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Biomedical subjects

I Kuvacić

Publications and source records attributed to I Kuvacić.

At least 19 recordsLinked to original sources
PubMed2000

Pregnancy outcome in renal transplant recipients.

OBJECTIVE: To correlate pregnancy outcome with complications in pregnancy and transplantation-to-pregnancy interval in renal transplant recipients in Croatia. METHOD: Data on 23 pregnancies after prepregnancy stabilization of blood pressure and normalization of graft function were retrospectively analyzed. RESULT: The mean interval between transplantation and conception was 3.1 years. Primary renal disease was chronic glomerulonephritis in 7, chronic pyelonephritis in 7 and agenesis of right kidney and stenosis of left renal artery in 1 patient. There were 10 term and 5 preterm deliveries, 6 induced and 2 spontaneous abortions. The mean gestational age was 38.1 weeks and the mean newborn birthweight was 3015 g. The prematurity rate was 21.7%. Patients with arterial hypertension in pregnancy, elevated serum creatinine level and bacteriuria, as well as those with conception occurring less than 2 years after transplantation, had a higher rate of therapeutic and spontaneous abortions, preterm deliveries and low birth weight infants. CONCLUSION: The interval between transplantation and conception, as well as allograft function during pregnancy, seem to be of great importance for successful obstetric outcome in renal transplant patients.

Adult↗
PubMed2000

Antenatal predictors of the neurologic sequelae at 3 years of age: a multivariate analysis.

OBJECTIVE: To study the association between fetal blood flow abnormalities and the occurrence of long-term neurologic sequelae. STUDY DESIGN: Umbilical, aortic and middle cerebral artery blood flow parameters were obtained by Doppler examination and retrospectively analyzed in 128 high-risk singleton pregnancies, followed by neurologic examination of the surviving children at 3 years of age. Traditional parameters of neurologic outcome (Apgar scores, intrauterine growth retardation (IUGR), umbilical artery pH and base deficit, gestational age, birth weight, newborn encephalopathy, mode of delivery, fetal heart rate, neurosonographic examination) were included as possible confounding factors. Mann-Whitney U-test, Student's t-test, analysis of variance or Fisher's exact test, where applicable, were used for the univariate analysis. A stepwise logistic regression procedure was conducted to test the independent association of selected perinatal risk factors on neurological outcome. Statistical significance was assumed at P<0.05. RESULTS: Eighteen out of 114 surviving children suffered neurologic illness at 3 years of age. Four children had major neurologic dysfunction and the remaining 14 suffered minor or mild form of the disease. Although blood flow parameters and various perinatal parameters did not differ significantly between the group of children with major neurologic dysfunction and healthy children, aortic resistance index showed an independent association with occurrence of minor or mild neurologic disabilities. CONCLUSION: Antenatal evaluation of the aortic blood flow might be an important predictive variable for permanent neurologic disturbances.

Apgar Score↗
PubMed2000

Maternal neonatal outcome in quadruplet and quintuplet versus triplet gestations.

OBJECTIVE: Examination and comparison of the natural histories of triplet versus quadruplet and quintuplet gestations. STUDY DESIGN: A retrospective study of sixty-four multifetal pregnancies (fifty-two sets of triplets, nine sets of quadruplets and three sets of quintuplets) cared for during past 12 years in our department. Quintuplets and quadruplets were compared with triplet pregnancies according to gestational age, birthweight, pregnancy complications and perinatal outcome. Student's t-test, Fisher exact test and chi2 test were used for statistical analysis, considering P value of <0.05 as statistically significant. RESULTS: Although mean gestational age at delivery between triplets and higher order gestations was not significantly different, birthweight of quadruplets and quintuplets was significantly lower. Pregnancy complications, including intrauterine growth retardation, were equally distributed between the groups. Early neonatal and perinatal mortality were significantly higher in quadruplets and quintuplets than in triplets. Surprisingly, survival of growth retarded fetuses was better than survival of their eutrophic counterparts. The spontaneous loss rate was 11.5% for entire triplet gestation and 16.7% for quadru- and quintuplet pregnancies. CONCLUSIONS: As the spontaneous loss rate of triplets and higher order pregnancies observed in our study is quite similar to pregnancy loss rate caused by multifetal pregnancy reduction, conservative management of multifetal pregnancies in specialised tertiary centers seems to be a prudent solution.

Birth Weight↗
PubMed2000

Pheochromocytoma with negative urinalysis in pregnancy.

We present a rare case of adrenal pheochromocytoma in pregnancy, with serial 24-h urine specimen collections showing normal concentrations of catecholamine metabolites. The diagnosis was based on clinical presentation, abdominal ultrasound, and magnetic resonance imaging, and was confirmed on post-operative pathohistological examination. Clinical suspicion of pheochromocytoma in pregnancy should be sufficient to implement adequate therapeutic measures, regardless of urine catecholamine concentrations.

Adrenal Gland Neoplasms↗
PubMed1988

HLA and red blood group antigens in pregnancy disorders.

Total of 356 women with various types of pregnancy disorders as well as their husbands were classified in four groups regarding the type of the disorder as follows: 1. Recurrent spontaneous abortions (RSA) of unknown etiology (N = 105) and RSA - primary aborters only (N = 84); 2. Blighted ovum (N = 80); 3. Rh immunization in pregnancy (N = 90); 4. ABO immunization in pregnancy (N = 47). Two groups of couples were used as controls: 1. Couples randomly taken from forensic medicine cases of paternity evaluation (N = 104); 2. Couples having two or more children with HLA immunization in pregnancy (N = 78). The couples from all groups were typed for red blood group antigens of ABO, Rhesus, MNSs, Kell, Duffy, Lewis, Kidd and P systems and also for HLA antigens. Significantly higher frequency of antigen HLA-A9 was found in women with RSA (corr. p = 0.0003) and in women with pregnancy disorders caused by Rh immunization (corr. p = 0.0136). In couples with RSA the degree of HLA compatibility was significant (p = 0.0048) and the reactivity of spouses in MLR was significantly decreased (p = 0.0001). Significantly, more low responders in MLR were also found among the women with RSA as compared to the controls (p = 0.0217). Two possible pathologic mechanisms may explain the association between HLA antigens and RSA: 1. immunological defects which are linked to HLA-D/DR region causing malfunction of immunosuppressive mechanisms during pregnancy; 2. endocrinological defect which is linked to HLA region as 21-OH hydroxylase deficiency gene.

Female↗
PubMed1979

HLA antigen studies in women with recurrent gestational disorders.

The frequencies of HLA antigens were determined in an experimental group of women with recurrent gestational disorders mainly expressed as spontaneous abortions of unknown etiology. The estimated antigen frequencies in this group were compared with the antigen frequencies in 158 unrelated persons (79 couples with no record of secondary infertility). A significantly higher frequency of antigen HLA-A9 was found in the experimental group as compared with the controls (corrected P = 0.0015). A greater degree of HLA compatibility was found between each woman from this group and her husband, considering 45 couples, as compared with 79 control couples. These results indicate that gene(s) close to the HLA region may have an influence on the reproductive performance in humans.

Abortion, Spontaneous↗
PubMedDate not supplied

[Pregnancy outcome after early amniocentesis].

The indications, karyotype, and outcome of 1812 pregnancies following midtrimester amniocentesis (eACZ/as) performed from 1977 to 1989 are presented, especially regarding the risk of pathologic karyotypes and spontaneous abortion. There were 37 pathologic karyotypes (trisomy 21 in 24 pregnancies). The spontaneous abortion rate following amniocentesis was 2.8% although it was almost halved after direct ultrasound guidance had been introduced (1.87% versus 3.66%). In gravidas with previous spontaneous abortion, the preterm delivery rate and spontaneous abortion rates following rACZ were significantly increased. There is a progressive increase of the spontaneous abortion rate after eACZ with the number of previous spontaneous abortions; 5.83% when there was only 1 previous spontaneous abortion, 7.83% when there were 2, and 8.75% when there were 3 or more spontaneous abortions. Previous spontaneous abortions do not increase the risk of chromosomal aberration. In women aged 37 years or more the risk of trisomy 21 is 0.69%, aged 38 years 1.55% and over 39 years 0.44%. The risk is rapidly increasing after 40 years of age (2.25%). The proportion of pathologic karyotypes in these age groups was significantly higher in comparison to younger women. The age limit of 37-38 years as the indication of a possible appearance of mid-trimester ACZ is discussed.

Abortion, Eugenic↗
PubMedDate not supplied

[T lymphocyte subpopulations in women with spontaneous abortions].

Investigations were carried out to observe changes in the functional T-lymphocyte activity, as well as the presence of single T-lymphocyte subpopulations in the first trimester of pregnancy in 10 pregnant women with recurrent abortions in their previous pregnancies, compared to 8 healthy pregnant women in the first trimester and 20 of them in the third trimester of pregnancy, and in 30 healthy nonpregnant women at the fertile age. The functional T-lymphocyte activity (PHA-test) was decreased in pregnant women with recurrent abortions (54 +/- 0.99) and in healthy pregnant women (56 +/- 2.50) compared to healthy nonpregnant women (76 +/- 4.80). The total number of lymphocytes in the first trimester was decreased in the investigated group (22 +/- 5.38) and also in healthy pregnant women (25 +/- 1.55) in relation to nonpregnant women (33 +/- 3.15). The percentage of T-lymphocytes was similar (59 +/- 4.32 and 58 +/- 1.96 in relation to 80 +/- 2.80). Helper T-lymphocytes (T-4) were significantly decreased in the investigated group (28 +/- 4.25) compared to the group of healthy pregnant women in the first trimester (32 +/- 1.60) and healthy nonpregnant women (55 +/- 2.37). Suppression T-lymphocytes (T-8) were significantly increased in the investigated group (30 +/- 3.11) in relation to healthy pregnant women in the first trimester (25 +/- 2.45) and to healthy nonpregnant women (23 +/- 1.95). The ratio of helper T-lymphocytes and suppression T-lymphocytes (T4:T8) was significantly lower in pregnant women with recurrent abortions compared to healthy pregnant women in the first trimester and to healthy nonpregnant women.

Abortion, Habitual↗
PubMedDate not supplied

[Pregnancy outcome after conization].

The outcome of pregnancy in 68 women with previously made conisation of the uterine cervix is presented. As a control group were 68 pregnancies which were the first in the protocol following the examined ones. Of 68 women of observed group there were 45 (66.2%) term deliveries, 10 (14.7%) preterm deliveries, and 13 (19.1%) spontaneous abortions, while in women of control group the results were 52 (76.5%), 6 (8.8%) and 10 (14.7%) respectively. This did not represent a statistical significance (chi 2 = 1.89; p less than 0.05). In the first desired pregnancy after conisation 43 (63.2%) women were resting in bed and taking medicaments, 20 (29.4%) had cervical cerclage, while in women of the control group there were 14 (20.6%) and 5 (7.4%), respective what represents statistically significant difference (chi 2 = 25.4; p less than 0.01; chi 2 = 11.3; df = 1, p less than 0.01). Of 43 women of observed group with resting and medicaments in pregnancy 33 (76.7%) had term deliveries, 8 (18.6%) preterm deliveries and 2 (4.7%) spontaneous abortions, while in 25 women without resting and no medicaments, the results were 13 (52%), 11 (44%), 1 (4%) respectively. This represents statistical significant difference (chi 2 = 4.42; p less than 0.05). In the control group of 54 women without resting and no medicaments, there were 45 (83.3%) term deliveries, 3 (5.6%) preterm deliveries and 6 (11.1%) spontaneous abortions, while in 25 women after conisation and no resting there were 13 (52%), 11 (44%), 1 (4%) respectively. This represents a statistical significance (chi 2 = 8.59; p less than 0.01). (ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Electromyography of the uterus in monitoring pregnancies with symptoms of premature labor].

Characteristics of uterine muscle action potentials in 100 gravidas with symptoms of preterm labor or imminent abortion (presence of contractions with cervical changes) from 18th till the 32nd weeks of pregnancy are analysed. Twenty four gravidas with uncomplicated pregnancy were monitored electromyographically from the 20th weeks until term, once a week. There was low electrical activity in uncomplicated pregnancies up to 7 days before labor. A similar trend was observed in pregnancies that were finished before term. But, in symptomatic pregnancies finished preterm, the index of uterine muscle electrical activity (expressed in the percentage of voltage plus frequency) was continuously, although not significantly, above the values in symptomatic and asymptomatic term pregnancies. In only 2 out of 18 (11.1%) before term terminated pregnancies and in 45 out of 82 (54.9%) in term accomplished pregnancies, was electrical silence was registered during clinical symptoms (p less than 0.01). In preterm accomplished pregnancies, higher voltages and more frequent occurrence of biphasic and polyphasic spikes were registered (p less than 0.05), although the single parameter was of no prognostic significance. With a successful tocolytic treatment, the index of uterine muscle electrical activity was significantly reduced (from 57.16 to 20.86, t = 2.52, p less than 0.02) and was similar to that registered in symptomatic term pregnancies subjected to no tocolytic treatment. Although intravenous tocolysis was shown diminish voltage and frequency, in preterm delivered pregnancies no reduction in electrical activity was observed. Uterine electromyography could be used as a predictor of successful or unsuccessful tocolytic treatment.

Action Potentials↗
PubMedDate not supplied

[Maternal and fetal monitoring during labor].

By use of cardiotocography, as screening method, and by fetal acid-base status estimation, it is possible, nowdays, to assess fetal oxygenation during every labor, allowing that way to recognize jeopardized fetus, and to undertake termination of labor on time. Fetal intrapartal mortality in Croatia has been declining for years. In 1985 fetal intrapartal mortality was 1.2%, in 1988 1.0% and in 1990 only 0.6%. At the Department of Obstetrics and Gynecology School of Medicine University of Zagreb fetal intrapartal mortality dropped from 3.3% in period from 1963 to 1967 to 0.6% in 1990. Increase in proportion of caesarean section deliveries, as well as increase in number of CTG equipments on our disposal is roughly parallel to this decline in intrapartal and perinatal mortality. In 1972 in only 4% of maternity hospitals there were more than 6% caesarean section deliveries, whereas in 1990 even in 26% of them the proportion of caesarean section deliveries exceeded 10%. In 1985 we were in need for 29 CTG equipments, and in 1990 for only 19. The decrease in perinatal, intrapartal and early neonatal mortality must be put in connection with increase in proportion of caesarean section deliveries and with increase in CTG's on disposal. On the contrary, fetal mortality during pregnancy has not changed for years and is between 4.7 and 5.7%. In spite of clearly improved perinatal outcome, this points to still not adequate antenatal surveillance with inadequate screening of high risk pregnancies.

Cesarean Section↗
PubMedDate not supplied

[Peroral and intracervical administration of prostaglandin E2 for stimulation of term labor in premature rupture of fetal membranes].

The outcome of stimulation of labour in 219 primiparous patients with more than 6 hours following a premature rupture of the membranes, and with an ripe cervix, without the established labour, was analysed according to the mode of treatment. One hundred and thirty eight (138) women received PGE2 peroral tablets, 14 intracervical PGE2 gel, and 67 oxytocin intravenously. There were 73.2% vaginal deliveries in the group that received PGE2 per os, 77.5% in the group that received oxytocin, and 92.9% in the group that was given intracervical gel. The differences were significant. The cervix remained unripe in 9.4% patients that received PGE2 perorally, in 14.9% of those that received oxytocin, while in the gel group it became favourable in all parturients. Uterine polisistoly was encountered in 10.9% labours after peroral stimulation, in 7.1% in the gel group and in 1.5% in the oxytocin group, and perinatal asphyxia in 16.7%, 7.1% and 13.4%, respectively. When too frequent, especially if combined with oxytocin and given to patients with a moderately favourable cervix, peroral stimulation predisposes to uterine polisitoly. Intracervical application of PGE2 gel is the method of choice in primigravid patients with a premature rupture of the membranes and the unripe cervix (Bishop score O). In gravidas with a more favourable cervix (Bishop score 4-6) the administration of oxytocin is acceptable with less complications. In those with a moderately favourable cervix (Bishop score 1-4) the gel application proved to be preferable, although stimulation could be carried out as well.

Administration, Oral↗