Vekoslav Lilic

Placental complications after a previous cesarean section

INTRODUCTION The incidence of cesarean section has been rising in the past 50 years. With the increased number of cesarean sections, the number of pregnancies with the previous cesarean section rises as well. The aim of this study was to establish the influence of the previous cesarean section on the development of placental complications: placenta previa, placental abruption and placenta accreta, as well as to determine the influence of the number of previous cesarean sections on the complication development. MATERIAL AND METHODS The research was conducted at the Clinic of Gynecology and Obstetrics in Nis covering 10-year-period (from 1995 to 2005) with 32358 deliveries, 1280 deliveries after a previous cesarean section, 131 cases of placenta previa and 118 cases of placental abruption. The experimental groups was presented by the cases of placenta previa or placental abruption with prior cesarean section in obstetrics history, opposite to the control group having the same conditions but without a cesarean section in medical history. RESULTS The incidence of placenta previa in the control group was 0.33%, opposite to the 1.86% incidence after one cesarean section (p<0.001), 5.49% after two cesarean sections and as high as 14.28% after three cesarean sections in obstetric history. Placental abruption was recorded as placental complication in 0.33% pregnancies in the control group, while its incidence was 1.02% after one cesarean section (p<0.001) and 2.02% in the group with two previous cesarean sections. The difference in the incidence of intrapartal hysterectomy between the group with prior cesarean section (0.86%) and without it (0.006%) shows a high statistical significance (p<0.001). CONCLUSION The previous cesarean section is an important risk factor for the development of placental complications.

Assessment of endometrial receptivity by color Doppler and ultrasound imaging

INTRODUCTION Color Doppler sonography is a new method used to investigate changes during the menstrual cycle in infertile women. The objective of this study was to investigate the correlation of uterine and endomterial-subendomterial blood flow in infertile women using ultrasound and color Doppler sonography. MATERIAL AND METHODS A prospective clinical study included 65 infertile women divided into three groups. Transvaginal ultrasound examination was performed on days XI, XIV and XX All results were statistically analyzed. We investigated the correlation between cycles, pregnancy outcome and distribution of endomterial-subendomterial blood flow, as well as uterine arterial blood flow. RESULTS AND CONCLUSION Endomterial-subendometerial blood flow distribution pattern assessed by transvaginal color Doppler, as well as good flow in uterine vessels, are necessery for good pregnancy rates. Thin endomterium, undetectable subendomterial blood flow and higher uterine arterial resistance, were associated with low pregnancy rate and poor outcome.

Decidual natural killer cells in recurrent spontaneous abortions

BACKGROUND/AIM A repeated or habitual miscarriage (PSP) is defined as three or more consecutive losses of pregnancy. In the first three months of pregnancy, habitual miscarriages occur in about 1% of pregnant women, out of which 50% are of an unknown etiology. It is believed that among them, the greatest number is the consequence of an inadequate alloimmune response of a women to the pregnancy. The endocrine and immune systems are in a close interaction during the implantation and maintaining of pregnancy. This communication is the most obvious on endometrium of pregnancy decidua. The aim of the study was to identify the number and the subpopulation distribution of the decidual NK cells in the decidua by using an immunohistochemical method. METHODS The research included a group of 30 women who had had two spontaneous miscarriages consecutively in the first three months of their pregnancy, while the curettage after the third spontaneous abortion was histopathologically and immunohistochemically analyzed. The control group consisted of 20 women without a problematic reproductive anamnesis, who had had their pregnancy terminated for social reasons. The criteria for the eliminating from the research were the diagnosed uterus anomalies, positive screening on thrombophilia, as well as women suffering from diabetes melitus and the ones with the thyroid gland function disorder. RESULTS The number and the phenotype structure of the uterus NK cells were significantly different between the decidua of a normal pregnancy and that in PSP. In the decidua in PSP, there were much more NK cells with the phenotype of the peripheral circulation CD57 and CD56dim, while in the decidua of the control group the dominant cells were the typical uNK cell subpopulation CD56bright. CONCLUSION The above mentioned results show that the disregulation of the immunocompetent cells of the decidua, by creating an inadequate cytokine milieu, is one of the mechanism of rejecting the semiallogeneic blastocyst.

Controversies in the Choice of the Optimal Therapeutic Approach to High Grade Intraepithelial Lesions (HSIL) of the Cervix

Controversies in the Choice of the Optimal Therapeutic Approach to High Grade Intraepithelial Lesions (HSIL) of the Cervix The incidence of preinvasive changes in the cervix is constantly rising. It is particularly alarming that there is a larger number of younger patients in whom some stage of these changes has been diagnosed or who had already received some type of treatment before. Technological development and improvement of various forms of treatment have lead to changes in the surgical approach to intraepithelial lesions of the cervix. The techniques that have been developed for this purpose, besides the coldknife conization, include loop excision, radio wave conization, laser conization and, recently, the conization by Harmonic scalpel. The question that inevitably arises is: Has the technological development led to more conservative approaches and improvement in the results of surgical treatment? This paper will try to partly answer this question and initiate some new questions and dilemmas. A comparative review of all of the abovementioned surgical techniques and their detailed analysis is expected to provide at least some answers to the controversial opinions for and against the new surgical procedures. The results of surgical treatments and their complications were analyzed with particular emphasis on the influence that these methods have on fertility. The conclusion is that there is no ideal surgical procedure which could replace and neglect the experience of a colposcopist. New surgical techniques have brought more surgical comfort and faster recovery but have not demonstrated significant change in the final results of treatment and recurrence. Kontraverze u izboru najoptimalnijeg terapijskog pristupa intraepitelnim lezijama grlića materice visokog gradusa (HSIL) Incidenca preinvazivnih promena grlića materice je u stalnom porastu. Ono što je posebno zabrinjavajuće je da sve veći procenat bolesnica mlađe starosne dobi ima dijagnozu nekog od stadijuma ovih promena ili je već imala neki od vidova lečenja. Sa razvojem tehnologije i usavršavanjem različitih vidova lečenja došlo je i do promena u operativnom pristupu intraepitelnih lezija grlića materice. Uporedo sa klasičnom konizacijom nožem, razvijala se i tehnika Loop excizia, konizacija radiotalasima, konizacija laserom i u novije vreme konizacija ultrazvučnim nožem. Ono što se nameće kao pitanje je da li je razvoj tehnologije doveo do konzervativnijeg pristupa i boljitka u hirurškim rezultatima lečenja? Ovaj rad će pokušati da delimično odgovori na ovo pitanje i da pokrene neka nova pitanja i dileme. Uporednim prikazom svih gore pomenutih hirurških tehnika i njihovom detaljnom analizom očekujemo da dobijemo bar neke odgovore na kontraverzne stavove - za i protiv novih hirurških procedura. Analizirali smo rezultate hirurškog lečenja i njihove komplikacije, sa posebnim akcentom na uticaj ovih metoda na fertilnost. Došlo se do zaključka da ne postoji idealna hirurška procedura koja će zameniti i zanemariti iskustvo lekara kolposkopičara. Nove hirurške tehnike su dovele do većeg operativnog komfora, bržeg oporavka bolesnica, ali nisu bitno pro-menile ukupne rezultate lečenja i pojavu recidiva.

[Perinatal outcome of growth restricted fetus with absent end-diastolic umbilical blood flow--case report].

INTRODUCTION Absent or reversed end-diastolic blood flow in the umbilical artery is usually associated with poor perinatal outcome and high perinatal mortality rate. CASE REPORT We present the case of a pregnant woman with absent end-diastolic blood flow in the umbilical artery in the 27th week of pregnancy with initial restriction of fetal growth. Allthough it was more and more obvious that the fetal growth was hindered, the Doppler, cardiotocographic and biophysical parameters did not get any worse as the pregnancy developed. The full fetal maturation was reached after the intense monitoring of the fetal condition and the pregnancy was terminated in the 37th week by elective Cesarean section. CONCLUSION The basic purpose of prenatal fetal monitoring in the situation of hindered fetal growth with chronic hypoxia is to predict the phase of decompensation and to terminate pregnancy before it is developed. The major problem is in great individual variations at the moment of development of decompensation phase, so the major obstetric aim in the monitoring of the fetus hindered in growth is to determine the optimal time and way of delivery.