Background: Pelvic inflammatory disease (PID) is a public health problem that demands rapid diagnosis and treatment and may severely impair female reproductive health. Objective: To analyze anamnestic information, laboratory findings, and clinical and microbiological features of patients with severe acute PID that underwent a surgical procedure. Methods: This retrospective study enrolled 97 cases that were surgically treated in the Department of Obstetrics and Gynecology, University Hospital „ Sveti Duh“ between 2009 and 2019. Results: Most women were within the age group 35-44 (38.14%). Lower abdominal pain was the most common symptom (92.78%). Compared to intraoperatively confirmed PID, C-reactive protein (CRP) yielded the highest sensitivity (88.10%) while cervical motion tenderness possessed the highest specificity (53.85%). The tubo-ovarian abscess was detected in 35.05% of intraoperative specimens, mainly occurring in women between 45-54 years (P=0.017) and absent between 15-24 (P=0.012) and 25-34 years (P=0.049). The length of hospital stay was influenced by the number of symptoms (ρ=0.316, P=0.002), admission CRP levels (ρ=0.620, P<0.001), and admission body temperature (ρ=0.386, P<0.001). Out of 59.30% of positive cultures, one pathogen was isolated in 70.59%, mainly Escherichia coli (41.18%). Admission CRP levels impacted the efficacy of microbiologic isolation (P=0.001). The empirical treatment was mostly based on the clindamycin/gentamicin combination (51.72%). Conclusion: Severe clinical picture that requires surgical treatment can be expected in women >35 years. Longer hospital stay was associated with more symptoms, higher CRP, and temperature values on admission. It is important to have a low threshold for diagnosis and to consider both aerobic and anaerobic pathogens when selecting antibiotic treatment.

Prikazujemo pacijenta s aorto-lijevo ventrikulskim tunelom (ALVT, engl. aorto-left ventricular tunnel) kojemu je dijagnoza postavljena u gestacijskoj dobi (GD) od 27 tjedana. Indikaciju za pregled postavio je opstetričar zbog kardiomegalije. Ona se očitovala izrazitom dilatacijom lijeve klijetke (LVIDd 32 mm, >2SD), značajno smanjenom sposobnosti kontraktilnosti (EF 40 %) i obojenim doplerskim prikazom asimetrične insufi cijencije aortalne valvule putem kanala koji ide od sinotubularne konekcije do lijeve klijetke, između interventrikulskog septuma i subinfundibularnog trakta desne klijetke. Ventrikulska učinkovitost (engl. Myocardial Performance Index –MPI ili Tei indeks) bio je 0,62 (n.v. 0,25-0,50), kardiovaskularni profi l (engl. Cardiovascular Profi le Score – CVPS) prema Huhtai 4 (normalno 10), a-val u duktus venozus (DV) pozitivan (++) (kao siguran dokaz srčane insufi cijencije kod fetusa) i pozitivne pulsacije u umbilikalnim venama. Uz to je nađena ekstremna dilatacija tubularne aorte (18 mm – >2 SD, iznad 95. percentile). Prsten aortalne valvule u toj gestacijskoj dobi iznosi 5,8 mm (75. percentila), a širina ekstravalvularnog tunela 4-5 mm. Intrauterino se ne provodi medikamentno liječenje jer nije nađen hidrops. I postpartalno se nalazi kardiomegalija (rendgenska slika), a ehokardiografski potvrđuje dijagnoza ALVT-a. Kanal se nalazi iznad desnog koronarnog kuspisa, odnosno ispred rafe koja spaja lijevi i desni koronarni kuspis tako da se nalazi i dijagnoza bikuspidalne aortalne valvule (BAV) anteroposteriorne orijentacije. Zbog razvoja srčane insufi cijencije ordinira se inotropna i diuretska terapija. Dijagnoza je potvrđena i MSCT-om te kateterizacijom srca (angiokardiografi ja). Kardiokirurška operacija učinjena je u dobi od 16 dana postavljanjem autologne perikardijske zakrpe (engl. patch) na aortalni otvor kanala. Postpartalno se ordinira diuretik, digitalis i ACE inhibitor. Postupno dolazi do oporavka lijeve klijetke (3 mjeseca nakon operacije EF 50 %), ali perzistira patološka dilatacija tubularne aorte. Očekuje se potpuni oporavak lijeve klijetke uz potrebu daljnje opservacije bolesnika zbog bikuspidalne aortalne vavule s mogućim reperkusijama na samoj valvuli i uzlaznoj aorti. U dobi od 10 mjeseci nađena je uredna kontraktilnost lijeve klijetke (EF 65 %), blaga aortalna insufi cijencija (centralna), uz uredan protok kroz aortalnu valvulu, ali dalje postoji dilatacija uzlazne aorte (promjer 2,1 cm, >2 SD).

Background: In our study, we examined the frequency of surgical procedures due to the acute presentation of the pelvic inflammatory disease (PID) in regard to all gynecological procedures in a single institution. We also wanted to present patients' age range and type of surgical approach as well as surgical extension. Materials and methods: This retrospective study investigated a total of 10,175 surgical procedures, out of which 103 were due to acute PID. The study included 101 patients. We obtained data from surgical proceduresperformed from September 2009 to September 2019. Results: In the observed ten years period, the frequency of surgical procedures due to the acute PID was 1.01%. It was found that women were mostly older than 25 (85.15%). Laparoscopy was performed in 52.43% of cases and laparotomy in 37.86% of cases. Laparotomy incisions were transverse in 26.67% of cases and vertical in 42.22% of cases. The most radical procedures were performed in 17.48% of cases in which patients underwent a subtotal or total hysterectomy with unilateral or bilateraladnexectomy. Conclusion: In conclusion, although rare, surgical procedures in PID are relevant because they are, according to our data, more common in patients older than 25, and surgical procedures tend to be more extensive.

Ruptured uterine pseudoaneurysm (RUPA) is a rare cause of secondary postpartum hemorrhage and is usually treated with uterine artery embolization [ [1] Nagayama C. Gibo M. Nitta H. Uezato T. Hirakawa M. Masamoto H. et al. Rupture of pseudoaneurysm after vaginal delivery successfully treated by selective arterial embolization. Arch Gynecol Obstet. 2011; 283: 37-40https://doi.org/10.1007/s00404-009-1271-1 Crossref PubMed Scopus (23) Google Scholar , [2] Kwon H.S. Cho Y.K. Sohn I.S. Hwang H.S. Seo K.J. Park W.I. et al. Rupture of a pseudoaneurysm as a rare cause of severe postpartum hemorrhage: analysis of 11 cases and a review of the literature. Eur J Obstet Gynecol Reprod Biol. 2013; 170: 56-61https://doi.org/10.1016/j.ejogrb. 2013.04.007 Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar ].

In the past decades, advances in modern imaging methods, especially three-dimensional/four-dimensional ultrasound (3D/4D US), functional magnetic resonance imaging (fMRI) and fetal magnetoencephalography (fMEG), enabled the studies of the important neurodevelopmental events and opened the field of the investigation of fetal cognitive functions. Prenatal structural, functional and behavioral development, including the development of the central nervous system (CNS) and cognitive functional developments, are nowadays accessible to a better assessment due to the implementation of these methods. 3D/4D ultrasound imaging provides much important information about the fetus. It can detect various malformations and clarify suspicious findings, improve diagnostic accuracy, display fascinating fetal activity and also, it supports the advancements in fetal neurobehavioral and cognitive science. In this paper, a brief review of 3D/4D US assessed insights in the field of fetal neurodevelopment, particularly the development of fetal cognitive functions: sensory perception, motor action, emotions, learning, and memory, as well as the role of the fetal stress in cognitive development are discussed. Investigation of fetal cognitive functions is still in its beginning, but it is certain that future advances in the application of new imaging methods, such as different 3D/4D US modes and fMRI, will enable a better understanding of the cognitive abilities and functions of the fetus.

The fascinating journey of the human life begins with two cells merging and continuing to grow into a perfectly designed apparatus comprised of multiple systems working together.Even before one draws his first breath, our nervous system plays the key role of creating a synergy in every single action and process.It all begins during fetal development, which can nowadays be observed and studied through modern imaging technologies, such as ultrasound.This gives the reader an insight on how every part of the nervous system develops and correlates with the developing body using a minimally invasive approach.This article gives an assessment of the knowledge we have regarding fetal neurophysiology and what has been learned about fetal motor and sensory development so far, as well as memory and learning, behavior and emotions and fetal cognitive functions reviewed for selected sections.Furthermore, the article provides a review of how different external factors can harm the fetus and how fetal stress presents a potential threat in fetal neurodevelopment with lasting consequences on brain structure and function.The complexity and maturation processes build up during pregnancy and continue postnatally, allowing further accommodation and development to show the astonishing capacity of brain to learn and adapt.

Peripartum cardiomyopathy (PPCM) is a rare form of dilated cardiomyopathy that occurs in previously healthy women in the last month of pregnancy and up to several months after delivery. The incidence of PPCM is low, but its morbidity and mortality rate are high, with a substantial risk of poor outcome of the pregnancy. Patients who have recovered from PPCM run a high risk of reoccurrence in subsequent pregnancies. In this case report we present a 32-year old female patient who developed acute heart failure (HF) associated with significantly reduced systolic function due to PPCM soon after a delivery of triplets. Treatment was immediately initiated in the intensive coronary unit with oxygen-therapy, loop diuretics, aldosterone blockers, beta blockers, angiotensin-converting enzyme (ACE) inhibitors and bromocriptine. During the follow up period, a year and a half after delivery, a complete recovery of systolic function was observed with no residual symptoms.

The incidence of heterotopic/ectopic pregnancy in recent times has increased partly due to the increase in assisted reproductive technologies, whereas such medical cases and cervical pregnancy in particular are extremely rare with spontaneous conception. We report on three patients referred to our department in one week: one patient each with spontaneous heterotopic pregnancy, cervical pregnancy and tubal pregnancy. All of them had conceived spontaneously and were properly diagnosed and treated, however, additional care is needed in diagnosing and managing the potentially fatal consequences of ectopic pregnancy if not recognized early and managed properly, despite its low incidence.

AIM:This study aimed to evaluate the ethnic difference in fetal behavior between Asian and Caucasian populations.METHODS:Fetal behavior was assesed by Kurjak's antenatal neurodevelopmental test (KANET) using four-dimensional (4D) ultrasound between 28 and 38 weeks of gestation. Eighty-nine Japanese (representative of Asians) and seventy-eight Croatian (representative of Caucasians) pregnant women were studied. The total value of KANET score and values of each parameter (eight parameters) were compared.RESULTS:The total KANET score was normal in both populations, but there was a significant difference in total KANET scores between Japanese (median, 14; range, 10-16) and Croatian fetuses (median, 12; range, 10-15) (P<0.0001). When individual KANET parameters were compared, we found significant differences in four fetal movements (isolated head anteflexion, isolated eye blinking, facial alteration or mouth opening, and isolated leg movement). No significant differences were noted in the four other parameters (cranial suture and head circumference, isolated hand movement or hand to face movements, fingers movements, and gestalt of general movements).CONCLUSION:Our results suggest that ethnicity should be considered when evaluating fetal behavior, especially during assessment of fetal facial expressions. Although there was a difference in the total KANET score between Japanese and Croatian populations, all the scores in both groups were within normal range. Our results indicate that ethnical differences in fetal behaviour do not affect the total KANET score, but close follow-up should be continued in some borderline cases.

ABSTRACT The traditional concept that brain damage is caused during birth or early neonatal period has been challenged. This is supported by the fact that the incidence of cerebral palsy stayed unchanged despite the global increase of cesarean sections. Consequently, the medicolegal importance of fetal neurological research is essential and needed. Years of research have provided us with important knowledge about association of fetal movements with brain development. The basic studies were done by two-dimensional ultrasound. The implementation of four-dimensional ultrasound in evaluation of fetal behavior has opened new and unexplored possibilities of evaluating the quality of fetal movements and a detailed assessment of fetal facial expressions. It is known that early postnatal neurological assessment, regarding future prediction of neurological optimality, has great limitations do to wonderful brain plasticity. Taking this very important limitation in to the account we could conclude that the preliminary studies comparing prenatal and postnatal neurological assessment are comparable. More importantly they emphasize the fact that the study of fetal behavior is most probably the right path in the study of fetal neurological development. How to cite this article Vasilj O. Is in utero Fetal Neurological Assessment Comparable to Postnatal Neurological Assessment? Donald School J Ultrasound Obstet Gynecol 2015; 9(1):91-95.

We presume that advances in technology usually make our lives easier. The adagium is that the more we know, the better it is; however, occasionally, seeing more may be not the best scenario.

Thanatophoric dysplasia is a severe skeletal disorder with estimated frequency of 0.2-0.5 per 10,000 births. Affected infants die shortly after birth. The diagnosis of thanatophoric dysplasia can be made by two-dimensional ultrasound but the perception of these images is very difficult for the patients. The use of four-dimensional real time ultrasound gives the physician the possibility to discuss and counsel the patients with images that are more understandable to the general public.

Puerperal mastitis often occurs in younger primiparous women. Most cases occur between 3 and 8 weeks postpartum. If mastitis results in the formation of a breast abscess, surgical drainage or needle aspiration is most commonly performed. We report a case of an extremely large breast abscess in a primiparous 20-year-old woman, which presented 6 weeks postpartum. Surgical incision and evacuation of 2 liters of exudate were performed, and intravenous antibiotics therapy was administered. On the sixth day after incision, we secondarily closed the wound. Examination after 3 months showed symmetrical breasts with a small scar in the incision area of the right breast. A high degree of suspicion and adequate diagnostic procedures are essential to avoid delay in the treatment of mastitis and breast abscess and thereby prevent unnecessary surgical treatment.