Antenatal fetal demise in multiple gestation--the outcome of surviving fetus at one to four years of age.

The outcome of 26 multifetal pregnancies with single fetal demise after 12 weeks of pregnancy cared for at the University Medical School of Zagreb from 1986 to 1991 is presented. Growth retardation of dead and surviving infant and pathohistological findings consistent with reduced uterine blood flow to cotyledonary space was the most frequent complication, irrespective of the type of placentation. Perinatal infection was the most frequent neonatal complication. Neonatal asphyxia was observed in only one infant. The outcome at 1-4 years of age was perfect in 14 out of 15 surviving infants for whom data are available. An early diagnosis of multifetal pregnancy, based essentially on ultrasonography and appropriate monitoring of the mother and the survivor, with cesarean delivery carried out at first signs of imminent asphyxia, is the best guarantee for a favorable outcome.

Antithrombin III in fetuses and newborn children.

Antithrombin III (AT III) was measured in plasma of healthy fetuses between 20-29 weeks of gestation, in plasma of suspected growth retarded or malformed fetuses between 30-39 weeks of gestation, in healthy newborn infants after delivery, and in healthy infants during the first year of life. Measurements were performed with an AT III assay (Orion Diagnostica, Espoo, Finland Turbox) on nephalometer Turbox. The results were expressed as a percentage of the mean adult value (300 mg/l) and statistically analysed with the non-parametric Kruskal-Walles test. AT III levels in fetuses were low but increasing. They continued to increase after birth (F = 34.53 p < 0.001) and reached adult values in the age between the tenth and twelfth month of life.

[The effect of chronic kidney disease on the course and outcome of pregnancy]. / Utjecaj kronicnih bubreznih bolesti na tijek i ishod trudnoce.

In order to estimate the effect of renal disease on the pregnancy, and the effect of pregnancy on the natural course of renal disease, the course and outcome of the 37 pregnancies was analyzed in gravidas with chronic renal disease. The women were cared for between 1978 and 1990 at the Department of Obstetrics, School of Medicine University of Zagreb. Analysis of the results in this article is retrospective. Thirty-six pregnancies finished by vaginal or cesarean delivery or by abortion, while one pregnancy was ectopic and ended by laparotomy during the 20th week. There were 31 live births from 36 fetuses (86.1%), 5 stillbirths (13.19%), of which 2 pregnancies ended in fetal death (abortion). In addition, there were 6 instances of neonatal death (8.3%). Twenty-five percent of pregnancies finished before 37 weeks of gestation. In 6 of 34 (17.6%) deliveries amniotic fluid was meconium stained, and 5 of 31 (16.1%) infants were born hypoxic. There were 29 percent of growth retarded liveborn fetuses. Perinatal mortality was 167/1000. Renal insufficiency was noted in 12 of 37 (32.4%) pregnancies, 54% of pregnant women had hypertension, 8.1% hyperkalemia, 78.4% were anemic, 27% had significant bacteriuria and 21.6% overt pyelonephritis. There was one case of acute deterioration in renal function that required hemodialysis, and one case of preeclampsia. Renal insufficiency or hypertension reduce drastically the chances for a successful outcome of pregnancy in gravidas with kidney disorders. However renal insufficiency in the presence of hypertension, carries even poorer prognosis, with perinatal mortality of 428/1000.

[Perinatal care]. / Perinatalna zastita.

In the Republic of Croatia, the perinatal mortality, as an indicator of perinatal care, has decreased from 38.6% in 1950-54 to 10.9% in 1989 which means that today it is on the low mortality level like in the Middle- and West-European countries. The decline of perinatal mortality is especially evident after 1985. There are pronounced differences within the different regions of the Republic of Croatia, the lowest perinatal mortality is in the town of Zagreb and in the central Croatia, while the highest one in the region of Bjelovar, Slavonia and Dalmatia. Comparing the data from 29 maternity hospitals and taking into account a decrease in the number of hospitals with high perinatal mortality (48% in 1972 to zero in 1990) and an increase in the number of hospitals with low mortality (11 or 38% with mortality less than 10% in 1990), an increase of the delivery frequency completed by cesarean section was found: in 1990 there were 31% of the maternity hospitals with more than 10%, 45% with 6-10% and 24% with less than 6% of cesarean sections. Over recent years the maternity hospitals are better supplied with the necessary medical equipment: in 1990 97% of the hospitals were provided with cardiotocographs, 97% with ultrasound apparatuses and 90% with baby incubators. A sufficient number of specialists in gynecology and obstetrics is available, while there are lacking 21 specialists in pediatrics--neonatology, what is one third of the required number.(ABSTRACT TRUNCATED AT 250 WORDS)

[Pregnancy outcome after early amniocentesis]. / Ishod trudnoce nakon rane amniocenteze.

The indications, karyotype, and outcome of 1812 pregnancies following midtrimester amniocentesis (eACZ/as) performed from 1977 to 1989 are presented, especially regarding the risk of pathologic karyotypes and spontaneous abortion. There were 37 pathologic karyotypes (trisomy 21 in 24 pregnancies). The spontaneous abortion rate following amniocentesis was 2.8% although it was almost halved after direct ultrasound guidance had been introduced (1.87% versus 3.66%). In gravidas with previous spontaneous abortion, the preterm delivery rate and spontaneous abortion rates following rACZ were significantly increased. There is a progressive increase of the spontaneous abortion rate after eACZ with the number of previous spontaneous abortions; 5.83% when there was only 1 previous spontaneous abortion, 7.83% when there were 2, and 8.75% when there were 3 or more spontaneous abortions. Previous spontaneous abortions do not increase the risk of chromosomal aberration. In women aged 37 years or more the risk of trisomy 21 is 0.69%, aged 38 years 1.55% and over 39 years 0.44%. The risk is rapidly increasing after 40 years of age (2.25%). The proportion of pathologic karyotypes in these age groups was significantly higher in comparison to younger women. The age limit of 37-38 years as the indication of a possible appearance of mid-trimester ACZ is discussed.

[Peroral and intracervical administration of prostaglandin E2 for stimulation of term labor in premature rupture of fetal membranes]. / Peroralna i intracervikalna primjena prostaglandina E2 u stimulaciji rocnog poroda kod prijevremenog prsnuca vodenjaka.

The outcome of stimulation of labour in 219 primiparous patients with more than 6 hours following a premature rupture of the membranes, and with an ripe cervix, without the established labour, was analysed according to the mode of treatment. One hundred and thirty eight (138) women received PGE2 peroral tablets, 14 intracervical PGE2 gel, and 67 oxytocin intravenously. There were 73.2% vaginal deliveries in the group that received PGE2 per os, 77.5% in the group that received oxytocin, and 92.9% in the group that was given intracervical gel. The differences were significant. The cervix remained unripe in 9.4% patients that received PGE2 perorally, in 14.9% of those that received oxytocin, while in the gel group it became favourable in all parturients. Uterine polisistoly was encountered in 10.9% labours after peroral stimulation, in 7.1% in the gel group and in 1.5% in the oxytocin group, and perinatal asphyxia in 16.7%, 7.1% and 13.4%, respectively. When too frequent, especially if combined with oxytocin and given to patients with a moderately favourable cervix, peroral stimulation predisposes to uterine polisitoly. Intracervical application of PGE2 gel is the method of choice in primigravid patients with a premature rupture of the membranes and the unripe cervix (Bishop score O). In gravidas with a more favourable cervix (Bishop score 4-6) the administration of oxytocin is acceptable with less complications. In those with a moderately favourable cervix (Bishop score 1-4) the gel application proved to be preferable, although stimulation could be carried out as well.

Percutaneous transluminal renal angioplasty (PTRA) as a method of therapy for renovascular hypertension in children.

The results of PTRA in treatment of renovascular hypertension in four children aged 5, 7, 13 and 15 are presented. All patients suffered from severe hypertension. Tests showed all of them to have fibromuscular dysplasia stenosis of the main renal artery and significant lateralization of renin levels. One suffered from associated polycystosis of kidneys and in another the renal artery stenosis was bilateral. In all patients successful patency was achieved. In one patient, the arterial pressure after PTRA was normalized, while in the others it was considerably improved. Two patients, tested 8 and 12 months after PTRA, were lost to further follow-up. In one of the remaining two, stenosis and hypertension reappeared 5 years after PTRA. After autotransplantation the patient was normotensive. In the other, also 5 years later, recurrent hypertension appeared related to the associated polycystosis.

[Renin levels in renal veins in patients with essential arterial hypertension]. / Vrijednosti renina iz bubreznih vena u bolesnika s esencijalnom arterijskom hipertenzijom.

The data on plasma renin activity (PRA) obtained by catheterization of renal veins in 272 patients with essential arterial hypertension (EH) are reported. In order to exclude a secondary nature of hypertension, all patients were hospitalized and submitted to the extensive clinical and laboratory examinations (according to the protocol) including renal angiography. The aim of the work was to get evidence whether in the apparently homogeneous group of patients with EH there are differences in renin activity between the renal veins giving the quotient (Q) higher than 1.5, and possibly to recognize the clinical meaning of the differences of Q found. In the examined patients as a whole regardless of PRA, 50 of them (18.3%) showed Q greater than or equal to 1.5 and among them in 16 (5.8%) patients Q greater than or equal to 2 was found. The patients were divided according to PRA into those with low, normal and high PRA. In the hyperreninemic group of patients no Q greater than or equal to 2.0 has been found. In the hyporeninemic group 9 patients (9.9%) exhibited Q greater than or equal to 2.0. Although, one does not expect in EH to find differences in PRA between left and right renal vein, we have found the values of Q greater than or equal to 1.5 in nearly 1/5 of our patients. These differences found could be resulting from the existence of asymmetrical angiosclerotic or other renal pathological changes that can not be examined by the available clinical methods.(ABSTRACT TRUNCATED AT 250 WORDS)