Faculty of Medicine

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VITAMIN D STATUS AMONG PREGNANT WOMEN OF NORTH MACEDONIA:ASSESSING DEFICIENCY RATES AND ASSOCIATED RISKS FACTORS
(Walter de Gruyter, 2025-04-16)
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Aleksovski, Vasko
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Gjorgievska Nikolovska, Elena
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Objective. Vitamin D is an essential vitamin that plays a key role in maintaining overall health. During pregnancy, the demand for vitamin D increases to support the growing needs of the fetus. Vitamin D deficiency is highly prevalent in pregnant women worldwide. The aim of our study was to evaluate the vitamin D deficiency rate among pregnant women in the Republic of North Macedonia, along with influencing factors. Materials and Methods: We conducted a prospective study of randomly selected pregnant women with different body mass index and in two different seasons among vitamin supplementation users and non-users. Results: A total of 309 pregnant women aged > 18 years were recruited from August 2022 to January 2023, with an average vitamin D concentration of 38.9 (36.6-40.2) nmol/l. During the winter period, 80.8 % of pregnant women had vitamin D deficiency. Conclusion: Despite the fact that more than 77.3 % of pregnant women consume multivitamins containing vitamin D, vitamin D deficiency is highly prevalent among pregnant women especially among obese pregnant woman and during the winter months.
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ANEMIA IN PREGNANCY AND RISK FACTORS
(Македонско лекарско друштво = Macedonian medical association, 2025-09)
Aleksandar Nakov
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Bekim Dika
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Introduction: During pregnancy, there is a “dilution” of hemoglobin concentration due to the increase in plasma volume. Iron and folic acid are necessary for the development of the fetus and are transported to it, so the mother can develop anemia due to their deficiency. Anemia affects 36% of pregnant women worldwide. Of those affected, about 40% are due to iron deficiency. Iron is an essential micronutrient involved in vital processes such as erythropoiesis, immune responses, and during pregnancy in the development of the placenta and fetus. The aim of our research was to determine the prevalence of anemia in pregnancy as well as the influence of certain risk factors: age, body mass index - BMI, parity and history of taking iron supplements. Material and methods: A blood count was performed in 100 patients in the third trimester of pregnancy in order to determine the hemoglobin concentration. The patients' body weight and height (to determine BMI) were measured and data were collected about age, number of previous births, and whether they were taking iron supplements. Results: Anemia (hemoglobin level below 110g/L) was present in 42.1% of pregnant women. Anemia was significantly common in women with ≥3 births and in those not taking iron supplements. Statistically insignificant anemia was more common in women under 25 years of age and in those with a BMI below 20. Conclusion: The results of the study showed the importance of regular controls of hemoglobin levels as well as the significance of iron supplementation during pregnancy, when the needs for this element are significantly higher.
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INCIDENTAL HEMATOPERITONEUM IN LAPAROSCOPIC APPENDECTOMY IN PREGNANT PATIENT
(Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2025-04)
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Shurlani, Arben
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Ismaili, Bashkim
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Acute appendicitis is the most common non obstetric emergency in pregnant women and often associated with a late diagnosis and complications such as perforation and fetal loss. We present a case of a 25-year-old primigravida, with epigastric pain radiating to the lower right quadrant that appeared 12 hours before admission, nausea, vomiting, white tongue and foetor ex ore. The laboratory values: WBC 18.000, RBC 4.12, HCT 36.2, CRP 22. Ultrasound examination: fetal biometry corresponded to 7 gestational weeks, positive cardiac activity, a small amount of peritoneal fluid was present in the right paracolic, ileocecal region and in Douglas's space, thickening of the wall of appendix vermiformis, surrounding inflammation of fatty tissue. The patient was observed in the next 6 hours, pain persisted in the lower right quadrant with propagation to the left quadrant. An indication for laparoscopic intervention for acute appendicitis has been made. The patient was placed in the supine position with the first camera and extraction port supraumbilically (10 mm) and the second port (5 mm) suprapubically. On laparoscopic exploration, 200 ml of bloody content was found in the pelvis and the vermiform appendix with reactive changes in the middle part towards the apex. An infundibular paraovarian cyst with a diameter of 20 mm was present on the right fallopian tube. The right ovary was ruptured with bleeding on one side. A third port (5 mm) was placed left pararectally. Aspirated pelvic blood was sent in the laboratory for beta HCG determination and partial resection of the right ovary and appendectomy were performed. After lavage, a Redon drain was placed in the pelvis through the suprapubic port. Postoperative course was normal and the drain was removed on the second postoperative day. Gynecological ultrasound was performed on the third postoperative day, the findings were normal and patient was discharged home.
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UNPREDICTABLE NATURE AND OUTCOMES IN PREGNANCIES COMPLICATED WITH SLE. POSSIBILITY OF A FAVORABLE OUTCOME IN SUBSEQUENT PREGNANCIES
(Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2025-04)
Filipovska Rafajlovska, Marijana
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Kapushevska, Dobrila
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Sarachini Hajdari, Shqipe
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Kacarska Mickoska, Milena
Systemic lupus erythematosus (SLE) is chronic inflammatory connective tissue disease that mainly affects women in reproductive age. This autoimmune disorder significantly impacts pregnancy outcomes. Patients with SLE are at increased risk of complications such as spontaneous abortion, intrauterine fetal demise, preterm delivery, preeclampsia, intrauterine growth restriction and neonatal lupus including congenital heart block. This case report describes a 34-year-old pregnant patient with her third pregnancy and a history of SLE, diagnosed during her second pregnancy that was complicated by fetal atrio-ventricular block of III-rd degree that required neonatal pacemaker implantation at birth. During her current pregnancy she has been closely monitored due to her previous history. The maternal autoantibody profile showed elevated levels of antiRo/SAA and anti-La/SSB antibodies, similar to her second pregnancy. However, fetal echocardiography at 20-28weeks of gestation showed no signs of heart block. The pregnancy progressed to full term without any serious complications. The neonate was without physical and biochemical signs of neonatal lupus. This report highlights the role of biomarkers and clinical management strategies in predicting and preventing fetal complication, as well as the variable outcomes in subsequent pregnancies. It demonstrates the complex and unpredictable nature of pregnancy in women with SLE. Although the patient had elevated anti-Ro/SSA and anti-La/SSB antibodies, her last pregnancy did not result in the expected complication of fetal AV block or neonatal lupus. This shows the high range of variability in the manifestation of neonatal lupus and congenital heart block even in pregnancies in the same women.

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