Transvaginal ultrasonography of uterine cervix in prediction of the outcome of labour induction.

The aim of this prospective, blind, observational study was to estimate the role of transvaginal ultrasound examination of the uterine cervix in prediction of labour induction outcome in order to adequately chose patients that will have high chance for labour induction. One hundred patients scheduled for induction of labour had a transvaginal ultrasound scan during which cervical length and anterior cervical angle were assessed and the presence/absence of cervical tunneling was noted. Induction was successful if a vaginal delivery within 24 hours took place. The difference between the mean values of the cervical lengths assessed by transvaginal ultrasonography in the group of successful (25.89 mm--SD 8.27, 95% CI 23.65-28.13) and unsuccessful inductions (32.03 mm--SD 6.25, 95% CI 29.01-34.96) is statistically significant (p < 0.05). The anterior cervical angle is not a useful predictor of induction success (sensitivity 22%, positive predictive value 40%). Cervical length assessed by transvaginal ultrasonography is a reliable predictor of labour induction outcome and the best statistical performance of this parameter this test has at the cut-off value of 30 mm (positive predictive value 87.2%, sensitivity 74%, specificity 70%).

[Levels of fetal fibronectin in the cervix and vagina during pregnancy]. / Koncentracija cervikovaginalnog fetalnog fibronektina tokom trudnoce.

INTRODUCTION: Fibronectin is a glycoprotein produced by different types of cells. It can be divided into two main groups--soluble fibronectin, found in human plasma and other body fluids (amniotic fluid) and tissue fibronectin, found in basal membrane and connective tissue between endothelial cells (2). There are three subtypes--plasmatic, cellular and onco-fetal fibronectin, the most important during pregnancy, with different concentrations during the course of pregnancy. The aim of the study is to establish normal distribution of fetal fibronectin in cervicovaginal fluid during pregnancy in our population and afterwards establish the relation between concentrations in different stages of pregnancy and the pregnancy outcome. MATERIAL AND METHODS: This prospective, observational study was done at the Department of Obstetrics and Gynaecology, Clinical Centre Novi Sad, during the period June-October 1988. The presented results are preliminary ones. The patients were randomly chosen from the population that came for routine consultations as well as the ones hospitalized at the Department, at the High Risk Pregnancy Unit, for reasons other than threatening miscarriage and preterm delivery. One-hundred and thirty two pregnant women were examined, divided into three groups, according to gestational age. In group I were women between 7-20 weeks, in group II between 21 and 37 weeks and in group III 38 and more weeks. In every case general and obstetric data were collected, and cervico-vaginal fibronectin was taken from the posterior vaginal fornix, using a special kit (Specimen Collection Package, Adeza Biomedical). Fetal fibronectin concentration was tested using enzyme immunoassay (Adeza Biomedical) and positive was considered the concentration of and above 0.05 microgram/ml. RESULTS: The mean cervico-vaginal fibronectin concentration, uncorrected for the outcome of the pregnancy was as follows--in group I 0.045 (0-0.11) microgram/ml, group II 0.037 (0-1.22) microgram/ml, and in group III 0.226 (0.001-1.05) microgram/ml. The concentration trend was from weakly negative during the period 7-20 weeks, over highly negative (21-37 weeks) to very positive, after 38 weeks. The positive/negative relation in group I was 29.2%/70.8%, group II 11.7%/88.3% and group III 48.4%%/51.6%. After the correction of the results for miscarriages/preterm deliveries/failed induction in postterm pregnancies, the mean concentrations were somewhat different--group I 0.029 microgram/ml, II 0.019 microgram/ml and III 0.282 microgram/ml. The relations of positive and negative results were changed as well and in group I the relation was 27.3%/72.7%, group II 6.8%/93.2% and group III 71.4%/28.6%. DISCUSSION: After the correction for duration and outcome of the pregnancy, our results differed from the results in the literature. Thus in the 1st trimester fetal fibronectin was positive in cervico-vaginal fluid of 27.3% pregnant women, which is double the number usually found in the literature, between 21 and 37 weeks, when a positive result (> 0.05 microgram/ml) would be expected in only 3% of cases, it was positive in 6.8%, whereas 2.3 of the women delivered at term had a positive concentration. The discrepancy in group II (21-37 weeks) cannot be explained neither with a higher incidence of late miscarriages, nor preterm deliveries, for the incidence of such complications was only 3%, which is far less than usually found in the non-selected population (10%) (9). It is also possible that the discrepancy in our results and the results found in literature is based on a fact that our population was not preselected, which was the case in other studies' populations that did not include women with heavy, non-treated vaginal discharge, nor the ones that had sexual intercourse within 24 hours from the moment of fibronectin sampling. (ABSTRACT TRUNCATED)

[Folic acid in the prevention of neural tube defects]. / Folna kiselina u prevenciji defekta neuralne cevi.

INTRODUCTION: The term neural tube defects (NTD) stands for anencephaly, iniencephaly, cephalocoele and spina-bifida. The cause of these anomalies is failure of brain spinal cord to properly develop, together with their protective shield of skull and spine, around the 4th gestational week. The prevalence of NTD in continental Europe is 11.2 10,000 live births. THE LEVEL OF FOLATES IN SERUM AND NTD: The level of folates in serum can influence the risk of a child affected with NTD. Studies on women with previous pregnancies with NTD showed that supplementary intake of folic acid, with or without other vitamins, preconceptual period throughout the first trimester has a preventive effect on its recurrence. Inadequate intake of folic acid is also connected with preterm delivery, intrauterine growth retardation and placental abruption and infarction. FOLATES IN NUTRITION: It is not folic acid, but folates, from the vitamin B group, that can naturally be found in food. There are several groups of folates that differ in the quantity by which they can be absorbed from food. Folates are temperature and storage sensitive and cooking can cause a significant fall of their concentration in food. FOLIC ACID SUPPLEMENTATION: The mean daily intake of folates by food is 0.218 mg whereas a reference nutritive intake for a woman of reproductive age is 0.2 mg per day. The currently recommended daily dose for prevention of first NTD occurrence is 0.4 mg, so it is clear that a certain amount of folic acid has to be supplemented preconceptionally and during the first trimester. It can be done in two ways, by telling all women to take it before conceiving, or to fortify food with sufficiently high doses of folic acid in order to achieve adequate serum levels. Neither of the ways is ideal, for not all women would take the supplement, and by aggressively fortifying the food, we create a potential hazard to those that do not need it and may have some problems with the excess of it. The best solution would be a widespread campaign about the need for folic acid and the risks of NTD. CONCLUSION: Recommendations of The Expert Advisory Group on Folic Acid in prevention of neural tube defects has several aspects (1) reducing the risk of the first NTD occurrence by preconceptional vitamin supplementation of folic acid in the dose of 0.4 mg day, which would go on until the end of the 12th week (2) reducing the risk of NTD recurrence in offspring of men and women with spina-bifida or with obstetric history affected with NTD by preconceptional vitamin supplementation of folic acid in the dose of 4 mg daily during the first 12 weeks and (3) organizing educational programmes for medical staff as well as the whole population in order to popularize vitamin supplementation.

[Implementation of health informatics: system of the medical educational informatics]. / Generisanje informacionog sistema u zdravstvu: informacioni sistem medicinske edukacije--organizacija prijemnog ispita.

Topics of this report concerns the existing elements of informatics related to education of graduate students of the Medical Faculty in Belgrade. The already used practice of this system makes possible effectiveness and quality in this work. System itself contains quite a few data bases: for students, for teaching stuff and their associates, general juridic features, curricula as defined according to respective mode. In this academic year 1993/94 this system undergoes the exploitation step while, for the first time, has been used in the admission of students. Using this respective model results (particularly those of the testing in Chemistry and Biology as well as in some crucial questions therein) were analysed related to admission testing and numerous other competitor's characteristics, including success in previous studying and many other socio-demografic data. Improvement of such an approach reflects in feedback information derived from precedent educational institutions, and in possibility of the prompt reaction in case of any remark attributed to the actual studying. It is also capable of meeting primary requirements in every educational process for the rational analysis about minor failure and/or positive elements in education.

Splenic vein thrombosis. Diagnosed with Doppler ultrasonography.

The case of a 31-year-old pregnant woman with an isolated splenic vein thrombosis, diagnosed with Doppler ultrasonography is presented. Routine ultrasound examination in the fourth month of the pregnancy revealed massive splenomegaly of unknown origin. Doppler ultrasonography subsequently revealed splenic venous thrombosis with absence of blood flow. Noteworthy gastric varices were present at the endoscopic examination. On splenectomy, a spleen weighing 2,600 was removed, and numerous venous collaterals were found in the perigastric region. The postoperative course was satisfactory, pregnancy evolved normally, and a healthy female baby was delivered at term. The patient remained in excellent health with normal clinical and laboratory data.

Three-dimensional human somatosensory evoked potentials.

Median nerve somatosensory evoked potentials were recorded from 30 normal adults using conventional scalp derivations and an orthogonal bipolar surface electrode montage. This allowed the determination of the spatial orientation of the hypothetical centrally located equivalent dipole derived from the evoked response recorded in 3-dimensional voltage space. The 3-dimensional voltage trajectory describing changes in equivalent dipole orientation and magnitude revealed 4 major apices between 5 and 25 msec, 3 of which corresponded to the traditional P14, N20 and P25 peaks. A fourth apex at 17 msec was not as evident in the conventional recordings and signaled a transition from a vertical P14-N18 generator process to a horizontal N20 generator process. The normal within- and between-subject variability of trajectory apices, segments and planes are described, along with the theoretical and practical implications of this recording technique.

Spectral analysis of EEG during carotid endarterectomy.

Spectral analysis of the electroencephalogram (EEG) was monitored during 105 carotid endarterectomies. Seventy-eight percent of the patients showed no significant change in EEG spectral power as a result of clamping of the internal carotid artery. Two patterns of change were observed in the remaining 22% of patients: partial reduction (significant decrease of power in one or two of three frequency bands) and global reduction (significant decrease of power in all three frequency bands). High frequencies (over 10.5 Hz) changed more frequently with clamping than did low frequencies (less than 6 Hz), but reduction of high frequencies alone was tolerated with no postoperative deficits. The only non-shunted patient demonstrating global EEG reduction for the duration of carotid clamping suffered a transient hemiparesis.

[Intrauterine development of newborns of mothers with diabetes mellitus]. / Intrauterini rast novorodencadi majki sa diabetes mellitusom.

The examination of 170 babies born to diabetic mothers revealed that the body weight of these children was by a significant percent higher than that of other babies of the corresponding gestation age. Hypertrophic babies are born more frequently to mothers with manifest diabetes than to those with gestation diabetes. In mothers with the long-lasting disease accompanied by vascular lesions, retardation of the intrauterine fetal growth may occur. In order to improve the condition of these infants, their mothers should be constantly supervised during pregnancy and they should be prescribed adequate diet and therapy. Diabetic mothers also require greater care at delivery and a more liberal attitude towards the application of the cesarean section in order to prevent hypoxia and obstetric traumas of the infant.