[Ambulatory blood pressure monitoring in children and adolescents--our results]. / Kontinuirano mjerenje arterijskog tlaka u djece i adolescenata--nasa iskustva.

UNLABELLED: Objective of the study was to present the results of ambulatory blood pressure monitoring (ABPM) in children and adolescents with hypertension diagnosed by primary care physician. METHODS: we retrospectively reviewed ABPM studies in 76 children. Mean patient age was 14.3 years (4-17 years); 53 boys (69.7%) and 23 girls (30.3%). Children were classified as having either primary or secondary hypertension following a standardised evaluation. According to ABPM data hypertension was defined as mean blood pressure greater than 95 th percentile for age, gender and height and/or blood pressure load (BP load) greater than 25 percent. RESULTS: In 16 (21.1%) children the ABPM studies were normal, leading to a diagnosis of "white coat hypertension" (WCH). Among 50 (65.8%) children with primary hypertension the most (20 or 40% children) had stage 3 hypertension. In secondary hypertension group 6 (60%) of children had stage 3 hypertension. Daytime and nocturnal systolic and diastolic blood pressure values were greater in patients with secondary hypertension compared with patients with primary hypertension. DISCUSSION: The oscillometric monitors for ABPM are generally preferred in children. The high percentage of stage 3 hypertension in both primary and secondary hypertension can be partly explained with normative values used witch were those recommended by consensus group such as the Second Task Force. Daytime and nocturnal systolic and diastolic blood pressure values greater in patients with secondary hypertension correspond to data in literature. CONCLUSIONS: ABPM is important tool in the evaluation and management of childhood hypertension. A normotension in ABPM study will suggest WCH. According toABPM results it is possible to classify hypertension, to identify children who require more detailed evaluation and to asses the efficacy of antihypertensive treatment. The lack of consensus and generaly accepted normative data for pediatric population in ABPM interpretation require further investigation.

Treatment of a retained placenta with intraumbilical oxytocin injection.

The aim of the study was to assess the effect of intraumbilical administration of oxytocin in the management of retained placenta. This prospective double-blinded clinical study included 31 mothers with retained placenta. The women were divided into three groups: group 1 (n = 19) was given 20 IU syntocinon in 20 ml 0.9% NaCl saline intraumbilically into the vein (IUV); group 2 (n = 8) received 20 ml 0.9% NaCl saline; and group 3 (n = 4) received 0.2 mg ergometrine IUV in 20 ml 0.9% NaCl saline. Intraumbilical injection was used 30-45 min after delivery, and the distal cord segment was clamped to the umbilical vein.--In group 1, placental expulsion within 60 min of IUV oxytocin injection occurred in 13 (68.4%) women; in group 2, placental expulsion was recorded in one (12.5%) woman, whereas no placental expulsion occurred in group 3 women (p < 0.001). Complications in terms of major hemorrhage were not observed in group 1, whereas a hemorrhage of > 500 ml was recorded in one group 2 and 3 woman each. Febrility developed in one woman, and abdominal pain in two women from each group. Manual lysis of the placenta was performed in seven group 1, seven group 2, and all four group 3 women. IUV oxytocin injection provides a useful and inexpensive non-surgical, non-aggressive, cheap and pharmacological method which should be included in the treatment protocol for retained placenta before turning to the procedure of manual lysis of the placenta.

Sudden death from trophoblastic embolism in pregnancy.

A case of a 24-year-old multigravida, with dry cough, dyspnea, fatigue, and weight loss with normal foetal growth rate is reviewed. Upon admission the patient suddenly became tachycardic, tachypnoic, cyanotic, followed by a non-palpable peripheral pulse, and asystole unresponsive to resuscitation. The autopsy revealed massive pulmonary trophoblastic embolism, bilateral pregnancy luteoma, and accelerated placental maturation. Trophoblastic embolism should be taken into consideration whenever cardiorespiratory emergency develops during pregnancy.

Successful treatment of alloimmune thrombocytopenia using corticosteroid therapy in a woman with two consecutive neonatal deaths--case report.

Alloimmune thrombocytopenia is a serious fetal disorder resulting from platelet-antigen incompatibility between the mother and the fetus. In mild cases, the diagnosis is usually made upon detection of neonatal thrombocytopenia, but serious consequences such as fetal intracranial hemorrhage and/or unexplained fetal death may complicate the disorder. Various treatment modalities are suggested in the management of alloimmune thrombocytopenia, however, none has yet been confirmed as obviously superior. We report on the successful use of corticosteroids during pregnancy in a woman with a history of two consecutive neonatal deaths due to severe thrombocytopenia and HPA 5b platelet-specific antigen incompatibility.

[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%).

Diagnostic value of a P-fimbriation test in determining duration of therapy in children with urinary tract infections.

The patients were 117 children (aged 4 months to 14 years) with uncomplicated urinary tract infections caused by co-trimoxazole-sensitive Escherichia coli. The patients were randomly assigned to receive treatment with co-trimoxazole for 3 days (n = 58) or 7 days (n = 59). Urine was analyzed for bacteria before and immediately after treatment and again at 1 and 2 months. After 3 days' treatment, infection persisted in 14 of 31 patients with P-fimbriated strains of E coli and in 1 of 27 patients with non-P-fimbriated strains. After 7 days' treatment, infection persisted in 2 of 40 patients with fimbriated strains and in none of the 19 patients with nonfimbriated strains. One or 2 months after treatment, 3 days' treatment was rated successful in 26 of 27 patients with nonfimbriated strains and in none of the patients with fimbriated strains. Seven days' treatment was rated successful in all patients with nonfimbriated strains and in 32 of 40 patients with fimbriated strains. The results indicate that the length of treatment of urinary tract infections in children should be adjusted according to the presence of bacterial P-fimbriae in addition to the patients' clinical condition.

Glucose, insulin, HGH and IGF-I levels in maternal serum, amniotic fluid and umbilical venous serum: a comparison between late normal pregnancy and pregnancies complicated with diabetes and fetal growth retardation.

Fetal growth and development is dependent upon various growth factors such as glucose, insulin, HGH and IGF-I. These growth factors were measured in maternal serum (MS), amniotic fluid (AF) and umbilical venous serum (UV) in late gestation in normal, insulin dependent diabetic pregnancies (IDDM) and in pregnancies complicated with intrauterine growth retardation (IUGR). The UV glucose values of 1.9 +/- 0.9 mmol/L and UV insulin values of 8.0 +/- 1.8 mU/L were the lowest in IUGR pregnancies, and the highest were in UV serum from IDDM pregnancies, and the difference was statistically significant for this two groups. IGF-I values in UV indicated that there was significant difference in IGF-I concentrations when both, IUGR and IDDM groups were compared to the controls. There was a parallel shift in AF and MS glucose and insulin concentration as birthweight increased. The highest IGF-I values of 7.2 +/- 9.6 mumol/L in AF and MS were found in pregnancies with infants whose birthweight was 3500 grams and greater. Infants from pregnancies complicated with IUGR and IGF-I low values of 0.6 +/- 1.2 mumol/L in AF. HGH concentrations of 15.6 +/- 9.4 micrograms/L in UV were observed in IDDM pregnancies and significantly lower than the values in IUGR and normal pregnancies. HGH umbilical venous values decreased with duration of pregnancy and with increase in fetal size. The high HGH concentrations in the fetus and its dramatic fall after parturition, and the obtained negative correlation between HGH and IGF-I in umbilical vein may exhibit the maturation of the hypothalamic-growth hormone-IGF-I axis. It seems likely that changes in maternal serum, umbilical venous and amniotic fluid insulin-like growth factor I influence birthweight in normal and IUGR infants and in those of diabetic mothers.

[Management of preterm breech presentation]. / Nacin dovrsenja prijevremenog porodaja kod stava zatkom.

At the department for Obstetrics and Gynecology in Zagreb we analyzed 342 preterm singleton breech deliveries during three different periods of time: the first from 1975-1978, the second from 1982-1986, and the most recent one from 1987-1989. All studied cases were infants with birth weight of 1.200 gr or more. Out of 135 infants born in the first time interval, the Bracht maneuver was employed in 90 (66.6%) cases; 13.3% of vaginal deliveries from the same time interval were managed by partial extraction, and total etraction was applied in 3.7% of vaginal deliveries. The cesarean delivery rate was 16.3% in the first analyzed period. From 1982-1986, 79 (67.5%) out of a total of 117 infants were delivered vaginally by the Bracht maneuver, 3.4% by partial extraction, and only one child was delivered by total extraction. In this time interval, 28.2% of all deliveries were terminated by cesarean section. In the most recent interval from 1987-89, our attitude towards preterm breech delivery has completely changed. The Bracht maneuver was applied in only 32.2% out of a total of 90 born infants, and partial extraction in 3.3%. None of the infants were delivered by total extraction. The cesarean section rate doubled and amounted to 64.4%. Nevertheless, the best indicator of results is the perinatal mortality of infants according to the observed time intervals. Perinatal mortality in the first period was 20%, in the second period it was 12% and 5.6% in the third period.(ABSTRACT TRUNCATED AT 250 WORDS)

[Epilepsy and pregnancy]. / Epilepsija i trudnoca.

A total of 132 women with epilepsy were confined in the period from 1978-1989. Their pregnancies and outcomes were analysed. The special aim was to find out if the anticonvulsive therapy has any correlation with the occurrence of fetal malformations in the studied group of women. In 43.9% of pregnant women with epilepsy, methyl-phenobarbitone as an anticonvulsive drug was administered, while carbamazepine was applied in 13.6% cases. A combination of phenytoin and phenobarbitone was prescribed in 18.9% of cases. Primidone was the drug of choice in 8% cases and 5.3% of patients were treated with various combinations of anticonvulsive drugs. Hyperemesis, threatened spontaneous abortion and premature labor complicated significantly more pregnancies in patients with epilepsy than on controls. Pregnancies from the studied group were terminated by the cesarean section in significantly more cases (11.2%) than in the control group (5.4%). Newborns from mothers with epilepsy had a statistically lower birthweight (3173 +/- 575 g) than those born from healthy mothers (3376 +/- 510g). Fifteen newborns or 11.2% were born with congenital malformations, while among the control group of newborns only two were malformed. It is noticed that the newborns from mothers treated with phenitoin and phenobarbitone had dysmorphic anomalies of the face more frequently. The drugs mentioned above interfere with the metabolism of K vitamin and as a result of this interreaction, mothers and newborns can suffer from coagulation disorders. In conclusion it is important to mention that no anticonvulsant drug seems to be absolutely safe when used during pregnancy since each of them has a teratogenic effect on the fetus.

[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.

[Inflammation of the female genital organs caused by Chlamydia trachomatis]. / Upale zenskih spolnih organa uzrokovane Chlamydiom trachomatis.

Chlamydia trachomatis has been presented in a growing number of recent papers as a causative agent of diseases such as cervicitis, endometritis, salpingitis and peritonitis. Based on the results available in literature, significance of an early detection of female genital tract inflammations caused by Chlamydia trachomatis because of its often asymptomatic flow, irreparable sequels of uncured inflammation and possible curing with tetracyclines and macrolides therapy has been discussed.

Placental lipid contents in preterm labor complicated by chorioamnionitis.

Fifteen decidua free placental samples from nine preterm deliveries without evidence of chorioamnionitis and six preterm deliveries with evidence of chorioamnionitis were analyzed for fatty acids contents. The percentage of arachidonic acid in phospholipids, in free fatty acids, in triglycerides and cholesterol esters were also measured in each sample. Arachidonic acid was found to be present in significantly increased amounts in the placentas of women with chorioamnionitis and preterm delivery, as compared to those of women with preterm delivery and the absence of chorioamnionitis.

[Delivery after previous cesarean section]. / Porodaj nakon prethodnog carskog reza.

In a four-year period (1980-1983) there were 452 women in whom one of the previous pregnancies terminated by cesarean section. Out of them, 283 (62.6%) delivered vaginally and 169 (37.4%) by repeated cesarean section. Vacuum extractor was used in 106 deliveries (23.5%). In 254 (89.8%) parturients of the examined group and in 21 (5%) parturients of the control group the manual revision of the uterus was performed. Seven incomplete and one complete silent ruptures of the uterus occurred in the examined group, the incidence being 1.8%. Six rupture of the uterus were revealed during cesarean section. Two ruptures were detected by the manual revision of the uterus. The authors are of the opinion that the manual revision of the uterus in women with previous cesarean section is necessary and that the prophylactic use of vacuum extractor is not justified.