[Transitory hypothermia as early prognostic factor in term newborns with intrauterine growth retardation].

INTRODUCTION: According to numerous researches, transitory hypothermia is a part of the neonatological energetic triangle and represents a significant prognostic factor within morbidity and mortality in newborns with intrauterine growth retardation (IUGR), that are, due to their characteristics, more inclined to transitory hypothermia. OBJECTIVE: The aim of the study was an analysis of frequency of transitory hypothermia in term newborns with IUGR, as well as an analysis of frequency of the most frequent pathological conditions typical of IUGR newborns depending on the presence of transitory hypothermia after birth (hypoglycaemia, perinatal asphyxia, hyperbilirubinaemia and hypocalcaemia). METHODS: The study included 143 term newborns with IUGR treated at the Neonatology Ward of the Gynaecology-Obstetrics Clinic "Narodni front", Belgrade. The newborns were divided into two groups: the one with registered transitory hypothermia--the observed group, and the one without transitory hypothermia--the control group. The data analysis included the analysis of the frequency of transitory hypothermia depending on gestation and body mass, as well as the analysis of pathological conditions (perinatal asphyxia, hypoglycaemia, hypocalcaemia, hyperbilirubinaemia) depending on the presence of hypothermia. The analysis was done by statistical tests of analytic and descriptive statistics. RESULTS: In morbidity structure dominate hypothermia (65.03%), hypoglycaemia (43.36%), perinatal asphyxia (37.76%), hyperbilirubinaemia (30.77%), hypocalcaemia (25.17%). There were 93 newborns in the observed group, and 50 in the control one. Mean value of the measured body temperature was 35.9 degrees C. 20 newborns (32.26%) had moderate hypothermia, and 73 newborns (67.74%) had mild hypothermia. In the observed group, average gestation was 39.0 weeks, and 39.6 (p < 0.01) in the control group. Average body mass at birth in the whole group was 2339 g: 2214 g in the observed and 2571 g in the control group. The frequency of hypoglycaemia in the observed group was 53.8%, and 24% in the control group (p < 0.01). In the observed group, the frequency of pH < 7.25 was 38.71%, and 14% in the control group (p < 0.05). The frequency of hyperbilirubinaemia was 38.71% in the observed group, and 16% in the control group (p < 0.01). The frequency of hypocalcaemia was 32.26% in the observed, and 12% in the control group (p < 0.01). CONCLUSION: Transitory hypothermia in the first ten hours of life represents a significant risk factor for deepening hypoglycaemia, asphyxia, hyperbilirubinaemia and hypocalcaemia in term newborns with IUGR.

[Preterm delivery in a patient with frontal lobe brain tumor].

INTRODUCTION/AIM: Brain tumors are very rare in pregnancy. Diagnosis could be very simple if one consider brain tumor alongside blurred symptoms of headache, repetitive vomiting and/or epileptic attacks during pregnancy. The aim of this paper was to emphasize the importance of such pregnancy expert control and completion. CASE REPORT: We presented a 45-year-old pregnant woman at 30 weeks of gestation, and with brain tumor recidive in frontal lobe, hystologicaly confirmed as astrocytoma. The patient was newly diagnosed with tumor in 1995, and monitored until 2003, when she was operated. Due to malignant profile and a partial removal of tumor masses, postoperative gamma-ray therapy was recommended. Because of the continuous need for that kind of therapy, termination of preganancy was also recommended. It was carried out by the application of PGE2 vaginal tablets. Delivery lasted for 8 hours and 50 minutes, and with auxilium manuale sec. Bracht, due to the breech presentation, newborn was delivered 1 550 gramms in weight and 39 cm length. Apgar score was 6/7. CONCLUSION: Pregnancy in patient with brain tumors can be intensively monitored by neurosurgeons and obstetricians, and with the use of the symptomatical therapy almost up to the delivery term. Surgical intervention is recommended to be performed during the second and/or third trimester if the condition requires. The way of delivery in these patients should be individually determined in the most appropriate way both for the mother and the newborn, under given circumstances.

[Frequency of uterine rupture at delivery and accompanying risks for the mother and the newborn].

BACKGROUND/AIM: Uterine rupture at delivery is a severe lifethreatening complication for both mather and the newborn. The aim of the study was to determine the frequency of total number uterine rupture within the deliveries, to perceive circumstances and causes that lead to rupture, to establish perinatal and maternal mortality and to present our therapeutic procedure. METHODS: In the group of 37 ruptures at 59 660 deliveries from the period 1991-2000 included in this retrospective study we analyzed age, level of education, gestational age, parity, previous caesarian section and other operations on uterus, time of diagnosing rupture, grade and place of rupture, use of Syntocinon and Prostaglandin at delivery, perinatal and maternal mortality, as well as therapeutic procedures at rupture that occurred. RESULTS: The highest influence on uterine rupture in our group had been exerted by previous caesarian section and myomectomy in relation 33 : 4. Incomplete uterine ruptures were more frequent, 26 (70.27%), in relation to complete ones, 11 (29.75%). The most frequent place of uterine rupture was the front wall, 34 (91.89%), two ruptures occurred on the fundus and one on the back wall. The most frequently applied therapeutic procedures were rupture suture in 31 (83.78%) cases, and in six (16.22%) cases hysterectomy. Perinatal mortality was three times higher than average (17.78%) in that period and was 51.28%. CONCLUSION: We emphasize that rupture frequency in the total number of deliveries was one rupture at 1 612 deliveries, whereas rupture frequency on the intact uterus was 1 : 17 269, and frequency of uterine rupture after caesarian section was one rupture at 245 deliveries. Our research as well as researches of other authors, showed that a previous caesarian section is the most frequent cause for the occurrence of uterine rupture. Therefore, caesarian section should be avoided whenever possible, not just because of a potential rupture, but also because of more frequent hysterectomy that interrupts woman's reproductive ability.

[Effects of epidural anesthesia on I and II delivery stage and on a newborn].

BACKGROUND/AIM: Epidural anaesthesia (EA) is the most efficient method of pain reduction and its total elimination during delivery. The aim of this study was to establish an influence of EA on the first and the second part of delivery process, frequency of vacuum extractor and forceps appliance, and the effect of EA on the newborn. METHODS: A total of 360 patients with EA were analysed at delivery and 1130 controls without EA. Both groups had vaginal delivery. In both groups deliveries were stimulated by 10 IU of oxytocin in 500 mL of crystalloid solvent, with 15-20 drops per minute. As anaesthetic, Bupivacain (0.25% or 0.125%) was used by the 18 G catheters Braun and Wigon. Level of application was L2-L3 part of spine. RESULTS: The results of this study indicate that deliveries with EA were shorter in duration, but also had much more vacuum extractor and forceps appliance (over 2.5 times) than those without EA. Apgar score was significantly higher in the experimental group with multiple deliveries. However, there was no significant deference between avarage Apgar score of newborns of patients with EA and that of newborns of patients without EA. CONCLUSION: Application of EA decreases duration of delivery, and has no any adverse effects on newborns.