Slobodan Arsenijevic

Oxidative stress in fetal distress: potential prospects for diagnosis.

Our aim was to investigate the relation between fetal distress and oxidative stress. Fetal distress was associated with increased concentration of superoxide in the fetal blood and with significant increase of the level of H2O2 in both maternal and fetal blood. The activity of superoxide dismutase was increased roughly sixfold (p<0.01) in the maternal (7330 +/- 2240 U/g of hemoglobin in controls (C) and 36811 +/- 16862 U/g in fetal distress (FD)) and fetal blood (C: 5930 +/- 2641 U/g; FD: 41912 +/- 17133 U/g). In contrast, fetal distress was related to a considerable decrease of catalase activity in both maternal (C: 26011 +/- 8811 U/g; FD: 7212 +/- 1270 U/g) and fetal blood (C: 37194 +/- 9191 U/g; FD: 6173 +/- 1965 U/g). From this we concluded that in fetal distress, the maternal and fetal bloods are exposed to superoxide- and H2O2-mediated oxidative stress, which could be initiated by hypoxic conditions in the fetal blood and placenta. A tremendous increase/decrease of the activities of superoxide dismutase/catalase in the blood of women bearing a distressed fetus in comparison to healthy subjects implies that the assessment of superoxide dismutase/catalase activity could be of use for establishing a timely and accurate ante- or intrapartum diagnosis of fetal distress.

Cervical precancerous lesions – chromosomal instability in peripheral blood lymphocytes in relation to lesion stage, age and smoking habits

Objective. To evaluate chromosomal damage in peripheral blood lymphocytes (PBL) of patients newly diagnosed with cervical precancerous lesions with respect to age, smoking habits, miscarriages, abortions and lesion stage. Design. Clinical study. Setting. Clinic of Gynecology and Obstetrics in Kragujevac, Serbia, during 2009‐2010. Population. The analyzed samples included 41 untreated patients aged 24–65years with a diagnosed low‐grade squamous intraepithelial lesion (LSIL; 19 patients) or a high‐grade squamous intraepithelial lesion (HSIL; 22 patients). Control samples were obtained from 40 healthy women aged 24–53 years. Methods. The frequency of micronuclei (MN) was estimated in circulating lymphocytes by using the cytokinesis‐block micronucleus assay. Main Outcome Measure. The frequency of MN in PBL. Results. The mean MN frequencies of both LSIL and HSIL patients were significantly higher than the MN frequency of healthy control women. There was no significant difference in MN frequency between LSIL and HSIL patients, between smokers and nonsmokers in both patient and control samples, or between miscarriage groups and abortion groups of patients. Considering confounder factors, age and health status influenced MN frequency. Conclusions. The results suggest that MN frequency in PBL of patients with cervical precancerous lesions corresponds to an increase of chromosomal damage, irrespective of smoking habits, miscarriages, abortions and lesion stages.

Glutathione S-Transferase T1 and M1 Polymorphisms and Risk of Uterine Cervical Lesions in Women from Central Serbia

The aim of this study was to investigate the frequencies of GSTT1 and GSTM1 deletion polymorphisms in newly-diagnosed patients with uterine cervical lesions from central Serbia. Polymorphisms of GST genes were genotyped in 97 patients with cervical lesions and 50 healthy women using a multiplex polymerase chain reaction (PCR). The GSTM1 null genotype was significantly more prominent among the patients than in controls (74.2% vs 56.0%), the risk associated with lesions being almost 2.3-fold increased (OR=2.26, 95%CI=1.10-4.65, p=0.03) and 3.17-fold higher in patients above >45 years old (95%CI=1.02-9.79, p=0.04). The analysis of the two genotypes demonstrated that GSTM1 null genotype significantly increased risk only for low grade squamous intraepithelial lesion-LSIL (OR=2.81, 95%CI=1.03-7.68, p=0.04). GSTT1 null genotype or different genotype combinations were not found to be risk factors, irrespective to lesion stages, age or smoking. We found that the risk of cervical lesions might be significantly related to the GSTM1 null genotype, especially in women aged above 45 years. Furthermore, the GSTM1 polymorphism might have greater role in development of early stage lesions.

Continuous controllable balloon dilation: a novel approach for cervix dilation

BackgroundCervical dilation using mechanical dilators is associated with various complications, such as uterine perforation, cervical laceration, infections and intraperitoneal hemorrhage. To achieve safe and painless cervical dilation, we constructed a new medical device to achieve confident mechanical cervical dilation: a continuous controllable balloon dilator (CCBD).MethodsControlled pumping of incompressible fluid into the CCBD increases the pressure and outer diameter of the CCBD, continuously dilating the cervical canal. The reliability of the CCBD was confirmed in vitro (testing for consistency and endurance, with no detected risk for breakage) and in vivo. A multi-center clinical study was conducted,with 120 pregnant women randomly assigned to one of three groups: Group I,control group, no dilation;Group II,mechanical dilation, Hegar dilator (HeD); and Group III,CCBD. The tissue material for histological evaluation was obtained from the endocervical mucosa before and after dilation using the HeD or CCBD.ResultsThe CCBD dilations were successful and had no complications in all 40 patients of Group III. The cervical tissue was markedly less damaged after CCBD dilation compared with HeD dilation (epithelium damage: 95% (HeD) vs. 45% (CCBD), P <0.001; basal membrane damage: 82.5% (HeD) vs. 27.5% (CCBD), P <0.001; stromal damage: 62.5% (HeD) vs. 37.5% (CCBD), P <0.01). Cervical hemorrhagia was observed in 90% of the patients after HeD dilation versus in 32.5% of the patients after CCBD dilation.ConclusionsThe CCBD should be used as a replacement for mechanical dilators to prevent uterine and cervical injury during cervical dilation.Trial registrationISRCTN54007498

Muscle strength measurement of pelvic floor in women by vaginal dynamometer

INTRODUCTION The pelvic floor is made of a mutually connected system that consists of muscles, connecting tissue and nerve components. Damage to any of these elements creates dysfunction which is exerted through stress, urinary incontinence, prolapse of genital organs and faecal incontinence. OBJECTIVE The primary aim of this study was to present the possibility of objective assessment of pelvic floor muscle force in healthy and sick women using a newly designed instrument, the vaginal dynamometer, as well as to establish the correlation between the values of pelvic floor muscle force obtained by the vaginal dynamometer and digital palpation method. METHODS The study included 90 female patients, age 20-58 years. One group of respondents was made of healthy women (who gave birth, and those who have not given birth), while the other one consisted of sick women (who suffered from incontinence or prolapse of genital organs, operated on or not). The pelvic floor muscle strength of every woman was measured with a newly-constructed device for measuring and monitoring of the pelvic floor muscle force in women, the vaginal dynamometer. Then it was compared with the valid clinical digital palpation (palpation with two fingers) based on the scale for measuring muscle contractions with the digital palpation - the digital pelvic assessment rating scale. The vaginal dynamometer consists of a redesigned speculum which is inserted into the vagina and a sensor for measuring the force. RESULTS Statistically significant linear correlation was found in the values of the measured muscle force with the vaginal dynamometer and ratings produced by digital palpation (r = 0.92; p < 0.001). Mean value of the muscle force of the healthy women measured by the vaginal dynamometer was 1.44 +/- 0.38 daN and that value of the sick women was 0.78 +/- 0.31 daN (t = 8.89 for df = 88; p < 0.001). Mean value of the ratings produced by digital palpation in healthy women was 4.10 (95% of trust limits 3.83-4.37), while the value in sick women was 2.41 (95% of trust limits 2.10-4.16) (Z = -6.38; p < 0.001). CONCLUSION The vaginal dynamometer has been presented as an attempt to overcome the limitations of the previously presented techniques for muscle force measurement. The application of the vaginal dynamometer in clinical practice makes objective and numerical assessment of pelvic floor muscle force possible, independent of the subjective assessment of the examiner. The usage of this instrument enables not only the diagnostics of womens pelvic floor muscle problem, but also the objective monitoring of rehabilitation gynaecological medicine results.

The frequency of micronuclei among newborns from Kragujevac, Central Serbia, after NATO bombing in the spring of 1999

Kragujevac, as an important industrial and economic center of the region, is now placed on the top of the list of environmentally endangered cities in our country. The aim of this biomonitoring study was to evaluate cytogenetic damage in a sample of newborns from Kragujevac after contamination of the environment entailed by the intensive bombing of the industrial zone of this city in the spring of 1999. The frequency of micronuclei (MN) in peripheral blood lymphocytes in a total of 61 phenotypically healthy newborns was analyzed before and after the NATO bombing. Analysis of micronuclei has been performed using the cytokinesis-block technique (CB MN test). Average MN frequency in lymphocytes of newborns before the bombing (N = 25) was 5.77 ± 0.85/1000 analyzed cells. After the bombing (N = 36), the average frequency of MN increased by a factor of 1.4 (8.11 ± 0.85), compared to the control frequency before the bombing. Statistical difference (p < 0.05) was established by Students t-test. Our data suggest that such changes in genetic material were a direct consequence of contamination of the living environment.

Computer simulation of cervical tissue response to a hydraulic dilator device

BackgroundClassical mechanical dilators for cervical dilation are associated with various complications, such as uterine perforation, cervical laceration, infections and intraperitoneal hemorrhage. A new medical device called continuous controllable balloon dilator (CCBD) was constructed to make a significant reduction in all of the side effects of traditional mechanical dilation.MethodIn this study we investigated numerically the cervical canal tissue response for Hegar and CCBD using our poroelastic finite element model and in-house software development. Boundary conditions for pressure loading on the tissue for both dilators in vivo were measured experimentally. Material properties of the cervical tissue were fitted with experimental in vivo data of pressure and fluid volume or balloon size.ResultsObtained results for effective stresses inside the cervical tissue clearly showed higher stresses for Hegar dilator during dilation in comparison with our CCBD.ConclusionThis study opens a new avenue for the implementation of CCBD device instead of mechanical dilators to prevent cervical injury during cervical dilation.

Breech presentation at term: Caesarean section or vaginal delivery?

INTRODUCTION Term breech presentation occurs in 3-4% of all deliveries. Most obstetricians are completely sure how to end delivery when the foetus is in breech presentation, by caesarean section as the only option. OBJECTIVE The main goal of the paper was to present the method of delivery for term breech presentation analyzed at the Hospital of Gynaecology and Obstetrics and Clinical Centre in Kragujevac, and parameters that influenced the decision on the method of choice to perform delivery with the foetus in breech position. METHODS During a three-year prospective study, the course and outcome of all term breech deliveries were under followup. The study involved only deliveries in breech presentation, with a trial of labour ending by vaginal delivery, while elective caesarean section due to breech presentation of the foetus was not included in the study. The following parameters were compared: body mass, newborns first minute Apgar score and head circumference, gestational maturity, gestational age, delivery duration, maternal level of education and maternal parity. RESULTS Of total 6,470 deliveries, 653 (10.10%) were finalized by caesarean section. Of these, there were 202 (3.12%) term breech presentations, of which 72 (35.64%) women had caesarean and 130 (64.36%) vaginal delivery. A difference was detected in newborns body mass and head circumference, delivery duration, maternal level of education and parity between pregnancies terminated surgically in comparison to vaginal delivery, while pregnancy duration, maternal age, first minute Apgar score, and most significantly, perinatal morbidity did not show any difference regardless of the method of delivery for term breech presentation. CONCLUSION With respect of all known parameters, vaginal delivery in breech presentation is also accepted.