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Sokol Karadjole V, D’Amato A, Milošević M, Herman M, Mikuš M, Laganà AS, Chiantera V, Etrusco A. Impact of Thrombophilic Polymorphisms in Antenatal Women on Perinatal Health: A Single-Center Prospective Study. J Pers Med 2024; 14:433. [PMID: 38673060 PMCID: PMC11050971 DOI: 10.3390/jpm14040433] [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: 02/29/2024] [Revised: 04/08/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Despite pregnancy's hypercoagulable state, the correlation between inherited thrombophilia and thrombotic adverse pregnancy outcomes remains uncertain. The objective of this study was to determine the prevalence of inherited thrombophilic polymorphisms among asymptomatic pregnant individuals and to examine their potential correlation with adverse perinatal outcomes. METHODS in this single-center prospective study, 105 healthy pregnant women were included. Genotyping was conducted for factor V Leiden (FVL), prothrombin gene mutation, methylenetetrahydrofolate reductase enzyme (MTHFR) C677T, MTHFR A1298C, and plasminogen activator inhibitor-1 (PAI-1), alongside the assessment of protein C (PC), protein S (PS), and antithrombin (AT) levels. The study analyzed the association between inherited thrombophilic polymorphisms and pregnancy complications linked to placental insufficiency, such as gestational hypertension (GH), preeclampsia (PE), intrauterine death (IUD), fetal growth restriction (FGR), and placental abruption. RESULTS The prevalence of identifiable thrombophilic polymorphism mutations was 61.9% (95% confidence interval-CI 52.4-70.8%), with the most common single mutation being PAI-1 4G/5G (12/105, 11.4%, 95% CI 6.4-18.5). The most frequent combined mutation was heterozygosity for MTHFR C677T and PAI-1 (12/105, 11.4%, 95% CI 6.4-18.5). Notably, no FVL homozygous carriers or single homozygous and heterozygous carriers for prothrombin polymorphisms were found. Additionally, no deficiencies in PC and AT were detected among participants. Except for homozygosity for PAI-1, none of the studied polymorphisms demonstrated a significant association with pregnancy complications linked to placental insufficiency. CONCLUSIONS The asymptomatic carriers of inherited thrombophilic polymorphisms do not have an increased risk of adverse perinatal outcomes.
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Affiliation(s)
- Vesna Sokol Karadjole
- Department of Obstetrics and Gynecology, University Hospital Center Zagreb, 10000 Zagreb, Croatia; (V.S.K.); (M.H.); (M.M.)
- School of Medicine Zagreb, University of Zagreb, 10000 Zagreb, Croatia;
| | - Antonio D’Amato
- Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Milan Milošević
- School of Medicine Zagreb, University of Zagreb, 10000 Zagreb, Croatia;
- School of Medicine, Andrija Štampar School of Public Health, University of Zagreb, 10000 Zagreb, Croatia
| | - Mislav Herman
- Department of Obstetrics and Gynecology, University Hospital Center Zagreb, 10000 Zagreb, Croatia; (V.S.K.); (M.H.); (M.M.)
- School of Medicine Zagreb, University of Zagreb, 10000 Zagreb, Croatia;
| | - Mislav Mikuš
- Department of Obstetrics and Gynecology, University Hospital Center Zagreb, 10000 Zagreb, Croatia; (V.S.K.); (M.H.); (M.M.)
| | - Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, 90127 Palermo, Italy; (A.S.L.); (A.E.)
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
| | - Vito Chiantera
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
- Unit of Gynecologic Oncology, National Cancer Institute, IRCCS, Fondazione “G. Pascale”, 80131 Naples, Italy
| | - Andrea Etrusco
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, 90127 Palermo, Italy; (A.S.L.); (A.E.)
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
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Augustin G, Kovač D, Karadjole VS, Zajec V, Herman M, Hrabač P. Maternal diaphragmatic hernia in pregnancy: A systematic review with a treatment algorithm. World J Clin Cases 2023; 11:6440-6454. [PMID: 37900237 PMCID: PMC10601005 DOI: 10.12998/wjcc.v11.i27.6440] [Citation(s) in RCA: 1] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/10/2023] [Accepted: 08/29/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Diaphragmatic hernia (DH) is extremely rarely described during pregnancy. Due to the rarity, there is no diagnostic or treatment algorithm for DH in pregnancy. AIM To summarize and define the most appropriate diagnostic methods and therapeutic options for DH in pregnancy based on scarce literature. METHODS Literature search of English-, German-, Spanish-, and Italian-language articles were performed using PubMed (1946-2021), PubMed Central (1900-2021), and Google Scholar. The PRISMA protocol was followed. The search terms included: Maternal diaphragmatic hernia, congenital hernia, pregnancy, cardiovascular collapse, mediastinal shift, abdominal pain in pregnancy, hyperemesis, diaphragmatic rupture during labor, puerperium, hernie diaphragmatique maternelle, hernia diafragmática congenital. Additional studies were identified by reviewing reference lists of retrieved studies. Demographic, imaging, surgical, and obstetric data were obtained. RESULTS One hundred and fifty-eight cases were collected. The average maternal age increased across observed periods. The proportion of congenital hernias increased, while the other types appeared stationary. Most DHs were left-sided (83.8%). The median number of herniated organs declined across observed periods. A working diagnosis was correct in 50%. DH type did not correlate to maternal or neonatal outcomes. Laparoscopic access increased while thoracotomy varied across periods. Presentation of less than 3 days carried a significant risk of strangulation in pregnancy. CONCLUSION The clinical presentation of DH is easily confused with common chest conditions, delaying the diagnosis, and increasing maternal and fetal mortality. Symptomatic DH should be included in the differential diagnosis of pregnant women with abdominal pain associated with dyspnea and chest pain, especially when followed by collapse. Early diagnosis and immediate intervention lead to excellent maternal and fetal outcomes. A proposed algorithm helps manage pregnant women with maternal DH. Strangulated DH requires an emergent operation, while delivery should be based on obstetric indications.
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Affiliation(s)
- Goran Augustin
- Department of Surgery, University Hospital Centre Zagreb, Zagreb 10000, Croatia
- Chair of Surgery, School of Medicine University of Zagreb, Zagreb 10000, Croatia
| | - Diana Kovač
- Institute of Emergency Medicine of Dubrovnik-Neretva County, Croatian Institute of Emergency Medicine, Dubrovnik 20000, Croatia
| | - Vesna Sokol Karadjole
- Department of Gynaecology and Obstetrics, University Clinical Hospital Centre Zagreb, Zagreb 10000, Croatia
| | - Vendy Zajec
- Department of Gynaecology and Obstetrics, University Hospital Centre Zagreb, Zagreb 10000, Croatia
| | - Mislav Herman
- Department of Gynaecology and Obstetrics, University Hospital Centre Zagreb, Zagreb 10000, Croatia
| | - Pero Hrabač
- Department of Biostatistics, "Andrija Štampar" School of Public Health, Zagreb 10000, Croatia
- Department of Biostatistics, School of Medicine University of Zagreb, Zagreb 10000, Croatia
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Habek D, Karadjole VS, Knežević F, Marton I, Ivanišević M. Morbidly Adherent Placenta in the First Trimester with Consecutive
Hysterectomy. Z Geburtshilfe Neonatol 2022; 226:339-342. [DOI: 10.1055/a-1812-5574] [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: 10/17/2022]
Abstract
AbstractBackground Morbidly adherent placenta (MAP) represents a risk factor for a
maternal adverse outcome and its incidence continues to rise following the
increasing rate of caesarean deliveries. The detection of a pathology of
placental adherence in the first trimester is challenging. Transvaginal
ultrasound represents (TVUS) a reliable tool for accurate and timely diagnosis.
Case We report on a case of MAP in a pregnant woman at 10 weeks of gestation
with two prior caesarean deliveries. She presented with abdominal pain and
hematometra. The first trimester diagnosis was made with TVUS and confirmed with
magnetic resonance imaging. The patient required an urgent hysterectomy.
Conclusion Antenatal care in the first trimester in women with a previous
cesarean delivery should include a detailed examination of the placenta with
TVUS.
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Affiliation(s)
- Dubravko Habek
- Department of Obstetrics and Gynecology, University Hospital
“Sveti Duh”, Zagreb, Catholic University of Croatia,
Zagreb
- Department of Obstetrics and Gynecology, University Hospital Centre
Zagreb
| | | | - Fabijan Knežević
- Department of Obstetrics and Gynecology, University Hospital
“Sveti Duh”, Zagreb, Catholic University of Croatia,
Zagreb
| | - Ingrid Marton
- Department of Obstetrics and Gynecology, University Hospital
“Sveti Duh”, Zagreb, Catholic University of Croatia,
Zagreb
| | - Marina Ivanišević
- Department of Obstetrics and Gynecology, University Hospital Centre
Zagreb
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Mikuš M, Škegro B, Sokol Karadjole V, Lešin J, Banović V, Herman M, Goluža T, Puževski T, Elveđi-Gašparović V, Vujić G. Maternity Blues among Croatian Mothers - A Single-Center Study. Psychiatr Danub 2021; 33:342-346. [PMID: 34795176 DOI: 10.24869/psyd.2021.342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Maternity blues is a transient change of mood that occurs within the first few days after delivery. Some of the most common symptoms include mood swings, tearfulness, irritability, loss of appetite, fatigue. The aim of the study was to investigate the relationship between maternity blues, psychological, demographic and obstetrics risk factors. SUBJECTS AND METHODS A cross-sectional study was conducted between October 2019 and February 2020 at the University Hospital Center Zagreb, Croatia. Final analysis included 227 mothers. Participants were assessed with Stein's Maternity Blues Scale, Connor-Davidson Resilience Scale (CD-RISC), Multidimensional Scale of Perceived Support (MSPSS) and Brennan's Experiences in Close Relationship Scale, as well as demographic and obstetric data. RESULTS The prevalence of maternity blues in our study was 19.9%. Higher result on Stein's Maternity Blues Scale was associated with anxious attachment style (r=0.425, p<0.01), oxytocin (r=0.308, p<0.01), lower birth weight (r=-0.242), lower resilience (r=-0.252) and less perceived social support from family and significant other (p<.01). CONCLUSIONS This report presents the very first study assessing maternity blues occurence among Croatian mothers and in Croatian cultural environment. We believe that our report will address importance of employing adequate screening methods in preventing and timely recognizing maternity blues and subsequent postpartum depression in Croatian population.
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Affiliation(s)
- Mislav Mikuš
- Department of Obstetrics and Gynecology, University Hospital Center Zagreb, Zagreb, Croatia
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Mikuš M, Sokol Karadjole V, Kalafatić D, Orešković S, Šarčević A. Increase of stillbirths and unplanned out-of-hospital births during coronavirus disease 2019 lockdown and the Zagreb earthquake. Acta Obstet Gynecol Scand 2021; 100:2119-2120. [PMID: 34448194 PMCID: PMC8652766 DOI: 10.1111/aogs.14250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 08/16/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Mislav Mikuš
- School of Medicine, University of Zagreb, Zagreb, Croatia.,Department of Obstetrics and Gynecology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Vesna Sokol Karadjole
- School of Medicine, University of Zagreb, Zagreb, Croatia.,Department of Obstetrics and Gynecology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Držislav Kalafatić
- School of Medicine, University of Zagreb, Zagreb, Croatia.,Department of Obstetrics and Gynecology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Slavko Orešković
- School of Medicine, University of Zagreb, Zagreb, Croatia.,Department of Obstetrics and Gynecology, University Hospital Center Zagreb, Zagreb, Croatia
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Škegro B, Bjedov S, Mikuš M, Mustač F, Lešin J, Matijević V, Ćorić M, Elveđi Gašparović V, Medić F, Sokol Karadjole V. Endometriosis, Pain and Mental Health. Psychiatr Danub 2021; 33:632-636. [PMID: 34718292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Endometriosis is a chronic and progressive disease which can significantly affect a woman's personal, as well as intimate and professional aspects of life. The aim of this study was to asses health-related quality of life and mental health status in patients with endometriosis, investigating also their relationship with endometriosis-related comorbid symptoms and conditions, such as pain and infertility. SUBJECTS AND METHODS An observational cross-sectional study involved 79 women with endometriosis. All patients filled the Endometriosis Health Profile (EHP-5), the Depression Anxiety Stress Scales (DASS-21) and the Visual Analogue Scale (VAS). Their medical data were retrieved from medical records. Data was analyzed using the SPSS 23.0 (IBM Corp., Armonk, NY). RESULTS Of all the patients evaluated in our study, 44.3% presented depressive symptoms and 25.3% presented anxiety, while 31.7% reported stress symptoms. Moderate correlations were found between results on EHP-5 and depression (r=0.515), stress (r=0.558) and VAS score (r=0.565). Furthermore, weak positive relationship was observed between EHP-5 and anxiety (r=0.295) and infertility (r=0.267). Additionally, moderate correlation was found between depression and infertility (r=0.519), while there was weak association between VAS score and stress (r=0.236). CONCLUSIONS This study showed complex relationships between symptoms and conditions manifesting in patients with endometriosis. Due to diversity of symptoms, potentially including mental health issues, it is important to emphasize the need for combined personalized treatment for these patients, taking into account both physical and psychological aspect of the disease.
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Affiliation(s)
- Bernarda Škegro
- Department of Rheumatology, Physical Medicine and Rehabilitation, University Hospital Center Sestre milosrdnice, Zagreb, Croatia
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