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Heat shock proteins (hsps), in certain circumstances, could shape unique features of decidual dendritic cells (DCs) that play a key role in inducing immunity as well as maintaining tolerance. The aim of the study was to assess the binding of gp96 to Toll-like receptor (TLR) 4 and CD91 receptors on decidual CD1a+ DCs present at the maternal-fetal interface in vitro as well as the influence of CD1a+ DCs maturation status. Immunohistology and immunofluorescence of paraffin-embedded first-trimester decidua tissue sections of normal and pathological (missed abortion MA and blighted ovum BO) pregnancies were performed together with flow cytometry detection of antigens in CD1a+ DCs after gp96 stimulation of decidual mononuclear cells. Gp96 efficiently bound CD91 and TLR4 receptors on decidual CD1a+ DCs in a dose-dependent manner and increased the expression of CD83 and HLA-DR. The highest concentration of gp96 (1000 ng/mL) increased the percentage of Interferon-γ (INF-γ) and IL-15 expressing gp96+ cells. Gp96 binds CD91 and TLR4 on decidual CD1a+ DCs, which causes their maturation and significantly increases INF-γ and IL-15 in the context of Th1 cytokine/chemokine domination, which could support immune response harmful for ongoing pregnancy.

Objectives: To investigate GLUT-9 immunohistochemical expression in decidual cells (DC), extravillous trophoblast (EVTB), villous trophoblast (VTB) and vasculosyntitial membranes (VSM) in placentas from pregnancies complicated with gestational diabetes mellitus (GDM) and to compare the results with placnetas from normal pregnancies. Secondary outcome was to determine neonatal birth weight and placental weight in both study groups and to compare the results. Materials and methods: The study included 13 placentas from pregnancies complicated with GDM, and 11 placentas from normal pregnancies served as a control group. GLUT-9 immunohistochemical expression was noted separately for DC, VTB, EVTB and VSM in placentas from in studied placentas. Results: There was no statistically significant difference in the GLUT-9 immunohistochemical expression among studied groups in all of the studied placental compartents. Neonatal birth weight and placental weight were higher in GDM group compared to control group, however the finding wasnt statistically significant. Conclusions: The results of our study indicate there is no difference in GLUT-9 immunohistochemial expression between studied groups, which supports the thesis that GLUT-9 isn’t a key player in placental glucose uptake when there’s no need for insulin treatment of GDM., Ciljevi: Istražiti imunohistokemijski izražaj GLUT-9 u decidualnim stanicama (DC), ekstraviloznom trofoblastu (EVTB), vilozusnom trofoblastu (VTB) i vaskulosincijskim membranama (VSM) u postiljicama iz trudnoća kompliciranih s gestacijskim dijabetes melitusom (GDM) i usporediti rezultate s placentama iz normalnih trudnoća. Sekundarni ishod bio je određivanje novorođenačke porođajne mase i mase posteljice u obje ispitivane skupine i usporediti rezultate. Materijali i metode: Istraživanjem je ispitano 13 posteljica iz trudnoća kompliciranih GDM, a 11 posteljica iz normalnih trudnoća služilo je kao kontrolna skupina. Imunohistokemijski izražaj GLUT-9 zabilježena je odvojeno za DC, VTB, EVTB i VSM u posteljicama od svih ispitivanih posteljica. Rezultati: Nije bilo statistički značajne razlike u imunohistokemijskom izražaju GLUT-9 među ispitivanim skupinama u svim ispitivanim dijelovima posteljice. Neonatalna porođajna težina i težina posteljice bile su veće u GDM skupini u usporedbi s kontrolnom skupinom, međutim rezultat nije bio statistički značajan. Zaključci: Rezultati naše studije su pokazali da nema razlike u imunohistokemijskom izražaju GLUT-9 između ispitivanih skupina, što podupire tezu da GLUT-9 nije ključni igrač u unosu glukoze u posteljici kada nema potrebe za inzulinskim liječenjem GDM-a.

Cilj ovog rada bio je opisati ulogu primalje u predviđanju i prevenciji preeklampsije. Preeklampsija je najčešći oblik hipertenzivne bolesti u trudnoći. Definira se kao pojava hipertenzije nakon 20.tjedna trudnoće i to vrijednostima krvnog tlaka >140/90 mmHg (18,7/12,0 kPa) u dva mjerenja u razmaku većem od 6 sati te proteinurijom od 300mg u 24-satnom urinu ili 0,1/L urina u 2 uzorka uzeta u razmaku 4-6 sati. Obzirom na javnozdravstveno značenje preeklampsije provedena su brojna istraživanja o etiopatogenezi i prevenciji ove bolesti. Od metoda predviđanja danas postoje upoznavanje sa osobnom i opstetričkom anamnezom, mjerenje arterijskog tlaka, ultrazvučna doplerska mjerenja te biokemijski testovi i njihove kombinacije. Za prevenciju se koristi heparin, pravastatin, magnezijev sulfat, a najšire se primjenjuje aspirin u dozi 100mg od 12. tjedna trudnoće. Postoje brojne podjele preeklampsije od kojih je danas najznačajnija ona s ranim početkom (prije 24.tjedna) te ona s kasnim početkom (nakon 37.tjedna). Uloga primalje u predviđanju je da već prilikom prvog pregleda izdvoji trudnice sa osobnom i opstetričkom anamnezom koje bi mogle rezultirati nastankom preeklampsije u trudnoći. Na sljedećim pregledima primalja treba trudnicu upozoravati na znakove koji mogu dovesti do preeklampsije. Također, u dogovoru s liječnikom može trudnicu upoznati sa ostalim metodama predviđanja. U pogledu prevencije, uloga primalje je da kroz opće higijensko-dijetetske mjere uputi trudnicu kako je moguće odgovornim ponašanjem smanjiti učestalost preeklampsije. The aim of this paper was to describe the role of the midwife in predicting and preventing preeclampsia. Preeclampsia is the most common form of hypertensive disease in pregnancy. It is defined as the appearance of hypertension after the 20th week of pregnancy, with blood pressure values >140/90 mmHg (18.7/12.0 kPa) in two measurements more than 6 hours apart and proteinuria of 300 mg in 24-hour urine or 0,1/L urine in 2 samples taken 4-6 hours apart. Given the public health significance of preeclampsia, numerous studies have been conducted on the etiopathogenesis and prevention of this disease. Prediction methods today include personal and obstetric anamnesis, arterial pressure measurement, ultrasound Doppler measurements, and biochemical tests and their combinations. Heparin, pravastatin, magnesium sulfate are used for prevention, whilst the most widely used is aspirin in a dose of 100 mg from the 12th week of pregnancy. There are numerous divisions of preeclampsia, the most significant of which nowadays is early onset (before the 24th week) and late onset (after the 37th week). The midwife's role in prediction is to single out pregnant women with a personal and obstetric history that could result in the onset of preeclampsia during the first examination. At the next examinations, the midwife should warn the pregnant woman about the signs that can lead to preeclampsia. Also, in agreement with the doctor, the pregnant woman can be introduced to other prediction methods. In terms of prevention, the midwife's role is to guide the pregnant woman through general hygiene and dietary measures on how to reduce the frequency of preeclampsia through responsible behavior.

Autoimuna bolest štitne žlijezde čest je poremećaj tijekom trudnoće. Majčino tijelo brojnim promjenama u funkciji, morfologiji i anatomiji štitne žlijezde prilagođava se vlastitim povećanim potrebama, ali i potrebama fetusa. Fetus je do početka drugog tromjesečja trudnoće ovisan o majčinim hormonima štitnjače koji su važni za njegov normalan neurološki razvoj. Bitno je prije i tijekom trudnoće unositi dovoljne količine joda za normalan rad i majčine i fetalne štitnjače. Hipotireoza je stanje smanjene funkcije štitne žlijezde. Najčešći uzrok hipotireoze u trudnoći u razvijenim zemljama je autoimuni Hashimotov tireoiditis, a simptomima i znakovima može sličiti trudnoći. Autoimuna hipotireoza povezana je s brojnim neželjenim ishodima trudnoće kao što su spontani pobačaj, prijevremeni porođaj, ali i negativnim utjecajem na neurokognitivni razvoj djeteta. Zbog toga je neobično važno svaku buduću ili novootkrivenu trudnicu podvrgnuti kliničkoj procjeni, odnosno uputiti na probir za hipotireozu. Ako se dijagnostičkim postupcima utvrdi hipotireoza, pristupa se liječenju levotiroksinom. Tireotoksikoza najčešće nastaje kao posljedica hipertireoze, a dva najčešća uzroka u trudnoći su gestacijska tranzitorna tireotoksikoza i autoimuna hipertireoza ili Gravesova bolest. Hipertireoza može biti prikrivena trudnoćom, no znakovi poput guše i orbitopatije mogu upućivati na hipertireozu. Iako rjeđa nego hipotireoza, i hipertireoza može imate fatalne posljedice za majku, samu trudnoću i za fetus – zabilježeni su spontani pobačaji, prijevremeni porođaji, mrtvorođenost, kongestivno zatajenje srca majke. Dijagnostičkim postupcima isključuje se najprije gestacijska tranzitorna tireotoksikoza kao mogući uzrok, a ukoliko se potvrdi autoimuna hipertireoza, pristupa se liječenju. Prvi izbor su antitireoidni lijekovi, i to propiltiouracil, a ukoliko postoji indikacija, napravi se tireoidektomija., Autoimmune thyroid disease is common during pregnancy. The mother’s body adapts by numerous changes in the function, morphology and anatomy of the thyroid gland to its own increased needs, and to the needs of the fetus. Until the beginning of the second trimester, the fetus is dependent on the maternal thyroid hormones which are important for its normal neurological development. Adequate iodine intake is important before and during pregnancy for normal functioning of both mother’s and fetal thyroid gland. Hypothyroidism is a condition of decreased thyroid function. The most common cause of hypothyroidism in developed countries is Hashimoto’s thyroiditis, with symptoms and signs similar to those in pregnancy. Autoimmune hypothyroidism is associated with number of unwanted pregnancy outcomes, such as miscarriage, premature birth, but also with a negative impact on the neurocognitive child development. Therefore, screening for thyroid dysfunction in pregnant women or women planning pregnancy is extremely important. If hypothyroidism is diagnosed, levothyroxine treatment is initiated. Thyrotoxicosis occurs as a consequence of hyperthyroidism, and the two most common causes in pregnancy are gestational transient thyrotoxicosis and autoimmune Graves' disease. Although less common than hypothyroidism, hyperthyroidism can have fatal consequences for both mother and fetus – spontaneous abortions, premature births, stillbirths, congestive heart failure have been reported. If gestational transient thyrotoxicosis is ruled out as a possible cause, and autoimmune hyperthyroidism is confirmed, treatment is initiated. The first choice is implementation of antithyroid drugs, and if there are contraindications for drug therapy, surgery is recommended.

Trudnoća (graviditet, drugo stanje) jedinstveno je razdoblje u životu žene u kojemu se događaju brojne fiziološke promjene u svim fiziološkim sustavima koje osiguravaju normalan rast i razvoj ploda i pripremu majke za porođaj. Normalno trajanje trudnoće jest 40 tjedana ili 280 dana, računajući od prvoga dana posljednjega menstrualnog ciklusa. Fiziološke promjene tijekom trudnoće utječu na oralno zdravlje usne šupljine, stoga je poznavanje normalnih fizioloških promjena nužno za pružanje kvalitetne dentalne zaštite trudnicama. Stomatolog ima važnu ulogu u održavanju oralnoga zdravlja trudnice i informiranju o najčešćim promjenama koje se događaju u oralnoj šupljini tijekom trudnoće, kao što su gingivitis, parodontitis, epulis, karijes, dentalne erozije, odontogene bolesti, ptijalizam i povećana pomičnost zubi. Posljedice neliječenja infekcije u usnoj šupljini tijekom trudnoće nadilaze moguće rizike od upotrebe lijekova, stoga nije opravdano nepotrebno odlaganje dentalnih zahvata i liječenja u trudnoći. Terapija bolnih i upalnih stanja radi olakšavanja boli i kontrole infekcije provodi se neovisno o stadiju trudnoće, elektivne zahvate potrebno je planirati u razdoblju od 14. do 34. tjedna trudnoće, kada su najsigurniji za majku i dijete, a složenije protetske i estetske zahvate potrebno je odgoditi za vrijeme nakon porođaja. Radiološku dijagnostiku treba ograničiti samo na hitna stomatološka stanja i ako je takva pretraga doista nužna. Pregnancy is a unique period in a woman's life in which numerous physiological changes occur in all physiological systems, with these changes ensuring the normal growth and development of the fetus as well as preparing the mother for childbirth. The normal duration of pregnancy is 40 weeks, or otherwise 280 days, counting from the first day of the last menstrual cycle. Physiological changes during pregnancy affect the health of the oral cavity, so being aware of the expected physiological changes is necessary to provide quality dental care to pregnant women. The dentist has an important role in maintaining the oral health of pregnant women and informing them about the most common changes that occur in the oral cavity during pregnancy – such as gingivitis, periodontitis, epulis, caries, dental erosions, odontogenic diseases, ptialysm and increased tooth mobility. The consequences of not treating an oral infection during pregnancy outweigh the possible risks of using medication, so there is no justification for unnecessarily delaying dental procedures and treatment during pregnancy. Therapy of painful and inflammatory conditions to relieve pain and control infection is carried out regardless of the stage of pregnancy, elective procedures should be planned in the period from 14 to 34 weeks of pregnancy when these procedures are safest for both the mother and child, whereas the more complex prosthetic and aesthetic procedures should be postponed until after childbirth. Radiological diagnosis should be limited to emergency dental conditions, and only if such an examination really is necessary.

Trudnoća je stanje organizma koje dovodi do različitih promjena u usnoj šupljini zajedno s ostalim fiziološkim promjenama koje se odvijaju u čitavom ženskom tijelu. Povećana sekrecija hormona i rast fetusa induciraju sistemske i lokalne fiziološke i fizičke promjene. Glavne sistemske promjene javljaju se u kardiovaskularnom, hematološkom, respiratornom, bubrežnom, gastrointestinalnom, endokrinom i genitourinarnom sustavu. Lokalne fizičke promjene događaju se u različitim dijelovima tijela, uključujući usnu šupljinu. Najčešće bolesti usne šupljine i promjene oralne sluznice povezane s trudnoćom su piogeni granulom, bolesti parodontalnih tkiva (povećana pomičnost zubi, trudnički gingivitis i parodontitis), erozije cakline, povećana učestalost zubnog karijesa i poremećaji žlijezda slinovnica, poput smanjenja pH i puferskog kapaciteta. Loše oralno zdravlje nije povezano samo s razvojem sistemskih bolesti poput dijabetesa i kardiovaskularnih bolesti, već i s nepovoljnim ishodima trudnoće. Bolesti usne šupljine koje nastaju prije i tijekom trudnoće odavno su prepoznate kao rizik za razvoj komplikacija u trudnoći, poput prijevremenog porođaja, ograničenja rasta fetusa, preeklampsije, spontanih pobačaja i mrtvorođenja. Sustavno širenje oralnih patogena s naknadnim majčinim, fetalnim i/ili placentarnim upalnim odgovorom povezano je s komplikacijama u trudnoći. Brojna istraživanja pokazala su kako je parodontalna bolest u trudnoći povezana s prijevremenim porođajem, smanjenom porođajnom težinom i preeklampsijom, komplikacijom u trudnoći koju karakterizira novonastala gestacijska hipertenzija i proteinurija te koja u velikom broju slučajeva rezultira fetalnom smrtnošću ili morbiditetom kod novorođenčadi. Također, znanstvene studije potvrdile su kako je novorođenčad žena koje imaju jedan ili više karijesa učestalije ili povećane (> 4,0 kilograma) ili smanjene (< 2,5 kilograma) porođajne težine od prosječne težine novorođenčadi čije majke nisu imale zubni karijes. Potvrđena je i izravna povezanost prijevremenog porođaja i održavanja oralne higijene. Stopa prijevremenih porođaja značajno je veća kod trudnica koje zanemaruju oralnu higijenu i koje ne posjećuju redovito svog doktora dentalne medicine. Oralno zdravlje zahtijeva posebnu pozornost, od iznimne je važnosti i sastavni je dio općeg zdravlja. U razdoblju trudnoće ono postaje još važnije jer ne samo da utječe na zdravlje buduće majke već izravno utječe i na zdravlje njezinog nerođenog djeteta. Pregnancy is a body condition that leads to various changes in the oral cavity along with other physiological changes that take place in the entire female body. Increased hormone secretion and fetal growth induce systemic and local physiological and physical changes. The main systemic changes occur in the cardiovascular, hematological, respiratory, renal, gastrointestinal, endocrine, and genitourinary systems. Local physical changes occur in various parts of the body, including the oral cavity. The most common oral diseases and pregnancy-related oral mucosal changes are pyogenic granuloma, periodontal tissue diseases (increased tooth mobility, gestational gingivitis and periodontitis), enamel erosions, increased incidence of dental caries, and salivary gland disorders, such as decreased pH and buffer capacity. Poor oral health is not only associated with the development of systemic diseases such as diabetes and cardiovascular disease, but also with adverse pregnancy outcomes. Oral infections that occur before and during pregnancy have long been recognized as a risk for developing complications in pregnancy, such as premature birth, fetal growth restriction, preeclampsia, miscarriages, and stillbirths. Systemic spread of oral pathogens with subsequent maternal, fetal, and / or placental inflammatory responses has been associated with complications in pregnancy. Numerous studies have shown that periodontal disease in pregnancy is associated with preterm birth, decreased birth weight, and preeclampsia, a complication in pregnancy characterized by new-onset gestational hypertension and proteinuria that result in significant fetal mortality or neonatal morbidity. Also, scientific studies have confirmed that infants of women who have one or more caries are more frequently of larger (>4.0 kg) or smaller (

Until now, there have been few studies that have used imaging modalities to assess the volume of a non-pregnant female cervix; the first study did so with magnetic resonance imaging [1], and the remaining two with three-dimensional ultrasound [2, 3]. The two latter studies showed that a geometric formula for regular cylinders can be used to determine normal cervical volume [1, 3].

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.

Citomegalovirus (CMV) je DNA virus endemičan u cijelom svijetu. Seroprevalencija u populaciji iznosi 40-90 %, ovisno o sociekonomskom statusu i zemljopisnom položaju. U većini slučajeva, infekcija CMV-om u zdravoj populaciji ostaje nedijagnosticirana zbog nekarakteristične kliničke slike i blagog tijeka bolesti, a ozbiljnija klinička slika prisutna je kod imunokompromitiranih bolesnika. Infekcija CMV-om u trudnoći ne povećava opasnost za zdravlje majke, međutim predstavlja rizik za nepovoljan ishod trudnoće i zdravlje djeteta. Istraživanja su pokazala kako je u razvijenim zemljama 0,6 do 0,7 % novorođenčadi inficirano CMV-om. Iako infekcija ploda tijekom trudnoće najčešće ne izaziva nikakve promjene, u 10 % do 15 % inficirane djece razvit će se simptomatska bolest, obilježena simptomima brojnih organa, posebice retikuloendotelnog i središnjeg živčanog sustava. Naime, kongenitalna infekcija CMV-om je glavni negenetski uzrok senzorineuralnog gubitka sluha, te neurorazvojnih abnormalnosti u novorođenčadi. Primarna infekcija u prvoj polovici trudnoće rezultira težom kliničkom slikom, zbog čega se razmatra uvođenje sustavnog probira trudnica. Dijagnozu CMV infekcije moguće je postići serološkim testiranjem trudnice ili prenatalnom dijagnostikom. Serološko testiranje trudnica je neinvazivan i pouzdan dijagnostički postupak koji se temelji na otkrivanju CMV IgG i IgM protutijela te testu avidnosti IgG protutijela. Prenatalna dijagnoza uključuje ultrazvučnu dijagnostiku, magnetnu rezonancu te invazivne metode poput amniocenteze i kordocenteze. Kako bi se smanjio transplacentarni prijenos virusa i učestalost simptomatske kongenitalne infekcije, istražuju se brojne mogućnosti liječenja trudnica s dokazanom CMV infekcijom. U obzir trenutno dolazi pasivna imunizacija CMV hiperimunim globulinom, aktivna imunizacija i antivirusno liječenje, međutim potrebno je provesti dodatna istraživanja u svrhu pronalaska najučinkovitijeg lijeka., Cytomegalovirus (CMV) is a DNA virus endemic worldwide. The seroprevalence in the population is 40-90 %, depending on the socioeconomic status and geographical location. In most cases, CMV infection in a healthy population remains undiagnosed due to the uncharacteristic clinical presentation and mild course of the disease, and a more serious clinical presentation is present in immunocompromised patients. CMV infection in pregnancy does not increase the risk to the health of the mother, however it poses a risk to an adverse pregnancy outcome and the health of the baby. Studies have shown that in developed countries 0.6 to 0.7 % of newborns are infected with CMV. Although infection of the fetus during pregnancy usually does not cause any changes, 10 % to 15 % of infected children will develop symptomatic disease, characterized by symptoms of numerous organs, especially the reticuloendothelial and central nervous systems. Namely, congenital CMV infection is the main non-genetic cause of sensorineural hearing loss and neurodevelopmental abnormalities in the newborn. Primary infection in the first half of pregnancy results in a more severe clinical presentation, which is why the introduction of systematic screening of pregnant women is being considered. The diagnosis of CMV infection can be achieved by serological testing of the pregnant woman or prenatal diagnosis. Serological testing of pregnant women is a non-invasive and reliable diagnostic procedure based on the detection of CMV IgG and IgM antibodies and the avidity test of IgG antibodies. Prenatal diagnosis includes ultrasound, magnetic resonance imaging, and invasive methods such as amniocentesis and cordocentesis. To reduce transplacental virus transmission and the incidence of symptomatic congenital infection, a number of treatment options for pregnant women with proven CMV infection are being explored. Passive immunization with CMV hyperimmune globulin, active immunization, and antiviral therapy are currently being considered, but further research is needed to find the most effective drug.

Preeklampsija je hipertenzivni poremećaj specifičan za trudnoću s prevalencijom u svijetu od 5 do 8%. Definirana je kao sindrom karakteriziran novonastalom hipertenzijom i proteinurijom, ili hipertenzijom uz pridružene znakove oštećenja ciljnih organa koji se očituju trombocitopenijom, bubrežnom insuficijencijom, nedostatnom jetrenom funkcijom, plućnim edemom te simptomima središnjeg živčanog, s ili bez proteinurije, nakon 20. tjedna trudnoće. Radi se o progresivnoj multisustavnoj bolesti koja predstavlja pravi izazov ne samo u okvirima porodništva već i anesteziološke prakse. Kod trudnica s preeklampsijom je nužna pravovremena anesteziološko evaluacija, a preporuča se već u ranom peripartalnom razdoblju zbog povećanog rizika za razvoj abrupcije posteljice, moždanog krvarenja, plućnog edema, akutne bubrežne ozljede, jetrenog zatajenja ili rupture, DIK-a te progresije do eklampsije. Općenito se preanesteziološka evaluacija temelji na procjeni dišnoga puta, hemodinamike i abnormalnosti zgrušavanja. Među anesteziološkim tehnikama analgezije, preferirana metoda je epiduralna analgezija. Prije aplikacije anestezije/analgezije, važno je reevaluirati čimbenike rizika za pojedinu trudnicu, poput višeplodne trudnoća, hipertenzije, prekomjerne debljine, očekivane otežane endotrahelana intubacija ili terapije antitromboliticima. Potreban je podroban nadzor (monitoring) majčinih vitalnih parametara i temeljita dokumentacija. Među terapijskim mjerama od posebnog je značaja antihipertenzivna terapija koja za ciljne vrijednosti krvnog tlaka uzima sistolički, Preeclampsia is a hypertensive, pregnancy related disorder with world prevalence 5 to 8 %. The condition is characterized by the new onset of hypertension and proteinuria, or hypertension with associated signs of end-organ dysfunction such as thrombocytopenia, renal dysfunction, liver dysfunction, pulmonary edema or central nervous system damage, with or without proteinuria, after 20 weeks of pregnancy. It is a progressive multisystem disorder that is challenging for both obstetric clinician and anesthesiologist as well. With preeclamptic patients early anesthetic evaluation is mandatory; it is recommended early in peripartum period due to increased risk for developing placental abruption, brain hemorrhage, pulmonary edema, acute renal failure, liver dysfunction or rupture, DIC or progression to eclampsia. In laboratory findings in preeclamptic patients it is crucial to determinate thrombocyte count over time (TRC). In general, the preanesthesia evaluation focuses on airway evaluation, hemodynamic status and coagulation abnormalities. Among different anesthetic techniques of analgesia, preferred method is epidural analgesia. Before anesthesia/analgesia administration, it is necessary to reevaluate pregnancy related risk factors, such as multiparous pregnancy, hypertension, overweight, expected difficulty with endotracheal intubation or antitrombolytic therapy. Maternal vital signs should be monitored closely and well documented. Among medication measures antihypertensive therapy plays a key role. Blood pressure goals, although still not precisely supported by data, are

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.

Bolesti jetre u trudnoći javljaju se u oko 3-5% trudnica i povezane su sa značajnim rizikom za majku i fetus. Podijeljene na one koje se javljaju u prvom tromjesečju (kao hyperemesis gravidarum) i one koje se javljaju tijekom drugog i trećeg tromjesečja (akutna masna atrofija jetre trudnoće, preeklampsija, HELLP sindrom itd.) Zbog nespecifičnih simptoma, lako ih se može zamijeniti sa drugim jetrenim bolestima, koje se javljaju neovisno o trudnoći. Bolesti jetre nespecifične za trudnoću mogu se javiti „de novo“ u trudnoći ili pacijentica može imati patologiju jetre prije trudnoće. Za ranu i kvalitetnu terapiju, bitno je razlučiti dali je bolest jetre specifična ili nespecifična za trudnoću. Samo na taj način možemo izbjeći dodatne rizike, koji mogu ugroziti zdravlje majke i fetusa. Ovaj pregledni rad obrađuje rizične čimbenike, dijagnostičke protokole, i terapijske mogućnosti za bolesti jetre u trudnoći. Zbog složenosti prirode ovih bolesti, postoje određena neslaganja među znanstvenicima po pitanju terapije. Međutim, zahvaljujući napretku na polju feto maternalne medicine, stope smrtnosti su značajno smanjene., Liver diseases in pregnancy occurs in about 3-5% of pregnant women and are associated with significant risk for mother and fetus mortality. They are devided into those occurring in the first trimester (such as hyperemesis gravidarum) and those occurring in second and third trimester (acute fat liver atrophy of pregnancy, preeclampsia, HELLP syndrome etc.). Because of unspecific symptoms they can be easily replaced with other liver diseases, that occur independently of pregnancy. Liver diseases that are unspecific for pregnancy, may occurr „de novo“ in pregnancy or patient may have liver pathology prior to pregnancy. For early and high quality therapy, it is important to distinguish whether the liver disease is specific or not specific to pregnancy. Only in this way, we can avoid additional side effects and drug contraindications, which can endanger the heatlh of the mother and the fetus. This review deals with the risk factors, diagnostic protocols and therapeutic options for liver diseases in pregnancy. Because of the complex nature of these diseases, there are some disagreements among scientists on therapy. However, due to progress in the field of feto maternal medicine, mortality rate have been significantly reduce.

Cilj istraživanja: Cilj ovog istraživanja je bio opisati životne navike trudnica na području Dalmacije i usporediti navike između prvorotkinja i višerotkinja. Materijali i metode: Provedeno je presječno istraživanje među trudnicama koje su došle na probirni kombinirani test u Kliniku za ženske bolesti i porode KBC-a Split. Ukupno su sudjelovale 173 trudnice od njih 183 kojima je ponuđen upitnik. Prikupljanje uzastopnog uzorka provedeno je od listopada 2019. godine do ožujka 2020. godine. Upitnikom su ispitane životne navike trudnica koje uključuju pušenje cigareta i konzumaciju alkohola, prehrambene navike, tjelesnu aktivnost, navike spavanja i psihološke osobine ispitanica. U statističkoj analizi korišteni su Kolmogorov–Smirnovljev test, hi-kvadrat test, Mann-Whitney U test, studentov t-test, Spearmanov test ranga korelacije. U slučaju P vrijednosti manje od 0,05, rezultat je smatran statistički značajnim. Za analizu podataka korišten je SPSS statistički program (IBM SPSS Statistics v21). Rezultati: Trudnice iz ovog istraživanja svrstane su po paritetu u skupinu prvorotkinja i višerotkinja. Pronađena je statistički značajna razlika u zastupljenosti mediteranske prehrane između navedenih skupina. Medijan MDSS zbroja za višerotkinje je iznosio 10,0 (5,0), dok je za prvorotkinje iznosio 7,0 (6,0) (P=0,013). Uspoređujući tjelesnu aktivnost s obzirom na paritet, nije pronađena statistički značajna razlika među skupinama. Što se tiče navika spavanja, tijekom radnog dijela tjedna, prvorotkinje su dnevno spavale 30 minuta duže nego višerotkinje (P=0,017). Medijan samoprocjene kvalitete života bio je bolji kod prvorotkinja i iznosi 9,0 (1,0) za razliku od višerotkinja kojima je iznosio 8,0 (2,0) (P=0,021). Indeks tjelesne mase bio je u značajnoj negativnoj korelaciji sa samoprocjenom zdravlja (r=-0,216, P=0,007), trajanjem sna tijekom radnih dana (r=-0,168, P=0,034) i trajanjem sna tijekom slobodnih dana (r=-0,175, P=0,027). Percepcija stresa statistički je značajno negativno korelirala s kvalitetom života (r=-0,330, P

Cilj istraživanja: Definirati preporuke prirasta tjelesne mase u odnosu na visinu ţene temeljem promjene indeksa tjelesne mase (BMI) tijekom trudnoće. Ispitanici i metode: Analizirani su podaci 21404 parova majki i novoroĎene djece iz terminskih jednoplodovih trudnoća. Iz studije su isključene trudnoće komplicirane preeklampsijom, gestacisjkim i drugim oblicima šećerne bolesti te porodi malformirane i mrtvoroĎene djece. Rast novoroĎenčadi je ocijenjen prema poroĎajnoj masi u odnosu na dob trudnoće, paritet i spol (hiporofija, eutrofija, hipertrofija) i prema pondralnom indeksu (simetričan i asimetričan rast). Ţenama je izračunat BMI na početku i koncu trudnoće. Razlika je korištena kao mjera promjene mase iz koje je prema visini pojedine ţene izračunat ekvivalent u kilogramima. Majke su prema standardnima Svjetske zdravstvene organizacije podijeljene u četiri kategorije obzirom na BMI prije trudnoće. Cilj je bio odrediti granice prirasta mase tijekom trudnoće unutar kojih udio hipotrofije i/ili hipertrofije, odnosno asimetričnih podtipova fetalnog rasta (mršavost, pretilost) nije bio statistički značajno veći od definicijom pretpostavljenih 10%. Rezultati: Najveći broj ispitivanih majki prije trudnoće je imao uredan BMI (16751; 78,3%). Ţena s prekomjernom masom je bilo 2906 (13,6%), prethodno mršavih 1205 (5,6%), a pretilih prije trudnoće 542 (2,5%). Promjena BMI-ja tijekom trudnoće kod kojeg je postignut uredan fetalni rast je iznosila >5 kg/m2 za prethodno mršave trudnice, 3 – 8 kg/m2 za one uredne mase prije trudnoće, Aim: Define recommendations for weight gain relative to a woman's height based on changes in body mass index (BMI) during pregnancy. Subjects and methods: Data from 21404 mother-infant couples from singleton term pregnancies were analyzed. Pregnancies complicated with preeclampsia, with any type of diabetes mellitus, neonatal malformations and stillbirths were excluded. Fetal growth was assessed by birth weight according to gestational age, parity and sex (hypotrophy, eutrophy, hypertrophy) and by the ponderal index (symmetrical and asymmetric growth). BMI was calculated at the beginning and end of pregnancy. The aim was to determine the limits of weight gain during pregnancy, within the proportion of hypotrophy and / or hypertrophy, respectively asymmetric subtypes of fetal growth (thinness, obesity) was not statistically significantly higher than the definition assumed 10%. Results: Most of the examined mothers had a normal BMI before pregnancy (16751; 78,3%). The overweight woman were 2,906 (13.6%), previously underweight 1205 (5.6%), and obese before pregnancy 542 (2.5%). The change in BMI during pregnancy in which normal fetal growth was achieved was ≥ 5 kg/m2 for previously underweight women, 3–8 kg/m2 for normal weight women, ≤ 6 kg/m2 for overweight women, and ≤ 4 kg/m2 for previously obese. Weight gain had no significant effect on the symmetry of fetal growth. Conclusion: The use of a BMI change to measure weight gain during pregnancy incorporates body height into the final calculation, which is an improvement of the previous guidelines and a way of defining them.

Cilj istraživanja ovog doktorskog rada je ispitati izražaj citotoksične molekule granulizina na razini bjelančevine i glasničke ribonukleinske kiseline (gRNK) na spoju majčinih i embrijskih tkiva u anembrijskoj trudnoći i zadržanom pobačaju te rezultate usporediti s decidualnim tkivom elektivno prekinute normalne trudnoće prvog tromjesečja. Materijali i metode: Uzorke bazalne decidue normalne i anembrijske trudnoće, te zadržanog pobačaja dobivali smo s Klinike za ginekologiju i porodništvo, KBC Rijeka. Od imunoloških metoda koristili smo imunohistologijsko obilježavanje antigena u decidualnom tkivu uklopljenom u parafin (citokeratin, granulizin, IL-15, Apaf-1, NF-B, CD56) uz kompjutersko kvantificiranje broja obilježenih stanica/mm2 tkiva i semikvantitativnu analizu jačine obilježavanja (H score). Višestrukom imunofluorescencijom obilježavali smo citokeratin i CD56, IL-15, granulizin, Apaf-1 ili NF-B u decidualnom tkivu uz očitavanje na fluorescentnom mikroskopu i obilježavali smo CD3/CD56 i NKp46, NKp44, CD94, NKG2A ili NKG2D u suspenziji DMS dobivenih enzimatskom razgradnjom protočnom citometrijom. Metodom lančane reakcije polimeraze u stvarnom vremenu (RT-qPCR) određivali smo izražaj gena za granulizin i perforin. Rezultati: Udio CD3ˉCD56⁺ stanica NK u suspenziji DMS, apsolutni broj CD56⁺ stanica i IL-15⁺ stanica/mm2 decidualnog tkiva bio je manji u zadržanom pobačaju Učestalost NKG2A, NKG2D i NKp46 biljega na CD3ˉCD56⁺ stanicama NK u suspenziji DMS iz zadržanog pobačaja je bila statistički značajno manja u odnosu na normalnu trudnoću. U anembrijskoj trudnoći udio stanica NK se nije mijenjao. Učestalost NKG2C, CD94 i NKP44 nije se značajnije mijenjala. Glasnička RNK za granulizin je četverostruko manja u DMS zadržanog pobačaja, a četverostruko veća u DMS anembrijske trudnoće, dok je gRNK za perforin povećana u objema. U normalnoj trudnoći dominiralo je citoplazmatsko obilježavanje granulizina, dok se u patološkim trudnoćama granulizin nalazio u jezgrama stanica. Apsolutni broj NF-B⁺ stanica/mm2 decidualnog tkiva je najveći u anembrijskoj trudnoći a najniža učestalost NF-B⁺ stanica je utvrđena u resicama trofoblasta zadržanog pobačaja. Zaključak: Slabije učinkovito ubijanje trofoblasta granulizinom može biti uključeno u sporije odbacivanje trofoblasta u anembrijskoj trudnoći i zadržanom pobačaju, zbog smanjene dopreme granulizina u jezgre trofoblasta u odnosu na normalnu trudnoću., The research objective of this doctoral thesis was to examine the expression of the cytotoxic molecule of granulysin at the level of protein and messenger ribonucleic acid (mRNA) at the interface of maternal and embryonic tissues in anembryonic pregnancy and missed abortion, and to compare the results with decidual tissue from an electively terminated normal first trimester pregnancy. Materials and methods: Basal decidua samples from a normal and an anembryonic pregnancy as well as a missed abortion were obtained from the Obstetrics and Gynecology Clinic of the Clinical Hospital Center Rijeka Of immunoassays, we used immunohistochemical staining of antigens in decidual tissue embedded in paraffin (cytokeratin, granulysin, IL-15, Apaf-1, NF-B, CD56) with computer quantification of the number of stained cells/mm2 of tissue and semiquantitative analysis of the intensity of staining (H score). We performed multiple immunofluorescence labelling of cytokeratin and CD56, IL-15, granulysin, Apaf-1 or in decidual tissue with fluorescent microscope reading, as well as the staining of CD3/CD56 and NKp46, NKp44, CD94, NKG2A or NKG2D in the suspension of DMCs obtained by enzymatic degradation using flow cytometry. Using the real-time polymerase chain reaction method (RT-qPCR), we determined the gene expression for granulysin and perforin. Results: The content of CD3-CD56⁺ NK cells in the DMC suspension, the absolute number of CD56⁺ cells and IL-15⁺ cells/mm2 of decidual tissue was lower in the missed abortion. The frequency of NKG2A, NKG2D and NKp46 markers on CD3ˉCD56⁺ NK cells in the DMC suspension from the missed abortion was statistically significantly lower than in the normal pregnancy. In anembryonic pregnancy proportion of NK cells did not change. The frequency of NKG2C, CD94 and NKP44 did not differ significantly. The messenger RNA for granulysin was four times lower in the DMC from the missed abortion, and four times higher in the DMC from the anembryonic pregnancy, while the mRNA for perforin was increased in both. In the normal pregnancy, cytoplasmic staining of granulysin was predominant, while, in the pathological pregnancies, granulysin was present in cell nuclei. The absolute number of NF-B⁺ cells/mm2 of decidual tissue was the highest in the anembryonic pregnancy. The lowest frequency of NF-B⁺ cells was determined in the trophoblast villi of the missed abortion. Conclusion: A less efficient killing of trophoblasts with granulysin may be involved in a slower rejection of trophoblasts in anembryonic pregnancy and missed abortion, because of a decreased supply of granulysin to trophoblast nuclei compared to normal pregnancy.

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.

Trudnoća je stanje u kojem je fiziološki povećana sklonost grušanju krvi, zbog čega je i rizik od venske tromboembolije veći. Trombofilija je urođeno ili stečeno stanje poremećenog mehanizma hemostaze, koji predisponira nastanku tromboze. S obzirom da je trudnoća hiperkoagulabilno stanje, trombofilija je dodatna okolnost koja predisponira nastanku tromboze. Oko 15% svih klinički prepoznatih trudnoća, uz trombofiliju završava spontanim pobačajem, a u 1% parova javljaju se spontani ponavljajući pobačaji. Takvi parovi se zbog neuspjeha reprodukcije često liječe metodama medicinski pomognute oplodnje. Unatoč postupcima MPO, šansa začeća po postupku IVF-om iznosi od 25%-30%. Trombofilija se nerijetko povezuje s lošim ishodima MPO. U ovom istraživanju je retrospektivno analizirana medicinska dokumentacija 200 neplodnih pacijentica koje su bile podijeljene u dvije skupine s obzirom jesu li rodile ili ne. Osim te podjele, bile su podijeljene prema tome imaju li trombofiliju ili ne. Analizirali smo osnovne podatke o pacijenticama, uzroke neplodnosti prema međunarodnoj klasifikaciji bolesti (MKB-10), broj mutacija na genima sustava koagulacije, vrste mutacija i njihove kombinacije na genima sustava koagulacije, broj prirodno začetih trudnoća i broj spontanih pobačaja. Pacijentice sa trombofilijom imaju veće poteškoće u liječenju neplodnosti od onih koje nemaju trombofiliju. Ukoliko trombofilija nije dijagnosticirana, liječenje neplodnosti postupcima MPO, češće neće biti uspješno. Pregnancy is a condition in which a physiologically increased risk of blood coagulation is associated with higher risk of venous thromboembolism. Thrombophilia is an inherited or acquired condition of a disrupted hemostasis mechanism that predisposes the formation of thrombosis. Since pregnancy is a hypercoagulable condition, thrombophilia is an additional circumstance that predisposes the occurrence of thrombosis. Approximately 15% of all clinically recognized pregnancies end with spontaneous abortion, and in 1% pairs spontaneous recurring abortions occur. Due to the failure of reproduction, such couples often choose to be treated with the methods of assisted reproduction. Despite the procedures, IVF conception rate is 25%-30%. Thrombophilia is often associated with poor outcomes of the methods of assisted reproduction. In this study, 200 infertile patients were retrospectively analyzed. Patients were divided into two groups considering whether they gave birth or not. Another important parameter was presence or absence of thrombophilia. We analyzed patient`s basic data, cases of infertility according to international classification of diseases, the number of mutations, types and combination of mutations on the coagulation and pregnancy system genes, number of naturally conceived pregnancies and number of spontaneous abortions. Patients with thrombophilia had bigger problems in infertility treatments than patients without thrombophilia. In cases when thrombophilia is not diagnosed, positive outcomes of infertility treatments with the methods of assisted reproduction are lower.

Više od polovice žena fertilne dobi najrazvijenijih zemalja Zapada ima prekomjernu tjelesnu težinu. Debljina smanjuje mogućnost trudnoće. Masno je tkivo aktivni endokrini organ koji utječe na mnoge metaboličke procese. Rezultat su mnogobrojne komplikacije za vrijeme trudnoće, tijekom porođaja i u babinju. Trudnoća praćena debljinom često je komplicirana šećernom bolešću, povišenim krvnim tlakom i prijevremenim porođajem. Češće su i slabije uočljive fetalne malformacije, a visok je i rizik od intrauterine fetalne smrti. Porođaj je visokorizičan, često zbog komplikacija induciran, a nerijetko dovršen operacijom, carskim rezom koji je za pretile trudnice dodatni rizik. Osim neposrednih komplikacija tijekom porođaja i ranoga postpartalnog života, debljina trudnica nosi zbog epigenetskih promjena i fetalnog programiranja dugoročne posljedice. Antenatalna skrb mora spriječiti ili na vrijeme prepoznati i liječiti moguće posljedice pretilosti u trudnoći, no najvažnije je u okviru prekoncepcijskog savjetovanja upoznati buduće trudnice s potrebom regulacije tjelesne težine i promjenom životnih navika da bi trudnoću započele s idealnom tjelesnom težinom te kako bi tijekom trudnoće prirast tjelesne mase bio optimalan., More than half of women of reproductive age in the most developed Western countries are overweight. Obesity reduces fertility. Adipose tissue is an active endocrine organ that aKects many metabolic processes. As a result, obesity can cause a number of complications during pregnancy, labour, and puerperium. Maternal obesity in pregnancy often results in diabetes, hypertension and preterm birth. Fetal anomalies with lower detection rates are also more frequent, and there is an increased risk of intrauterine fetal death. Such pregnancies usually end in high-risk deliveries, frequently induced due to complications, and often completed by a Caesarean section, which poses an additional risk for obese pregnant women. In addition to short-term complications during labour and early postpartum period, maternal obesity has long-term consequences, which are the result of epigenetic changes and fetal programming. Antenatal care should prevent or detect and treat potential consequences of maternal obesity in pregnancy. Moreover, it is essential that during their preconception counselling women receive adequate information about the importance of weight loss and lifestyle changes in order to start their pregnancy with normal body weight and achieve a healthy weight gain during this period.

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

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.

We hypothesize that progesterone causes tolerogenic maturation of myeloid dendritic cells (DCs) in human decidua of threatened miscarriage or missed abortion characterized by a distinct phenotype and cytokine production, including reduction of the main NK cell proliferation and cytotoxic factor interleukin (IL)-15. During DC/NK cell interaction, progesterone-shaped DCs cannot efficiently multiply or equip NK cells with the cytotoxic mediators peforin and granulysin, which might harm trophoblasts and induce abortion. We propose that the presence, and maturation stage of decidual myeloid DCs be investigated using semi-quantitative immunohistological analyses and/or double-color immuno-fluorescent labeling of DC lineage and activation markers. The spatial arrangement of granulysin+ cells, NKp46+ NK cells, DCs, and trophoblasts might provide information about their mutual interactions in vivo. Multiple flow cytometry analyses of NK-receptors would provide insight into NK cell activation status. NK cell activation status could be also assessed by cytotoxicity assays against trophoblast cell lines, or isolated cognate extra-villous trophoblast cells. A correlation between decidual progesterone concentration or IL-15 expression, and the degree of DC maturation or the frequency of granulysin+ cells, might help to elucidate the mechanism of abortion retention in utero.

Perinatalna uključenost partnera u trudnoću gotovo je zanemaren konstrukt u kontekstu psiholoških i fizioloških ishoda dobrobiti za trudnice i fetus. Cilj istraživanja: utvrditi psihosocijalne čimbenike (osobine ličnosti, anksioznost, stil privrženosti, empatija, percipirani stres, bračna kvaliteta) koji se nalaze u osnovi percepcije uključenosti budućega oca u trudnoću iz perspektive obaju partnera (trudnica i njihovih partnera) prema biopsihosocijalnom modelu. Ispitanici i metode: 143 para (N=286) u trećem tromjesečju svoje prve trudnoće koji su ispunili Upitnik demografskih podataka, Skalu percipirane uključenosti partnera u trudnoću, Upitnik osobina ličnosti (EPQ), Upitnik anksioznosti kao stanja i osobina ličnosti, Interpersonalni indeks reaktivnosti, Skalu privrženosti kod odraslih, Skalu percipiranog stresa i Indeks bračne kvalitete. Rezultate dobivene na zavisnoj varijabli uključenosti partnera kategorizirali smo i podijelili uzorak po medijanu u dvije skupine: više uključenih i manje uključenih partnera u trudnoću. Rezultati: žene i muškarci slažu se u percepciji uključenosti partnera u trudnoću, bračnoj kvaliteti i percipiranom stresu. Važnim prediktorom percepcije uključenosti partnera u trudnoću pokazala se anksioznost kad je riječ o muškoj percepciji uključenosti u trudnoću te neuroticizam kad je riječ o ženinoj percepciji uključenosti partnera u trudnoću. Bračna kvaliteta obaju partnera povrh osobina ličnosti objašnjava percepciju uključenosti partnera u trudnoću. Anksioznost kao crta ličnosti medijacijska je varijabla u odnosu između percipiranoga stresa i uključenosti partnera u trudnoću. Situacijska anksioznost potvrđena je kao medijacijska varijabla u odnosu između percipiranoga stresa i uključenosti partnera u trudnoću samo u slučaju kad je riječ o muškoj percepciji vlastite uključenosti u trudnoću. Prediktorima dobrobiti trudnica pokazali su se anksioznost kao crta ličnosti i percipirani stres. Zaključak: Zadovoljstvo partnerskim odnosom i niža percepcija stresa te sniženi neuroticizam i anksioznost kao crta ličnosti, upućuju na višu uključenost partnera u trudnoću. Razumijevanje psihosocijalnih aspekata uključenosti partnera u trudnoću može utjecati na ciljane psihosocijalne intervencije i unapređivanje prenatalnih zdravstvenih ponašanja te smanjenje emocionalnoga stresa u trudnica. Perinatal couples’ pregnancy involvement is the understudied concept in psychological and physiological outcomes for pregnant women and fetuses. Objectives: The aim of this study was to investigate the differences in pregnancy involvement in prospective couples regarding personality traits, anxiety, empathy, attachment, perceived stress, relationship quality through the biopsychosocial model. Patients and methods: Participants were 134 prospective couples in the last trimester of pregnancy (N=286). They completed questionnaires including Eysenck Personality Questionnaire, StateTrait Anxiety Inventory, Quality of Marriage Index, Perceived Stress Scale, Adult Attachment Scale, Interpersonal Reactivity Index, Partner’s Involvement in Pregnancy Scale and demographics. Results: showed that men and women share their perception for each partners’ involvement in pregnancy, marital quality and perceived stress. A significant predictor of perceptions of partners’ involvement in pregnancy were anxiety for men's perceptions of involvement in pregnancy, and neuroticism in woman's perception of partners' involvement in pregnancy. Marital quality in addition to personality traits explains the perception of partners’ involvement in pregnancy. Anxiety as a personality trait is a mediating variable in the relationship between perceived stress and the involvement of partners in pregnancy. Situational anxiety was confirmed as a mediating variable in the relationship between perceived stress and the involvement of partners in pregnancy only when it comes to men's perceptions of their own involvement in the pregnancy. Predictors of pregnant women showed that anxiety as personality traits and perceived stress were detected as predictors in pregnant women’s well-being. Conclusion: The findings demonstrate the importance of psychological factors such as anxiety, neuroticism, quality of relationship and perceived stress, as predictors of prospective couples’ involvement in pregnancy. This finding could lead to targeted interventions that can modify and improve couples’ involvement in pregnancy: thus clinically important for promotion of healthy prenatal behaviour and decrease in mothers’ emotional distress.

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.

Background: Paternal involvement in pregnancy has been recognized to have an impact on new- born’s outcomes and only recently got under the spot light of mental health perspective. The aim of this study was to test differences in paternal involvement in pregnancy, perceived stress and relationship quality regarding complications in pregnancy and pregnancy duration (gestational weeks) in the last trimester of pregnancy. The role of personality traits (neuroticism and extroversion), relationship quality satisfaction and perceived stress in prospective father’s perception of pregnancy involvement were examined. Subjects and method: One-hundred forty- three primiparus couples in the last trimester of their pregnancy participated in the study. Prospective fathers completed a booklet with questionnaires including The Quality of Marriage Index, The Perceived Stress Scale, Eysenck Personality Questionnaire and Partner’s Involvement in Pregnancy Scale. Prospective mothers completed only Eysenck Personality Questionnaire and questions on pregnancy complications and demographics. Results: The prospective fathers showed high involvement in their partner’s pregnancies, elevated levels of perceived stress and high relationship quality. There were found no differences in the above named variables regarding complications in pregnancy and pregnancy duration. Higher involvement of prospective fathers was related with older age, lower male neuroticism and higher female extroversion, better relationship quality and lower perceived stress. Conclusion: The findings demonstrate that prospective father’s involvement in pregnancy is supported with psychological factors, namely personality traits, quality of relationship and perceived stress. These results should lead to target interventions that can modify and improve fathers’ involvement perspective and promoting a couples mental health during pregnancy: thus clinically important for promotion of healthy prenatal behaviour and decrease in mothers’ emotional distress.

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.

Kroz ovaj rad prošli smo najvažnije činjenice vezane uz trudnoću. Iako je to jedan od ljepših perioda u ženinom životu neizostavne su predrasude,strahovi i razni drugi problemi. Stoga su tu ponajprije liječnik ,ali i primalja koja svoje radno vrijeme provodi uz ženu. Primalja djeluje ne samo kao zdravstveni djelatnik već i kao prijatelj,savjetnik. Zadaće primalje su dobro poznavanje reprodukcijskog sustava,oplodnje i implantacije,poznavanje znakova trudnoće,izračunavanje termina poroda i uzimanje anamneze,poznavati promjene genitalnih i ekstragenitalnih organa te razlikovanje fizioloških od patoloških promjena kod trudnica. Primalja vodi fiziološku trudnoću te na temelju vanjskog i unutarnjeg pregleda procjenjuje stanje trudnice i ploda te prepoznaje nepravilnosti i procjenjuje moguće posljedice. Također,primalja educira trudnicu u vezi nastalih nepravilnosti u trudnoći,provjerava vitalne funkcije, izvodi venepunkciju i uzima uzorke za laboratorijske pretrage,provodi peroralnu i parenteralnu primjenu propisane terapije. Primalja , iako sve rjeđe , utvrđuje mjere zdjelice. Neizostavan dio primaljske skrbi je i asistencija liječniku pa tako primalja brine o sterilnosti i brojnosti instrumenata,o privatnosti pacijentice,čistoći sobe za pregled i mnogim drugim stvarima. Dio svog radnog vremena primalja posvećuje ispunjavanju medicinske dokumentacije. Vrlo je važno točno i čitko ispisivanje podataka kao i zapisivanje svih provedenih postupaka bilo da se radi o dijagnostičkim ili terapijskim. Mi kao primalje moramo uvijek imati na umu da naši postupci i izjave u prisustvu žene koja je trudna , rađa ili je u razdoblju neposredno nakon poroda mogu imati dalekosežne posljedice na njezin kasniji život i odnos prema djetetu,partneru i obitelji te zdravstvenim djelatnicima bilo pozitivno ili negativno. Naposljetku , dobra komunikacija ključ je uzajamne suradnje ,a dobra suradnja i uzajamno povjerenje vode dobrom ishodu te zadovoljsvu pacijentice i zdravstvenih djelatnik. Through this work, we passed the most important facts related to pregnancy. Although it is one of the most beautiful period in a woman's life we encounter prejudices, fears and other problems. Therefore, on the first place is a doctor, but the midwife with her working hours carried out by a woman. A midwife works not only as a health professional, but also as a friend, counselor. The tasks of midwives are a good knowledge of the reproductive system, fertilization and implantation, knowledge of signs of pregnancy, calculate the date of birth and medical history, knowledge of the changes of the genital organs and exstragenital, and differentiating physiological from pathological changes in pregnant women.The midwife takes physiological pregnancy and on the basis of external and internal inspection assesses the state of women and child and recognizes irregularities and estimated the possible consequences.Also, midwives educate pregnant women on the irregularities in the pregnancy, checks vital functions, performs venipuncture and take samples for laboratory tests, carried out oral and parenteral administration of the prescribed therapy. The midwife, though more rarely, establishes measures pelvis.An indispensable part of midwifery care is assistance to the doctor so the midwife concerned about sterility and number of instruments, patient privacy, cleanliness room for viewing and many other things. Part of their working time devoted to meeting the midwife medical records. It is important to accurately and legibly printing data as well as the recording of all proceedings conducted whether a diagnostic or therapeutic. We as midwives must always bear in mind that our actions and statements in the presence of a woman who is pregnant, gives birth, or in the period immediately after birth can have far-reaching consequences for her later life and relationship to the child, partner and family and medical professionals were positive or negative. After all, good communication is the key to mutual cooperation and good cooperation and mutual trust bring a good outcome and satisfaction of patients and medical professionals.

Trudnoća u žene koja boluje od dijabetesa, a i pojava dijabetesa u trudnoći žene koja prije nije bolovala od šećerne bolesti (gestacijski dijabetes) stanja su povezana s mnogobrojnim komplikacijama kod trudnice, fetusa i novorođenčeta, koja izrazito povećavaju perinatalni mortalitet i morbiditet. Najvažnija stvar pri smanjenju komplikacija takvih trudnoća jest pravodobno testiranje i otkrivanje dijabetesa te prilagodba prehrane, propisanom dijetom od 1800kcal koja će uz doziranu tjelovježbu najčešće biti dovoljna za liječenje ovog poremećaja, a ponekad ukoliko izostane rezultat dijetalnog režima uključenje inzulina u terapiji. Budući je dijabetes veliki i javnozdravstveni problem, jasno je da je liječenje istog multidisciplinarno a u tom smislu i primalje imaju neizostavnu ulogu. Pregnancy in women who have diabetes , and the incidence of diabetes in pregnant women who had not suffered from diabetes ( gestational diabetes ) conditions are associated with numerous complications in pregnant women , fetuses and newborns , which markedly increases perinatal mortality and morbidity . The most important thing to reduce complications such pregnancies is the timely testing and detection of diabetes and diet adjustment , prescribed a diet of 1800kcal to be with graded exercise usually be sufficient for the treatment of this disorder , and sometimes fails if the result of dietary regime involvement in insulin therapy . Since diabetes is a major public health problem and it is clear that the multidisciplinary treatment of the same in this regard and midwives have the indispensable role .

Cilj: Provedeno istraživanje ima za cilj istražiti zastupljenost i uzroke straha kod majki prvorotki. Metode: Istraživanje se provodilo u specijalističkoj pedijatrijskoj ambulanti dr.med. spec. ped. Velinka Jukić u Sinju u vremenskom periodu ožujak . travanj 2015. godine. Prilikom prvog pregleda dojenčeta u pedijatrijskom ordinaciji, majke su dobile upitnik kojeg su ispunile i odložile u za to predviđeno mjesto. Istraživanje je bilo potpuno anonimno i dobrovoljno. Istraživanje je provedeno pomoću modificiranog upitnika koištenog u izradi zavšnog rada studentice Blaženke Špike iz 2014. godine. Prikupljeni podatci iz upitnika uneseni su u Microsoft Excel tablice prema unaprijed pripremljenom kodnom planu. Za obradu je korištena deskriptivna statistika. Rezultati: U istraživanju je sudjelovalo 37 ispitanica prosjećne životne dobi od 27 godina (16-41). Najveći broj ispitanica ima srednješkolsko obrazovanje. Jedna ispitanica ima osnovnoškolsko obrazovanje. Zanimljivo je da je tu riječ o najstarijoj ispitanici. Jednaki broj ispitanica je zaposleno i nezaposleno, dok jedna ispitanica je u mirovini. Najveći broj ispitanica je u formalnoj ili neformalnoj bračnoj zajednici. Najveći broj ispitanica (N=11) živi u vlastitom stanu ili kući sa supružnikom. Ukupno 10 ispitanica živi u podstanarstvu, isti broj ih živi u kućanstvu partnerove/suprugove obitelji, dok 2 ispitanice žive sa svojim roditeljima.Nijedna ispitanica nije procijenila svoj seocioekonomski status lošim, odnosno, nijedna ispitanica ne prima socijalnu pomoć.Ukupno 76% ispitanica svoju trudnoću opisuje urednom, dok je 19% ispitanica povremeno imalo iznimno jake strahove, mučnine, povraćanja... Ukupno 5% ispitanica (N=“) imale su zdravstveni problem u trudnoći i to se radilo o gestacijskom dijabetesu (N=1) i infekciji (N=1). Sve ispitanice su kao dominantni majčinski osjećaj navele sreću. Ukupno dvanaest ispitanica je uz osjećaj sreće i radosti navelo i osjećaj sraha, zabrinutosti. Najveći uzrok straha u majki je izazivalo prvo kupanje djeteta (N=21), zatim toaleta pupčanog batrljka (N=14), dojenje (N=12) i majčina prehrana (N=16) (slika 9). Zaključci: Rezultati istraživanja pokazali su da iako je samo dvanaest ispitanica uz dominanti osjećaj sreće i radosti navelo i osjećaj sraha, zabrinutost, ipak 97% ispitanica (N=36) je u ponuđenim odgovorima pronašlo što ih je brinulo u skrbi za novorođenče. Najveći uzrok straha u majki je izazivalo prvo kupanje djeteta (N=21), zatim toaleta pupčanog batrljka (N=14), dojenje (N=12) i majčina prehrana (N=16). Budući je istraživanje provedeno na relativno malom broju ispitanika (37), preporučivo je istraživanje provesti na većem uzorku. Aim: This study is carried out in order to investigate occurence of fear in primiparas as well as to determine the causes of that fear. Methods: The study was carried out from march 2015 til april 2015 in specialistic pediatric ambulance dr.med.spec.ped. Velinka Jukić in Sinj. Upon the first examination of an infant, the questionnaire was given to the mothers. After fullfilling the questionnaire they were supposed to dispose it on for that purpose provided spot. This survey was completely anonimous and participation was volountary. Questionnarie was modified and previously used for the purposes of writing a thesis by student Blaženka Špika in 2014. Data provided by the questionnaires was entered in Microsoft Excel tables according to the previously prepared code plan. Descriptive statistics was used for processing of the results. Results: Thirty seven examinees of mean age being 27 years (16-41) participated in this study. Most of the examinees has graduated from high school, while one examinee has graduated from elementary school. The number of employed and unemployed examinees was the same, while one examinee is retired. Most of the examinees is in formal or informal marital union and most of them (N=11) live in their own apartment or house together with their spouse. Ten examinees live in rented apartments, the same number lives together with the family of the spouse, and two of them live with their own parents. None of the examinees did not estimate her socioeconomic status as being bad, in the other words – none of them is receiving dole from the state. 76% of examinees describe their pregnancy as being normal, while 19% experienced fear, nausea, vomiting... 5% of examinees (N=2) had some health issue during pregnancy (gestational diabetes (N=1) and infection (N=1)). All of them said that dominant maternal feeling is happiness. Twelve examinees mentioned fear and concern together with happiness and joy. The most important cause of fear was child's first bath (N=21), hygiene of umbilical stump (N=14), breast feeding (N=12) and diet of a mother (N=16) (figure 9). Conclusion: Results of this study have shown that, even though only 12 examinees mentioned fear and concern together with dominant feeling of happiness and joy, 97% (N=36) managed to recognize one of the aswers from the questionnaire as being the matter of concern when it comes to the infant care. The major causes of fear were first bath (N=21), hygiene of umbilical stump (N=14), breast feeding (N=12) and diet of a mother (N=16). Taking into account that this study included relatively small number of examinees (37), it is advisable to carry it out including a bigger sample.

Prenatalna skrb i dijagnostika omogućuju sprječavanje, prepoznavanje i liječenje svih bolesti i patoloških stanja koja mogu ugroziti trudnoću. Ona mora biti sustavna te obuhvatiti sve trudnice, pa bi tako svaka trudnica trebala obaviti prvi pregled već do 8. tjedna trudnoće, na kojem će ginekolog napraviti ultrazvučni te bimanualni pregled kao i potrebne pretrage. Ultrazvuk, kao neizostavna dijagnostička metoda u prenatalnoj dijagnostici zauzima važno mjesto. Omogućuje da se sve ranije u trudnoći otkriju kongenitalne malformacije, s visokom točnošću procjenjuje uredan ili poremećen fetalni rast, a biofizikalnim testom i doplerskim mjerenjima omogućuje aktivni nadzor nad stanjem fetusa. Neinvazivni testovi probira fetalnih anomalija prediviđeni su za sve trudnice bez obzira na dob, odnosno za one koje nemaju osobno ili obiteljsko genetičko opterećenje, već rođeno bolesno dijete i slično. Osobito važnu ulogu u informiranju trudnica o testovima probira, ali i o samoj trudnoći, za vrijeme redovitih ginekoloških pregleda, ima primalja. Njezina uloga je uvijek raznovrsna i veoma značajna, jer je upravo primalja ta koja će trudnici biti najbliža za vrijeme trajanja trudnoće. Prenatal care and diagnosis allows prevention, recognition and treatment of all diseases and patological conditions which may endanger the pregnancy. Prenatal care has to be systematic and cover all pregnant women, so each one of them should go at least once to their gynecologist during the first 8 weeks of pregnancy. Gynecologist will use ultrasound, bimanual examination, as well as all other necessary researches. Ultrasound, as an indispensable diagnostical tool in prenatal diagnosis, takes an important place. Ultrasound allows the early discoveries of congenital malformations and estimates with high accurancy a neat or disrupted fetal growth. Another thing is that with biophysical tests and doppler measurements provides active supervision over the fetus condition. Non-invasive prenatal testing is predicted for all pregnant women, regardless of their age, i.e. for those women who do not have family genetic history, but allready have a child with congenital malformation etc. Very important role in informing pregnant women about prenatal testing, as well as about the pregnancy has a midwife. She has got a significant role because midwife is the one who will be the closest to a pregnant women during the pregnancy.

Hipertenzija, preeklampsija i eklampsija u trudnoći je sindrom koji vitalno ugrožava majku i plod sa nepredvidivim početkom, ne izlječiv, izuzev završavanjm trudnoće. Javlja se kod 6-10% trudnica. Jedinstvene definicije i klasifikacije hipertenzivnog sindroma u trudnoći još uvijek nema tj. razlikuju se od jedne do druge ekspertne grupe. Hipertenzivni sindrom u trudnoći može biti uzrok abrupcije placente, intrakranijalnog krvarenja, teških oštećenja jetre, akutne insuficijencije bubrega i diseminirane intravaskularne koagulopatije. Prema izvještajima iz literature, 15-33% sveukupnog mortaliteta majki posljedica je hipertenzije u trudnoći. Kod novorođenčadi majki sa hipertenzijom i preeklampsijom češći su intrauterine zastoj rasta, nedonošenost, dismaturitet i nekrotizirajući enterokolitis. Hipertenzija je jedan od vodećih uzroka intrauterine i neonatalne smrti fetusa, novorođenčeta kao i glavni uzrok majčine smrti u cijelom svijetu. Pregnancy-induced hypertension, pre-eclampsia and eclampsia are parts of hypertensive syndrome which is a life- threatening condition both fot mother and fetus. Apart from being associated with unpredictable onset, it is approximately between 6-10% of pregnant women. There is no uniqe definition and classification of hypertensive syndrome in pregnancy, i.e. they differ from one expert group to another. Pregnancy-induced hypertension syndrome can cause placental abruption, intracranial hemorrhage, liver lesions, acute renal disorder and disseminated intravascular coagulation (DIC), adult respiratory distress syndrome (ARDS) , hypervolemia and inhalation of gastric content, due to deep sedation. Maternal mortality due to pregnancy-induced hypertension is 15-33% out of the total number of maternal deaths. Newborn infants of mothers with pregnancy-induced hypertension present with intrauterine growth retardation, prematurity, dysmaturity and necrotizing enterocolitis. Pregnancy-induced hypertension is one of the major causes of maternal and fetal/ neonatal morbidity and mortality.

A number of case–control studies investigated the association between idiopathic recurrent spontaneous abortion (IRSA) and variations in the gene encoding endothelial nitric oxide synthase (NOS3), but yielded contradictory results. Our aim was to test the association of the NOS3 variable number of tandem repeats (VNTR) in intron 4 and +894 G/T single-nucleotide polymorphism (SNP) with IRSA in Slovenian women (148 IRSA and 149 control women), conduct a systematic review of literature on the association between NOS3 gene variations and IRSA, and perform meta-analyses of studies that met the inclusion criteria, defined by virtue of the European Society for Human Reproduction and Embryology evidence-based guidelines for recurrent spontaneous abortion. Genotyping was performed using PCR and restriction fragment length polymorphism methods. The systematic review of literature (English language) was conducted using PubMed and Scopus databases, to 1 November 2014. We determined no association of IRSA with the VNTR in intron 4 and +894 G/T SNP in Slovenian women. Furthermore, 16 case–control studies were identified on the association between 15 NOS3 gene variations and IRSA. However, significant inconsistencies exist in the selection criteria of patients and controls between studies. The meta-analysis of VNTR in intron 4 was performed on five studies (894 patients, 944 controls), whereas the meta-analysis of +894 G/T SNP included six studies (1111 patients, 1121 controls). The association with IRSA was significant for the +894 G/T SNP under the dominant genetic model (GT+TT versus GG) based on fixed (odds ratio (OR) = 1.54, 95% confidence interval (CI) = 1.28–1.86, P =

Intrauterini zastoj u rastu nastaje zbog niza genetskih i okolišnih ĉimbenika,a odnosi se na usporenje rasta fetusa ĉiji potencijal je veći od izmjerenog. Svrha ovog rada je prouĉavanje novorođenĉadi ĉija porođajna teţina je ispod 10 centilne vrijednosti za određenu gestacijsku dob. Novorođenĉad su roĊena u rodilištu Klinike za ginekologiju i porodništvo KBC Rijeka u 2013 godini. Sva novorođenĉad imala su manje od 3000 grama. Kao izvor podataka korišten je porodni protokol iz 2013. godine. Parametri koji su obraĊivani u radu ukljuĉuju dob trudnice, paritet , komplikacije u trudnoći, trajanje trudnoće, stav ploda, spol djeteta, teţina, duljina, opseg glavice, Apgar indeks u prvoj i petoj minuti i naĉin dovršenja poroda. Od ukupnog broja ţivoroĊene djece 8,87% ima zastoj u rastu. RoĊeno je 58% ţenske djece i 42% muške djece. U terminu od 38 – 41 tjedna roĊeno je 60,75% , a prije 37 tjedna 39.25% djece. Komplikacije koje se javljaju u trudnoći placentarna insuficijencija, oligohidramnij, preeklampsija i hipertenzija utjeĉu na rast fetusa. Intrauterini zastoj u rastu najviše utjeĉe na poroĊajnu teţinu i veći postotak djece teţi manje od 2500 grama. Kod niţe poroĊajne teţine i manje gestacijske dobi povećan je mortalitet i morbiditet. Komplikacije kod novoroĊenĉadi s intrauterinim rastom zahtjevaju mnogobrone hospitalizacije, a u daljnjem rastu djece mogu se javiti motorna i neurološka oštećenja. Jedini pravi naĉin lijeĉenja je pravodobno dovršenje poroda. Odluka o termina poroda donosi se na temelju stanja majke i stanja fetusa. Intrauterine growth is due to a number of genetic and environmental factors, and refers to the slowing growth of the fetus whose potential is higher than measured. The purpose of this work is the study of infants whose birth weight was below the 10 percentile values for a given gestational age. Newborn babies are born in the maternity ward of the Clinic for Gynaecology and Obstetrics Hospital Rijeka in 2013. All infants had less than 3000 grams. As a source of data to the maternity Protocol of 2013. The parameters are processed in the work include pregnant women age, parity, pregnancy complications, duration of pregnancy, fetal attitude, gender, weight, length, head circumference, Apgar score at one and five minutes, and the way delivery. Of the total number of live births 8.87% have stunted growth. Born 58% girls and 42% of boys. In the period from 38 to 41 weeks born 60.75% and before 37 weeks 39.25% of children. Complications that occur in pregnancy, placental insufficiency, oligohydramnios, preeclampsia and hypertension affect fetal growth. Intrauterine growth mostly affects birth weight and a higher percentage of children weighing less than 2,500 grams. With lower birth weight and gestational age less increased mortality and morbidity. Complications in infants with intrauterine growth require many hospitalization, and further growth in children can occur motor and neurological damage. The only real treatment is timely completion of delivery. Decision on the due date shall be made on the basis of the maternal and fetal condition.

Cilj istraživanja: Bjelančevine toplinskog šoka su visoko očuvane i ubikvitarne molekule prisutne unutar stanice na majčino-fetalnom spoju. Tijekom implantacije dolazi do opsežne tkivne pregradnje, pri čemu se u izvanstanični prostor mogu otpustiti bjelančevine toplinskog šoka. Snažno imunogeno djelovanje ovih bjelančevina može postati okidač za aktivaciju pro-upalnog imunološkog odgovora te prijetnja održavanju trudnoće. Cilj ovog rada bio je utvrditi obrazac izražaja bjelančevina toplinskog šoka 70 i gp96 (od engl. glycoprotein 96) te njihovih receptora CD91 i TLR4 (od engl. Toll Like Receptor 4) na mjestu prodora trofoblasta u decidualno tkivo prvog tromjesečja normalne i patoloških trudnoća (anembrijska trudnoća i zadržani pobačaj) te tkiva posteljice na terminskoj trudnoći. Nadalje, ispitati mehanizme nadziranja izražaja bjelančevina toplinskog šoka (HSP70 i gp96) i njihovih receptora CD91 i TLR4 pod utjecajem PIBF-a (od engl. Progesterone Induced Blocking Factor) i pro-upalnih citokina (IL-15 i IL-2). Također, proučiti utjecaj HSP70 i gp96 na fenotip i funkciju decidualnih CD1a+ dendritičkih stanica in vitro. Materijali i metode: Raspodjela Hsc70, Hsp70, gp96, CD91 i TLR4 u decidualnom tkivu prvog tromjesečja normalne i patoloških trudnoća te tkiva posteljice na terminskoj trudnoći uklopljenih u parafin ispitana je metodama imunohistologije i imunoflorescencije. Enzimatskom razgradnjom tkiva i centrifugiranjem na gradijentu gustoće izdvojene su decidualne mononuklearne stanice (DMS) i analiziran je utjecaj rastućih koncentracija PIBF-a, IL-15 i IL-2 na izražaj HSP70, gp96, CD91 i TLR4 protočnom citometrijom i RT-qPCR metodom. Vezanje HSP70 i gp96 za receptore CD91 i TLR4 na CD1a+ DS dokazano je testom specifičnog vezanja. Ispitan je utjecaj HSP70 i gp96 na fenotip, stupanj sazrijevanja, unutarstanično izražavanje citokina i kemokina u decidualnim CD1a+ DS protočnom citometrijom nakon 18-sati stimulacije in vitro. Rezultati: Hsc70, Hsp70, gp96, CD91 i TLR4 prisutni su u uzorcima decidualnog tkiva prvog tromjesečja zdrave i patoloških trudnoća te tkiva posteljice na terminskoj trudnoći i to posebno u žlijezdanom epitelu, endotelu kapilara, stanicama raspršenim u stromi decidue i stanicama trofoblasta. Pod utjecajem PIBF-a dolazi do smanjenja izražaja HSP70, gp96, CD91 i TLR4 na razini gena i bjelančevina u suspenziji DMS. Citokini, IL-2 i IL-15 smanjuju izražaj gRNK za HSP70, CD91 i TLR4, dok povećavaju izražaj gRNK za gp96. IL-2 također, smanjuje udio CD91+ i TLR4+ stanica u različitim staničnim subpopulacijama DMS-a. IL-15 povećava udio CD91+ stanica NK, ali smanjuje udio TLR4+ stanica NK, limfocita T, nezrelih i zrelih DS. HSP70 i gp96 specifično se vežu za CD91 i TLR4 na decidualnim CD1a+ DS. Pod utjecajem HSP70 i gp96 nezrele CD1a+ DS povećavaju izražaj CD83, HLA-DR, ko-stimulacijskih molekula (CD80 i CD86) te kemokina (CCL3 i CCL22) i citokina (INF- i IL-15). Zaključak: Bjelančevine toplinskog šoka (HSP70, gp96) i njihovi receptori (CD91 i TLR4) su prisutni na majčino-fetalnom spoju tijekom prvog tromjesečja zdrave i patoloških trudnoća te u tkivu posteljice na terminskoj trudnoći, što predstavlja molekulsku osnovu za njihovo međudjelovanje. Intenzitet izraženosti ovih molekula mogla bi biti posljedica složenih međuodnosa PIBF-a, IL-15 i IL-2. U pokusima in vitro, HSP70 i gp96 kao prirodni ligandi za CD91 i TLR4 potiču sazrijevanje i aktivaciju CD1a+ DS sa stvaranjem pretežno pro-upalnih medijatora, što može podržati štetan imunološki odgovor i nepovoljan ishod trudnoće Objectives: Heat shock proteins are highly conserved and ubiquitous molecules present in the cells at the maternal-fetal interface. During the extensive tissue remodelling which is followed by the release of HSPs into the extracellular space. Strongly immunogenic activity of these proteins might bias the immune response towards the Th1 pattern and could cause undesirable pregnancy termination. The aim of the study was to evaluate the expression of HSP70 family members (Hsc70 and Hsp70), glycoprotein 96 (gp96) and their receptors CD91 and Toll like receptor 4 (TLR4) was investigated at maternal-fetal interface of the first trimester normal and pathological pregnancies (blighted ovum and missed abortion) and placental tissue at term. The mecchanisam of regulation of HSP70, gp96, CD91 and TLR4 expression was analysed by increasing concentration of Progesterone Induced Blocking Factor (PIBF), interleukin (IL)-15 and IL-2. The influence of HSP70 and gp96 on phenotype and maturation process of decidual CD1a+ dendritic cells (DC) was evaluated in vitro. Material and methods: Immunohistological and immunofluorescent labelling were performed on paraffin-embedded decidual sections of normal and pathological first trimester pregnancies (blighted ovum and missed abortion) and term placenta to detect gp96, Hsc70, Hsp70, CD91 and TLR4. The samples of normal first trimester pregnancy decidua were enzymatically digested and gradient density centrifuged to obtain the suspension of decidual mononuclear cells (DMC). DMC were stimulated with increasing concentration of PIBF, IL-15 and IL-2 and the expression of HSP70, gp96, CD91 and TLR4 was analysed by flow cytometry and RT-qPCR. The specific binding of HSP70 and gp96 was asset for receptors CD91 and TLR4 on CD1a+ DC. Flow cytometry was used to evaluate the influences of HSP70 and gp96 on the phenotype, the maturation process and the intracellular expression of cytokines and chemokines in decidual CD1a+ DC. Results: Hsc70, Hsp70, gp96, CD91 and TLR4 are present in decidual tissue of normal and pathological pregnancies first trimester (blighted ovum and missed abortion) and term placenta and they were found in glandular cells, endothelial cells, cells randomly distributed in stroma and trophoblast cells. PIBF down-regulated HSP70, gp96, CD91 and TLR4 at gene and proteins levels in DMCs. Cytokines, IL-2 and IL-15 decreased mRNA for HSP70, CD91 and TLR4, while increased mRNA for gp96. IL-2 also decreased the frequency of CD91+ and TLR4+ cells in different subpopulations of DMC. IL-15 treatment increased the frequency of CD91+ NK cells, but decreased the frequency of TLR4 expressing NK cells, T cells, immature and mature DC. HSP70 and gp96 efficiently binds CD91 and TLR4 receptors on decidual CD1a+ DC. In the presence of HSP70 and gp96 immature CD1a+ DC assume a more mature phenotype due to increased expression of CD83, HLA-DR, co-stimulatory CD80 and CD86 molecules, chemokines (CCL22 and CCL3) and cytokines (IFN-γ and IL-15). Conclusion: The presence of heat shock proteins (HSP70 and gp96) and their receptors CD91 and TLR4 at the maternal-fetal interface during normal and pathological first trimester pregnancies (blighted ovum and missed abortion) and term placenta provides a molecular basis for their interaction. The expression intensity of these molecules could be influenced by the interplay among PIBF, IL-15 and IL-2. HSP70 and gp96, as natural ligands for CD91 and TLR4 receptors induce maturation process of CD1a+ DC toward the expression of predominantly pro-inflammatory mediators, which could support a harmful immune response and adverse pregnancy outcome.

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.

The aim of the study was to investigate the effects of continuous epidural analgesia (EA) on the course of vaginal delivery with an emphasis on duration of labor and instrumental interventions. In a prospective 2-year trial, the study group included singleton vaginal births between 35 and 41 gestational weeks with a vertex fetus, in which continuous EA with bupivacaine or chirocaine in concentration of 0.125% combined with 2-4 microg of fentanyl or 0.5 microg of sufenta was used. The control group was created randomly from laboring patients with singleton pregnancies but without EA. The groups were adjusted for epidemiological characteristics and compared regarding the obstetric data and perinatal outcome. Student t-test and Mann-Whitney U-test were performed for normally and non-normally distributed results, respectively. Out of 1284 patients, 551 pregnant women were included in the study group and 733 in the control group. The statistically significant differences between the groups related to duration of the first and second stage of labor, frequency of premature rupture of membranes, intrapartal complications, and incidence of operative deliveries were found. Both stages of labor were significantly protracted and the incidence of operative deliveries was higher in the study group of patients compared with controls. There is a need for an active obstetric approach and management of vaginal deliveries of women who receive continuous EA, particularly if it is medically indicated.

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.

Tumor-associated glycoprotein-72 (TAG-72) is physiologically present in secretory phase endometrium, but its presence and possible immunological role in early normal human pregnancy decidua has not received attention. The double labeling of paraffin-embedded early pregnancy decidua sections using B-72.4 anti-TAG-72 mAb and MNF 116 anticytokeratin mAb revealed the absence of TAG-72 in uterine decidua of normal and pathological pregnancies (non-embryonic pregnancy and missed abortion) at the implantation sites, although it was present in epithelial cells at and away from the tubal implantation site of an ectopic pregnancy. TAG-72 binds and internalizes by reacting with the mannose receptor (MR-CD206) or with DC-specific ICAM reacting non-integrin (DC-SIGN-CD209) on decidual CD1a+ cells. Decidual CD1a+ cells stimulated with TAG-72 decreased CD83 expression and diminished IL-15 and IFN- intracellular production. TAG-72-treated CD1a+ cells decreased IFN- production in syngenic decidual and allogenic cord blood T cells even in the presence of lipopolysaccharide. TAG-72- and lipopolysaccharide-pre-treated CD1a+ cells significantly increased IL-4 expression in allogenic cord blood T cells. TAG-72 increased allogenic cord blood T cell proliferation, mediated by decidual CD1a+ cells, compared with its effect on the proliferation of syngenic decidual T cells. All these data emphasize the anti-inflammatory properties of TAG-72-treated decidual CD1a+ cells in terms of their interaction with T cells. Thus, the absence of TAG-72 at the maternal–fetal interface during early pregnancy could lead to a mild pro-inflammatory response that may be beneficial for pregnancy success and trophoblast growth control.

Phenotype of NK cells and cytotoxic/apoptotic mediators expression in ectopic pregnancy. Am J Reprod Immunol 2010 Problem The expression of cytotoxic/apoptotic mediators and the phenotype characteristics of uterine NK cells (uNK) in tubal ectopic pregnancy (EP) were investigated. Method of study Samples of uterine decidua and tubal mucosa as well as peripheral blood (PB) of the same women with EP were used for phenotype characterization of NK cells and detection of cytotoxic/apoptotic mediators and IL-15. Results In tubal mucosa, perforin, FasL, granulysin and IL-15 were almost completely absent, but they were present in normal and EP uterine deciduas. TRAIL was present on trophoblast and tubal mucosa, contrary to its lack in normal and EP uterine decidua. CD16-CD56dim NK cells, mostly CD94- and NKG2A-, predominate in tubal mucosa, whereas CD16-CD56bright NK cells, predominantly CD94+ and NKG2A+ prevail in EP uterine decidua. NK cells at the EP implantation site express lower percentages of perforin and granulysin, but they express a higher percentage of TRAIL than do EP uterine decidual and PB NK cells. Lower percentage of TNF-α-expressing and IL-4-expressing NK cells were found at the implantation site compared to EP uterine decidua. Conclusions Authentic uNK cell population seems to be insufficient to restrict trophoblast invasion because of low expression of cytotoxic/apoptotic mediators.

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.

Hypertensive disorders are among the most common complications in pregnancy and a major cause of perinatal morbidity and mortality. The aim of this study was to investigate the risk factors and adverse perinatal outcomes of pregnancies in mothers with hypertensive disorders, as well as the adequacy of prenatal care during the wartime and postwar period in South-Western region of Bosnia and Herzegovina. This study included a total of 542 pregnancies with hypertensive disorders during 5-year study period (1995–1999) and 1559 randomly selected controls. Data on risk factors, adverse perinatal outcomes (for singleton pregnancies only) and prenatal care on pregnant women were extracted from the medical records and compared with controls. Chi-square test and crude odds ratio (OR) with 95% confidence interval (95% CI) were used in statistical analysis. The average five-year incidence of hypertensive pregnancy disorders was 6.5% and it was significantly higher in 1995, the last year of the war, than in the postwar period (1996–1999) (p=0.02). Factors significantly associated with hypertensive pregnancy disorders were maternal age >34, nulliparity, multifetal gestation and male newborn (p

Cilj istraživanja: Utvrditi i usporediti ishod trudnoće i poroda na početku i pri kraju reproduktivne dobi. Materijal i metode: U istraživanje je uključeno 59 prvorotkinja mlađih od 18 godina i 233 prvorotkinje starije od 35 godina, koje su rodile u našoj ustanovi tijekom dvogodišnjeg razdoblja (od 2006. do 2007. god.). Podaci su prikupljeni retrospektivno, pretraživanjem medicinske dokumentacije i rađaoničkog protokola hospitaliziranih rodilja. Rezultati: U starih prvorotkinja značajno je povećan broj medicinskih zahvata u trudnoći kao i učestalost komplikacija u trudnoći (36,48% vs. 16,94%, p, Aim: Tto determine and compare the frequency of the risk of pregnancy and delivery outcome at the beginning and ending of reproductive age. Methods: The study included 59 nulliparous adolescents younger than 18 years and 233 nulliparous women 35 years and older in the period of two years (2006-2007). Birth records and patient files were retrospectively analised and compared. Results: In the primiparae of 35 years or more, medical interventions during pregnancy were higher, and the risk of chronic diseases which complicated their pregnancies increased (36,48% vs. 16,94, p

ProblemDendritic cells (DC)⁄natural killer (NK) cells interactions in the deciduasof early human pregnancies were analyzedin vitro.Method of studyPhenotype, cytokine expression and⁄or cytolytic mediators’ expressionwere measured by flow cytometry in NK and DC from the freshly iso-lated decidual mononuclear cells or after their purification and co-cul-turein vitro.Proliferationof5(6)-CarboxyfluoresceindiacetateN-succinimidyl ester (CFSE)-labeled CD56+cells was analyzed by flowcytometry after the co-culture with CD1a+or CD83+DC.ResultsDecidual CD1a+cells show less mature phenotype with no expression ofCD197, lower expression of CD80 and CD86 and higher expression ofCD206 and CD195 in comparison to CD83+cells. Interleukin (IL)-15,interferon-cand tumor necrosis factor-aproductions were higher inimmature than mature DC, whereas IL-10 and IL-18 were equally pro-duced in both subpopulations. Immature DC increase perforin, FasL andTRAIL protein expression and proliferation of NK cells, but decreasetheir intracellular IL-15 production. Mature DC caused less efficient pro-liferation of NK cells, and did not affect cytokine and cytolytic mediatorexpression.ConclusionThese results suggest that decidual CD1a+cells regulate and shape NKcell function more profoundly than CD83+cells in decidua.ORIGINAL ARTICLEAmerican Journal of Reproductive Immunology59(2008) 433–445ª2008 The AuthorsJournal compilationª2008 Blackwell Munksgaard433

Sažetak Cilj: Utvrditi tijek i ishod trudnoća nakon 22. tjedna gestacije u žena koje su rodile tijekom desetgodišnjeg razdoblja u našoj ustanovi, a začele su klasičnom in vitro fertilizacijom (IVF/ET) ili intracitoplazmatskom injekcijom sjemena (ICSI). Metode: Provedeno je retrospektivno pretraživanje računalne baze podataka koja se odnosi na tijek trudnoća i poroda 30 553 hospitaliziranih žena u našoj ustanovi u desetgodišnjem razdoblju. Skupina žena koja je zanijela nakon MPO (N = 102) uspoređena je s općom populacijom hospitaliziranih žena. Rezultati: Tijek trudnoća u žena koje su začele nakon MPO bio je obilježen znatno češćim komplikacijama već od prvog tromjesečja trudnoće i nadalje. Elektivni i hitni carski rez kao način dovršavanja trudnoće i poroda znatno je češće odabran u ovoj skupini. Zaključak: Ovim istraživanjem utvrdili smo višestruke razlike u tijeku trudnoća začetih nakon postupaka potpomognute oplodnje i načinu dovršenja poroda u odnosu na spontano začete trudnoće, stoga je ova skupina trudnica i rodilja rizična, te zahtijeva drugačiji pristup u nadzoru trudnoće, kao i planiranje vremena i načina porođaja., Aim: The aim of our study was to compare pregnancy and labor outcome of IVF/ET – ICSI pregnancy after 22 weeks of gestation with those spontaneous conceived and delivered in our hospital during ten years period. Methods: The study included 102 IVF/ICSI pregnant woman delivered in our hospital during ten years period and 30 553 pregnancies from the registry of the hospital as control parturient population. Maternal databases were retrospectively analised and compared. Results: The pregnancy outcome after assisted reproductive technology was complicated including first trimester of pregnancy, also. Pregnancy and delivery was terminated more freqently as elective or urgent caesarean section. Conclusion: In our study we found a number of significantly differences between IVF/ICSI and general population pregnancies and delivery. Those pregnancies and delivery are high-risk and management should be different from general population.

Immune response in ten MS patients was studied during pregnancy and puerperal period. Lymphocyte subpopulations in peripheral blood were identified by the rosette forming method. Concentration of immunoglobulins in sera was measured by the radioimmunodiffusion test, and functional reactivity of lymphocytes to polyclonal mitogens by the Hartzman's method. Total and active T lymphocytes showed significantly lower levels during the second and the third trimester of pregnancy. Active T lymphocytes were the lowest in postpartum period. There were no significant changes in percentage of B lymphocytes in pregnant MS patients versus controls. Percentage of total and active T lymphocytes decreased intensively in pregnant MS patients during the relapse. Concentration of immunoglobulins was significantly lower in pregnant MS patients versus healthy non-pregnant woman. Concentration of IgG decreased significantly during the third trimester of pregnancy in pregnant MS patients ; it was extremely low. Proliferative response to mitogens decreased significantly in pregnant patients during the post-partum period in regard to the period of pregnancy. Proliferative response to PHA and ConA measured in pregnant MS patients during the relapse was significantly decreased. It is apparent that gestation is associated with the depression of selective rather than general aspects of cell mediated immunity. Humoral immunity continues to function normally during pregnancy, although opinions about the concentations of immunoglobulins in the blood of pregnant woman are still controversial.

Gestational diabetes mellitus is a carbohydrate intolerance recognized in pregnancy. The objective of this study was to determine the prevalence of gestational diabetes mellitus (GDM) of all deliveries at the University Hospital Rijeka, Croatia (34 997 deliveries over 10-year period) using 2-hour 75 g oral glucose tolerant test and to evaluate the impact of GDM on neonatal outcomes and mother's health. Gestational diabetes was diagnosed in 55 of 128 pregnant women with suspected glucose intolerance. Logistic regression analysis was used to examine the relationship between fasting plasma glucose, age, family history, body mass index, maternal weight gain, neonatal weight, neonatal head diameter and Apgar score in the gestational diabetes group and in the non-diabetes group. The results indicate that fasting plasma glucose greater than 7.0 mmol/L and maternal overweight are strong predictors for GDM and macrosomia. There was no difference in the mode of delivery, and vitality and metabolic complications among the infants of all analyzed mothers. We concluded that to prevent GDM as well as to reduce the rate of macrosomic infants good glycemic control should be initiated as soon as possible. The 2-hour 75 g OGTT is worth enough to evaluate GDM. Women should be counseled and encouraged to lose weight before or at the beginning of the conception period.