HLA antigen studies in women with recurrent gestational disorders.

The frequencies of HLA antigens were determined in an experimental group of women with recurrent gestational disorders mainly expressed as spontaneous abortions of unknown etiology. The estimated antigen frequencies in this group were compared with the antigen frequencies in 158 unrelated persons (79 couples with no record of secondary infertility). A significantly higher frequency of antigen HLA-A9 was found in the experimental group as compared with the controls (corrected P = 0.0015). A greater degree of HLA compatibility was found between each woman from this group and her husband, considering 45 couples, as compared with 79 control couples. These results indicate that gene(s) close to the HLA region may have an influence on the reproductive performance in humans.

[Committee for Human Rights and Medical Ethics of the Croatian Medical Association]. / Komisija za ljudska prava i medicinsku etiku Hrvatskoga lijecnickog zbora.

The historical development of ethical standards and institutions of Croatian Medical Association is presented. The first standards were "Medical order and Community" in 1895 and the ethical codex under the name "Main principles of Medical dignity" in 1901 resp. 1921. According to the new Association's Statute in 1990 the first "Committee on Human Rights and Medical Ethics" was founded. Since 1995 the Committee operates as a common "Committee on Medical Ethics and Deontology" of Croatian Medical Association and of Croatian Medical Chamber. In short the activities of committees in both periods, 1991-1995 and 1995-1999 are presented, including the establishing of a new "Codex of Medical Ethics". Since 1999 the Croatian Medical Chamber divorced the cooperation with Croatian Medical Association and founded his own Committee. The Croatian Medical Association is now without ethical committee. The establishment of a new, common Committee of the Medical Association, Medical Chamber and Universities is suggested.

[Continuing medical education in Croatia and the European Union]. / Trajna lijecnicka izobrazba u Hrvatskoj i Europskoj uniji.

The Continuing Medical Education (CME), with attention to other forms of Continuing Professional Development (CPD) in Croatia and the today endeavors in the European Union, are presented. In European Union the formal CME is in its starting. The "European Accreditation Council for Continuing Medical Education" (EACCME) of the UEMS is established, which has formulated the principles of continuing education, the credit hours and their realizing, that would enable the mutual recognition of education in all European countries. In Croatia the starting of CME was at beginning of the 20th century, when the professional societies of Croatian Medical Association were founded. CPD was almost exclusively connected to activities of "Andrija Stampar" School of Public Health, to the School of Medicine in Zagreb and partly in Rijeka, which established a great number of postgraduate studies. The CME i.e. the courses of education were tightly connected to activities of the Croatian Medical Association, of its professional societies and its Academy of Medical Sciences, but also to activities of School of Medicine in Zagreb and Rijeka, and recently in Split and Osijek. Since 1995 the third partner, the Croatian Medical Chamber joined too. The number of CME meetings during 1998 is presented. The approximate calculation for needed annual courses of CME for all medical specialties in Croatia is presented. The formation of the National Authority for CME is suggested, in which all the interested institutions should be represented.

[History of gynecology and perinatology in Croatia. Midwifery. Clinics and hospitals in Zagreb]. / Povijest ginekologije i perinatologije u Hrvatskoj. Primaljstvo. Klinike i bolnice u Zagrebu.

The development of obstetrics in Croatia and the formation of unique discipline of obstetrics and gynecology in Croatia in first ten years of 20th century are presented. The midwifery is mentioned in Croatia for the first time in Dubrovnik in 14th century. The "protomedicus" from Varazdin Johan Baptist Lalangue in 1777 has published the booklet "Brevis institutio de re obstetritia". First public school of midwifery was founded in Zadar on 1820 and the second one in Zagreb in 1877. In Zadar, Ante Kuzmanic, "magister obstetritiae et chirurgiae" published a short textbook "Sixty lessons from midwifery for midwifes", thereafter in 1908 Nikola Lalich "Book for midwifes". In Zagreb, Antun Lobmayer published in 1877 "The midwifery". Gynecology was developing in the second half of 19th century as a part of surgery. On break-time from 19th to 20th century rose the unique medical profession obstetrics and gynecology. In Croatia the unique discipline established Dr Franjo Durst, since he was in 1905 installed for the first head of Royal Country Maternity Hospital in Ilica street and thereafter in 1921 for the first head and university professor of Royal University Clinic for Gynecology and Obstetrics in Petrova street. The evolution of gynecology and obstetrics, respective of perinatology, during last 30 years, in the Zagreb in departments of clinical hospitals "Clinical Hospital Center", "Sestre Milosrdnice", "Merkur" and "Sv. Duh" is presented.

[History of gynecology and perinatology in Croatia. Clinics and hospitals in Zagreb. Primary health care. Specialty societies of the Croatian Medical Association]. / Povijest ginekologije i perinatologije u Hrvatskoj. Klinike i bolnice izvan Zagreba. Primarna zastita. Strucna drustva Hrvatskoga lijecnickog zbora.

The formation and development of University clinics in Rijeka, Split and Osijek, and thereafter the formation and development of maternity departments in all Croatian hospitals are presented. Shortly the formation of out-patients clinics for women and maternity health-care is described, then the formation and development of Croatian Society of Gynecology and Obstetrics and of Croatian Society of Perinatal Medicine, as scientific societies (formerly "Sections") of Croatian Medical Association.

[Pregnancy and labor associated with encephalopathy in neonates during the early neonatal period]. / Trudnoca i porod u novorodencadi s encefalopatijom u ranom neonatalnom razdoblju.

Pregnancy complications, drugs and surgical interventions during pregnancy, fetal growth, medications and interventions during labor, labor complications as well as fetal heart activity during labor in a group of 114 term infants without malformations, but with signs of central nervous system (CNS) damage throughout early neonatal period are compared with paired group of term healthy infants born in the same presentation and mode of delivery. Among prelabor factors only maternal hypertension (found in 16.7% of encephalopathy children versus 0.8% in a control group) was significantly correlated with CNS damage. Fetal growth retardation and long term ritodrine administration were found more frequent in encephalopathy than in healthy group of infants, although statistical significance between the groups could not be demonstrated. A prolonged second stage of labor, high oxytocin dosage, too frequent uterine contractions and vacuum extractions were found significantly correlated with neonatal encephalopathy. CTG pattern during labor was normal in only 28.9% of children, with encepalopathy prepathologic in 46.4% and pathologic in 24.7%. The respective percentages for healthy newborns were: 82.5%, 16.25% and 1.2%. All differences between the groups were statistically significant. Mean duration of prepathologic CTG score in the group of infants with encephalopathy (78.8 minutes) as well as of pathologic score (51.7 minutes) was significantly longer than in healthy infants (23.7 minutes prepathologic and 7 minutes pathologic).(ABSTRACT TRUNCATED AT 250 WORDS)

[Perinatal care]. / Perinatalna zastita.

In the Republic of Croatia, the perinatal mortality, as an indicator of perinatal care, has decreased from 38.6% in 1950-54 to 10.9% in 1989 which means that today it is on the low mortality level like in the Middle- and West-European countries. The decline of perinatal mortality is especially evident after 1985. There are pronounced differences within the different regions of the Republic of Croatia, the lowest perinatal mortality is in the town of Zagreb and in the central Croatia, while the highest one in the region of Bjelovar, Slavonia and Dalmatia. Comparing the data from 29 maternity hospitals and taking into account a decrease in the number of hospitals with high perinatal mortality (48% in 1972 to zero in 1990) and an increase in the number of hospitals with low mortality (11 or 38% with mortality less than 10% in 1990), an increase of the delivery frequency completed by cesarean section was found: in 1990 there were 31% of the maternity hospitals with more than 10%, 45% with 6-10% and 24% with less than 6% of cesarean sections. Over recent years the maternity hospitals are better supplied with the necessary medical equipment: in 1990 97% of the hospitals were provided with cardiotocographs, 97% with ultrasound apparatuses and 90% with baby incubators. A sufficient number of specialists in gynecology and obstetrics is available, while there are lacking 21 specialists in pediatrics--neonatology, what is one third of the required number.(ABSTRACT TRUNCATED AT 250 WORDS)

[Myasthenia gravis in pregnancy]. / Miastenija gravis i trudnoca.

Twenty-nine patients with myasthenia gravis in pregnancy have been presented. These patients represent a total of 31 deliveries and 33 newborns. Despite that myasthenia gravis is an illness that poses potentially grave complications for both mother and infant, there were no maternal and neonatal deaths. Only two patients experienced significant exacerbation of their disease during pregnancy. Most of patients underwent vaginal delivery. Cesarean section is not indicated unless there are obstetrical reasons. Incidence of cesarean section delivery was 16.1%. Vacuum extractor has been used to shorten the second stage of labor and its incidence was 16.1%. In the seven (22.6%) patients myasthenic signs and symptoms got worse during the postpartal period. Neonatal myasthenia gravis was observed in 13 (39.4%) newborns. Inverse relationship was found between neonatal myasthenia and duration of disease in mothers. Incidence of neonatal myasthenia was higher in newborns born by mothers with short duration of myasthenia gravis.

[Fetal growth in pregnant women with chronic hypertension]. / Rast fetusa u trudnica s kronicnom hipertenzijom.

This study represents a retrospective analysis of pregnancies with chronic arterial hypertension and their outcomes. The aim was to evaluate the influence of arterial hypertension on 101 essential and 109 cases of secondary hypertension in comparison to the control group consisting of 499 normotensive pregnancies. According to the obtained data, 27.7% of the women with chronic hypertension had proteinuria, 61% had bacteriuria and 58.6% had superimposed EPH gestosis. The occurrence of EPH gestosis among the controls was 5.6%, that is significantly less than in the experimental group (X2 = 282.8%; p < 0.001). The outcomes of pregnancies associated with chronic hypertension were: 19% preterm deliveries compared to the controls in which only 9.2% preterm deliveries occurred (X2 = 14.4; p < 0.001). Newborns from pregnancies with essential hypertension were significantly heavier, weighing 3177 +/- 734 g, than those from pregnancies with secondary hypertension, which weighted 2578 +/- 932 g. Perinatal mortality was higher in the study group and significantly higher in the pregnancies with associated secondary hypertension (30.3%) than in pregnancies associated with essential hypertension (15.8%).

[Prenatal diagnosis of congenital adrenal hyperplasia due to 21-hydroxylase enzyme deficiency]. / Prenatalna dijagnostika kongenitalne adrenalne hiperplazije zbog nedostatka enzima 21-hidroksilaze.

Prenatal diagnosis of the "classical" forms of congenital adrenal hyperplasia (CAH) which is a result of 21-hydroxylase (21-OH) deficiency either complete, with salt-wasting or incomplete without salt wasting, is performed in two ways: by measuring concentration of 17-hydroxyprogesterone (17-OHP) and androstendione (delta 4) in amniotic fluid and by HLA typing of fetal cells from amniotic fluid. Having ones own normal values is the basic condition for the safe prenatal diagnosis of CAH 21-OH deficiency by measuring steroid concentration in amniotic fluid. Normal concentrations of 17-OHP in amniotic fluid achieved by amniocentesis in 85 pregnant women from 16-23 gestation week have been measured, as well as concentrations of delta 4 in 66 pregnant women in the same period of gestation. It has been proved that there are no differences between the concentrations of delta 4 in amniotic fluid regarding the sex. As far as 17-OHP is concerned, the same was confirmed earlier. The results of 9 prenatal diagnosis in 8 families, having already one child with "classical" form of CAH with salt-wasting, have been presented. It was achieved by combination of two methods: by measuring concentration of 17-OHP and delta 4 in amniotic fluid and HLA typing of fetal cells from amniotic fluid. In 8 fetuses at risk the birth of healthy children was correctly predicted, which was confirmed after the birth in three cases by HLA typing and measuring concentration of 17-OHP and delta 4 and from the blood of newborn babies.(ABSTRACT TRUNCATED AT 250 WORDS)