Faculty of Medicine

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Maternal, Fetal, and Neonatal Outcomes of Gestation in Women with and Without Brucella Infection
(Maad Rayan Publishing Company, 2023-03)
Majzoobi, Mohammad Mahdi
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Teimori, Roya
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Nouri, Shahla
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Karami, Manoochehr
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Maternal, fetal, and neonatal complications of brucellosis in pregnant women are probably higher than those in the general population. This comparative study aimed to survey the mentioned complications in pregnant women with positive and negative Brucella serologic tests.
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Hypertensive disorders in women with peripartum cardiomyopathy: insights from the ESC EORP PPCM Registr
(John Wiley & Sons Ltd on behalf of European Society of Cardiology, 2021-12-23)
Alice M Jackson
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Mark C Petrie
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Alexandra Frogoudaki
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Cécile Laroche
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Finn Gustafsson
Hypertensive disorders occur in women with peripartum cardiomyopathy (PPCM). How often hypertensive disorders co-exist, and to what extent they impact outcomes, is less clear. We describe differences in phenotype and outcomes in women with PPCM with and without hypertensive disorders during pregnancy. Methods and results: The European Society of Cardiology EURObservational Research Programme PPCM Registry enrolled women with PPCM from 2012-2018. Three groups were examined: (i) women without hypertension (PPCM-noHTN); (ii) women with hypertension but without pre-eclampsia (PPCM-HTN); (iii) women with pre-eclampsia (PPCM-PE). Maternal (6-month) and neonatal outcomes were compared. Of 735 women included, 452 (61.5%) had PPCM-noHTN, 99 (13.5%) had PPCM-HTN and 184 (25.0%) had PPCM-PE. Compared to women with PPCM-noHTN, women with PPCM-PE had more severe symptoms (New York Heart Association class IV in 44.4% vs. 29.9%, P < 0.001), more frequent signs of heart failure (pulmonary rales in 70.7% vs. 55.4%, P = 0.002), a higher baseline left ventricular ejection fraction (LVEF) (32.7% vs. 30.7%, P = 0.005) and a smaller left ventricular end-diastolic diameter (57.4 ± 6.7 mm vs. 59.8 ± 8.1 mm, P = 0.001). There were no differences in the frequencies of death from any cause, rehospitalization for any cause, stroke, or thromboembolic events. Compared to women with PPCM-noHTN, women with PPCM-PE had a greater likelihood of left ventricular recovery (LVEF ≥ 50%) (adjusted odds ratio 2.08, 95% confidence interval 1.21-3.57) and an adverse neonatal outcome (composite of termination, miscarriage, low birth weight or neonatal death) (adjusted odds ratio 2.84, 95% confidence interval 1.66-4.87). Conclusion: Differences exist in phenotype, recovery of cardiac function and neonatal outcomes according to hypertensive status in women with PPCM.
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Recurrence of venous thromboembolism in patients with recent gestational deep vein thrombosis or pulmonary embolism: Findings from the RIETE Registry
(Elsevier, 2016)
Barillari G
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Londero AP
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Brenner B
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Nauffal D
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Muñoz-Torrero JF
Introduction: The aim of this study was to investigate the recurrence rate of venous thromboembolism (VTE) and the prevalence of major bleeding or death in patients with previous VTE in pregnancy and puerperium. Risk factors for VTE recurrence were also assessed. Materials and methods: We evaluated a cohort of patients enrolled in the international, multicenter, prospective Registro Informatizado de la Enfermedad Trombo-Embólica (RIETE) registry with objectively confirmed VTE. Results: In the registry, 607 women were presenting with VTE that occurred during pregnancy or puerperium. The 2-year VTE recurrence rate was 3.3% (CI: 95 1.5-5.0%) and the recurrent VTE incidence rate was 2.28events/100 patients-year. Among the 16 cases of VTE recurrence 11 cases appeared during drug treatment while only five cases were diagnosed after therapy discontinuation. No significant difference was found in treatment duration among these two subgroups of VTE recurrence cases and women without recurrence. Furthermore, the use of thrombolytics and inferior vena cava filter in initial treatment was associated to an increased risk of VTE recurrence. Conclusions: The current study provides new insights on VTE recurrence rate in patients with deep vein thrombosis (DVT) or pulmonary embolism (PE) that occurred in pregnancy or postpartum period. These findings can contribute to risk assessment of thrombotic burden, thereby allowing for better decision making regarding antithrombotic management in this clinical setting.
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Rh D genotyping in pregnancy-present and future
(ECronicon Open Access, 2021-11-01)
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Hristova Dimcheva, Anita
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Dejanova-Ilijevska, Violeta
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Background: The RBC’s (Red Blood Cell’s) antigen can cause alloimmunisation during pregnancy if the fetus inherited the antigen from the father that is not present in the mother. In most of the cases the RBS’s antibody are from IgG class and they cross the placental barrier, binding the Fc receptors as an active one way transport from the mother to the fetus and never cross versa. Aim: To emphasize that methods of genotyping in pregnancy improve the management of sensibilised pregnancies in high risk of HDFN easier and safer minimising the unnecessary procedure. Prove that with genotyping antenatal use of RhIG can be reduced, same as use of RhD-negative blood for transfusion. Materials and Methods: All pregnant women were tested for ABO, RhD, Rh phenotype, K and screening of alloantibodies in the first trimester of pregnancy. Pregnant women who have the DVI phenotype are typed as D-negative. Pregnant women, 50 in total, with weak expression of D, with score < 2+, including those with DEL phenotype, were tested with a panel of D monoclonal antibodies, commercial kit, or by molecular testing, for RhD variants. Results: The results that we have obtained show that 17 samples were RhD-negative and 33 samples showed results for weak D: weak D Type 1 (60,6%), Type 2 (12,2%), Type 3 (24,2%) and only 1 pregnant woman was RhD Type 4. The research also included 30 pregnant women where the RhD fetal status had been detected by non-invasive technique from the mother’s plasma, by Real time PCR method, between the 12 and 31 gestation week. Acquired results demonstrated that 12 fetuses were female, 16 were male and 3 fetuses were without specified sex. Conclusion: In our study only 3% of RhD-negative mothers needed RhIG prophylaxis, and 97% were weak D variants 1 - 3 that we can consider as RhD-positive and they didn’t need an RhIG prophylaxis, subsequently they can be transfused with RhD-positive blood. According to the results, we provide RhIG antenatal prophylaxis in 97% unnecessarily and expose the women on human product, with all risk of it. Also, there is a possibility to save a stock of RhD-negative blood in these women, if the transfusion is necessary.
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Pregnancy with Large Intra-Abdominal Tumor – Case Report
(International Organization Of Scientific Research (IOSR), 2020-05-01)
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Jasna Bushinoska
Abstract: The aim of this case report, is to make a Clinical presentation of a rare case of pregnancy, followed by large intra-abdominal intestinal tumor, which compromised the pregnancy and it was the reason for premature delivery. This tumor was diagnosed in 32 estational week of the pregnancy, when patient started with the symptoms of sudden and extreme vomiting and collapsing. She was hospitalized at the Department of Pathologic Pregnancies at Gynecology and Obstetrics Clinic in Skopje, after she was sent from a Clinical Hospital- Shtip, were she was first hospitalized. During the hospitalization at our Department, she undergo several Obstetrics and abdominal ultrasound examinations, hematological examinations, serological and infective examinations, tumor markers, gastroscopy and MRI which shown large abdominal intra peritoneal tumor located under the liver and gaster, dislocated the bowels toward the lower and the frontal part of the abdomen. The patient was submitted to a rehydration and symptomatic therapy, double antibiotic, anti anemic and thromboprophylactic therapy to relieve the symptoms of vomiting and exhaustion. A fetal maturation with Flosteron 14mg was provided for two days, in 2 doses, within a period of 18 days. The premature delivery was planned with a surgeon. The patient gave birth 21 days after her hospitalization in the 35-th week of the pregnancy, with a Cesarean section and a medial infra umbilical incision. She gave birth to a living 2200 g male, 44 cm long with APGAR score 7/8. The Cesarean section was followed by opening of the upper abdomen with para- and supra umbilical incision and after the large abdominal tumor was removed by abdominal surgeon, it was sent to Pathohysthological examination. The pathohystologic diagnosis was: Adenocarcinoma intestini crassi Stage II b. In rare cases, pregnancy can be compromised by large intra-abdominal tumors which can put the health of both, the mother and the fetus in danger. The entire pregnancy period should be carefully observed, too, since the symptoms can sometimes lead to interdisciplinary examinations and consultations with other specialists.
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Early Ultrasound Screening for Fetal Malformations in the Second Pregnancy after Combined Modality Treatment for Hodgkin’s Disease: A Case Report
(SCVISION Publishers, 2017-11)
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Jordancho Ivanov
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ABSTRACT Introduction: Therapeutic progress in HD has led to a high rate of cure, but at the expense of some side effects. Abnormalities reported so far are: cardiac toxicity, pulmonary toxicity, endocrinal failure, second cancers and congenital malformations. Although several studies reported in the literature showed no or slightly increased risk of congenital abnormalities among newborns of women previously treated for Hodgkin’s disease compared with the general population, abnormalities do occur and sometimes they are very odd and difficult. This is the first report of delayed appearance of specific malformations found in the literature. Case Report: We report a case of female patient, 25 years old, macedonian, presented with Hodgkin’s disease, subtype nodular sclerosis, stage IIIA. The patient received chemotherapy according to ABVD protocol – 6 cycles. Thereafter she received mantle field radiation with 3600 cGy. The first and normal pregnancy occurred after 36 months. Second pregnancy occurred 87 months after completion of treatment. At 13th gestational week ultrasound assessment revealed malformations and induced abortion was performed. A male fetus with malformations on the head such as proboscis, cyclopia and omphalocele on the front abdominal wall containing liver and small bowels was found. Conclusion: I consider this case important in bringing the potential late side-effect to the attention of both patients and doctors. They should be alert for the risk of congenital abnormalities in newborns of women previously treated for Hodgkin’s disease, especially with combined modality treatment, and should check for them during pregnancy, at birth, in early childhood, or in adulthood. Thus, odd and difficult malformations could be avoided.

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