Strict Standards: call_user_func_array() expects parameter 1 to be a valid callback, non-static method JModuleHelper::renderModule() should not be called statically in /home/vasginek/public_html/libraries/joomla/cache/handler/callback.php on line 99

Strict Standards: Non-static method JFactory::getApplication() should not be called statically in /home/vasginek/public_html/plugins/system/advancedmodules/modulehelper.php on line 143

Strict Standards: Non-static method JRequest::getCmd() should not be called statically in /home/vasginek/public_html/plugins/system/advancedmodules/modulehelper.php on line 144

Strict Standards: Non-static method JRequest::getVar() should not be called statically in /home/vasginek/public_html/libraries/joomla/environment/request.php on line 255

Strict Standards: Non-static method JFactory::getConfig() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 394

Strict Standards: Non-static method JRegistryFormat::getInstance() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/registry/registry.php on line 373

Strict Standards: Non-static method JFilterInput::clean() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/registry/format.php on line 45

Strict Standards: Non-static method JFactory::getLanguage() should not be called statically in /home/vasginek/public_html/plugins/system/advancedmodules/modulehelper.php on line 188

Strict Standards: Non-static method JRegistryFormat::getInstance() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/registry/registry.php on line 373

Strict Standards: Non-static method JFilterInput::clean() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/registry/format.php on line 45

Strict Standards: Non-static method JRequest::getBool() should not be called statically in /home/vasginek/public_html/plugins/system/advancedmodules/modulehelper.php on line 219

Strict Standards: Non-static method JRequest::getVar() should not be called statically in /home/vasginek/public_html/libraries/joomla/environment/request.php on line 217

Strict Standards: Non-static method JRequest::_cleanVar() should not be called statically in /home/vasginek/public_html/libraries/joomla/environment/request.php on line 151

Strict Standards: Non-static method JFilterInput::getInstance() should not be called statically in /home/vasginek/public_html/libraries/joomla/environment/request.php on line 577

Strict Standards: Non-static method JDispatcher::getInstance() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 511

Strict Standards: Non-static method JFactory::getApplication() should not be called statically in /home/vasginek/public_html/plugins/system/advancedmodules/advancedmodules.php on line 132
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Strict Standards: Non-static method JLoader::import() should not be called statically in /home/vasginek/public_html/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/vasginek/public_html/libraries/loader.php on line 71

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/vasginek/public_html/libraries/loader.php on line 186

Strict Standards: Non-static method JLoader::load() should not be called statically in /home/vasginek/public_html/libraries/loader.php on line 161

Strict Standards: Non-static method JLoader::register() should not be called statically in /home/vasginek/public_html/libraries/loader.php on line 138

Strict Standards: Non-static method JModuleHelper::getLayoutPath() should not be called statically in /home/vasginek/public_html/modules/mod_mainmenu/mod_mainmenu.php on line 42

Strict Standards: Non-static method JFactory::getApplication() should not be called statically in /home/vasginek/public_html/plugins/system/advancedmodules/modulehelper.php on line 266

Strict Standards: Non-static method JDispatcher::getInstance() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 511

Strict Standards: Non-static method modMainMenuHelper::render() should not be called statically in /home/vasginek/public_html/modules/mod_mainmenu/tmpl/default.php on line 82

Strict Standards: Non-static method JSite::getMenu() should not be called statically in /home/vasginek/public_html/modules/mod_mainmenu/legacy.php on line 345

Strict Standards: Non-static method JApplication::getMenu() should not be called statically in /home/vasginek/public_html/includes/application.php on line 345

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/vasginek/public_html/libraries/loader.php on line 186

Strict Standards: Non-static method JMenu::getInstance() should not be called statically in /home/vasginek/public_html/libraries/joomla/application/application.php on line 720

Strict Standards: Non-static method JError::isError() should not be called statically in /home/vasginek/public_html/libraries/joomla/application/application.php on line 721

Strict Standards: Non-static method JFactory::getUser() should not be called statically in /home/vasginek/public_html/modules/mod_mainmenu/legacy.php on line 346

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/vasginek/public_html/libraries/loader.php on line 186

Strict Standards: Non-static method JFactory::getSession() should not be called statically in /home/vasginek/public_html/libraries/joomla/factory.php on line 163

Strict Standards: Non-static method JRegistryFormat::getInstance() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/registry/registry.php on line 373

Strict Standards: Non-static method JFilterInput::clean() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/registry/format.php on line 45

Strict Standards: Non-static method JRoute::_() should not be called statically in /home/vasginek/public_html/modules/mod_mainmenu/legacy.php on line 107

Strict Standards: Non-static method JFactory::getApplication() should not be called statically in /home/vasginek/public_html/libraries/joomla/methods.php on line 41

Strict Standards: Non-static method JFactory::getConfig() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/application.php on line 372

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/vasginek/public_html/libraries/loader.php on line 186

Strict Standards: Non-static method JRouter::getInstance() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 674

Strict Standards: Non-static method JError::isError() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 675

Strict Standards: Non-static method JSite::getMenu() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/router.php on line 419

Strict Standards: Non-static method JApplication::getMenu() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/application.php on line 345

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/vasginek/public_html/libraries/loader.php on line 186

Strict Standards: Non-static method JMenu::getInstance() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 720

Strict Standards: Non-static method JError::isError() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 721

Strict Standards: Non-static method JFactory::getApplication() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/router.php on line 401

Strict Standards: Non-static method JSite::getMenu() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/router.php on line 295

Strict Standards: Non-static method JApplication::getMenu() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/application.php on line 345

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/vasginek/public_html/libraries/loader.php on line 186

Strict Standards: Non-static method JMenu::getInstance() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 720

Strict Standards: Non-static method JError::isError() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 721

Strict Standards: Non-static method JSite::getMenu() should not be called statically in /home/vasginek/public_html/components/com_content/router.php on line 19

Strict Standards: Non-static method JApplication::getMenu() should not be called statically in /home/vasginek/public_html/includes/application.php on line 345

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/vasginek/public_html/libraries/loader.php on line 186

Strict Standards: Non-static method JMenu::getInstance() should not be called statically in /home/vasginek/public_html/libraries/joomla/application/application.php on line 720

Strict Standards: Non-static method JError::isError() should not be called statically in /home/vasginek/public_html/libraries/joomla/application/application.php on line 721

Strict Standards: Non-static method JFactory::getApplication() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/router.php on line 90

Strict Standards: Non-static method JFactory::getConfig() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 394

Strict Standards: Non-static method JFactory::getConfig() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 394

Strict Standards: Non-static method JURI::base() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/router.php on line 109

Strict Standards: Non-static method JRegistryFormat::getInstance() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/registry/registry.php on line 373

Strict Standards: Non-static method JFilterInput::clean() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/registry/format.php on line 45

Strict Standards: Non-static method JRoute::_() should not be called statically in /home/vasginek/public_html/modules/mod_mainmenu/legacy.php on line 107

Strict Standards: Non-static method JFactory::getApplication() should not be called statically in /home/vasginek/public_html/libraries/joomla/methods.php on line 41

Strict Standards: Non-static method JFactory::getConfig() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/application.php on line 372

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/vasginek/public_html/libraries/loader.php on line 186

Strict Standards: Non-static method JRouter::getInstance() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 674

Strict Standards: Non-static method JError::isError() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 675

Strict Standards: Non-static method JSite::getMenu() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/router.php on line 419

Strict Standards: Non-static method JApplication::getMenu() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/application.php on line 345

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/vasginek/public_html/libraries/loader.php on line 186

Strict Standards: Non-static method JMenu::getInstance() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 720

Strict Standards: Non-static method JError::isError() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 721

Strict Standards: Non-static method JFactory::getApplication() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/router.php on line 401

Strict Standards: Non-static method JSite::getMenu() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/router.php on line 295

Strict Standards: Non-static method JApplication::getMenu() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/application.php on line 345

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/vasginek/public_html/libraries/loader.php on line 186

Strict Standards: Non-static method JMenu::getInstance() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 720

Strict Standards: Non-static method JError::isError() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 721

Strict Standards: Non-static method JComponentHelper::getComponent() should not be called statically in /home/vasginek/public_html/components/com_contact/router.php on line 23

Strict Standards: Non-static method JComponentHelper::_load() should not be called statically in /home/vasginek/public_html/libraries/joomla/application/component/helper.php on line 39

Strict Standards: Non-static method JSite::getMenu() should not be called statically in /home/vasginek/public_html/components/com_contact/router.php on line 24

Strict Standards: Non-static method JApplication::getMenu() should not be called statically in /home/vasginek/public_html/includes/application.php on line 345

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/vasginek/public_html/libraries/loader.php on line 186

Strict Standards: Non-static method JMenu::getInstance() should not be called statically in /home/vasginek/public_html/libraries/joomla/application/application.php on line 720

Strict Standards: Non-static method JError::isError() should not be called statically in /home/vasginek/public_html/libraries/joomla/application/application.php on line 721

Strict Standards: Non-static method JFactory::getApplication() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/router.php on line 90

Strict Standards: Non-static method JFactory::getConfig() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 394

Strict Standards: Non-static method JFactory::getConfig() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 394

Strict Standards: Non-static method JURI::base() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/router.php on line 109

Strict Standards: Non-static method JRegistryFormat::getInstance() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/registry/registry.php on line 373

Strict Standards: Non-static method JFilterInput::clean() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/registry/format.php on line 45

Strict Standards: Non-static method JRoute::_() should not be called statically in /home/vasginek/public_html/modules/mod_mainmenu/legacy.php on line 107

Strict Standards: Non-static method JFactory::getApplication() should not be called statically in /home/vasginek/public_html/libraries/joomla/methods.php on line 41

Strict Standards: Non-static method JFactory::getConfig() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/application.php on line 372

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/vasginek/public_html/libraries/loader.php on line 186

Strict Standards: Non-static method JRouter::getInstance() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 674

Strict Standards: Non-static method JError::isError() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 675

Strict Standards: Non-static method JSite::getMenu() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/router.php on line 419

Strict Standards: Non-static method JApplication::getMenu() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/application.php on line 345

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/vasginek/public_html/libraries/loader.php on line 186

Strict Standards: Non-static method JMenu::getInstance() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 720

Strict Standards: Non-static method JError::isError() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 721

Strict Standards: Non-static method JFactory::getApplication() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/router.php on line 401

Strict Standards: Non-static method JSite::getMenu() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/router.php on line 295

Strict Standards: Non-static method JApplication::getMenu() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/application.php on line 345

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/vasginek/public_html/libraries/loader.php on line 186

Strict Standards: Non-static method JMenu::getInstance() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 720

Strict Standards: Non-static method JError::isError() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 721

Strict Standards: Non-static method JSite::getMenu() should not be called statically in /home/vasginek/public_html/components/com_content/router.php on line 19

Strict Standards: Non-static method JApplication::getMenu() should not be called statically in /home/vasginek/public_html/includes/application.php on line 345

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/vasginek/public_html/libraries/loader.php on line 186

Strict Standards: Non-static method JMenu::getInstance() should not be called statically in /home/vasginek/public_html/libraries/joomla/application/application.php on line 720

Strict Standards: Non-static method JError::isError() should not be called statically in /home/vasginek/public_html/libraries/joomla/application/application.php on line 721

Strict Standards: Non-static method JFactory::getApplication() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/router.php on line 90

Strict Standards: Non-static method JFactory::getConfig() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 394

Strict Standards: Non-static method JFactory::getConfig() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 394

Strict Standards: Non-static method JURI::base() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/router.php on line 109

Strict Standards: Non-static method JRegistryFormat::getInstance() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/registry/registry.php on line 373

Strict Standards: Non-static method JFilterInput::clean() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/registry/format.php on line 45

Strict Standards: Non-static method JRoute::_() should not be called statically in /home/vasginek/public_html/modules/mod_mainmenu/legacy.php on line 107

Strict Standards: Non-static method JFactory::getApplication() should not be called statically in /home/vasginek/public_html/libraries/joomla/methods.php on line 41

Strict Standards: Non-static method JFactory::getConfig() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/application.php on line 372

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/vasginek/public_html/libraries/loader.php on line 186

Strict Standards: Non-static method JRouter::getInstance() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 674

Strict Standards: Non-static method JError::isError() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 675

Strict Standards: Non-static method JSite::getMenu() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/router.php on line 419

Strict Standards: Non-static method JApplication::getMenu() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/application.php on line 345

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/vasginek/public_html/libraries/loader.php on line 186

Strict Standards: Non-static method JMenu::getInstance() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 720

Strict Standards: Non-static method JError::isError() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 721

Strict Standards: Non-static method JFactory::getApplication() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/router.php on line 401

Strict Standards: Non-static method JSite::getMenu() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/router.php on line 295

Strict Standards: Non-static method JApplication::getMenu() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/application.php on line 345

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/vasginek/public_html/libraries/loader.php on line 186

Strict Standards: Non-static method JMenu::getInstance() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 720

Strict Standards: Non-static method JError::isError() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 721

Strict Standards: Non-static method JSite::getMenu() should not be called statically in /home/vasginek/public_html/components/com_content/router.php on line 19

Strict Standards: Non-static method JApplication::getMenu() should not be called statically in /home/vasginek/public_html/includes/application.php on line 345

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/vasginek/public_html/libraries/loader.php on line 186

Strict Standards: Non-static method JMenu::getInstance() should not be called statically in /home/vasginek/public_html/libraries/joomla/application/application.php on line 720

Strict Standards: Non-static method JError::isError() should not be called statically in /home/vasginek/public_html/libraries/joomla/application/application.php on line 721

Strict Standards: Non-static method JFactory::getApplication() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/router.php on line 90

Strict Standards: Non-static method JFactory::getConfig() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 394

Strict Standards: Non-static method JFactory::getConfig() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 394

Strict Standards: Non-static method JURI::base() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/router.php on line 109

Strict Standards: Non-static method JRegistryFormat::getInstance() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/registry/registry.php on line 373

Strict Standards: Non-static method JFilterInput::clean() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/registry/format.php on line 45

Strict Standards: Non-static method JRoute::_() should not be called statically in /home/vasginek/public_html/modules/mod_mainmenu/legacy.php on line 107

Strict Standards: Non-static method JFactory::getApplication() should not be called statically in /home/vasginek/public_html/libraries/joomla/methods.php on line 41

Strict Standards: Non-static method JFactory::getConfig() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/application.php on line 372

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/vasginek/public_html/libraries/loader.php on line 186

Strict Standards: Non-static method JRouter::getInstance() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 674

Strict Standards: Non-static method JError::isError() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/libraries/joomla/application/application.php on line 675

Strict Standards: Non-static method JSite::getMenu() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/router.php on line 419

Strict Standards: Non-static method JApplication::getMenu() should not be called statically, assuming $this from incompatible context in /home/vasginek/public_html/includes/application.php on line 345

Strict Standards: Non-static method JLoader::import() should not be called statically in /home/vasginek/public_html/libraries/loader.php on line 186

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BMI Kalkulator

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Unesite datum poslednjeg ciklusa:
Skrining hromozomopatija
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LošeNajbolje 
Napisao Administrator   

Hromozomopatije su poremećaji hromozoma - nasledne osnove deteta, a najčešći ovakav poremećaj kod živorođene dece je trizomija 21 (Daunov sindrom, mongoloidnost)...              

 

Svaka žena ima rizik da rodi bebu koja ima problem sa hromozomima. Za odgovorom da li je kod kod Vas povećan rizik da kod bebe postoji problem sa hromozomima, možemo tragati na dva načina - neinvazivno i invazivno.

 

Šta je neinvazivni skrining hromozomopatije?

Skrining predstavlja pregled cele populacije u cilju definisanja grupe kod koje je povećan rizik od neke pojave. U ovom slučaju, neinvazivni skrining hromozomopatija obuhvata godine majke, Ultrazvučni skrining i biohemijski skrining. 

 

Kako godine utiču na rizik od hromozomopatija kod bebe?

Rizik se procenjuje po principu «što je starija majka, veći je rizik da je beba bolesna», ali na ovaj način se kao rizična grupa definise samo 30% od onih beba koje će zaista i imati hromozomopatiju i zato se, u savremenom skriningu, godine majke koriste samo kao polazna osnova za procenu rizika.

 

Na koji način se radi Ultrazvučni skrining hromozomopatija?

Ultrazvučni skrining hromozomopatija se deli na skrining u prvom i u drugom trimestru.ULTRAZVUČNI PREGLED U PRVOM TRIMESTRU, IZMEĐU 11-14 NEDELJA GESTACIJETokom ultrazvučnog pregleda, u ovom periodu pregleda se anatomija ploda i izmeri debljina bebinog vrata (ovaj metod rizičnim oznacava oko 75% beba sa hromozomopatijama, prema principu «što je bebin vrat debiji, veća je šansa da je beba bolesna», a otkriva 75%, jer oko 25% beba sa hromozomopatijama NEMA debeo vrat). ULTRAZVUČNI PREGLED U DRUGOM TRIMESTRU, OKO 20 NEDELJA GESTACIJEU ovom periodu detaljno se pregleda izgled bebe - ukoliko se ne nađe nikakav problem, rizik za hromozomopatije se smanjuje, a ukoliko se nađe, povećava se. Tokom pregleda traga se za određenim znakovima, tzv «Ultrazvučnim markerima» za hromozomopatije i rizik procenjuje na osnovu toga da li oni postoje ili ne.

 

 

Šta je to biohemijski skrining romozomopatija?

Biohemijski skrining se radi pregledom krvi majke, a zasniva se na utvrđivanju postojanja odredenih materija u krvi majke u većim ili manjim količinama u odnosu na «normalu». Na osnovu toga se menja početni rizik, koji se zasniva na starosti majke i debljini bebinog vrata.Postoje ranije određene fiziološke (,,normalne") vrednosti nivoa hormona koji se koriste u biohemijskom skriningu koje su specifične za odredenu populaciju i za odredenu gestacijsku nedelju. Na osnovu informacije o rođenju zdravog deteta, prosečna vrednost datih hormona u krvi kod žena sa zdravim novorođenčetom oznacava se kao «medijana» (daje joj se vrednost 1), a sva odstupanja od te vrednosti za gestacijsku nedelju izračunavaju se kao «umnošci medijane» (multiple of median - MoM). Što je vrednost bliža medijani (1 MoM) šanse da je beba dobro su veće. Biohemijski skrining se radi se u prvom (između 12 i 14 nedelja starosti trudnoće) ili drugom trimestru trudnoće (između 16 i 19 nedelja), sam ili, što je daleko bolje, u sklopu sa Ultrazvučnim pregledom.U drugom trimestru biohemijski skrining može se koristiti na dva načina - kao skrining hromozomopatija ali i defekata tzv. neuralne cevi (lobanje, kičme) i prednjeg trbušnog zida.Biohemijski skrining hromozomopatija u prvom trimestruU ovom periodu ovaj metod, zajedno sa godinama majke i debljinom bebinog vrata, otkriva oko 90% beba sa hromozomopatijama. Analiziraju se dve materije u krvi majke:

• slobodni beta HCG i

• PAPP-A.Kod dece sa Daunovim sindromom slobodni beta HCG je ČESĆE povišen (umnožak medijane 1,8 i veci) a PAPP-A je ČEŠĆE snižen (umnožak medijane 0,4 i manji).

Biohemijski skrining hromozomopatija u drugom trimestruU drugom trimestru se biohemijski skrining koristi dvojako:

• za korigovanje rizika od hromozomopatija ali i

• za postavljenje sumnje za postojanje nekih anomalija na bebi.

 

Za prvu namenu koriste se dva ili tri hormona (što zavisi od centra koji vrši skrining) i to: alfa-feto protein (AFP), beta humani horionski gonadotropin (beta HCG) i, u nekim centrima, estriol (uE3).

Kod beba sa Daunovim sindromom:

• AFP je ČEŠĆE snižen (umnožak medijane 0,75 i manji), sto se mora posmatrati u kontekstu godina, jer je kod mlađih žena ta granica niža,

• beta HCG je ČEŠĆE povišen (umnožak medijane iznad 1,8), dokj e i

• estriol ČEŠĆE povišen.

Kod nekih drugih hromozomopatija ove vrednosti su nesto drugacije, ali je Daunov sindrom najčešća, te je najvažnije znati te vrednosti.U slučajevima gde sva tri hormona, i niži AFP i viši beta HCG i niži estriol povećaju rizik od hromozomopatija, savetuje se kariotipizacija ploda, odnosno analiza hromozoma ploda.Što se nekih anomalija tiče (na prvom mestu defekata tzv. «neuralne cevi» - kičmenog stuba i lobanje, odnosno prednjeg trbušnog zida), kod njih je situacija obrnuta:

• AFP, koji je jedini od značaja, je značajno povišen, iznad 2 unmoška medijane (2 MoM).

 

Za razliku od slučajeva kod kojih postoji sumnja na hromozomopatije, kod kojih skrining NE TREBA PONAVLJATI, u slučajevima kod kojih je AFP povišen ispitivanje se može ponoviti nakon nedelju dana.Ukoliko je nivo u opadanju, znači da se radilo o prolaznoj pojavi, koja je najverovatnije rezultat prethodnioh krvarenja u amnionskoj šupljini. Obavezno je kod ovakvih nalaza povišenog AFP-a uraditi detaljan ultrazvučni pregled u referentnom centru za prenatalni ultrazvuk, da bi se dodatno potvrdilo nepostojanje anomalije ploda.U slučajevima povišenog AFP, kariotipizacija ploda (vađenjem plodove vode ili krvi) neće dati odgovore, jer takvi poremećaji najčešće ne idu sa patološkim kariotipom.Ukoliko skrining pokaže da postoji povećani rizik od hromozomopatija, to NE ZNAČI DA JE DETE BOLESNO, samo znači da su se rizici izmenili, ali da su šanse i dalje veoma velike da je sa detetom sve u redu.Rizik od 1 u 300 i dalje znači da je u 299 slucajeva nalaz normalan, rizik od 1 u 30 da je u 29 slucajeva beba dobro.Skrining nam, dakle, služi samo kao orijentacija, da bismo znali da li treba dalje ispitivati stanje ploda ili da on spada u onu niskorizičnu grupu kod koje bez daljih ispitivanja nastavljamo trudnoću.

 

Šta se radi kada skrining pokaže da postoji povećan rizik od hromozomopatija kod bebe?

Kada se nakon skrininga pokaže da postoji povećan rizik od hromozomopatija, trudnica se upućuje kod genetičara i odiučuje se da li je potrebno raditi invazivnu dijagnostiku.Invazivna dijagnostika predstavlja uzimanje nekog tkiva - posteljice, plodove vode ili bebine krvi, u cilju odredivanja stanja hromozoma bebe- kariotipa.

Postoji nekoliko vrsta:

- biopsija horionskih čupica (CVS)

- radi se posle 10. nedelje gestacije.Može se, kao biopsija posteljice, raditi do 32 nedelje;

- vađenje plodove vode (amniocenteza)

- radi se između 16. i 19. nedelje;

- vađenje plodove krvi (kordocenteza)

- radi se posle 20. nedelje.

 
 
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