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The presented Croatian guidelines are among the first guidelines which include the use of biomarkers as a major component in risk assessment across all trimesters of pregnancy to aid in diagnosis and rule in/out of preeclampsia.

IntroductionComprehensive updated information on cervical cancer surgical treatment in Europe is scarce.ObjectiveTo evaluate baseline characteristics of women with early cervical cancer and to analyze the outcomes of the ESGO quality indicators after radical hysterectomy in the SUCCOR database.MethodsThe SUCCOR database consisted of 1272 patients who underwent radical hysterectomy for stage IB1 cervical cancer (FIGO 2009) between January 2013 and December 2014. After exclusion criteria, the final sample included 1156 patients. This study first described the clinical, surgical, pathological, and follow-up variables of this population and then analyzed the outcomes (disease-free survival and overall survival) after radical hysterectomy. Surgical-related ESGO quality indicators were assessed and the accomplishment of the stated recommendations was verified.ResultsThe mean age of the patients was 47.1 years (SD 10.8), with a mean body mass index of 25.4 kg/m2 (SD 4.9). A total of 423 (36.6%) patients had a previous cone biopsy. Tumor size (clinical examination) ConclusionsIn this European cohort, the rate of adjuvant therapy after radical hysterectomy is higher than for most similar patients reported in the literature. The majority of centers were already following the European recommendations even 5 years prior to the ESGO quality indicator implementations.

Sažetak. Cilj: Prikazati slučaj pacijentice s ponavljajućim rupturama jajnika s ciljem rasprave moguće etiologije rupture koja može nastati u različitim fazama liječenja u predisponiranih pacijentica. Prikaz slučaja: Pacijentica u dobi od 28 godina zaprimljena je u hitnu ginekološku ambulantu zbog jakih bolova u donjem dijelu abdomena praćenih dispnejom i općim lošim osjećanjem. Tog jutra pacijentica je bila na aspiraciji oocita. U krvnoj slici bile su snižene vrijednosti eritrocita, hemoglobina i hematokrita. Transvaginalnim ultrazvukom postavljena je sumnja na hematoperitoneum. Indicirana je hitna dijagnostička laparoskopija kojom je potvrđeno intraperitonealno krvarenje, a izvor je bio rupturirani jajnik. Hemostaza je učinjena tijekom zahvata termokauterizacijom. Nakon pet godina pacijentica je nastavila liječenje neplodnosti in vitro fertilizacijom u prirodnom ciklusu u kojem je učinjen prijenos zametka. Dva dana kasnije javlja se u hitnu ginekološku ambulantu zbog bolova u abdomenu. Ultrazvučnom dijagnostikom postavljena je sumnja na hematoperitoneum koji je potvrđen dijagnostičkom laparoskopijom, a krvarenje je zaustavljeno termokauterizacijom. Tri tjedna nakon prijenosa zametka transvaginalnim ultrazvukom potvrđen je intrauterino smješten gestacijski mjehurić, čime je potvrđena trudnoća. U 26. tjednu trudnoće započeo je prijevremeni porod prsnućem vodenjaka te je porod dovršen carskim rezom. Zaključak: Tijek liječenja neplodnosti i zbivanja tijekom perinatalnog razdoblja ukazuju da su ponavljane rupture jajnika moguće u predisponiranih pacijentica. Prikazani slučaj ukazuje na skupinu pacijentica koja je sklonija komplikacijama u različitim okolnostima reprodukcijske dobi., Aim: To present a patient with recurrent ovarian ruptures in order to discuss the possibility of etiology of rupture that may occur at different stages of treatment in therefore predisposed patients. Case report: A-28-year-old patient was admitted to an emergency gynecological ambulance due to pain in the lower abdomen, dyspnea, and general weakness. That morning, the oocyte retrieval was done. In the laboratory findings, erythrocytes, hemoglobin, and hematocrit were reduced. Transvaginal ultrasound raised the suspicion of hemoperitoneum so urgent diagnostic laparoscopy was indicated. It confirmed the intraperitoneal bleeding whose cause was the ruptured ovary. Hemostasis was performed during the thermocauterization procedure. After five years, the patient continued infertility treatment by in vitro fertilization in the natural cycle in which the embryo was transferred. Two days later, the patient was admitted to an emergency gynecological ambulance due to pain in the lower abdomen. After the examination, the hemoperitoenum was suspected and confirmed by diagnostic laparoscopy, the bleeding was stopped. Three weeks after embryo’s transfer, the transvaginal ultrasound confirmed gestatinal sac located in uterus which confirmed the pregnancy. In the 26th week of pregnancy, preterm labor was caused by the rupture of the membranes so the delivery was completed by Caesarean section. Conclusion: The infertility treatment and events during the perinatal period indicate that recurrent ovarian ruptures are possible in predisposed patients. The presented case indicated a group of patients who are more prone to complications in different circumstances of reproductive age.

Despite widespread use of technology, type one diabetes mellitus (T1DM) is still a great clinical challenge during pregnancy. This study aims to assess how prenatal variables of T1DM patients using continuous subcutaneous insulin infusion (CSII) influence pregnancy outcomes. We performed a retrospective study of 35 patients with T1DM treated with CSII during pregnancy. Alterable preconception variables (A1C, body mass index, basal and bolus insulin dose) were analysed as possible contributors to birth weight and large-for-gestational-age (LGA) prevalence. Inclusion criteria were presence of T1DM for more than two years, A1C &lt, 7.4% and treatment with CSII for at least three months prior to conception. The preconception basal insulin dose and A1C had a significant correlation to the neonatal birth weight (p = 0.01, r = 0.4 and p = 0.04, r = 0.3, respectively) and were significant in regression analysis together contributing 22% of the variance in birth weight percentiles (sig = 0.17, R square = 0.22). Prevalence of LGA was 46%. Women who had LGA neonates also had a higher preconception basal insulin dose compared to women with non-LGA neonates (26 &plusmn, 9 vs. 18 &plusmn, 7 IU (international units), p = 0.01). The LGA group had a higher preconception A1C, but it did not reach statistical significance (6.5 &plusmn, 0.5% vs. 6.2 &plusmn, 0.9%, respectively, p = 0.2). Women with T1DM treated with CSII who had unregulated glycaemia and more basal insulin were at greater risk for development of LGA neonates.

Objectives Novel coronavirus disease (COVID-19) is rapidly spreading all over the world. Although in many cases the infection causes very weak symptoms, it can be severe in patient with diverse chronical diseases and immunological compromising patients. Pregnancy is a unique condition in which mother and fetus peacefully collaborate. Diverse endocrine-immune mechanisms, mostly under progesterone control work together to protect the fetus from maternal immunocompetent cell activation driven rejection. The physiological shift to Th2 dominant environment, while favourable for fetus, it makes mothers susceptible to infective pathogens, making pregnancy during COVID-19 pandemic challenging. Materials and methods Studies involving COVID-19 in pregnancy and those analysing changes of immune system induced by COVID-19 were searched in databases such as PubMed, Scopus, Google Scholar and ScienceDirect. Databases were searched using a keyword COVID-19/coronavirus, that was combined with following terms: immune system, pregnancy, oestrogen, or progesterone. Search included studies published up to 01.07.2020. Almost 1,500 articles were found, but only 18 met criteria. Results Most frequent symptoms of COVID-19 in mothers infected in the late pregnancy were fever and cough accompanied with lymphopenia and elevated C-reactive protein. Mothers reported to have severe disease had comorbidities and were obese. Low rate of neonatal complications of maternal Sars-Coc-2 infection without neonatal mortality was observed. Conclusions Currently available data didn’t show significant relationship between COVID-19 severity and pregnancy and there is no strong evidence that mother’s infection can lead to adverse pregnancy outcome, but further studies are needed to determinate the possible effects of COVID-19 gained during earlier pregnancy.

Aim: Pallister-Killian syndrome (PKS) is a rare chromosomal disorder, caused by tissue-limited mosaicism for an isochromosome 12p. Prenatal diagnosis of PKS is generally incidental. Although clinical presentation of PKS varies, cytogenetic findings are constant, and include a tetrasomy of chromosome 12p. We report a case of prenatally diagnosed PKS with unique dysmorphic feature: bifid cardiac apex, a type of morphology that has not been documented before. Case presentation: Our patient was the 38-year-old pregnant woman who underwent amniocentesis. Cytogenetic analysis of amniotic fluid detected a mosaic karyotype with a supernumerary chromosome (SMC) in 64 % of fetal amniocytes. To determine the chromosomal origin of SMC, fluorescence in situ hybridization was performed and tetrasomy 12p was confirmed: mos 47,XY,+mar[18]/46,XY[10].ishi(12p)(8M16/SP6++,CEP12+,VIJyRM2196-). Ultrasound examination showed a fetus with cleft lip, echogenic focus in the left ventricle of the heart and shortened fetal long bones. After receiving a genetic counseling for PKS, the woman requested a termination of pregnancy. A postmortem inspection of the fetus revealed a complex heart anomaly that includes bifid cardiac apex and ventricular septal defect. Conclusions: This report expands the clinical manifestations of PKS with a unique feature of bifid cardiac apex, and highlights the targeted prenatal diagnosis of PKS if specific ultrasound markers are present., Cilj: Sindrom Pallister-Killian (PKS) rijedak je kromosomski poremećaj uzrokovan tkivno ograničenim mozaicizmom za prekobrojni izokromosom 12p. Prenatalno se dijagnoza PKS-a postavlja uglavnom slučajno. Iako je težina kliničke slike različita i varira od vrlo blage do izrazito teške, citogenetički nalaz uvijek uključuje tetrasomiju 12p. Ovim radom prikazan je prenatalno dijagnosticirani PKS s jedinstvenim dismorfološkim obilježjem: bifidnim srcem, koje do sada nije opisano u literaturi, kao dio kliničke slike ovoga sindroma. Prikaz slučaja: Tridesetosmogodišnja trudnica upućena je na amniocentezu. GTG metodom oprugavanja kromosoma utvrđen je aberirani mozaični muški kariotip s malim prekobrojnim marker kromosomom (engl. small supernumerary marker chromosome, sSMC) u 64 % fetalnih amniocita. Za određivanje podrijetla marker kromosoma korištena je metoda fluorescentne in situ hibridizacije te je utvrđena tetrasomija 12p: mos 47,XY,+mar[18]/46,XY[10].ishi(12p)(8M16/SP6++,CEP12+,VIJyRM2196-). Nalaz ultrazvuka ukazao je na fetus s rascjepom usne, ehogenim fokusom u lijevoj srčanoj klijetki te skraćenim dugim kostima. Po genetičkom savjetovanju, trudnica se odlučila za prekid trudnoće. Obdukcijom fetusa otkrivena je kompleksna srčana anomalija koja uključuje bifidno srce te ventrikularni septalni defekt. Zaključci: Ovaj prikaz slučaja prvi put opisuje jedinstveno dismorfološko obilježje bifidnog srca u PKS-u te naglašava važnost ciljanog pristupa u prenatalnoj dijagnostici PKS-a, ako postoje specifični ultrazvučni biljezi.

The majority of endometrial carcinoma are diagnosed at an early stage and exhibit a favorable prognosis. However, 10% to 15% of ECs recur and the majority are type II tumors which are high-grade carcinomas. The epithelial-mesenchymal transition (EMT) has been considered as a fundamental step for the development of the invasive phenotype of cancer cells. During EMT, many of epithelial surface markers, primarily E-cadherin disappear, and mesenchymal markers including N-cadherin gain. This feature resides predominantly at the invasive front (IF) of the tumor. Therefore, we examined the immunohistochemical expression of E-cadherin and N-cadherin at the IF, in central areas of the tumor and lymphovascular space, in type I and type II endometrial carcinoma. The association of each protein with the clinicopathologic features was also evaluated. Our results confirmed a stronger E-cadherin immunostaining in type I tumors indicating that the loss of E-cadherin may be responsible for a more aggressive behavior of type II ECs. In both types, E-cadherin was strongly expressed in central areas and the reactivity decreased toward the IF. On contrary, N-cadherin was overexpressed at the IF confirming an inverse relationship between these markers. In addition, a decrease in E- cadherin expression was observed in cells within the lymphovascular space. Downregulation of E-cadherin was associated only with high-grade tumors while no correlations between both markers and other clinicopathologic features were found. Our results confirm that EMT occurs at the IF that represents a critical interface between the tumor and the host.

Urethral coitus is a rare type of sexual practice, usually due to vaginal agenesis or hymeneal anomalies. We report a case of urethral coitus in a healthy couple who were evaluated for infertility. The female partner had cribriform hymen and dilated urethral orifice but did not report any problems except infertility and her genital anatomy was normal. The male partner reported concerns over his penile size but was otherwise healthy. After incision of hymen, they were able to have vaginal coitus and successfully conceived. While urethral coitus is rare, it should be suspected in women presenting with infertility and a dilated urethral orifice.

Trophoblast expressing paternal HLA-C resembles a semiallograft, and could be rejected by maternal T cells. IL-22 seems to be involved in allograft rejection and thus could be responsible for miscarriages. We examined the role of decidual IL-22-producing CD4+ T on human pregnancy. In those experiencing successful pregnancy and those experiencing unexplained recurrent abortion (URA), the levels of IL-22 produced by decidual CD4+ T cells are higher than those of peripheral blood T cells. We found a correlation of IL-22 and IL-4 produced by decidual CD4+ T cells in those experiencing successful pregnancy, not in those experiencing URA. The correlation of IL-22 and IL-4 was also found in the serum of successful pregnancy. A prevalence of CD4+ T cells producing IL-22 and IL-4 (Th17/Th2/IL-22+, Th17/Th0/IL-22+, Th17/Th2/IL-22+, and Th0/IL-22+ cells) was observed in decidua of those experiencing successful pregnancy, whereas Th17/Th1/IL-22+ cells, which do not produce IL-4, are prevalent in those experiencing URA. Th17/Th2/IL-22+ and Th17/Th0/IL-22+ cells are exclusively present at the embryo implantation site where IL-4, GATA-3, IL-17A, ROR-C, IL-22, and AHR mRNA are expressed. T-bet and IFN-&gamma, mRNA are found away from the implantation site. There is no pathogenic role of IL-22 when IL-4 is also produced by decidual CD4+ cells. Th17/Th2/IL-22+ and Th17/Th0/IL-22+ cells seem to be crucial for embryo implantation.

OBJECTIVE:The QUiPP algorithm combines cervical length, quantitative fetal fibronectin (qfFN) and medical history to quantify risk of preterm birth. We assessed the utility of QUiPP to inform preterm birth prevention treatment decisions. DESIGN:A prospective cohort study with a subsequent impact assessment using the QUiPP risk of birth before 34 weeks gestation. SETTING:A UK TERTIARY REFERRAL HOSPITAL: SAMPLE: 119 women with previous spontaneous preterm birth (sPTB) or preterm premature rupture of membranes (PPROM) before 34 weeks gestation. METHODS:Cervical length and qfFN were measured at 19+0 - 23+0 weeks gestation. Clinical management was based on history and cervical length. After birth, clinicians were unblinded to qfFN results and QUiPP analysis was undertaken. MAIN OUTCOME MEASURES:Predictive statistics of QUiPP algorithm using 10% risk of sPTB before 34+0 weeks as treatment threshold. RESULTS:Fifteen of 119 women (13%) had PPROM or sPTB before 34 weeks. Of these 53% (8/15) had QUiPP risk of sPTB before 34+0 weeks above 10%. Applying this treatment threshold in practice would have doubled our treatment rate (20% vs 42%). QUIPP threshold of 10% had positive likelihood ratio (LR) of 1.3 (95% CI 0.76-2.18), and negative LR of 0.8 (95% CI 0.45-1.40) for predicting sPTB before 34+0 weeks. CONCLUSIONS:Use of the QUiPP algorithm in this population may lead to substantial increase in interventions without evidence that currently available treatment options are beneficial for this particular group. This article is protected by copyright. All rights reserved.

Vaginal birth trauma is the leading cause of stress urinary incontinence (SUI) in women. Also, the process of ageing and hormonal deprivation in postmenopause alters the metabolism of connective tissues and decreases collagen production leading to pelvic floor dysfunction. Noninvasive treatment is recommended as first-line management of urinary incontinence (UI) in women. Surgical procedures are more likely to be implemented to cure UI but are associated with more adverse events. Sex hormone deficiency affects changes also in the lower urinary tract where estrogens are the main regulators of physiological functions of the vagina. In the last decade, laser treatment of SUI and of the genitourinary syndrome of menopause (GSM) has been shown a promising treatment method in peer-reviewed literature. This review’s aim is to present the evidence-based medical data and laser treatment of SUI and GSM in an outpatient setting to be a good treatment option, regarding short-term as well as long-term follow-ups. Long-term follow-up studies are needed to confirm that laser treatment is a good, painless outpatient procedure with no side effects in postmenopausal women.

Differences in health care professionals' and cancer patients' views on sexual health issues.

PURPOSE: The vascular endothelial growth factor A (VEGFA) is crucial for normal vasculogenesis and angiogenesis during pregnancy, and alterations in the VEGFA gene expression were detected in women with idiopathic recurrent spontaneous abortion (IRSA) and spontaneously aborted conceptuses. Our aim was to evaluate whether there is an association between the functional -2549 insertion/deletion (I/D) polymorphism in the promoter region of the VEGFA gene and IRSA in reproductive couples. METHODS: We performed a case-control study involving 149 women and their 140 partners with three or more IRSA and 149 control women and men. Allele-specific polymerase chain reaction was used for genotyping. RESULTS: We found no association of the -2549 I/D polymorphism with IRSA in women. However, men with the DD genotype have a 1.75-fold increased risk of IRSA compared with men carrying the ID and II genotypes (95 % confidence interval (CI) = 1.05-2.93, P = 0.032). In addition, the D allele in men contributes to a 1.42-fold increased risk of IRSA (95 % CI = 1.02-1.97, P = 0.036) compared to men carrying the I allele. CONCLUSIONS: Our results indicate that the -2549 I/D polymorphism in the VEGFA gene in men might be associated with IRSA. Additional genetic association studies including both partners, as well as expression studies, are needed to elucidate the role of this polymorphism in IRSA.

Objective: Fetal growth in the first trimester is estimated by measuring the crown to rump length of the fetus (CRL). There are no data on the relation between fetal growth and fat distribution in pregnant women. The objective was to investigate the influence of fat distribution in pregnant women on fetal growth in the first trimester of pregnancy. Methods: This was a controlled observation using a random sampling method. Newly registered pregnant women were included in the sample during a 12-18-month period. The study included 400 pregnant women from Bjelovarsko- bilogorska County, Croatia. Participants were divided into three groups according to their pregravid BMI values, normal weight (n = 254), overweight (n = 103), and obese (n = 43). In the 12th week of pregnancy, the CRL was measured by transvaginal ultrasound. The subcutaneous and preperitoneal fat was measured by transabdominal ultrasound, using the Suzuki method. The correlation was tested by the Pearson's coefficient, and a linear regression analysis was performed on the variables with good correlation. Results: In normal weight pregnant women, there is no correlation between the adipose tissue and fetal length, but there is a significant correlation between overweight and obese ones. Conclusion: The distribution of adipose tissue in obese and overweight pregnant women is associated with fetal length in the first trimester of pregnancy, with a stronger correlation between visceral fat and fetal length. The influence of this correlation on the overall fetal growth should be investigated by longitudinal monitoring of these variables during the entire pregnancy

Cilj: Utvrditi pojavnost makrosomije novorođenčeta, porođaja carskim rezom, gestacijskog dijabetesa melitusa i gestacijske hipertenzije u odnosu na prirast tjelesne mase u trudnoći. Ispitanici i metode: Podaci su prikupljeni na Klinici za ginekologiju i porodništvo Kliničkog bolničkog centra u Rijeci. U retrospektivnu kohortnu studiju je uključeno 3433 trudnica koje su imale indeks tjelesne mase veći od 25 kg/m2 te jednoplodne, živorođene i terminske trudnoće u periodu od 5 godina. Trudnice su podijeljene u skupine s povećanom tjelesnom masom i pretilošću, a svaka skupina sadržava podskupine trudnica koje su dobile više i manje od 15 kg. Makrosomija novorođenčeta, dovršetak porođaja, pojava gestacijskog dijabetesa i gestacijske hipertenzije su analizirani, a statistička analiza je provedena u programu Rgui X2-testom uz razinu statističke značajnosti p, Aim: To evaluate the occurrence of macrosomia, type of birth, gestational diabetes mellitus and gestational hypertension relative to weight gain during pregnancy. Patients and methods: We collected data from the Department of Gynaecology and Obstetrics at the University Hospital Rijeka. Retrospective cohort study included 3433 pregnant women with body mass index higher than 25 kg/m2 and singleton term pregnancies over a period of five years. Women were divided between overweight and obese pregnant women. Each group contained subgroups of those who gained more and less than 15 kilograms. Macrosomia, type of birth, gestational diabetes mellitus and hypertension were analyzed. Statistical analysis was performed in Rgui using X2 test, with a statistical significance level of p

ObjectivesVulva cancer (VC) treatment carries a high risk of severe late effects that may have a negative impact on quality of life (QoL). Patient-reported outcome measures (PROMs) are increasingly used when evaluating disease- and treatment-specific effects. However, the adequacy of measures used to assess sequelae and QoL in VC remains unclear. The aims of the present study were to evaluate disease- and treatment-related effects as measured by PROMs in VC patients and to identify available VC-specific PROMs.Methods/MaterialsA systematic literature search from 1990 to 2016 was performed. The inclusion criterion was report of disease- and treatment-related effects in VC patients using PROMs in the assessment. Methodological and reporting quality was in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. This systematic review was performed as part of phase 1 of the development of a European Organisation for Research and Treatment of Cancer QoL questionnaire for VC patients.ResultsThe search revealed 2299 relevant hits, with 11 articles extracted including a total of 535 women with VC; no randomized controlled trials were identified. The selected studies exhibited great heterogeneity in terms of PROMs use. Twenty-one different instruments assessed QoL. Most of the questionnaires were generic. Different issues (sexuality, lymphedema, body image, urinary and bowel function, vulva-specific symptoms) were reported as potentially important, but the results were not systematically collected. Only one VC-specific questionnaire was identified but did not allow for assessment and reporting on a scale level.ConclusionsVulva cancer treatment is associated with considerable morbidity deteriorating QoL. To date, there is no validated PROM available that provides adequate coverage of VC-related issues. The study confirms the need for a VC-specific QoL instrument with sensitive scales that allows for broad cross-cultural application for use in clinical trials.

One of the least studied topics in the field of obstetrics is liver disease during pregnancy, which creates a challenge for both gynecologists and hepatologists. Approximately 3% of pregnant women are affected by some form of liver disease during pregnancy. Some of these conditions can be fatal for both the mother and child. In addition, 3 types of liver disease need to be differentiated during pregnancy. One type is liver disease directly related to pregnancy, which can occur at a specific time during pregnancy. Another type is liver disease not related to pregnancy, which can occur at any time, such as viral- or drug-induced hepatitis. Furthermore, pregnancy can occur in women with pre-existing liver disease. It is essential that the clinicians are familiar with this disorder so they can respond promptly and appropriately in all of these situations, especially when emergency delivery is needed and must not be postponed.

The aim of this article was a critical appraisal of current GDM screening and diagnosis status as well as a presentation of a potentially new approach to this perinatologic and public health problem of increasing clinical significance. Medline, EMBASE and Cochrane databases were searched. Most professional organisations recommend universal screening at 24-28 weeks of gestation, while some of them state that selective screening could also be recommended. Expert opinions regarding GDM diagnosis significantly differ throughout the world. Authors call for an open and broad professional and scientific discussion and suggest a combination of screening and diagnosis procedures in a form of one-step 1-h screening method, creation of regional GDM diagnostic criteria and standardisation of outcome-based randomised control trials. They also advise introduction of a conceptually new approach, where the risk of hyperglycaemia rather than insisting on GDM diagnosis itself should be detected.

The aim of this case report is to present the life saving use of extracorporeal membrane oxygenation (ECMO) in an obstetric pa-tient with acute cardiorespiratory collapse following massive bleeding caused by an atonic uterus post partum. A 39-year-old patient, following a spontaneous abor-tion at 21 weeks of pregnancy, developed uterine atony and massive bleeding and was ultimately referred to the operating room for an emergent hysterectomy. Post-operatively, she was referred to the inten-sive care unit (ICU) where she developed severe acute respiratory distress syndrome (ARDS) that was successfully treated by employing ECMO. Following discontinu-ation of ECMO, her treatment was further complicated by a manifest hemolytic trans-fusion reaction. Although extensive testing was done to establish the cause of this reac-tion, we were unable to find it. The patient responded well to treatment with erythro-poietin (EPO) and corticosteroids as well as a restrictive transfusion regime. This treatment pointed to a possible immune reaction to massive transfusions of blood products. This case demonstrated the im-portance of early aggressive treatment us-ing ECMO in reversal of life threatening ARDS, as well as the need for a judicious approach when transfusing blood prod-ucts.

Imperforate hymen is a congenital anomaly of female external genitalia, which is mostly diagnosed in puberty, at the age of 9–13 years, or very rarely at a younger age. Clinical picture varies from abdominal pain and low back pain to acute urinary retention. We describe a case of a 16-month-old female infant where the imperforate hymen presented as a vaginal cyst. The cyst was first observed by the patient’s mother, although the child had been examined by a paediatrician on several occasions after birth. Complete workup performed for differential diagnosis, mostly to exclude other reproductive system anomalies, led to the final diagnosis of imperforate hymen. The aim of this report is to emphasise the necessity of thorough examination of genitalia in female newborns in order to avoid possible complications associated with this diagnosis later in life, as well as other, more severe differential diagnostic anomalies.

Problem: Differences in the expression of gp96 and its receptors were analysed in normal and pathological human pregnancy. Material and Methods: Immunohistology and immunofluorescence of sections from decidual part of term placenta, first trimester normal decidua, missed abortion and blighted ovum decidua were performed together with reverse transcriptase-quantitative polymerase chain reaction and flow cytometry. Results: In missed abortion, gp96 was intensively stained, when compared to normal early pregnancy. The intensity of CD91 and TLR4 was higher in the first trimester pregnancy and blighted ovum, when compared to missed abortion. Decidual part of the term placenta is invaded with gp96+, CD91+ and TLR4+ trophoblast. Progesterone-induced blocking factor (PIBF) decreased the frequency of TLR4+ T lymphocytes, CD91+ T, natural killer (NK) and mature dendritic cells after an 18-h culture. Decidual mononuclear cells (DMCs) treated with PIBF down-regulated CD91, TLR4 and gp96 gene expression. Conclusion: The presence of gp96, CD91 and TLR4 at the maternal-foetal interface provides a molecular basis for their interaction, particularly in the absence of PIBF.

Objective To investigate the potential association of Y chromosome microdeletions with idiopathic recurrent spontaneous abortion (IRSA) in a Slovenian population and compare our results with those of previously published studies in different populations, with the intention of clarifying the potential impact of Y chromosome microdeletions on IRSA. Design Case–control and association study. Setting Departments of gynecology and obstetrics and university-based research laboratory. Patient(s) Male partners of 148 couples with at least three spontaneous pregnancy losses of unknown etiology, and 148 fertile men. Intervention(s) Multiplex polymerase chain reactions. Main Outcome Measure(s) Azoospermia factor (AZF) regions were tested for Y chromosome microdeletions according to European Academy of Andrology/European Molecular Genetics Quality Network guidelines. The PubMed database was searched to retrieve articles linking Y chromosome microdeletions and susceptibility to IRSA. Result(s) None of the IRSA or control men had microdeletions in the AZFa, AZFb, or AZFc regions. A total of nine previous studies examined the relationship between Y chromosome microdeletions and IRSA, yielding contradictory results, which we discuss in detail. Conclusion(s) On the basis of our comparisons, it is unlikely that Y chromosome microdeletions contribute to IRSA and are therefore currently not recommended for the routine evaluation of IRSA couples.

Objective To investigate the potential association of tissue inhibitor of metalloproteinases (TIMP) 1, 2, 3, and 4 gene polymorphisms with idiopathic recurrent spontaneous abortion (IRSA). Design Case-control and association study. Setting Departments of gynecology and obstetrics and university-based research laboratory. Patient(s) A total of 149 couples with a history of three or more idiopathic spontaneous pregnancy losses and 149 fertile men and 149 fertile women with at least two live births and no history of pregnancy pathologies. Intervention(s) Polymerase chain reaction and restriction-fragment-length polymorphism methods. Main Outcome Measure(s) Detection of TIMP-1 −372 C/T, TIMP-2 −303 C/T, TIMP-3 −915 A/G, TIMP-3 −1296 C/T, and TIMP-4 −3′-UTR C/T genotypes and allele frequencies. Result(s) There were no statistically significant differences in the distribution of any genotype and allele frequencies or any genetic model between IRSA patients and controls. Additionally, no significant associations occurred between combinations of TIMP polymorphisms and the risk of IRSA. Conclusion(s) We found no evidence for the association of TIMP-1, -2, -3, and -4 with IRSA in a Slovenian population.

Respiratory distress syndrome (RDS) occurs in infants delivered before the completion of fetal lung maturation and remains a major cause of neonatal morbidity and mortality in premature infants (1). RDS affects approximately 1% of all live births, but 10 to 15% of all infants with a birth weight less than 2500 g (2). The risk of RDS is increased with prematurity, but is also significant in infants born by electively scheduled cesarean delivery between 38 and 39 weeks of gestation (3). Therefore, the American College of Obstetricians and Gynecologists recommends the documentation of fetal lung maturity for elective deliveries at less than 39 weeks of gestation to avoid neonatal RDS (4). There are several antenatal tests for lung maturity. Evaluation is commonly based on laboratory measurements of the concentrations of particular components of pulmonary surfactant (4-7). Most of them are either complex, expensive, or with low diagnostic efficiency (8). Amniotic fluid lamellar body count (LBC) is one among various biophysical tests, based on measuring the concentration of pulmonary surfactant in amniotic fluid (9). Lamellar bodies (LB) are storage form of surfactant within type II pneumocytes and are actively secreted into the alveolar space and hence into the amniotic fluid (4). The size of LBs, similar to platelets, permits the use of a standard hematologic counter to quantify LB concentration in amniotic fluid samples. This technique quantitatively estimates surfactant production and thus can predict the degree of fetal lung maturation. Still, there are no clearly established protocols and cutoff values for LBC that predict RDS (4). The maturity thresholds for LB vary due to different factors, ie, centrifugation (leads to substantial loss of the LBs), sample contamination (meconium or platelets from the blood can be counted as LBs), and sample type (vaginal pool specimen containing mucus can artificially increase the LBC) (10,11). Depending on the protocols, the cutoff values of LBC that predict the absence of neonatal RDS can vary from 15 000 to even 80 000/µL (4,10,11). Also, the type of particle count analyzer used is critical in setting the cutoff values, so it has been proposed to establish analyzer-specific references for LBC (1). The aim of our investigation was to evaluate the LBC cutoff value using Cell-Dyn 1800 analyzer (Abbott Diagnostics, Abbott Park, IL, USA) and evaluate the efficiency in predicting different grades of neonatal RDS.

Aim. To assess whether imminent amniocentesis is associated with an elevated perception of stress and state anxiety in both women and their partners, and to explore whether greater partner involvement during pregnancy could alleviate women’s stress and anxiety. Methods. Two hundred twenty women undergoing amniocentesis and 90 male partners participated in the study. The State-Trait Anxiety Inventory, Perceived Stress Scale, and Partner’s Involvement in Pregnancy Scale were administered. Statistical analysis was performed using t-test, one way ANOVA, and Pearson’s correlation. Results. The imminence of amniocentesis causes elevated stress (17.6±6.8 ; t=7.32, p=0.000) and anxiety (42.0±11.9 ; t=8.51, p=0.000) in pregnant women, but not their partners (for stress 14.3±6.1 ; t=0.17, p=0.862, and for anxiety 36.4±10.40 ; t=0.66, p=0.510). Women’s stress was even more pronounced in those who experienced another stressor like unplanned pregnancy, prenatal-related nausea and vomiting, or chromosomal aberration in a previous pregnancy. Statistically significant, negative correlations were found between women’s perception of their partner’s involvement during pregnancy and women’s stress (r=-0.23 ; p=0.001) ; the same was not found for women’s anxiety. Conclusion. Greater partner involvement during pregnancy could diminish the women’s stress, but elevated state anxiety just before amniocentesis could not be alleviated in the same way. Thus, health care professionals must pay greater attention to the psychological status of women undergoing amniocentesis to help them better cope with the specificity of the situation.

Background Compared with their ovarian counterparts, serous borderline tumors of the fallopian tube are uncommon, with limited experience about their clinical behaviour. We present a case of serous borderline tumor of the fallopian tube with unusual presentation and summarise all the published cases to date. Case presentation A case of serous borderline tumor of the fallopian tube in a 34-year old patient is presented, incidentally found during routine gynecologic examination. At laparoscopy the tumor was unusualy presented as hematosalpinx and was treated by salpingectomy. Cell-cycle analysis of the tumor tissue revealed a diploid DNA content and a low S-phase fraction. There was no evidence of the disease during the follow-up period of 4.6 years. Conclusion The current case and review of the literature suggest salpingectomy as the optimal treatment for patients with serous borderline tumor of the fallopian tube.