[Morbidity in newborns exposed to organophosphorus pesticides].

INTRODUCTION: Insecticides are toxins by which we destroy harmful insects. The most frequent insecticides which are used today are organophosphorus pesticides. This group of compounds make substances whose activity mechanism is based on the inhibition of acetylcholinesterase in nerve synapsis, thus producing holynergic syndrome, resulting from the accumulation of acetylcholine which developed due to the absence of decomposition under the influence of cholinesterase. In the clinical picture of acute toxication by cholinesterase inhibitors there is a clear difference between muscarinic and nicotine effects. The basic aim of the study was to establish the effects of organophosphorus pesticides present in blood and breast milk of mothers on newborns morbidity. MATERIAL AND METHODS: The study group consisted of 18 newborns whose mothers had isolated organophosphorus pesticides in their blood and breast-milk on the third day after delivery, and the control group consisted of 84 newborns whose mothers did not have isolated organophosphorus pesticides in their blood and breastmilk. RESULTS: Morbidity is three times greater, often in combination with some disorders of the central nervous system, and the relative risk for its appearance is eight time greater in newborns exposed to organophosphorus pesticides. DISCUSSION: Disorders that appear in newborns exposed to pesticides are mutagenic, cancerogenic and neurotoxic and some agenses could disturb the immune system which is reflected in morbidity increase, primarly of the central nervous system. CONCLUSION: The presence of organophosphorus pesticides in blood and breast milk has negative effects on newborns. In addition to acetylcholinesterase inhibition, organophosphorus pesticides react by means of other mechanisms as well.

[Unknown pregnancy--presentation of the case].

INTRODUCTION: There are two kinds of unknown pregnancies. A denied, unknown pregnancy, graviditatas ignota, when the pregnant woman unconsciously denies the existence of the pregnancy. Contrary to the denied pregnancy there is a hidden pregnancy, a concealed pregnancy in women who know they are pregnant but actively hide their pregnancy from the family, partner, friends, teachers, colleagues, etc. The prevalence of an unknown pregnancy during the first 20 gestation weeks is 1 in 475 pregnancies, in the second half of pregnancy it is 1 in 2455 pregnancies and at the moment of delivery it is 1 in 7225. CASE REPORT: A 40-year-old woman was transported by an ambulance and admitted to Gynecology and Obstetrics Clinic in Kragujevac after the delivery in home conditions and this patient found out about her pregnancy at the moment of delivery. DISCUSSION: This case presents a classical example of a denied pregnancy. The reasons are probably at all levels, physiological, psychological and social. The patient was 40 years old, with two children aged 17 and 15 and irregular periods. Denied pregnancies present a multidisciplinary problem, which requires work of different specialties and services and this interferes with family and social life. CONCLUSION: The denied pregnancy should always be taken into consideration in case of irregular periods, especially in perimenopause. Patients in perimenopause should have regular medical examination by their gyneocolgists, at least once in six months and the delivery outside hospital conditions that bears a great risk should be avoided at any rate.

[Ovarian metastasis in patient with endometrial carcinoma or synchronous tumors--presentation of a case].

INTRODUCTION: Synchronous, independent tumors are two or more tumors which appear independently from each other at the same moment. Metastatic tumors originate by disseminating malignant cells from other organs. Synchronous, primary malignities make 1.7% of all genitals malignities. Joined endometrial and ovarian carcinomas are found in 5% of cases. PRESENTATION OF A CASE: In this research, we present the case of an obese woman, 37 years old, who had associated endometrial tumors of uterus and ovary, without malign cells in peritoneal dilution, positive estrogen. negative progestine and focal expression of p53 receptors present in about 10-15% tumor cells. DISCUSSION: This patient underwent the classic hysterectomy with reciprocal adnexectomy. After the operation, complete radial and hemiotheraphy was performed. The patient was without recurrence of the disease 30 months after the operation. The differentiation of primary independent synchronous and metastatic tumors is important not only for the prognosis, but also for the choice of the therapy. CONCLUSION: There are no reliable clinical and histological criteria for diagnoses. Most cases are most frequently regarded as higher stages.

[Decidual transformation in adenomyosis during pregnancy as an indication for hysterectomy].

INTRODUCTION: Incidence of adenomyosis is estimated on 20% in all of extracted uteruses. Clinically, it usually exists asymptomatically, but could be followed with dysmenorrhoea, menorrhagia and pelvic pain. One third of patients with adenomyosis are sterile, however in other two thirds, conception and pregnancy could have normal development, with delivery without complications. One of possible complications related to adenomyosis is rupture of uterus during delivery. CASE REPORT: A pregnant woman at the end of the 10th lunar month of pregnancy, showed minimal labour contractions, following amnion rupture and the delivery was terminated by section ceasar. Subtotal hysterectomy was performed because of concominant profuse bleeding. Myometrium was occupied with decidual cells in trabecular arrangement, among which elongated endometrial glands were placed. Surrounding muscle fascicles showed atrophic, apoptic, and occasionally necrotic changes. Myometrial stroma was edematous, and infiltrated with mesenchymal cells, as well as with adipose cells, which were extending toward serosa. DISCUSSION: The patient had been receiving treatment, for a long period, because of sterility without clear etiological factor. A small number of similar cases ends with complications. Here, it is evident that abundant decidual transformation of stromal cells in adenomiosis leads to atrophy and necrosis of muscle cells. The reduction of uterine muscle mass causes atony and threating rupture, through separation of muscle cells, and therefore the absence of their synchronized contractions. CONCLUSION: Atony of uterine muscle could be caused by decidual transformation in adenomyosal fields, atrophy of muscle fascicles, edema of the stroma, mesenchymal transformation, and fibrosis. This leads to a decrease in myometrial contractions, and prolonged postpartal bleeding.

Rectus abdominis muscle endometriosis after cesarean section--case report.

Endometriosis is defined by the presence of functional endometrial tissue outside the uterus, where it is normally located. Endometriosis is one of the most common gynecologic entities affecting 8%-18% of menstrual women. Endometriosis can occur at intra- and extrapelvic localizations. The most common intrapelvic localizations are those involving the ovaries, Douglas' area, pelvic peritoneum, uterus, bladder and rectum. Abdominal endometriosis is the most common localization of extrapelvic endometriosis and usually develops in connective tissue. Extra-pelvic implantation of endometrial tissue may develop in any organ including the skin, lungs, liver, extremities, brain and stomach. Three years after cesarean section, a 35-year-old female was operated on for suspected anterior abdominal hernia at the site of previous section. An egg-sized tumor was removed from the rectus abdominis muscle and referred for histopathologic and immunohistochemical analyses. The results showed endometriosis of the muscle with positive estrogen and progesterone receptors. A year after the procedure, treatment with gonadotropin-releasing hormone analogs was continued due to recurrent pain in the scar area, along with ultrasonography and biochemical marker (carbohydrate antigen 125) follow-up. Clinical diagnosis of scar endometriosis can be made by thorough history and physical, ultrasonography and biochemical examinations. Scar endometriosis should always be considered when the symptoms occur in a cyclic and hormone-dependent pattern, mostly after gynecologic operations, and worsening during menstruation. Definitive diagnosis is based on histopathologic analysis.

[Neonate--newborn condition and prematurity with breech delivery].

INTRODUCTION: Before birth, most of foetuses located in mother's uterus have head presentation down towards the breech exit. Preterm delivery presents the delivery before the end of the 37th gestational week. Etiology of preterm breech deliveries is the same as of the ones at term, such as uterine malformations and myomas, polyhydramnion, foetal abnormalities, high parity, short umbical cord, placenta previa. The complications include passing of the body through insufficiently dilated cervical channel and "capturing " of the head, umbilical cord prolapse, intrapartal hipoxy, discoordinated delivery, aspiration pneumonia, traumatic injuries. The basic aim of the research was to determine prematurity, mortality, colority of the amniotic fluid, and newborn condition with breech deliveries comparing to the head presentation deliveries. MATERIAL AND METHODS: The study group consisted of 282 newborns that came from breech deliveries and the same number of the controls born with head presentation. In cases of breech deliveries there was greatly higher quantity of green and meconium amniotic fluid, significantly higher prematurity, significantly lower average Apgar score as well as seven times higher mortality of newborns comparing with the values in head presentation deliveries. DISCUSSION: Meconium amniotic fluid can result in greater risk than aspiration pneumonia which is the characteristics of breech deliveries. There are more causes endangering fetal vitalty after breech delivery and those are along with prematurity, greater number of congenital malformations, often traumas which depend on delivery course as well as hipoxy caused during delivery. Prematurity of fetus is one of risk factors resulting in breech delivery but it is also its main characteristics. CONCLUSION: Breech delivery brings greater risk measured by Apgar score values, appearance of meconium amniotic fluid, prematurity with its consequences and perinatal mortality.

[Infant biochemical and clinical parameters within the baby friendly programme].

INTRODUCTION: Breastfeeding is the best nourishing method for the health protection, child's growth and development with greatly reduced risks for acute and chronic disorders. The first hours after the childbirth are the most important. The objective of the research. The objective of the research is to establish whether the baby friendly programme affects the infants' biochemical and clinical parameters during the first days of their lives. MATERIALS AND METHODS: The research was conducted on 216 infants in both groups. The tests on glycaemia were done in both groups on 65 infants, tests on bilirubinemia on 75, and tests on temperature, stomatomycosis and weight loss tests during the first three days in all infants. RESULTS: Hypoglycaemia, hypothermia, significant weight loss during the first days and stomatomycosis were observed with the significantly high possibility in the infant group outside the baby friendly programme, and bilirubinemia did not depend on the programme. DISCUSSION: Frequent breastfeeding reduces the starvation periods and the need for involvement of alternative metabolic courses in the process of glucose homeostasis preservance, and the less frequent cooling of the infant as well, it can affect the prevention of hyperbilirubinemia, practically eliminate stomatomycosis and lead to less weight loss during the first days of life. CONCLUSION: Implementation of the baby friendly programme has the positive effect on the glycaemia level and cooling, it does not affect bilirubinemia, its results can be seen in less weight loss and in elimination of stomatomycosis.

Ectopic mammary tissue in vulva.

BACKGROUND: Ectopic mammary gland tissue is a residual tissue that persists during the embryologic development along ectodermal primitive milk streaks. Incomplete involution anywhere along the primitive milk streak can result in accessory or ectopic mammary tissue. CASE REPORT: A woman, 27-year old, admitted to Obstetrics and Gynecology Clinic Kragujevac for surgery, of goose-egg size, vulva tumor, of elastic consistency. Menarche started in 12 years of age, with the regular menstrual cycle, without previous gyneocological diseases. The woman had one pregnancy terminated by cesarean section because of the multiple (twin) pregnancy. Excision of the tumor was completely done in the total endotracheal anesthesia. Pathohistologic (PH) findings was: Dysplasia fibrosa cystica simplex mammae, with focuses of sclerosing adenosis. Expression of estrogen (ER) and progesterone receptors (PR) were positive. CONCLUSION: Ectopic mammary tissue in vulva in adult period is very rarely seen, and can be changed pathologically as well as normally positioned breast tissue into benign cystic changes, benign tumors, adenomas and fibroadenomas and tumors. Cells with low ER/PR receptor level grow independently of estrogene stimulation and they could be resistant to hormonal therapy effects.

[An early contact with the baby--benefit for the mother].

INTRODUCTION: Numerous studies on the early contact between mother and the baby and the time they spend together-common stay stress the fact that these are invaluable for the mothers, infants, family and society in general. The objective of the research. The objective of the research was to establish whether mother benefits from the early contact with her baby and the importance of the time period they spend and share together MATERIALS AND METHODS: The study group consisted of 216 mothers that spend the time with their babies and had the early contact with the babies as well, and the control group consisted of 216 mothers that were detached from their babies. Puerpera were observed in the aspects of the uterus involution, post delivery hemogramme on the third day after the childbirth, sanitary napkin consumption and the hospitalization length. RESULTS: For the study group the following was significant: less of the bad uterus involution, less of the post delivery anemia measured in the hemoglobin values and in the number of erythrocytes, less of the sanitary napkin consumption and the shorter hospitalization length. DISCUSSION: The early contact and the time spent with their babies after the childbirth influence the less blood loss analized by post delivery hemogramme, better uterus involution, less of the sanitary napkin consumption analyzed in the first three days after the childbirth and the shorter hospitalization length. The positive component of the breastfeeding oxytocic reflex is probably responsible for these effects. CONCLUSION: Puerpera benefit from the early contact and the time spent with their babies.

[Postpartum hysterectomy performed as a consequence of chronic myometritis].

INTRODUCTION: As a diffuse chronic inflammation, myometritis is very rare and usually follows after postpartal placenta remains or postabortion infections, but it can be also associated with endometrial or ascendent infection. Chronic myometritis is often followed by profuse bleeding, though in most cases it cannot be recognized as it is asymptomatic. Histologically, that chronic process is characterized by the presence of fibriosis within the muscles and mononuclear cells (lymphoplasmocytic and histiocytic) infiltration. CASE REPORT: A 24 old woman's second child was delivered per vias naturalis but the next day the profuse bleeding occured which would not stop even after repeated curretages and suspecting a case of placenta accreta and uterus atony, subtotal hysterectomy was performed. Histologically, the disappearance of the regular arrangement of the smooth muscles and stroma could be seen with the devastation of myometrium due to the diffuse reduction of its smooth muscle bundles and cells, as well as their atrophy, necrobiosis and apoptosis with the minimal preservation of the muscle bundles and little cell groups of the myometrium, an abundant presence of the fibrocollagene and myxoid transformed connective tissue, group cells similar to the mesenchymal tissue and adipocytes. DISCUSSION: It was not possible to find this variant of the changes on the myometrium in the available literature. The present case is about the clinically unknown asymptomatic myometritis, possibly developed in the postpartal period of the previous pregnancy. It is our opinion that it is most probably an autoagressive process directed towards the smooth muscle cells of the myometrium, as shown by their reduction and inflammatory cells composition, which plays an important role in the immune reactions (lymphocytes, plasma cells, eosinophilis, histocytes). CONCLUSION: A subtotal hysterectomy was performed on a woman, 24 years old, who gave birth to her second child and had profuse postpartal bleeding in sprite of repeated curettages. On the basis of this uterus atony, there is the clinically non-manifested chronic myometritis. The chronic inflammation resulted in a subtotal reduction of myometrium muscle mass, its replacement sclerosis, the multiplication of adipocytes, mesenchymal cells, histiocytes, lymphomonocytes and dissection of muscle fascicles.

[Maternal and fetal death due to placenta previa/accreta in a concealed pregnancy--a case report].

INTRODUCTION: This is a case report of maternal and fetal death due to major hemorrhage of a patients with placenta previa/accreta in a concealed pregnancy. Bleeding is the leading cause of maternal mortality in obstetrics. Postpartum hemorrhage is the most important cause of maternal death. Placenta accreta is a severe complication involving an abnormal attachment to the uterine wall so that it cannot be easily separated from the uterus. CASE REPORT: Due to the fact that one part of the placenta is partially detached, while the other part has grown into the uterus, postpartum hemorrhage may occur with lethal outcome, unless the mother is hospitalized. Fetal death was caused by severe meconium aspiration. One way to prevent such complications is to support legal abortions.

A study of alloreactivity in couples with habitual abortions of unknown etiology.

During 2003, we investigated 22 couples with three or more consecutive spontaneous abortions without liveborn children. The study group consisted of 9 couples with three or more successive spontaneous abortions without liveborn children and without known endogenous or exogenous causes of habitual abortions. The first control group comprised 9 couples with liveborn children, while the second one included 9 randomly selected couples without children. The immunologic status was evaluated in regard to functional capacity of lymphocytes, response of T-lymphocytes to disabled histocompatible antigens of partner's lymphocytes, and T-lymphocytes to partner's alloantigens. In women from study and control groups there were no statistically significant differences in general immunologic status functional capacity of lymphocytes). In women from the study group, T-lymphocytes response to stimulation by disabled partner's lymphocytes was significantly lower compared to both control groups (P < 0.05). However, the immunologic reaction of women from the study group to alloantigens of men from control groups did not show any significant difference compared to control groups results (P > 0.05). According to our study, it can be concluded that immunologic factors have an important role in a great proportion of habitual abortions with unknown etiology.