Safety of vaginal erbium laser: A review of 113,000 patients treated in the past 8 years.

Background: Energy-based devices are becoming a popular option for minimally invasive vaginal procedures. The aim of this study was to obtain information on the frequency of occurrence of adverse effects (AEs) related to vaginal erbium laser (VEL™) treatment.Materials and methods: The global survey was conducted among practitioners using the non-ablative VEL™ (Fotona, Ljubljana, Slovenia). Users were invited to provide the number of patients treated with VEL™ and the number of observed laser-related AEs.Results: The survey was conducted from August 2018 to April 2019. Responses from 535 practitioners were collected, with a total of 113,174 patients treated in the period from 2012 to 2019. Out of 535 respondents, 160 (30%) shared detailed information about the indications they treated in a population of 62,727 patients, whereas 188 (35%) respondents provided information on the frequency of AEs observed in their treated population of 43,095 patients. All observed AEs were mild to moderate, transient and appeared with low frequencies.Conclusions: Minimally invasive thermal-only laser treatment using the non-ablative VEL™ procedures appears to be safe and the incidence of AEs is low.

Polyhydramnios and bone development: an unexplored relationship.

Immersion of a humans and Macaca mulatta into a pool with fluid whose specific weight is equal to their specific weight cause bone demineralization. Also, in professional scuba divers, bone mineral density is reduced. Because of water immersion, the apparent weight of scuba divers represents 10% of their actual weight. The aim of this paper was to point out a previously unexplored aspect of fetal bone development in an environment lacking adequate mechanical stress on fetal bone, such as polyhydramnios. In the first part of gestation, the human fetus develops under conditions similar to neutral floating and has an apparent weight which is approximately 5% of its actual weight. During the last trimester of gestation, the fetus overgrows the intrauterine cavity and its apparent body weight is 60-80% of its actual weight. Polyhydramnios represents an excess of amniotic fluid in the uterus during gestation and it can reduce the apparent weight of the fetus to 10-20% of its actual weight. Reduction of the mechanical stress on fetal bone caused by polyhydramnios may significantly affect bone development and ossification during the last trimester of gestation. It is necessary to direct further studies towards examining bone development and mineralization in newborns from gestations complicated by polyhydramnios. A complete lack of data and studies on fetal bone development and bone mineralization in pregnancies complicated by polyhydramnios is not surprising. There is still a misleading opinion that the fetus is in weightlessness condition in the intrauterine environment throughout the second half of gestation regardless of the amount of amniotic fluid.

[Therapy of inflammatory changes in Bartholin's glands]. / Terapija zapaljenjskih promena Bartolinijeve zlezde.

INTRODUCTION: Bartholin's glands are bilateral structures whose function begins after puberty, so the diseases of these glands are most common during the reproductive period. Management of the inflammatory changes--abscess and cyst can be invasive and conservative, and quite often the changes become chronic, due to the failure of techniques. The aim of the study was to assess efficacy of various therapeutic approaches in the treatment of the inflammatory changes of Bartholin's glands. MATERIAL AND METHODS: The study was done at the Department of Obstetrics and Gynecology, Clinical Centre in Novi Sad, during the period 1993-1996, at the Dept. of Inflammatory Gynaecological Diseases. The total of 129 patients was treated. The first two years were analyzed retrospectively while during the years 1995 and 1996 a prospective study was done. The analysis of the therapeutic results was done according to the immediate efficacy of the therapeutic approach, incidence of recurrence, length of hospitalization and use of antibiotics. RESULTS: A total of 129 patients was treated, the mean age was 35.4 years. Cysts were treated in 14.7% and abscess in 85.3% of cases. Therapeutic approaches were different during different years. During 1993 and 1994 in majority of cases incision and complete extirpation of the glands were done, and rarely marsupialization, alone or in combination with silver nitrate (AgNO3). In 1995 and 1996 in a majority of cases incision of the gland was performed, together with the AgNO3 application (94.3% in 1995, 64% in 1996). In 1995 total gland extirpation was performed (5.7%) while in 1996 in 9 cases (36%) incision was done. The length of hospitalization was longer in earlier years, the shortest being when incision and AgNO3 application was performed (3.1/2.4 days). The use of antibiotics was significantly lower in the years when incision and AgNO3 were used. DISCUSSION: Our results are in concordance with the results of similar studies except for the fact that in our group the changes were seen more often in the age group 30-39 years. The parity was of no significance. The recurrence of the disease when this method is applied is the same as in other studies--around 3%, whereas the complications were rare. The length of hospitalization and the cost of the antibiotic therapy is of great significance as well, and they can be brought to minimum by employment of this method. CONCLUSION: The therapeutic approach of incision and AgNO3 application in therapy of inflammatory changes of Bartholin's glands is an efficient, safe, simple and cheap method, which can easily be applied in ambulatory conditions.

[Prenatal diagnosis of skeletal dysplasia: case report of a fetus with multiple anomalies]. / Problem antenatalne dijagnostike skeletnih displazija: prikaz slucaja fetusa sa multiplim anomalijama.

INTRODUCTION: Skeletal anomalies are in the group of anomalies most difficult to be diagnosed antenatally. But, because of high lethality and morbidity rate as well as high possibility to be found again in the next pregnancy, they need to be systematically and actively looked for during every scan. CASE REPORT: A pregnant woman, aged 18, primigravida, was admitted to the Dept. of Obstetrics and Gynaecology because of polyhydramnios and suspected multiple fetal malformations. Fetal biparietal diameter and abdominal circumference were adequate for 33 weeks gestation, whereas all the long bones were short for the gestational age. A detailed ultrasound morphology check was impossible because of the excessive amount of amniotic fluid, but the skull, brain, lungs, spine and abdomen appeared normal. There was an impression of frontal bossing and left-sided cleft lip. A thoraco-abdominal disproportion was evident. All the extremities were short, feet were normal, and hands were not extended during the whole scan. The woman underwent an uneventful amino-drainage and three days after that she ruptured the membranes, giving birth to a live female, 2150 gr, 46 cm, Apgar score 6/7. The anomalies seen on ultrasound were confirmed after birth. After a series of dyspnea the neonate was transferred to the Dept. of Paediatrics where it underwent a series of further extensive diagnostic procedures and 37 days after birth it passed away. Postmortem examination led to the following diagnoses: Neonatus femininus eutrophicus temporis aetatis. Defectus partis memebranacei septi interventricularis. Ductus arteriosus Botalli persistence. Hypoplasia thymi. Cheliognathopalatoschisis. Low set ears. Extremitates breves. Atelectasis subtotalis pulmonis bilateralis. Foramen ovale apertum cum valvula competent. Oedema cerebri gradus maioris. DISCUSSION: Majority of fetal skeletal malformations can be relatively easily visualised during ultrasound scans and hence ultrasound is the most sensitive way of prenatal diagnosis of these anomalies. Maternal habitus, fetal position, alteration of amniotic fluid volume and gestational age can be factors that may aggravate check-ups. A prerogative for an early prenatal diagnosis of fetal skeletal anomalies is a well organized scan of each and every fetus that checks all bones, starting with the skull and finishing with hands and feet. Should an anomaly be found an extensive detailed scan by an expert should be performed, as well as karyotyping and a consultation with pediatrician/surgeon. In case of a lethal anomaly, an option of pregnancy termination should be considered and if the parents decide against it, the pregnancy should be closely monitored, with parents fully counseled about the prognosis for the child. In this case the anomaly was noted only after the 30th week of gestation and even then only because the patient came because she had some subjective difficulties because of the excessive amniotic fluid volume. On the other hand, some skeletal dysplasias can be diagnosed only in the late second, early third trimester and sometimes stay unnoticed until the end of pregnancy. This case could not be resolved definitely, for the anomalies were conclusive neither of a specific genetic syndrome, nor of an isolated skeletal dysplasia. Extensive further examination of parents as well as their families is needed in order to be able to give some information about the risks in the next pregnancy. CONCLUSION: Although skeletal anomalies are extremely difficult to diagnose antenatally, a detailed scan of a complete fetal anatomy between 20 and 32 gestational weeks with special attention given to the entire skeleton, gives certain assurance of excluding majority of major skeletal dysplasias or enables their diagnosis and further adequate plan for pregnancy management.

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.