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Stopar Pintarič T, Pavlica M, Druškovič M, Kavšek G, Verdenik I, Pečlin P. Relationship between labour analgesia modalities and types of anaesthetic techniques in categories 2 and 3 intrapartum caesarean deliveries. Biomol Biomed 2024. [PMID: 38488674 DOI: 10.17305/bb.2024.10186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/04/2024] [Indexed: 04/20/2024]
Abstract
General anesthesia (GA) is typically recommended for category 1 emergency cesarean delivery (CD). For categories 2–4 emergencies, either regional or GA can be used. The factors influencing the choice of anesthetic technique in these categories remain poorly understood. We analyzed the association between the type of labor analgesia and subsequent anesthetic techniques employed for intrapartum categories 2 and 3 CD. In a prospective longitudinal cohort study, 300 women were consequently enrolled and categorized according to Lucas’s classification of CD urgency. The techniques of anesthesia (GA, spinal, and epidural anesthesia [EA]) employed for CD were analyzed with respect to labor analgesia methods (remifentanil patient-controlled analgesia [remifentanil-PCA], EA, and nitrous oxide [N2O]). EA was the most frequent analgesic option (43.8%), followed by remifentanil-PCA (20.7%) and N2O (5.1%), while 30.4% of parturient women received no analgesia. All anesthetic methods showed a significant relationship with analgesic modalities (P < 0.001). Remifentanil-PCA was associated with a higher incidence of GA. Contraindication to EA was the primary factor related to the transition from remifentanil-PCA to GA. Most parturients who received EA were successfully converted to EA. Spinal anesthesia was the most common technique in women using N2O and those without labor analgesia. GA was associated with lower 5-min Apgar scores. The method of labor analgesia was associated with the anesthesia technique employed for categories 2 and 3 CD. This finding may guide patient counseling and intrapartum anesthetic planning. However, the analysis should be cautiously interpreted as the selection of anesthesia is a complex decision influenced by several clinical considerations.
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Affiliation(s)
- Tatjana Stopar Pintarič
- Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana, Ljubljana, Slovenia; Institute of Anatomy, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Maja Pavlica
- Department of Perinatology, Division of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Mirjam Druškovič
- Department of Perinatology, Division of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Gorazd Kavšek
- Department of Perinatology, Division of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Ivan Verdenik
- Department of Perinatology, Division of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Polona Pečlin
- Department of Perinatology, Division of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Amyx M, Philibert M, Farr A, Donati S, Smárason AK, Tica V, Velebil P, Alexander S, Durox M, Elorriaga MF, Heller G, Kyprianou T, Mierzejewska E, Verdenik I, Zīle-Velika I, Zeitlin J. Trends in caesarean section rates in Europe from 2015 to 2019 using Robson's Ten Group Classification System: A Euro-Peristat study. BJOG 2024; 131:444-454. [PMID: 37779035 DOI: 10.1111/1471-0528.17670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE To assess changes in caesarean section (CS) rates in Europe from 2015 to 2019 and utilise the Robson Ten Group Classification System (TGCS) to evaluate the contribution of different obstetric populations to overall CS rates and trends. DESIGN Observational study utilising routine birth registry data. SETTING A total of 28 European countries. POPULATION Births at ≥22 weeks of gestation in 2015 and 2019. METHODS Using a federated model, individual-level data from routine sources in each country were formatted to a common data model and transformed into anonymised, aggregated data. MAIN OUTCOME MEASURES By country: overall CS rate. For TGCS groups (by country): CS rate, relative size, relative and absolute contribution to overall CS rate. RESULTS Among the 28 European countries, both the CS rates (2015, 16.0%-55.9%; 2019, 16.0%-52.2%) and the trends varied (from -3.7% to +4.7%, with decreased rates in nine countries, maintained rates in seven countries (≤ ± 0.2) and with increasing rates in 12 countries). Using the TGCS (for 17 countries), in most countries labour induction increased (groups 2a and 4a), whereas multiple pregnancies (group 8) decreased. In countries with decreasing overall CS rates, CS tended to decrease across all TGCS groups, whereas in countries with increasing rates, CS tended to increase in most groups. In countries with the greatest increase in CS rates (>1%), the absolute contributions of groups 1 (nulliparous term cephalic singletons, spontaneous labour), 2a and 4a (induction of labour), 2b and 4b (prelabour CS) and 10 (preterm cephalic singletons) to the overall CS rate tended to increase. CONCLUSIONS The TGCS shows varying CS trends and rates among countries of Europe. Comparisons between European countries, particularly those with differing trends, could provide insight into strategies to reduce CS without clinical indication.
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Affiliation(s)
- Melissa Amyx
- Université de Paris Cité, Épidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé), Centre de Recherche Épidémiologie et Statistiques Sorbonne Paris Cité (CRESS), INSERM U1153, INRA, Paris, France
| | - Marianne Philibert
- Université de Paris Cité, Épidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé), Centre de Recherche Épidémiologie et Statistiques Sorbonne Paris Cité (CRESS), INSERM U1153, INRA, Paris, France
| | - Alex Farr
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità, Italian Ministry of Health (ISS), Rome, Italy
| | - Alexander K Smárason
- Institution of Health Science Research, University of Akureyri, Akureyri, Iceland
| | - Vlad Tica
- Faculty of Medicine, East European Institute for Reproductive Health, Academy of Romanian Scientists, University 'Ovidius' Constanţa, Constanța, Romania
| | - Petr Velebil
- Institute for the Care of Mother and Child, Prague, Czech Republic
- 3rd Medical School of Charles University, Prague, Czech Republic
| | - Sophie Alexander
- Perinatal Epidemiology and Reproductive Health Unit, CR2, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Mélanie Durox
- Université de Paris Cité, Épidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé), Centre de Recherche Épidémiologie et Statistiques Sorbonne Paris Cité (CRESS), INSERM U1153, INRA, Paris, France
| | | | - Günther Heller
- Institute for Quality Assurance and Transparency in Healthcare (IQTIG), Berlin, Germany
| | | | - Ewa Mierzejewska
- Department of Epidemiology and Biostatistics, Institute of Mother and Child, Warsaw, Poland
| | - Ivan Verdenik
- Department of Obstetrics and Gynaecology, University Medical Centre, Ljubljana, Slovenia
| | - Irisa Zīle-Velika
- The Centre for Disease Prevention and Control of Latvia, Riga, Latvia
| | - Jennifer Zeitlin
- Université de Paris Cité, Épidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé), Centre de Recherche Épidémiologie et Statistiques Sorbonne Paris Cité (CRESS), INSERM U1153, INRA, Paris, France
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Franić D, Franić Ivanišević M, Verdenik I. Radiofrequency as the New Opportunity in Treating Overactive Bladder and Urge Urinary Incontinence-A Single-Arm Pilot Study. Medicina (Kaunas) 2024; 60:197. [PMID: 38399486 PMCID: PMC10890003 DOI: 10.3390/medicina60020197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/02/2024] [Accepted: 01/15/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Until now, overactive bladder (OAB) with or without urge urinary incontinence (UUI) has been treated mainly in two ways: with behavioral methods and patient education, or using antimuscarinic drugs and/or beta-3 adrenergic receptor agonists. Unfortunately, these drugs may cause side effects in some women or are insufficiently effective, so patients abandon them. Therefore, in this pilot study, radiofrequency was evaluated as a new option in the treatment of OAB and UUI. Materials and Methods: Nineteen patients were enrolled in this pilot study using radiofrequency (RF), where the level of OAB and UUI was assessed using the validated ICIQ-OAB questionnaire. RF was applied four times for 20 min, once a week. Two weeks after treatment, the level of OAB and UUI was reassessed and processed statistically and the treatment effect evaluated. Results: Using the ICIQ-OAB, the severity of OAB and UUI was assessed: 0-3 mild symptoms; 4-7 moderate symptoms; 8-11 severe symptoms; 12-16 very severe symptoms. Before treatment, 10.5% of patients had mild symptoms, 21.1% moderate symptoms, 63.2% severe symptoms and 5.3% very severe symptoms. After treatment, 42.9% had mild symptoms, 50% moderate symptoms and 7% severe OAB and UUI symptoms. All four main symptoms-frequency, nocturia, urgency and incontinence-decreased statistically significantly, with the best results being found in urgency (p = 0.002). Conclusions: Based on this pilot study, RF seems a very promising method in the treatment of OAB and UUI. To extend our initial findings, it is necessary to perform a prospective, randomized and placebo-controlled study in order to obtain reliable results and to determine for how long one set of treatment maintains the results obtained immediately after the end of that treatment. In this way, we may determine how often the treatment needs to be repeated, if necessary, and when.
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Affiliation(s)
- Damir Franić
- Ginekologija Dr. Franić d.o.o., 3250 Rogaška Slatina, Slovenia
- Medical Faculty, University of Maribor, 2000 Maribor, Slovenia
| | - Maja Franić Ivanišević
- Obstetric and Gynecology Unit, Health Centre Slovenske Konjice, 3210 Slovenske Konjice, Slovenia;
| | - Ivan Verdenik
- Research Unit, University Gynecological Clinic Ljubljana, 1000 Ljubljana, Slovenia;
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Janša V, Osredkar J, Verdenik I, Rižner TL, Ban Frangež H. Oxidative stress markers cannot be used as endometriosis biomarkers in infertile patients. Gynecol Endocrinol 2023; 39:2242956. [PMID: 37607570 DOI: 10.1080/09513590.2023.2242956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 02/14/2023] [Accepted: 07/26/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVES Endometriosis is a common benign gynaecological disease that significantly compromises the quality of life of patients. To date, invasive surgery is the method of choice to visually and histologically confirm endometriosis. Thus, there is a major interest to develop noninvasive diagnostic tools. Oxidative stress is one of the proposed mechanisms of pathogenesis and may be involved in pelvic pain, dysmenorrhea, dyspareunia, and infertility in endometriosis patients. Thus, markers of oxidative stress may serve as diagnostic biomarkers for endometriosis. DESIGN This prospective case-control study assessed erythrocyte superoxide dismutase (SOD), erythrocyte glutathione peroxidase (GPX), serum hexanoyl lysine (HEL) and peritoneal fluid HEL. PARTICIPANTS/MATERIALS, SETTING, AND METHODS We enrolled 86 women with primary infertility; the case group included 57 women with endometriosis, and the control group included 29 women with unexplained primary infertility. All the patients underwent laparoscopy, and the diagnosis was confirmed histologically. RANDOX and RANSEL reagents were used to determine the levels of SOD and GPX, respectively, and ELISA was used to determine the levels of HEL. RESULTS We found no statistically significant differences in the erythrocyte levels of GPX (p value 0.623) or SOD (p value 0.122) or the serum or peritoneal fluid levels of HEL (p value 0.562 and 0.329 accordingly). CONCLUSIONS SOD, GPX, and HEL levels most likely do not differ between patients with unexplained infertility and patients with endometriosis.
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Affiliation(s)
- Vid Janša
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Joško Osredkar
- Clinical Institute of Clinical Chemistry and Biochemistry, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Ivan Verdenik
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tea Lanišnik Rižner
- Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Helena Ban Frangež
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Ovsenik A, Podbregar M, Lakič N, Brešar M, Boškoski P, Verdenik I, Fabjan A. Neurovascular coupling in severe aortic valve stenosis. Brain Behav 2023; 13:e3155. [PMID: 37475651 PMCID: PMC10454277 DOI: 10.1002/brb3.3155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/18/2023] [Accepted: 07/06/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVES Aortic stenosis (AS) is characterized by obstruction of blood outflow from the left ventricle, which can impair target organ perfusion such as the brain. We hypothesized that hemodynamic changes in AS may lead to dysfunction of cerebral blood flow regulatory mechanisms. The aim of our study was to evaluate neurovascular coupling in patients with AS by Transcranial Doppler ultrasonography. METHODS Neurovascular coupling was assessed using visually evoked cerebral blood flow velocity responses (VEFR) calculated as relative blood flow velocity changes in the posterior cerebral artery upon visual stimulation. We analyzed peak systolic, mean and end diastolic VEFR in 54 patients with severe AS and 43 controls in 10 consecutive cycles of visual stimulation. Repeated-measures ANOVA test was used to compare cerebral hemodynamic data by group. RESULTS Patients with AS had significantly higher peak systolic (12.9% ± 5.6% and 10.5% ± 4.5%; p = .009) and mean VEFR (14.4% ± 5.8% and 12.2% ± 4.9%; p = .021) compared to controls, whereas only a tendency for higher end diastolic VEFR was observed (16.7% ± 6.9% and 14.4% ± 6.2%; p = .061). CONCLUSION We have shown for the first time that patients with severe AS exhibit higher VEFR than controls indicating dysregulation of neurovascular coupling, which can be one of the factors contributing to development of cognitive decline.
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Affiliation(s)
- Ana Ovsenik
- Faculty of Medicine, Department of BiomedicineUniversity of LjubljanaLjubljanaSlovenia
- Department of CardiologyUniversity Medical Centre LjubljanaLjubljanaSlovenia
| | - Matej Podbregar
- Faculty of Medicine, Department of Internal MedicineUniversity of LjubljanaLjubljanaSlovenia
- Department of Intensive CareGeneral Hospital CeljeCeljeSlovenia
| | - Nikola Lakič
- Department of Cardiovascular SurgeryUniversity Medical Centre LjubljanaLjubljanaSlovenia
| | - Martin Brešar
- Jožef Stefan International Postgraduate SchoolLjubljanaSlovenia
- Department of Systems and ControlJožef Stefan InstituteLjubljanaSlovenia
| | - Pavle Boškoski
- Department of Systems and ControlJožef Stefan InstituteLjubljanaSlovenia
| | - Ivan Verdenik
- Department of Obstetrics and Gynaecology, Division for ResearchUniversity Medical Centre LjubljanaLjubljanaSlovenia
| | - Andrej Fabjan
- Faculty of Medicine, Institute for PhysiologyUniversity of LjubljanaLjubljanaSlovenia
- Department of Vascular Neurology and Neurological Intensive CareUniversity Medical Centre LjubljanaLjubljanaSlovenia
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Lucovnik M, Verdenik I, Stopar Pintaric T. Intrapartum Cesarean Section and Perinatal Outcomes after Epidural Analgesia or Remifentanil-PCA in Breech and Twin Deliveries. Medicina (Kaunas) 2023; 59:1026. [PMID: 37374230 DOI: 10.3390/medicina59061026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023]
Abstract
Comparative data on the potential impact of various forms of labor analgesia on the mode of delivery and neonatal complications in vaginal deliveries of singleton breech and twin fetuses are lacking. The present study aimed to determine the associations between type of labor analgesia (epidural analgesia (EA) vs. remifentanil patient-controlled analgesia (PCA)) and intrapartum cesarean sections (CS), and maternal and neonatal adverse outcomes in breech and twin vaginal births. A retrospective analysis of planned vaginal breech and twin deliveries at the Department of Perinatology, University Medical Centre Ljubljana, was performed for the period 2013-2021, using data obtained from the Slovenian National Perinatal Information System. The pre-specified outcomes studied were the rates of CS in labor, postpartum hemorrhage, obstetric anal sphincter injury (OASI), an Apgar score of <7 at 5 min after birth, birth asphyxia, and neonatal intensive care admission. A total of 371 deliveries were analyzed, including 127 term breech and 244 twin births. There were no statistically significant nor clinically relevant differences between the EA and remifentanil-PCA groups in any of the outcomes studied. Our findings suggest that both EA and remifentanil-PCA are safe and comparable in terms of labor outcomes in singleton breech and twin deliveries.
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Affiliation(s)
- Miha Lucovnik
- Department of Perinatology, Division of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Slajmerjeva 3, 1000 Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Ivan Verdenik
- Department of Perinatology, Division of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Slajmerjeva 3, 1000 Ljubljana, Slovenia
| | - Tatjana Stopar Pintaric
- Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana, Slajmerjeva 3, 1000 Ljubljana, Slovenia
- Institute of Anatomy, Medical Faculty, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
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Čehovin K, Gortnar A, Verdenik I, Lučovnik M, Kornhauser-Cerar L, Grosek Š. Comparison of Neonatal Morbidity and Mortality Following Spontaneous and Medically Indicated Preterm Births: A Retrospective Population-Based Study Using Data from the Slovenian National Perinatal Information System 2013-2018. Med Sci Monit 2023; 29:e938941. [PMID: 36740819 PMCID: PMC9912692 DOI: 10.12659/msm.938941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND This retrospective population-based study analyzed data from the Slovenian National Perinatal Information System (NPIS) between 2013 and 2018 to compare neonatal morbidity and mortality following spontaneous and medically indicated preterm births. MATERIAL AND METHODS Retrospective population-based cohort. Entries to the NPIS database were searched by gestational age (GA) <37 weeks in Slovenia between 2013 and 2018. Of 9200 (6252 following spontaneous birth, 2948 following medically indicated) neonates included, 1358 were born at extremely to very preterm GA (998 following spontaneous birth, 360 following medically indicated). Logistic regression analysis was used to examine the association between neonatal mortality and composite severe neonatal morbidity and preterm birth type (spontaneous vs medically indicated) controlling for potential confounding variables. Analysis was first performed for all preterm births (GA 22 0/7 to 36 6/7) and later only for extremely to very preterm births (GA 22 0/7 to 31 6/7). RESULTS Neonatal mortality was significantly lower following spontaneous preterm birth at extremely to very preterm GA (odds ratio [OR] 0.34; 95% confidence interval [CI] [0.14, 0.81]), while there was no association in all preterm births group (OR 0.56; 95% CI [0.26, 1.20]). No significant correlation between preterm birth type and neonatal morbidity was found (OR 0.76; 95% CI [0.54, 1.09] for all preterm births and OR 0.71; 95% CI [0.47, 1.07] for extremely to very preterm births). CONCLUSIONS In this population study from Slovenia between 2013 and 2018, medically indicated preterm births at <32 weeks of GA were associated with significantly increased neonatal mortality but not neonatal morbidity.
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Affiliation(s)
- Katja Čehovin
- Department of Gynaecology and Perinatology, General Hospital Trbovlje, Trbovlje, Slovenia
| | - Ajda Gortnar
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ivan Verdenik
- Division of Obstetrics and Gynecology, Department of Perinatology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Miha Lučovnik
- Division of Obstetrics and Gynecology, Department of Perinatology, University Medical Center Ljubljana, Ljubljana, Slovenia,Department of Gynecology and Obstetrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Lilijana Kornhauser-Cerar
- Division of Obstetrics and Gynecology, Department of Perinatology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Štefan Grosek
- Division of Obstetrics and Gynecology, Department of Perinatology, University Medical Center Ljubljana, Ljubljana, Slovenia,Division of Pediatrics, Pediatric Intensive Care Unit, University Medical Center Ljubljana, Ljubljana, Slovenia,Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Globevnik Velikonja V, Verdenik I, Erjavec K, Kregar Velikonja N. Influence of Psychological Factors on Vaccination Acceptance among Health Care Workers in Slovenia in Three Different Phases of the COVID-19 Pandemic. Vaccines (Basel) 2022; 10:1983. [PMID: 36560393 PMCID: PMC9782158 DOI: 10.3390/vaccines10121983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/18/2022] [Accepted: 11/20/2022] [Indexed: 11/24/2022] Open
Abstract
COVID-19 vaccination acceptance among healthcare workers (HCWs) is very important to control the pandemic and to ensure the safety of HCWs and patients. As psychological factors may affect the decision to be vaccinated, the aim of this study was to investigate the influence of psychological factors on vaccination acceptance in different phases of the COVID-19 pandemic. A cross-sectional study using a web-based survey was conducted among HCWs in Slovenia at the beginning of the pandemic (N = 851), one month later (N = 86), and one year later (N = 145) when vaccines were already available. The results showed that the influence of psychological factors (anxiety, psychological burden, perceived infectability, and germ aversion) was specific for each survey period. At the beginning of the pandemic, vaccination intention was positively associated with anxiety. In the third survey period, anxiety was not exposed as a predictive factor for vaccination intention. However, comparison of vaccination status among groups with different levels of anxiety revealed an interesting distinction within those in favour of vaccination; in the group with minimal levels of anxiety, there was a relatively high share of respondents that were already vaccinated, whereas in the group with severe anxiety, most individuals intended to be vaccinated but hesitated to take action.
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Affiliation(s)
- Vislava Globevnik Velikonja
- Division for Obstetrics and Gynaecology, University Medical Centre Ljubljana, Šlajmerjeva 4, 1000 Ljubljana, Slovenia
- Faculty of Health Sciences, University of Novo Mesto, 8000 Novo Mesto, Slovenia
| | - Ivan Verdenik
- Division for Obstetrics and Gynaecology, University Medical Centre Ljubljana, Šlajmerjeva 4, 1000 Ljubljana, Slovenia
- Faculty of Health Sciences, University of Novo Mesto, 8000 Novo Mesto, Slovenia
| | - Karmen Erjavec
- Faculty of Health Sciences, University of Novo Mesto, 8000 Novo Mesto, Slovenia
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Smith L, Farr A, Zurriaga O, Cuttini M, Verdenik I, Vidal Benedé MJ, Kearns K, Sakkeus L, Kyprianou T, Barros H. Socioeconomic differences in perinatal health outcomes: perinatal health surveillance through a health-equity prism. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Socioeconomic status (SES) is strongly associated with perinatal health outcomes, perpetuating intergenerational health inequalities. Our aim was to assess the utility of population data in Europe to monitor social inequalities in key perinatal health indicators.
Methods
Using the PHIRI federated analysis protocol to aggregate routine birth data from across Europe, we collected data on selected perinatal health indicators by SES from 2015 to 2020. Mothers’ education level (primary/lower secondary; upper secondary; postsecondary) was the preferred SES indicator; if unavailable, parents’ occupation or area-based deprivation scores were provided. The International Standard Classification of Occupations was used to group parents’ occupations into 4 categories, while area-based deprivation scores were measured in quintiles. For each country, we calculated risk ratios (RR) for preterm birth, stillbirth, neonatal death and caesarean delivery (CD) comparing the most with the least disadvantaged group
Results
17 countries provided data on maternal education, 5 on area-based deprivation, 1 on parents’ occupation and 2 could not provide data. For preterm birth, stillbirth and neonatal death, lower SES was associated with worse outcomes with most RR between lowest and highest groups in the range of 1.5 to 3.0. In contrast, in some countries, such as Croatia, Latvia, Lithuania and Spain, CD rates were higher for socially advantaged groups whereas the gradient was reversed in others (Denmark, Luxembourg, the Netherlands and Italy).
Conclusions
European countries can provide perinatal health indicators by SES, revealing marked socioeconomic inequalities in perinatal health. The differing SES gradient between countries for CD raise questions about care organization and clinical practice. Further exploration of the harmonization of differing SES measure across countries is required, while countries that do not monitor SES data should aim to improve existing systems.
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Affiliation(s)
- L Smith
- Department of Health Sciences, University of Leicester , Leicester, UK
| | - A Farr
- Department of Obstetrics and Gynecology, Medical University of Vienna , Vienna, Austria
| | - O Zurriaga
- Public Health and Preventive Medicine Department, University of Valencia , Valencia, Spain
| | - M Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children’s Hospital , Rome, Italy
| | - I Verdenik
- Department of Obstetrics and Gynecology, University Medical Centre , Ljubljana, Slovenia
| | | | - K Kearns
- Healthcare Pricing Office, National Finance Division, HSE , Dublin, Ireland
| | - L Sakkeus
- Estonian Institute for Population Studies, Tallinn University , Tallinn, Estonia
| | - T Kyprianou
- Health Monitoring Unit, Ministry of Health , Nicosia, Cyprus
| | - H Barros
- EPIUnit, Instituto de Saúde Pública, University of Porto , Porto, Portugal
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Pečlin P, Kovač L, Tul N, Verdenik I, Bregar AT. Comparison of “growth promoted” and “normally grown” dichorionic–diamniotic twins: A population-based study. Eur J Obstet Gynecol Reprod Biol X 2022; 15:100154. [PMID: 35664429 PMCID: PMC9160657 DOI: 10.1016/j.eurox.2022.100154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objectives Macrosomia in singleton pregnancies and associated risks have been well characterized. Less is known about the outcomes of macrosomic newborns in twin pregnancy.Objective of this study was to compare maternal characteristics and perinatal outcomes of "growth promoted twins" (twin pairs with a total twin birth weight above 90th percentile) to "normally grown twins" (twin pairs with a total twin birth weight between 50th and 90th percentile). Methods We evaluated data (maternal characteristics and perinatal outcomes) of dichorionic–diamniotic twins born at 34 weeks of gestational age or later over a sixteen-year period (2002–2018) in two birth weight groups. We excluded twin pairs born before 34th week of gestation and discordant twin pairs. We used data from the Slovenian National Perinatal Information System.To define the percentiles, twin-specific growth curves have been used. Results Our study population consisted of 390 twin pregnancies with a twin total birth weight over 90th percentile and 1618 pregnancies with a total twin birth weight between 50th and 90th percentile for gestational age. Women in "growth promoted" twin group were significantly taller, heavier and more often multiparous. There was a higher incidence of gestational diabetes (10.8% vs 7.3%, OR 1.53 95% CI 1.06 – 2.22), a lower rate of caesarean births (48.2% vs 53.9%, OR 0.80 CI 0.64 – 0.99) and lower rate of assisted reproduction (21.0% vs 27.1%, OR 0.71 CI 0.55 – 0.93) in women in "growth promoted" twin group. There were no statistically significant differences in neonatal outcomes in both groups. Conclusion In contrast to macrosomia in singletons, macrosomia in twins does not appear to increase the risk for adverse perinatal outcomes.
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11
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Lucovnik M, Druskovic M, Vidmar Simic M, Verdenik I, Mesaric V, Kosir R, Kornhauser Cerar L, Tojner Bregar A, Steblovnik L, Kavsek G, Premru Srsen T. Perinatal outcomes in women with severe acute respiratory syndrome coronavirus 2 infection: comparison with contemporary and matched pre-COVID-19 controls. J Perinat Med 2022; 50:253-260. [PMID: 34881547 DOI: 10.1515/jpm-2021-0313] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/26/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To compare perinatal outcomes in women with vs. without severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS Perinatal outcomes in SARS-CoV-2 positive pregnant women who delivered at our institution between October 27th 2020 and January 31st 2021 were compared to SARS-CoV-2 negative pregnancies (contemporary controls) and historical 2019 controls matched by maternal age, pre-pregnancy body mass index and parity. Testing was performed based on symptoms or close contact at any time during pregnancy and as part of universal screening at hospital admission. Multivariable log-linear regression models were used adjusting for potential confounders (p < 0.05 statistically significant). RESULTS One thousand three hundred seventeen women delivered at our institution during the study period. 1,124 (85%) tested negative and 193 (15%) positive for SARS-CoV-2. 189 (98%) were infected during third trimester. 19 (10%) were asymptomatic, 171 (89%) had mild to moderate coronavirus disease 2019 (COVID-19), and 3 (2%) were critically ill with one case of maternal death. There were no significant differences in preterm birth, small-for-gestational-age birth weight, congenital anomalies, operative delivery, intrapartum hypoxia, and perinatal mortality in SARS-CoV-2 positive pregnancies compared to contemporary reference group or historical controls from pre-COVID-19 period. Labor was more commonly induced in SARS-CoV-2 positive women compared to reference SARS-CoV-2 negative group (68 [35%] vs. 278 [25%], adjusted odds ratio 1.62; 95% confidence interval 1.14-2.28). CONCLUSIONS SARS-CoV-2 infection in pregnancy was not strongly associated with adverse perinatal outcomes. While the majority of SARS-CoV-2 positive women had no or mild/moderate symptoms, 2% were critically ill, with one case of maternal death.
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Affiliation(s)
- Miha Lucovnik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Mirjam Druskovic
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Marijana Vidmar Simic
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Ivan Verdenik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Vita Mesaric
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Renata Kosir
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Lilijana Kornhauser Cerar
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Andreja Tojner Bregar
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Lili Steblovnik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Gorazd Kavsek
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Tanja Premru Srsen
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
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12
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Kregar Velikonja N, Globevnik Velikonja V, Verdenik I, Jurišić I, Stanisavljević S, Dobrowolska B, Erjavec K. Vaccination intention among healthcare workers during the first wave of the coronavirus disease 2019 pandemic in relation to knowledge: a cross-sectional study in Croatia, Slovenia, Serbia, and Poland. Croat Med J 2022. [PMID: 35230009 PMCID: PMC8895327 DOI: 10.3325/cmj.2022.63.79] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Aim To analyze SARS-CoV-2 vaccination intention and acceptance in relation to the knowledge about coronavirus disease 2019 (COVID-19) among healthcare workers (HCWs) in Croatia, Slovenia, Serbia, and Poland. Methods In spring 2020, an online survey was distributed among HCWs by using snowball sampling. The questionnaire was fully completed by 623 respondents: 304 from Croatia, 86 from Slovenia, 90 from Serbia, and 143 from Poland. The survey collected data on demographic characteristics (age, gender, education), vaccination acceptance, and knowledge about COVID-19. Results A total of 31% of respondents declared their intention to be vaccinated when a vaccine against COVID-19 is available, and 45% were undecided. Vaccination intention was associated with age, educational level, and knowledge about the pandemic, and differed significantly among the countries. Younger HCWs (18-25 years) and those with higher education more frequently expressed vaccination acceptance. Vaccination acceptance score was not associated with gender. Conclusions HCWs with higher knowledge were more likely to express vaccination intention. Improving the knowledge about COVID-19 and increasing HCWs' education might also increase vaccination acceptance among HCWs, and consequently in the general population.
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Bitenc M, Ovsenik L, Lučovnik M, Verdenik I, Kornhauser Cerar L. Association between latency period and perinatal outcomes after preterm premature rupture of membranes at 32-37 weeks of gestation: a perinatal registry-based cohort study. J Perinat Med 2022; 50:18-24. [PMID: 34284530 DOI: 10.1515/jpm-2021-0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/25/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To investigate association between latency after preterm premature rupture of membranes (PPROM) and perinatal outcomes at moderately and late preterm gestation. METHODS National perinatal registry-based cohort study using data for the period 2013-2018. Singleton pregnancies with non-malformed fetuses in cephalic presentation complicated by PPROM at 32+0-36+6 weeks were included. Associations between latency period and perinatal mortality, neonatal respiratory distress syndrome (RDS), early onset neonatal infection (EONI), and cesarean section were assessed using multiple logistic regression, adjusting for potential confounders (labor induction, maternal body-mass-index, maternal age, antenatal corticosteroids, and small-for-gestational-age). p<0.05 was considered statistically significant. RESULTS Of 3,017 pregnancies included, 365 (12.1%) had PPROM at 32+0-33+6 weeks and 2,652 (87.9%) at 34+0-36+6 weeks. Among all cases, 2,540 (84%) had latency <24 h (group A), 305 (10%) 24-47 h (group B), and 172 (6%) ≥48 h (group C). Longer latency was associated with higher incidence of EONI (adjusted odds ratio [aOR] 1.350; 95% confidence interval [CI] 0.900-2.026 for group B and aOR 2.500; 95% CI 1.599-3.911 for group C) and higher rate of caesarean section (aOR 2.465; 95% CI 1.763-3.447 for group B and aOR 1.854; 95% CI 1.172-2.932 for group C). Longer latency was not associated with rates of RDS (aOR 1.160; 95% CI 0.670-2.007 for group B and aOR 0.917; 95% CI 0.428-1.966 for group C). CONCLUSIONS In moderately to late PPROM, increased latency is associated with higher risk of EONI and cesarean section with no reduction in RDS.
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Affiliation(s)
- Marie Bitenc
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Lea Ovsenik
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Miha Lučovnik
- Department of Perinatology, Division of Obstetrics and Gynaecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Ivan Verdenik
- Research Unit, Division of Obstetrics and Gynaecology, University Medical Center Ljubljana, Ljubljana, Slovenia
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Osredkar D, Verdenik I, Gergeli AT, Gersak K, Lucovnik M. Apgar Score and Risk of Cerebral Palsy in Preterm Infants: A Population-Based Cohort Study. Neuropediatrics 2021; 52:310-315. [PMID: 34162009 DOI: 10.1055/s-0041-1729181] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A low Apgar score is associated with increased risk of cerebral palsy (CP) in term infants, while such association remains controversial in preterm neonates. The objective of this study was to assess association between 5-minute Apgar scores and CP in different subcategories of preterm birth based on gestational age. The Slovenian National Perinatal Information System was used to identify singleton children without congenital malformations live-born at 22 to 37 weeks of gestation between 2002 and 2010. Data were linked to the Slovenian Registry of Cerebral Palsy in children born between 2002 and 2010. CP was diagnosed at a minimum of 5 years of age. Of 11,924 children included, 241 (2.0%) died before discharge and 153 (1.3%) were diagnosed with CP. Five-minute Apgar scores <7 were significantly associated with higher risk of death or CP (compared with scores ≥9) at all preterm gestations. CP alone was associated with Apgar scores <7 only at moderately or late preterm gestation (32-36 weeks) (adjusted relative risk [aRR]: 8.27; 95% confidence interval [CI]: 1.87-36.64 for scores 0-4 and aRR: 4.96; 95% CI 1.89-13.06 for scores 5-6). In conclusion, a low 5-minute Apgar score was associated with combined outcome of neonatal death or CP in all preterm births, while in surviving preterm infants at >32 weeks a low 5-minute Apgar score was associated with CP.
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Affiliation(s)
- Damjan Osredkar
- Department of Child, Adolescent and Developmental Neurology, University Children's Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ivan Verdenik
- Division of Obstetrics and Gynecology, Department of Perinatology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Anja Troha Gergeli
- Department of Child, Adolescent and Developmental Neurology, University Children's Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Ksenija Gersak
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Miha Lucovnik
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Division of Obstetrics and Gynecology, Department of Perinatology, University Medical Center Ljubljana, Ljubljana, Slovenia
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15
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Kregar Velikonja N, Dobrowolska B, Stanisavljević S, Erjavec K, Globevnik Velikonja V, Verdenik I. Attitudes of Nursing Students towards Vaccination and Other Preventive Measures for Limitation of COVID-19 Pandemic: Cross-Sectional Study in Three European Countries. Healthcare (Basel) 2021; 9:781. [PMID: 34206217 PMCID: PMC8305964 DOI: 10.3390/healthcare9070781] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 12/23/2022] Open
Abstract
Several preventive measures have been applied to limit the COVID-19 pandemic, including successful the development and introduction of vaccines. The aim of this study was to investigate adherence to preventive measures and vaccination intentions among nursing students in three European countries and the factors associated with vaccination intention and advising vaccination. A cross-sectional study using convenience/snow-ball sampling strategy was performed in Slovenia, Poland, and Serbia between 12 February and 5 March 2021. Data from 872 eligible respondents were analyzed (mean age 23.5 ± 6.5 years, 89% female). Higher adherence to preventive behavior was declared by those working in healthcare (p < 0.001), engaged in COVID-19 departments (p < 0.001), had not had the disease yet (p < 0.001), and had children (p = 0.01). Those groups also expressed higher vaccination intention and advised vaccination to others. Higher vaccination intention and advising vaccination were mostly associated with belief in benefits of vaccine, trust in institutions, perceived effectiveness of vaccine, influence of social environment, protection of patients and perceived health care professionals' duty. Fear of side effects and general refusal of vaccines are the main reasons for vaccination hesitancy. The results of the study indicate how higher education institutions can support the development of appropriate professional attitudes and behaviors among nursing students.
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Affiliation(s)
- Nevenka Kregar Velikonja
- Faculty of Health Sciences, University of Novo Mesto, 8000 Novo Mesto, Slovenia; (K.E.); (V.G.V.); (I.V.)
| | - Beata Dobrowolska
- Department of Nursing Management, Faculty of Health Sciences, Medical University of Lublin, 20-081 Lublin, Poland;
| | - Sanja Stanisavljević
- The College of Health Sciences, Academy of Applied Studies Belgrade, 11000 Belgrade, Serbia;
| | - Karmen Erjavec
- Faculty of Health Sciences, University of Novo Mesto, 8000 Novo Mesto, Slovenia; (K.E.); (V.G.V.); (I.V.)
| | - Vislava Globevnik Velikonja
- Faculty of Health Sciences, University of Novo Mesto, 8000 Novo Mesto, Slovenia; (K.E.); (V.G.V.); (I.V.)
- Division for Obstetrics and Gynaecology, University Medical Centre Ljubljana, Šlajmerjeva 4, 1000 Ljubljana, Slovenia
| | - Ivan Verdenik
- Faculty of Health Sciences, University of Novo Mesto, 8000 Novo Mesto, Slovenia; (K.E.); (V.G.V.); (I.V.)
- Division for Obstetrics and Gynaecology, University Medical Centre Ljubljana, Šlajmerjeva 4, 1000 Ljubljana, Slovenia
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16
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Premru-Srsen T, Bokal Vrtačnik E, Bizjak T, Verdenik I, Korošec S, Ban Frangež H. Preterm delivery risk in infertile women who conceived after reproductive surgery: natural conception versus IVF/ICSI. Hum Reprod 2021; 36:1630-1639. [PMID: 33527990 DOI: 10.1093/humrep/deaa380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/21/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Is preterm delivery an infertility treatment-related adverse outcome in infertile women who conceived after reproductive surgery? SUMMARY ANSWER Compared with matched fertile women, preterm delivery appears to be a modest infertility treatment-related adverse outcome in infertile women who have reproductive surgery then conceived naturally or after IVF/ICSI. WHAT IS KNOWN ALREADY Most observational studies have shown that women who receive any infertility treatment are more likely to deliver preterm than do fertile women. However, studies on the outcome of pregnancies in infertile women who conceive naturally after reproductive surgery are scarce. STUDY DESIGN, SIZE, DURATION This was a single-centre historical two-part study: cohort and matched cohort study. Anonymized data of 761 infertile women who conceived after reproductive surgery and 758 fertile women were obtained by linking three computerized databases from 1 July 2012 to 31 December 2015. PARTICIPANTS/MATERIALS, SETTING, METHODS In the cohort study, we evaluated the association between the mode of conception and preterm delivery <37 and <32 gestational weeks in 703 infertile women, with a singleton pregnancy who conceived after reproductive surgery, using logistic regression adjusted for relevant co-variates to calculate the adjusted odds ratio with a 95% CI. In the matched cohort study, we evaluated preterm delivery as infertility treatment-related adverse outcome using the propensity score (PS) method. The matched cohort comprised 758 infertile women and 758 fertile women with a twin or singleton pregnancy. Infertile women conceived after reproductive surgery either naturally or through IVF/ICSI. Infertile and fertile women were matched using PS matching. Infertile and fertile women were matched for pre-defined risk factors for preterm delivery. Three infertile women out of an original 761 were not included in the analysis because they lacked all required matching variables. We performed a 1:1 matching with an optimal matching algorithm with a caliper width of the linear predictor of 0.1 standard deviations. The effect of reproductive surgery on preterm delivery was evaluated in the PS-matched sample using Pearson's χ2 test and presented as the odds ratio (OR) with 95% CI. All women delivered at the Department of Perinatology, University Medical Centre Ljubljana, Slovenia. MAIN RESULTS AND THE ROLE OF CHANCE Among 761 infertile women who conceived after reproductive surgery, 428 (56.2%) women conceived naturally and 333 (43.8%) conceived after IVF/ICSI. The incidence of twin pregnancies was significantly lower after natural conception (2.6% vs 14.1%). Among the 703 infertile women with a singleton pregnancy, 417 (59.3%) conceived naturally and 286 (40.7%) conceived after IVF/ICSI. Adjusted for maternal age and parity in infertile women with singleton pregnancies, IVF/ICSI showed a moderate association with preterm delivery <32 weeks. Compared with natural conception after reproductive surgery, the odds for preterm delivery after IVF/ICSI was 1.07 (95% CI 0.63-1.81) <37 weeks and 2.25 (95% CI 0.80-6.34) <32 weeks. Preterm delivery appears to be a modest infertility treatment-related adverse outcome. Compared with fertile women in the PS-matched sample, infertile women who conceived after reproductive surgery either naturally or after IVF/ICSI the odds of preterm delivery <37 weeks were 1.31 (95% CI 0.97-1.78) and odds of preterm delivery <32 weeks were 1.57 (95% CI 0.78-3.18). However, none of the estimations were statistically significant. LIMITATIONS, REASONS FOR CAUTION The main limitations of the study were the retrospective design, the heterogeneity of the types of reproductive surgery performed and underlying reproductive pathologies. The low number of preterm deliveries in the present study might influence the precision of estimations. WIDER IMPLICATIONS OF THE FINDINGS The present study aims to alter the prevailing opinion that reproductive surgery should only be considered preceding IVF to increase implantation and pregnancy rates after IVF. It implies that in selected infertile women who have had reproductive surgery, a high rate of natural conception, a low rate of multiple pregnancies, and a modest infertility treatment-related effect on preterm delivery should be the reasons to encourage natural conception after reproductive surgery. Furthermore, by allowing for natural conception, we can avoid a high-cost invasive medical procedure. STUDY FUNDING/COMPETING INTEREST(S) The study received no funding. We have no competing interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Tanja Premru-Srsen
- Division of Obstetrics and Gynecology, Department of Perinatology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Eda Bokal Vrtačnik
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.,Division of Obstetrics and Gynecology, Department of Human Reproduction, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tina Bizjak
- Department of Obstetrics and Gynecology, General Hospital Slovenj Gradec, Slovenj Gradec, Slovenia
| | - Ivan Verdenik
- Division of Obstetrics and Gynecology, Research Unit, University Medical Centre, Ljubljana, Slovenia
| | - Sara Korošec
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.,Division of Obstetrics and Gynecology, Department of Human Reproduction, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Helena Ban Frangež
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.,Division of Obstetrics and Gynecology, Department of Human Reproduction, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Hojnik M, Kenda Šuster N, Smrkolj Š, Frković Grazio S, Verdenik I, Rižner TL. AKR1C3 Is Associated with Better Survival of Patients with Endometrial Carcinomas. J Clin Med 2020; 9:jcm9124105. [PMID: 33352741 PMCID: PMC7766127 DOI: 10.3390/jcm9124105] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/13/2020] [Accepted: 12/16/2020] [Indexed: 12/19/2022] Open
Abstract
The aldo-keto reductase (AKR) superfamily is gaining attention in cancer research. AKRs are involved in important biochemical processes and have crucial roles in carcinogenesis and chemoresistance. The enzyme AKR1C3 has many functions, which include production of prostaglandins, androgens and estrogens, and metabolism of different chemotherapeutics; AKR1C3 is thus implicated in the pathophysiology of different cancers. Endometrial and ovarian cancers represent the majority of gynecological malignancies in developed countries. Personalized treatments for these cancers depend on identification of prognostic and predictive biomarkers that allow stratification of patients. In this study, we evaluated the immunohistochemical (IHC) staining of AKR1C3 in 123 paraffin-embedded samples of endometrial cancer and 99 samples of ovarian cancer, and examined possible correlations between expression of AKR1C3 and other clinicopathological data. The IHC expression of AKR1C3 was higher in endometrial cancer compared to ovarian cancer. In endometrioid endometrial carcinoma, high AKR1C3 IHC expression correlated with better overall survival (hazard ratio, 0.19; 95% confidence interval, 0.06−0.65, p = 0.008) and with disease-free survival (hazard ratio, 0.328; 95% confidence interval, 0.12–0.88, p = 0.027). In patients with ovarian cancer, there was no correlation between AKR1C3 IHC expression and overall and disease-free survival or response to chemotherapy. These results demonstrate that AKR1C3 is a potential prognostic biomarker for endometrioid endometrial cancer.
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Affiliation(s)
- Marko Hojnik
- Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Nataša Kenda Šuster
- Division of Gynecology, Department of Obstetrics and Gynecology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (N.K.Š.); (Š.S.); (I.V.)
- Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Špela Smrkolj
- Division of Gynecology, Department of Obstetrics and Gynecology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (N.K.Š.); (Š.S.); (I.V.)
- Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Snježana Frković Grazio
- Division of Gynecology, Department of Pathology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia;
| | - Ivan Verdenik
- Division of Gynecology, Department of Obstetrics and Gynecology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (N.K.Š.); (Š.S.); (I.V.)
| | - Tea Lanišnik Rižner
- Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
- Correspondence: ; Tel.: +386-1-5437657; Fax: +386-1-5437641
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Likar IP, Jere KS, Možina T, Verdenik I, Tul N. Pregnancy Loss After Amniocentesis and Chorionic Villus Sampling: Cohort Study. Zdr Varst 2020; 60:25-29. [PMID: 33488819 PMCID: PMC7780764 DOI: 10.2478/sjph-2021-0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 11/19/2020] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Introduction: To estimate the procedure-related risks of pregnancy loss following chorionic villus sampling (CVS) and amniocentesis (AC) compared to pregnancies without procedure. METHODS This cohort study enrolled all women who underwent CVS or AC at the Department of Perinatology, University Medical Centre, Ljubljana, Slovenia (from January 2013 to June 2015). For each group we obtained a maternal age and gestational age (11-14 weeks for CVS and >15 weeks for AC) for a matched control group without invasive procedures from the national database. The data was obtained from hospital records and telephone surveys concerning pregnancy outcomes. Pregnancy loss rates in intervention vs. control groups were compared by generating relative risk (RR) with a 95% confidence interval. RESULTS During the study period, 828 women underwent CVS and 2,164 women underwent AC. Complete outcome data was available in 2,798 cases (93.5%, 770 CVS, 2,028 AC). Pregnancy loss occurred in 8/770 (1.04%, 95% CI 0.4-2.0%) after CVS vs. 15/1130 (1.33%, 95% CI 0.8-2.2%) in matched control (RR 0.8, 95% CI 0.33-1.8, p=0.6). It occurred in 16/2028 (0.79%, 95% CI 0.5-1.3%) after AC vs. 14/395 (3.29%, 95% CI 2.1-5.8%) in matched control (RR 0.2, 95% CI 0.11-0.45, p<0.0001). CONCLUSION The pregnancy loss rates after CVS and AC were comparable to losses in pregnancies without these procedures. With the increasing use of non-invasive prenatal testing, information that the invasive procedures are safe when indicated is essential.
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Affiliation(s)
- Ivana Paljk Likar
- University Medical Centre Ljubljana, Department of Perinatology, Division of Obstetrics and Gynecology, Šlajmerjeva ulica 3, 1000Ljubljana, Slovenia
- University of Ljubljana, Faculty of Medicine, Vrazov trg 2, 1000Ljubljana, Slovenia
| | - Ksenija Slavec Jere
- University Medical Centre Ljubljana, Department of Perinatology, Division of Obstetrics and Gynecology, Šlajmerjeva ulica 3, 1000Ljubljana, Slovenia
| | - Teja Možina
- University Medical Centre Ljubljana, Department of Perinatology, Division of Obstetrics and Gynecology, Šlajmerjeva ulica 3, 1000Ljubljana, Slovenia
| | - Ivan Verdenik
- University Medical Centre Ljubljana, Department of Perinatology, Division of Obstetrics and Gynecology, Šlajmerjeva ulica 3, 1000Ljubljana, Slovenia
| | - Nataša Tul
- Women’s Hospital Postojna, Prečna ulica 4, 6230Postojna, Slovenia
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Jakimovska M, Černe K, Verdenik I, Kobal B. High preoperative serum sVCAM-1 concentration as a predictor of early ovarian cancer recurrence. J Ovarian Res 2020; 13:107. [PMID: 32933568 PMCID: PMC7490865 DOI: 10.1186/s13048-020-00705-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 08/13/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Marina Jakimovska
- Department of Obstetrics and Gyaecology, University Medical Centre, Ljubljana, Slovenia
| | - Katarina Černe
- Institute of Pharmacology and Experimental Toxicology, Faculty of medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ivan Verdenik
- Department of Obstetrics and Gyaecology, University Medical Centre, Ljubljana, Slovenia
| | - Borut Kobal
- Department of Obstetrics and Gyaecology, University Medical Centre, Ljubljana, Slovenia. .,Faculty of medicine, University of Ljubljana, Ljubljana, Slovenia. .,Department of Gynaecology and Obstetrics, Faculty of medicine, University of Ljubljana, Šlajmarjeva 3, SI-1000, Ljubljana, Slovenia.
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20
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Krneta Đokić B, Zhurov A, Richmond S, Verdenik I, Ovsenik M. 3D soft‐tissue evaluation of a Class III treatment with rapid maxillary expander and face mask in pre‐pubertal phase—A retrospective cohort study. Orthod Craniofac Res 2020; 23:323-331. [DOI: 10.1111/ocr.12373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Bojana Krneta Đokić
- Department of Orthodontics and Dentofacial Orthopedics Faculty of Medicine University of Ljubljana Ljubljana Slovenia
| | - Alexei Zhurov
- Department of Applied Clinical Research and Public Health School of Dentistry Cardiff UK
| | - Stephen Richmond
- Department of Applied Clinical Research and Public Health School of Dentistry Cardiff UK
| | - Ivan Verdenik
- Department of Obstetrics and Gynecology University Medical Centre Ljubljana Ljubljana Slovenia
| | - Maja Ovsenik
- Department of Orthodontics and Dentofacial Orthopedics Faculty of Medicine University of Ljubljana Ljubljana Slovenia
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21
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Premru-Srsen T, Kocic Z, Verdenik I. Effect of current guidelines on prevention of pre-eclampsia with low-dose aspirin in primary settings: A population-based case-control study. Int J Gynaecol Obstet 2020; 149:333-338. [PMID: 32119125 DOI: 10.1002/ijgo.13133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/26/2019] [Accepted: 02/27/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To evaluate the effect of low-dose aspirin, which was administered at or before the 16th week of pregnancy due to maternal characteristics and history of a pre-existing medical condition, on prevention of pre-eclampsia, and on the birth of a small-for-gestational-age (SGA) neonate without pre-eclampsia in nulliparas in primary settings. METHODS We performed a case-control study using population-based data on 47 271 nulliparas with a singleton pregnancy who delivered in Slovenia from 2013 to 2017. The treated group received low-dose aspirin. For the untreated group, propensity score matching was used to perform a 1:1 matching. In the matched sample, we calculated the odds ratios (OR) with a 95% confidence interval (95% CI) with a two-way test for pre-eclampsia, as well as SGA neonates. RESULTS In the treated group (n=584), the odds for an SGA neonate were significantly increased by 42.7% (OR 1.427, 95% CI 1.001-2.034). However, we found no significant effect on the odds for pre-eclampsia (OR 1.308, 95% CI 0.847-2.022). CONCLUSIONS In anticipation of more substantial population-based data studies, in the Slovenian population, preventive treatment with low-dose aspirin due to maternal characteristics and history of a pre-existing medical condition is not beneficial for the prevention of pre-eclampsia and can harm fetal growth.
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Affiliation(s)
- Tanja Premru-Srsen
- Division of Obstetrics and Gynecology, Department of Perinatology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Zorana Kocic
- Division of Obstetrics and Gynecology, Department of Perinatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Ivan Verdenik
- Research Unit,, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
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22
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Lucovnik M, Steblovnik L, Verdenik I, Premru‐Srsen T, Tomazic M, Tul N. Changes in perinatal outcomes after implementation of
IADPSG
criteria for screening and diagnosis of gestational diabetes mellitus: A national survey. Int J Gynaecol Obstet 2020; 149:88-92. [DOI: 10.1002/ijgo.13098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 09/05/2019] [Accepted: 01/06/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Miha Lucovnik
- Division of Obstetrics and GynecologyDepartment of PerinatologyUniversity Medical Centre Ljubljana Ljubljana Slovenia
| | - Lili Steblovnik
- Division of Obstetrics and GynecologyDepartment of PerinatologyUniversity Medical Centre Ljubljana Ljubljana Slovenia
| | - Ivan Verdenik
- Division of Obstetrics and GynecologyDepartment of PerinatologyUniversity Medical Centre Ljubljana Ljubljana Slovenia
| | - Tanja Premru‐Srsen
- Division of Obstetrics and GynecologyDepartment of PerinatologyUniversity Medical Centre Ljubljana Ljubljana Slovenia
| | - Marjeta Tomazic
- Division of Internal MedicineDepartment for Endocrinology, Diabetes and Metabolic DisordersUniversity Medical Centre Ljubljana Ljubljana Slovenia
| | - Natasa Tul
- Division of Obstetrics and GynecologyDepartment of PerinatologyUniversity Medical Centre Ljubljana Ljubljana Slovenia
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23
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Šuster NK, Meznaric M, Škorja N, Virant-Klun I, Verdenik I, Smrkolj Š. Cancer stem cell-related marker NANOG expression in ovarian serous tumors using Western blotting and immunohistochemistry: comparison of two techniques. EUR J GYNAECOL ONCOL 2019. [DOI: 10.12892/ejgo4700.2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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24
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Premru-Srsen T, Kocic Z, Fabjan Vodusek V, Geršak K, Verdenik I. Total gestational weight gain and the risk of preeclampsia by pre-pregnancy body mass index categories: a population-based cohort study from 2013 to 2017. J Perinat Med 2019; 47:585-591. [PMID: 31150361 DOI: 10.1515/jpm-2019-0008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/22/2019] [Indexed: 11/15/2022]
Abstract
Background Identifying the risk factors for preeclampsia (PE) is essential for the implementation of preventive actions. In the present study, we aimed at exploring the association between total gestational weight gain (GWG) and PE. Methods We performed a population-based cohort survey of 98,820 women with singleton pregnancies who delivered in Slovenia from 2013 to 2017. Aggregated data were obtained from the National Perinatal Information System (NPIS). The main outcome measure was the incidence of PE. The main exposure variable was total GWG standardized for the gestational duration by calculating the z-scores. The associations between total GWG and PE stratified by pre-pregnancy body mass index (BMI) categories adjusted for a variety of covariates were determined using multivariable logistic regression. We calculated the crude odds ratio (OR) and adjusted odds ratio (aOR) with a 95% confidence interval using a two-way test. Results Excessive GWG was associated with increased odds of PE in all pre-pregnancy BMI categories. The increase in the odds of PE by 445% was the highest in underweight women and by 122% was the lowest in obese women. Low GWG was associated with decreased odds of PE in all pre-pregnancy BMI categories except in normal-weight women with a GWG below -2 standard deviation (SD) and underweight women. The decrease in the odds of PE by 67% was the highest in obese women and by 41% was the lowest in normal-weight women. Conclusion Excessive GWG is a significant risk factor for PE, especially in underweight women, while low GWG is an important protective factor against PE, especially in obese women.
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Affiliation(s)
- Tanja Premru-Srsen
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Zorana Kocic
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre, Ljubljana, Slovenia
| | - Vesna Fabjan Vodusek
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre, Ljubljana, Slovenia
| | - Ksenija Geršak
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.,Research Unit, Division of Obstetrics and Gynecology, University Medical Centre, Ljubljana, Slovenia
| | - Ivan Verdenik
- Research Unit, Division of Obstetrics and Gynecology, University Medical Centre, Ljubljana, Slovenia
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25
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Abstract
Work-related musculoskeletal (MS) disorders are considered one of the most frequent occupational diseases among dental workers. Dental work consists of static, demanding tasks that involve repeated gripping of small-sized instruments. The purpose of this study was to investigate the prevalence of MS pain, the areas of pain, and the risk factors for MS pain in dental workers. A self-administrated questionnaire was used as a data collection instrument for dental workers who voluntarily responded to the invitation. To determine the prevalence and severity location of MS pain, the Cornell Musculoskeletal Discomfort Questionnaire was administered among 87 dental workers, with a total of 79.8%, who reported at least one MS complaint. MS pain occurred in 82.6% of general dentists, 75.0% of dental specialists, 66.7% of dental assistants, and 33.3% of dental technicians. Pain most frequently occurred in the neck (60.7%), upper back (52.4%), right shoulder (44.0%), lower back (41.7%), hips/buttocks (29.8%), and the right wrist (23.8%). The prevalence of pain among dental workers could be reduced by ergonomic working environment, regular breaks, maintenance of health, and performing specific exercises designed to dental workers.
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26
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Razem K, Tul N, Verdenik I, Simic MV, Blickstein I. Maternal characteristics of preterm singleton birth following assisted reproduction: a population-based study. J Matern Fetal Neonatal Med 2019; 34:873-875. [PMID: 31106642 DOI: 10.1080/14767058.2019.1621836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To identify pregestational maternal characteristics that are associated with an increased risk for preterm births (PTB) of assisted reproductive technology (ART) singleton pregnancies. PATIENTS AND METHODS We evaluated the Slovenian National Perinatal Information System (NPIS). We included all ART singletons born during the period 2006-2015. We compared births before and after 36 completed weeks' gestation for maternal age, parity, prepregnancy BMI, height, previous PTB, preexisting hypertension and diabetes, and history of uterine gynecological operations. RESULTS Chronic hypertension (OR 2.5, 95% CI 1.3-4.8), previous preterm birth (OR 2.4, 95% CI 1.5-3.7), pregravid obesity (OR 1.6, 95% CI 1.2-2.1) and an existing indication for cerclage (OR 6.2, 95% CI 3.7-10.5) were associated with an increased risk of PTB. CONCLUSIONS Chronic hypertension, previous PTB, pregravid obesity and an existing indication for cerclage are associated with increased risk of PTB among ART pregnancies.
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Affiliation(s)
- Katja Razem
- Division of Obstetrics and Gynecology, Department of Perinatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nataša Tul
- Division of Obstetrics and Gynecology, Department of Perinatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Ivan Verdenik
- Division of Obstetrics and Gynecology, Department of Perinatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Marijana Vidmar Simic
- Division of Obstetrics and Gynecology, Department of Perinatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Isaac Blickstein
- Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel
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Premru-Srsen T, Verdenik I, Mihevc Ponikvar B, Hugh O, Francis A, Gardosi J. Customised birthweight standard for a Slovenian population. J Perinat Med 2019; 47:270-275. [PMID: 30653469 DOI: 10.1515/jpm-2018-0219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/30/2018] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Tanja Premru-Srsen
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Ivan Verdenik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Merc MD, Lučovnik M, Bregar AT, Verdenik I, Tul N, Blickstein I. Stillbirths in women with pre-gravid obesity. J Perinat Med 2019; 47:319-322. [PMID: 30496140 DOI: 10.1515/jpm-2018-0266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/29/2018] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Maja Dolanc Merc
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Miha Lučovnik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Andreja Trojner Bregar
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ivan Verdenik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nataša Tul
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Isaac Blickstein
- Department of Obstetrics and Gynecology, Kaplan Medical Center, affiliated with the Hadassah-Hebrew University School of Medicine, Jerusalem, Rehovot, Israel
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Cerne K, Hadzialjevic B, Skof E, Verdenik I, Kobal B. Potential of osteopontin in the management of epithelial ovarian cancer. Radiol Oncol 2019; 53:105-115. [PMID: 30712025 PMCID: PMC6411016 DOI: 10.2478/raon-2019-0003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/27/2018] [Indexed: 02/07/2023] Open
Abstract
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.
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Affiliation(s)
- Katarina Cerne
- Institute of Pharmacology and Experimental Toxicology, Faculty of Medicine, University Ljubljana, Ljubljana, Slovenia
| | - Benjamin Hadzialjevic
- Institute of Pharmacology and Experimental Toxicology, Faculty of Medicine, University Ljubljana, Ljubljana, Slovenia
| | - Erik Skof
- Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Ivan Verdenik
- Department of Gynaecology, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Department of Gynaecology and Obstetrics, Faculty of Medicine, University Ljubljana, Ljubljana, Slovenia
| | - Borut Kobal
- Department of Gynaecology, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Department of Gynaecology and Obstetrics, Faculty of Medicine, University Ljubljana, Ljubljana, Slovenia
- Prof. Borut Kobal, M.D., Ph.D, Department of Gynaecology and Obstetrics, Faculty of Medicine, University Ljubljana, Šlajmarjeva 3, SI-1000 Ljubljana, Slovenia. Phone: +386 1 522 6060
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30
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Paljk I, Verdenik I, Blickstein I, Tul N. Maternal BMI and weight gain in singleton pregnancies: has something changed in the last decade? J Matern Fetal Neonatal Med 2019; 34:7-11. [PMID: 30704327 DOI: 10.1080/14767058.2019.1570111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
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.
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Affiliation(s)
- Ivana Paljk
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Ivan Verdenik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Isaac Blickstein
- Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel and Affiliated with the Hadassah-Hebrew University School of Medicine, Jerusalem, Israel
| | - Nataša Tul
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
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31
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Košir Pogačnik R, Trojner-Bregar A, Lučovnik M, Verdenik I, Blickstein I, Tul N. Gestational diabetes mellitus in underweight women. J Matern Fetal Neonatal Med 2019; 33:3068-3070. [PMID: 30632845 DOI: 10.1080/14767058.2019.1568979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
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.
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Affiliation(s)
- Renata Košir Pogačnik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Andreja Trojner-Bregar
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Miha Lučovnik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Ivan Verdenik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Isaac Blickstein
- Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel
| | - Nataša Tul
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
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32
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Fabjan-Vodusek V, Kumer K, Osredkar J, Verdenik I, Gersak K, Premru-Srsen T. Correlation between uterine artery Doppler and the sFlt-1/PlGF ratio in different phenotypes of placental dysfunction. Hypertens Pregnancy 2018; 38:32-40. [PMID: 30485134 DOI: 10.1080/10641955.2018.1550579] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
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.
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Affiliation(s)
- Vesna Fabjan-Vodusek
- a Department of Perinatology, Division of Obstetrics and Gynecology , University Medical Centre Ljubljana , Ljubljana , Slovenia
| | - Kristina Kumer
- b Institute for Clinical chemistry and Biochemistry , University Medical Centre Ljubljana , Ljubljana , Slovenia
| | - Josko Osredkar
- b Institute for Clinical chemistry and Biochemistry , University Medical Centre Ljubljana , Ljubljana , Slovenia
| | - Ivan Verdenik
- c Research Unit, Division of Obstetrics and Gynecology , University Medical Centre Ljubljana , Ljubljana , Slovenia
| | - Ksenija Gersak
- c Research Unit, Division of Obstetrics and Gynecology , University Medical Centre Ljubljana , Ljubljana , Slovenia.,d Medical Faculty , University Ljubljana , Ljubljana , Slovenia
| | - Tanja Premru-Srsen
- a Department of Perinatology, Division of Obstetrics and Gynecology , University Medical Centre Ljubljana , Ljubljana , Slovenia.,d Medical Faculty , University Ljubljana , Ljubljana , Slovenia
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Košir Pogačnik R, Trojner Bregar A, Lučovnik M, Krajec M, Verdenik I, Blickstein I, Tul N. The effect of interaction between parity, gestational diabetes, and pregravid obesity on the incidence of preeclampsia. J Matern Fetal Neonatal Med 2018; 33:931-934. [PMID: 30081684 DOI: 10.1080/14767058.2018.1509311] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
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.
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Affiliation(s)
- Renata Košir Pogačnik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre, Ljubljana, Slovenia
| | - Andreja Trojner Bregar
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre, Ljubljana, Slovenia
| | - Miha Lučovnik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre, Ljubljana, Slovenia
| | - Maja Krajec
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre, Ljubljana, Slovenia
| | - Ivan Verdenik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre, Ljubljana, Slovenia
| | - Isaac Blickstein
- Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel (Affiliated with the Hadassah-Hebrew University School of Medicine, Jerusalem, Israel)
| | - Nataša Tul
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre, Ljubljana, Slovenia
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Petročnik P, Mivšek AP, Škodič Zakšek T, Verdenik I, Jug Došler A. Perineal trauma during vaginal birth in Slovenia. Obzor Zdrav Neg 2018. [DOI: 10.14528/snr.2018.52.3.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
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.
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Vidmar Šimic M, Lučovnik M, Leskošek V, Pavše L, Krajnc M, Verdenik I, Blickstein I, Tul N, Premru Sršen T, Globevnik Velikonja V. Abuse of pregnant women in the healthcare system. J Matern Fetal Neonatal Med 2018; 33:790-793. [PMID: 30021483 DOI: 10.1080/14767058.2018.1502746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
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.
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Affiliation(s)
| | - Miha Lučovnik
- Department of Perinatology, University Medical Centre, Ljubljana, Slovenia
| | | | - Lucija Pavše
- Department of Perinatology, University Medical Centre, Ljubljana, Slovenia
| | - Megie Krajnc
- Department of Perinatology, University Medical Centre, Ljubljana, Slovenia
| | - Ivan Verdenik
- Department of Perinatology, University Medical Centre, Ljubljana, Slovenia
| | - Isaac Blickstein
- Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel, affiliated with the Hadassah Hebrew University School of Medicine, Jerusalem, Israel
| | - Nataša Tul
- Department of Perinatology, University Medical Centre, Ljubljana, Slovenia
| | - Tanja Premru Sršen
- Department of Perinatology, University Medical Centre, Ljubljana, Slovenia
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Premru-Srsen T, Verdenik I, Ponikvar BM, Steblovnik L, Geršak K, Cerar LK. Infant mortality and causes of death by birth weight for gestational age in non-malformed singleton infants: a 2002-2012 population-based study. J Perinat Med 2018; 46:547-553. [PMID: 28599397 DOI: 10.1515/jpm-2017-0103] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 04/19/2017] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Tanja Premru-Srsen
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Ivan Verdenik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Lili Steblovnik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Ksenija Geršak
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Lilijana Kornhauser Cerar
- Neonatal Intensive Care Unit, Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Lubljana, Ljubljana, Slovenia
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Stimpfel M, Verdenik I, Zorn B, Virant-Klun I. Magnetic-activated cell sorting of non-apoptotic spermatozoa improves the quality of embryos according to female age: a prospective sibling oocyte study. J Assist Reprod Genet 2018; 35:1665-1674. [PMID: 29946759 DOI: 10.1007/s10815-018-1242-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 06/13/2018] [Indexed: 10/28/2022] Open
Abstract
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.
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Affiliation(s)
- Martin Stimpfel
- Department of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Slajmerjeva 3, 1000, Ljubljana, SI, Slovenia.
| | - Ivan Verdenik
- Department of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Slajmerjeva 3, 1000, Ljubljana, SI, Slovenia
| | - Branko Zorn
- Department of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Slajmerjeva 3, 1000, Ljubljana, SI, Slovenia
| | - Irma Virant-Klun
- Department of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Slajmerjeva 3, 1000, Ljubljana, SI, Slovenia
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Blaganje M, Šćepanović D, Žgur L, Verdenik I, Pajk F, Lukanović A. Non-ablative Er:YAG laser therapy effect on stress urinary incontinence related to quality of life and sexual function: A randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2018; 224:153-158. [DOI: 10.1016/j.ejogrb.2018.03.038] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/13/2018] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
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Lang A, Ovsenik M, Verdenik I, Remškar M, Oblak Č. Nanoparticle concentrations and composition in a dental office and dental laboratory: A pilot study on the influence of working procedures. J Occup Environ Hyg 2018; 15:441-447. [PMID: 29370575 DOI: 10.1080/15459624.2018.1432864] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
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.
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Affiliation(s)
- Andreja Lang
- a Faculty of Medicine , University of Ljubljana , Ljubljana , Slovenia
| | - Maja Ovsenik
- b Department of Orthodontics and Jaw Orthopaedics, Faculty of Medicine , University of Ljubljana , Ljubljana , Slovenia
| | - Ivan Verdenik
- c Department of Obstetrics and Gynecology , University Medical Center , Ljubljana , Slovenia
| | - Maja Remškar
- d Solid-State Physics Department , Josef Stefan Institute , Ljubljana , Slovenia
| | - Čedomir Oblak
- e Department of Prosthodontics, Faculty of Medicine , University of Ljubljana , Ljubljana , Slovenia
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Simenc GB, Blickstein I, Verdenik I, Bregar AT, Lucovnik M, Tul N. Is forty the new thirty? Population based study of advanced maternal age. J Perinat Med 2018; 46:247-250. [PMID: 28708575 DOI: 10.1515/jpm-2017-0060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/12/2017] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Gabrijela Brzan Simenc
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Isaac Blickstein
- Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot 76100, Israel, E-mail:
| | - Ivan Verdenik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Andreja Trojner Bregar
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Miha Lucovnik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Natasa Tul
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
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Franic D, Verdenik I. Risk Factors for Osteoporosis in Postmenopausal Women - from The Point of View of Primary Care Gynecologist. Zdr Varst 2018; 57:33-38. [PMID: 29651313 PMCID: PMC5894367 DOI: 10.2478/sjph-2018-0005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 11/27/2017] [Indexed: 12/26/2022] Open
Abstract
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.
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Affiliation(s)
- Damir Franic
- Outpatient Clinic for Obstetrics and Gynecology, Celjska cesta 10, 3250Rogaska Slatina, Slovenia
| | - Ivan Verdenik
- University Clinical Center Ljubljana, Department for Obstetrics and Gynecology, Zaloska cesta 7, 1000Ljubljana, Slovenia
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Franic D, Verdenik I. Risk factors for osteoporosis in postmenopausal women – from the point of view of primary care gynecologist. Zdr Varst 2018. [DOI: 10.1515/sjph-2018-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractIntroductionOsteoporosis 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.MethodsFrom 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.ResultsThe 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.ConclusionPrimary 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.
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Šalamun V, Verdenik I, Laganà AS, Vrtačnik-Bokal E. Should we consider integrated approach for endometriosis-associated infertility as gold standard management? Rationale and results from a large cohort analysis. Arch Gynecol Obstet 2017; 297:613-621. [PMID: 29274003 DOI: 10.1007/s00404-017-4633-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 12/15/2017] [Indexed: 10/18/2022]
Abstract
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.
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Affiliation(s)
- Vesna Šalamun
- Division of Obstetrics and Gynecology, Department of Human Reproduction, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Ivan Verdenik
- Division of Obstetrics and Gynecology, Department of Human Reproduction, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Antonio Simone Laganà
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Via C. Valeria 1, 98125, Messina, Italy.
| | - Eda Vrtačnik-Bokal
- Division of Obstetrics and Gynecology, Department of Human Reproduction, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Leskošek V, Lučovnik M, Pavše L, Sršen TP, Krajnc M, Verdenik I, Velikonja VG. The Role of Health Services in Encouraging Disclosure of Violence Against Women. Zdr Varst 2017; 56:220-226. [PMID: 29062396 PMCID: PMC5639811 DOI: 10.1515/sjph-2017-0030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 07/06/2017] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- Vesna Leskošek
- University of Ljubljana, Faculty of Social Work, Topniška 31, 1000, Ljubljana, Slovenia
| | - Miha Lučovnik
- University Medical Centre Ljubljana, Division of Obstetrics and Gynaecology, Department of Perinatology, Šlajmerjeva 3, 1000, Ljubljana, Slovenia
| | - Lucija Pavše
- University Medical Centre Ljubljana, Division of Obstetrics and Gynaecology, Department of Perinatology, Šlajmerjeva 3, 1000, Ljubljana, Slovenia
| | - Tanja Premru Sršen
- University Medical Centre Ljubljana, Division of Obstetrics and Gynaecology, Department of Perinatology, Šlajmerjeva 3, 1000, Ljubljana, Slovenia
| | - Megie Krajnc
- University Medical Centre Ljubljana, Division of Obstetrics and Gynaecology, Department of Perinatology, Šlajmerjeva 3, 1000, Ljubljana, Slovenia
| | - Ivan Verdenik
- University Medical Centre Ljubljana, Division of Obstetrics and Gynaecology, Department of Perinatology, Šlajmerjeva 3, 1000, Ljubljana, Slovenia
| | - Vislava Globevnik Velikonja
- University Medical Centre Ljubljana, Division of Obstetrics and Gynaecology, Department of Perinatology, Šlajmerjeva 3, 1000, Ljubljana, Slovenia
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Korenčan S, Pinter B, Grebenc M, Verdenik I. The Outcomes of Pregnancy and Childbirth in Adolescents in Slovenia. Zdr Varst 2017; 56:268-275. [PMID: 29062402 PMCID: PMC5639817 DOI: 10.1515/sjph-2017-0036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 08/17/2017] [Indexed: 12/02/2022] Open
Abstract
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.
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Affiliation(s)
- Simona Korenčan
- University Medical Centre Ljubljana, Division of Gynecology and Obstetrics, Šlajmerjeva3, 1000 Ljubljana, Slovenia
| | - Bojana Pinter
- University Medical Centre Ljubljana, Division of Gynecology and Obstetrics, Šlajmerjeva3, 1000 Ljubljana, Slovenia
- Tel: + 386 41 718 923
| | - Mojca Grebenc
- Community Health Centre, Female Healthcare Service, Derčeva ulica5, 1000Ljubljana, Slovenia
| | - Ivan Verdenik
- University Medical Centre Ljubljana, Division of Gynecology and Obstetrics, Šlajmerjeva3, 1000 Ljubljana, Slovenia
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Obreza K, Verdenik I, Mivšek AP. ANALYSIS OF POST-TERM PREGNANCY MANAGEMENT IN SLOVENIA IN 2012. Slov Nurs Rev 2017. [DOI: 10.14528/snr.2017.51.3.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Sinreih M, Štupar S, Čemažar L, Verdenik I, Frković Grazio S, Smrkolj Š, Rižner TL. STAR and AKR1B10 are down-regulated in high-grade endometrial cancer. J Steroid Biochem Mol Biol 2017; 171:43-53. [PMID: 28232277 DOI: 10.1016/j.jsbmb.2017.02.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 02/16/2017] [Accepted: 02/18/2017] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Maša Sinreih
- Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Saša Štupar
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Luka Čemažar
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ivan Verdenik
- Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Snježana Frković Grazio
- Department of Pathology, Division of Gynaecology and Obstetrics University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Špela Smrkolj
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tea Lanišnik Rižner
- Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
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Trojner Bregar A, Tul N, Fabjan Vodušek V, Verdenik I, Lucovnik M, Janša V, Blickstein I. A dose–response relation exists between different classes of pre-gravid obesity and selected perinatal outcomes. Arch Gynecol Obstet 2017. [DOI: 10.1007/s00404-017-4441-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
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.
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Affiliation(s)
- Anita Jug Došler
- Faculty of Health Sciences, Department of Midwifery, University of Ljubljana, Ljubljana, Slovenia
| | - Ana Polona Mivšek
- Faculty of Health Sciences, Department of Midwifery, University of Ljubljana, Ljubljana, Slovenia
| | - Ivan Verdenik
- Department of Perinatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Teja Škodič Zakšek
- Faculty of Health Sciences, Department of Midwifery, University of Ljubljana, Ljubljana, Slovenia
| | - Tina Levec
- Faculty of Health Sciences, Department of Midwifery, University of Ljubljana, Ljubljana, Slovenia
| | - Petra Petročnik
- Faculty of Health Sciences, Department of Midwifery, University of Ljubljana, Ljubljana, Slovenia
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Hudadi N, Tul N, Trojner Bregar A, Verdenik I, Lucovnik M, Blickstein I. Does an ideal prototype of a twin mother exist? J Perinat Med 2017; 45:479-482. [PMID: 27458660 DOI: 10.1515/jpm-2016-0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/22/2016] [Indexed: 11/15/2022]
Abstract
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.
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