Vladimir Banović

Uterine anomalies and pregnancy outcome following resectoscope metroplasty.

Objective: To compare reproductive outcome in women with uterine anomalies and women with a normal uterus, and evaluate the effect of resectoscope metroplasty. Methods: The pregnancy outcomes, past and present, of 105 women with congenital uterine anomalies were compared with those of 182 women with a normally shaped uterus. The outcomes of 25 women with septate and bicornuate uteri before and after resectoscope metroplasty were also analyzed. The χ2 and Mann‐Whitney U test were used for statistical analysis, with P < 0.05 considered statistically significant. Results: Uterine anomalies were associated with higher rates of spontaneous abortion, preterm delivery, intrauterine growth retardation, breech presentation, and cesarean delivery (P < 0.001). The highest incidence of early spontaneous abortion was noted among women with septate uteri, and the highest incidence of preterm labor was noted among women with arcuate or bicornuate uteri. Among women with arcuate uteri, significantly lower gestational age and birth‐weight were observed compared with any other type of adverse outcome. Compared with their previous pregnancies, the abortion rates were lower and delivery rates were higher in women who conceived following hysteroscopic metroplasty (P < 0.001). Conclusion: Resesctoscope metroplasty significantly improved pregnancy outcome in women with uterine anomalies.

Maternal plasma interleukin-6, interleukin-1β and C-reactive protein as indicators of tocolysis failure and neonatal outcome after preterm delivery

Objective. To investigate whether maternal serum interleukin-6 (IL-6), interleukin-1β (IL-1β) and high sensitive C-reactive protein (CRP) could be used as markers of tocolysis failure and adverse neonatal outcome in pregnancies with preterm labor (PL). Methods. Forty-seven maternal blood samples taken because of PL at admission and delivery were analyzed. Control samples were taken from 20 gravidas with normal pregnancies. Differences in interleukins and CRP levels with or without chorioamnionitis, connatal infection or periventricular leukomalacia (PVL) were analyzed. Cut-off values were estimated for prediction of tocolysis failure and adverse neonatal outcome. Results. All three parameters were significantly higher in patients delivering prematurely than in patients delivering at term. All three parameters were significantly higher with than without histologic chorioamnionitis (p < 0.001), with than without connatal infection (p < 0.01), with than without PVL (p < 0.01 for IL-6 and IL-1β, p < 0.05 for CRP), and in pregnancies with preterm premature rupture of membranes (PPROM) delivered within 48 hours compared to those more prolonged (p < 0.01). Choosing 50.9 pg/mL of IL-6 and a CRP of 19.7 as cut-offs in maternal blood admission concentrations for neonatal PVL, resulted in sensitivity of 81% and specificity of 91% and sensitivity of 91% and specificity of 81%, respectively. At respective maternal blood admission cut-off levels of 27.8 pg/mL of IL-6 and 8.9 of CRP, both parameters were effective predictors of connatal infection. Conclusions. Maternal blood IL-6 and CRP could become useful in predicting tocolysis failure and intrauterine treat for the fetus.

Perinatal factors associated with the neurologic impairment of children born preterm.

To determine the perinatal risk factors of long‐term neurologic impairment for preterm infants.

Fetal brain magnetic resonance imaging and long-term neurodevelopmental impairment.

To determine the incidence of fetal brain injury by fetal brain magnetic resonance imaging (MRI) in pregnancies complicated with preterm labor (PL), preterm premature rupture of the membranes (PPROM), and intrauterine growth restriction (IUGR), and to compare fetal brain MRI with prenatal surveillance methods, and with immediate and long‐term neurodevelopmental outcome.

The Value of HPV-HR DNA Testing During the Follow-Up After Treatment of CIN3/AIS

Up to 30 % of women treated for a preinvasive cervical disease are diagnosed with a residual/recurrent disease including an invasive carcinoma during follow-up. Studies have shown a higher sensitivity in detection of residual/recurrent disease with the use of combined testing (cytology and HPV. One hundred and thirty five patients treated with cold-knife conization (CKC) or large loop excision of the transformation zone (LLETZ) for a preinvasive cervical disease, were enrolled in the study. The follow-up consisted of cytology, colposcopy with biopsy if needed and HPV testing. Only patients with at least two cytology smears and one HPV test during the first two post-treatment years remained in the study. The HPV test was performed by EIA PCR and by Line immuno Probe Assay. The statistic analysis was performed using the χ2 test. Results of our study suggest that in our setting the best approach is to have a first control cytology smear 6 months after conization. HPV test should be done in patients with a positive smear any time during follow-up as the point of decision for a second treatment. With this approach we could considerably decrease the number of reoperated patients and co-morbidities without decreasing the quality of follow-up.