezultati: MCA PSV i Hct su u negativnoj korelaciji, pri čemu je senzitivnost merenja MCA PSV 83%, specifičnost 40%, PPV 56%, NPV 71%. Spektrofotometrijsko određivanje ugroženosti fetusa po Liley-u i Hct su u negativnoj korelaciji, pri čemu je senzitivnost metode po Liley-u 70%, specifičnost 46%, PPV 55%, NPV 61%. Hct i MCA PSV su u negativnoj korelaciji pre terapije inutero transfuzijom (p=0.035) i pre i posle druge transfuzije (p=0.046). Obratno, posle prve (p=0.954), pre druge (p=0.738), kao i pre (p=0.092) i po, Introduction: Rhesus alloimmunization is a rare condition, but still very challenging for assessment. Doppler sonography of fetal middle cerebral artery peak systolic velocity (MCA PSV) is noninvasive procedure and it could be used in the prediction of fetal anemia and the need for in-utero intravascular transfusion (IUT) in red blood cell (RBC) alloimmunization pregnancies. Objective: The aim of this study was to evaluate whether measurement of MCA PSV is in correlation with spectrophotometric measurement by amniocentesis, as well as with hematocrit values achieved by cordocentesis, which is a gold standard for assessment of severity of fetal anemia. Methods: Study included 36 pregnancies treated due to RBC alloimmunization in our tertiary referral center during the 5 year period (2012–2017). We measured MCA PSV and spectrophotometric values in all patients. We measured Hct in all patients where there was a need to perform IUT for correction of fetal anemia, and in all neonates upon birth. In patients with IUT we compared MCA PSV and Hct values before and after every transfusion. Results: MCA PSV and Hct correlated negatively, with sensitivity for MCA PSV test of 83%, specificity 40%, PPV 56%, NPV 71%. Spectrophotometric measurement by Liley negatively correlated with Hct values, with sensitivity of 70%, specificity of 46%, PPV 55%, NPV 61%. MCA PSV and Hct correlated negatively before transfusion therapy (p=0.035) and after the second transfusion (p=0.046). Contrary, after the first (p=0.954), before the second (p=0.738), as well as before (p=0.092) and after (p=0,741) the third transfusions there were no significant correlations between Hct and MCA-PSV values. Conclusion: Doppler sonography can be used in assessment of fetal anemia in pregnancies with Rh alloimmunization, as non-invasive and fast procedure. It is more accurate than invasive procedure, amniocentesis. There is a reduction in MCA PSV accuracy for assessing fetal anemia in previously transfused fetus

Prema sadašnjim stavovima i preporukama, ultrasonografska fetalna merenja u prvom i drugom trimestru imaju najveću moć za predikciju daljih komplikacija kao i samih ishoda monohorionskih trudnoća, ali su rezultati prethodnih studija nekonzistentni ili nedovoljno pouzdani zbog male incidence monohorionskih blizanaca, pa su dalja istraživanja na ovu temu još uvek potrebna. Cilj: Ciljevi studije su bili analizirati tok i ishod monohorionskih blizanačkih trudnoća, a zatim ispitati povezanost i potencijalnu prediktivnu vrednost ultrasonografskih parametara koji se određuju u prvom i drugom trimestru trudnoće na tok i ishod monohorionskih blizanačkih trudnoća. Materijal i metod: Sprovedena je prospektivna kohortna studija svih trudnica sa monohorionskim blizanačkim trudnoćama koje su kontrolisane i porođene u Klinici za ginekologiju i akušerstvo Kliničkog centra Srbije u Beogradu, u periodu od 01. januara 2010. godine do 31. decembra 2015. godine. Svakoj pacijentkinji je već tokom prvog pregleda uzeta kompletna anamneza sa podacima o godinama života, komorbiditetima, paritetu, kao i načinu nastanka trudnoće. U prvom trimestru, između 11 i 14 nedelje trudnoće za svakog blizanca su ultrazvučno izmereni dužina teme-trtica (crown-rump lenght CRL) i debljina nuhalne translucence (NT). U periodu od 16 do 18 nedelje trudnoće, ultrazvučnim pregledom za oba blizanca, određeni su biometrijski parametri: biparijetalni dijametar (biparietal diameter BPD), obim trbuha (abdominal circumference AC) i dužina butne kosti (femur length FL). Redovno su registrovane sve komplikacije trudnoće. Naročita pažnja se obraćala na pojavu intrauterinog zastoja u rastu jednog ili oba blizanca (intrauterine growth restriction IUGR), interblizanačkog transfuzionog sindroma (twin-to-twin transfusion syndrome TTTS), spontanog pobačaja (pre 24. nedelje gestacije) ili prevremenog porođaja (pre 35. nedelje gestacije) i smrti jednog ili oba blizanca..., According to current positions and recommendations, ultrasonographic fetal measurements in the first and second trimesters have the greatest power to predict further complications as well as the outcomes of monochorionic pregnancies, but the results of previous studies are inconsistent or insufficiently reliable due to the small incidence of monochorion twins, so further research on this matter is always necessary. Objective: The aims of the study were to analyze the course and outcome of monochorionic twin pregnancies, and then examine the connection and potential predictive value of ultrasonographic parameters that are assessed in the first and second trimester of pregnancy on the cource and outcome of monochorion twin pregnancies. Material and Method: We conducted a prospective cohort study of all pregnant women with monochorionic twin pregnancies checked-up and delivered at the Clinic for Gynecology and Obstetrics Clinical Center of Serbia in Belgrade, in the period from January 1, 2010 to December 31.2015. Already during the first examination, a complete history was taken from every patient with data on age, comorbidity, parity, and the way of pregnancy commencement. In the first trimester, between 11 and 14 weeks of pregnancy for each twin, the crown-rump lenght (CRL) and the thickness of nuchal translucency (NT) were measured ultrasonically. In the period from 16 to 18 weeks of pregnancy, ultrasound examination for both twins determined biometric parameters: biparietal diameter (BPD), abdominal circumference (AC) and femur length (FL). All complications of pregnancy were registered regularly. Particular attention was paid to the occurrence of intrauterine growth restriction (IUGR) in one or both twins, twin-totwin transfusion syndrome (TTTS), spontaneous abortion (before 24 weeks of gestation) or premature labor (before 35 weeks of gestation) and the death of one or both twins...

Biohemijski markeri prvog i drugog trimestra, osim u skriningu hromozomopatija, pokazuju vaţnu i nesumnjivu povezanost sa maternalnim i fetalnim ishodom trudnoće kod pacijentkinja gde se radi o fetusu sa euplodnim brojem hromozoma. Smatra se da u osnovi najozbiljnijih komplikacija trudnoće, kao što su hipertenzija, abrupcija placente, intrauterusna restrikcija rasta ploda, mala telesna masa za gestacijsku dob i intrauterusna smrt ploda, osim sliĉnih faktora rizika, postoji i ishemijska bolest placente. Morfološke promene u graĊi placente direktno utiĉu na promenu u nivoima sekrecije biohemijskih markera:βHCG-a(beta humanog horionskog gonadotropina), PAPP-a (plasma protein A u vezi sa trudnoćom) u periodima od 11.do 14. nedelje, kao i HCG-a, AFP (alfa feto proteina), uE3 (nekonjugovanog estriola) i inhibina A u periodu od 16.do 19. nedelje gestacije. Raznolikost biohemijskih markera je velika, ali se prednost daje onima koji se rutinski rade u kliniĉkoj praksi, ranije detektuju nego što je pojava prvih kliniĉkih manifestacija bolesti, kao i to da su u dobroj korelaciji sa ozbiljnošću komplikacija, uz što veću senzitivnost i specifiĉnost i manje troškove analize. Cilj:Cilj rada je bio utvrditi korelaciju vrednosti biohemijskih markera skrininga prvog i drugog trimestra sa razliĉitim komplikacijama trudnoće, analizirati period trudnoće kada se komplikacije javljaju, ispitati maternalni i fetalni morbiditet u vezi sa markerima, kao i neonatalni ishod trudnoća gde su pacijentkinje imale razliĉite kategorije vrednosti navedenih markera. Materijal i metod: Studija je bila kliniĉka i prospektivna, sprovedena u periodu od 1.1.2013. do 01.07.2014.godine na Klinici za ginekologiju i akušerstvo (KGA) Kliniĉkog centra Srbije. U studiju su bile ukljuĉene 104 trudnice, sa monofetalnom trudnoćom nastalom prirodnim putem. U prvoj studijskoj grupi su bile 54 ispitanice kod kojih su jedan ili više fetalnih biohemijskih markera prvog ili drugog trimestra imali vrednosti ispod 0,5 i pre, Biochemical markers of the first and second trimester of pregnancy, show an important and indisputable correlation with the maternal and fetal outcome of pregnancy in patients with euploid chromosomic fetuses. It is believed that, in the basis of the most severe complications of pregnancy, such as hypertension, placental abruption, intrauterine restriction of fetal growth, low birth weight for gestational age and intrauterine fetal death, besides similar risk factors, there is also ischemic placental disease. Morphological changes of placental structure directly affect the changes in the secretion levels of the biochemical markers: βHCG (beta human chorionic gonadotrophin), PAPP-A(pregnancy associated plasma protein A) in the period of 11.th-14.th gestational weeks, and HCG, AFP (alpha-feto protein), uE3 (unconjugated estriol) and inhibin A in the period from 16.th to 19.th weeks of gestation. The diversity of biochemical markers is high, but the advantage is given to those who are routinely being done in clinical practice, those who are previously detected than the onset of the first clinical manifestations of the disease, and which correlate with the seriousness of complications, with greater sensitivity and specificity and less analysis costs. Objective: The aim of this study was to determine the correlation of the biochemical markers values of the first and second trimester screening with different complications of pregnancy, to analyze the period of pregnancy when complications occurred, to examine maternal and fetal morbidity related to markers, as well as the neonatal outcome of pregnancy, where the patients had different categories of markers values. Material and method: The study was clinical and prospective, conducted in the period from 01.01.2013.th until 01.07.2014.th at the Clinic for Gynecology and Obstetrics of the Clinical Center of Serbia...

Preeclampsia is a pregnancy-specific disorder clinically characterized by hypertension and proteinuria that occurs after 20 weeks of gestation. Affecting 5% of pregnancies, it remains one of the leading causes of both maternal and fetal morbidity and mortality worldwide. Preeclampsia covers a spectrum of conditions, with eclampsia (its convulsive form) and HELLP syndrome representing its most severe forms. Despite recent advances in the field of angiogenesis and anti-angiogenesis in preeclampsia, urine and serum measurements of circulating angiogenic proteins have not provided a reliable screening tool for preeclampsia with current techniques. Emerging evidence suggests that podocyte plays a critical role in the evolution of kidney injury in this disorder. Studies of human tissue show that the expressions of podocyte-specific proteins (including nephrin and synaptopodin) are severely affected by preeclampsia. In addition, the detection of podocyte products and live podocytes in the urine (podocyturia) may serve as clinically useful tools for prediction and diagnosis of preeclampsia. Identification of podocytes using the techique of culturing and staining of urinary sediments is time consuming and requires special expertise. To overcome these limitations, a new technique using Mass spectrometry was developed that allows to confirm the presence of urinary podocytes trough identification of the podocyte-specific proteins. In addition, it was shown that women with preeclamptic pregnancies demonstrate signs of small vessel disease and less favorable cardiovascular risk profile both at the time of delivery and years after their affected pregnancies. One possible mechanism for this relationship is that hypertensive pregnancy disorders (preeclampsia, in particular) and CVD share several common risk factors (obesity, diabetes mellitus, and renal disease) or, alternatively, hypertension in pregnancy may induce long-term metabolic and vascular abnormalities that may increase a, Preeklampsija je oboljenje koje se javlja u trudnoći i klinički se karakteriše pojavom hipertenzije i proteinurije nakon dvadesete nedelje trudnoće. Javlja se u 7 – 10% svih trudnoća i čini vodeći uzrok mortaliteta i morbiditeta trudnica i fetusa. Klinička slika ovog oboljenja varira od lakih do najtežih formi, koje mogu da se manifestuju pojavom konvulzija tj. razvojem eklampsije, kao i razvojem hemolize, poremećaja funkcije jetre i koagulacije u okviru tzv. HELP sindroma. Uprkos nedavnom napretku u razumevanju uloge proteina angiogeneze u patofiziologiji preeklampsije, postojeći dokazi iz kliničkih studija još uvek su nedovoljni za korišćenje u ranom otkrivanju trudnoća koje su pod rizikom za razvoj preeklampsije. Prvi objavljen rad iz serije radova o dijagnostičkom i prognostičkom značaju podociturije kod žena sa preeklampsijom pokazao je da je pojava proteinurije u preeklampsiji povezana sa podociturijom, odnosno pojavom i gubitkom glomerularnih epitelnih ćelija (podocita) u mokraći, kao i sa promenama u ekspresiji strukturnih proteina (nefrina i sinaptopodina) ovih ćelija. Ovi klinički podaci uputili su na zaključak da se podociturija javlja pre proteinurije i hipertenzije, te da može da posluži kao rani pokazatelj i dijagnostički marker ovog oboljenja. S obzirom da je tehnika identifikacije podocita koja se bazira na kulturi sedimenta urina komplikovana i da zahteva posebnu obučenost za interpretaciju rezultata, u nastavku studije razvijena je nova tehnika identifikacije podocita koja se bazira na masnoj spektrometriji. Ovom tehnikom, potvrđeno je da se podociturija moze dijagnostikovati identifikacijom peptida koji je specifičan za podocin...

Intrauterusni zastoj rasta (IUZR) je jedan od vodećih uzroka perinatalnog morbiditeta i mortaliteta. Hipertenzija, insulinska rezistencija (IR), dijabetes mellitus tip 2 (T2DM), metabolički sindrom (MS), nizak rast i osteoporoza se dovode u vezu sa IUZR. Skorašnje kliničke i eksperimentalne studije su rasvetlile ulogu koju masno tkivo igra u razvoju insulinske rezistencije i MS kao posledica fetalnog programiranja in utero Cilj ove studije je bio da ispita da li je koncentracija adipokina u krvi pupčanika (P) i u trećem danu (d3) povezana sa usporenim fetalnim rastom i nivoom lipida kod blizanaca sa IUZR. Testirana je povezanost nivoa leptina i adiponektina sa somatskim parametrima i IR na roĎenju i u d3 kod diskordantnih i konkordantnih blizanaca. U studiju je uključeno 36 diskordantnuh (razlika u poroĎajnoj telesnoj masi-TM≥20% računato u odnosu na većeg blizanca) i 42 konkordantna para blizanaca (razlika u TM≤10%), roĎenih≥32 gestacionih nedelja (GN). TM manjeg blizanca je bila ispod 10. percentila (IUZR blizanac) udruženo sa abnormalnim protocima u umbilikalnoj arteriji. Iz venske krvi iz pupčanika kao i iz venske krvi uzete u trećem danu pre jela (d3) su odreĎivani nivoi hormona (leptin, adiponektin, insulin) i bihemijski parametri (glukoza, ukupni holesterol-TC, high density lipoprotein holesterol –HDL C, low density lipoprotein holesterol-LDL C i trigliceridi-TG). Indeksi body mass index-BMI, ponderalni indeks-PI, homeostasis model assesment insulin resistance index-HOMA IR, TG/HDL C i glukoza/insulin (G/I) su izračunati a poslednja tri predstavljaju markere insulinske rezistencije/senzitivnosti. Rezultati: U diskordantnoj grupi nivoi leptina i leptina/TM u krvi iz pupčanika i d3 bili su uporedivi izmeĎu IUZR i blizanaca sa odgovarajućim rastom (appropriate for gestational age-AGA). Kada smo poredili blizance roĎene posle 35 GN koncentracije leptina su bile značajno niže kod IUZR blizanaca u d3 (p=0,011). Nivoi leptina i L/TM u d3 su bili značajno viši kod di, Intrauterine growth restriction (IUGR) is one of the leading causes of perinatal morbidity and mortality. Hypertension, insulin resistance (IR), type 2 diabetes mellitus (T2DM), metabolic syndrome (MS), short stature and osteoporosis were found to be associated with IUGR. The recent clinical and experimental studies have highlighted the role of adipose tissue (AT) in the development of insulin resistance and MS as consequences of fetal programming in utero. The aim of this study was to explore whether adipokines concentrations in cord blood (CB) and on day3 (d3) were related to impaired fetal growth and lipids in IUGR twins. The relationship between leptin and adiponectin levels with somatic parameters and IR at birth and on d3 in discordant and concordant twins were tested. Patients and methods: 36 discordant (birth weight BW discordance ≥20% calculated in relation to the heavier cotwins) and 42 concordant (birth weight discordance ≤10%) twin pairs≥32 gestational weeks (GW) were included. BW of the smaller twins was less than 10th percentile (IUGR twins) with abnormal umbilical artery Doppler velocimetry. Umbilical venous CB and venous blood samples on d3 were obtained from each pair of twins in the fasting state both for hormone determination (leptin, adiponectin and insulin) and biochemical analysis (glucose, total cholesterol-TC, high density lipoprotein cholesterol –HDL C, low density lipoprotein cholesterol-LDL C and triglyceride-TG). Indices body mass index-BMI and ponderal index- PI,. homeostasis model assessment insulin resistance index HOMA IR, TG/HDL C and glucose/insulin (G/I) ratio were calculated as a markers of insulin resistance/sensitivity. Results: Within the discordant group leptin and leptin/PTM levels in cord blood and on d3 were comparable between AGA (appropriate for gestational age) twins and IUGR twins. When we compared late preterm and term twins (≥35 GW) on d3 leptin concentration was significantly lower in IUGR twins (p=0,011). Leptin lev

UVOD: Trudnice sa urođenom trombofilijom imaju veći rizik za razvoj venskih tromboembolijskih komplikacija, spontanih i habitualnih pobačaja, peeklampsije, intrauterusnog zastoja u rastu ploda i abrupcije posteljice. Etiopatogeneza obstetričkih komplikacija kod trombofilije nije jasno definisana, što je i jedan od razloga povremenih neuspeha terapije. Ključni faktor za normalan razvoj trudnoće je kontakt između fetalne i maternalne cirkulacije, kao i ravnoteža između koagulacije i fibrinolize u posteljici na nivou hemohorionske membrane. Najčešće se govori o trombozi fetoplacentne cirkulacije kao uzroku obstetričkih komplikacija kod trudnica sa urođnom trombofilijom. S obzirom na značajan broj neuspelih trudnoća i uz primenjenu antikoagulantnu terapiju, evidentno je da postoje i drugi uzroci opstetričkih komplikacija u trudnoćama sa naslednom trombofilijom. Obstetričke komplikacije tokom drugog i trećeg trimestra kod trudnica sa trombofilijom su slične komplikacijama preeklampsije. Kod trudnica sa preeklampsijom je dokazan porast koncentracije reaktivnih kiseoničkih vrsta kao i smanjena aktivnost enzima zaštite od oksidacionih oštećenja, što za posledicu ima endotelijalnu disfunkciju, neadekvatnu invaziju trofoblasta i hipoperfuziju posteljice što pojačava oksidativni stres. Hipoteza studije bi bila, da je u trudnoćama sa naslednom trombofilijom oksidativni stres uzrok komplikacija. CILJ RADA: Uticaj primene LMWH kod pacijentkinja sa opterećenom akušerskom anamnezom i dokazanom urođenom trombofilijom na broj živorođene dece i pojavu komplikacija u trudnoći (spontani pobačaj, intrauterusna smrt ploda, abrupcija posteljice, PE, IUGR, VTE). Ispitati i uporedi aktivnost antioksidativnog enzimskog zaštitnog sistema u krvi trudnica obolelih od trombofilije i zdravih trudnica nakon porodjaja. METODOLOGIJA: Longitudinalnom studijom je obuhvaćeno 60 trudnica koje su bile hospitalizovane i kontrolisane u GAK “Narodni Front” u Beogradu u toku 2013 godine, a kod kojih je dijagn, BACKGROUND: Pregnant women with inherited trombophylia have a higher risk for developing venous embolic complications, spontaneous and habitual miscarriages, preeclamspia, IUGR, and placental abruption. Genesis of obstetric complications is not clearly defined, and as such may present one of the reasons for therapy failure. The key for the development of a normal pregnancy is the contact between the fetal and maternal circulation, as is the balance between coagulation and fibrinolysis in the placenta at the chorionic membrane level, Usualy we target fetoplacental thrombosis, as the main cause for obstetrical complication in pregnant women with congenital thrombophilia. Considering the number of unsuccesfull pregnancies, even when using anticoagulant therapy, it becomes evident that other causes exist for obstetric complications in pregnancies with inherited trombophylia. Obstetric complications during the second and third trimester, in pregnancies with inherited thrombophilia are similair to eclamptic complications, An elevated level of reactive oxygen is found in pregnant patients with preeclampsia, and an impaired enzyme protection from oxidative damage, which effect in endothelial dysfunction, less than adequate trophoblast invasion and a hypoperfussion of the placenta, which all increase oxidative stress. THE GOALS: To examine the influence of LMWH application in patients with inherited trombophylia on the number of live born children and number of manifest complkications in pregnancy (spontaneous abortion, intrauterine fetal death, placental abruption, PE, IUGR, VTE). To investigate the activity of enzyme antioxidative protection system in patients with trombophylia and to compare with healthy patients after live birth. METHODS: Through this longitudinal study 60 gravide patients were followed. These patients were hospitalized and/or controlled in GAK “Narodni Front” in Beograd during 2013., with a diagnosis of inherited trombophylia prior to pregnancy. For all

Uvod: Cilj ovog istraživanja je mogućnost predikcije razvoja preeklampsije (PE), intrauterusnog zastoja u rastu ploda (IUZR), abrupcije placente (AP) i intrauterusne smrti ploda (FMU) pojedinačnom i kombinovanom upotrebom niskih vrednosti plazma-proteina-A povezanog sa trudnoćom (PAPP-A) i slobodne beta-subjedinice humanog-horionskog-gonadotropina (free-βHCG), kao i visokih srednjih vrednosti doplerskog pulsatilnog-indeksa (PI) uterinih arterija u prvom trimestru trudnoće. Metodologija: Serumski PAPP-A, free-βHCG i srednji doplerski-PI su određivani tokom 11-13+6 nedelja gestacije kod normotenzivnih nulipara sa jednoplodnom trudnoćom. Pacijentkinje su ispunjavale minimum jedan od tri navedena kriterijuma: ekstremno niske vrednosti PAPP-A (PAPP-A≤0.52MoM), free-βHCG (free-βHCG≤0.56MoM) i ekstremno visok srednji doplerski-PI (PI≥2.52). Rezultati: Od 85 trudnica, njih 14 (16.5%) je razvilo PE , 14 (16.5%) IUZR, 7 (8.2%) AP i 1 (1.2%) FMU. ROC-analiza je identifikovala PAPP-A i PI, kao kontinualne varijable, sa značajnom prediktivnom moći za razvoj PE (p=0.001; p=0.002), IUZR (p=0.045; p=0.004) i AP (p=0.009; p=0.011). Ista analiza je utvrdila da free-βHCG nema prediktivnu moć za razvoj PE (p=0.709), IUZR (p=0.142) i AP (p=0.141). Kombinovani prediktivni model kategorijalnih varijabli (PAPP-A≤0.52MoM+PI≥2.52) je pokazao značajnu prediktivnu moć za razvoj PE (OR=5.83, 95%CI=1.217-27.297, p=0.027), ali ne i zarazvoj IUZR (OR=2.171, 95%CI=0.622-7.576, p=0.224) i AP (OR=5.143, 95%CI=0.591-44.742, p=0.138). Zaključak: Ova istraživanje je pokazalo da niske vrednosti PAPP-A i povišene sdrednje vrednosti doplerskog-PI prvog trimestra trudnoće, kao pojedinačne varijable, imaju značajan prediktivni kapacitet za razvoj PE, IUZR i AP. Ekstremno niske vrednosti PAPP-A i ekstremno visoke srednje vrednosti 6 doplerskog-PI u kombinovanom prediktivnom modelu prvog trimestral trudnoće, pokazuju značajnu prediktivnu moć za razvoj PE...

UVOD: Trudnice sa urođenom trombofilijom imaju veći rizik za razvoj venskih tromboembolijskih komplikacija, spontanih i habitualnih pobačaja, peeklampsije, intrauterusnog zastoja u rastu ploda i abrupcije posteljice. Etiopatogeneza obstetričkih komplikacija kod trombofilije nije jasno definisana, što je i jedan od razloga povremenih neuspeha terapije. Ključni faktor za normalan razvoj trudnoće je kontakt između fetalne i maternalne cirkulacije, kao i ravnoteža između koagulacije i fibrinolize u posteljici na nivou hemohorionske membrane. Najčešće se govori o trombozi fetoplacentne cirkulacije kao uzroku obstetričkih komplikacija kod trudnica sa urođnom trombofilijom. S obzirom na značajan broj neuspelih trudnoća i uz primenjenu antikoagulantnu terapiju, evidentno je da postoje i drugi uzroci opstetričkih komplikacija u trudnoćama sa naslednom trombofilijom. Obstetričke komplikacije tokom drugog i trećeg trimestra kod trudnica sa trombofilijom su slične komplikacijama preeklampsije. Kod trudnica sa preeklampsijom je dokazan porast koncentracije reaktivnih kiseoničkih vrsta kao i smanjena aktivnost enzima zaštite od oksidacionih oštećenja, što za posledicu ima endotelijalnu disfunkciju, neadekvatnu invaziju trofoblasta i hipoperfuziju posteljice što pojačava oksidativni stres. Hipoteza studije bi bila, da je u trudnoćama sa naslednom trombofilijom oksidativni stres uzrok komplikacija. CILJ RADA: Uticaj primene LMWH kod pacijentkinja sa opterećenom akušerskom anamnezom i dokazanom urođenom trombofilijom na broj živorođene dece i pojavu komplikacija u trudnoći (spontani pobačaj, intrauterusna smrt ploda, abrupcija posteljice, PE, IUGR, VTE). Ispitati i uporedi aktivnost antioksidativnog enzimskog zaštitnog sistema u krvi trudnica obolelih od trombofilije i zdravih trudnica nakon porodjaja. METODOLOGIJA: Longitudinalnom studijom je obuhvaćeno 60 trudnica koje su bile hospitalizovane i kontrolisane u GAK “Narodni Front” u Beogradu u toku 2013 godine, a kod kojih je dijagn, BACKGROUND: Pregnant women with inherited trombophylia have a higher risk for developing venous embolic complications, spontaneous and habitual miscarriages, preeclamspia, IUGR, and placental abruption. Genesis of obstetric complications is not clearly defined, and as such may present one of the reasons for therapy failure. The key for the development of a normal pregnancy is the contact between the fetal and maternal circulation, as is the balance between coagulation and fibrinolysis in the placenta at the chorionic membrane level, Usualy we target fetoplacental thrombosis, as the main cause for obstetrical complication in pregnant women with congenital thrombophilia. Considering the number of unsuccesfull pregnancies, even when using anticoagulant therapy, it becomes evident that other causes exist for obstetric complications in pregnancies with inherited trombophylia. Obstetric complications during the second and third trimester, in pregnancies with inherited thrombophilia are similair to eclamptic complications, An elevated level of reactive oxygen is found in pregnant patients with preeclampsia, and an impaired enzyme protection from oxidative damage, which effect in endothelial dysfunction, less than adequate trophoblast invasion and a hypoperfussion of the placenta, which all increase oxidative stress. THE GOALS: To examine the influence of LMWH application in patients with inherited trombophylia on the number of live born children and number of manifest complkications in pregnancy (spontaneous abortion, intrauterine fetal death, placental abruption, PE, IUGR, VTE). To investigate the activity of enzyme antioxidative protection system in patients with trombophylia and to compare with healthy patients after live birth. METHODS: Through this longitudinal study 60 gravide patients were followed. These patients were hospitalized and/or controlled in GAK “Narodni Front” in Beograd during 2013., with a diagnosis of inherited trombophylia prior to pregnancy. For all

Background: Periodontitis is considered to be a risk factor for preterm birth. Mechanisms have been proposed for this pathologic relation, but the exact pathologic pattern remains unclear. Therefore, the objective of the present study is to evaluate levels of four major labor triggers, prostaglandin E-2 (PGE(2)), interleukin (IL)-1 beta, IL-6, and tumor necrosis factor (TNF)-alpha, in gingival crevicular fluid (GCF) and serum samples between women with preterm birth (PTB) and full-term birth (FTB) and correlate them with periodontal parameters. Methods: PGE(2), IL-1 beta, IL-6, and TNF-alpha levels were estimated using enzyme-linked immunosorbent assays in GCF and serum samples collected 24 to 48 hours after labor from 120 women (60 FTB, 60 PTB). Results: Women with PTB exhibited significantly more periodontitis, worse periodontal parameters, and increased GCF levels of IL-6 and PGE(2) compared with the FTB group; there were no significant differences in serum levels of measured markers. GCF levels of IL-1 beta, IL-6, and PGE(2) and serum levels of TNF-alpha and PGE(2) were significantly higher in women with periodontitis compared with periodontally healthy women. Serum levels of PGE(2) were positively correlated with probing depth (PD) and clinical attachment level (CAL) as well as with GCF levels of TNF-alpha in women with PTB. Conclusions: Women with PTB demonstrated worse periodontal parameters and significantly increased GCF levels of IL-6 and PGE(2) compared with those with FTB. Based on significant correlations among serum PGE(2) and PD, CAL, and GCF TNF-alpha in PTB, periodontitis may cause an overall increase of labor triggers and hence contribute to preterm labor onset.

Cilj:Karcinom grlića je treći po uĉestalosti u svetu meĊu malignim bolestima. Displazije epitela grlića predstavljaju niz prekursorskih lezija karcinoma grlića.Najznacajniji faktor rizika za displaziju epitela grlića jeste infekcija humanim papiloma virusima.Cilj ove disertacije je bio da se utvrdi dijagnostiĉki znaĉaj imunohistohemijskih metoda markerima p16, p63, ciklin d1 i survivin u epitelnim displazijama grlića,morfometrijske nalize i histomorfološkog skora. Metodologija:Retrospektivnom studijom je bilo obuhvaćeno 100 pacijentkinja pregledanih na Ginekološkom odeljenju Vojnomedicinske akademije u trogodišnjem periodu.Kriterijumi za ulazak u studiju su: primarna, ranije netretirana lezija, kolposkopski nalaz koji upućuje na prisustvo premaligne lezije grlića: uĉinjen citološki test epitela grlića po metodi Papanikolau koji je interpretiran po Bethesda kriterijumu sa nalazom displazije lakog stepena (low-grade squamous intraepithelial lesion,LSIL), displazije teškog stepena (high-grade sqamous intraepithelial lesion,HSIL), atipiĉnih ćelija neodreĊenog znaĉaja (atypical squamous cells of undeterminated significance,ASCUS);uĉinjena tipizacija humanih papiloma virusa reakcijom lanĉane polimerizacije sa dokaznim prisustvom virusa tipa 16,18,31,33 kod svih zena. Ovoj grupi pacijentkinja je uradjena biopsija, imunohistohemijske i morfometrijske analize bioptiranog tkiva. Primenjena su imunohistohemijska bojenja p16, p63, ciklin d1 i survivin. Analiza imunohistohemijskih reakcija je vršena svetlosnim mikroskopom u zonama displazije. Od 100 zena koje su ušle u studiju, kod kojih je prvom biopsijom dokazano prisustvo displazije (HSIL, LSIL), kod 48 zena je ucinjena ponovna biopsija u perodu do sedam meseci, na osnovu istih dijagnostickih kriterijuma kao za prvu biopsiju, gde su primenjivane sve metode istraživanja koje su korišćene u prvoj biopsiji. Kontrolnu grupu su ĉinile 12 žena,koje su se javile na kontrolni pregled bez displazije i bez verifikovane infekcije grlića, Aim:Cervical cancer is the third most common cancer in the world.Cervical dysplasia, such as minor and severe dysplasia, is a group of precursor lesion of the squamous cell carcinoma. The most important etiologic risk factors for dysplasia are infection with the human papilloma virus (HPV).The aim of this study was to determine the relevance of correlation between epithelial p16,p63,ciklin d1 and survivin expression and the degree of human papilloma virus (HPV)- induced cervical epithelial dysplasia, as well as, to establish the significance of morphometric analysis of nuclear area and histomorphologic score in assessment of cervical dysplasia degrees Methodology: This retrospective study included 100 patients examined at the Department of Gynaecology of the Military Medical Academy in the period from three years.Criteria for inclusion into the study were primary, previously untreated lesions, colposcopic findings that suggest the presence of premalignant lesions of the cervix; findings from Papanikolaou cytological test, interpreted by the Bethesda criteria with the findings of LSIL, HSIL, ASCUS. HPV typisation was done by PCR with evidence of viruses type 16, 18, 31 and 33 in all women. After the bipsy of the cervical mucosa, we performed pathohistological analysis by hematoxilineosin staining, immunohistochemical analysis for p16,p63,ciklin d1 and survivin and morphometric analysis of cervical epithelium. After the first biopsy, during next seven months in group of 48 patients with dysplasias, according the same criteria for inclusion, we performed rebiopsy and uniform examination . The control group consisted of 12 women without dysplasia and without verified infection of cervical high-risk HPV, with pathological diagnosis of leiomyoma in material obtained after the hysterectomy.Criteria for exclusion from the study was previously diagnosed and treated dysplasia or squamous cell carcinoma...

Uvod: Termin metabolički sindrom (MS), sindrom insulinske rezistencije i sindrom X, koristi se za precizno definisanje udruženih abnormalnosti koje su povezane sa povećanim rizikom za razvoj dijabetes melitusa tipa 2 i aterosklerotskih kardiovaskularnih bolesti. Uniformna definicija MS ne postoji. Ciljevi rada: Utvrđivanje učestalosti MS u ispitivanom uzorku; ispitivanje povezanosti između osnovnih socio - demografskih karakteristika trudnica i MS; prisustva specifičnih navika trudnica i MS; ispitivanje pojedinih komponenti MS u trudnoći; ispitivanje prognostičkog značaja metaboličkog sindroma u proceni toka i ishoda trudnoće. Materijal i metode: Prospektivna, kohornta studija je obuhvatila 135 trudnica, hospitalizovanih u periodu 2013. i 2014. godine. Korišćena je medicinska dokumentacija Klinike za ginekologiju i akušerstvo, Kliničkog centra Srbije, kao i posebno, formiran strukturalni upitnik. Za analizu rezultata korišćene su deskriptivne i analitičke statisitičke metode. Rezultati: Učestalost MS u populaciji trudnica bila je 31,1%. Nakon kontrole na poznati konfaunding faktor uzrast, registrovano je da su trudnice sa MS imale 1,685 puta veću šansu za da im se porođaj završi carskim rezom (OR=1,685, p=0,048), da je MS bio statistički značajan prognostički faktor ranijih nedelja gestacije na porođaju (p=0,001), te da je MS bio statistički značajan prognostički faktor niže vrednosti Apgar skora novorođenčadi (p=0,003). Zaključak: Rana detekcija MS tokom trudnoće smanjuje perinatalni morbiditet i značajan je činilac kako toka tako i ishoda trudnoće., Introduction: The term metabolic syndrome (MS), syndrome of insulin resistance and syndrome X has been used to precisely define the associated abnormalities which are associated with an increased risk for the development of type 2 diabetes mellitus, as well as atherosclerotic cardiovascular disease. The uniform definition of the MS does not exist. Objectives: Determining the incidence of MS in the tested sample; testing connectivity between the main socio - demographic characteristics of pregnant women and MS; the presence of specific habits of pregnant women and MS; testing of individual components of MS in pregnancy; the prognostic significance of the metabolic syndrome in assessing the course and outcome of pregnancy. Material and methods: Prospective cohort study included 135 pregnant women hospitalized in the period 2013 and 2014 year. Medical documentation of the Clinics for Gynecology and Obstetrics, Clinical center Serbia was used, as well the structural question - mark for pregnant women. Data analysis included descriptive and analytical methods. Results: The incidence of MS in the population of pregnant women was 31,1%. After controlling for the known confounding factor of age, we confirmed that women with MS had 1,685 times more likely to finish their birth by caesarean section (OR = 1.685, p = 0.048); that the MS was statistically significant prognostic factor in the earlier weeks of delivery (p = 0.001); also that the MS was statistically significant prognostic factor of lower Apgar scores in newborns (p = 0.003). Conclusion: The early detection of MS during pregnancy reduces perinatal morbidity and is an important factor for the pregnancy outcome.

Cilj: Sve veća primena i rasprostranjenost metoda asistirane reprodukcije IVF/ICSI, dovodi i do očekivanog interesovanja o bezbednosti metode i stanju dece iz ovakvih trudnoća. Prvi opšti ciljevi obuhvataju ispitivanje uticaja faktora asistirane reprodukcije na tok i ishod jednoplodnih i blizanačkih trudnoća, kao i trajanje i način završavanja trudnoća, u poređenju sa spontanom populacijom. Drugi deo prvog opšteg cilja obuhvata novorođenče iz ART, njegovo stanje, prisustvo kongenitalnih malformacija, epigenetskih poremećaja, mortaliteta i morbiditeta u odnosu na spontanu populaciju novorođenčadi. Drugi opšti cilj obuhvata poređenje uticaja specifične metode asistirane reprodukcije IVF i ICSI na trudnoće, tok, ishod i pojavu komplikacija u okviru populacije nastale asistiranom reproduktivnom tehnologijom. Takođe, poređenje uticaja vrste metode asistirane reprodukcije IVF ili ICSI na novorođenčad međusobno, nastalih ovim metodama u pogledu njihovog stanja, pojave kongenitalnih malformacija, hromozomopatija, epigenetskih sindroma, kao i mortaliteta i morbiditeta, posebno za jednoplodne i blizanačke trudnoće. Metodologija: Delom retrospektivna, delom prospektivna studija je sprovedena na Klinici za ginekologiju i akušerstvo, Kliničkog centra Srbije u periodu od 01.01.2001. do 31.12.2011. godine i odnosi se na populaciju 1441 trudnice, starih do 45 godina, porođenih nakon 24. nedelje gestacije sa trudnoćom nastalom IVF i ICSI metodom asistirane fertilizacije, bez prisustva težih i sistemskih bolesti, sa jednoplodnom (881) i blizanačkom trudnoćom (560). Kao kontrola su korišćene trudnice, porođene na KGA KCS u istom vremenskom periodu (u toku istog meseca), odgovarajućeg godišta, obrazovanja, pariteta, sa odgovarajućim brojem plodova, i spontano nastalom trudnoćom, svakoj pojedinačnoj ispitanici je dodeljena pojedinačna kontrola. Pod postupkom asistirane fertilizacije se podrazumevaju samo sveži ciklusi IVF i ICSI sa embriotransferom, sa celokupnom dokumentacijom. Kod kon, Objective: With widespread use and more demand tendency for ART all over the world, there is growing concern regarding safety of the method. First, we want to determine whether in vitro fertilization/ intracytoplasmic sperm injection (IVF/ICSI) singleton and twin pregnancies are at increased risk for maternal pregnancy and fetal complications than spontaneous singleton and twin conceptions. Also, we want to investigate the neonatal outcome of singletons and twins after IVF/ICSI comparing with spontaneous neonatal population in the categories of congenital malformation, chromosomopathies, and admission to neonatal intensive care unit. Second, it is necessary to determine the possible negative effect on the ART singletons and twins according to the use of different method IVF or ICSI on perinatal outcome and occurrence of maternal and fetal complications. Also, our purpose is to determine the influence of the method of ART, IVF or ICSI on the neonatal outcome of ART children (singletons, twins) in the frequency of admission to NICU, congenital malformations, mortality rates. Methods: The obstetrical outcome of 881 consecutive singleton and 560 consecutive twin pregnancies (1441) after IVF/ICSI, delivered at the Clinic for Gynaecology and obstetrics, Clinical Centre of Serbia, beyond 24th weeks of gestation, from the period 1st January, 2001 to 31st December 2011, were compared to 881 and 560 matched controls (spontaneously conceived singletons and twins), matching one to one by age, education, parity, time and place of delivery in the retrospective and prospective study. Only pregnancies resulting from fresh IVF/ICSI and embryotransfer cycles were included in the study, and those with oocyte donations and cryopreserved embryos were excluded. Details on patients demographics, life style, and pregnancy outcome, and IVF procedure were collected from clinical protocols, patients charts and previous patients documentation. All pregnancies were monitored according to clinic

Aim: To determine the role of fetal multiples of the median of middle cerebral artery peak systolic velocity (MoM MCA-PSV), predicts the rate of decline in fetal hematocrit (Hct) for determination of the best timing for the second intrauterine intravascular transfusion (IUIVT) in fetuses with Rh alloimmunisation. Materials and Method: Retrospective study of 59-monofetal alloimmunized pregnancies from 2005 to 2012 that underwent first and second IUIVT were assessed in Department of Gynecology and Obstetrics, Belgrade, Serbia. Result: There was an inverse statistically significant correlation between measurements MCA MoM-1 and fetal Hct-1 before the first IUIVT r =- 0.622; p = 0.001 and MCA-MoM-3 and Hct-3 before the second IUIVT r =- 0.381; p = 0.001, also as the significant correlation between the interval between both procedures (expressed in day) and measurement MCA-MoM-3, before the second IUIVT r =- 0.284; p = 0.029. Conclusion: The measurements MoM-MCA before every IUIVT can be useful for prediction of the best timing for the next IUIVT.

Uticaj različitih antepartalnih, intrapartalnih i ranih neonatalnih faktora rizika, značajan je za tok i ishod trudnoće, za rani neonatalni period i za kasniji rast i razvoj deteta. Oštećen plod u trudnoći i/ili porođaju nije samo problem akušera i neonatologa već i izuzetan (veliki) problem sociologa, porodice i društva. Sve ovo nameće potrebu za ranim prepoznavanjem problema ploda sa rizikom u cilju smanjivanja perinatalnog (antenatalnog) morbiditeta i mortaliteta i omogućavanja normalnog rasta i razvoja deteta. Aloimunizacija označava postojanje cirkulišućih antitela majke protiv eritrocita fetusa, koja nastaju kao odgovor na postojanje stranog antigena na membrani eritrocita fetusa. O problemu aloimunizacije u svetu je dosta pisano i rađeno, a ima i zemalja, posebno onih sa razvijenom zdravstvenom zaštitom gde aloimunizacije više nema. U Srbiji, međutim, slično kao i okolnim Balkanskim državama, aloimunizacija je i dalje prisutna i predstavlja jedan od gorućih problema perinatalne kontrole. Hemolitička bolest definisana Rh(D) aloimunizacijom zauzima značajno mesto u perinatalnom morbiditetu i mortalitetu), ona predestavlja oboljenje sa genetskom predispozicijom. Hemolitička bolest fetusa/neonatusa (HBFN), je proces stvaranja IgG anti-D antitela u krvi Rh(D) negativne trudnice koja prelaze u cirkulaciju Rh(D) pozitivnog ploda, apsorbuju se na D pozitivne eritrocite ili ostaju slobodna u fetalnom serumu. Ovako apsorbovana antitela predstavljaju hemolizine koji razaraju eritrocite. Izvesni klinički aspekti Rh(D) aloimunizacije bili su poznati stotinama godina, ali etiologija oboljenja otkrivena je sredinom prošlog veka, što je uslovilo veliki napredak u razumevanju, dijagnostici i terapiji ovog problema. Rh faktor otkrilli su Landsteiner i Weiner 1940. godine, kada su utvrdili da se u serumu eksperimentalnih zečeva, prethodno imunizovanih eritrocitima Rhesus majmuna, stvara antitelo koje aglutiniše ne samo eritrocite majmuna već i eritrocite 85% ljudi bele rase; im, The impact of different antepartal, intrapartal and early neonatal risk factors is significant for the course and outcome of a pregnancy, for an early neonatal period and for later growth and development of a child. The case of fetal damage during pregnancy and/or childbirth is a significant problem not only for obstetricians and neonatologists but also for sociologists, family and society as a whole. This calls for an early problem identification of fetus with a risk in order to decrease perinatal (antenatal) morbidity and mortality, and enable normal growth and development of a child. Allo-immunization indicates the existence of maternal circulating antibodies against fetal erythrocytes, that emerge in response to the existence of extraneous antigen on the fetal erythrocyte membrane. Around the world, a great deal of scientific and practical work has been dedicated to the problem of allo-immunization, and there are countries, especially those with developed health care systems, where alloimmunization is no more existent. However, in Serbia and its neughboring Balkan countries allo-immunization is still present and represents one of the vital problems of perinatal contol. Тhe hemolytic disease defined by Rh(D) allo-immunization contributes significantly to perinatal morbidity and mortality. The hemolytic disease of fetus/neonate is the disease (HDFN) with genetic predisposition and it represents a process of production of IgG anti-D antibodies in blood of a Rh(D) negative pregnant woman that go over into the circulation of Rh(D) positive fetus, get absorbed on D positive erythrocytes or stay free in fetal serum. Antibodies absorbed in this way represent hemolysins that destroy erythrocytes. Certain clinical aspects of Rh(D) allo-immunization have been known for hundreds of years, but the disease etiology was discovered in the middle of 20th centuary, and that greatly improved understanding of the problem, and its diagnostics and treatment. Rh factor was discovered

Aim: The relation between placental histopathological examination, umbilical cord pathology and abnormal umbilical and cerebral Doppler as a predictor of stillbirth at later gestations was evaluated. Materials and Methods: A retrospective study of 55 monofetal pregnancies complicated with late fetal death from 2005-2008 was conducted at the Institute of Gynecology and Obstetrics, Belgrade. Statistical analysis: chi-square likelihood ratio test and Spearman's coefficient correlation. Results: Intrauterine fetal demise occurred most frequently at term -32.7% of the time. Changes in the umbilical artery resistance index were not significantly different from placental histopathology findings, p = 0.363. There was a significant correlation between neonatal birth weight and weeks of gestation at delivery, r = 0.796; p = 0.001. Conclusion: Umbilical artery Doppler is a relatively poor predictor of stillbirths due to placental dysfunction. It seems that neonatal birth weight is the best predictor of late stillbirth in high-risk pregnancies.

Hysterosalpingography is an important diagnostic method for the evaluation of the female re productive tract involving the exposure of patients to ionizing radiation The irradiation of ovaries is unavoidable and radiation exposure of the patient and the associated radiological risk for the foetus and born child during the period of growth should be considered, as well The purpose of this work is to evaluate organ and patient doses and radiation risks during hysterosalpingography procedures performed in a dedicated gynecological hospital The entrance surface air kerma was measured for a total of 31 patients during hvsterosalpingography Based on the results obtained, the radiogenic risk for hereditary effects and cancer induction was estimated The patient dose levels are in the range of 3-15 mGy, with a median value of 10 mGy, in terms of entrance surface air kerma Estimated median ovarian and uterus doses are 1 7 and 2 3 mGy, respectively The risk for fatal cancer and hereditary effects is estimated to be 5 5 10(-5) and 3 4 10(-6), respectively Although low compared to the natural incidence of genetic effects and cancer, it can be elevated in cases of prolonged or repeated procedures or procedures where the non-optimized protocol is used

Hysterosalpingography is an important diagnostic method for the evaluation of the female re productive tract involving the exposure of patients to ionizing radiation The irradiation of ovaries is unavoidable and radiation exposure of the patient and the associated radiological risk for the foetus and born child during the period of growth should be considered, as well The purpose of this work is to evaluate organ and patient doses and radiation risks during hysterosalpingography procedures performed in a dedicated gynecological hospital The entrance surface air kerma was measured for a total of 31 patients during hvsterosalpingography Based on the results obtained, the radiogenic risk for hereditary effects and cancer induction was estimated The patient dose levels are in the range of 3-15 mGy, with a median value of 10 mGy, in terms of entrance surface air kerma Estimated median ovarian and uterus doses are 1 7 and 2 3 mGy, respectively The risk for fatal cancer and hereditary effects is estimated to be 5 5 10(-5) and 3 4 10(-6), respectively Although low compared to the natural incidence of genetic effects and cancer, it can be elevated in cases of prolonged or repeated procedures or procedures where the non-optimized protocol is used

Objective: The aim of the study was to assess the short-term effects of direct intramuscular (i.m.) corticosteroid therapy on fetal biophysical profile, baseline fetal heart rate and the nonstress test, which indicate the degree of fetal hypoxia. Method: We evaluated the effect of direct i.m. fetal single-dose dexamethasone (4 mg/kg) on the fetal biophysical profile 2 h before and 2-4 h after corticosteroid therapy in 41 fetuses in the 32nd week of gestation at risk of preterm delivery. Risk factors for preterm delivery included pregnancy-induced hypertension and preeclampsia. Result: There was a statistically significant difference between fetal breathing movements before and after corticosteroid therapy (p = 0.019; 95% confidence interval for difference -11.75, -1.12). No significant changes were observed between baseline fetal heart rate before and after corticosteroid therapy (p = 0.99; 95% confidence interval for difference -4.81, +4.81), biophysical profile before and after fetal corticosteroid therapy, p = 0.235 as well as the nonstress test before and after therapy (p = 0.564). Conclusion: Direct corticosteroid i.m. fetal therapy results in increasing profound short-term fetal breathing movements. There are no changes in baseline fetal heart rate, biophysical profile score, and nonstress test.