Tanja Premru Sršen

Impact of prenatal screening on the prevalence of Down syndrome in Slovenia

Objectives To evaluate the impact of prenatal screening and genetic testing for trisomy 21 (T21) on the prevalence of T21 in Slovenia. Design and setting Data about all prenatally and postnatally confirmed cases of T21 in Slovenia between 1981 and 2012 were collected retrospectively from all genetic laboratories in Slovenia. The expected number of babies with T21 according to maternal age was calculated. Main outcome measures The primary outcomes measures were number of fetuses and newborn infants with T21 diagnosed prenatally and postnatally and the impact of advances in screening and genetic diagnostics on the prevalence of newborns with T21 in Slovenia. Results Despite a significantly increased mean maternal age from 25.4 years in year 1981 to 30.3 years in year 2012 the prevalence of newborn infants with T21 was 0.51 per 1000 births compared to 0.55 per 1000 births, respectively. The prevalence of prenatally diagnosed cases increased from 0.03 per 1000 births to 2.06 per 1000. The detection rate of T21 in year 2012 was 78,9%. The total number of prenatal invasive procedures (chorionic villous sampling and amniocenteses) carried out during that period was rising until 2002, since when it is stable at around 7%. Conclusion The advancement and implementation of screening tests and prenatal diagnostic procedures in Slovenia caused an important improvement in the efficiency of the prenatal detection of T21.

Violence before pregnancy and the risk of violence during pregnancy

Abstract Objective: To investigate the relationships among different forms of violence before and during pregnancy. Material and methods: An anonymous questionnaire (adapted NorAQ) was given to 1269 women after childbirth. Results: The response rate was 80% (n=1018). Different forms of violence were experienced by 46.9% of the women; 9.2% reported violence in pregnancy. Suffering from the consequences of violence was reported by 43.8% of the women; sexual (76.6%) and psychological (54.1%) ranked the highest. Past experience of any form of violence increased the risk of violence in pregnancy, violences experienced in adulthood even more than that in childhood [odds ratio (OR) 4.2, 95% confidence interval (CI) 2.7–6.5 vs. OR 1.9, 95% CI 1.2–2.9]. The onset of violence during pregnancy is rare. Violence was most frequently exerted by the intimate partner. Conclusion: Healthcare systems have access to most women of reproductive age, thus they have the unique opportunity to identify and adequately manage violence against women and its consequences.

Abuse of pregnant women in the healthcare system

Abstract Objective: The purpose of this study was to determine the incidence of abuse in healthcare system during pregnancy and its impact on pregnancy outcomes. Materials and methods: A validated screening Norvold Abuse Questionnaire for the identification of female victims of four kinds of abuse: emotional, physical, sexual, and the abuse in the healthcare system was anonymously offered to all women in the first 2 days postpartum. Results: The study group consisted of 1018 women, 6.2% of which reported experiencing abuse in healthcare system during pregnancy. Affected women had a higher incidence of preterm delivery (OR 2.4; 95% CI 1.2–4.8) and cesarean section rate (OR 2.0; 95% CI 1.1–3.6). Sexual abuse and abuse in healthcare system during childhood were associated with abuse in healthcare system during pregnancy (OR 4.4; CI 95% 1.2–16.2 and OR 6.9; CI 95% 1.3–35.4, respectively). Conclusions: Our study indicates that as many as 6.2% of pregnant women experience abusive encounters with perinatal care providers. These pregnancies eventually end more often preterm and by cesarean section. This possibly causal relationship should be further explored.

The role of health services in encouraging disclosure of violence against women

Abstract Introduction The aim of the survey was to assess the differences in disclosure by the type of violence to better plan the role of health services in identifying and disclosing violence. Methods A validated, anonymous screening questionnaire (NorAQ) for the identification of female victims of violence was offered to all postpartum women at a single maternity unit over a three-month period in 2014. Response rate was 80% (1018 respondents). Chi square test was used for statistical analysis (p<0.05 significant). Results There are differences in disclosure by type of violence. Nearly half (41.5%) of violence by health care services was not reported, compared to 33.7% physical, 23.4% psychological, and 32.5% sexual that was reported. The percentage of violence in intimate partnership reported to health care staff is low (9.3% to 20.8%), but almost half of the violence experienced by heath care services (44%) is reported. Intimate partnership violence is more often reported to the physician than to the psychologist or social worker. Violence in health care service is reported also to nurses. Conclusions Disclosure enables various institutions to start with the procedures aimed at protecting victims against violence. Health workers should continuously encourage women to speak about violence rather than asking about it only once. It is also important that such inquiries are made on different levels of health care system and by different health care professions, since there are differences to whom women are willing to disclose violence.

Management of a pregnant woman with multiple erythrocyte alloantibodies – Case report

Background: Hemolytic disease of the fetus and newborn (HDFN) is caused by erythrocyte allo‑antibodies present in the maternal plasma dur‑ing pregnancy, which cross the placental barrier and enter the fetal bloodstream, bind to fetal erythrocyte antigens and cause destruction of fetal erytrhocytes. Hemolysis leads to fetal anemia, which can cause fetal death if not treated. Case report: We report a case of HDFN in a multiparous female with multiple erythrocyte alloantibodies of anti‑C+G, anti‑E, anti‑Kp(a) and anti‑Kn(a) specificity. In her third preg‑nancy we found erythrocyte alloantibodies of anti‑C+G and anti‑Kp(a) specificity for the first time. Erythrocyte alloantibodies titers were low and fetal hemolysis was not expected. However, in the 30th week of pregnancy obstetricians observed rapid development of fetal anemia, which was due to hemolysis. The pregnancy was ter‑minated. Despite an exchange transfusion, the newborn died a few days after birth because of HDFN. In the following pregnancy, titers of al‑ready known erythrocyte alloantibodies were high and very severe hemolysis was predicted. In the 22nd week obstetricians found fetal hydrops. Despite intrauterine transfusion (IUT), the preg‑nancy ended with intrauterine fetal death. The fifth pregnancy ended with miscarriage in the 11th week of pregnancy. In the last pregnancy, titers of known erythrocyte alloantibody were high and again very severe hemolysis was predicted. In the 17th and 20th week of pregnancy, erythrocyte alloantibody titers increased. In the 22nd week of pregnancy, obstetricians observed fetal anemia and decided to perform an IUT. The fetus received seven IUTs. After the second IUT, additional erythrocyte alloantibodies of anti‑E and anti‑Kn(a) specificity were found in the ma‑ternal plasma. In the 34th week of pregnancy, ob‑stetricians terminated the pregnancy with elec‑tive caesarean section. The child was born with no signs of hemolytic anemia. Conclusion: HDFN is still considered an unpredictable disease. By the help of modern pro‑cedures for monitoring of immunised pregnant women also those pregnant women with mulip‑le, clinically significant erythrocyte alloantibod‑ies can be successfully managed in the course of pregnancy.