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F Mikulandra

Publications and source records attributed to F Mikulandra.

31 records · Page 2Linked to original sources
PubMedDate not supplied

[Pregnancy and labor in women over 40 years of age].

During the 1970-1989 period, there were 23,915 deliveries of which 278 (1.16%) occurred in women 40 years of age or older. The latter included 62 (22.3%) primiparas, 158 (56.8%) pluriparas and 58 (20.9%) multiparas. The control group consisted of 14,400 women 20-34 years of age (50% primiparas and 50% pluriparas) from the same period. There was no antenatal visit in 9.4% of the women 40 years of age or older. This group included more housewives, more unmarried women and more women with previous spontaneous and induced abortions than the control group (P less than 0.05). Threatened abortion (16.2%), EPH gestosis (22.3%), impaired glucose tolerance (8.3%), gestational diabetes (7.2%), delivery before 37 weeks (11.5%), delivery after 42 weeks (3.6%), premature rupture of the membranes (18.3%), meconium-stained amniotic fluid (19.8%), elective caesarean section (11.5%), caesarean section delivery (16.5%), vacuum extraction (4.7%), placental lysis or uterine exploration (4.3%) were more frequent in the study than in the control group (P less than 0.05). There were more cases with episiotomy (P less than 0.001) in the control group, whereas there were no differences as regards cervical cerclage, weight gain above 14kg, breech presentation, transverse presentation and assisted breech delivery between the two groups (P greater than 0.05). There was no case of uterine rupture or maternal death either in the study or the control group. The authors conclude that a woman 40 years of age and older is in an advanced age for pregnancy and delivery.(ABSTRACT TRUNCATED AT 250 WORDS)

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[Perinatal outcome in older primiparas].

Pregnancy, delivery and the newborn infant of 212 old primiparas (aged greater than or equal to 35 years) and of 1968 age-matched old multiparas as controls were studied for the 1970-1989 period. The frequency of old primiparas and old multiparas was 0.9% and 4.1%, respectively, with no change for the 1970-1979 (1.0%) and 1980-1989 (0.8%) periods. The mean age in the old primiparous and old multiparous groups was 38.08 + 4.2 and 38.2 + 4.8 years, respectively (P greater than 0.05). The old primiparas had an average of 7.37 +/- 2.8 antenatal visits, whereas the old multiparas had 6.08 +/- 3.3 visits (P less than 0.05). The old primiparous group included more employees and fewer unskilled workers and housewives (P less than 0.05), more urban and unmarried pregnant women (P less than 0.001), whereas the old multiparas had more spontaneous and induced abortions (P less than 0.05). Threatened abortion (23.7%), EPH gestosis (20.3%), meconium-stained amniotic fluid (21.7%), caesarean section (35.8%), placental lysis or uterine exploration (6.6%) and episiotomy (100.0%) are more frequent in old primiparas than in old multiparas (P less than 0.05). The duration of labour in old primiparas tends to be longer: there was a significantly smaller number of pregnant women with an up 6-hour duration of labour (42.5%; P less than 0.05). The average duration of labour in the old primiparous and old multiparous groups was 8.18 +/- 5.40 and 5.89 +/- 3.80 hours, respectively (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

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[Pregnancy, labor and the neonate in pluriparas and multiparas].

From 1971 to 1988, out of 22001 deliveries (multiple pregnancies excluded) 212 (0.96%) occurred in multiparas with five or more deliveries. The control group included 7340 pluriparas (two to four deliveries) from the same period. In 82.1% cases the multiparas were para 5 and 6, and 63 (29.7%) were less than 34 years of age. 15.9% had no antenatal visit; for the most part they were housewives and rural pregnant women. Transverse presentation, preterm delivery, meconium-stained amniotic fluid, and placental lysis or uterine exploration were more frequent in the multiparous group (P less than 0.001), whereas cervical cerclage and episiotomy were more frequent in the control group (P less than 0.05). Newborn infants in the multiparous group were severely asphyxiated at birth more frequently than those in the control group (P less than 0.05). There were no differences as regards late fetal and early neonatal deaths between the two study groups. The overall perinatal death rate in the multiparas and pluriparas was 2.83% and 1.81%, respectively (P less than 0.05). There was no case of uterine rupture or maternal death in the multiparous and pluriparous group.

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[The course and outcome of pregnancy in adolescence in relation to chronologic and gynecologic age].

A total of 509 single pregnancies in teenagers up to 18 years old were examined. Younger teenagers proved to have low (1-2) gynecological years in 10.7% and older teenagers in 3.9%. There is no difference in the frequency of threatened abortions, EPH gestosis, placenta removal, and uterine exploration between the groups of younger and older, teenagers, but in teenagers with low gynecological years these complications observed significantly more frequently than in those with more gynecological years (p less than 0.001). No significant difference was recorded in the frequency of pre-term deliveries between younger and older teenagers (chronological age), whereas in teenagers with a low gynecological age there were significantly more pre-term deliveries than in those with more gynecological years (p less than 0.05). Vacuum extractor was applied significantly more frequently in teenagers 15-16 years old than in those 17-18 years (p less than 0.01). There is an even more pronounced significance in the frequency of delivery termination by vacuum extractor in teenagers with a low than in those with a higher gynecological age (p less than 0.001). Chronological and gynecological age have an significant effect on low birth mass children, the frequency of early neonatal complications, or perinatal mortality which in the teenagers examined was 15.7.

Adolescent↗
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[Advantages of preventing Rh isoimmunization].

The authors analysed the frequency of Rh immunization from 1972 to 1983. The incidence of Rh-immunized women who after the birth of a Rh (D) positive child were not given anti-D immunoglobulin G and in subsequent pregnancies gave birth to a Rh (D) positive child was found to amount to 11.76%, while in women who were given anti-D immunoglobulin D this incidence was 0.77% (t = 5.98; p less than 0.05). Out of 29 Rh-immunized pregnant women, two developed Rh immunization in the course of the first pregnancy, three after the unsuccessful prevention of Rh immunization, and the rest after delivery or after delivery and abortion. Out of 29 Rh-immunized women, 27 (93.10%) were ABO-compatible and 2 (6.90%) ABO-incompatible with their child (p less than 0.05). In the first pregnancy the incidence of Rh immunization was 1.86 per 1000 deliveries in Rh negative pregnant women and 21.19 per 1000 deliveries in subsequent pregnancies (p less than 0.05). In the period observed there were 2.24 Rh immunizations per 1000 of all deliveries. From 1972 to 1977 there were 3.19 Rh immunizations per 1000 deliveries and from 1978 to 1983 only 1.43 (t = 2.08; p less than 0.05), which is a reduction by 55.17%. The perinatal mortality rate of children affected by Rh-hemolytic disease was 20%. In the last six years it has gone down by 60%, while the number of children with Rh-hemolytic diseases has been reduced by 50%.

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[Scoring of risk factors in pregnancy, labor and in the early neonatal period].

The authors established a risk factor scale for pregnancy, delivery, and newborns: the risk factor score up to 9 meaning a low risk, from 10 to 19 a moderate risk, and from 20 onwards a high risk. They found a high pregnancy risk in 10.9% of cases, high delivery risk in 14.02% of cases, and high risk newborns in 16.35% of cases. Low risk pregnant women had a premature delivery in 1.68%, those at moderate risk in 3.99%, and high risk pregnant women in 22.66% (P less than 0.001). There were 0.37% severely asphyxial (Apgar index 3 or below it) newborns in the low risk delivery group, 0.81% in the moderate risk group, and 4.36% in the high risk group (P less than 0.001). In the antepartal low risk group, the birth mass up to 2,499 g was found in 1.07%, in the moderate risk group in 1.71%, and in the high risk group in 19.70% of children (P less than 0.001). The mean birth mass of children from the low antepartal risk group was by 551.48 g higher than that from the high risk group (P less than 0.001). Neonatal morbidity in the low pregnancy risk group amounted to 11.0%, in the moderate risk group to 16.2%, and in the high risk group to 43.3% (P less than 0.001). There were 0.76% stillborns in the low pregnancy risk group and 34.48% in the high risk group (P less than 0.01). In the latter group also neonatal and perinatal mortality rates were higher (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

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[Pregnancy, labor and the neonate of the adolescent female].

The authors studied pregnancies in adolescents, younger than 18, from 1973 to 1983. The control group, randomly selected, consisted of 1000 child-bearing-women from 1976 (excluding adolescents and multiple pregnancies). The frequency of their labours was 3.24% and for the past five and a half years it decreased from 3.56% to 2.93% (P 0.05). There were 17.86 labours per 1000 adolescents in the age between 15 and 18. Adolescents are considerably more often living in rural areas, are single and unemployed than pregnant women in the control group. (P 0.001). EPH gestosis and threatened miscarriage are more frequent in adolescents than in the control group (P 0.05). Premature labour in adolescents occurs in 11.13% of cases, and postmature labour in 1.81% of cases, which is more frequent than in the control group (P 0.01). Pregnancy in adolescents lasts on the average 39.0 and in the control group 39.4 weeks. Adolescents are mostly primiparas (95.7%) and their labour lasts up to 12 hours (89.37%). Labours are mostly spontaneous (94.34%) and the frequency of cesarean sections is lower than in the control group (P 0.05). Adolescents' newborn infants are lighter than newborn infants in the control group (P 0.05). The newborn infants' birth weight increases with the age of their adolescents mothers. At birth, newborn infants of adolescent mothers have lower values of Apgar index than infants in the control group, have early neonatal complications in 16.06% of cases while infants in the control group in 12.40% of cases (P 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
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[Pregnancy and labor in women with heart diseases].

In a ten-year period the frequency of pregnant women with heart disorders amounted to 0.50%. In 83.87% of cases the disorders were acquired and in 16.13% congenital. According to the functional condition of the heart, 95% of the women observed belonged to the first and the second stage. In 82.26% the deliveries were spontaneously vaginal. The frequency of cesarean section proved four times as frequent as that in the control group (P less than 0.05). In not a single case was heart trouble alone the indication for cesarean section. Newborn children of women with heart disorders were slightly asphyxial (Apgar index 7-4) in 9.68% of cases as compared with 5.0% in the control group (P less than 0.05). The average birth mass of these newborns was 3491.9 +/- 2 SD 780.5 g and that in the control group 3,767.5 +/- 2 SD 824.2 g (P less than 0.05). Sixteen (25.8%) newborns in the early neonatal days had one or more neonatal complications, while those in the control group developed such complications in 14.2% of cases (P less than 0.05). Not a single child died perinatally. In the course of pregnancy, delivery, and puerperium only 3 (4.84%) women received cardiotonics and 22 (34.84%) antibiotics. The second day after delivery one puerpera developed paroxysmal tachycardia, while in all the remaining women the course of pregnancy, delivery, and puerperium was normal.

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[Intrauterine growth of live-born twins in the area of Sibenik, Split and Zadar].

By a retrospective analysis the authors studied live-born twins by gestation weeks and birth weight and height: there were 1,195 first-born and 1,189 second-born twins, all from three neighbouring Dalmatian towns (Split, Sibenik and Zadar). A common curve was worked out of the intrauterine growth of both the first and the second twins and a separate curve of each of them. The curves have shown that the twins' birth weight was increassing up to the 40th week of pregnancy; in the 41st week the curve already went down. The authors conclude that twin pregnancy should not last more than 40 weeks.

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[Twin pregnancies at the gynecology-obstetric unit of the medical center at Sibenik (1959-1978)].

In the period reported there were 244 (1.036%) twin pregnancies out of 23,535 deliveries. From 1959 to 1968 the incidence was 1.133% and from 1969 to 1978 0.946% (P < 0.05). Twins were most frequently delivered in the head presentation (48.36%) but also in such a way that the first twin was delivered in the head and the second in the breach presentation (26.22%), or both in the breech presentation (11.06%), or the first in the breech and the second in the head presentation (9.42%). Other presentations were far less frequent. Spontaneous delivery of the first twin was recorded in 71.31% and of the second in 54,50% of cases (P < 0.05). Surgery was required for the birth of the first twin in 28.69% and of the second in 45.50% of cases (P < 0.05). The birth weight of the first twin was below 2500 g in 38.11% and of the second in 40.98% of cases. The mean birth weight of twins was 2590.67 +/- 2 SD 977.29 g. The first twins were by 70.7 g heavier than the second ones. The perinatal mortality of the first twins amounted to 6.96% and of the second to 11.47% (P < 0.05), their total perinatal mortality amounting to 9.22%. The authors recommend domiciliary rest, preventive cerclage in the majority of cases, spasmolytics, and tocolytics (if needed) from the 20th week of pregnancy and hospitalization after the 28th week of pregnancy, as well as intensive care during and after delivery.

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[Causes of perinatal mortality in twins].

The author analyses perinatal mortality in 244 twin pregnancies. In 80% the twins' Apgare score at birth was 10 to 8 and neonatal mortality in this group 1.26%. The slightly asphyxial group (Apgar 7 to 4) comprised 62 (38.75%) twins and the neonatal mortality in this group was 14.51%. There were 20 (12.5%) severely asphyxial (Apgar 3 or less) twins, their neonatal mortality amounting to 80.0%. Out of 193 twins weighing at birth less than 2500 g, 45 (23.31%) died, while in the twins weighing more than 2500 g there was not a single death. The perinatal mortality of twins up to the 37th week of pregnancy amounted to 17.37% and from the 38th week of pregnancy to 1.22%. The mean duration of pregnancy in twins was 38.1 +/- 2 SD 6.3 weeks. The most frequent cause of death in twins has proved to be immaturity and asphyxia at birth, leading to the development of hyaline membranes (80.0%). Other causes were far less frequent. The author concludes that in the perinatal mortality of twins their vitality at birth (assessed by the Apgar score), birth weight, and the duration of pregnancy play an important role.

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[Proportion of psoriasis in cases treated at the dermatology service at the Sibenik Medical Center over a 5-year period].

The paper reviews medical record data on psoriasis at the Sibenik Medical Center, Department of Skin Diseases, over a five-year period (1986-1990). Separate analysis was performed for hospital and outpatient departments. Various parameters were analysed, the most important being sex, age, type of disease and occupation. The outpatient department recorded 539 psoriasis patients, 302 (56.0%) males and 237 (44.0%) females. Psoriasis vulgaris was found in 478 (88.7%), arthropathic in 39 (7.2%), pustular in 9 (1.7%) and erythrodermic in 13 (2.4%) patients. Out of a total of 54,129 visits to the outpatient department, 2281 (4.2%) were due to psoriasis. A total of 1598 patients were hospitalized over the same study period, of whom 131 (8.2%) due to psoriasis, i.e. 81 (61.8%) males and 50 (38.2%) females. Psoriasis vulgaris was reported in 92 (70.2%), arthropathic psoriasis in 19 (14.5%), pustular in 9 (6.9%) and erythrodermic in 11 (8.4%) patients. A total of 46,368 hospital days were realized, with an average of 18 inpatient days. Out of those, 4710 (10.2%) were due to psoriasis, the average treatment lasting 16.7 days. In relation to the incidence and nature of this disease, as well as to health care costs, it can be concluded that psoriasis represents not only a serious medicosocial but also an economic and public problem.

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