Matija Prka

• MD, PhD, Ob/Gyn specialist
• Obstetrician, Labor & Delivery Unit at Sveti Duh University Hospital

Objective: The goal of this study was to (a) examine the association between childbirth-related posttraumatic stress disorder (CB-PTSD) symptoms and possible risk factors of previous trauma, individual characteristics (neuroticism, anxiety sensitivity, and resilience), type of birth, and birth satisfaction and (b) explore whether birth satisfaction...

Background and purpose: The aim of this study was to correlate obstetric admissions at a tertiary perinatal center with biometeorological forecast and weather conditions. Materials and methods: This retrospective study was conducted at the Department of Gynaecology and Obstetrics Clinical Hospital “Sveti Duh” over five years, from January 1, 2014 t...

Yolk sac tumors are highly malignant and commonly affect the ovaries, with a median age of occurrence of 23 years. We describe the case of an ovarian yolk sac tumor in a 12-year-old premenarchal girl suffering from Hashimoto's thyroiditis and chronic spontaneous urticaria, which presented as a rapidly growing solid cystic formation in the hypogastr...

Background and purpose: The effect of weather on people’s well-being and health has been previously noticed and has been a subject of interest for medical professionals and laypeople throughout human history. There are many studies connecting gynecology and obstetrics with weather, some of them investigating the weather and physiological processes...

Objectives This study will present our results in management of fetal shoulder dystocia with special consideration of maternal and neonatal outcome. Study design A retrospective study was performed at a university tertiary perinatal center. The study included data of singleton vaginal term deliveries in the period of 15 years (2006-2020). Analized...

Objectives Prove the success of transvaginal hemostatic procedures in treatment of the early postpartum hemorrhage caused by lower uterine segment atony. Methods We have conducted a retrospective, clinical study during a 10-year period (2010–2019) in our institution that is tertiary perinatal university center. Results This particular study enrol...

We report and discuss the case of a 29-year-old tercigravida with intrapartum cardiorespiratory arrest due to a massive amniotic fluid embolism and disseminated intravascular coagulopathy. Perimortem caesarean section with B-Lynch compression uterine suture with simultaneous fetal and maternal resuscitation were performed with a favorable outcome f...

Aim of the study: Lateral episiotomy is a widely used procedure, although it is rarely mentioned in the literature and its effects on the pelvic floor are largely unexplored. The purpose of this study is to evaluate the impact of lateral episiotomy on the incidence of urinary incontinence (UI) after vaginal delivery in primiparas. Material and me...

Objectives: To evaluate peripartum hysterectomy (PH) at a tertiary referral center during the 1994-2018 period. Methods: Retrospective analysis of all patients having undergone PH included data on obstetric history, indications, maternal mortality and morbidity. Results: During the study period, 52 PHs were performed. The incidence of PH was 0.71‰;...

Background: Fetal malpresentations and malpositions are more common in placenta previa and uterine cavity abnormalities. Aim: To show successful management of focal increta placentomegaly and uterine preservation in primiparous woman. Case report: We describe posterior low-lying focal increta placentomegaly verified during cesarean section, wh...

Synopsis A new and simple method for volumetric measurement of a normal female cervix by three‐dimensional transvaginal ultrasound, using a geometric formula for elliptic cylinders.

Purpose: Lower uterine segment atony is recently being recognized as one of the major reasons for early postpartum hemorrhage. Methods: We present our experience in surgical treatment of lower uterine segment atony patients that were delivered in our tertiary perinatal center during the 10 years period (2010-2019). Results: This particular study en...

Increasing the incidence of caesarean section is not in line with professional and deontological guidelines. Elective cesarean section prevents primordial prevention of chronic cardiovascular, gastrointestinal, imunological, endocrinological morbidity by peripartal programming. Elective non-medical indicated caesarean section is not a procedure tha...

• Rutinska epiziotomija isključena je iz kliničke prakse • Punu potvrdu dobila je restriktivna epiziotomija, utemeljena na medicinskim indikacijama • Potrebno je pronaći ravnotežu (u uvjetima mediolateralne ili lateralne epiziotomije) između optimalne stope epiziotomije < 30 % (prvorodilje: < 50 %, višerodilje: < 10 %) i s time povezane stope OASIS...

At the beginning of 2016, the Ministry of Health of the Republic of Croatia established an expert working group with the aim of developing and adapting the guidelines of the International Federation of Gynecologists and Obstetricians (FIGO) for the implementation of the "Mother Friendly Hospital Initiative” in Croatia. Representatives of the Rijeka...

Aim: To determine the number and prevalence of third- and fourth-grade perineal tears with restrictive use of episiotomy, and the prevalence of obstetric anal sphincter injuries (OASIS) according to parity, mode of labor termination, delivery duration, epidural analgesia, obstetric team experience, and neonatal birth weight and head circumference....

Studies indicate that 3D power Doppler imaging can improve the ability to differentiate benign from malignant ovarian masses, increasing significantly specificity and positive predictive value (PPV) in ovarian cancer detection. Therefore, the problem of low PPV in ultrasound-only strategies may be solved by introducing new 3D ultrasound technologie...

Multidisciplinarni sveučilišni udžbenik namijenjen čitateljstvu raznih struka koji se izravno ili neizravno bave forenzikom u ginekologiji i perinatologiji.

Introduction and aim of the study. In Sveti Duh Hospital restrictive lateral episiotomy was introduced during the year 2010, when total episiotomy rate (TER) has fallen for the first time below 30% (Prka et al., 2015). In comparison with TER of 39.1% on the national level in the year 2012, annual TER in our institution was significantly lower 18.1%...

The aim is to present the 60-year experience in modified Ritgen maneuver according to perineal injuries. This retrospective clinical observational study (1950-2010) analyzed the impact of modified Ritgen maneuver delivery technique (controlled fetal head deflexion with left hand and synchronous reduction of perineal strain with extended right hand...

Lateralisation of episiotomy, slowing of the expulsion of the fetal head, and manual perineal protection (MPP) represent important set of preventive interventions for avoiding obstetric anal sphincter injuries (OASIS) (Kalis et al., 2016). Until now, three techniques of MPP were described: 1) hands-on: perineal protection during crowning of the fet...

Introduction. Routine episiotomy has currently been abandoned according to the leading guidelines (ACOG), systematic reviews (Cochrane Database), and web databases (UpToDate®). In 1993, Belizán et al. reported that the restrictive episiotomy rate above 30% was not clinically justified. When defining the lower limit for 'safe' episiotomy rate, it is...

Although known for decades as an obstetric maneuver and described by Liepmann, there are only few literature reports on manual rotation (MR) of fetal head in intrapartum arrest caused by fetal malrotation and malpresentation in the second stage of labor [1–3]. In our hospital as a tertiary center in perinatal medicine, MR is regularly used by four...

We report a rare case of spontaneous intraperitoneal bladder rupture following normal vaginal delivery without concomitant uterine rupture. Key diagnostic clinical features were acute renal failure, new-onset ascites and bowel ileus with urosepsis. Laparotomy and bladder repair with omentum patch were performed with no adverse outcome reported. © G...

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Episiotomy is a surgical incision to the perineum made during the last part of labour to facilitate delivery. It should always be defined by the location of the beginning, direction, length, and timing. Seven episiotomy types have been identified. However, only three (midline, mediolateral, and lateral) are routinely used. Exact placement of episio...

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We present a case of invasive malplacenta-tion of the lower uterine segment found in a first trimester, 38-year old woman following curettage for missed abortion. Uncontrolled hemorrhage and obstetric hemorrhagic shock developed, resulting in abdominal hysterectomy, with resuscitation. The patient made a full recovery.

Objective: To report a rare uterine anomaly of a septate uterus, double cervix and double vagina in patient who conceived spontaneously and delivered vaginaly. Design: Case report. Setting: Department of Obstetrics and Gynecology, Zagreb University School of Medicine, Clinical Hospital “Sveti Duh”, Zagreb, Croatia. Patient(s): A 34-year-old nulligr...

Trauma je vodeći neopstetrički uzrok maternalne smrtnosti, a prema procjenama u SAD-u doživi je 5-8% žena tijekom trudnoće. Osnovni uzroci traume u trudnoći uključuju prometne nesreće, obiteljsko i seksualno nasilje, padove, ubojstva i samoubojstva, penetrirajuće ozljede, opekline, te otrovanja. Skrb za trudnicu koja je pretrpila traumu zahtijeva m...

Purpose. We present experience of B-Lynch compression sutures for treatment of severe postpartum hemorrhage. Methods. Between 2007-2014 in the Department of Gynecology and Obstetrics, University Hospital “Sveti Duh”, Zagreb, Croatia, as a tertiary perinatal center (3200 delivery/year), 10 B-Lynch compression sutures were placed. Results. Out of 10...

Introduction: Peripartal hysterectomy (PPH) is a life saving surgical procedure that is performed when conservative measures fail to control bleeding. According to literature data there is an increase in incidence among developed countries. Aim: To define the rate of PPH during two eight-year periods in five Croatian hospitals in respect to mode of...

Introduction: Over the last >30 years, obstetricians and midwives around the world keep asking continuously significance of episiotomy. Methods: Concise review of relevant and recently published articles in the field of obstetric perineal trauma, and short analysis of annual rate of episiotomy and obstetric anal sphincter injuries (OASIS) in Clini...

Vacuum extractor has progressively replaced forceps as the device of choice for assisted vaginal births in everyday practice. The primary goal of this retrospective study was to analyze the impact of Malmström stainless steel vacuum cup versus polyethylene-silastic cup and KiwiTM OmniCup extractor on short term maternal and neonatal outcomes. The s...

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Purpose The acronym for obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) was created to describe patients with an obstructed hemivagina and ipsilateral renal anomaly and enables inclusion of other uterine anomalies except uterus didelphys. The main goal of this article is to present a rare case of OHVIRA syndrome with intrapartal ruptu...

Vasa previa is rare (1 in 2500 deliveries) and serious condition that can be fatal for the fetus. Significant difference was found in the survival rate of the neonates in pregnancies with prenatally diagnosed and undiagnosed vasa previa (97% vs. 44%). The main goal of this report is to emphasize the importance of antenatal diagnosis of vasa previa.

Purpose of the study: To review relevant information about postpartum hysterectomies (PH) and assess trends in incidence, indications, maternal mortality and morbidity and associated factors in tertiary referral center during 20 years' period. Study design: Retrospective study of all patients having PH (either early or late) in period from 1994 to...

A case is presented of a operated giant pedunculated vulvar lipoma weighing 14 kg in a patient with concomitant inoperable giant ventral postoperative hernia, complete diastasis of the anterior abdominal wall musculature and endometrial adenocarcinoma.

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Shoulder dystocia as an unpredictable intrapartal emergency with incidence from 0,6-1,4% represents one of the most important problem among obstetric controversies today. Medico-legal approach for shoulder dystocia is based upon good clinical practice according to algorithms of modern obstetrics. Well trained and cool-headed obstetrician with corre...

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Ovarian metastatic malignant melanoma is a rare form of disseminated malignant melanoma. We present a rare case of acute abdomen due to rupture of ovarian metastatic malignant melanoma seven years after removal of a primary cutaneous malignant melanoma lesion, followed by reexcision of the cicatrix and axillary dissection (Clark III, Breslow IV), o...

Episiotomy is obstetrician’s surgical procedure of perineal incision and it is done as prophylaxis against soft-tissue trauma of perineal region. According to prevalence it represents second surgical procedure in the world at all, following another surgical procedure from our profession, clamping and cutting the umbilical cord. During last 30 years...

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Abstract In developed countries more women die annually from ovarian cancer than from all other gynecologic malignancies combined. The fact that the ovaries are deep within the pelvic cavity and difficult to palpate is an obstacle to early diagnosis, especially in peri-post menopausal women, the group with the highest incidence of the disease. Seve...

To analyze two different methods for performing three-dimensional power Doppler angiography (3D-PDA) vascular sampling in solid and cystic-solid adnexal masses. Twenty-one 3D-PDA volumes from 18 consecutive and unselected solid or cystic-solid adnexal masses (13 malignant and five benign) were analyzed. A single examiner (J. L. A.) acquired all the...

Transvaginal grayscale sonography plays an important role in the assessment of the morphology of ovarian lesions. However, the accuracy of the technique is limited due to the significant number of false-positive results. Color Doppler imaging enable evaluation of ovarian tumor blood flow, analysis of the distribution of blood vessels, and quantitat...

To determine whether introducing three-dimensional (3D) ultrasonography with power Doppler facilities as a secondary screening test, preceded by annual transvaginal grayscale ultrasonography (TVUS) (followed by transvaginal color Doppler (TVCD) in selected cases) as a primary screening test for ovarian cancer improves the accuracy of ovarian cancer...

Maldevelopment of the vagina is usually combined with aplasia/hypoplasia of the uterus. Complete vaginal aplasia with a normally developed uterus and cervix is an extremely rare form of developmental failure. The accepted treatment for this kind of maldevelopment is hysterectomy plus creation of a neovagina. We present the case of 12-year-old girl...

Objective. Ultrasound diagnostics and hysteroscopic technique made a hughe progress in accurate detection of failure of fusion of the Müllerian ducts and failure of resorption of the intervening septum, which are occuring during embryologic development from 6 to 20 weeks and result in formation of uterine septa of variable lengths and positions. Th...

The objective was to determine the diagnostic accuracy of three-dimensional (3D) sonography and 3D power Doppler imaging, used together with standard 2D transvaginal grayscale and color/power Doppler modalities, for preoperative sonographic assessment of suspected ovarian lesions. Five-year retrospective analysis was performed by our experts on ult...

During the last decade, a great interest in developing an effective strategy for ovarian cancer screening has been observed. Two distinct strategies have emerged: the first based on transvaginal ultrasound, and the second called multimodal screening. This review addresses most of the papers published on this topic in the last 5 years and summarizes...

To analyze medical students wishes regarding their professional and private life and whether their wishes change over the years of medical studies. We surveyed 886 of 1,686 students at the Zagreb University School of Medicine during the academic year 2000/2001. The students were asked to complete an anonymous questionnaire with two groups of 5 wish...

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https://www.bmj.com/content/322/Suppl_S5/0105156

To assess whether the prospect of waiving tuition fees influences the academic performance of the students with the lowest admission test scores and consequent mandatory tuition. We compared the 110 tuition-paying students with the students who did not have to pay tuition because they scored well on 1994-1997 admission tests to the Zagreb School of...

War, as a major human disaster, affects many aspects of life, including medical education. This report describes curricular and extracurricular activities of the students at the Zagreb University School of Medicine during the wars in Croatia and neighboring Bosnia and Herzegovina. Although condensed versions of the curricula were prepared in case o...