Faculty of Medicine
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Item type:Publication, INCIDENTAL STUMP DURING CESAREAN SECTION IN IVFEGG DONATION PREGNANCY: A CASE EMPHASIZING THE IMPERATIVE OF ROUTINE HISTOPATHOLOGICAL EVALUATION OF MYOMAS(Македонско лекарско друштво = Macedonian medical association, 2024-12); ; ; Uterine myomas are commonly benign tumors of the female reproductive system. Although many are diagnosed preoperatively, some are incidentally discovered during obstetric surgery, such as the cesarean section. This case illustrates the necessity of routinely sending any excised uterine myoma for histopathological evaluation to determine its true biological potential and guide further management. We report the case of a 45-year-old primiparous woman (G1P0A1) with a history of in vitro fertilization (IVF) and egg donation, admitted at 37+4 weeks of gestation for elective cesarean section. The procedure was uncomplicated, yet multiple small intramural and subserous myomas were incidentally observed and excised. Histopathological analysis revealed a Smooth Muscle Tumor of Uncertain Malignant Potential (STUMP), characterized by areas of focal necrosis, mild cytologic atypia, and low mitotic activity-features straddling benign leiomyoma and malignant leiomyosarcoma designations. STUMP comprises a rare histologic category representing 0.3-0.9% of presumed fibroids, with unpredictable behavior. Recurrence rates vary from 7% to 36%, with occasional progression to leiomyosarcoma (median time to recurrence ~79 months) [1-5]. Because of this uncertain prognosis, we recommended followup imaging and multidisciplinary consultation. A postoperative MRI followed by hysterectomy revealed additional subserous leiomyomas and chronic granulomatous inflammation. Given the potential risk of progression, the patient underwent definitive hysterectomy with ovarian preservation. This case highlights the crucial role of histopathological evaluation in incidental uterine myomas. Even small lesions may harbor atypical or borderline features warranting close monitoring or definitive treatment. Early detection and accurate classification influence patient prognosis and enable timely surgical and therapeutic interventions. When STUMP is diagnosed, hysterectomy is often recommended as definitive management to reduce recurrence or malignant transformation risk. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Subdural hematoma with symptom of epileptic attacks after subarachnoidal anesthesia - a case report(University of Nis, Faculty of Medicine, 2018); - Some of the metrics are blocked by yourconsent settings
Item type:Publication, ROBSON CLASSIFICATION OF CESAREAN SECTION IN NORTH MACEDONIA - CURRENT TRENDS(Македонско лекарско друштво = Macedonian medical association, 2021); ; ; ; Dalipi, AdelinaAbstract Introduction. Over the last few decades, the global cesarean section rate has significantly increased and reached an unprecedented level. The World Health Organization (WHO) has advised that cesarean section (CS) rates should not rise above 15%. Several classify¬cation systems have been proposed to tackle the increased cesarean section epidemic. Most of the countries have adopted and started using the Robson (10 groups) classification as the best and the one that is the easiest internationally applicable CS classification. Aim. To present the Robson classification as a way to start better classification of cesarean section and hence to reduce the number of unnecessary cesarean section deliveries. Methods: This study was realized at the University Clinic for Gynecology and Obstetrics in Skopje, North Macedonia. It is a retrospective study where two years were compared. Results. The rate of cesarean sections for 2017 was 38.5% and for 2019 42.6%. Categorization of deliveries according to Robson criteria showed a different rate of cesarean section for each subgroup. Discussion. The implementation of the Robson classi-fication in most countries has shown a reduction in the number of cesarean deliveries and thus a reduction in overall maternal and neonatal morbidity and mortality. The analysis has shown that group 5 had the largest number of cesarean section deliveries in both years, 2017 and 2019; these were patients with previous cesarean sections. They were followed by group 1 and 2, or pri¬mi¬para with spontaneous onset and induced delivery. Conclusion. The goal of Robson clasification is to identify the target groups that contribute most in the percentage of cesarean sections and to act on these tar-get groups through appropriate education and training. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, MATERNAL OBESITY AS A PREDICTOR OF UNFAVORABLE PREGNANCY OUTCOME(Македонско лекарско друштво = Macedonia Medical Association, 2017); ; ; ; Introduction: Obesity is a growing concern worldwide. Maternal obesity has significant health implications, contributing to increased morbidity for mother and baby. Body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults. Aim. The aim of the study was to show a correlation between BMI, delivery mode, hypertension, and prematurity. Methods. The study was done at the University Clinic for Gynecology and Obstetrics. It was a case-control observational prospective study, in which 63 pregnant women were evaluated. According to BMI pregnant women were divided into 3 groups: normal, overweight, and obese. Women were recruited in the 28th gestational weeks and were followed until they delivered. Of interest were: hypertensive disorders in pregnancy, delivery mode, prematurity, Apgar score, and newborns weight. Results. We found that increased BMI has a strong association with hypertensive disorders in pregnancy, prematurity as well as with an increased Cesarean section. We found that more than 76% of obese patients (BMI>30 kg/m2 ) were delivered with a cesarean section, median gestational age at delivery was 35.0 gestational weeks and hypertension in pregnancy was seen in 71% of these patients. Conclusion. Maternal BMI shows strong associations with pregnancy complications and outcomes. Preventive strategies have to be introduced to reduce obesity and improve perinatal outcomes for both mother and baby. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Acute appendicitis in the third trimester of a pregnancy finished with spontaneous vaginal delivery(Asclepius, 2018); ; ; Acute appendicitis is the most common surgical problem occurring during pregnancy. Its incidence is more common in the second trimester and is confirmed in 1/1000 pregnancies. Clinical manifestations of acute appendicitis in pregnant patients are generally very similar to non- pregnant patients. We present, here, the case of a 29-year-old pregnant patient at 35+4 weeks of gestation with the signs of acute appendicitis. The patient underwent a successful open appendectomy of her perforated appendix, without performing a cesarean section (CS) at the same time. 5 weeks postoperatively, at term, labor was induced with vaginal prostaglandins and the patient delivered a healthy female baby without any complications. Immediate diagnosis of acute appendicitis during pregnancy is recommended and management with the suitable surgical intervention should not be delayed for >24 h as it increases the risk of perforation with its subsequent critical complications. The treatment of acute appendicitis is always surgical, with an appendectomy and perioperative broad-spectrum antibiotics. Except in cases of high maternal and fetal mortality, a CS should not be done simultaneously with the appendectomy in cases of a perforated appendix with diffuse peritonitis, due to the very high risk of dehiscence of the uterus.