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Košec A, Gašić A, Hergešić F, Rašić I, Košec V, Bedeković V. Assessing Symptomatic Hypocalcemia Risk After Total Thyroidectomy: A Prospective Study. Int Arch Otorhinolaryngol 2024; 28:e12-e21. [PMID: 38322433 PMCID: PMC10843930 DOI: 10.1055/s-0043-1777450] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 06/05/2022] [Indexed: 02/08/2024] Open
Abstract
Introduction The most common postoperative complication of total thyroidectomy is hypocalcemia, usually monitored using serum parathyroid hormone and calcium values. Objective To identify the most accurate predictors of hypocalcemia, construct a risk assesment algorithm and analyze the impact of using several calcium correction formulas in practice. Methods A prospective, single-center, non-randomized longitudinal cohort study on 205 patients undergoing total thyroidectomy. Parathyroid hormone, serum, and ionized calcium were sampled post-surgery, with the presence of symptomatic or laboratory-verified asymptomatic hypocalcemia designated as primary outcome measures. Results Parathyroid hormone sampled on the first postoperative day was the most sensitive predictor of symptomatic hypocalcemia development (sensitivity 80.22%, cut-off value ≤2.03 pmol/L). A combination of serum calcium and parathyroid concentration sampled on the first postoperative day predicted the development of hypocalcemia during recovery with the highest sensitivity and specificity (94% sensitivity, cut-off ≤2.1 mmol/L, and 89% specificity, cut-off ≤1.55 pmol/L, respectively). The use of algorithms and correction formulas did not improve the accuracy of predicting symptomatic or asymptomatic hypocalcemia. Conclusions The most sensitive predictor of symptomatic hypocalcemia present on the fifth postoperative day was PTH sampled on the first postoperative day. The need for algorithms and correction formulas is limited.
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Affiliation(s)
- Andro Košec
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Centre “Sestre milosrdnice,” Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ana Gašić
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Filip Hergešić
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ivan Rašić
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Centre “Sestre milosrdnice,” Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Vesna Košec
- Department of Gynecology and Obstetrics, University Hospital Centre “Sestre milosrdnice,” Zagreb, Croatia
| | - Vladimir Bedeković
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Centre “Sestre milosrdnice,” Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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Kličan-Jaić K, Djaković I, Orešković N, Magdić Turković T, Pešić M, Košec V. DILEMMAS ABOUT THE SELECTION OF ANESTHESIA FOR ELECTIVE CESAREAN SECTION IN PREGNANT WOMEN WITH MYOTONIC DYSTROPHY TYPE 2 AND SUSPECTED von WILLEBRAND DISEASE: A CASE REPORT. Acta Clin Croat 2023; 62:224-229. [PMID: 38304361 PMCID: PMC10829951 DOI: 10.20471/acc.2023.62.01.26] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 01/07/2020] [Indexed: 02/03/2024] Open
Abstract
With advancement of medicine in the field of diagnostics and treatment of women suffering from certain genetic disorders, more and more women have attained reproductive age and desired fertility. Maintaining pregnancy, as well as bringing it to an end poses a real challenge not only for obstetricians, but also for anesthesiologists involved in the procedure. In our case report, we describe anesthetic management of a female patient suffering from myotonic dystrophy type 2 and suspected von Willebrand's disease, and undergoing elective cesarean section. It is acknowledged that both diseases have their own peculiarities and specificities related to anesthesia and require careful consideration when it comes to selecting it. Bearing in mind the advantages and disadvantages of certain types of anesthesia, we believe that in this case, general anesthesia was a better choice compared to the regional techniques of anesthesia.
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Affiliation(s)
- Katarina Kličan-Jaić
- Department of Anesthesiology, Intensive Care Medicine and Pain Management, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Ivka Djaković
- Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Nika Orešković
- Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Tihana Magdić Turković
- Department of Anesthesiology, Intensive Care Medicine and Pain Management, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Maja Pešić
- Department of Anesthesiology, Intensive Care Medicine and Pain Management, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Vesna Košec
- Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
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Kruezi E, Habek D, Luetić A, Marton I, Prka M, Srnec L, Plačko-Vršnak D, Košec V, Kuna K. IS THERE A RELATIONSHIP BETWEEN COMPLICATIONS OF EARLY PREGNANCY AND BIOMETEOROLOGICAL FORECAST? Acta Clin Croat 2022; 61:629-635. [PMID: 37868180 PMCID: PMC10588383 DOI: 10.20471/acc.2022.61.04.09] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/30/2021] [Indexed: 10/24/2023] Open
Abstract
The aim of our study was to connect the possible complications of early pregnancy (miscarriage and symptomatic ectopic pregnancy) up to the 12th week of gestation with biometeorological conditions while assuming a greater number of incidents with an unfavorable biometeorological forecast. We performed a retrospective observational study using medical data of a single medical center of Department of Gynecology and Obstetrics, Sveti Duh University Hospital and meteorological data from the Croatian Meteorological and Hydrometeorological Service in Zagreb. We tracked the number of visits to the gynecology and obstetrics emergency unit on a daily basis during 2017. Days with five or more visits were selected and underwent further analysis, during which the number of miscarriages and symptomatic ectopic pregnancies was noted. The information from the biometeorological forecast was then extracted and added to the database. Our results did not show a statistically significant difference between the groups determined by biometeorological forecast in the number of spontaneous abortions or ectopic pregnancy. Also, statistically significant results did not follow the expected trend of the increasing number of complications related to worse biometeorological forecast, or vice versa, a decreased number of complications with better forecast. Our single-center retrospective analysis of emergency unit visits related to weather conditions did not show a connection between the complications of early pregnancy and biometeorological conditions. However, different results could emerge in future studies. Considering the large and high-quality database collected for this study, efforts in researching the connection between other gynecologic pathologies and weather conditions will be feasible.
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Affiliation(s)
- Egon Kruezi
- Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Dubravko Habek
- Department of Gynecology and Obstetrics, Sveti Duh University Hospital, Catholic University of Croatia, Zagreb, Croatia
| | - Ana Luetić
- Department of Gynecology and Obstetrics, Sveti Duh University Hospital, Catholic University of Croatia, Zagreb, Croatia
| | - Ingrid Marton
- Department of Gynecology and Obstetrics, Sveti Duh University Hospital, Catholic University of Croatia, Zagreb, Croatia
| | - Matija Prka
- Department of Gynecology and Obstetrics, Sveti Duh University Hospital, Catholic University of Croatia, Zagreb, Croatia
| | - Lidija Srnec
- Croatian Meteorological and Hydrometeorological Service, Zagreb, Croatia
| | | | - Vesna Košec
- Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Krunoslav Kuna
- Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
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Meyra Potkonjak A, Gall V, Milošević D, Košec V, Filipović-Grčić B. PERINATAL ASPECTS OF SARS-CoV-2 INFECTION DURING PREGNANCY: A POTENTIAL CAUSE FOR CONCERN. Acta Clin Croat 2022; 61:681-691. [PMID: 37868177 PMCID: PMC10588398 DOI: 10.20471/acc.2022.61.04.15] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 08/23/2021] [Indexed: 10/24/2023] Open
Abstract
Ever since the beginning of COVID-19 pandemic, uncertainty regarding clinical presentation and differences among various subpopulations exist. With more than 209,870,000 confirmed cases and more than 4,400,000 deaths worldwide, we are facing the new era of health crisis which will undoubtedly impair global health, economic and social circumstances. In the past year, numerous genetic mutations which code SARS-CoV-2 proteins led to the occurrence of new viral strains, with higher transmission rates. Apart from the implementation of vaccination, the effect of SARS-CoV-2 on pregnancy outcome and maternal fetal transmission remains an important concern. Although neonates diagnosed with COVID-19 were mostly asymptomatic or presented with mild disease, the effect on early pregnancy is yet to be evident. While positive finding of SARS-CoV-2 RNA in some samples such as amniotic fluid, placental tissue, cord blood and breast milk exists, additional research should confirm its association with transplacental transmission.
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Affiliation(s)
- Ana Meyra Potkonjak
- Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Vesna Gall
- Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Danko Milošević
- Department of Pediatrics, Zagreb University Hospital Center, School of Medicine, University of Zagreb, Zagreb, Croatia
- University of Zagreb, School of Medicine, Department of Pediatrics, Zagreb, Croatia
| | - Vesna Košec
- Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Boris Filipović-Grčić
- Department of Pediatrics, Zagreb University Hospital Center, School of Medicine, University of Zagreb, Zagreb, Croatia
- University of Zagreb, School of Medicine, Department of Pediatrics, Zagreb, Croatia
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Djaković I, Ibukić A, Kovačević D, Košec V. OBSTETRIC INJURY OF THE RECTUM WITH INTACT ANAL SPHINCTER - TWO CASE REPORTS. Acta Clin Croat 2022; 61:534-536. [PMID: 37492364 PMCID: PMC10364094 DOI: 10.20471/acc.2022.61.03.20] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 11/09/2017] [Indexed: 07/27/2023] Open
Abstract
Background Injury of the rectum with intact anal sphincter is an extremely rare but very serious complication of vaginal delivery. It is also called a "buttonhole" tear. Case We present two cases of "buttonhole" tear/injury. Results In one case, the injury was recognized at the time of delivery and adequately treated. In the other case the injury was not diagnosed on time and the patient was treated for complications on the 6th postpartal day. Conclusion The consequences for the wellbeing of young mothers with perineal injury can be serious and affect social and sexual aspects of their lives. Adequate surgical treatment and postoperative care assure optimal results and prevent long term complications such as fistulas or fecal incontinence.
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Affiliation(s)
- Ivka Djaković
- Clinic for Gynecology, Bethesda Hospital, Basel, Switzerland
| | - Amir Ibukić
- Department od Surgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Dujo Kovačević
- Department od Surgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Vesna Košec
- Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
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Potkonjak AM, Djaković I, Sabolović Rudman S, Poljak L, Košec V. RISK ASSESSMENT IN PREGNANCY AMONG WOMEN AGED OVER FORTY. Acta Clin Croat 2021; 60:290-295. [PMID: 34744280 PMCID: PMC8564834 DOI: 10.20471/acc.2021.60.02.16] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 05/11/2021] [Indexed: 11/24/2022] Open
Abstract
The objective of this study was to assess the relationship between women's age and risk of pregnancy-related complications. The study was a retrospective cohort analysis of the pregnancy-related complications and outcomes between two age groups of parturient women. Categorical data were expressed as absolute and relative frequencies. Statistical analysis was performed using χ2-test. The incidence of gestational diabetes was higher in the 40-47 age group as compared with the 20-24 age group. The rates of hypertension, preeclampsia, intrahepatic cholestasis of pregnancy and hypothyroidism did not differ between the two groups. The rates of labor induction, oxytocin use, vaginal delivery, and need for episiotomy were higher in younger age group. Dystocia and breech presentation as indications for cesarean section were more common among younger women. According to study results, the risk of gestational diabetes and rates of cesarean delivery increased with advanced maternal age.
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Affiliation(s)
| | - Ivka Djaković
- 1Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Senka Sabolović Rudman
- 1Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Lara Poljak
- 1Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Vesna Košec
- 1Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Dental Medicine, University of Zagreb, Zagreb, Croatia
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Košec V, Čukelj M, Djaković I, Butorac D. UTERINE RUPTURE IN THIRD TRIMESTER OF PREGNANCY FOLLOWING CORNUAL RESECTION DUE TO ECTOPIC PREGNANCY. Acta Clin Croat 2021; 60:153-155. [PMID: 34588737 PMCID: PMC8305347 DOI: 10.20471/acc.2021.60.01.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 12/20/2017] [Indexed: 11/24/2022] Open
Abstract
Uterine rupture during pregnancy is a critical obstetric complication associated with maternal and fetal mortality and morbidity. The risk is increased in patients with a history of previous uterine surgery including cesarean section, myomectomy, salpingectomy, as well as uterine and placental anomalies and polyhydramnios. It can also occur spontaneously. We present a case of uterine rupture in the early third trimester in a woman who had undergone previous laparoscopic removal of the left fallopian tube due to sactosalpinx and laparotomic removal of left uterine horn due to ectopic pregnancy.
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Affiliation(s)
| | - Marijo Čukelj
- Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Ivka Djaković
- Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Dražan Butorac
- Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
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Potkonjak AM, Sabolović Rudman S, Nikolac Gabaj N, Kuna K, Košec V, Stanec Z, Zovak M, Tučkar N, Djaković I, Prkačin I, Svaguša T, Bakoš M. Urinary troponin concentration as a marker of cardiac damage in pregnancies complicated with preeclampsia. Med Hypotheses 2020; 144:110252. [PMID: 33254557 DOI: 10.1016/j.mehy.2020.110252] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/18/2020] [Accepted: 09/04/2020] [Indexed: 12/20/2022]
Abstract
Pregnant women with preeclampsia experience significant hemodynamic changes which lead to an increased myocardial workload. In response to increased demands in pregnancy, the heart muscle responds with ventricular remodeling process which involves cardiac muscle hypertrophy. Opposed to occurrence of eccentric ventricular hypertrophy in normal pregnancy, myocardial remodeling in a form of concentric hypertrophy will occur in pregnant patients with preeclampsia. Increased myocardial workload is manifested by an increased troponin release. As process of troponin degradation continue, filtration of degradation fragment through glomerular membrane occur, raising the possibility of it's detection in urine. Degradation fragments of troponin molecules are estimated to be 20 kDa with preserved immunoreactivity to high-sensitivity assays. Some of the authors suggest that serum levels of cardiac troponin I might be elevated in patients with hypertension, as well as in preeclamptic pregnant women. It is to be expected that evaluation of severity of the myocardial damage in pregnant woman with preeclampsia may be performed by measuring levels of troponin in the urine using high-sensitivity assays. Designing of urine dipstick will help to detect an early phase of myocardial involvement in preeclamptic pregnancies.
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Affiliation(s)
- Ana Meyra Potkonjak
- Department of Gynecology and Obstetrics, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia.
| | - Senka Sabolović Rudman
- Department of Gynecology and Obstetrics, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Nora Nikolac Gabaj
- University Department of Chemistry, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Krunoslav Kuna
- Department of Gynecology and Obstetrics, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Vesna Košec
- Department of Gynecology and Obstetrics, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Zdenko Stanec
- University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Mario Zovak
- Department of Surgery, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Neven Tučkar
- Department of Gynecology and Obstetrics, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Ivka Djaković
- Department of Gynecology and Obstetrics, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Ingrid Prkačin
- Department of Internal Medicine, University Hospital Merkur, Zagreb, Croatia
| | - Tomo Svaguša
- Department of Internal Medicine, Clinical Hospital Dubrava, Zagreb, Croatia
| | - Matija Bakoš
- Department of Paediatrics, University Hospital Centre Zagreb, Croatia
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Košec V, Djaković I, Čukelj M, Ejubović E, Sumpor B, Djaković Ž. INCREASED OASIS INCIDENCE - INDICATOR OF THE QUALITY OF OBSTETRIC CARE? Acta Clin Croat 2019; 58:365-370. [PMID: 31819335 PMCID: PMC6884390 DOI: 10.20471/acc.2019.58.02.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 09/15/2018] [Indexed: 11/24/2022] Open
Abstract
In the era of new molecular, epigenetic and proteomic discoveries, birth canal injuries seem like outdated discussion. A vast increase in the incidence of obstetric anal sphincter injuries (OASIS) has been recorded in the last two decades despite advantages in modern medicine and new obstetric methods. This increase might be attributed to the new classification of perineal injury but also to the new imaging methods, including endoanal sonography, which earlier identifies injuries that previously were considered to be occult and actually underwent unrecognized, and which should have been recognized immediately postpartum. OASIS are third and fourth degree perineal injuries that occur during delivery. The reported incidence of OASIS varies from 0.1% to 10.9%. It is well known that third and fourth degree perineal injuries occur more often in primiparae, and in cases of macrosomic newborn, dorsoposterior position of fetal head and shoulder dystocia. The protective role of episiotomy is controversial. Birth canal injury during delivery can happen to any parturient woman. It is important for obstetricians to have this in mind at every delivery. Repercussions of OASIS are serious and can persist for life. They include emotional, psychological, social, physical and sexual disturbances. Therefore, it is very important to recognize the risk factors, diagnose the injury on time and treat it properly by a multidisciplinary team. Accordingly, it can be concluded that the increased incidence of OASIS is a result of better recognition of the risk factors, reduced rates of unrecognized sphincter injuries, adoption of the new classification and better postpartum imagining methods for detection of occult injuries.
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Abstract
Gestational diabetes involves disorder of glucose metabolism first diagnosed in pregnancy. Obese women undoubtedly have more often complications in reproductive age, such as fertility difficulties, spontaneous and recurrent miscarriages, premature births, and various obstetric and surgical complications related to the course of pregnancy, delivery and puerperium. Children of obese pregnant women are more likely to develop obesity in childhood and adulthood. We analyzed the outcome of 51 pregnancies in obese pregnant women and 50 pregnant women with normal body mass index. All women in both groups were diagnosed with gestational diabetes by the IADPSG criteria. We analyzed gestational age at delivery and mode of delivery, gestational weight gain, presence of concomitant diagnosis of gestational or chronic hypertension, difference in birth weight, and prevalence of hypertrophic newborns. There was no significant difference in gestational age at pregnancy termination and in the mode of delivery. There was a significant difference in gestational weight gain, number of pregnant women with hypertension, neonatal birth weight and number of hypertrophic children. Based on the data presented, we conclude that obesity is an unfavorable factor for pregnancy outcome. It also influences birth weight and fetal hypertrophy, as well as gestational weight gain.
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Affiliation(s)
| | - Ivka Djaković
- 1Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Jordanovac Department of Thoracic Surgery, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Vesna Gall
- 1Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Jordanovac Department of Thoracic Surgery, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Željko Djaković
- 1Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Jordanovac Department of Thoracic Surgery, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Vesna Košec
- 1Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Jordanovac Department of Thoracic Surgery, Zagreb University Hospital Centre, Zagreb, Croatia
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Košec V, Djaković I, Sabolović Rudman S. CERVICAL RIPENING BALLOON AS A METHOD OF PREINDUCTION - ONE CENTER STUDY. Acta Clin Croat 2018; 57:762-767. [PMID: 31168214 PMCID: PMC6544105 DOI: 10.20471/acc.2018.57.04.19] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
- Cervical ripening can be promoted in many ways, but mechanical methods are among the oldest. Like all other methods, this one also has its pros and cons. Disadvantages compared to pharmacological methods include some maternal discomfort upon manipulation of the cervix, a theoretical increase in the risk of maternal and neonatal infection from the introduction of a foreign body, potential disruption of a low-lying placenta, and increase in the need of oxytocin induction of labor. The aim of the study was to evaluate the effect of using cervical ripening balloon in preinduction on the mode of delivery. This was a longitudinal, cohort, intervention, non-randomized one center study. Inclusion criteria were term pregnancies with gestational diabetes, oligohydramnios, intrauterine growth restriction, gestational hypertension/preeclampsia and pregnancies after 41 weeks of pregnancy. Preinduction of labor was performed in term pregnancies at Sestre milosrdnice University Hospital Center. Results in the first 150 women having undergone labor preinduction with cervical ripening balloon were included. Two-sided p values <0.05 were considered significant. Statistical analysis was done using SPSS Version 20.0. The study included 150 women; one woman was excluded from further analyses due to conversion of fetal presentation (head to breech). Indications for labor preinduction were as follows: gestational diabetes, oligohydramnios, intrauterine growth restriction, gestational hypertension/preeclampsia and pregnancies after 41 weeks of pregnancy. Women with normal vaginal delivery (96/149) had lower rates of gestational diabetes and oligohydramnios and used epidural analgesia more frequently. Women with dystocia (32/53) had a significantly longer labor duration and higher neonatal birth weight. In multivariate analysis, multiparity, greater cervical dilatation after balloon removal and use of epidural analgesia were associated with a decreased risk of cesarean section, while the presence of gestational diabetes and oligohydramnios was associated with an increased risk of cesarean section. We found this preinduction method safe and efficient, with a potential to increase the rate of vaginal deliveries.
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Affiliation(s)
| | - Ivka Djaković
- Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Senka Sabolović Rudman
- Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
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Pitner I, Gall V, Mihovilović Prajz L, Djaković I, Mamić J, Košec V. Perinatal outcome of infants with congenital diaphragmatic hernia: two case reports. Gazz Med Ital - Arch Sci Med 2018. [DOI: 10.23736/s0393-3660.18.03693-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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13
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Djaković I, Ejubović E, Bolanča I, Markuš-Sandrić M, Bečić D, Djaković Ž, Košec V. Third and Fourth Degree Perineal Tear in Four-Year Period at Sestre Milosrdnice University Hospital Center, Zagreb, Croatia. Open Access Maced J Med Sci 2018; 6:1067-1071. [PMID: 29983803 PMCID: PMC6026410 DOI: 10.3889/oamjms.2018.253] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 05/23/2018] [Accepted: 05/24/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES: Obstetric anal sphincter injury (OASIS) includes the third and fourth degree of perineal injury. The risk for OASIS is about 1% of all vaginal deliveries. If not recognised and treated properly, obstetric anal sphincter injury can have serious consequences for reproductive age woman. MATERIAL AND METHODS: We have retrospectively gathered and analysed data on obstetric anal sphincter injury in a four-year period at our department. The control group in this study included vaginal deliveries in 2012. RESULTS: We recorded 0.34% third and fourth degree of perineal injury in all vaginal deliveries, and 87.9% of those patients were primiparae. Episiotomy was performed in 57.6% of all women with obstetric anal sphincter injury. In 30.3% of cases, newborns were large for gestational age. Gestational diabetes was found in 9.1% of OASIS cases, occipitoposterior position was found in 9.1% of cases. Induced labour took place in 39.4%, and oxytocin infusion was applied in 60.6% of OASIS cases. Vacuum extraction was performed in 12.1% of deliveries with OASIS. The average BMI in 3a and 3b injuries was 29.9. In 3c degree it was 28.0, and in the fourth degree, it was 32.1. In 27.0% of OASIS cases due to the extent of the injury surgeon engagement was necessary. When compared with vaginal deliveries in 2012 we found a significant increase in OASIS in primiparas, large for gestational age, occipitoposterior position, induced labour, vacuum extraction and hypertension (P < 0.01). There is also increased incidence of OASIS in episiotomy and oxytocin use group (P < 0.05). CONCLUSION: Low incidence of OASIS in our department is a result of active management of delivery, manual perineal protection and timely episiotomy.
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Affiliation(s)
- Ivka Djaković
- Sestre Milosrdnice University Hospital Center, Vinogradska 29, Zagreb, Croatia
| | - Emina Ejubović
- Sestre Milosrdnice University Hospital Center, Vinogradska 29, Zagreb, Croatia
| | - Ivan Bolanča
- Sestre Milosrdnice University Hospital Center, Vinogradska 29, Zagreb, Croatia
| | | | - Dino Bečić
- Sestre Milosrdnice University Hospital Center, Vinogradska 29, Zagreb, Croatia
| | - Željko Djaković
- Sestre Milosrdnice University Hospital Center, Vinogradska 29, Zagreb, Croatia
| | - Vesna Košec
- Sestre Milosrdnice University Hospital Center, Vinogradska 29, Zagreb, Croatia
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Abstract
SUMMARY – Rupture of the internal iliac artery is a rare complication in pregnancy that is associated with maternal and fetal morbidity and mortality. We present a case of a 30-year-old primipara admitted to our department in 39th week of gestation after sudden onset of intense abdominal pain. On admission, the patient was pale, tachycardiac, but with normal blood pressure and afebrile. Symptoms of acute abdomen were clear and surgery was indicated. Diagnosis was confirmed during cesarean section. Enlarged gravid uterus compressed the ruptured artery and prevented heavier bleeding. Acute bleeding due to arterial rupture causes severe symptoms, predominantly abdominal pain. Changes in blood count become significant some time after the onset of rupture. As the gravid uterus compressed the arterial rupture, preoperative bleeding was by far less abundant than the bleeding after the baby had been delivered and the size of the uterus decreased. Any cause of acute abdomen during pregnancy (abruption of the placenta, spleen rupture, visceral artery thrombosis) requires urgent surgical treatment, as well as intraoperative and postoperative intensive treatment. Rupture of the internal iliac artery is a rare complication in pregnancy, but has to be considered as a differential diagnosis of abdominal pain.
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Affiliation(s)
| | - Ivka Djaković
- Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Vesna Košec
- Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | | | - Krunoslav Kuna
- Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
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15
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Miškov S, Gjergja Juraški R, Mikula I, Bašić S, Bošnjak Pašić M, Košec V, Sabol Z, Fučić A, Sajko T, Bašić Kes V. The Croatian Model of Integrative Prospective Management of Epilepsy and Pregnancy. Acta Clin Croat 2017; 55:535-548. [PMID: 29116720 DOI: 10.20471/acc.2016.55.04.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Epilepsy is the most common neurological complication in pregnancy. Women
with epilepsy have a higher risk of complications in pregnancy. In Croatia, women with epilepsy are
treated by neurologists at tertiary centers according to the place of residence. We prospectively
followed-up pregnancies in women with epilepsy and healthy controls, and analyzed the factors
responsible for their delivery outcomes and development of their babies. Healthy pregnant women
had a higher level of education and economic status, but pregnant women with epilepsy took folic acid
in a higher proportion than controls, possibly due to timely preconception counseling. Complications
during pregnancy depended on the number of antiepileptic drugs and epilepsy control. We noticed
some behavioral and cognitive aspects in children exposed in utero to valproic acid, which required
follow up. The rate of congenital malformations was not increased. In conclusion, women with epilepsy
should receive preconception counseling about the risk for pregnancy, but also about the possibilities
to minimize that risk. We have introduced a model of integrative management of pregnancy
and epilepsy based on close collaboration among different clinical experts in Croatia, in order to
provide prompt counseling and timely intervention.
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Affiliation(s)
- Snježana Miškov
- Clinical Department of Neurology and Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Romana Gjergja Juraški
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; Srebrnjak Children's Hospital, Zagreb, Croatia
| | | | - Silvio Bašić
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; Dubrava University Hospital, Zagreb Croatia
| | - Marija Bošnjak Pašić
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek Croatia; Zagreb University Hospital Center, Clinical Department of Neurology, Zagreb, Croatia
| | - Vesna Košec
- Clinical Department of Neurology and Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | | | | | - Tomislav Sajko
- Clinical Department of Neurosurgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Vanja Bašić Kes
- Clinical Department of Neurology and Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
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16
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Gopčević A, Rode B, Vučić M, Horvat A, Širanović M, Gavranović Ž, Košec V, Košec A. Ethical and medical management of a pregnant woman with brain stem death resulting in delivery of a healthy child and organ donation. Int J Obstet Anesth 2017; 32:82-86. [DOI: 10.1016/j.ijoa.2017.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 06/11/2017] [Accepted: 06/18/2017] [Indexed: 11/28/2022]
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Sabolović Rudman S, Djaković I, Košec V. Meckel Gruber Syndrome. Gazz Med Ital - Arch Sci Med 2017. [DOI: 10.23736/s0393-3660.16.03395-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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18
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Djaković I, Sabolović Rudman S, Košec V. Effect of epidural analgesia on mode of delivery. Wien Med Wochenschr 2016; 167:390-394. [DOI: 10.1007/s10354-016-0511-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 08/02/2016] [Indexed: 10/21/2022]
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Djaković I, Sabolović Rudman S, Gall V, Košec A, Markuš Sandrić M, Košec V. Do Changing Diagnostic Criteria for Gestational Diabetes Influence Pregnancy Outcome? Acta Clin Croat 2016; 55:422-427. [PMID: 29045107 DOI: 10.20471/acc.2016.55.03.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The incidence of pregnancy related diabetes has been steadily increasing during
the past decade. The aim of this retrospective study was to evaluate the type and prevalence of gestational
diabetes complications after implementing new diagnostic criteria for gestational diabetes. The
incidence of gestational diabetes, maternal age, mode of delivery and birth weight were analyzed.
Study patients were divided into three groups. The first group consisted of patients who gave birth
during 2005, the second group during 2011 and the third group during 2012. In 2005, the World
Health Organization criteria were used on diagnosing gestational diabetes, whereas in 2011 and 2012
the criteria issued by the International Association of Diabetes and Pregnancy Study Groups were
considered. There was no statistically significant difference among the groups according to maternal
age, birth weight (p=0.203) and mode of delivery (p=0.883). Cesarean section was performed in about
30% of deliveries in all groups combined. There was no significant difference in the number of neonatal
hypertrophy (p=0.348), although the distribution of hypertrophy showed a tendency towards higher
values in 2005. The incidence of gestational diabetes was 2.2% in 2005, 6.6% in 2011 and 12% in
2012. In conclusion, difference in the incidence of pregnancy related diabetes appeared to have resulted
directly from using different diagnostic criteria. The new criteria contributed to a relatively
higher incidence of gestational diabetes but also achieved better gestational glycemic control and
consequently better fetal growth regulation.
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Affiliation(s)
| | - Senka Sabolović Rudman
- University Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Center
| | - Vesna Gall
- University Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Center
| | - Andro Košec
- University Department of ENT and Head and Neck Surgery, Sestre milosrdnice University Hospital Center
| | | | - Vesna Košec
- University Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Center
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Abstract
Background: Acupuncture use in obstetrics has been increasing in Western medicine, especially to alleviate complications of pregnancy, the most important cause of maternal mortality worldwide. One quarter of maternal deaths are caused by complications in the third stage of labor, an interval between complete delivery of the baby and the complete expulsion of the placenta. Methods: This review analyzes the increased acupuncture use for pregnancy complications as a potential method of reducting maternal mortality during the third stage of labor. This overview focuses on acupuncture points and techniques to manage the third stage of labor and help patients with retained placentas. Passive (or expectant) management of the third stage of labor is occasionally associated with massive obstetric hemorrhage, a major cause of maternal morbidity and mortality, especially in low-income countries. Conclusions: Active management of the third stage of labor has been shown to reduce the risk of postpartum hemorrhage. Use of acupuncture in the first and second stages of labor could lead to a faster separation of the placenta in the third stage of labor. The possible effects of acupuncture in cases of retained placentas may have significant implications for possible complications and final outcomes of labor. Further studies are needed for more conclusive results.
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Affiliation(s)
- Ivka Djakovic
- Department of Gynecology and Obstetrics, University Hospital Center “Sestre Milosrdnice,” Zagreb, Croatia
| | - Zeljko Djakovic
- Department of Thoracic Surgery “Jordanovac”, University Hospital Center Zagreb, Jordanovac, Zagreb, Croatia
| | - Nada Bilić
- Department of Anesthesiology and Intensive Care, University Hospital Center “Sestre Milosrdnice,” Zagreb, Croatia
| | - Vesna Košec
- Department of Gynecology and Obstetrics, University Hospital Center “Sestre Milosrdnice,” Zagreb, Croatia
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Košec V, Nakić Radoš S, Gall V. Development and validation of the Prenatal Diagnostic Procedures Anxiety Scale. Prenat Diagn 2014; 34:770-7. [PMID: 24676886 DOI: 10.1002/pd.4365] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 03/12/2014] [Accepted: 03/23/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVES As there are currently no specific measures of anxiety due to prenatal diagnostic procedures, the aim of the study was to develop and validate a new measure called the Prenatal Diagnostic Procedure Anxiety Scale (PDPAS). METHODS Seventy-four pregnant women scheduled for amniocentesis and ultrasound completed the PDPAS, the State-Trait Anxiety Inventory, the Edinburgh Postnatal Depression Scale, and the Perceived Stress Scale before undergoing the diagnostic procedure. Reliability, concurrent validity, factor structure, scale sensitivity, and specificity were analyzed. Differences between amniocentesis and ultrasound groups in the PDPAS score were analyzed with a t-test. RESULTS The final scale comprised 11 items and two subscales measuring 'fear of procedure' and 'fear of abnormal result'. Concurrent validity analysis showed that the PDPAS is an independent measure of anxiety. At a cut-off score of >11, sensitivity was 75.0% and specificity was 72.01% with moderate accuracy. Fear of procedure was higher in the amniocentesis group, whereas fear of abnormal result was equally present in both amniocentesis and ultrasound groups. CONCLUSION The PDPAS has good internal consistency and concurrent validity with satisfactory psychometric characteristics. As a short measure of situation-specific anxiety, it can be used as a screening tool in prenatal clinical settings.
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Affiliation(s)
- Vesna Košec
- Department of Obstetrics & Gynecology, University Hospital Center Sisters of Mercy, Zagreb, Croatia
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Nakić Radoš S, Košec V, Gall V. The psychological effects of prenatal diagnostic procedures: maternal anxiety before and after invasive and noninvasive procedures. Prenat Diagn 2013; 33:1194-200. [PMID: 23966135 DOI: 10.1002/pd.4223] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 08/15/2013] [Accepted: 08/16/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVES (1) To examine the change in anxiety before and after prenatal diagnostic procedures in women undergoing invasive (amniocentesis) and noninvasive (ultrasound) procedures; and (2) to examine predictors of anxiety before the diagnostic procedure. METHODS A short-term follow-up study was conducted on a sample of pregnant women in the second trimester. Questionnaires were administered to women scheduled for amniocentesis (n = 37) and ultrasonography (n = 37) before and immediately after the procedure. The following questionnaires were administered: the State-Trait Anxiety Inventory, the Affect Intensity Measure, the COPE inventory, and the Optimism-Pessimism Scale. RESULTS Prior to the administration of the prenatal diagnostic procedure, measured anxiety levels were the same in both groups of women (p > 0.05). An interaction effect of a two-way ANOVA revealed that anxiety decreased after the procedure in the ultrasound but not the amniocentesis group (F(1, 72) = 5.01, p = 0.028). Although coping styles and affect intensity were found to be related to anxiety (p < 0.05), they were not significant predictors of anxiety before the diagnostic procedure when controlling for trait anxiety and procedure type. CONCLUSION Anxiety levels associated with noninvasive but not after invasive, prenatal diagnostics tests decrease immediately following the procedure.
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Affiliation(s)
- Sandra Nakić Radoš
- Department of Obstetrics and Gynecology, University Hospital Center Sisters of Mercy, Zagreb, Croatia
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