[The role of myomectomy in female infertility].

The aim was to examine which is the role of myoma in women infertility. We analyzed 100 patients with infertility that underwent classic abdominal myomesctomy from 2000. to 2003. year. Frequency of conception was 46%. Most patients were over 30-years-old. Conception happened in 80% patients aged 30-39 years. In 69,6% patients with secundar infertility happened conception. Pregnancies occured more often in infertility shorter than 36 months, in front wall myoma and in intramural-subserose or subserose type. In 11 patients with intramural-submucose myomas, uteral cave was opened and only two of them got pregnant. Recidives of myoma happened in 18%, and postoperative adhesions in 29% of pacients. Age, duration of pre-operative infertility and characteristics of myoma did not have statistically significant influence on the conception. Miomectomy is the important method in treatment of infertility, especially if the other possible causes were excluded.

[Propofol and thiopentone in elective cesarean section: effect on the mother and neonate]. / Propofol i tiopenton kod elektivnog carskog reza: uticaj na majku i novorodjeno dete.

All the anesthetics used for induction of anesthesia in cesarean section cross the placenta and can induce neonatal depression. The aim of this investigation was to compare intravenous anesthetics propofol and thiopentone as induction agents in patients scheduled for elective cesarean section and studying of their affection of mothers and new-born children. A total of 40 female patients were scheduled for elective cesarean section. They were randomly divided in two equal groups, each of them was to receive different anesthetic: propofol 2.5 mg/kg (n = 20) or thiopentone 5 mg/kg (n = 20). Orotracheal intubation was facilitated with suxamethonium 1.5 mg/kg. Anesthesia was maintained by controlled ventilation with mixture of nitrous oxide and oxygen (50%:50%) and pancuronium 4 mg. After extraction of the foetus, anesthesia was maintained with mixture of nitrous oxide and oxygen (70%:30%), fentanyl 0.15-0.20 mg and pancuronium 1-2 mg. At the end of operation, competitive neuromuscular block was antagonised with neostigmine. There were no significant differences among the groups, as regards age, body weight and height, ASA classification grade and week of gestation. Following induction of anesthesia, a significantly greater decrease of blood pressure and heart rate was found in the propofol group, when compared with the patients in thiopentone group. During the induction and maintenance of anesthesia, the frequency of adverse effects was greater in thiopentone, than in propofol group (6/20 versus 2/20 patients). There was no significant difference between the groups when induction-delivery (l-D) interval was concerned. The new-borns from the propofol group had significantly higher Apgar score in the 1st minute (8.35) and 5th minute (9.25), than the new-borns in thiopentone group (7.90 and 8.90, respectively).

[The course and outcome of pregnancy in pregnant women with hypothyroidism]. / Tok i ishod trudnoce kod trudnica s hipotireozom.

The report presents the analysis of 56 pregnant women with hypothyroidism as a consequence of different aetiopathogenetic factor, and 20 healthy pregnant women with normal pregnancies and term deliveries. Patients with hypothyroidism diagnosed prior pregnancy (46) were treated before and during pregnancy with thyroid hormone preparations. Patients with hypothyroidism verified in subclinical form during pregnancy (10) were not treated. In all examined pregnant women the mean values with standard deviations for thyroid-stimulating form hormone levels, total thyroxine and triiodothyronine, in each trimester of pregnancy, free thyroxine and triiodothyronine in the first and the last trimester were recorded; dynamics of their trends, as well as correlation of values in healthy pregnant women were presented. The analysis of the pregnancy course revealed a significantly higher incidence of gestational diabetes mellitus and preeclampsia (p < 0.001). It may be suggested that hypothyroidism is one of the risk factors for development of gestational diabetes, and also one of the pre-existing factors for development of preeclampsia. Delivery occurred in 83.9% of patients; in 12.8% of patients delivery was prior to term while spontaneous abortion occurred in 16.1% of cases (in one third in the first trimester). Similar results were observed in pregnant women with subclinical hypothyroidism. There were 4.2% of stillbirths which corresponded to the rate of perinatal mortality. One infant was born with hydrocephalus and the others were healthy. In the authors' opinion it is necessary to achieve normal metabolic state before pregnancy which should be maintained with substitutional therapy during the whole pregnancy.

[The effect of pre-eclampsia on thyroid gland function]. / Uticaj preeklampsije na funkciju tireoidne zlezde.

The prospective study involved 183 pregnant women with disorders of the thyroid gland, who were regularly followed up and delivered at the Department of Gynaecology and Obstetrics, University Clinical Centre, Belgrade, over a period of 10 years (1981-1990). There were 15 euthyroid patients in whom development of pre-eclampsia was diagnosed in the last trimester of pregnancy, and 20 healthy pregnant women with normal pregnancies and termed deliveries. The incidence of pre-eclampsia was analyzed depending on the basic disease, therapy and pregnancy metabolic status, as well as on their influence on the function. A statistically significant higher incidence of pre-eclampsia (p < 0.001) was observed in pregnant women with hyperthyroidism (26.0%) and hypothyroidism (26.8%). On the other hand, in euthyroid patients with pre-eclampsia the authors found that the concentration of total and free thyroxine was somewhat lower, while that of thyroid-stimulating hormone was a little higher comparing to the healthy pregnant women in the last trimester of pregnancy. Similar changes were noticed in patients with hypothyroidism. In pregnant women with hyperthyroidism and pre-eclampsia it was established that the concentration of thyroxine and triiodothyronine was somewhat higher, and that concentration of thyroid-stimulating hormone was a little lower comparing to all examined women in the equal metabolic condition. In the authors' opinion diseases of the thyroid gland represent a predisposing factor, i.e. a risk factor for the development of pre-eclampsia. The aim of further investigation is to observe mutual influences, pathogenetic mechanisms of further development of pre-eclampsia in patients with thyroid disorders, i. e. the influence of pre-eclampsia on thyroid disorders.

[Sonosalpingography and/or hysterosalpingography, advantages and disadvantages]. / Sonosalpingografija i /ili histerosalpingografija, prednosti i nedostaci.

Sonosalpingography is a new procedure in the examination of the passage of the uterine tube. It was first used by Dr. Richman from the United States. On the basis of the comparison of sonosalpingographic and histerosalpingographic findings it was concluded that in spite of advantages (simple and fast method) sonosalpingography should be indicated only in cases where hysterosalpingography is contra-indicated.

[Thyroid gland function during pregnancy]. / Aktivnost stitaste zlezde u trudnoci.

In order to examine the thyroid gland function we analysed healthy pregnant women (20) with normal pregnancy course and term delivery, who had normal endocrinological findings before the investigated pregnancy. In all patients TSH, T4 and T3 concentrations were radioimmunologically determined by trimester, median values with standard deviations were analysed in order to establish normal values during gravidity, as well as the possible changes in relation to non-gravid condition. We determined that T4 (29.3%) and T3 (23.5%) concentrations significantly increased and that TSH insignificantly decreased (12.1%) in the first trimester of pregnancy. In healthy pregnant women during the advance of gestation there was a significant increase of T4 and T3, which was significantly higher in the following than in the previous trimester. TSH concentrations during pregnancy gradually decreased but the decrease during the whole course of pregnancy, and in separate trimesters, was not found to be statistically significant.