Objective: The aim of this study was to evaluate perinatal outcome in newborns of mothers who are smokers. Methods: The study included 87 pregnant women with a single pregnancy in the cephalic position, 64 of them nonsmokers (group 1), 13 who smoked 5–20 cigarettes per day (group 2) and 10 who smoked more than 20 cigarettes per day (group 3). Maternal demographic variables and laboratory hemoglobin concentration, hematocrit and erythrocyte count in the last trimester were recorded. Perinatal outcome included type of delivery (vaginal or cesarean section), birth weight, occurrence of meconium in the amniotic fluid, 5-min Apgar score, umbilical arterial blood pH postpartum, sex of the newborn, need for treatment at a neonatal intensive care unit (NICU) and clinically and neurosonographically verified postpartum neurologic complications in the newborn. Results: A statistically significant correlation (p < 0.01) was found with the mean gestational age at delivery in all three groups of women, especially in those smoking >20 cigarettes per day, who had a higher incidence of premature deliveries. Maternal laboratory findings also differed significantly among the three groups of women, i.e. erythrocyte count (p < 0.01), hemoglobin concentration (p < 0.01) and hematocrit (p < 0.001). The rate of delivery by cesarean section was significantly higher in the groups of smokers, irrespective of the number of cigarettes per day (groups 2 and 3). Birth weight was lower by about 250 and 350 g (p < 0.001) in groups 2 and 3, respectively. Five-minute Apgar score and umbilical arterial blood pH were lower in group 3 as compared with groups 1 and 2 (p < 0.01). NICU treatment was required in more than 50% of infants born to group 3 mothers, in whom 70% of perinatal neurologic complications such as subependymal hemorrhage, periventricular hemorrhage, porencephalic cysts, intracranial hemorrhage and swallowing disturbance of the newborn were recorded (p < 0.001). The infants born to group 3 mothers had a longer and more difficult period of adaptation, thus often requiring an NICU stay. Conclusion: Our study confirmed that pregnancy burdened with smoking, especially in the case of >20 cigarettes a day, is associated with a high risk due to the development of maternal anemia and fetal hypoxia and polyglobulia, which in turn result in a significantly poorer perinatal outcome in infants born to smoking mothers and compromised subsequent development of the child, as evidenced by the morphological substrates on the brain resulting from the fetal mechanism of defense against hypoxia. Clinically, there was no other (etiologic) reason for (chronic) fetal hypoxia; thus, the clinical substrate of fetal tobacco syndrome could be presumed to have developed consequentially to chronic smoking during pregnancy, as a preuterine factor of fetal hypoxia. Other gestational or gestation-related diseases (e.g., gestosis, diabetes) that may potentially cause nutritional and respiratory insufficiency of the placenta were ruled out.

More than 60% of the women in both groups suffered from premenstrual syndrome (PMS) symptoms, such as anxiety, mastalgia, insomnia, nausea and gastrointestinal disorders, whereas a smaller number of women suffered from phobic disorders, premenstrual headaches and migraines. There were three women from the first group and seven women from the second group who continued the medication treatment with progestins, whereas one woman from the first group and nine women from the second group continued to take fluoxetine. In the first group, nine women stopped having PMS symptoms after two AP treatments, eight women stopped having them after three treatments and one woman stopped having them after four treatments. In four women from the first group and 16 women from the second group, PMS symptoms appeared during the following period (cycle) or continued even after four treatments, so the medication was continued. In the first group, one woman had a smaller subcutaneous hematoma after the AP acupoint Ren 6. There was a statistical and relevant reduction in PMS symptoms with the AP treatments in the first group (P<0.001), whereas their reduction was irrelevant in the placebo AP group (P>0.05). The success rate of AP in treating PMS symptoms was 77.8%, whereas it was 5.9%. in the placebo group. The positive influence of AP in treating PMS symptoms can be ascribed to its effects on the serotoninergic and opioidergic neurotransmission that modulates various psychosomatic functions. The initial positive results of PMS symptoms with a holistic approach are encouraging and AP should be suggested to the patients as a method of treatment.

Heart rate variability is a physiological feature indicating the influence of the autonomic nervous system on the heart rate. Association of the reduced heart rate variability due to myocardial infarction and the increased postinfarction mortality was first described more than thirty years ago. Many studies have unequivocally demonstrated that coronary artery bypass grafting surgery generally leads to significant reduction in heart rate variability, which is even more pronounced than after myocardial infarction. Pathophysiologically, however, the mechanisms of heart rate variability reduction associated with acute myocardial infarction and coronary artery bypass grafting are different. Generally, heart rate variability gradually recovers to the preoperative values within six months of the procedure. Unlike the reduced heart rate variability in patients having sustained myocardial infarction, a finding of reduced heart rate variability after coronary artery bypass surgery is not considered relevant in predicting mortality. Current knowledge about changes in heart rate variability in coronary patients and clinical relevance of such a finding in patients undergoing coronary artery bypass grafting are presented.

Objective: The aim of this study was to evaluate the antiemetic effect of acupuncture (AP) and acupressure (APr) of the Pc 6 acupoint in pregnant women with hyperemesis gravidarum (HG). Methods: A prospective, placebo-controlled trial included 36 pregnant women with HG. Two methods of acupuncture were used: bilateral manual AP of the Pc 6 (Neiguan) acupoint (group 1, n = 10) and bilateral APr of the Pc 6 acupoint (group 2, n = 11); furthermore, superficial intracutaneous placebo AP (group 3, n = 8) and placebo APr (group 4, n = 7) was carried out. Results: Anxiodepressive symptoms occurred in 9 pregnant women with HG from group 1, 8 women from group 2, 7 women from group 3, and 5 women from group 4 (p < 0.001). The average gestation age at the occurrence of HG symptoms and the beginning of treatment was 7 weeks in group 1 and 8 weeks in groups 2, 3, and 4. Four women from group 1 and 7 women from groups 2, 3, an 4 needed intravenous compensation of liquid and electrolytes. The antiemetic metoclopramide was given intravenously to 1 woman from group 1, 2 women from group 2, 6 women from group 3, and 4 women from group 4. Promethazine was given to 1 woman from group 2, 1 woman from group 3, and to 3 women from group 4. The efficiency of the HG treatment with AP of the point Pc 6 was 90%, with APr of the Pc 6 63.6%, with placebo AP 12.5%, and with placebo APr 0%. Conclusion: Acupuncture (p < 0.0001) and acupressure (p < 0.1) are effective, nonpharmacologic methods for the treatment of HG.

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Aim: The aim of this study was to assess the value of acupuncture (AP) in the conversion of fetal breech presentation into vertex presentation. Patients and Methods: A randomized prospective controlled clinical study included 67 pregnant women with fetal breech presentation: 34 women with singleton pregnancies treated with manual AP (urinary bladder 67, Zhiyin) and a control group which included 33 women with singleton pregnancies without AP treatment. The AP treatment lasted 30 min a day, and was conducted during and after 34 weeks of pregnancy with simultaneous cardiotocography. Results: The success rate of the AP correction of fetal breech presentation is 76.4% (26 women), and spontaneous conversion without AP in vertex presentation is observed in 15 women (45.4%; p < 0.001). Conclusions: We believe that AP correction of fetal malpresentation is a relatively simple, efficacious and inexpensive method associated with a lower percentage of operatively completed deliveries, which definitely reflects in improved parameters of vital and perinatal statistics.

The aim of this study was to determine the incidence of N. gonorrhoae (NG) and/or C. trachomatis (CT) in acute mucopurulent cervicitis (MPC). The study included 617 non-pregnant women with MPC, who had not been receiving any antimicrobial treatment. The average age of patients was 22.2 years. There were no statistically signifi cant differences according to place of residence, education, and marital status. Samples for laboratory analysis were collected using a routine procedure; NG was identifi ed using the cytochrome oxidase test and Gram staining. CT was isolated on McCoy cell culture and stained with Lugol solution. NG was isolated in three women (0.8 %) and CT in 58 women (9.4 %). Fifty-six of the CT-positive patients were nullipara and only two were unipara. All NG-positive patients were also nullipara. The mean number of sexual partners was 2.2 in all study subjects, 2.4 in CT-positive subjects, and 2.9 in NG-positive subjects. Vaginal discharge purity according to Schröder was signifi cantly deteriorated in CT-positive patients (p=0.011). When asked about the use of contraceptives, as many as 32.7 % patients answered that they did not use any protection, 39 % women used the rhythm method and coitus interruptus, 20 % were taking oral contraceptives, 6.1 % used mechanical devices, and 1.9 % used chemical protection. Previous acute and chronic pelvic infl ammatory diseases correlated with MPC (p<0.01). Our statistical analysis suggests that chlamydial infection signifi cantly reduces the purity of vaginal discharge, which is more pronounced in nulliparae. Pap smear was not specifi c enough to demonstrate chlamydial infection. In view of the MPC fi ndings, the prevalence of CT and NG infection is low.

Objective: The aim of this study was to evaluate the effect of acupuncture (AP) in the treatment of primary dysmenorrhea (PD). Methods: A clinical prospective, placebo-controlled trial included 57 women with PD. Of these, 30 were treated with manual AP points: Du 20 (Baihui), bilateral Li 4 (Hegu), Ren 3 (Zhongji), Ren 4 (Guanyuan), Ren 6 (Qihai), bilateral Gb 34 (Yanglingquan), bilateral Ub 23 (Shenshu), bilateral Lp 6 (Sanyinjao) and auriculoacupuncture points (Shenmen); 27 women were treated with placebo AP. AP treatments were considered successful if PD did not occur any more, medication of PD became unnecessary or PD symptoms did not occur for 2 years after the AP treatment. Results: The occurrence of PD in nulliparae was statistically relevant (p < 0.001). Statistically relevant was also the decrease in medication in women to whom AP had been applied (p < 0.0001), which was not the case in the placebo group (p > 0.5). Conclusions: The success rate of AP for the treatment of PD symptoms within 1 year after the AP treatment is 93.3% in the first group and 3.7% in the placebo group.