Oleg Petrovic

Regarding the various aspects of screening strategies for gestational diabetes mellitus (GDM) and to express important conclusions, the recent literature in the field is reviewed. There are no randomized controlled trials examining the effects of different screening methods on health outcomes. Only few studies investigated the new screening strategies. There is an agreement that universal GDM screening is cost-effective. Several professional societies changed their own guidelines recommending universal GDM screening. Currently, the American College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynaecologists of Canada, and the U.K. National Institute for Health and Clinical Excellence recommend routine risk-factor-based screening, whereas the Canadian Diabetes Association, Australasian Diabetes in Pregnancy Society, U.S. Preventive Services Task Force, and ATLANTIC Diabetes in Pregnancy recommend that all asymptomatic women should be screened at 24-28 weeks' gestation. The American Diabetes Association recommends screening all women with a 75-g 2-h oral glucose tolerance test (oGTT). The International Association of Diabetes and Pregnancy Study Groups recommend no glucose challenge test, but proposed new screening criteria introducing fasting glucose levels less than 5.1 mmol/l. There is more and more evidence in the recent literature that GDM screening should be universally performed at 24-28 gestational weeks and followed by definitive testing in women who are labeled as high-risk population. Logically, the best strategy would be connecting the screening with diagnosing GDM in the same procedure using a 75-g oGTT, which should be evaluated. General consensus is about measuring plasma glucose to detect pregestational diabetes in high-risk populations by early testing before 20 weeks of gestation.

... Artur Franko1, Izidora Holjar-Erlić1, Damir Miletić1, Oleg Petrović2 ... Figure 1. Axial FLAIR-weighted image (IR, 6741/ 110/1700) reveals ill-defined area of the increased sig-nal intensity occupying the right cerebellar hemi-sphere with perifocal white matter oedema (arrow). ...

A case of fetal tachydysrhythmia with intermittent episodes of bradycardia associated with severe nonimmune hydrops was detected at 36 weeks of pregnancy. Paroxysms of supraventricular tachycardia were documented postnatally. Induction of labor and postnatal administration of digoxin showed to be a rational therapeutic approach in this case. In spite of some unfavorable clinical predictors the treatment resulted in a benign course of the disease.

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.

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 ...

To analyse mortality of extremely low (ELBW) and very low (VLBW) birth weight nawborns at the Department of Gynecology and Obstetrics of Rijeka University Hospital, before, during and after implementing a model of regionalization of perinatal care. In Croatia this model is still not established so the results can help us evaluate whether the suggested model is practicable and whether its appliance decrease newborns' mortality. We compared early neonatal mortality (RNM), neonatal mortality (NM) and intrahospital mortality (MOB) of ELBW and VLBW newborns at the pediods before (1997-2000), during (2000-2001) and after (2003-2006) the implemented changes. RNM was significantly lowered for both weight groups, but NM and MOB only for VLBW newborns. Our results show that appliance of regionalization of perinatal care is possible and unquestionable on local level, so it should be implemented on national level too.

Long-lasting respiratory symptoms have a huge impact on the quality of life in prematurely born children. We aimed to investigate the perinatal and maternal risk factors involved in the development of chronic respiratory morbidity in preterm infants, with an emphasis on the importance of Foetal Inflammatory Response Syndrome (FIRS). Prospective cohort study. Demographic, antenatal, delivery and outcomes data were collected from 262 infants with less than 32 completed weeks of gestational age, over a 10-year period. Presence of chronic lung disease of prematurity and early childhood wheezing. In multivariate logistic regression analysis the presence of FIRS appears to be the most important risk factor for both, chronic lung disease of prematurity (OR 31.05, 95% CI 10.7-87.75, p<0.001) and early childhood wheezing (OR 5.63, 95% CI 2.42-13.05, p=0.01). In the alternative regression model for early childhood wheezing, with chronic lung disease included as a variable, the statistical ...

To determine thresholds of maternal glycemia at which specific adverse pregnancy outcomes occur in high-risk population. A total of 1002 pregnant women with risk factors for gestational diabetes mellitus (GDM) underwent an originally modified glucose tolerance test (OGTT) with 75 g of glucose. Information on OGTT results and pregnancy outcomes were collected from database and medical records. Large for gestational age (LGA) newborn, infant's stay in the neonatal intensive care unit (NICU) >24 h, neonatal hyperbilirubinemia and cesarean section due to cephalopelvic disproportion were identified as specific GDM adverse outcomes. In the study group of participants with one or more specific GDM adverse outcomes, mean glycemic values during the modified OGTT (4.2 ± 1.0 mmol/L at 0 min, 6.8 ± 1.7 mmol/L at 30 min, 7.9 ± 2.1 mmol/L at 60 min, 7.7 ± 2.3 mmol/L at 90 min and 7.5 ± 2.3 mmol/L at 120 min) according to Student's t-test for independent samples were significantly higher than mean glycemic values in the control group of participants without specific adverse outcomes (p < 0.001, p = 0.02, p < 0.001, p < 0.001, p < 0.001). This study provides additional data that support the acceptance of the newly recommended outcome-based GDM diagnostic criteria.

To test if secular growth acceleration occurs during fetal life. ANOVA Kruskal-Wallis and Mann-Whitney U-test have been used for the biometric characteristics comparison of nowadays fetal population with those three decades ago and to test the hypothesis about the existence of secular growth acceleration during fetal life. For this purpose, we first calculated mean values of particular biometric parameters for the whole pregnancy. During the period 2002-2009 biparietal diameter, fetal length and abdominal circumference measurements in singleton uncomplicated pregnancies between 22 and 41 gestational weeks were obtained. Gestational age was estimated according to Naegele's rule and confirmed with an early ultrasound examination. Pregnancies with fetal cromosomopathies and malformations were excluded as well as those resulting in perinatal death. There were no statistically significant differences of the examined fetal biometric parameters measured by ultrasound between contemporary fetal population and those from 35 years ago. Our investigation did not undoubtedly prove that significant changes of fetal biometric parameters occurred in the last three decades. It is possible that secular growth acceleration does not exist in prenatal period but also the observed time period could have been short for this phenomenon to manifest.

To create curves of three most commonly used biometric parameters for singleton pregnancies from 22 to 41 weeks of gestation in the County of Primorje-Gorski Kotar (Croatia) and to compare results with other studies. From January 2002 to December 2009, ultrasound examination was performed on fetuses of 1248 pregnant women with uncomplicated pregnancy. Values for biparietal diameter, femur length, and fetal abdominal circumference were measured. Results were compared with studies pertaining to European and North American population. Mean, percentile scale, and Wilcoxon's matched pairs test were used. Regression analysis was applied to analyze data correlation and to determine correlation quotients. Total of 2178 measurements for fetal biometry charts were performed. Established mean and centile values for fetal biometry parameters are reported numerically and graphically. Comparison of obtained values with values of identical fetal biometric parameters of other world populations has revealed statistically significant differences (p < 0.01). Normal fetal biometry charts for population of pregnant women in the northern coastal region of Croatia were constructed. Due to existence of statistically significant differences in ultrasound fetal biometry values among various populations under comparison, construction of own charts and their implementation in routine obstetrical work are justified.

Immunohistochemical analysis of tissue specimens from human pregnancy decidua basalis in contact with invasive trophoblast of chorion frondosum and decidua parietalis in contact with non-invasive chorion laeve do not differ in the frequency of lymphoid cells of the following phenotypes (CD2, CD4, CD8, CD14, CD21 and gamma/delta TCR). A practical implication of this observation is that the collection of lymphoid cells from whole decidua by curettage for functional studies is justified.

The aim of this study was to describe the cytogenetic observations on abnormal human pregnancies (anembryonic pregnancy, early fetal loss, and hydatidiform moles), and to detect the most frequent or typical chromosomal aberration for anembryonic pregnancy and early fetal loss. Abnormal pregnancies were divided into three clinical and morphological groups: (a) anembryonic pregnancy; (b) early fetal loss, and (c) hydatidiform mole. Of the 119 karyotyped tissue samples, 42 (35%) were from anembryonic pregnancies, 64 (54%) from early fetal losses, and 13 (11%) were from hydatidiform moles (6 complete and 7 partial moles). Long-term cultures of chorionic villi and GTG-banding techniques were used for chromosome analysis. The overall frequency of chromosome anomalies among the 119 karyotyped spontaneous abortions was found to be 37.8%. Trisomy (double trisomy included) accounted for 35.6% of all aberrations, followed by polyploidy (33.3%), mosaicism (11.1%), structural abnormalities (4.4%), and monosomy X (2.2%). Although the difference was not statistically significant, single trisomy was the predominant chromosome abnormality found in anembryonic pregnancies (64.3 %) while in cases of early fetal loss, trisomy (double trisomy included) (38.9%) and triploidy (27.8%) were quite frequently present. The frequency of triploidy among all chromosomal abnormalities was 28.9%, and 53.8% of them were found in partial hydatidiform mole. The rest of them were almost exclusively found in early fetal losses. Complete hydatidiform moles (androgenetic in origin) were present in 13.3% of all aberrations, of which 83.3% had a 46,XX, and the rest of them had a 46,XY karyotype.

To investigate the relationship between unexplained elevated second-trimester free beta-human chorionic gonadotropin (beta-hCG) levels and pregnancy complications as well as adverse pregnancy outcomes. The study cohort comprised 2,110 non-smoking women with chromosomal and structurally normal fetuses at low-risk for both Down's syndrome (risk <1:250) and neural tube defects (maternal serum alpha-fetoprotein <2.0 MoM). A free beta-hCG value of > or =2.0 MoM was used to define the populations with elevated levels of free beta-hCG. Descriptive statistics, chi2 test, Fisher's exact test, and logistic regression analysis were used for statistical analysis, and p < 0.05 was considered statistically significant. The mean maternal age of the study group was significantly lower than in controls (27.9 +/- 4.3 and 30.6 +/- 5.1 years, respectively, p < 0.05), while the proportion of primigravidas was significantly higher compared to that of controls (p < 0.05). After adjustment of the 2 groups according to maternal age and parity, we observed an increased incidence of preeclampsia among women with elevated free beta-hCG levels in relation to controls (p < 0.05). However, a logistic regression analysis demonstrated that the free beta-hCG level was not a predictor of the occurrence of preeclampsia. No significant relationship was found with the incidence of gestational diabetes, oligohydramnios, polyhydramnios, pregnancy-related hypertension, intrauterine growth retardation, preterm delivery, spontaneous abortion and stillbirths (p > 0.05).