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OBJECTIVE: The objective of this study is to determine the differences in histopathological features of basal decidua and placenta in cases of preeclampsia with or without fetal intrauterine growth restriction (IUGR). METHODS: A prospective case-control study included a study group consisting of 30 pregnant women with preeclampsia completed by cesarean section (CS), in 19 of whom preeclampsia was associated with IUGR, and in 11 it was not. The control group consisted of 20 healthy pregnant women delivered by elective CS. Placentas and samples of placental bed obtained during CS were histopathologically (HP) analyzed after hematoxylin-eosin staining and immunohistochemical labeling of Cytokeratin 7 (CK7) trophoblastic cells in decidua. RESULTS: Regarding the HP changes in the spiral arteries in preeclampsia, the most frequent features were inadequate transformation of spiral arteries with poor trophoblastic invasion (70.0%) and fibrinoid necrosis of the media (66.7%), and rarely acute atherosis (33.3%) and thrombosis (30.0%). Villous hypermaturity was more frequently found in placentas of patients with preeclampsia with IUGR (p < 0.05), while there were no differences between subgroups of preeclampsia with and without IUGR regarding some of HP alterations of placental bed. CONCLUSION: Alterations of the placental bed in terms of decidual vasculopathy are more the characteristics of the preeclampsia itself than IUGR, while changes in placental villi primarily follow the presence of IUGR, which could indicate that preeclampsia with and without IUGR are two pathogenetically different entities.

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BACKGROUND & OBJECTIVES: The process of human placentation is complex and still not well understood. This study was aimed to examine the relationship between clinical features of pre-eclampsia and degree of trophoblastic invasion after its immunohistochemical visualization in the context of possible alterations in the number of natural killer (NK) cells and macrophages in the decidua. METHODS: This prospective study included a study group comprising 30 pregnant women with pre-eclampsia delivered by caesarean section and a control group comprising 20 healthy pregnant women also delivered by caesarean section. Samples of placental bed obtained during caesarean section were analyzed after immunohistochemical labelling CD56 + NK cells, CD68 + macrophages and cytokeratin 7 trophoblastic cells. RESULTS: In pre-eclampsia, there was a significantly lower number of CD56 + NK cells in the decidua (P<0.001) and a higher number of CD68 + macrophages (P<0.001) compared to control group. In the subgroup of pre-eclampsia with intrauterine growth retardation (IUGR), a significantly greater number of NK cells (P<0.05) was recorded, as well as an increased number of macrophages, but not significantly compared to pre-eclampsia without IUGR. There was no significant difference in the distribution of these cells in the decidua in relation to the severity of pre-eclampsia. CD56 + NK cells were significantly less (P<0.05) and macrophages were more (P<0.05) in the group with poor trophoblastic invasion. INTERPRETATION & CONCLUSIONS: Alterations in the number of immune cells in relation to the degree of trophoblastic invasion indicated their role in aetiopathogenesis of pre-eclampsia, while the direct association between their number and severity of pre-eclampsia was not confirmed.

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INTRODUCTION: We evaluated the effects of botulinum toxin type A (BTA) with physical therapy on dynamic foot equinus correction and higher motor functional outcome in children with spastic type of cerebral palsy (CP). MATERIAL AND METHODS: Ankle joint active and passive movement, gastrocnemial muscle spasticity levels (Modified Ashworth Scale (MAS)), and higher motor functional status (Gross Motor Function Classification System (GMFCS) and Gross Motor Function Measure (GMFM) (GMFM-D - standing and GMFM-E - walking) were assessed before treatment and 3, 8, 16 weeks and 6 months after BTA administration in 12 children. RESULTS: There was a significant improvement of active (initial - (-)13.07 ±5.78; 6 months - (-)10.64 ±4.77; p < 0.001) and passive (initial - 4.21 ±2.29; 6 months - 4.71 ±2.16; p < 0.05) ankle joint foot dorsiflexion. GMFM-D and GMFM-E were significantly higher after 3, 8, 16 weeks (p < 0.001) and GMFM-D after 6 months (p < 0.001). CONCLUSIONS: Botulinum toxin type A administration and physical therapy in patients with spastic CP improves the motion range of dynamic foot equinus after 3 weeks and higher motor functional outcome (standing and walking).

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BACKGROUND/AIM: There are many specificities of merital infertility and sometimes surprising connections between some thinks with no connections at first sight. Examinations of these patients imply diagnostic actions such as the blood basal hormone sample, doing hysterosalpingography, ultrahysterosonography, ultrasound examinations, and sometimes laparoscopy and hysteroscopy if there are necessary. The aim of the study was to determine the characteristics of the connection between policystic ovary (PCO) syndrome (Sy) and congenital Müllerian ducts abnormalities. METHODS: This study included 356 patients treated in the period from January 1, to December 31, 2009, in the Department of Infertility of the Clinic for Obstetrics and Gynecology in Nis, Serbia. Exclusion criteria were no myoma, ovary cysts, tubal and male factors of infertility. RESULTS: A total of 180 patients were divided into 3 groups: the group I with PCO sy, the group II with uterine congenital malformation and the group III with a combination of these disorders. The middle age of patients was 29.6 +/- 4.8, body mass index (BMI) was 26.1 +/- 4,8 kg/m2 the middle thicknes of endometrium was 5.2 + 2.7 mm, and there were no significant differences between the examined groups. There were no significant among in a number of miscarriages in the examined groups. We found that PCO Sy and congenital abnormalities of Müllerian ducts were conjoint in 30% of examined patients. CONCLUSION: Conjoined PCO Sy and congenital abnormalities of Müllerian ducts do not result in a higher number of miscarriages than only either PCO Sy or abnormalities of Müllerian ducts. It is important to check BMI, basal level of follicle stimulating hormone and number of antral follicles because the induction protocol and concentracion of inductors depends on these characteristics, thus, the succsessful cycles and pregnancy.

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AIM: We evaluated the effects of botulinum toxin type A (BTA) - abobotulinumtoxinA on passive motion resistance (PMR) values of lower limbs affected muscles and on the functional motor status in children with spastic cerebral palsy (CP). METHODS: In Group I (28 lower limbs with spastic muscles), and in Group II (14 lower limbs with dynamic spastic equinus) BTA was administered. Physical therapy was prescribed for 16 weeks. We estimated PMR using the Modified Ashworth Scale. Achieved functional motor level was evaluated by Gross Motor Function Classification System (GMFCS) and Gross Motor Function Measure (GMFM). Parameters were assessed before treatment and after 3,8,16 weeks and 6 months respectively. RESULTS: In Group I, PMR was significantly lower for hip adductors and knee extensors over 3-16 weeks, and for ankle joint extensors in both groups. There were significant differences for both groups in frequencies of GMFCS values after 16 weeks from BTA application. There was a significant increase in GMFM scores after 8 and 16 weeks from BTA application in both groups of patients. CONCLUSIONS: BTA treatment in CP children is followed by reduction in PMR values and improvement in functional motor status.

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INTRODUCTION: The frequency of occurrence of RhD alloimmunization, due to preventive protocols, is decreased in our country, but more often there are other antigens that emerge as a cause of hemolytic disease of fetus. The most prominent is Kell antigen, which promotes specific course of disease based on an innate pathogenetic mechanism. Anti-Kell antibody production is, just as in other atypical antibodies, provoked with transfusion of incompatible blood. Except for the immune-mediated hemolysis, anti-Kell antibodies can also inhibit the function of progenitor (erytroid and megakariocyte) cell lines. CASE REPORT: We present the case of G1P1 woman in whom a distinct fetal hydrops was sonographically detected in the 28th week of pregnancy. The results of immunological tests undoubtedly pointed to Kell immunization (anti-Kell antibody titer was more than 1:32), and antenatal tests for evaluation of fetal condition (Doppler ultrasound and CTG) clearly showed the severe form of hemolytic disease. We concluded that the fetus was in a hopeless, terminal stage of the disease, and then decided to terminate the pregnancy. CONCLUSION: The only clinical approach to a problem of Kell alloimunization is active one. Early cordocentesis is recommended as the optimal method for evaluation of fetal condition. The clinical outcome of the fetus will strictly depend on a timely intrauterine transfusion (IUT) procedure. Prophylaxis emerges as a crucial factor in prevention of Kell-alloimmunization. It is to be considered that all females in childhood and throughout the reproductive period should take only K1-negative blood transfusion in order to decrease the incidence of Kell-alloimmunization.

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INTRODUCTION: The incidence of cesarean section has been rising in the past 50 years. With the increased number of cesarean sections, the number of pregnancies with the previous cesarean section rises as well. The aim of this study was to establish the influence of the previous cesarean section on the development of placental complications: placenta previa, placental abruption and placenta accreta, as well as to determine the influence of the number of previous cesarean sections on the complication development. MATERIAL AND METHODS: The research was conducted at the Clinic of Gynecology and Obstetrics in Nis covering 10-year-period (from 1995 to 2005) with 32358 deliveries, 1280 deliveries after a previous cesarean section, 131 cases of placenta previa and 118 cases of placental abruption. The experimental groups was presented by the cases of placenta previa or placental abruption with prior cesarean section in obstetrics history, opposite to the control group having the same conditions but without a cesarean section in medical history. RESULTS: The incidence of placenta previa in the control group was 0.33%, opposite to the 1.86% incidence after one cesarean section (p<0.001), 5.49% after two cesarean sections and as high as 14.28% after three cesarean sections in obstetric history. Placental abruption was recorded as placental complication in 0.33% pregnancies in the control group, while its incidence was 1.02% after one cesarean section (p<0.001) and 2.02% in the group with two previous cesarean sections. The difference in the incidence of intrapartal hysterectomy between the group with prior cesarean section (0.86%) and without it (0.006%) shows a high statistical significance (p<0.001). CONCLUSION: The previous cesarean section is an important risk factor for the development of placental complications.

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INTRODUCTION: Color Doppler sonography is a new method used to investigate changes during the menstrual cycle in infertile women. The objective of this study was to investigate the correlation of uterine and endomterial-subendomterial blood flow in infertile women using ultrasound and color Doppler sonography. MATERIAL AND METHODS: A prospective clinical study included 65 infertile women divided into three groups. Transvaginal ultrasound examination was performed on days XI, XIV and XX All results were statistically analyzed. We investigated the correlation between cycles, pregnancy outcome and distribution of endomterial-subendomterial blood flow, as well as uterine arterial blood flow. RESULTS AND CONCLUSION: Endomterial-subendometerial blood flow distribution pattern assessed by transvaginal color Doppler, as well as good flow in uterine vessels, are necessery for good pregnancy rates. Thin endomterium, undetectable subendomterial blood flow and higher uterine arterial resistance, were associated with low pregnancy rate and poor outcome.

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