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Author: search.filters.author.Milkovski, DanielSubject: search.filters.subject.pregnancy

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    Echocardiographic Heart Changes in Pregnancies Complicated with Gestation Hypertension and Preeclampsia
    (International Scientific Invention Journals, 2019-02-13)
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    Milkovski, Daniel
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    Introduction: Echocardiography as an imaging method is increasingly being used in obstetrics in the management of hemodynamic changes which occur in normal but also in pregnancies with gestational hypertension/preeclampsia. Aim: The aim of the study is to show that some of the heart changes in pregnancies complicated with gestational hypertension and preeclampsia are abnormal and further follow up of these patients is needed. Methods: A total of 81 patients were enrolled in the study. The patients were further divided in two groups. Pregnant women with gestational hypertension or preeclampsia (51) and a control group of normotensive pregnancies (30). A total of 3 echocardiograph exam were made, the first upon entry in the study (28 -34 g.w), the second 2 weeks after delivery and the last 6 months after delivery. Results and discussion: We found several statistically significant results that involve the IVS, PWLV, LKM, left chamber hypertrophy and diastolic function. Diastolic dysfunction usually shows up before systolic dysfunction in the evolution of ischemic/hypertensive cardiovascular disease and is of prognostic value in predicting long term cardiovascular morbidity. The changes seen 6 months after delivery on our last control mean that those changes are permanent and need further prevention strategies. Conclusion: From the noninvasive methods echocardiography is the most favorable method in identifying structural changes and functional changes in pregnancies with hypertension. Echocardiography allows fast, reproducible information and is both safe for mother and fetus.
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    DIASTOLIC DYSFUNCTION IN GESTATIONAL HYPERTENSION/ PREECLAMPSIA
    (DEPARTMENT OF ANAESTHESIA AND REANIMATION, FACULTY OF MEDICINE, “SS. CYRIL AND METHODIUS” UNIVERSITY, SKOPJE, MACEDONIA, 2024-03)
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    Milkovski, Daniel
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    Introduction: Hypertensive disorders in pregnancy including preeclampsia are present in 10% of pregnancies and are one of the biggest reasons for both maternal and fetal morbidity and mortality. Materials and Methods: The study was undertaken at the University Clinic for Gynecology and Obstetrics in Skopje, North Macedonia. After initial assessment, 81 patients were enrolled in the study after signing a written consent. Patients were divided into two groups depending on whether they had hypertension or not. In the hypertensive group 51 patients were enrolled and 30 normotensive pregnancies were used as controls. Results: Based on the values ​​of the parameters of diastolic function obtained with PDA of the transmittance flow and the values ​​of the parameters obtained with TDI of the longitudinal movement of the mitral ring, diastolic dysfunction was found in 17 (33.2%) pregnant women of the studied population, LV function (p <0.001). In the pregnant women from the examined group in whom the presence of LV diastolic dysfunction was identified, the disorders were of mild degree, that is type of delayed relaxation of LV in all 17 pregnant women. Conclusion: Early recognition and management of symptoms are essential. Women who suffer from hypertensive disorders in pregnancy require close monitoring after delivery.
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    SMALL INTESTINE INTUSSUSCEPTION DUE TO GASTROINTESTINAL STROMAL TUMOUR IN PREGNANCY: A CASE REPORT
    (Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2022)
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    Simonovska Paneva, Iva
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    Gastrointestinal stromal tumour (GIST) is very rare in pregnancy and only a few cases have been described in the literature. We present a case of a 38-year-old primigravida, presented with non-specific symptoms for the first time in the second trimester. Due to the non-specificity of the symptoms on one hand and the rarity of the tumour on the other, it took a long time for the final diagnosis to be made. Accidentally, on a routine obstetric ultrasound examination, a solid tumour formation was observed, localized under the lower pole of the left kidney. On MRI of the abdomen, in front of the left kidney there was a tubular structure, in close relation with small intestine, suspected for intussusception. At 28 weeks of gestation, an exploratory laparotomy was performed with resection of the involved part of the jejunum and TT anastomosis. Pregnancy was terminated electively, by caesarean section, in 38+6 gestational weeks. The clinical presentation of the GIST depends on the primary location of the tumour. Due to the extremely rare occurrence of these tumours in pregnancy, there is no solid scientific evidence for the most appropriate time of their treatment and the time of termination of pregnancy. The biggest challenge in pregnancy is timely diagnosis and treatment, without impact on the foetus. A multidisciplinary approach is needed. In our case, the severity of the mother’s symptoms outweighed the danger to the foetus from general anaesthesia and surgery itself.
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    Acute appendicitis in the third trimester of a pregnancy finished with spontaneous vaginal delivery
    (Asclepius, 2018)
    Milkovski, Daniel
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    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.