Customised birthweight standard for a Slovenian population

Objective To produce a customised birthweight standard for Slovenia. Methods This retrospective study used a cohort from the National Perinatal Information System of Slovenia (NPIS). Prospectively collected information from pregnancies delivered in all of Slovenia's 14 maternal hospitals between 1st January 2003 and 31st December 2012 was included. Coefficients were derived using a backward stepwise multiple regression technique. Results A total of 126,627 consecutive deliveries with complete data were included in the multivariable analysis. Maternal height, weight in early pregnancy and parity as well as the baby's sex were identified as physiological variables, with coefficients comparable to findings in other countries. The expected 280-day birthweight, free from pathological influences, of a standard size mother (height 163 cm, weight 64 kg) in her first pregnancy was 3451.3 g. Pathological influences on birthweight within this population included low and high maternal age, low and high body mass index (BMI), smoking, pre-existing and gestational diabetes and pre-existing and gestational hypertension. Conclusion The analysis confirmed the main physiological variables that affect birthweight in studies from other countries, and was able to quantify additional pathological factors of maternal age and gestational diabetes. Development of a country-specific customised birthweight standard will aid clinicians in Slovenia with the distinction between normal and abnormal small-for-gestational age (SGA) fetuses, thus avoiding unnecessary interventions and improving identification of at risk pregnancies, and long-term outcomes for infants.

Stillbirths in women with pre-gravid obesity

Objective To determine the association between pre-gravid obesity and stillbirth. Methods A retrospective study of a population-based dataset of births at ≥34 weeks' gestation. We excluded fetal deaths due to lethal anomalies and intrapartum fetal deaths. We calculated the incidence of stillbirths, neonatal respiratory distress syndrome (RDS) and neonatal intensive care unit (NICU) admissions per ongoing pregnancies for each gestational week in the two body mass index (BMI) categories (≥30 vs.<30). Results Pre-pregnancy obesity (BMI≥30), pre-pregnancy diabetes, oligo- and polyhydramnios, being small for gestational age (SGA) and preeclampsia were significantly associated with stillbirth. However, the only pre-gravid factor that is amenable to intervention was obesity [adjusted odds ratio (OR) 2.0; 95% confidence interval (CI) 1.20, 3.3]. The rates of stillbirth seem to increase with gestational age in both BMI categories. RDS and NICU admission would be presented. Conclusion Birth near term might reduce stillbirths and decrease NICU admissions occurring in term and in post-term obese women. This presumable advantage might be offset by the potential risk of labor induction and cesarean section among obese women. Women of childbearing age with a BMI≥30 should be counseled about these risks of obesity during pregnancy and childbirth.

Potential of osteopontin in the management of epithelial ovarian cancer

Background Osteopontin (sOPN) is a promising blood tumour marker for detecting epithelial ovarian cancer (EOC). However, other clinical uses of sOPN as a tumour marker in EOC are still lacking. Since sOPN concentrations in serum are not associated with those in ascites, we compared clinical value of sOPN concentrations in the two body fluids. Patients and methods The study included 31 women with advanced EOC and 34 women with benign gynaecological pathology. In the EOC group, serum for sOPN analysis was obtained preoperatively, after primary debulking surgery and after chemotherapy. In the control group, serum was obtained before and after surgery. Ascites and peritoneal fluid were obtained during surgery. sOPN concentrations were determined by flow cytometry bead-based assay. Results The sensitivity and specificity of sOPN in detecting EOC was 91.2% and 90.3% (cut-off = 47.4 ng/ml) in serum, and 96.8% and 100% (cut-off = 529.5 ng/ml) in ascites. Kaplan-Meier analysis showed a significant association between higher serum sOPN concentration and overall survival (p = 0.018) or progression free survival (p = 0.008). Higher ascites sOPN concentrations were associated with suboptimally debulked tumour and unresectable disease. Higher serum sOPN concentrations were associated with refractory disease or incomplete response to platinum-based chemotherapy. Conclusions The study showed that ascites sOPN level mirrors present disease and is superior to serum level for diagnostic purposes and surgical planning, although the end result of treatment is the response of the whole body in fighting the disease. The preoperative sOPN concentration in serum thus better reflects disease outcome.

Maternal BMI and weight gain in singleton pregnancies: has something changed in the last decade?

Aim: To assess the trend of the pregravid body mass index (BMI), pregnancy weight gain, and BMI gain in singleton pregnancies delivered at ≥38 completed weeks during the last decade.Materials and methods: We used data from a population-based dataset for the period of 2006-2015. Linear regression was used to assess the relationship between BMI, pregnancy weight gain, and BMI change over time.Results: A total of 70,866 women were included and stratified as primiparous and multiparous. The average BMI in the primiparous women increased 0.52 kg/m² in the past decade, increasing for 0.05 kg/m² every year. The average pregnancy weight gain in this group decreased in this period by 0.7 kg, consequently lowering for 0.07 kg per year, the average BMI change during pregnancy decreased overall by 0.26 kg/m² (0.026 kg/m²/year). However, in multiparous women, the average pregravid BMI did not change over time, but the average pregnancy weight gain decreased by 0.21 kg (0.021 kg/year), and the average BMI change decreased for 0.10 kg/m².Conclusions: Our study showed that the pregravid BMI is increasing in the pregnant primiparous women, but the BMI gain, as well as the pregnancy weight gain, decreased irrespective of parity. Given that the range of differences is not clinically significant, we conclude that pregravid BMI, pregnancy weight gain, and BMI change during pregnancy did not change in the last decade.

Gestational diabetes mellitus in underweight women

Objective: To compare outcomes of pregnancies complicated by gestational diabetes mellitus (GDM) in underweight women with those of normal pregravid BMI.Methods: We used a population-based dataset to identify singleton pregnancies complicated by GDM in underweight and normal weight women.Results: Among women with GDM, we identified 301 and 6494 women with pregravid underweight and normal BMI. Underweight women were younger, more often nulliparous, and had lower birth weight (p < .05) and lower incidence of birth weight > 4000 g (OR 0.3, 95% CI 0.1, 0.6) as compared to normal weight GDM women.Conclusions: It appears that pregravid maternal weight rather than GDM might be responsible for larger babies. A dose-response relationship should be established, however.

Correlation between uterine artery Doppler and the sFlt-1/PlGF ratio in different phenotypes of placental dysfunction

OBJECTIVE

To explore correlations between the sFlt-1/PlGF ratio and uterine arteries (UtA) Doppler indexes in placental dysfunction-related disorders (PDD).

METHODS

We prospectively included women with a singleton pregnancy with preeclampsia (PE) only (n = 22), preeclampsia with fetal growth restriction (FGR) (n = 32), FGR only (n = 12), or normal pregnancy (n = 29).

RESULTS

In PDDs, significantly positive correlations between the sFlt-1/PlGF ratio and the mean UtA pulsatility (mPI-UtA), as well as the resistance index (mRI-UtA) were found (p = 0.015, p = 0.019, respectively), but not in normal pregnancies. PDD with signs of impaired placentation, evidenced by the increased sFlt-1/PlGF ratio and mPI-UtA, was found in 50.0%, and, by the increased sFlt-1/PlGF ratio and mRI-UtA, in 65.2%. PDD without signs of impaired placentation, evidenced by the increased sFlt-1/PlGF ratio but normal mPI-UtA, was found in 24.2%, and, by the increased sFlt-1/PlGF ratio but normal mRI-UtA, in 7.6%. A substantial proportion of women with signs of impaired placentation were diagnosed with FGR with or without PE.

CONCLUSION

In PDD, the sFlt-1/PlGF ratio and UtA Doppler indexes increase proportionally. Correlations between the sFlt-1/PlGF ratio and UtA Doppler indexes might help to distinguish between PDDs with and without impaired placentation. However, further studies are needed to explore the correlations in different phenotypes of PDD.

The effect of interaction between parity, gestational diabetes, and pregravid obesity on the incidence of preeclampsia

Objective: To examine the effect of parity, prepregnancy obesity and gestational diabetes on the incidence of preeclampsia in singleton pregnancies using a population-based dataset.Methods: We used the national perinatal information system (NPIS) to identify singleton pregnancies complicated by preeclampsia and analyzed dichotomous-independent variables: being obese or normal weight before pregnancy, being primiparous or multiparous, and being without gestational diabetes mellitus (GDM), with GDMA1, or GDMA2.Results: We found a significantly higher incidence of pregravid obesity among primiparas with preeclampsia (OR 1.6, 95% CI 1.55, 1.66). The data indicate that multiparas had always a significantly lower incidence of preeclampsia, regardless if the women had GDMA1, GDMA2 or had no GDM, and regardless of being of normal weight or obese before pregnancy. The data indicate that the incidence of preeclampsia was not influenced by GDM status, irrespective of parity pregravid BMI category.Conclusions: Our data indicate that GDM is not significantly associated with the development of preeclampsia.

Perineal trauma during vaginal birth in Slovenia

Introduction: The aim of this retrospective study was to examine the rates of perineal tears during childbirth in Slovenian  maternity hospitals in the period from 2013 to 2015.Methods: A causal non-experimental method of quantitative empirical approach was conducted. Data were pooled from the Slovenian National Perinatal Information System and analysed for the period of 2013 to 2015. Data analysis was performed with the use of frequency distribution of attributive variables and the basic descriptive statistics of numerical variables.Results: The incidence of perineal trauma during childbirth in all the 14 maternity hospitals varies from the "perineum without injury" to the "fourth degree perineal tear". Overall, 26.1 % of women sustained a first degree perineal tear, whereas 4.8 % of women had a second degree perineal tear. Severe perineal trauma included 0.8 % of third degree tears and 0.1 % of fourth degree tears.Discussion and conclusion: Perineal trauma varies between Slovenian maternity hospitals. Women who have sustained tears that cut into their bowels may face serious health problems and should be given relevant advice regarding the state of their pelvic floor after childbirth. It is of great importance to appropriately recognise the severity of the perineal trauma. Moreover, health professionals should be familiar with the perineal trauma classification and the factors that may cause the perineum to tear during childbirth.

Abuse of pregnant women in the healthcare system

Objective: The purpose of this study was to determine the incidence of abuse in healthcare system during pregnancy and its impact on pregnancy outcomes.Materials and methods: A validated screening Norvold Abuse Questionnaire for the identification of female victims of four kinds of abuse: emotional, physical, sexual, and the abuse in the healthcare system was anonymously offered to all women in the first 2 days postpartum.Results: The study group consisted of 1018 women, 6.2% of which reported experiencing abuse in healthcare system during pregnancy. Affected women had a higher incidence of preterm delivery (OR 2.4; 95% CI 1.2-4.8) and cesarean section rate (OR 2.0; 95% CI 1.1-3.6). Sexual abuse and abuse in healthcare system during childhood were associated with abuse in healthcare system during pregnancy (OR 4.4; CI 95% 1.2-16.2 and OR 6.9; CI 95% 1.3-35.4, respectively).Conclusions: Our study indicates that as many as 6.2% of pregnant women experience abusive encounters with perinatal care providers. These pregnancies eventually end more often preterm and by cesarean section. This possibly causal relationship should be further explored.

Infant mortality and causes of death by birth weight for gestational age in non-malformed singleton infants: a 2002-2012 population-based study

OBJECTIVE

To explore the associations between birth weight for gestational age (GA) and infant mortality as well as causes of infant death.

STUDY DESIGN

A population-based observational study conducted between 2002 and 2012 included 203,620 non-malformed singleton live births from Slovenia. Poisson regression analyses were performed to estimate the crude relative risk (RR) and adjusted RR (aRR) for infant mortality by birth weight percentiles stratified by the GA subgroups term, moderate-to-late preterm, very preterm and extremely preterm.

RESULTS

Compared with appropriate for GA (AGA) term infants (referent-AGA), infant mortality was significantly higher in small for GA (SGA) term infants [aRR=2.79 (1.41-5.50)], with significant cause-specific infant mortality risk for neuromuscular disorders [RR=10.48 (2.62-41.91)]. The differences in infant mortality and cause-specific infant mortality in preterm subgroups between referent-AGA and SGA were insignificant.

CONCLUSIONS

In the Slovenian population, birth weight for GA is significantly associated with infant mortality only in infants born at term.

Magnetic-activated cell sorting of non-apoptotic spermatozoa improves the quality of embryos according to female age: a prospective sibling oocyte study

PURPOSE

The main aim of our study was to evaluate the benefit of the use of non-apoptotic spermatozoa selected by magnetic-activated cell sorting (MACS) for ICSI procedures for couples in which the women had good prognoses and the male factor of infertility was teratozoospermia.

METHODS

Twenty-six couples were treated with ICSI after MACS selection of non-apoptotic spermatozoa following a sibling oocyte approach. Half of the oocytes were microinjected with conventionally prepared spermatozoa, and the other half were microinjected with non-apoptotic, MACS-selected spermatozoa. To assess the influence of MACS selection of spermatozoa on the outcomes of the ICSI cycles, the fertilization, embryo quality, pregnancy, and delivery rates were evaluated and compared between the sibling oocyte groups.

RESULTS

When subpopulations of couples according to female age were analyzed, a significant difference in quality of blastocyst was observed. More precisely, in a group that was treated with MACS-ICSI, a higher percentage of good quality blastocysts was found among women older than 30 years (75.0 vs. 33.3%; P = 0.028), while there was no difference among younger women. If all included couples were compared regardless of age, no significant difference was observed in the outcome of the ICSI/MACS-ICSI cycles in terms of oocytes and embryos. Additionally, after the ICSI and MACS-ICSI procedures, the morphologies of the prepared spermatozoa were compared. Results showed that the overall percentage of morphologically normal spermatozoa did not differ significantly between the ICSI and MACS-ICSI procedures. However, detailed analyses of the morphologically abnormal spermatozoa revealed significantly more spermatozoa with abnormal tails after MACS-ICSI procedure, which may be potential consequence of the selection procedure. Moreover, the trends towards less spermatozoa with abnormal heads and towards more spermatozoa with abnormal necks and midpieces after MACS-ICSI procedure were revealed, although the differences were not significant.

CONCLUSIONS

Couples dealing with male infertility due to teratozoospermia can benefit from MACS selection of spermatozoa with higher percentage of good quality blastocysts but only when the woman is older than 30 years.

Nanoparticle concentrations and composition in a dental office and dental laboratory: A pilot study on the influence of working procedures

During material treatment in dentistry particles of different size are released in the air. To examine the degree of particle exposure, air scanning to dental employees was performed by the Scanning Mobility Particle Sizer. The size, shape and chemical composition of particles collected with a low-pressure impactor were determined by scanning electronic microscopy and X-ray dispersive analysis. The average concentrations of nanoparticles during working periods in a clean dental laboratory (45,000-56,000 particles/cm³), in an unclean dental laboratory (28,000-74,000 particles/cm³), and in a dental office (21,000-50,000 particles/cm³), were significantly higher compared to average concentrations during nonworking periods in the clean dental laboratory (11,000-24,000 particles/cm³), unclean laboratory (14,000-40,000 particles/cm³), and dental office (13,000-26,000 particles/cm³). Peak concentration of nanoparticles in work-intensive periods were found significantly higher (up to 773,000 particles/cm³), compared to the non-working periods (147,000 particles/cm³) and work-less intensive periods (365,000 particles/cm³). The highest mass concentration value ranged from 0.055-0.166 mg/m³. X-ray dispersive analysis confirmed the presence of carbon, potassium, oxygen, iron, aluminum, zinc, silicon, and phosphorus as integral elements of dental restorative materials in form of nanoparticle clusters, all smaller than 100 nm. We concluded that dental employees are exposed to nanoparticles in their working environment and are therefore potentially at risk for certain respiratory and systematic diseases.

Is forty the new thirty? Population based study of advanced maternal age

OBJECTIVE

To compare perinatal outcomes in different advanced maternal age groups.

PATIENTS AND METHODS

We used a population-based data set to compare perinatal outcomes in three maternal age groups: 30-34.9, 35-39.9, and in women over 40 years.

RESULTS

Over a 10-year period there were 23,422 (25.2%) births in the 35-39.9 years group, 3987 (4.3%) in the over 40 years group, and 65,492 births (70.5%) in our reference group (30-34.9 years). A direct significant relationship was found between maternal age and BMI and between pregnancy complications such as diabetes and hypertensive disorders, whereas an inverse relationship was found between older age and nuliparity and spontaneous conceptions. Also, older mothers had a higher incidence of both types of cesareans, and more early as well as late preterm births. Perinatal mortality was similar in all groups.

CONCLUSIONS

Advanced maternal age is associated with higher, gradually increasing, incidence, of adverse perinatal outcomes.

Risk Factors for Osteoporosis in Postmenopausal Women - from The Point of View of Primary Care Gynecologist

INTRODUCTION

Osteoporosis is a highly prevalent public health problem with osteoporosis-related fractures that account for high morbidity and mortality. Therefore, prevention strategies and early detection of osteoporosis should be carried out in primary gynaecological care units, so as to substantially reduce the risk of fractures and allow the best treatment option for a particular woman.

METHODS

From 2002 to 2011, we recruited 2956 women. Of the total number of women, we additionally extrapolated 1274 women aged 60-75 years, assumingly, the group of women at higher risk of osteoporosis. Demographic and anthropometrical data as well as the information regarding risk factors for osteoporosis were collected using a questionnaire.

RESULTS

The odds ratio for osteoporosis increased by 8% (p=0.001) with each additional year of life. The OP prevalence increased with age from 24.9% in 60-64 years to 37.4% in 70-75 years. In non-smokers the odds ratio for osteoporosis was 0.424, which was statistically significant (p<0.05). BMI <18.5 increased the odds ratio for osteoporosis by 2 times, which was not statistically significant. In women 60-75 years old (N=1274), the risk of fractures increased with increasing age, considering previous fractures in the last 5 years (p<0.001), hip fracture (p=0.001), wrist fracture (p=0.002) and observed height loss (p<0.001). Hormone therapy (HT) use decreased the prevalence of OP by 25% in comparison with non-users.

CONCLUSION

Primary care gynaecologist with a DXA centre has every opportunity for a holistic approach to the management of postmenopausal women, including the prevention and treatment of postmenopausal osteoporosis.

Risk factors for osteoporosis in postmenopausal women – from the point of view of primary care gynecologist

Introduction

Osteoporosis is a highly prevalent public health problem with osteoporosis-related fractures that account for high morbidity and mortality. Therefore, prevention strategies and early detection of osteoporosis should be carried out in primary gynaecological care units, so as to substantially reduce the risk of fractures and allow the best treatment option for a particular woman.

Methods

From 2002 to 2011, we recruited 2956 women. Of the total number of women, we additionally extrapolated 1274 women aged 60-75 years, assumingly, the group of women at higher risk of osteoporosis. Demographic and anthropometrical data as well as the information regarding risk factors for osteoporosis were collected using a questionnaire.

Results

The odds ratio for osteoporosis increased by 8% (p=0.001) with each additional year of life. The OP prevalence increased with age from 24.9% in 60-64 years to 37.4% in 70-75 years. In non-smokers the odds ratio for osteoporosis was 0.424, which was statistically significant (p<0.05). BMI <18.5 increased the odds ratio for osteoporosis by 2 times, which was not statistically significant. In women 60-75 years old (N=1274), the risk of fractures increased with increasing age, considering previous fractures in the last 5 years (p<0.001), hip fracture (p=0.001), wrist fracture (p=0.002) and observed height loss (p<0.001). Hormone therapy (HT) use decreased the prevalence of OP by 25% in comparison with non-users.

Conclusion

Primary care gynaecologist with a DXA centre has every opportunity for a holistic approach to the management of postmenopausal women, including the prevention and treatment of postmenopausal osteoporosis.

Should we consider integrated approach for endometriosis-associated infertility as gold standard management? Rationale and results from a large cohort analysis

PURPOSE

To evaluate reproductive and maternal-fetal outcomes after integrated approach for endometriosis-associated infertility (EAI).

METHODS

We retrospectively analyzed reproductive and maternal-fetal outcomes of 277 women affected by EAI, subdividing patients in two groups: in the first one (surgery group), we included all women who underwent laparoscopic surgery for EAI; in the second one (integrated group), we included women who failed to conceive spontaneously after surgery within 6-12 months and underwent in vitro fertilization and embryo transfer (IVF). We evaluated delivery rate (DR), maternal and neonatal outcomes of the first pregnancies, and, finally, the type (spontaneous or IVF) of subsequent pregnancies.

RESULTS

We did not find significant difference regarding DR between surgery and integrated groups. We found significantly lower birth weight (p < 0.001) and gestational age at delivery (p < 0.001) in integrated group respect to surgery group; conversely, we found higher rate of preterm birth (p < 0.001), small for gestational age (p = 0.003), and admission to the neonatal intensive care unit (p < 0.001) respect to surgery group. Finally, 92 women became pregnant for the second time: 8% were spontaneous and 20% were IVF pregnancies.

CONCLUSIONS

We suggest the integrated approach as gold standard treatment for carefully selected patients (young, good ovarian reserve, partner with normal semen parameters) affected by EAI. As consequence, IVF should be reserved as the secondary treatment for women who fail to conceive spontaneously after surgery within 6-12 months, since it is able to increase DR significantly.

The Role of Health Services in Encouraging Disclosure of Violence Against Women

Introduction

The aim of the survey was to assess the differences in disclosure by the type of violence to better plan the role of health services in identifying and disclosing violence.

Methods

A validated, anonymous screening questionnaire (NorAQ) for the identification of female victims of violence was offered to all postpartum women at a single maternity unit over a three-month period in 2014. Response rate was 80% (1018 respondents). Chi square test was used for statistical analysis (p<0.05 significant).

Results

There are differences in disclosure by type of violence. Nearly half (41.5%) of violence by health care services was not reported, compared to 33.7% physical, 23.4% psychological, and 32.5% sexual that was reported. The percentage of violence in intimate partnership reported to health care staff is low (9.3% to 20.8%), but almost half of the violence experienced by heath care services (44%) is reported. Intimate partnership violence is more often reported to the physician than to the psychologist or social worker. Violence in health care service is reported also to nurses.

Conclusions

Disclosure enables various institutions to start with the procedures aimed at protecting victims against violence. Health workers should continuously encourage women to speak about violence rather than asking about it only once. It is also important that such inquiries are made on different levels of health care system and by different health care professions, since there are differences to whom women are willing to disclose violence.

The Outcomes of Pregnancy and Childbirth in Adolescents in Slovenia

Introduction

The objective of the study was to determine the course and outcomes of pregnancy and childbirth in adolescents compared to women aged 20–24 years in Slovenia.

Methods

In the retrospective study, the course of pregnancy and labour and the perinatal outcome of newborns in primiparous adolescents aged ≤19 years (study group) have been compared to the control group of primiparous women aged 20–24 years. The study group was further divided into a study subgroup of adolescents aged ≤17 years. Data were retrieved from the National Perinatal Information System in Slovenia for the period 2008–2012. Altogether, 13,663 women and their newborns were included.

Results

Adolescent pregnancy was associated with increased rates of unknown estimated date of delivery, preterm labour, low birth weight newborns, small for gestational age newborns and low gestational weight gain. Spontaneous labour was more common in adolescents, while emergency and elective Caesarean sections were less common than in women aged 20–24 years. In addition, pregnancy in adolescents aged ≤17 years was associated with increased rate of maternal anaemia and labour without complications. Higher rates of smoking, lower rates of parenting school attendance, lower rates of pregnancy check-ups and screening tests in pregnancy such as nuchal translucency in adolescents were found.

Conclusions

The results of the study show that adolescent pregnancy is related to higher health risks for pregnant adolescents and their newborns. In addition, adolescents are subject to poorer prenatal care comparing to older women.

STAR and AKR1B10 are down-regulated in high-grade endometrial cancer

Endometrial cancer is the most frequent gynecological malignancy in the developed world. The majority of cases are estrogen dependent, and are associated with diminished protective effects of progesterone. Endometrial cancer is also related to enhanced inflammation and decreased differentiation. In our previous studies, we examined the expression of genes involved in estrogen and progesterone actions in inflammation and tumor differentiation, in tissue samples from endometrial cancer and adjacent control endometrium. The aims of the current study were to examine correlations between gene expression and several demographic characteristics, and to evaluate changes in gene expression with regard to histopathological and clinical characteristics of 51 patients. We studied correlations and differences in expression of 38 genes involved in five pathophysiological processes: (i) estrogen-stimulated proliferation; (ii) estrogen-dependent carcinogenesis; (iii) diminished biosynthesis of progesterone: (iv) enhanced formation of progesterone metabolites; and (v) increased inflammation and decreased differentiation. Spearman correlation coefficient analysis shows that expression of PAQR7 correlates with age, expression of SRD5A1, AKR1B1 and AKR1B10 correlate with body mass, while expression of SRD5A1 and AKR1B10 correlate with body mass index. When patients with endometrial cancer were stratified based on menopausal status, histological grade, myometrial invasion, lymphovascular invasion, and FIGO stage, Mann-Whitney U tests revealed significantly decreased expression of STAR (4.4-fold; adjusted p=0.009) and AKR1B10 (9-fold; adjusted p=0.003) in high grade versus low grade tumors. Lower levels of STAR might lead to decreased de-novo steroid hormone synthesis and tumor differentiation, and lower levels of AKR1B10 to diminished elimination of toxic electrophilic carbonyl compounds in high-grade endometrial cancer. These data thus reveal the potential of STAR and AKR1B10 as prognostic biomarkers, which calls for further validation at the protein level.

Incidence of episiotomy in Slovenia: The story behind the numbers

Episiotomy is a surgical cut of the perineum performed in the second stage of labor in order to widen the vaginal opening and thus facilitate the birth of an infant. Despite current recommendations against the routine use of episiotomy, it is one of the most commonly performed surgical interventions during childbirth. This retrospective study explores the number of episiotomies performed in Slovenian maternity hospitals and the differences in episiotomy rates in relation to parity. Data were obtained from the Slovenian National Perinatal Information System and pooled for 2013. A causal and non-experimental method of empirical research was used. The results of the study show that episiotomy rates vary widely across Slovenian maternity hospitals, ranging from 2.5% to 51.7%. Moreover, the majority of Slovenian maternity hospitals exceed the recommended rate, with an overall incidence of episiotomy as high as 31.3%. Further research is recommended to obtain relevant information from women as well as from midwives and to draw new, evidence-based conclusions related to the maternal benefits and adverse effects of episiotomy.

Does an ideal prototype of a twin mother exist?

Objective To evaluate the association of a set (or the lack thereof) of pre-gravid maternal features with a better outcome in terms of gestational age and birth weight of twins. Methods Analysis of a Slovenian population-based cohort of all dichorionic twin pairs born at ≥22 weeks during an 11-year period from 2002 to 2013. The independent variables included tall stature (≥170 cm), multiparity, and normal pregravid body mass index (BMI). The outcome variables included gestational age and total twin birth weight. Results We studied 3232 dichorionic twins. Being "tall", multiparous, and with a normal pregravid BMI was significantly associated with a higher total twin birth weight, more advanced gestational age, fewer sets with a total twin birth weight <3000 g, fewer births at ≤32 weeks, more pairs with a total twin birth weight >5000 g and more pairs born at ≥37 weeks. In contrast, women with the converse features had a significantly worse outcome. Being just multiparous was different only in the incidence of total twin birth weight >5000 g. Conclusion Maternal stature >170 cm, being multiparous, and having a normal pregravid BMI is association with improved outcomes in terms of gestational age and birth weight of twins.

Data on expression of genes involved in estrogen and progesterone action, inflammation and differentiation according to demographic, histopathological and clinical characteristics of endometrial cancer patients

Endometrial cancer is the sixth most common cancer in women worldwide. It is associated with aberrant actions of steroid hormones, estrogens and progesterone, but also with enhanced inflammation and reduced cellular differentiation. Here, we show data on demographic and histopathological characteristics of 51 patients with endometrial cancer, together with data on correlations between the expression of 38 genes involved in estrogen and progesterone actions, inflammation and differentiation, and demographic characteristics. We also show data on changes in gene expression of these 38 genes according to histopathological and clinical characteristics of these patients. This article includes data referenced in the manuscript entitled »STAR and AKR1B10 are down-regulated in high-grade endometrial cancer by Sinreih et al. (in press) [1].