Tanja Premru-Srsen | University of Ljubljana (original) (raw)
Papers by Tanja Premru-Srsen
Slovenian Medical Journal, Apr 21, 2022
Slovensko strokovno stališče za zdravljenje s pripravki železa v nosečnosti Avtorske pravice (c) ... more Slovensko strokovno stališče za zdravljenje s pripravki železa v nosečnosti Avtorske pravice (c) 2022 Zdravniški Vestnik. To delo je licencirano pod Creative Commons Priznanje avtorstva-Nekomercialno 4.0 mednarodno licenco.
Clinical Nephrology, 2021
AIMS Different forms of apheresis have been proposed as potential therapeutic approaches to remov... more AIMS Different forms of apheresis have been proposed as potential therapeutic approaches to remove soluble Fms-like tyrosine kinase-1 (sFlt-1) and allow safe pregnancy prolongation in cases of extremely preterm preeclampsia. This is a follow-up study presenting our experiences with therapeutic plasma exchange (TPE) in 5 women with preeclampsia at < 28 weeks of gestational age. MATERIALS AND METHODS All women received standard treatment for preeclampsia and 2 - 3 TPE treatments per week. Blood samples for sFlt-1 and placental growth factor (PlGF) measurements were collected before and after each TPE. RESULTS Seventeen TPE procedures were performed, 2 - 5 per patient. TPE significantly reduced sFlt-1 (by 35 ± 6%), sFlt-1/PlGF ratio (by 24 ± 13%), and to a lesser degree also PlGF (by 12 ± 16%), with a rebound observed on day 1 post procedure. TPE procedures were well tolerated by pregnant women and fetuses. Stabilization of sFlt-1 allowed pregnancy prolongation for a median of 8 (range 2 - 14) days from first TPE and for a median of 10 (range 4 - 17) days from hospital admission. There were no signs of increased risks of adverse neonatal outcome associated with TPE. One neonate died due to extreme prematurity 3 days after delivery, 2 had bronchopulmonary dysplasia, and 1 had retinopathy of prematurity. CONCLUSION This study provides new evidence of effective reduction in sFlt-1 and sFlt-1/PlGF ratio with TPE treatment, which seems to allow a clinically meaningful prolongation of pregnancy. Controlled studies are necessary to convincingly show the potential benefit of apheresis treatment in preeclampsia at extremely preterm gestation.
Slovenian Medical Journal, Jul 3, 2016
Reproductive Medicine
Objective: We previously provided evidence to confirm that maternal serum levels of soluble Fms-l... more Objective: We previously provided evidence to confirm that maternal serum levels of soluble Fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), and their ratio are useful tools to direct the management of preeclampsia (PE), fetal growth restriction (FGR), and PE+FGR near delivery. In this secondary analysis, we further examine the potential additive value of maternal serum Inhibin-A, which is a hormone marker of the transforming growth factor family, to the accuracy provided by maternal serum PlGF and sFlt-1. Methods: We conducted a secondary analysis where we extracted the data of a cohort of 125 pregnant women enrolled near delivery at the clinics of the University Medical Center of Ljubljana, Slovenia. The dataset included 31 cases of PE, 16 of FGR, 42 of PE+FGR, 15 preterm delivery (PTD), and 21 unaffected controls with delivery of a healthy baby at term. Cases delivered before 34 weeks’ gestation included 10 of PE, 12 of FGR, 28 of PE+FGR, and 6 of PTD. In addi...
Reproductive Medicine
Objectives—To conduct a secondary analysis of prediction accuracy of biophysical markers for susp... more Objectives—To conduct a secondary analysis of prediction accuracy of biophysical markers for suspected Preeclampsia (PE), Fetal Growth Restriction (FGR) and the two combined near delivery in a Slovenian cohort. Methods—This was a secondary analysis of a database of a total 125 Slovenian pregnant women attending a high-risk pregnancy clinic due to suspected PE (n = 31), FGR (n = 16) and PE + FGR (n = 42) from 28–39 weeks gestation and their corresponding term (n = 21) and preterm (PTD, n = 15) controls. Data for Mean Arterial blood Pressure (MAP) and Uterine artery pulsatility index (UtA PI) estimated by Doppler sonography were extracted from the database of patients who were tested at admission to the high-risk clinic with the suspected complications. The reactive hyperemia index (RHI), and the Augmentation Index (AIX%) were extracted from the patient database using measured values obtained with the assistance of the Endo PAT, a device set to measure the signal of the peripheral art...
Objective—the objective of this study was to assess the accuracy of placental growth factor (PlGF... more Objective—the objective of this study was to assess the accuracy of placental growth factor (PlGF), soluble Fms-like Tyrosine Kinase 1 (sFlt-1), and endoglin (sEng) in the diagnosis of suspected preeclampsia (PE) with and without fetal growth restriction (FGR) near delivery. Methods—this is a secondary analysis of a dataset of 125 pregnant women presenting at the high risk pregnancy clinic with suspected PE, FGR or PE + FGR in the University Medical Center of Slovenia. The dataset included 31 PE cases, 16 FGR cases, 42 PE + FGR cases, 15 cases who developed with unrelated complications before 37 weeks (wks) (PTD), and 21 unaffected controls who delivered a healthy baby at term. We also analyzed a sub-group of women who delivered early ( 90%. For PE + FGR, the PPV value approached 100%, especially for early cases, and can thus be implemented in clinical management. Neither NPV nor PPV were high enough for managing all cases of PE. There was no added value in measuring the PlGF/(sFlt-...
Objective: We previously provided evidence to confirm that soluble Fms-like tyrosine kinase-1 (sF... more Objective: We previously provided evidence to confirm that soluble Fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), and their ratio, are useful tools to direct the management of preeclampsia (PE), fetal growth restriction (FGR), and PE+FGR near delivery. In this study we examine the potential additive value of Inhibin-A, a hormone marker of the transforming growth factor family. Methods: We used a cohort of 125 pregnant women enrolled near delivery at clinics of the University Medical Center of Ljubljana, Slovenia. There were 31 cases of PE, 16 of FGR, 42 of PE+FGR, 15 iatrogenic preterm delivery (PTD), and 21 unaffected controls with delivery of a healthy baby at term. Cases delivered before 34 weeks’ gestation included 13 of PE, 12 of FGR, 22 of PE+FGR, and 6 of PTD. We recorded demographic characteristics and medical history and the levels of PlGF, sFlt-1 and Inhibin-A. The predictive accuracy of each biomarker, their ratios, and combinations was estimated fro...
The International Journal of Health Planning and Management, 2019
Slovenian Journal of Public Health, 2019
Background Depression, anxiety and fear of childbirth have numerous consequences for women and th... more Background Depression, anxiety and fear of childbirth have numerous consequences for women and their developing offspring. Insecure attachment in close adult relationships is considered to be a risk factor for depressive symptoms. This study aims to gain further insight into the risk factors for depressive and anxiety symptoms in nulliparous women during the third trimester of pregnancy regarding the main contextual relations, with an emphasis on partner attachment. Methods A group of 325 nulliparas in the third trimester of pregnancy was enrolled in a childbirth preparation program. The following instruments were applied: Experiences in Close Relationships-Revised, the Edinburgh Depression Scale, the Zung Anxiety Scale, and a questionnaire regarding fear of childbirth. Three separate multiple linear regression models were built to explore the associations between demographic, social and attachment variables and mental health functioning. Results Highly educated nulliparas and those...
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, Jan 18, 2018
The purpose of this study was to determine the incidence of abuse in healthcare system during pre... more The purpose of this study was to determine the incidence of abuse in healthcare system during pregnancy and its impact on pregnancy outcomes. A validated screening Norvold Abuse Questionnaire for the identification of female victims of four kinds of abuse: emotional, physical, sexual, and the abuse in the healthcare system was anonymously offered to all women in the first 2 days postpartum. The study group consisted of 1018 women, 6.2% of which reported experiencing abuse in heath-care system during pregnancy. Affected women had a higher incidence of preterm delivery (OR 2.4; 95% CI 1.2-4.8) and cesarean section rate (OR 2.0, 95% CI 1.1-3.6). Sexual abuse and abuse in heath-care system during childhood were associated with abuse in heath-care system during pregnancy (OR 4.4; CI 95% 1.2-16.2, and OR 6.9; CI 95% 1.3-35.4, respectively). Our study indicates that as many as 6.2% of pregnant women experience abusive encounters with perinatal care providers. These pregnancies eventually e...
Zdravstveno varstvo, 2017
The aim of the survey was to assess the differences in disclosure by the type of violence to bett... more The aim of the survey was to assess the differences in disclosure by the type of violence to better plan the role of health services in identifying and disclosing violence. A validated, anonymous screening questionnaire (NorAQ) for the identification of female victims of violence was offered to all postpartum women at a single maternity unit over a three-month period in 2014. Response rate was 80% (1018 respondents). Chi square test was used for statistical analysis (p<0.05 significant). There are differences in disclosure by type of violence. Nearly half (41.5%) of violence by health care services was not reported, compared to 33.7% physical, 23.4% psychological, and 32.5% sexual that was reported. The percentage of violence in intimate partnership reported to health care staff is low (9.3% to 20.8%), but almost half of the violence experienced by heath care services (44%) is reported. Intimate partnership violence is more often reported to the physician than to the psychologist...
Journal of Perinatal Medicine, 2020
Objectives Information on the usefulness of screen-and-test strategies of pregnant women for seve... more Objectives Information on the usefulness of screen-and-test strategies of pregnant women for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is lacking. Methods We retrospectively reviewed the Ljubljana Maternity Hospital database and searched for pregnant women, who were admitted to the hospital between March 15 and May 16, 2020, for a planned procedure or hospitalization. Their medical records were examined and SARS-CoV-2 test results were retrieved. Results During the two-month period analyzed, there were a total of 265 scheduled admissions of pregnant women to our hospital. Two hundred two (76.2%) were tested for SARS-CoV-2 1 day prior to admission. All tested negative for SARS-CoV-2 RNA, regardless of having coronavirus disease 2019 (COVID-19)-compatible signs or symptoms (n=28) or not (n=174). Conclusions In a population with a low SARS-CoV-2 burden, usefulness of universal testing of pregnant women before admission to the hospital is limited. We recommend that ob...
The Lancet regional health, Jun 1, 2021
Background: The COVID-19 pandemic threatens the impact of cervical cancer screening and global ce... more Background: The COVID-19 pandemic threatens the impact of cervical cancer screening and global cervical cancer elimination goals. As cervical cancer screening programmes were adjusting to the new situation, we evaluated the intensity, quality, and outcomes of cervical cancer screening in Slovenia in the first seven months of the pandemic. Methods: Historical observational study on data from a population-based cervical cancer screening registry. Number of cervical cytopathology (screening and follow-up), histopathology (diagnostic procedures, invasive procedures and number of newly diagnosed CIN2+ cases) and HPV test results from the entire Slovenian women population between January 1st and September 30th 2020 were compared to a three-year average of the years 2017À19. Findings: A two-month screening lock-down between March 12th and May 8th 2020 resulted in an epidemic deficit of screening (-92%), follow-up (-70%), and HPV triage tests (-68%), as well as invasive diagnostic (-47%) and treatment (-15%) of cervical lesions. Time to diagnosis and treatment did not increase; times to laboratory results fluctuated but stayed within standards. Slovenia has entered the second epidemic intending to add as little as possible to the pandemic deficit of screening smears (-23%) and yearly CIN2+ cases (-10%). Women aged 30À39 were most affected, with the highest pandemic deficit of screening smears (-26%) and yearly CIN2+ cases (-19%). Interpretation: The pandemic has deeply affected all levels of our lives. New vulnerable groups and inequalities have emerged that require recognition and action. To prevent long-term increases in the cervical cancer burden due to the COVID-19 pandemic, it is crucial that organised screening is maintained and monitored in settings where it can be safely and comprehensively provided. Funding: None.
Journal of Reproductive Immunology, Aug 1, 2023
Slovenian Medical Journal, 2003
Background. Multiple pregnancy is in itself already a risk factor for the course and outcome of t... more Background. Multiple pregnancy is in itself already a risk factor for the course and outcome of the pregnancy and birth. Its frequency in in-vitro fertilisation is approximately twenty fold in comparison to natural conception which is also why it is one of the main problem areas of pregnancy and birth after an IVF-ET procedure. The aim of our research is to determine whether the twins, born after an IVF-ET procedure are any different than twins, born after spontaneous conception. Methods. The research was retrospective in nature. It included 1511 twin pregnancy patients who gave birth to twins between April 1987 and May 1995 and between January 1997 and December 1999. Our research group consisted of 255 mothers and 510 twins, born after an IVF-ET procedure. The research was divided into a cohort and controlled study. In the cohort study the research group was compared to the entire Ljubljana cohort of 1256 mothers and 2512 twins resulting from spontaneous conception. In the controlled study 93 mothers and 186 twins from the research group were compared with 93 mothers and 186 newborns after spontaneous conception. In this group the mothers matched the research group in age, parity and birth year. The course of and complications during the pregnancy, and the course, complications and outcome of the birth as well as the characteristics of the newborns were compared. Results. Certain serious complications during the course of the pregnancy, including hypertension, gestation diabetes and threatened preterm labours, were no more frequent with the IVF group of mothers with twin pregnancy than with the control group. However more bleeding in the first trimester and less proteinuria were determined in comparison to the control group. During the course of birth and its outcome more premature labours were determined (62.3–68.8% vs. 51.4– 50.5%), a 6 to 7 days lower average gestation age, a coresponding birth weight, three times more elective and urgent caesarean sections were determined for the IVF group than for the control group and the differences were all statistically significant. Conclusions. Multiple pregnancies are a complication of an IVF-ET procedure. Women who conceive after an IVF-ET procedure and with a twin pregnancy outcome are not subject to any more danger than pregnant women after spontaneous conception. Children are born somewhat earlier and are therefore lighter, however the perinatal outcome of newborns is no different and the morbidity and mortality rates are similar to that of newborns after spontaneous conception.
Slovenian Medical Journal, Oct 6, 2015
Izhodišče: Progesteron je pomemben za vzdrževanje nosečnosti. Z dodajanjem progesterona lahko v d... more Izhodišče: Progesteron je pomemben za vzdrževanje nosečnosti. Z dodajanjem progesterona lahko v določenih skupinah nosečnic zmanjšamo tveganje za prezgodnji porod. Namen članka je predstaviti slovenska priporočila za uporabo progesterona za preprečevanje prezgodnjega poroda in sistematični pregled literature, na katerem priporočila temeljijo. Metode: Pregledali smo zbirko Medline s ključnimi besedami: progesteron, nosečnost, prezgodnji porod, randomizirana raziskava in randomizirana kontrolirana raziskava. Vključili smo raziskave, v katerih so mikronizirani progesteron pri enoplodnih ali večplodnih nosečnostih dali vaginalno z namenom preprečiti prezgodnji porod. Izključili pa smo raziskave, v katerih so uporabili 17-α-hidroksiprogesteron kaproat. Rezultati: Predstavljamo glavne značilnosti dvanajstih randomiziranih raziskav, objavljenih v letih 2003-2014. Raziskave se razlikujejo po vključitvenih merilih, odmerku progesterona, pripravku progesterona in trajanju zdravljenja. Dve raziskavi sta vključevali nosečnice s kratkim materničnim vratom, dve s prezgodnjim porodom pred to nosečnostjo, tri s simptomi prezgodnjega poroda, tri z dvojčki in dve z različnimi dejavniki tveganja (med katerimi je bil najpogostejši prezgodnji porod v prejšnjih nosečnostih). Šest od dvanajstih raziskav je pokazalo značilno znižanje tveganja za prezgodnji porod s progesteronskim zdravljenjem. Zaključki: Na podlagi trenutno dostopnih podatkov se priporoča uporaba 200 mg mikroniziranega progesterona dnevno vaginalno pri nosečnicah s kratkim materničnim vratom (≤ 25 mm) z začetkom v 19-24. tednu in nadaljevanjem zdravljenja do 37. tedna.
Slovenian Medical Journal, Oct 28, 2019
Zmanjšana plodova aktivnost ali sprememba vzorca plodovega gibanja je lahko povezana s slabim per... more Zmanjšana plodova aktivnost ali sprememba vzorca plodovega gibanja je lahko povezana s slabim perinatalnim izidom. Ugotaljali so, da je neustrezen odziv zdravnika ginekologa in porodničarja ob srečanju z nosečnico, ki poroča o zmanjšanem gibanju ploda, dejavnik, ki prispeva k mrtvorojenosti. Vse nosečnice bi morale dobiti informacije o normalnem gibanju ploda. Priporočamo enotno podajanje informacij o spremljanju plodovih gibov, enotno metodo spremljanja gibov ploda (modificirano metodo »štej do deset«) in uporabo enotne tabele za beleženje plodovih gibov, namenjene nosečnicam. Če je nosečnica v dveh urah naštela manj kot 10 gibov, naj ne čaka in naj se takoj dogovori za pregled. Z izbranim ginekologom naj se dogovori za pregled tudi v primeru spremembe vzorca gibanja ploda in nenadnega pomembnega podaljšanja časa do naštetih 10 gibov, ki, tako podaljšan, vztraja več dni. Z anamnezo in kliničnim pregledom moramo odkriti nosečnice z večjim tveganjem za zaplete. Ob vsakem pregledu je potrebno izmeriti krvni tlak in izključiti proteinurijo. V nadaljevanju pregleda je potrebno ugotoviti, ali je rast ploda primerna gestacijski starosti. Po 28. tednu nosečnosti je potrebno s pomočjo CTG ugotavljati ogroženost ploda. V primeru dejavnikov tveganja za smrt ploda v maternici ali za zastoj rasti ploda, v primeru nenavadnega zapisa CTG ter v primeru normalnega zapisa CTG ob vztrajanju slabšega gibanja ploda je potrebna ultrazvočna preiskava.
Slovenian Medical Journal, Mar 2, 2018
Parvovirus B19 (B19V) povzroča pri otrocih in mlajših odraslih večinoma blago bolezen erythema in... more Parvovirus B19 (B19V) povzroča pri otrocih in mlajših odraslih večinoma blago bolezen erythema infectiosum ali peto otroško bolezen. V nosečnosti se virus v 33-51 % lahko prenese na plod, pri katerem lahko zaradi inhibicije eritropoeze povzroči hudo anemijo, neimunski fetalni hidrops ali fetalno smrt. Vpliva tudi na srčno mišico, centralni živčni sistem in kosti ter najverjetneje lahko povzroči tudi kasnejši zastoj v nevrološkem razvoju pri otrocih. Ocenjujejo, da je 25-45 % nosečnic seronegativnih, zato je možnost sveže okužbe v nosečnosti velika. Okužbo z B19V pri nosečnici ugotavljamo z določanjem specifičnih IgM in IgG protiteles in v dvomu z določanjem virusne DNA z metodo PCR. Pri plodu okužbo z B19V zanesljivo ugotavljamo z določanjem virusne DNA v plodovnici. Pri sumu na okužbo pri plodu ali potrjeni okužbi plod tedensko ultrazvočno spremljamo v terciarnem centru. Ob prvih znakih anemije ali hidropsa pri plodu plod zdravimo z intrauterino transfuzijo. Za preprečevanje sveže okužbe z B19V v nosečnosti je potrebno o tveganjih za plod ozaveščati ženske in zdravstvene delavce. V prispevku so objavljena priporočila za obravnavo nosečnic s tveganjem za okužbo, s sumom na okužbo ali potrjeno okužbo z B19V.
Journal of Maternal-fetal & Neonatal Medicine, Jan 23, 2023
DOAJ (DOAJ: Directory of Open Access Journals), 2015
<p><strong>Background:</strong> Cesarean section on maternal request is defined... more <p><strong>Background:</strong> Cesarean section on maternal request is defined as a cesarean section performed in the absence of maternal or fetal indications. The objective was to evaluate the attitude of perinatal care providers in Slovenia towards cesarean section on maternal request.</p><p><strong>Methods:</strong> We performed a cross-sectional questionnaire based survey. Participants responded to five Likert-type attitudinal questions. Data were analyzed by ANOVA for statistical significance (P<0.05).</p><p class="Body"><strong>Results:</strong> We included 159 participants: 22 midwifes, 12 pediatricians, 23 nurses, 17 obstetricians gynecologysts, 13 trainees in obstetrics and gynecology, 19 midwifery students, 25 students of nursery, and 28 medical students. The attitude towards cesarean section on request differed significantly among groups. Midwifes, midwifery students and obstetricians had a less favorable, while pediatricians, nurses and medical students a more favorable attitude towards cesarean section on request.</p><strong>Conclusion:</strong> There are significant differences in attitudes towards cesarean section on request among different groups of perinatal care providers in Slovenia.
Slovenian Medical Journal, Apr 21, 2022
Slovensko strokovno stališče za zdravljenje s pripravki železa v nosečnosti Avtorske pravice (c) ... more Slovensko strokovno stališče za zdravljenje s pripravki železa v nosečnosti Avtorske pravice (c) 2022 Zdravniški Vestnik. To delo je licencirano pod Creative Commons Priznanje avtorstva-Nekomercialno 4.0 mednarodno licenco.
Clinical Nephrology, 2021
AIMS Different forms of apheresis have been proposed as potential therapeutic approaches to remov... more AIMS Different forms of apheresis have been proposed as potential therapeutic approaches to remove soluble Fms-like tyrosine kinase-1 (sFlt-1) and allow safe pregnancy prolongation in cases of extremely preterm preeclampsia. This is a follow-up study presenting our experiences with therapeutic plasma exchange (TPE) in 5 women with preeclampsia at < 28 weeks of gestational age. MATERIALS AND METHODS All women received standard treatment for preeclampsia and 2 - 3 TPE treatments per week. Blood samples for sFlt-1 and placental growth factor (PlGF) measurements were collected before and after each TPE. RESULTS Seventeen TPE procedures were performed, 2 - 5 per patient. TPE significantly reduced sFlt-1 (by 35 ± 6%), sFlt-1/PlGF ratio (by 24 ± 13%), and to a lesser degree also PlGF (by 12 ± 16%), with a rebound observed on day 1 post procedure. TPE procedures were well tolerated by pregnant women and fetuses. Stabilization of sFlt-1 allowed pregnancy prolongation for a median of 8 (range 2 - 14) days from first TPE and for a median of 10 (range 4 - 17) days from hospital admission. There were no signs of increased risks of adverse neonatal outcome associated with TPE. One neonate died due to extreme prematurity 3 days after delivery, 2 had bronchopulmonary dysplasia, and 1 had retinopathy of prematurity. CONCLUSION This study provides new evidence of effective reduction in sFlt-1 and sFlt-1/PlGF ratio with TPE treatment, which seems to allow a clinically meaningful prolongation of pregnancy. Controlled studies are necessary to convincingly show the potential benefit of apheresis treatment in preeclampsia at extremely preterm gestation.
Slovenian Medical Journal, Jul 3, 2016
Reproductive Medicine
Objective: We previously provided evidence to confirm that maternal serum levels of soluble Fms-l... more Objective: We previously provided evidence to confirm that maternal serum levels of soluble Fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), and their ratio are useful tools to direct the management of preeclampsia (PE), fetal growth restriction (FGR), and PE+FGR near delivery. In this secondary analysis, we further examine the potential additive value of maternal serum Inhibin-A, which is a hormone marker of the transforming growth factor family, to the accuracy provided by maternal serum PlGF and sFlt-1. Methods: We conducted a secondary analysis where we extracted the data of a cohort of 125 pregnant women enrolled near delivery at the clinics of the University Medical Center of Ljubljana, Slovenia. The dataset included 31 cases of PE, 16 of FGR, 42 of PE+FGR, 15 preterm delivery (PTD), and 21 unaffected controls with delivery of a healthy baby at term. Cases delivered before 34 weeks’ gestation included 10 of PE, 12 of FGR, 28 of PE+FGR, and 6 of PTD. In addi...
Reproductive Medicine
Objectives—To conduct a secondary analysis of prediction accuracy of biophysical markers for susp... more Objectives—To conduct a secondary analysis of prediction accuracy of biophysical markers for suspected Preeclampsia (PE), Fetal Growth Restriction (FGR) and the two combined near delivery in a Slovenian cohort. Methods—This was a secondary analysis of a database of a total 125 Slovenian pregnant women attending a high-risk pregnancy clinic due to suspected PE (n = 31), FGR (n = 16) and PE + FGR (n = 42) from 28–39 weeks gestation and their corresponding term (n = 21) and preterm (PTD, n = 15) controls. Data for Mean Arterial blood Pressure (MAP) and Uterine artery pulsatility index (UtA PI) estimated by Doppler sonography were extracted from the database of patients who were tested at admission to the high-risk clinic with the suspected complications. The reactive hyperemia index (RHI), and the Augmentation Index (AIX%) were extracted from the patient database using measured values obtained with the assistance of the Endo PAT, a device set to measure the signal of the peripheral art...
Objective—the objective of this study was to assess the accuracy of placental growth factor (PlGF... more Objective—the objective of this study was to assess the accuracy of placental growth factor (PlGF), soluble Fms-like Tyrosine Kinase 1 (sFlt-1), and endoglin (sEng) in the diagnosis of suspected preeclampsia (PE) with and without fetal growth restriction (FGR) near delivery. Methods—this is a secondary analysis of a dataset of 125 pregnant women presenting at the high risk pregnancy clinic with suspected PE, FGR or PE + FGR in the University Medical Center of Slovenia. The dataset included 31 PE cases, 16 FGR cases, 42 PE + FGR cases, 15 cases who developed with unrelated complications before 37 weeks (wks) (PTD), and 21 unaffected controls who delivered a healthy baby at term. We also analyzed a sub-group of women who delivered early ( 90%. For PE + FGR, the PPV value approached 100%, especially for early cases, and can thus be implemented in clinical management. Neither NPV nor PPV were high enough for managing all cases of PE. There was no added value in measuring the PlGF/(sFlt-...
Objective: We previously provided evidence to confirm that soluble Fms-like tyrosine kinase-1 (sF... more Objective: We previously provided evidence to confirm that soluble Fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), and their ratio, are useful tools to direct the management of preeclampsia (PE), fetal growth restriction (FGR), and PE+FGR near delivery. In this study we examine the potential additive value of Inhibin-A, a hormone marker of the transforming growth factor family. Methods: We used a cohort of 125 pregnant women enrolled near delivery at clinics of the University Medical Center of Ljubljana, Slovenia. There were 31 cases of PE, 16 of FGR, 42 of PE+FGR, 15 iatrogenic preterm delivery (PTD), and 21 unaffected controls with delivery of a healthy baby at term. Cases delivered before 34 weeks’ gestation included 13 of PE, 12 of FGR, 22 of PE+FGR, and 6 of PTD. We recorded demographic characteristics and medical history and the levels of PlGF, sFlt-1 and Inhibin-A. The predictive accuracy of each biomarker, their ratios, and combinations was estimated fro...
The International Journal of Health Planning and Management, 2019
Slovenian Journal of Public Health, 2019
Background Depression, anxiety and fear of childbirth have numerous consequences for women and th... more Background Depression, anxiety and fear of childbirth have numerous consequences for women and their developing offspring. Insecure attachment in close adult relationships is considered to be a risk factor for depressive symptoms. This study aims to gain further insight into the risk factors for depressive and anxiety symptoms in nulliparous women during the third trimester of pregnancy regarding the main contextual relations, with an emphasis on partner attachment. Methods A group of 325 nulliparas in the third trimester of pregnancy was enrolled in a childbirth preparation program. The following instruments were applied: Experiences in Close Relationships-Revised, the Edinburgh Depression Scale, the Zung Anxiety Scale, and a questionnaire regarding fear of childbirth. Three separate multiple linear regression models were built to explore the associations between demographic, social and attachment variables and mental health functioning. Results Highly educated nulliparas and those...
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, Jan 18, 2018
The purpose of this study was to determine the incidence of abuse in healthcare system during pre... more The purpose of this study was to determine the incidence of abuse in healthcare system during pregnancy and its impact on pregnancy outcomes. A validated screening Norvold Abuse Questionnaire for the identification of female victims of four kinds of abuse: emotional, physical, sexual, and the abuse in the healthcare system was anonymously offered to all women in the first 2 days postpartum. The study group consisted of 1018 women, 6.2% of which reported experiencing abuse in heath-care system during pregnancy. Affected women had a higher incidence of preterm delivery (OR 2.4; 95% CI 1.2-4.8) and cesarean section rate (OR 2.0, 95% CI 1.1-3.6). Sexual abuse and abuse in heath-care system during childhood were associated with abuse in heath-care system during pregnancy (OR 4.4; CI 95% 1.2-16.2, and OR 6.9; CI 95% 1.3-35.4, respectively). Our study indicates that as many as 6.2% of pregnant women experience abusive encounters with perinatal care providers. These pregnancies eventually e...
Zdravstveno varstvo, 2017
The aim of the survey was to assess the differences in disclosure by the type of violence to bett... more The aim of the survey was to assess the differences in disclosure by the type of violence to better plan the role of health services in identifying and disclosing violence. A validated, anonymous screening questionnaire (NorAQ) for the identification of female victims of violence was offered to all postpartum women at a single maternity unit over a three-month period in 2014. Response rate was 80% (1018 respondents). Chi square test was used for statistical analysis (p<0.05 significant). There are differences in disclosure by type of violence. Nearly half (41.5%) of violence by health care services was not reported, compared to 33.7% physical, 23.4% psychological, and 32.5% sexual that was reported. The percentage of violence in intimate partnership reported to health care staff is low (9.3% to 20.8%), but almost half of the violence experienced by heath care services (44%) is reported. Intimate partnership violence is more often reported to the physician than to the psychologist...
Journal of Perinatal Medicine, 2020
Objectives Information on the usefulness of screen-and-test strategies of pregnant women for seve... more Objectives Information on the usefulness of screen-and-test strategies of pregnant women for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is lacking. Methods We retrospectively reviewed the Ljubljana Maternity Hospital database and searched for pregnant women, who were admitted to the hospital between March 15 and May 16, 2020, for a planned procedure or hospitalization. Their medical records were examined and SARS-CoV-2 test results were retrieved. Results During the two-month period analyzed, there were a total of 265 scheduled admissions of pregnant women to our hospital. Two hundred two (76.2%) were tested for SARS-CoV-2 1 day prior to admission. All tested negative for SARS-CoV-2 RNA, regardless of having coronavirus disease 2019 (COVID-19)-compatible signs or symptoms (n=28) or not (n=174). Conclusions In a population with a low SARS-CoV-2 burden, usefulness of universal testing of pregnant women before admission to the hospital is limited. We recommend that ob...
The Lancet regional health, Jun 1, 2021
Background: The COVID-19 pandemic threatens the impact of cervical cancer screening and global ce... more Background: The COVID-19 pandemic threatens the impact of cervical cancer screening and global cervical cancer elimination goals. As cervical cancer screening programmes were adjusting to the new situation, we evaluated the intensity, quality, and outcomes of cervical cancer screening in Slovenia in the first seven months of the pandemic. Methods: Historical observational study on data from a population-based cervical cancer screening registry. Number of cervical cytopathology (screening and follow-up), histopathology (diagnostic procedures, invasive procedures and number of newly diagnosed CIN2+ cases) and HPV test results from the entire Slovenian women population between January 1st and September 30th 2020 were compared to a three-year average of the years 2017À19. Findings: A two-month screening lock-down between March 12th and May 8th 2020 resulted in an epidemic deficit of screening (-92%), follow-up (-70%), and HPV triage tests (-68%), as well as invasive diagnostic (-47%) and treatment (-15%) of cervical lesions. Time to diagnosis and treatment did not increase; times to laboratory results fluctuated but stayed within standards. Slovenia has entered the second epidemic intending to add as little as possible to the pandemic deficit of screening smears (-23%) and yearly CIN2+ cases (-10%). Women aged 30À39 were most affected, with the highest pandemic deficit of screening smears (-26%) and yearly CIN2+ cases (-19%). Interpretation: The pandemic has deeply affected all levels of our lives. New vulnerable groups and inequalities have emerged that require recognition and action. To prevent long-term increases in the cervical cancer burden due to the COVID-19 pandemic, it is crucial that organised screening is maintained and monitored in settings where it can be safely and comprehensively provided. Funding: None.
Journal of Reproductive Immunology, Aug 1, 2023
Slovenian Medical Journal, 2003
Background. Multiple pregnancy is in itself already a risk factor for the course and outcome of t... more Background. Multiple pregnancy is in itself already a risk factor for the course and outcome of the pregnancy and birth. Its frequency in in-vitro fertilisation is approximately twenty fold in comparison to natural conception which is also why it is one of the main problem areas of pregnancy and birth after an IVF-ET procedure. The aim of our research is to determine whether the twins, born after an IVF-ET procedure are any different than twins, born after spontaneous conception. Methods. The research was retrospective in nature. It included 1511 twin pregnancy patients who gave birth to twins between April 1987 and May 1995 and between January 1997 and December 1999. Our research group consisted of 255 mothers and 510 twins, born after an IVF-ET procedure. The research was divided into a cohort and controlled study. In the cohort study the research group was compared to the entire Ljubljana cohort of 1256 mothers and 2512 twins resulting from spontaneous conception. In the controlled study 93 mothers and 186 twins from the research group were compared with 93 mothers and 186 newborns after spontaneous conception. In this group the mothers matched the research group in age, parity and birth year. The course of and complications during the pregnancy, and the course, complications and outcome of the birth as well as the characteristics of the newborns were compared. Results. Certain serious complications during the course of the pregnancy, including hypertension, gestation diabetes and threatened preterm labours, were no more frequent with the IVF group of mothers with twin pregnancy than with the control group. However more bleeding in the first trimester and less proteinuria were determined in comparison to the control group. During the course of birth and its outcome more premature labours were determined (62.3–68.8% vs. 51.4– 50.5%), a 6 to 7 days lower average gestation age, a coresponding birth weight, three times more elective and urgent caesarean sections were determined for the IVF group than for the control group and the differences were all statistically significant. Conclusions. Multiple pregnancies are a complication of an IVF-ET procedure. Women who conceive after an IVF-ET procedure and with a twin pregnancy outcome are not subject to any more danger than pregnant women after spontaneous conception. Children are born somewhat earlier and are therefore lighter, however the perinatal outcome of newborns is no different and the morbidity and mortality rates are similar to that of newborns after spontaneous conception.
Slovenian Medical Journal, Oct 6, 2015
Izhodišče: Progesteron je pomemben za vzdrževanje nosečnosti. Z dodajanjem progesterona lahko v d... more Izhodišče: Progesteron je pomemben za vzdrževanje nosečnosti. Z dodajanjem progesterona lahko v določenih skupinah nosečnic zmanjšamo tveganje za prezgodnji porod. Namen članka je predstaviti slovenska priporočila za uporabo progesterona za preprečevanje prezgodnjega poroda in sistematični pregled literature, na katerem priporočila temeljijo. Metode: Pregledali smo zbirko Medline s ključnimi besedami: progesteron, nosečnost, prezgodnji porod, randomizirana raziskava in randomizirana kontrolirana raziskava. Vključili smo raziskave, v katerih so mikronizirani progesteron pri enoplodnih ali večplodnih nosečnostih dali vaginalno z namenom preprečiti prezgodnji porod. Izključili pa smo raziskave, v katerih so uporabili 17-α-hidroksiprogesteron kaproat. Rezultati: Predstavljamo glavne značilnosti dvanajstih randomiziranih raziskav, objavljenih v letih 2003-2014. Raziskave se razlikujejo po vključitvenih merilih, odmerku progesterona, pripravku progesterona in trajanju zdravljenja. Dve raziskavi sta vključevali nosečnice s kratkim materničnim vratom, dve s prezgodnjim porodom pred to nosečnostjo, tri s simptomi prezgodnjega poroda, tri z dvojčki in dve z različnimi dejavniki tveganja (med katerimi je bil najpogostejši prezgodnji porod v prejšnjih nosečnostih). Šest od dvanajstih raziskav je pokazalo značilno znižanje tveganja za prezgodnji porod s progesteronskim zdravljenjem. Zaključki: Na podlagi trenutno dostopnih podatkov se priporoča uporaba 200 mg mikroniziranega progesterona dnevno vaginalno pri nosečnicah s kratkim materničnim vratom (≤ 25 mm) z začetkom v 19-24. tednu in nadaljevanjem zdravljenja do 37. tedna.
Slovenian Medical Journal, Oct 28, 2019
Zmanjšana plodova aktivnost ali sprememba vzorca plodovega gibanja je lahko povezana s slabim per... more Zmanjšana plodova aktivnost ali sprememba vzorca plodovega gibanja je lahko povezana s slabim perinatalnim izidom. Ugotaljali so, da je neustrezen odziv zdravnika ginekologa in porodničarja ob srečanju z nosečnico, ki poroča o zmanjšanem gibanju ploda, dejavnik, ki prispeva k mrtvorojenosti. Vse nosečnice bi morale dobiti informacije o normalnem gibanju ploda. Priporočamo enotno podajanje informacij o spremljanju plodovih gibov, enotno metodo spremljanja gibov ploda (modificirano metodo »štej do deset«) in uporabo enotne tabele za beleženje plodovih gibov, namenjene nosečnicam. Če je nosečnica v dveh urah naštela manj kot 10 gibov, naj ne čaka in naj se takoj dogovori za pregled. Z izbranim ginekologom naj se dogovori za pregled tudi v primeru spremembe vzorca gibanja ploda in nenadnega pomembnega podaljšanja časa do naštetih 10 gibov, ki, tako podaljšan, vztraja več dni. Z anamnezo in kliničnim pregledom moramo odkriti nosečnice z večjim tveganjem za zaplete. Ob vsakem pregledu je potrebno izmeriti krvni tlak in izključiti proteinurijo. V nadaljevanju pregleda je potrebno ugotoviti, ali je rast ploda primerna gestacijski starosti. Po 28. tednu nosečnosti je potrebno s pomočjo CTG ugotavljati ogroženost ploda. V primeru dejavnikov tveganja za smrt ploda v maternici ali za zastoj rasti ploda, v primeru nenavadnega zapisa CTG ter v primeru normalnega zapisa CTG ob vztrajanju slabšega gibanja ploda je potrebna ultrazvočna preiskava.
Slovenian Medical Journal, Mar 2, 2018
Parvovirus B19 (B19V) povzroča pri otrocih in mlajših odraslih večinoma blago bolezen erythema in... more Parvovirus B19 (B19V) povzroča pri otrocih in mlajših odraslih večinoma blago bolezen erythema infectiosum ali peto otroško bolezen. V nosečnosti se virus v 33-51 % lahko prenese na plod, pri katerem lahko zaradi inhibicije eritropoeze povzroči hudo anemijo, neimunski fetalni hidrops ali fetalno smrt. Vpliva tudi na srčno mišico, centralni živčni sistem in kosti ter najverjetneje lahko povzroči tudi kasnejši zastoj v nevrološkem razvoju pri otrocih. Ocenjujejo, da je 25-45 % nosečnic seronegativnih, zato je možnost sveže okužbe v nosečnosti velika. Okužbo z B19V pri nosečnici ugotavljamo z določanjem specifičnih IgM in IgG protiteles in v dvomu z določanjem virusne DNA z metodo PCR. Pri plodu okužbo z B19V zanesljivo ugotavljamo z določanjem virusne DNA v plodovnici. Pri sumu na okužbo pri plodu ali potrjeni okužbi plod tedensko ultrazvočno spremljamo v terciarnem centru. Ob prvih znakih anemije ali hidropsa pri plodu plod zdravimo z intrauterino transfuzijo. Za preprečevanje sveže okužbe z B19V v nosečnosti je potrebno o tveganjih za plod ozaveščati ženske in zdravstvene delavce. V prispevku so objavljena priporočila za obravnavo nosečnic s tveganjem za okužbo, s sumom na okužbo ali potrjeno okužbo z B19V.
Journal of Maternal-fetal & Neonatal Medicine, Jan 23, 2023
DOAJ (DOAJ: Directory of Open Access Journals), 2015
<p><strong>Background:</strong> Cesarean section on maternal request is defined... more <p><strong>Background:</strong> Cesarean section on maternal request is defined as a cesarean section performed in the absence of maternal or fetal indications. The objective was to evaluate the attitude of perinatal care providers in Slovenia towards cesarean section on maternal request.</p><p><strong>Methods:</strong> We performed a cross-sectional questionnaire based survey. Participants responded to five Likert-type attitudinal questions. Data were analyzed by ANOVA for statistical significance (P<0.05).</p><p class="Body"><strong>Results:</strong> We included 159 participants: 22 midwifes, 12 pediatricians, 23 nurses, 17 obstetricians gynecologysts, 13 trainees in obstetrics and gynecology, 19 midwifery students, 25 students of nursery, and 28 medical students. The attitude towards cesarean section on request differed significantly among groups. Midwifes, midwifery students and obstetricians had a less favorable, while pediatricians, nurses and medical students a more favorable attitude towards cesarean section on request.</p><strong>Conclusion:</strong> There are significant differences in attitudes towards cesarean section on request among different groups of perinatal care providers in Slovenia.