[Show abstract][Hide abstract] ABSTRACT: Aim:
The objective of the study was to examine whether cardiotocography can (CTG) predict asphyxia of the embryo, manifested as hypoxic-ischemic encephalopathy (HIE), and to what extent one can rely on CTG record.
Material and methods:
Retrospective research was carried out at the Clinic for Gynecology and Obstetrics UKC Tuzla and medical documentation from the history of mothers and newborns was used. The study group consisted of 68 pregnancies and newborns who developed HIE. The control group consisted of 40 pregnancies, which resulted in birth of healthy newborns – without signs of asphyxia. CTG records were analyzed, Apgar score, the ways of finishing delivery.
Pathological CTG records (bradycardia 100, tachycardia 180, silent type of curve, late decelerations) were found in 45 (66,17%) cases of the study group in comparison to 11 (27,5%) in the control group. In the study group Apgar score in 5th minute lower than 7 had 17,46% newborns and the highest incidence of the normally finished deliveries. We conclude that cardiotocography is one of the reliable methods of fetal monitoring in pregnancy and delivery, and that pathological CTG record very likely indicates the possible presence of perinatal asphyxia.
Achieving a low degree of correlation between pathological intrapartum cardiotocography findings and long-term outcome of children can be achieved by rapid and adequate obstetric intervention and the relatively short duration of fetal acidosis, and optimal procedures during intensive care of newborns.
Medical Archives 04/2014; 68(2):102-5. DOI:10.5455/medarh.2014.68.102-105
[Show abstract][Hide abstract] ABSTRACT: Each birth which has happened before gestation period of 37 weeks of gestation and which is not related to a degree of birth difficulty is called premature birth. Different researches pointed out that C-reactive protein (CRP) can be used as a possible marker of idiopathic preterm delivery. RESEARCH GOALS WERE: To examine reliability of CRP in mothers serum as a marker of premature birth among pregnant women who had no of the known risks for premature birth. To determine critical value of CRP in pregnancies this ended up as a premature birth. To determine connection between value of CRP and low birth weight of the newborn. The research is done in a form of prospective study on 200 pregnant women. Research included pregnant women without known risks factors for premature birth with condition that those women had suitable antenatal protection. All pregnant women were divided in into two groups, experimental and control group. Experimental group is consisted of 150 pregnant women who were regularly controlled in ambulance. Control group consisted of 50 pregnant women who were hospitalized at the Department for Pathology of pregnancy due to threatening miscarriage symptoms of condition that tocolytic index were less than 4. The value of CRP in serum of all pregnant women was determined in period from 20 to 24th week of gestation. In further course of pregnancy we followed those pregnant women with more often premature birth and if premature birth occurred more often in pregnant women with increased value of CRP in relation to women who had normal values. As a critical value for CRP was taken > 2 median value. Besides descriptive statistic methods in evaluating data processing were used (see text for symbols) test, student's t-test, Fishers test and Mann-Whitney test. RESULTS: Mean value of CRP in experimental group was 3.913 and in control group 14.92 (t = 4.72, p < 0.0001). Mean value of CRP was 18.17 in group of prematurely births and in women who gave birth on time 3.87 (t = 5.72, p < 0.0001). Value of CRP > 2 had 33 women who gave birth prematurely (16.5%). CONCLUSIONS: CRP can be used as a reliable marker of idiopathic premature birth. CRP value which is connected with development of premature birth is 4 mg/l. There is connection between the value of CRP > 2 and low birth weight of the newborn.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the influence of topical iodine-containing antiseptics on neonatal TSH in full-term infants born by Caesarean section in an iodine sufficient area.
Urinary iodide excretion (UIE) was estimated in 86 mothers on the second day after delivery by Caesarean section and their 86 full-term neonates. The mothers were divided into two groups according to the use of antiseptic to prepare Cesarean sections: 42 mothers who were prepared with povidone-iodine (Isosept, Bosnalijek) comprised the study group, and 47 mothers who were prepared with alcoholic solution (Skinsept color, Ecolab) formed the control group. Neonatal TSH was measured in whole blood drawn between day 3 and 5 of life, spotted on filter paper using a sensitive fluorometric assay (Delfia).
Maternal and neonatal UIE were significantly higher (p < 0.05) in the study group compared to the control group. No significant difference was found for neonatal TSH.
Our data suggest that perinatal iodine exposure of full-term neonates who were born by Caesarean section in an iodine sufficient area did not influence neonatal TSH, although median UIE was higher, suggesting optimal iodine intake during pregnancy. Further research is needed to define a critical value of urinary iodine concentrations in full-term neonates in an iodine sufficient area that may lead to the impairment of thyroid function.
[Show abstract][Hide abstract] ABSTRACT: Different researches pointed out that human placental alkaline phosphatase (hPIAP) can be used as a possible marker of idiopathic premature labour. Objective. To examine reliability of hPIAP in mothers serum as a marker of premature labour among pregnant women who had no any of known risks for premature labour and to determine critical value of hPIAP in pregnancies which terminated as a premature labour; to establish the relation between hPIAP and ¬newborns of low birth weight. Material and methods. The research is done in a form of prospective study of 150 pregnant women, who have had no known risks factors for premature labour and who have had adequate antenatal care. The value of hPIAP in serum of all pregnant women were determined in period from 20 to 24 weeks of pregnancy. In further course of pregnancy was evaluated does the premature labour occur more frequently in those with increased values of hPIAP in relation to women who had normal values. As a critical for hPIAP was taken the value over two medians (>2M). Results. The number of premature labours was 17 (11.3%). Mean value of hPIAP in pregnant women who delivered prematurely was 1195, while in those who gave birth on time 632.16. The difference is statistically significant (p<0.0001). Value of hPIAP >2M had 29 (19.34%) of women who gave birth prematurely. Conclusion. hPIAP can be used as a reliable marker of idiopathic premature labour in pregnant women who have no risk factor for premature labour. hPIAP values which is related to development of premature labour is 990 mU/l.
[Show abstract][Hide abstract] ABSTRACT: The objective is to examine the efficiency of the application of prostaglandins (PgE2) in labours with the complications of premature rupture of membranes (PRM) for the purpose of their more frequent use.
Two groups of term labours with the complications of PRM were observed in Gynaecology and Obstetric Clinic in Tuzla, in 2002. In the examination group No=59 (46.82%), we used vaginal suppositories prostin E2 (3 mg) for stimulation of labour. In the second group of pregnant women, No=67 (53.17%) we used oxytocin for stimulation. The following was observed: the age of pregnant women, parity, Bishop score, latent period (time from application of the medicine until delivery), manner in which the labour was ended, birth weight, Apgar score after the first and the fifth minute, incidence of complications (infections and bleeding) in the period of confinement/puerperium).
PgE2 were applied in pregnancies in earlier gesational age (37.31 versus 39.13), more often in nulliparous women (86.46%), in the case of immature cervix (Bishop score 3.70 versus 5.95). There were 80.45% successful stimulation, the same incidence of Cesarean sections, with no difference in the condition of newborns at birth (average Apgar score in the group with Pg 8.63), without difference in the incidence of complications in the confinement puerperium. In the group with Pg, there was a small percentage of infections, although the latent period was in 5.67% pregnancies longer than 24 hours.
The application of PgE2 vaginal suppositories for maturing and stimulation of labour is a modern, efficient and easy to use method in obstetrics which is very acceptable.
[Show abstract][Hide abstract] ABSTRACT: Objective. The aim of this study is to appreciate the mode of delivery in the pregnant women with placenta praevia. Methods. Retrospective study. We analized 9010 deliveries (two years period, 2001 and 2002) performed at the University Clinical Center, Tuzla, Ob/Gyn Clinic. Control group were 16 pregnant women without placenta praevia. In statistical analysis t-test was used. Results. The incidence of placenta praevia was 0.17% (16 out of 9010 deliveries). Placenta praevia partialis was established in 8 (50%), placenta praevia centralis in 4 (25%) and placenta praevia marginalis in 4 (25%) pregnant women. All pregnant women with placenta praevia were secundiparas and multiparas. The caesarean section was previously performed in 8 (50%) pregnant women. In actual pregnancy in 14 (87.5%) of pregnant women with placenta praevia the mode of delivery was by caesarean section, in the control group in 3 (18.75%), the t-test is 5.72, p<0.05. Apgar score 8–10 was in 12 and 4–7 in 4 (25%) neonates; in the control group Apgar score 4–7 was only in one case (6.25%); the statistical difference is not significant. The gestational age at delivery in 8 cases was 37 weeks, in the control grup in 2; the difference is statistically significant (t=2.51, p<0.05). Conclusion. Placenta praevia is a serious complication of pregnancy. The method of choise in the delivery for pregnant women with placenta praevia is caesarean section.
[Show abstract][Hide abstract] ABSTRACT: Preterm labour is most common complication of second half of pregnancy, incidence is 7 to 10% of all delivers. One of most important causes of increased mortality and morbidity of neonates is respiratory distress syndrome. Numerous studies prove that corticosteroids given antenatal to mother decrease the incidence of preterm delivered neonates. AIM OF THIS STUDY IS: To determined influence of dexamethasone given prepartal on maturation of neonatal lungs in correlation with gestational age.
This study include 150 pregnant women which delivered before 37 week of gestation. They are divide in three groups: two experimental and one control group. Group E1 consists of the pregnant women which received dexamethasone for five days in a single dose of 12 mg. Group E2 consists of the pregnant women which received dexamethasone less then five days, in a single dose of 12 mg. In the control group consists of the pregnant women which did not received dexamethasone. In this work we used gestational age in the moment of delivery. State of neonate is determined on the base of presence of clinical signs of respiratory distress syndrome after birth. Statistical method used in this work was test of proportion.
In this work we find that there is a less number of neonates who has respiratory distress syndrome in group consists of the pregnant women which received dexamethasone for five days, 5 (10%). In group consists of the pregnant women which received dexamethasone less then five days, number of neonates with respiratory distress syndrome was 12 (24%). The number of neonates with respiratory distress syndrome in control group was 21 (42%). The value of test of proportion: K/E1 (the pregnant women received dexamethasone for five days)-z = 1.95, p < 0.05; K/E2 (pregnant women received dexamethasone less than five days)-z = 3.92, p < 0.05. In all three groups largest number of neonates with respiratory distress syndrome was between 31-34 week of gestation. Highest mortality of neonate with respiratory distress syndrome was in control group, 7 (14%), than in group consists of the pregnant women received dexamethasone lass then five days, 4 (8%). In group consist pregnant women received dexamethasone for five days, there were not cases of mortality caused by respiratory distress syndrome. The value of test of proportion was z = 2.85 (p < 0.05), between control group and group consists of the pregnant women received dexamethasone for five days.
Dexamethasone accelerates maturation of fetal lungs, decrease number of neonates with respiratory distress syndrome and improves survival in preterm delivered neonates. Optimal gestational age for use of dexamethasone therapy is 31 to 34 weeks of gestation.