CONVERSION RATE OF EPIDURAL ANALGESIA TO CAESAREAN SECTION REGIONAL OR GENERAL ANESTHESIA.

Introduction: Epidural analgesia is acknowledged as the most common method of analgesia during labor. If emergent Caesarean section (CS) is indicated in parturient with existing labor epidural, the need for conversion from epidural analgesia to regional (RA) or general anesthesia (GA) increases accordingly. Recent guidelines suggest the rate of conversion to general anesthesia shows the quality of obstetric anesthesia care and should be under 5%. The aim: The aim of this study is to determine the conversion rate from epidural analgesia to Caesarean section anesthesia in "Sveti Duh" University Hospital Zagreb in order to enhance the quality of anesthetic care for obstetric patients. Methods: We retrospectively included in the study all parturients who received epidural labor analgesia but needed subsequent regional or general anesthesia for Caesarean section in our institution for the period of 1st January 2021 to 31st December 2021. After the data analysis on the conversion rate from epidural analgesia to Caesarean section anesthesia had been performed, we compared our data to current standards and relevant literature findings. Results: Altogether 1202 epidural catheters were placed for labor analgesia in the study period, and in 199 of these cases, the emergent Caesarean section was indicated. Epidural analgesia was converted to epidural anesthesia (EA) in 153 (76,9%) parturients, to general anesthesia in 40 (20,1%), and to spinal anesthesia (SA) in six (3%) parturients. After comparison with recommended quality standards and with the results of similar studies by other authors, our findings show a significantly higher rate of conversion from epidural analgesia to general anesthesia than has been desirable since then. Conclusion: In order to reach the required quality standards regarding the conversion rate from epidural analgesia to Caesarean section anesthesia, it is necessary to improve the organization of the work of the obstetric anesthesiology team according to the principle of subspecialization. It is imperative to implement the best clinical practice protocols for obstetric anesthesiologists, but also to enhance the communication and coordination with the obstetric team.

HISTOPATHOLOGIC FINDINGS IN WOMEN UNDERGOING HYSTEROSCOPIC RESECTION OF ENDOMETRIAL POLYPS AND UTERINE MYOMAS.

The aim of our study was to determine the prevalence of endometrial premalignant and malignant lesions in women undergoing hysteroscopy and to identify anthropologic factors related to the presence of malignancy. Data on 3470 women with submucosal myomas or endometrial polyps suspected on ultrasound were retrospectively analyzed. Hysteroscopy was performed in all these women in order to make a more precise diagnosis. Histologic analysis of endometrial samples obtained during hysteroscopy was used to confirm the diagnosis. Statistical analysis was performed using the SPSS 20.0.0 software. The mean age of study women was 49.1±13.3 years. The number of procedures performed due to the referral diagnosis of endometrial or submucosal myoma significantly increased over the 16-year study period. A significantly higher number of women had a benign histopathologic diagnosis. Histologic analysis revealed malignancy in 67 women. The youngest woman and oldest woman with malignant findings was aged 32 and 75, respectively. A significantly higher number of women with atypical hyperplasia and malignancy were in menopause. A comparable number of women with different histologic findings lived in urban and rural areas. There were a significantly larger proportion of widows among women with the histologic diagnosis of atypical hyperplasia or malignancy. The prevalence rate of malignancy in women having undergone hysteroscopy for polyps and myoma found by ultrasound was 1.93%. Postmenopausal status and older age were associated with an increased risk of malignancies, but premalignant changes and malignancies were also found in young and premenopausal women. Therefore, diagnostic hysteroscopy can be recommended in women of all age groups.

Changes in Sex Life after Childbirth.

BACKGROUND: Childbirth is major event in the life of closer and extended family. The aim of this study is to explore sex desire after childbirth and challenges for usual rhythm of intercourse. SUBJECTS AND METHODS: We studied 113 women who filled up questionnaire at the follow up examination. Inclusion criteria were: all women were secundigravidae and time between pregnancies was more than a year. Women anonymously filled out a survey with question on the time before first intercourse after delivery, frequency of sexual intercourse after delivery, sexual desire after delivery, sexual desire of partner after delivery, reasons for postponing sexual intercourse after delivery and frequency of intercourse in the first year after delivery. RESULTS: Most women had same number of intercourse after delivery like before pregnancy (Hi-square test: χ2(2)=22.04, p<0.0001). Significant proportion of women find their partners sexual desire to be the same like in the pre-pregnancy period (Hi-square test: χ2(2)=64.64, p<0.0001). Most women had intercourse once a week (several times a month) during first year after delivery (Hi-square test: χ2(3)=91.93, p<0.001). Fatigue, sleep deprivation, bad mood and lack of time are the most common reasons for intercourse postponement. Most women find life conditions to be very good. They do not find that they neglect their children and partners find them attractive. CONCLUSION: Sex life after delivery is still taboo in most countries. Women should have the information that sex life after delivery will turn to normal after a certain time.