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Impedance to blood flow through spiral arteries in the second trimester is lower in the central area of the placental bed, and is in agreement with previous histologic data. Physiologic change of the spiral arteries is functionally complete around 17 weeks' gestation.

Gestational diabetes mellitus (GDM) has become a major public health issue and one of the most discussed topics in contemporary obstetrics. Due to rising prevalence of GDM worldwide impact and importance of this medical condition in good quality antenatal care is growing. GDM is associated with serious adverse perinatal outcomes and unfavorable long-term health consequences for both, mother and her child. Despite a great amount of knowledge accumulated regarding GDM, medical community remains indecisive and still debates the most appropriate diagnostic strategy, screening policy, and treatment options for pregnancies complicated with GDM. These unresolved issues generate controversies, motivate further research and contribute to the growing interest surrounding GDM. In this review we will discuss and try to explain some of them.

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Objective. The purpose of this study was to assess the diagnostic accuracy of different parameters (clinical and sonographic) in the prediction and management of retained products of conception (RPOC) in the late postpartum period. Methods. This was a prospective cohort 3-year audit. Predefined data were collected and compared with histopathologic (HP) reports after uterine evacuation. The primary outcome measure was the diagnostic accuracy of different clinical and sonographic parameters, including color Doppler imaging in diagnosis of RPOC confirmed on HP reports. Secondary outcome measures were complication rates influencing maternal morbidity. Results. In total, 93 patients (0.92% of all deliveries) were selected. The presence of gestational tissue was confirmed on HP reports in 58% of cases. The likelihood ratio of sonography alone was 1.47 (95% confidence interval, 1.25-1.84), whereas that of sonography combined with color Doppler imaging was 2.16 (1.3-3.59), providing statistically significant accuracy regarding the prediction of RPOC. Conclusions. Sonography alone or combined with color Doppler imaging has better diagnostic accuracy than the usual clinical parameters used for the prediction of RPOC. Key words: cervical dilatation; color Doppler sonography; placenta; residua; sonography; vaginal bleeding. econdary postpartum hemorrhage (PPH), either alone or associated with pain, fever, or both, is a common clinical symptom of retained products of conception (RPOC). 1 The reported incidence in the literature is around 1% of all deliveries, and it represents one of the most common reasons for hospital referral and readmission in the postpartum period.1 The diagnosis of RPOC relies on different clinical symptoms and signs as well as sonographic assessment. 2-11After making a diagnosis, evacuation of the RPOC is indicated, and it is performed in approximately 70% of patients referred with secondary PPH.4 This is a relatively simple procedure that is generally thought to be safe. However, histopathologic (HP) samples obtained on uterine evacuation in cases of suspected RPOC after primary evacuation of the uterus were found to show positive findings for gestational remnants in approximately 60% of cases, whereas in the postpartum group, this incidence is 48.5%. 2,3,6,9 The false-positive rates are 28.9% if the diagnosis is based on sonography and 51.5% if it is based on clinical examination.