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Danas je prisustvo očeva na porodu uobičajena pojava. Shodno tome očevi su postali sastavni dio primaljske skrbi u porodu, međutim u formalnom obrazovanju primalje ne stječu dovoljna znanja o radu s očevima. Cilj ovog istraživanja bio je sagledati doživljaj poroda iz aspekta očeva. Istraživanje je provedeno u razdoblju od 19. srpnja do 4. kolovoza 2021. godine. Odazvalo se 33 očeva koji su najmanje dva sata nakon poroda, odnosno prije no što su napustili rađaonicu, ispunili online „upitnik za očeve“. Osim sociodemografskih karakteristika, upitnik je sadržavao pitanja o prenatalnoj informiranosti, karakteristikama poroda, emocionalnom stanju i zadovoljstvu kvalitetom zdravstvene usluge tijekom njihovog prisustvovanja porodu u rodilištu Kliničkog bolničkog centra (KBC) Rijeka. Analiza pitanja o osjećajima tijekom prisustvovanja porodu pokazala je kako je 96,97% očeva bilo sretno, 42,42% bespomoćno, 33,21% je osjetilo strah, 12,12% ih je bilo uzbuđeno, a 6,06% traumatizirano. Najveći postotak očeva (91,88%) mišljenja je da je najveću korist od njihove prisutnosti porodu imala supruga/partnerica. Da je prisustvovanje porodu bilo korisno iskustvo složilo se 81,31% ispitanika, a ujedno je koristilo braku/vezi (76,68%). Dojam da je prisustvovanje oca porodu bilo korisno za dijete složilo se 54,31% ispitanika. Samo 1,25% ispitanika je imalo dojam da je njihov dolazak na porod bio beskoristan. Nisu pronađene razlike u razini zadovoljstva i sociodemografskih obilježja ispitanika. Doživljaj i iskustvo poroda za očeve povezan je s pozitivnim i negativnim osjećajima. Pozitivni osjećaji i zadovoljstvo su prevladavajući. Očevi smatraju kako njihova prisutnost najviše koristi njihovoj partnerici

Cilj ovog osvrta je skrenuti pozornost na dijagnostičke nedoumice i neusklađenost dijagnostičkih kriterija za šećernu bolest u ranoj trudnoći koje u svakodnevnom radu koriste dijabetolozi odnosno ginekolozi. Neusaglašenost navedenih kriterija zbunjuje pacijentice i zdravstvene djelatnike. Nije jasno rezultira li primjena strožih kriterija nepotrebnim trošenjem zdravstvenih resursa i opterećenjem žena u osjetljivom razdoblju života ili s druge strane, ako se ne primjenjuju, podcjenjivanjem rizika povezanih s hiperglikemijom, izostankom pravodobne intervencije i posljedično većom incidencijom neželjenih ishoda trudnoće., The aim of this review is to draw attention to the diagnostic dilemma and inconsistency of the diagnostic criteria for diabetes in early pregnancy, used by diabetologists and gynecologists in everyday clinical practice. The lack of consistency of diagnostic criteria confuses patients and health-care providers. It is unclear whether the use of more stringent criteria results in unnecessary health-care costs and putting much pressure on women in the sensitive period of their life or, on the other hand, if not applied, underestimate hyperglycemia-related risks and results in the absence of timely intervention and consequently in a higher incidence of adverse pregnancy outcomes.

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.

This article provides an overview of the obstetric and gynecological manifestations of Crohn's disease (CD). High incidence of the new onset of the disease in young women in their reproductive years demands special concern from physicians involved in their treatment. Pregnant women with CD are considered high-risk patients, regardless of disease activity index, due to associated complications. Predominately described complications are premature birth, low birth weight, and congenital anomalies. To minimize the risk for adverse pregnancy/birth outcomes, it is recommended that remission be achieved before conception. Treatment of CD in pregnant women is similar to that among the nonpregnant population, and there is no valid reason to terminate it, since most of the drugs are proven to be safe. Women with CD who wish to conceive or are already pregnant need to be properly advised according to the newest guidelines on the subject, given by the European Crohn's and Colitis Organization. Gynecological manifestations are another special feature of CD. They are important in that they may facilitate early recognition of the underlying disease, which usually stays unrecognized for years before intestinal manifestation ; in this way, the underlying manifestations are often mistreated.

This article provides an overview of the obstetric and gynecological manifestations of Crohn’s disease (CD). High incidence of the new onset of the disease in young women in their reproductive years demands special concern from physicians involved in their treatment. Pregnant women with CD are considered high-risk patients, regardless of disease activity index, due to associated complications. Predominately described complications are premature birth, low birth weight, and congenital anomalies. To minimize the risk for adverse pregnancy/birth outcomes, it is recommended that remission be achieved before conception. Treatment of CD in pregnant women is similar to that among the nonpregnant population, and there is no valid reason to terminate it, since most of the drugs are proven to be safe. Women with CD who wish to conceive or are already pregnant need to be properly advised according to the newest guidelines on the subject, given by the European Crohn’s and Colitis Organization. Gynecological manifestations are another special feature of CD. They are important in that they may facilitate early recognition of the underlying disease, which usually stays unrecognized for years before intestinal manifestation; in this way, the underlying manifestations are often mistreated.

Prospektivno devetogodišnje istraživanje (2002- 2010) provedeno je u ciljanoj skupini od 306 trudnica s jednoplodnom trudnoćom u dobi od 22. do 41. tjedna trudnoće. Ukupno je izvršeno 378 amniocenteza. Zaključno, znakovito niže vrijednosti lamelarnih tjelešaca u plodovoj vodi u trudnoćama kompliciranim preeklampsijom u odnosu na ostale ispitivane skupine trudnoća ukazuje na njezin negativan utjecaj na fetalnu plućnu zrelost i veći rizik od respiracijskog distres sindroma u novorođenčadi rođene između 31. i 36. tjedna trudnoće.

Acute Pancreatitis During Pregnancy

U radu je opisan rijedak slučaj neprepoznate fetalne smrti u 39. tjednu trudnoće u mlade rodilje sa sinusnom tahikardijom. Tijekom detaljne analize ovog opstetričkog slučaja identificirane su subjektivne pogreške stručnog osoblja koje je zanemarilo neke postupke opstetričke propedeutike, ali su opažene i neke objektivne okolnosti koje su otežale dijagnozu kasne fetalne smrti, prije svega postojanje sinusne tahikardije, kojoj je trudnica bila sklona. Nesretnu okolnost autori su našli i u činjenici da je »CTG krivulja« sa snimljenom srčanom akcijom majke tijekom prijema u rađaonicu bila vrlo slična uobičajenoj krivulji s registriranim fetalnim srčanim otkucajima, pa je došlo do tragične zamjene. Autori apeliraju na stalan opstetričarov oprez, kritičko kliničko promišljanje i potrebu za preispitivanjem pojedinih stručnih odluka, osobito ako su tijekom analize prepoznate neke kliničke sumnje i nelogičnosti., Late fetal death was and still is a very sad and disappointing outcome of pregnancy. However, today, with all the classic and modern facilities at our disposal, it is really unacceptable that late fetal death remains unrecognized by qualified medical professionals at the beginning of labor. The authors have decided to present such an extremely rare case of unrecognized fetal death at the 39th week of singleton pregnancy in 19 years old primipara with sinus tachycardia which was recorded by external electronic fetal heart monitoring and mistakenly interpreted as normal fetal heart rate. The lack of timely diagnosis of gestational diabetes probably had resulted in undesirable fetal complications such as metabolic disorders, macrosomia and intrauterine fetal death, caused by fetal hypoxia and acidosis. Analysing the whole course of delivery a few fundamental obstetric rules were omitted: taking the patient’s medical history was done quite inadequately (nobody asked her about previous attack of tachycardia and fetal movements), and the simple auscultation of the fetal heartbeat with simultaneous checking of the maternal radial pulse rate was ignored, leading to an unacceptable situation, where intrauterine fetal death was unrecognized through the first 3 hours of labor. The authors offer a clinical opinion that the obstetricians, as well as midwifes have to use modern medical technology and diagnostic tests wisely and critically, but can never allow themselves to skip the simple propaedeutic rules of obstetric care. Only with the better collaboration of the patient and with a watchful and critical analysis of the complete medical documentation and diagnostic tests, it could be possible to correct possible own or somebody else’s professional errors.

Problem: The mannose receptor (CD206) is involved in initiation and orientation of the immune response and distributed mostly on early pregnancy decidual macrophages surrounding glands. Methods of Study: The effects of glandular mucin Tumor Associated Glycoprotein-72 (TAG-72) on decidual macrophages was evaluated. Binding and internalization of TAG-72 were measured by labelling of CD206 with PAM-1 monoclonal antibody or by FITC-Dextran uptake, respectively, in untreated or TAG-72 treated macrophages. The expression of maturation markers and cytokines were analyzed by flow cytometry, as well as the IL-4 protein expression in cord blood T cells after co-culture with purified decidual CD14+ cells untreated or treated with TAG-72. Results: TAG-72 can be bound and internalized by the carbohydrate recognition domain of CD206. It up-regulates CD86 expression, IL-4 and IL-10 cytokine production in decidual macrophages and their capability to support IL-4 production in cord blood T cells. Conclusions: TAG-72 is the natural ligand for the carbohydrate recognition domain of CD206 on early decidual macrophages involved in supporting distinct profile of cytokine secretion, leading to pregnancy success. The investigation was supported by grants of Croatian Ministry of Science No. 0062029 and EMBIC project No. 512040, LSHM-CT-2004-512040.

Prikazana su iskustva poroda u vodi te ishodi u majke i novorođenčadi

Prikazana je učestalost operacijskog dovršenja poroda u kojem je obezboljenje postignuto kontinuiranom epiduralnom analgezijom. Pojavnost opstetričkom operacija za dovršenje porod je češća u odnosu na opću poplaciju rodilja.

Retrospektivnom analizom su utvrđena učestalost i uzroci perinatalne smrti blizanaca, te proučene morfološke karakteristike placenti.

Retrospektivnom analizom poroda koji su vođeni uz epiduralnu analgeziju utvrdili smo značajno veću učestalost operacijski dovršenih poroda vakuum ekstrakcijom (7, 6%).

Indukcija porođaja je jedan od najčešćih postupaka u porodništvu koji se poduzima s ciljem započinjanja porođaja. Indukcija porođaja je postupak u kojem dolazi do sazrijevanja vrata maternice i izazivanja kontrakcija maternice. Indukcija porođaja se provodi kada postoji rizik od nastavka trudnoće za rodilju i fetus, ali ponekad se porođaji induciraju bez medicinskih razloga. Razlikujemo dvije vrste induciranoga porođaja a to su: terapijski inducirani porođaj i programirani (elektivni) inducirani porođaj. Postupak indukcije podrazumijeva uporabu lijekova (mizoprostola, oksitocina, prostaglandina) ili mehaničkih postupaka (odvajanje plodovih ovojnica od sveze sa deciduom, prokinuće vodenjaka, primjena balon katetera) kojima je cilj preindukcijsko sazrijevanje vrata maternice koje povećava vjerojatnost za vaginalni porođaj. Indukcija porođaja je povezan s češćim, operacijski dovršenim porođajima. Glavni cilj ovog istraživanja jest ispitati učestalost carskog reza u induciranim niskorizičnim terminskim porođajima u odnosu na niskorizične terminske, spontano započete porođaje. Dodatni cilj jest analizirati učestalost epiduralne analgezija u induciranim niskorizičnim terminskim porođajima u odnosu na spontano započete porođaje. Retrospektivno istraživanje provedeno je u skupini žena koje su rodile u razdoblju od 1. siječnja 2019. godine do 1. srpnja 2022. godine na Klinici za ginekologiju i porodništvo Kliničkog bolničkog centra Rijeka. Ispitivanu skupinu sačinjavaju niskorizične trudnice sa jednoplodnom trudnoćom u terminu čiji je porođaj programiran, odnosno elektivno induciran bez predležeće patologije tj. jasno definiranoga medicinskog razloga. Kontrolnu skupinu čine trudnice koje imaju iste karakteristike kao i istraživana skupina. U istraživanju je dokazana statistički značajna razlika (p, Induction of labor is most common intervention in obstetric wich goal is starting labor. Induction is procces of stimulating uterine contraction. It is a therapeutic procedure that is caried out when the risk of continuing the pregnancy for mother and fetus is greater than the risk of prolongede pregnancy. There are two types of inducion: therapeutic or medical indicate induction and elective induction. Induction of labor can be preformed with drugs like misoprostol, oxytocin and prostanglandins or with mechanical procedurse like membrane sweeping, balloon catether wich aim is cervical ripening. Induction of labor is associated with more frequent instrumental delivery. The main aim of this study is to examine the frequency of cesarean section in low- risk term induced labor compered to low- risk spontaneus labor. The specific aim is to analyze the frequency of epidural analgesion in induced low- risk term deliveris compered to low-risk term spontaneously initiated deliveries. The research was conducted of a group of women who gave birth between January 1,2019 and July 1,2022. The examined group constist of low- risk pregnant women with a singleton pregnancy at term whose delivery was programmed, i,e, electively induced without a underlying pathology, i.e. a clearly defined medical reason. The control group constistst of pregnant women who have the sam characteristics as the research group. The research confirmed a statistical difference in the completation of childbirth by caesarean section in the induced group (28,64%) and contol group (11,56%). A difference was demonstrated between epidural analgesion in induced group (66,24%) and control group (33,97%). A higher frequency of caesarean section and epidural analgesia in the induced group is possible because of diffrent dynamics of labor in induced labor and spontaneously initiated labor.

Svrha rada: Cilj ove retrospektivne studije je prikazati uspješnost prenatalne dijagnostike i prevalencije fetalnih malformacija u Klinici za ginekologiju i porodništvo Kliničkog bolničkog centra Rijeka u razdoblju od 2013. do 2015. godine uz statističku obradu anamnestičkih podataka trudnica s ishodima tih trudnoća. Ispitanice i postupci: Ispitanice su trudnice koje su nakon postavljene dijagnoze fetalne malformacije zatražile i dobile prvostupanjsko komisijsko odobrenje za prekid trudnoće prije navršenog 22. tjedna gestacije. Rezultati: U studiji je ukupno analizirano 47 trudnoća s velikom fetalnom malformacijom. Prenatalna dijagnostika zaslužna za smanjenje perinatalnog mortaliteta od 6,11‰, u 2014. za 4,67‰, a u 2015. za 4,73‰. Zaključak: Osim prevalencija središnjeg živčanog sustava i prednje trbušne stijenke koje se podudaraju s podatcima iz EUROCAT registra, ukupne i prevalencije ostalih kategorija fetalnih malformacija niže su u odnosu na europske. Postignuto smanjenje perinatalnog mortaliteta u sve tri ispitivane godine ukazuje na visoku kvalitetu prenatalne skrbi.

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.

Sindrom feto-fetalne transfuzije (TTTS) česta je komplikacija monokorionskih blizanačkih trudnoća zbog prijenosa volumena i hormonski aktivnih tvari s jednog blizanca na drugog preko krvožilnih anastomoza posteljice. Bez prepoznavanja i liječenja, uznapredovali TTTS značajno doprinosi smrti fetusa. Ultrazvučna dijagnoza monokorionske placente najpouzdanija je u prvom tromjesečju i određuje intenzitet praćenja trudnoće. Dijagnoza TTTS-a postavlja se ne temelju ultrazvučnog nalaza koji govori u prilog polihidramnija jednog blizanca i oligohidramnija drugog blizanca. Procjena punjenja mokraćnog mjehura, kao i Doppler mjerenja protoka pupčane arterije i vene, potrebni su za utvrđivanje stadija bolesti. Procjena fetalne srčane funkcije pruža dodatni uvid u ozbiljnost stanja fetusa, ali i pomaže izdvojiti fetuse kojima bi mogla biti potrebna postnatalna skrb i liječenje. Fetoskopska laserska fotokoagulacija krvožilnih anastomoza posteljice standardni je tretman za TTTS. Cilj je prekinuti vezu između blizanačkih cirkulacija kako bi se uklonila neravnoteža intravaskularnog volumena. Međutim, prijevremeni porođaj, usprkos liječenju, i dalje značajno doprinosi postnatalnom morbiditetu i mortalitetu. Dugoročni ishodi pokazuju da djeca nakon liječenja fetoskopskom laserskom fotokoagulacijom mogu pokazivati znakove neurološkog oštećenja. Strategije za smanjenje broja prijevremenog porođaja nakon liječenja i standardizirani izvještaji referentnih centara za fetoskopsku lasersku kirurgiju važni su za poboljšanje ukupnih ishoda i razumijevanje dugoročnih učinaka TTTS-a., Twin to twin transfusion syndrome (TTTS) is common complication of monochorionic twin pregnancies due to the transfer of volume and hormonally active substances from one twin to another via vascular anastomoses on the placenta. Without recognition and treatment, TTTS has significant contribution to fetal death. Ultrasound diagnosis of monochorionic placenta is the most reliable in the first trimester and determines the intensity of pregnancy monitoring. The diagnosis of TTTS is based on an ultrasound findings of polyhydramnios of one twin and oligohydramnios of the other twin. Assessment of bladder filling, as well as Doppler measurements of umbilical artery and vein flow, are needed to determine the stage of the disease. Assessment of fetal cardiac function provides additional insight into the severity of the fetal condition, but also helps to isolate fetuses that may need postnatal care. Fetoscopic laser ablation of vascular anastomoses between twins is the standard treatment for TTTS. The goal is to break the connection between the twin circulations in order to eliminate the imbalance of vascular volume. Despite the treatment, preterm birth still contributes to postnatal morbidity and mortality. Long-term outcomes indicate that children may show signs of neurological damage after treatment. Strategies of reducing preterm delivery after treatment and standardized reports from reference centers for fetoscopic laser surgery are important to improve overall outcomes and understand the long-term effects of TTTS.

Cilj istraživanja: Ispitati povezanost dob majke i pariteta, te ispitati način dovršenja trudnoće i vrijeme poroda (prijevremena ili terminska trudnoća) Materijali i metode: U ovom retrospektivnom kohortnom istraživanju koristit će se podaci dobiveni uvidom u medicinsku dokumentaciju – knjige rađaonskog protokola i knjige za vođenje statistike Klinike za ginekologiju i porodništvo KBC-a Rijeka. Prvu skupinu činiti će rodilje koje su začele MPO te drugu skupinu čine spontane trudnoće. Podaci koji će se prikupiti su: anamneza rodilje, podaci o sadašnjoj trudnoći, podaci o bolestima u trudnoći, podaci o porođajnoj masi djeteta i ishodu trudnoće. U ovo istraživanje je uključeno 186 rodilja koje su rodile na Klinici za ginekologiju i porodništvo od 1.siječnja.2020 do 31.prosinca.2020. Od 186 rodilja 93 rodilje su rodile iz MPO te 93 rodilje koje su rodile uz spontanu trudnoću Rezultati: Kod ispitivanih skupina, skupina MPO če češće trudnoću dovršiti carskim rezom odnosno kirurški (p, Research goal: To examine the connection between mother's age and parity and to examine the way of finishing the pregnancy and parturition time (premature or term pregnancy) Materials and methods: In this retrospective cohort study I will be using data obtained by accessing and inspecting medical documentation - records of birth protocol and books for keeping statistics of the Clinic for Gynecology and Obstetrics of KBC Rijeka. First group will be made up of mothers who gave birth with medical assistance and the second group will made up of mothers who had a spontaneous pregnancy. The data that will be collected is: maternity history, data on current pregnancy, data on diseases in pregnancy, data on the birth weight of the child and the outcome of pregnancy. This study included 186 mothers who gave birth at the Clinic of Gynecology and Obstetrics in the KBC Rijeka from January 1, 2020 to December 31, 2020. Out of 186 mothers, 93 mothers gave birth with MPO and 93 mothers who gave birth with a spontaneous pregnancy. Results: In the examined groups, the MPO group will more often complete the pregnancy by caesarean section or surgery (p

Svrha istraživanja Danas je prisustvo očeva na porodu uobičajena pojava. Shodno tome očevi su postali sastavni dio primaljske skrbi u porodu, meĎutim u formalnom obrazovanju primalje ne stječu dovoljna znanja o radu sa očevima. Cilj ovog istraţivanja bio je sagledati doţivljaj poroda iz aspekta očeva. Metode Istraživanje je provedeno u razdoblju od 19. srpnja do 4. kolovoza 2021. godine. Odazvalo se 33 očeva kojima je najmanje dva sata po porodu, odnosno prije no što su napustili rađaonicu, dano ispuniti online ”upitnik za očeve“. Osim sociodemografskih karakteristika, upitnik je sadržavao pitanja o prenatalnoj informiranosti, karakteristikama poroda, emocionalnom stanju i zadovoljstvu kvalitetom zdravstvene usluge očeva tijekom njihovog prisustvovanja porodu u rodilištu Kliničkom bolničkom centru (KBC) Rijeka. Rezultati Analiza pitanja o osjećajima tijekom prisustvovanja porodu pokazala je da se 96,97% očeva osjećalo sretno, 42,42% bespomoćno, 33,21% je osjetilo strah, 12,12% se osjećalo uzbuđeno, a 6,06% traumatizirano. Najveći postotak očeva (91,88%) mišljenja je da je najveću korist od njegove prisutnosti porodu imala supruga/partnerica. Da je prisustvovanje porodu bilo korisno iskustvo za ispitanika sloţilo se 81,31% ispitanika, te da je koristilo braku/vezi (76,68%). Dojam da je prisustvovanje oca porodu bilo korisno za dijete složilo se 54,31% ispitanika. Samo 1,25% ispitanika je imalo dojam da je njihov dolazak na porod bio beskoristan. Nisu pronađene razlike u razini zadovoljstva i socio-demografskih obiljeţja ispitanika. Zakljuĉak Doživljaj i iskustvo poroda za očeve povezan je s pozitivnim i negativnim osjećajima. Pozitivni osjećaji i zadovoljstvo su prevladavajući. Očevi smatraju kako njihova prisutnost najviše koristi njihovoj partnerici., The purpose of the research Today, the presence of fathers at childbirth is a common occurrence. Consequently, fathers have become an integral part of midwifery care in childbirth. However, in formal education midwives do not acquire sufficient knowledge about working with fathers. The aim of this research was to take a look at the experience of childbirth from the perspective of fathers. Methods The survey was conducted from July 19th to August 4th 2021. 33 fathers responded and were asked to complete an online ”fathers questionnaire“ at least two hours after the birth, and before leaving the delivery room. In addition to sociodemographic characteristics, the questionnaire included questions on prenatal information, birth characteristics, emotional state and satisfaction of quality of care they experienced during their stay in the maternity ward of KBC Rijeka. Results Analysis of data collected regarding their emotional state showed that 96.97% of fathers felt joy, 42.42% felt helpless, 33.21% felt fear, 12.12% felt excited, and 6.06% traumatized. The highest percentage of fathers (91.88%) felt that their presence at childbirth was most beneficial for their wife/partner. 81.31% of respondents agreed that attending childbirth was a useful experience for the respondents, and it reinforced the bond between partners (76.68%). The impression that the father's presence at the birth was beneficial for the child was agreed by 54.31% of respondents. Only 1.25% of respondents had the impression that their arrival at childbirth had no effect. No differences were found in the level of satisfaction and socio-demographic characteristics of the respondents. Conclusion The childbirth experience for fathers is associated with positive and negative feelings. Positive feelings and satisfaction are prevalent. Fathers feel that their presence benefits their partner the most.

Bolest Covid 19. uzrokovala je globalnu pandemiju u prosincu 2019. godine i unijela mnogo straha i nepoznanica diljem svijeta. Nova i nepoznata bolest pojavila se iznenada potkrepljena mnogim teorijama svog nastanka. Ishodište pandemije smatra se Wuhan u Kini. Do sada je zabilježeno 3,7 milijuna smrti uzrokovanih bolešću COVID-19. uz mnogo kratkoročnih i dugoročnih posljedica nakon preboljele bolesti. U ovom radu dostavljaju se statistički podatci dobiveni anketom o informiranosti i stavovima trudnica o cijepljenju protiv COVID-19 tijekom trudnoće u Republici Hrvatskoj. Online anketa je provedena u razdoblju od 20.05.2021. do 10.06.2021. na skupini od ukupno 537 ispitanica. Ispitanice su trudnice iz cijele Hrvatske. Cilj istraživanja je procijeniti informiranosti trudnica o cjepivu i samoj bolesti COVID-19 tijekom trudnoće, te utvrditi stavove trudnica o cijepljenju protiv bolesti uzrokovane COVIDom-19 tijekom trudnoće. Osnovna hipoteza je da zbog manjka informacija o cjepivu i bolesti uzrokovanoj infekcijom COVID-19, mala je procijepljenost trudnica cjepivom protiv COVID-19 u trudnoći. Provedenom anketom ustanovljeno je kako bi se 4,5% trudnica odlučilo na cijepljenje, 123 je neodlučno, a 83,4% se ne želi cijepiti. Glavni izvor informacija o bolesti Covid-19 ,komplikacijama i cijepljenju protiv Covid-19. je internet. Svega 14,1% trudnica informacije je dobilo od primarnog ginekologa, dobilo je dovoljno informacija o cjepivu. Dovoljnu količinu informacija o cjepivu od strane obiteljsko liječnika dobilo je 10,3% trudnica. Trudnice se ne žele cijepiti zbog manjka informacija od strane zdravstvenih djelatnika. Edukacijom zdravstvenih djelatnika i provedbom kampanje promocije cijepljenja u trudnoći moguće je povećati broj trudnica zainteresirati za cijepljenje., Covid’s 19th disease caused a global pandemic in December 2019 and brought a lot of fear and unknowns around the world. A new and unknown disease appeared suddenly supported by many theories of its origin. The origin of the pandemic is considered to be Wuhan in China. So far, 3.7 million deaths have been reported caused by COVID-19 disease. with many short-term and long-term consequences after overcoming it diseases. This paper presents statistical data obtained from the survey on information and attitudes pregnant women on vaccination against COVID-19 during pregnancy in the Republic of Croatia. It's an online survey conducted in the period from 20.05.2021. to 06/10/2021 on a group of a total of 537 respondents. The respondents are pregnant women from all over Croatia aged. The aim of the research is to assess information pregnant women about the vaccine and the disease COVID-19 during pregnancy, and to determine the attitudes of pregnant women about vaccination against diseases caused by COVID-19 during pregnancy. The basic hypothesis is yes due to a lack of information about the vaccine and the disease caused by COVID-19 infection, it is small number in vaccination of pregnant women with the vaccine against COVID-19 in pregnancy. Conducted a survey it was found that 4.5% of pregnant women would opt for vaccination, 123 were undecided, and 83.4% did not wants to get vaccinated. The main source of information on Covid-19 disease, complications and vaccination against Covid-19. is the internet. Only 14.1% of pregnant women received information from the primary gynecologist is enough information about the vaccine. Enough information about the vaccine by the family 10.3% of pregnant women received from a prime care doctor. Pregnant women do not want to be vaccinated due to lack of information from health professionals. By educating health professionals and implementing a promotion campaign vaccinations in pregnancy it is possible to increase the number of pregnant women interested in vaccination.

Iako se nalazimo u 21. stoljeću, U Republici Hrvatskoj porod kod kuće još uvijek nije adekvatno zakonski reguliran te gotovo sve žene rađaju u bolničkom okruženju. Cilj ovog istraživanja je bio utvrditi stavove prvostupnica primaljstva u Republici Hrvatskoj o porodu kod kuće. U istraživanju su sudjelovale 73 prvostupnice primaljstva u registru članova Hrvatske komore primalja. Istraživanje se provodilo putem on-line anonimnog anketnog upitnika koji je izrađen specifično za ovo istraživanje te se ono provodilo u mjesecu svibnju 2021. godine. Rezultati su pokazali kako dvije trećine ispitanika smatra da je mogućnost komplikacija u porodu niža ako se porod odvija u bolnici, dok trećina ispitanika smatra da se porodi ne trebaju isključivo voditi u bolnici. Gotovo trećina ispitanika navodi kako bi vodili porode kod kuće u slučaju adekvatne zakonske regulacije istih i najveći udio je u dobi od 21 do 31 godine s manje od pet godina radnog staža. Tek 27% prvostupnica primaljstva smatra da ima dovoljno znanja i vještina za vođenje kućnih poroda, a 18% bi uz više edukacije i radnog staža bilo spremno voditi kućne porode. Zbog sve više stope kućnih poroda u Republici Hrvatskoj, od važnosti je osigurati ženama mogućnost stručnog vođenja takvih poroda. Prvostupnici/ce primaljstva Republike Hrvatske najadekvatnije su zdravstveno osoblje za vođenje poroda kod kuće s ciljem što boljih ishoda, kako za žene, tako i za njihovu djecu., Although we are living in the 21st century, in the Republic of Croatia home birth is still not adequately regulated by law and almost all women give birth in a hospital environment. The aim of this research was to determine the attitudes of bachelors of midwifery in the Republic of Croatia about home birth. 73 bachelors of midwifery in the register of members of the Croatian Chamber of Midwives participated in the research. The research was conducted through an online anonymous survey questionnaire that was developed specifically for this research and it was conducted in May 2021. The results showed that two thirds of respondents believe that the possibility of complications in childbirth is lower if the birth takes place in a hospital, while one third of respondents believes that childbirth should not be conducted exclusively in a hospital. Almost a third of respondents states that they would conduct births at home in the case of adequate legal regulation of the same, and most of them are between the ages of 21 and 31 with less than five years of service. Only 27% of bachelors of midwifery believe that they have enough knowledge and skills to manage home births, and 18% would be ready to lead home births with more education and work experience. Due to the increasing rate of home births in the Republic of Croatia, it is important to provide women with the possibility of professional management of such births. Bachelors of midwifery in the Republic of Croatia are the most adequate of medical staff for conducting home birth with the aim of better outcomes, both for women and their children.

Edukacija mladeņi je od neprocjenjive vaņnosti vezano uz sprječavanje neņeljenog začeća, trudnoće i poroĎaja. Iako je posljednjih nekoliko godina u Republici Hrvatskoj zabilježen smanjen broj maloljetničkih trudnoća i porođaja, još su uvijek prisutni u određenoj mjeri. Cilj ovoga istraživanja je bio ispitati učestalost porođaja kod trudnica mlađih od 18 godina u Općoj županijskoj bolnici Našice u periodu od 2010. - 2020. godine. Tim je retrospektivnim istraživanjem analizirana medicinska dokumentacija prilikom koje je otkriven podatak o ukupnom broju od 84 maloljetne rodilje koje su se porodile na Odjelu ginekologije i opstetricije Opće županijske bolnice u Našicama. Najveći broj maloljetnih rodilja prilikom istraživanog perioda imalo je prebivalište na selu njih 76,2%, u radnom odnosu nije bilo 66,7% maloljetnih rodilja. Također najveći broj maloljetnih rodilja nije bilo u bračnom odnosu i to njih 67,9%, a najviše ih je redovito kontroliralo svoju trudnoću što iznosi također 67,9%. Manji broj rodilja je kao mjesto prebivališta navelo grad, njih 23,8%, neredovito je kontroliralo trudnoću 20,2% maloljetnih rodilja, Školu je pohađalo 32,1%, a isti postotak njih je bilo u bračnom odnosu. Samo jedna rodilja bila je u radnom odnosu što iznosi 1,2%, a najmanji je bio broj onih rodilja koje nisu kontrolirale trudnoću, odnosno 11,9%. Svi navedeni postoci odnose se na ukupan broj porođaja maloljetnica u istraživanom periodu. Uzevši u obzir godine života, veća je učestalost porođaja bila kod trudnica u dobi od 16-18 godina, nego kod onih koje su mlađe od 16 godina. Hipoteza nije potvrđena jedino u slučaju provođenja redovitih kontrolnih pregleda u trudnoći, gdje je najveći broj rodilja kontrolirao trudnoću, a hipoteza je postavljena upravo suprotno kako će biti najveći broj onih rodilja koje trudnoću nisu kontrolirale. Zadnje tri godine analiziranog perioda zabilježen je pad broja maloljetničkih porođaja u odnosu na prethodne godine, što se može povezati sa većom aktivacijom društva po pitanju edukacije o reproduktivnom zdravlju i odgovornom spolnom ponašanju., Adolescent education has invaluable importance related to unwanted conception, unwanted pregnancy, and childbirth prevention. Although the number of registered adolescent pregnancies and childbirths was reduced in the last few years in the Republic of Croatia, it is still present to at same extent. This research has aimed to examine the incidence of childbirth for pregnant women younger than 18 years old in General County Hospital Našice, in a period from 2010 until 2020. This retrospective research contains medical files, and it reveals the information that the total number of adolescent pregnant women who gave birth at the Department of Obstetrics and Gynecology in General County Hospital Našice is 84. During the research, most adolescent future mothers have had a residency in villages 76.2%, did not have marital status 67.9%, and 66.7% did not have a job, but 67.9% of them regularly monitored their pregnancy. A small number of adolescent future mothers, 23.8% of them, specified city as their residency place, 20.2% of them did not control their pregnancy, 32.1 % did not attended school, and the same percent of them had marital status. Only one adolescent mother ( 1.2%) had a job and a small number of adolescent future mothers , 11.9.% of them, did not control their pregnancy. All percentages refer to the total number of births of adolescent in the researched period. When it comes to age, the rate of adolescent childbirths was more often for teenagers from 16 to 18 years old than for adolescents under 16 years old. The hypothesis has not been confirmed only in the case of the implementation of regular pregnancy check-ups, where a great number of future mothers monitored their pregnancy. The research hypothesized opposite that a great number of adolescent mothers did not monitor their pregnancy. In the last three years, analyses registered a decrease in adolescent childbirths compared to previous years what can be related to social inclusion in matters of reproductive health and responsible sexual behavior.

Prenešenom trudnoćom smatra se trudnoća koja traje više od 42 navršena tjedna, odnosno više od 294 dana od zadnje menstruacije ili više od 14 dana od utvrđenog dana poroda. Incidencija prenešene trudnoće varira od manje od 1 do više od 15% ovisno o studiji i načinu određivanja gestacijske dobi. Etiološki faktori prenešenih trudnoća još uvijek su relativno nepoznati i nedovoljno istraženi. Prenešene trudnoće imaju veći rizik od nepovoljnih ishoda i taj rizik se povećava s gestacijskom dobi. Prikazane su brojne posljedice prenešenih trudnoća kod majke i novorođenčadi. Tako kod majki može doći do različitih trauma uslijed intervencija pri porodu kao i psiholoških posljedica uslijed isčekivanja i strahovanja. Kod novorođenčeta prenešene trudnoće povećavaju rizik od incidencije intrauterinog i neonatalnog morbiditeta i mortaliteta, makrosomije uslijed gubitka volumena amnijske tekućine ili placentarne insuficijencije. Obzirom da se gotovo sve komplikacije povećavaju s produljenjem gestacijske dobi važno je njeno točno određivanje kao i stalna i intenzivna skrb koja uključuje praćenje fetalnih znakova i općeg statusa majke kako bi se spriječili nepovoljni perinatalni ishodi po majku i novorođenče., A prolonged pregnancy is considered to be a pregnancy lasting more than 42 weeks, more than 294 days from the first day of the last menstruation or more than 14 days from the determined day of birth. The incidence of prolonged pregnancy varies from less than 1 to more than 15% depending on the study and the method of determining gestational age. The etiological factors of prolonged pregnancies are still relatively unknown and insufficiently investigated. Prolonged pregnancies have a higher risk of adverse outcomes and this risk increases with gestational age. Numerous consequences of prolonged pregnancies in mothers and newborns have been presented. Thus, mothers can experience various trauma due to childbirth interventions as well as psychological consequences due to anticipation and fear. In newborns, prolonged pregnancies increase the risk of incidence of intrauterine and neonatal morbidity and mortality, Since almost all complications increase with prolongation of gestational age, it is important to accurately determine it as well as constant and intensive care that includes monitoring fetal movement and general maternal status to prevent adverse perinatal outcomes for the mother and newborn.

Uvod: Stav ili prezentacija zatkom podrazumijeva nepravilnu prezentaciju u kojoj fetus zauzima uzdužni položaj, ali pritom je vodeća čest zadak, a glava se nalazi u fundusu maternice. Zbog dugačijeg mehanizma prolaska porodnim kanalom, češće se ovakve trudnoće dovršavaju carskim rezom. Cilj: Cilj istraživanja bio je utvrditi postoji li razlika u perinatalnim ishodima stava zatkom obzirom na način dovršenja trudnoće- vaginalni porod i carski rez. Ispitanici i postupci: Ispitivanu skupinu sačinjavalo je 1045 rodilja/trudnica koje su u Klinici za ginekologiju i porodništvo KBC-a Rijeka rodile novorođenčad u stavu zatkom u razdoblju od 1. siječnja 2010. do 31. prosinca 2019. godine. Iz istraživanja su isključene sve višeplodne trudnoće i svi slučajevi kasne fetalne smrti. Rezultati: Uočen je potpuni preokret u načinu dovršenja trudnoće u kojoj fetus zauzima stav zatkom. Posljednjih nekoliko godina dominantno se takve trudnoće dovršavaju carskim rezom. To se prema istraživanju u Riječkom rodilištu i nije pokazalo opravdanim, iz razloga što se nije pronašla statistički značajna razlika u perinatalnom ishodu novorođenčadi porođene vaginalnim putem, odnosno carskim rezom. Zaključak: Perinatalni ishodi novorođenčadi u stavu zatkom samo djelomično ovise o načinu dovršenja trudnoće. Puno je drugih faktora koji utječu na perinatalni ishod i iz tog je razloga od velike važnosti pravilna i pravodobna procjena porodničara te provođenje dobre kliničke prakse., Breech birth implies an incorrect presentation in which the fetus occupies a longitudinal position, but the leading one is often the buttocks, and the head is located in the fundus of the uterus. Due to the complicated mechanism of passage through the birth canal, such pregnancies are more often completed by caesarean section.The aim of the study was to determine whether there is a difference in the perinatal outcomes of the posture with regard to the manner of completion of pregnancy - vaginal delivery and cesarean section.The study group consisted of 1045 mothers/pregnant women who gave birth to newborns at the Clinical Hospital Center Rijeka in the period from 1 January 2010 to 31 December 2019. All multiple pregnancies and all cases of late fetal death were excluded from the study.A complete reversal was observed in the manner of completing the pregnancy in which the fetus takes a position with the buttocks. In recent years, such pregnancies have been predominantly completed by caesarean section. According to the research, this did not prove to be justified, due to the fact that no statistically significant difference was found in the perinatal outcome of newborns born vaginally, ie by caesarean section.The perinatal outcomes of breech birth neonates only partially depend on how the pregnancy is completed. There are many other factors that affect the perinatal outcome and for this reason it is of great importance for the obstetrician to properly and timely assess and implement good clinical practice.

Cilj rada: retrospektivna analiza perinatalnog ishoda poroda dovršenih VE u Klinici za ginekologiju i porodništvo Rijeka te usporedba poroda dovršenih metalnom čašom Malmström i Kiwi Omnicup-om od 1. siječnja 2018. do 31. prosinca 2020. godine. Materijali i metode: Od ukupno 7190 poroda 106 je dovršeno VE. Ispitanice smo podijelili u dvije skupine. Kod prvih je porod dovršen Malmström čašom, a drugih Kiwi Omnicup-om. Rodiljama smo analizirali dob, paritet, gestaciju, komplikacije u trudnoći, način početka, trajanje poroda, upotrebu analgezije te komplikacije u III. i IV. porodnom dobu. Novorođenčadi smo analizirali spol, porodnu masu, Apgar score u prvoj i petoj minuti, komplikacije i pH pupkovine. Statistička obrada učinjena je u programu Microsoft Excel. Skupine smo uspoređivali uz pomoć Studentovog t-testa gdje su signifikantne vrijednosti ukoliko je p < 0,05. Rezultati: Učestalost poroda dovršenih VE u KBC Rijeka iznosi 1,47%. Statistički značajnu razliku između dviju skupina pronašli smo u trajanju poroda (značajno kraći u skupini Malmström) te u distribuciji spola (više muške novorođenčadi skupini Kiwi Omnicup). Nuliparitet i EPA predstavljaju rizik za dovršenje poroda VE. Preacidoza i pupkovina omotana oko vrata imaju utjecaj na niži Apgar score u prvoj i petoj minuti. Od komplikacija III. i IV. porodnog doba kod poroda dovršenih Malmström čašom češće nalazimo laceracije vagine, a kod poroda dovršenih Kiwi Omnicup-om nalazimo teže povrede kao što su zastoj ramena i ruptura međice III. i IV.stupnja te adherirana placenta. Zaključci: Porod dovršen VE utječe na morbiditet majki i novorođenčadi. Postoje minimalne razlike u ishodu poroda dovršenih metalnom čašom i Kiwi Omnicup-om. Porod VE treba koristiti uz dobru procjenu, pravilnu indikaciju, treba ju izvoditi iskusni porodničar uz pravilnu tehniku izvođenja te uvijek treba uzeti u obzir moguće komplikacije., Objective: retrospective analysis of perinatal outcome of births completed by VE at the Clinic for Gynecology and Obstetrics Rijeka and comparison of births completed with a metal cup Malmström and Kiwi Omnicup from 1 January 2018 to 31 December 2020. Materials and methods: From 7190 births, 106 are completed via VE. We divided women into two groups. The 1st where the birth was completed with a Malmström cup, and the 2nd with a Kiwi Omnicup. We analyzed the age, parity, gestation, complications in pregnancy, duration of childbirth, use of analgesia and complications in III. and IV. childbearing age. In newborns, we analyzed sex, birth weight, Apgar score in the first and fifth minutes, complications, and umbilical cord pH. Finally, we compared the groups using student's t-test. Results: The frequency of births completed by VE in KBC Rijeka is 1.47%.We found a statistically significant difference between the two groups in the duration of labor (significantly shorter in the Malmström group) and in the sex distribution (more male infants in the Kiwi Omnicup group). Nulliparas and EPA pose a risk for the vacuum assisted delivery. Preacidosis and umbilical cord wrapped around the neck have an effect on lower Apgar score in the first and fifth minutes. From complication III. and IV. of childbearing age in births completed with a Malmström cup more often we find lacerations of the vagina, and in births completed with Kiwi Omnicup we find more serious injuries such as shoulder stagnation and rupture of the perineum III. and IV degree and adherent placenta Conclusions: VE birth affects the morbidity of mothers and newborns. There are minimal differences in the outcomes of births completed with a metal cup and Kiwi Omnicup. Vacuum assisted delivery should be used with a good assessment, the correct indication, it should be performed by an experienced obstetrician with the correct technique, and possible complications should always be taken into account.

COVID-19 je naziv bolesti uzrokovan sa SARS-CoV-2. Svjetska zdravstvena organizacija proglasila je 11. ožujka 2020. globalnu pandemiju. Prijenos virusa se najčešće događa bliskim kontaktom s zaraženim osobama ili preko onečišćenih površina. Vrijeme inkubacije je prosječno četiri dana, s rasponom do 14 dana. Prognoza većine zaraženih trudnica i novorođenčadi je dobra te se čini da trudnice imaju sličan tijek bolesti u usporedbi s općom populacijom. Trudnoća ne povećava rizik za zarazu, ali pogoršava klinički tijek COVID-19 u usporedbi s nerotkinjama iste dobi. Većina trudnica s poznatom ili sumnjivom COVID-19 infekcijom razvilo je blagu bolest koja ne zahtijeva skrb na razini bolnice u odsutnosti opstretičkih problema. Prevladavajući simptomi COVID-19 u trudnica su vrućica, suhi kašalj, dispneja, bol / stezanje u prsima, umor i mijalgije. Postoji nekoliko klasifikacija težine bolesti poput klasifikacije Nacionalnog zdravstvenog instituta ili klasifikacije koje su predložili Wu i suradnici. RT-PCR test je zlatni standard za otkrivanje SARS-CoV-2 iz respiratornih uzoraka. Najčešći lijekovi protiv COVID-19 koji se istražuju za primjenu u trudnica su hidroksiklorokin, liponavir / ritonavir, remdesivir i tociluzimab. Mnoga su društva predložila nove protokole prenatalne njege umjesto tradicionalnih kako bi se spriječilo širenje COVID-19. Preporuča se cijepljenje trudnica. Način poroda treba i dalje biti individualiziran i temeljen na rutinskim porodničkim indikacijama. COVID-19 nije indikacija za promjenu načina porođaja te nema dokaza koji favoriziraju jedan način poroda u odnosu na drugi. Dokazi o vertikalnom prijenosu su rijetki i uglavnom se temelje na malim serijama slučajeva., COVID-19 is the name of a disease caused by SARS-CoV-2. The World Health Organization declared a global pandemic on March 11, 2020. Transmission of the virus most often occurs through close contact with infected people or through contaminated surfaces. The incubation time is on average four days, with a range of up to 14 days. The prognosis of most infected pregnant women and newborns is good and pregnant women appear to have a similar course of the disease compared to the general population. Pregnancy does not increase the risk of infection, but worsens the clinical course of COVID-19 compared with non-pregnan women of the same age. Most pregnant women with known or suspected COVID-19 infection have developed a mild disease that does not require hospital-level care in the absence of obstetric problems. The predominant symptoms of COVID-19 in pregnant women are fever, dry cough, dyspnea, chest pain, fatigue and myalgia. There are several classifications of disease severity such as the National Institutes of Health classification or the classification proposed by Wu et al. The RT-PCR test is the gold standard for detecting SARS-CoV-2 from respiratory samples. The most common COVID-19 drugs being investigated for use in pregnant women are hydroxychloroquine, liponavir / ritonavir, remdesivir and tociluzimab. Many organizations have proposed new prenatal care protocols instead of traditional ones to prevent the spread of COVID-19. Vaccination of pregnant women is recommended. The mode of delivery should continue to be individualized and based on routine obstetric indications. COVID-19 is not an indication to change the mode of delivery and there is no evidence to favor one mode of delivery over another. Evidence of vertical transmission is rare and is mainly based on small series of cases.

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.

HELLP sindrom (H – hemolysis, EL – elevated liver enyzmes, LP – low platetet) teška je komplikacija trudnoće s potencijalno smrtnonosnim ishodom za majku i dijete. Etiologija i patogeneza još nisu razjašnjene u cijelosti, ali se temeljem bolesti smatra abnormalna placentacija. Zbog poremećaja prokrvljenosti posteljice, pokreće se patofiziološka kaskada koja uključuje prejaku aktivaciju imunološkog sustava, trombocita i endotela što rezultira ishemijskim oštećenjem ciljnog organa, jetre. Oštećenjem jetre, tipično između 27. i 37. tjedna gestacije, započinje klinička prezentacija sindroma, koja uključuje bol u trbuhu (epigastrična ili pod desnim rebrenim lukom), mučninu, povraćanje, malaksalost i glavobolju sa ili bez vizualnih fenomena. Dijagnoza se postavlja temeljem kliničke slike i dokazivanja laboratorijskih abnormalnosti u imenu sindroma. Na temelju broja trombocita, HELLP sindrom se može subklasificirati u tri kategorije koje govore o težini stanja. Okosnicu liječenja čini porođaj, koji se prije 24. i nakon 34. tjedna gestacije učini hitno, a između 24. i 34. tjedna s odgodom od 48 sati kako bi se primjenom kortikosteroida povećala zrelost fetalnih pluća. Terapija uključuje i primjenu magnezijevog sulfata za prevenciju konvulzija i fetalnu neuroprotekciju, antihipertenzive za kontrolu tlaka te transfuziju trombocita u slučaju teške trombocitopenije. Maternalni i peritnatalni ishod je lošiji nego u fiziološke trudnoće, s brojnim komplikacijama i povišenim stopama mortaliteta. Trudnica s HELLP sindromom u osobnoj anamnezi ima u sljedećoj trudnoći povišen rizik za razvoj svih gestacijskih hipertenzivnih poremećaja, uključujući HELLP sindrom, te za intrauterini zastoj rasta, abrupciju posteljice i prijevremeni porođaj., HELLP syndrome (H – hemolysis, EL – elevated liver enzymes, LP – low platelet) is a severe complication of pregnancy, with potentially lethal outcomes for both the mother and neonate. The etiology and pathogenesis are still being investigated, but the root cause is considered to be abnormal placentation. Due to the disruption of the placental circulation, the stressed placenta emits various products which results in an enhanced inflammatory response, as well as endothelial and platelet activation, causing ischemia in the liver. The gestational age at onset is typically between 27 and 37 weeks, and women usually present with pain in the upper abdomen (epigastric or in the right upper quadrant), nausea, vomiting, malaise and headache with or without neurological involvement. The diagnosis of HELLP is based on both the clinical presentation and laboratory abnormalities that the name of the acronym is comprised of. HELLP syndrome can then be categorized into three classes according to platelet count. Delivery is the basis of treatment. Before 24 and after 34 weeks of gestation the mother should be delivered immediately, while the delivery between 24 and 34 weeks' gestation can be briefly delayed in order to administer corticosteroids for fetal lung maturity. The treatment also includes administering magnesium sulphate for seizure prophylaxis and fetal neuroprotection, antihypertensive therapy for blood pressure control and platelet transfusion in case of very low platelet count. The HELLP syndrome is associated with poor maternal and perinatal outcomes, including increased rates of serious morbidity and mortality. The risk of recurrence is high, as are the risks for developing other gestational hypertensive disorders, intrauterine growth retardation, placental abruption and preterm delivery.

Patologija posteljice u blizanačkih trudnoća obuhvaća spektar promjena na makroskopskoj i mikroskopskoj razini. Za razliku od jednoplodnih trudnoća incidencija komplikacija kod blizanaca je veća jer ovdje imamo razvoj dvaju fetusa u istoj šupljini maternice. Ono što nam kod blizanačke trudnoće dolazi do izražaja i razlikuje se od jednoplodne trudnoće je zigotnost; blizanci mogu biti jednojajčani ili dvojajčani i način placentacije gdje trudnoća može biti BiBi, MoBi, MoMo. Što ranije određivanje zigotnosti i korioniciteta je ključno u antepartalnom praćenju blizanačkih trudnoća jer određuje rizike od komplikacija kao što su IUGR, kongenitalne malformacije, TTTS, TAPS i neželjeni ishodi s pupčanom vrpcom. Vrsta same placentacija značajno utječe na perinatalni morbiditet i mortalitet u blizanačkih trudnoća. Histopatološki pregled posteljica od velikog je kliničkog značaja jer iz njega možemo saznati više o komplikacijma blizanačkih trudnoća, uzroku nastanka fetalne smrti ili pobačaja. Cilj ovoga rada je bio prikazati pregled posebnosti makroskopskih i mikroskopskih patoloških promjena posteljica u blizanačkih trudnoća te najučestalije patologije u posteljica koje nalazimo kod blizanačkih trudnoća., Placental pathology in twin pregnancies includes a spectrum of changes on a macroscopic and microscopic level. Compared with single pregnancies, twin pregnancies have a higher rate of complications because two fetuses exist in the same uterus at the same time. An entity that is specific for twin pregnancies is zygosity; the twins can be monozygotic or dizygotic and the type of placentation can be BiBi, MoBi and MoMo. Early detection of zygosity and the type of placentation is key in antepartal tracking of twin pregnancies because it defines the risk of complications such as IUGR, congenital malformation, TTTS, TAPS and unwanted outcomes of the umbilical cord. The type of placentation directly affects perinatal morbidity and mortality in twin pregnancies. Histopathological examination of the placenta is of great clinical significance because it is very useful to learn about complications, causes of fetal death and abortion. The aim of this paper was to show special macroscopic and microscopic changes in the placenta and the most common pathology of placentas in twin pregnancies.

Karcinomi jajnika su značajno oboljenje u žena diljem svijeta. Oni su na sedmom mjestu svih malignih oboljenja u žena. Histološki razlikujemo epitelno – stromalne tumore, tumore spolnih stanica, tumore specijalizirane strome jajnika i metastatske tumore. Klinički ti tumori mogu biti benigni, maligni i tumori ograničenog malignog potencijala. Postoje tri osnovne teorije o patogenezi karcinoma jajnika, a sve se temelje na činjenici da na površini jajnika nastaje mikrotrauma prilikom ovulacije, to vodi do čestih mitoza, a sve to povećava vjerojatnost mutacija i razvoja tumora. S obzirom na to čimbenici koji dovode do rjeđih ovulacija ili izostanak ovulacije ima protektivni učinak. Tumori jajnika se klinički klasificiraju u stadije prema Međunarodnoj klasifikaciji udruženja ginekologa i opstetričara (FIGO). Fertility- sparing surgery je poštedni operacijski zahvat prilikom kojeg se čuva maternica, kontralateralni jajnik i jajovod. Taj operacijski pristup je namijenjen ženama ispod 40 godina koje imaju indikaciju i one koje žele zadržati reprodukcijsku sposobnost. FSS metoda je sigurna za bolesnice s epitelnim karcinomom stadija FIGO 1A, gradusa G1/2 i FIGO 1C, gradusa G1. Bolesnice koje imaju dijagnozu karcinoma svijetlih stanica prema FIGO nisu kandidati za FSS. Iznimka su borderline tumori i neepitelni tumori koji dozvoljavaju ovisno o histološkom tipu tumora FSS pristup kod višeg stadija bolesti. Bolesnice koje su bile podvrgnute FSS metodi obično su imale sposobnost menstruiranja, a one koje su ostale trudne su iznijele trudnoću do kraja i rodile zdravu djecu bez prisutnosti anomalija, neovisno o tome jesu li primale kemoterapiju, Ovarian cancer is one of significant diseases in women worldwide. It is in the seventh place of all malignant diseases in women. Histologically it is divided on epithelial – stromal tumors, germ cell tumors, tumors- specialised stromal tissue and metastatic tumors. Clinical tumors may be benign, malignant and tumors of limited malignant potential. There are three basic theories on the pathogenesis of ovarian cancer, all based on the fact that on the surface of the ovary occurs microtrauma during ovulation, this leads to frequent mitosis, and all this increases the likelihood of mutations and tumor development. Because of the factors leading to less ovulation or the absence of ovulation has a protective effect. Ovarian tumors are clinically classified in stages of FIGO association. Fertility-sparring surgery is a sparing surgical procedure in which the uterus, contralateral ovary and fallopian tubes are kept. This operating approach is indicated for women under 40 years of age who have the indication and those who want to retain reproductive capability. The FSS method is safe for patients with epithelial carcinoma of the stage FIGO 1A, grade G1/2 and FIGO 1C, grade G1. Patients who have been diagnosed with clear cell carcinoma according to FIGO are not candidates for FSS. The exception is borderline tumors and non-epithelial tumors that allow depending on the histological type of FSS-tumor approach in the upper stage of the disease. Patients who were undergoing FSS method usually had the ability to menstruating and those who were pregnant were pregnant until the end of pregnancy and born healthy children without the presence of anomalies, irrespective of whether they received chemotherapy.

Uvod: Stopa carskog reza kao metode dovršenja poroda je vrlo visoka i nastavlja rasti kako u većini dijelova svijeta, tako i u Hrvatskoj. Kako bi omogućio praćenje i analizu učestalosti carskog reza, stvoren je Robsonov klasifikacijski sustav koji dijeli žene u 10 grupa prema osnovnim parametrima: paritet, početak poroda, gestacijska dob, fetalna prezentacija i broj fetusa. Svrha rada: Svrha ovog retrospektivnog istraživanja bila je primijeniti metodu Robsonove klasifikacije na rodilje 2014., 2015. i 2016. godine na Klinici za ginekologiju i porodništvo KBC Rijeka u razdoblju od 3 godine, te identificirati, analizirati i usporediti grupe trudnica. Ispitanici i postupci: Metodom Robsonove klasifikacije analizirane su trudnice koje su iznijele trudnoću na Klinici za ginekologiju i porodništvo KBC Rijeka u razdoblju od 2014. do 2016. godine. U 2014. godini analizirano je 2850 trudnica, u 2015. godini 2775, a u 2016. godini 2653. Rezultati: Ukupna stopa carskog reza 2014. godine iznosila je 14,67%, 2015. godine 15,42%, dok je 2016. godine iznosila 19,64%. U svakoj godini, ukupnoj stopi carskog reza najviše doprinose grupa 1 i 2 Robsonove klasifikacije, te ih slijedi grupa 5. Grupa s najmanjim doprinosom je bila grupa 9. Zaključak: Kako bi se reducirala ukupna stopa carskog reza, trebalo bi intervenirati u grupu 1 i 2. Ideja provedbe redukcije je detaljna analiza indikacija za carski rez u nulipara. Odnosno, najveći korak je konsenzus klasifikacije za praćenje carskog reza i korištenje iste za analizu indikacija., Introduction: The rate of Cesarean section as a method of birth is very high and continues to grow in most parts of the world, as well as in Croatia. In order to enable monitoring and analysis of the frequency od Cesarean section, Robson classification system has been created that divides women against basic parameters: parity, birth, gestation age, fetal presentation and fetal number. Purpose: The purpose of this retrospective study was to apply the Robson Classification Method on Births 2014, 2015 and 2016 at the Clinic for Gynecology and Obstetrics at KBC Rijeka for a period of 3 years and to identify, analyze and compare pregnant women. Patients and methods: The Robson classification methodology analyzed pregnant women who reported pregnancy at the Clinic for Gynecology and Obstetrics at KBC Rijeka from 2014 to 2016. In 2014, 2850 pregnant women were analyzed, 2775 in 2015 and 2653 in 2016. Results: The overall rate of the Caesarean section in 2014 was 14.67%, 2015 15.42%, while in 2016 it was 19.64%. In each year, the total rate of the Caesarean section is the most contributing group 1 and 2 of the Robson classification, followed by group 5. The group with the lowest contribution was group 9. Conclusion: In order to reduce the total Caesarean section rate, the group should intervene in groups 1 and 2. For reduction s a detailed analysis of the indications for the Caesarean section is needed in primiparae. That is, the biggest step is the classification consensus for the Caesarean section and the use of the same for the analysis of indications.

Vrat maternice sastoji se od endocerviksa te egzocerviksa. Na egzocerviksu, između originalne i sekundarno nastale skvamokolumnarne granice, nalazi se zona transformacije koja je osjetljiva na djelovanje raznih onkogenih čimbenika pa je upravo ona područje nastanka cervikalnih prekanceroza i karcinoma. Smatra se da nastanku gotovo svih cervikalnih prekanceroza i karcinoma prethodi HPV infekcija. Postoji 30 do 40 HPV genotipova koji inficiraju genitalnu sluznicu, a dijele se u kategorije visokog i niskog onkogenog rizika. Genotipovi niskog onkogenog rizika uzrokuju benigne anogenitalne bradavice, dok su visokorizični tipovi povezani s prekancerozama i karcinomom materničnog vrata. U 90% slučajeva HPV infekcija prolazi spontano unutar dvije godine, samo mali dio perzistira i potom progredira u cervikalni karcinom, za što je potrebno 15 do 20 godina. Skrining, koji uključuje redovite ginekološke preglede i uzimanje PAPA-testa, omogućuje identifikaciju prekanceroznih lezija u fazama kada ih je lako liječiti pa je upravo neprovođenje probira kod žena najčešći čimbenik rizika za razvoj raka vrata maternice. Primarna prevencija infekcije HPV-om podrazumijeva cijepljenje koje se provodi prije započinjanja seksualne aktivnosti, u dobi između 9 i 14 godina. U Hrvatskoj se cijepljenje provodi Gardasil 9 cjepivom koje štiti od nisko i visokorizičnih genotipova HPV-a. Na taj se način sprječava oko 70-80% premalignih promjena na cerviksu te oko 90% karcinoma cerviksa. Budući da cijepljenje ne predstavlja zamjenu za probir raka vrata maternice, svaka cijepljena žena, kao i necijepljena, treba redovito odlaziti na ginekološke preglede radi uzimanja PAPA-testa., The cervix of the uterus is divided into endocervix and ectocervix. The transformation zone is the area between the original and the new squamocolumnar junction and it is located on the surface of ectocervix. Most cervical precancerous lesions and cancers begin in the transformation zone because many oncogenic factors affect the transformation zone. The most of precancerous lesions and cancers are preceded by human papillomavirus infection. About 30 to 40 HPV genotypes infect genital mucosa and are classified as low or high oncogenic risk. Low risk genotypes cause benign anogenital warts whereas high risk genotypes are associated with cervical precancerous changes and cancers. Approximately 90% of cervical HPV infections are cleared within 2 years, only a small percent of infections persist latently, leading to disease progression and it takes 15 do 20 years for cervical cancer to develop. Screening allows the identification of precancerous lesions at stages when they can easily be treated. The most common risk factor for developing cervical cancer is a low attendance for cervical screening. Primary prevention of HPV infection involves vaccination of girls and boys aged 9 to 14 years, before they become sexually active. A vaccine Gardasil 9 is currently in use in Croatia and it protects against low and high-risk HPV genotypes. Vaccination prevents about 70-80% of premalignant changes in the cervix and about 90% of cervical cancers. HPV vaccination doesn't replace cervical cancer screening, so every vaccinated woman, as well as non-vaccinated, should regularly go for gynecological examinations to get a Pap-test.

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.

Benigni tumori maternice su česte bolesti koje mogu zahvatiti žene svih dobnih skupina. Njihova učestalost povećava se sa dobi. Maligni potencijal benignih tumora maternice je nizak. Miomi, hiperplazija endometrija i polipi endometrija se prezentiraju sličnom kliničkom slikom. Najčešći simptom zbog kojeg se pacijentice javljaju liječniku je abnormalno uterino krvarenje. Uz to, može se javiti bol i pritisak u zdjelici. Kod nekih pacijentica ove promjene mogu biti asimptomatske te se slučajno otkriju tijekom rutinskog ginekološkog pregleda. Prilikom postavljanja dijagnoze važno je procijeniti o kojoj promjeni se radi da bi se mogla ordinirati primjerena terapija. Liječenje primarno počinje medikamentoznom terapijom, a ukoliko ona nije učinkovita primjenjuje se neka od kirurških metoda terapije., Benign uterine tumors are common diseases that affect women of all ages. Their frequency increases with age. The malignant potential of benign uterine tumors is low. Myomas, endometrial hyperplasia and endometrial polyps have similar clinical presentation. The most common symptom that patients report to a doctor is abnormal uterine bleeding. Additionally, other symptoms that can occur are pain and pressure in the pelvis. In some patients, these changes may be asymptomatic and are randomly discovered during routine gynecological examination. While diagnosing, it is important to evaluate the changes, in order to arrange appropriate therapy. Treatment initially starts with drug therapy, and if it is not effective, one of the surgical methods of therapy is applied.

Embolija plodovom vodom je rijetka ali potencijalno smrtonosna opstetrička komplikacija. Iako se razumijevanje ovog entiteta poboljšalo kroz godine, i dalje je embolija plodovom vodom povezana sa visokim majčinim i perinatalnim morbiditetom i mortalitetom. Točan uzrok kao ni patofiziološki mehanizmi još nisu u potpunosti razjašnjeni. Smatra se da je mehanizam nastanka bolesti povezan sa imunološkim odgovorom majke na fetalne antigene iz plodove vode. Iako se prije smatralo da je obdukcijski nalaz komponenti plodove vode u majčinoj cirkulaciji patognomoničan, to se napušta kao dijagnostička metoda. Dijagnoza se postavlja klinički, na temelju isključenja drugih mogućih uzroka. Trenutno ne postoji specifičan dijagnostički serološki niti histološki test. Liječenje je suportivno, usmjereno na održavanje vitalnih parametara i provodi se u jedinicama intenzivnog liječenja. Ishod liječenja je bolji što se ranije krene sa mjerama održavanja života. Ne postoje specifični rizični faktori koji bi opravdali bilo kakve promjene u trenutnoj opstetričkoj praksi a kako bi se izbjegla embolija plodovom vodom ili smanjili faktori rizika., Amniotic fluid embolism is infrequent but potentially lethal obstetrical complication. Altough the understanding of this entity has improved over the years, amniotic fluid embolism is still associated with high maternal and perinatal morbidity and mortality. The exact cause as well as the patophysiological mechanisms have not yet been fully clarified. It is believed that the mechanism of the disease is associated with the immune response of the mother to fetal antigenes. While it was previously considered that the autopsy finding of the fetal components in the mother`s circulation is pathognomonic, that is now abandoned as a diagnostic method. The diagnosis is clinical, based on the exclusion of other possible causes. Currently, there is no specific diagnostic serological or histological test. Treatment is supportive, focused on maintaining vital parameters and is performed in intensive care units. The outcome of the treatment is better in case of early start of life support measures. There are no specific risk factors that would justify any changes in current obstetric practices in order to avoid amniotic fluid embolism or reduce the risk factors.

Prijevremena menopauza predstavlja disfunkciju ili prestanak rada jajnika prije 40. godine života. Nije ireverzibilan poremećaj, te u 50% slučajeva može doći do intermitentne spontane remisije, a u 5-10% i do uspješno iznijete trudnoće. Pojavljuje se u 0.01% žena mlađih od 20 godina, 0.1% žena mlađih od 30 godina, te u 1% žena mlađih od 40 godina. Idiopatska prijevremena menopauza čini 50-90% svih slučajeva, dok se ostatak može obrazložiti genetskim, metaboličkim, autoimunim, ijatrogenim, infekcijskim ili okolišnim uzrocima. Definirana je trijasom kojeg čine amenoreja ili oligomenoreja 4 ili više mjeseci, te hipergonadotropni hipogonadizam, odnosno povišena razina FSH (>40 IU/L) te deficit estrogena (, Premature menopause represents the dysfunction or cessation of ovarian function before 40 years of age. It is not an irreversible disorder, because in 50% of cases there may be an intermittent spontaneous remission of ovarian function, and in 5-10% women can successfully conceive. It affects 0.01% of women under 20 years of age, 0.1% of women before the age of 30, and 1% of women under 40 years of age. Idiopathic premature menopause accounts for 50-90% of all cases, while the rest may be explained by genetic, metabolic, autoimmune, iatrogenic, infectious or environmental causes. It is defined by a trias consisting of amenorrhea or oligomenorrhoea of 4 or more months, and hypergonadotropic hypogonadism, which includes an increase of FSH levels (> 40 IU/L) and estrogen deficiency (

Every year more than 15 million babies are born preterm (born alive before 37 weeks of pregnancy are completed, according to WHO), and that number is rising. Complications from prematurity are the leading cause of death in children under the age of 5. One of the main risk factors of preterm birth is chorioamnionitis, acute inflammation of the membranes and chorion of the placenta. Chorioamnionitis can lead to development of maternal and fetal inflammatory response characterized by the release of cytokines and chemokines. That encourages prostaglandin release, ripening of the cervix, membrane injury and preterm birth. Preterm birth is major risk factor for development retinopathy of prematurity, retinal vascular disease, main cause of childhood blindness. We designed a prospective cohort study, that included born premature infants less than 32 weeks of gestation, during period between January 1999 and December 2008, whose placentas were regularly submitted for histopathological diagnosis. The aim of this study was to evaluate a causal relationship between histological chorioamnionitis and retinopathy of prematurity with the use a standard.