Case Report: Labor induced coccydynia associated with Modic I changes successfully treated with platelet-rich plasma.

Imaging can aid in determining potential causes of coccygeal pain and therefore guide clinicians to carry out individualized treatment. We represent a case of postpartum coccydynia treated by platelet-rich plasma (PRP) which was assessed and followed by MRI. A primipara with uncomplicated labor developed coccygeal pain after delivery that significantly limited her postpartum recovery. On the first MR scan, recorded 6 months after delivery, there were edematous changes of the vertebral endplates of Co1-4 level (Modic type I) with the presence of pronounced precoccygeal venous drainage. Degenerative changes with signs of edema in the area of the pubic symphysis were recorded. The sacroiliac joints had regular morphological features. Since the patient was breastfeeding, PRP therapy was applied with a total of three injections in the area of the coccyx subcutaneously, once every 3 months. The subjective feeling of pain reduction after each injection was about 30%, with the complete withdrawal of pain after one year and still pain-free at the two-year follow-up. One year after the initial MR imaging, a follow-up MR examination was performed, where almost complete resolution of edematous changes in the previously present zones was observed, with residual minor edema of the vertebral endplates at the Co2-3 level. Edema of the pubic bones in the area of the pubic symphysis also subsided. A case of labor-induced coccydynia that was represented as Modic type I changes without neither fracture or luxation was successfully treated with PRP with complete resolution of symptoms.

EFFECT OF DIPPING PATTERN OF GESTATIONAL HYPERTENSION ON MATERNAL SYMPTOMS AND PHYSICAL FINDINGS, BIRTH WEIGHT AND PRETERM DELIVERY.

The study aimed to determine if the non-dipping pattern of blood pressure (BP) influences preterm delivery in gestational hypertension (GH), but also maternal clinical findings and birth weight. Sixty women with GH, i.e. 30 women with a dipping BP profile (control group) and 30 non-dippers (study group), were included in the study. Echocardiography was performed in all subjects, as well as ambulatory blood pressure monitoring (ABPM) during third trimester. ABPM was repeated 6-8 weeks after delivery. Thirteen women with preterm delivery were classified as non-dippers and only four as dippers (p=0.01). The average and peak systolic and diastolic night-time BP had negative linear correlation with birth weight (p<0.0005). Total vascular resistance (p<0.0005) and mass index (p=0.014) were significantly higher as compared with women with term delivery, while ejection fraction (EF) (p=0.007) and circumferential systolic velocity (p=0.042) were significantly reduced in the preterm delivery group. Multivariate binary logistic regression identified the average night-time systolic BP, left ventricular mass index and EF as independent predictors of preterm delivery. Study results suggested a relationship of the non-dipping BP pattern in GH with preterm delivery, birth weight, and maternal clinical findings.

ALGORITHM OF OVULATION INDUCTION IN PATIENTS WITH POLYCISTIC OVARY SYNDROME.

INTRODUCTION: Polycystic ovary syndrome is the most frequent endocrine disturbance in the reproductive period of women's life and the most frequent cause of anovulatory infertility. Ovulation and pregnancy in patients having polycystic ovary syndrome may be a result of a wide range of therapeutic options, and the treatment assumes a gradual approach--from simple noninvasive to expensive and demanding procedures. MATERIAL AND METHODS: A systematic literature survey concerning the efficiency of particular ovulation induction methods in respect of the reproductive outcome was carried out with the aim of establishing the algorithm for ovulation induction in infertile patients having polycystic ovary syndrome. The search was confined to clinical investigations performed on human subjects, reported in English in the period from the beginning of 2010 to June of 2014. CONCLUSION: As a conclusion of this systematic survey of the efficiency of ovulation induction methods, which confirms and supplements the knowledge in this field, it is possible to form the algorithm for ovulation induction in infertile patients having polycystic ovary syndrome, consisting of the following subsequent steps: 1) modification of life style, 2) induction with clomiphene citrate 3) use of metformin, 4) use ofaromatase inhibitors, 5) application ofgonadotropins and laparoscopic ovarian drilling--as a second-line treatment, and 6) assisted reproductive techniques.

Fetal ultrasound scan--prerogatives for the basic level.

Adequate level of prenatal ultrasound scan is a prerequisite for a successful definition of high risk population that needs further investigations. "Basic", standardized fetal mid-trimester scan, with an informative report enables not only diagnosis of anomaly but also evaluation of state of pregnancy in general. This paper was aimed at reviewing the benefits of and requirements for a complete basic mid-trimester fetal ultrasound scan and the necessary documentation. Potential directions for development of organization of basic mid-trimester fetal ultrasound scans are standardization of the scan, with establishing the number and the level of examination, and continual education of both the doctors and the patients. In order to standardize the exam, a uniform check list is needed, so that the examination should always be done in the same manner and at the same level, no matter where it is done and by whom. International and national guidelines should be agreed upon and they should state clear standards on who should do the scan, how, what kind of ultrasound machine should be used and what documentation should be kept. This paper presents a possible standardization of basic level mid trimester fetal ultrasound scan. A routine complete second trimester ultrasound between 18 and 22 weeks and a complete ultrasound report will provide the best opportunity to diagnose fetal anomalies and to help in the management of prenatal care. It will also reduce the unnecessary number of ultrasound examinations done during the second trimester for completion of fetal anatomy survey, which would decrease the costs.

[Adaptation of the immune system as a response to pregnancy]. / Adaptacija imunog sistema kao odgovor na trudnocu.

INTRODUCTION: Pregnancy is an intriguing immunologic phenomenon. In spite of genetic differences, maternal and fetal cells are in close contact over the whole course of pregnancy with no evidence of either humoral and/or cellular immunologic response of mother to fetus as an allotransplant. The general opinion is that the fundamental protective mechanism must be located locally at the contact-plate, between the maternal and fetal tissues. Immunologic investigations proved the presence of specific systems which block the function of antipaternal maternal antibodies, as well as formation of cytotoxic maternal T-cells to paternal antigens. The system preventing rejection of graft during pregnancy is functioning at the level of maternal and fetal tissues. The protective mechanisms are coded by genes of MCH region, locus HLA-G. PROTECTIVE MECHANISMS IN THE PLACENTA: The placenta protects itself against antibody-mediated damage. A high level of complement-regulatory proteins (CD46, CD55 and CD59), being the response to the synthesis of complement-fixing maternal antibodies to paternal antigens and regulation of the placental HLA expression as a preventive reaction of the feto-placental unit to the influence of maternal CTL, are the most important protective mechanisms of placenta. PROTECTIVE MECHANISMS SHARED BY THE PLACENTA AND UTERUS: Protective mechanisms common both for placenta and uterus are as follows: expressions of Fas ligand prevention of infiltration of activated immune cells, regulation of immunosuppression which prevents proliferation of immune cells and high natural immunity (Na cells and macrophages) of the decidua.