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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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    Maternal and perinatal outcomes in high compared to low risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection (phase 2): the World Association of Perinatal Medicine working group on coronavirus disease 2019
    (Elsevier BV, 2021-07)
    D'Antonio, Francesco
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    Sen, Cihat
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    Mascio, Daniele Di
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    Galindo, Alberto
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    Villalain, Cecilia
    It has still to be ascertained whether severe acute respiratory syndrome coronavirus 2 infection in pregnancy is associated with worse maternal and fetal outcomes compared to low risk gestations. OBJECTIVE This study aimed to evaluate maternal and perinatal outcomes in high- and low-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection. STUDY DESIGN This was a multinational retrospective cohort study involving women with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection from 76 centers from 25 countries in Europe, the United States, South America, Asia, and Australia from April 4, 2020, to October 28, 2020. The primary outcome was a composite measure of maternal mortality and morbidity, including admission to the intensive care unit, use of mechanical ventilation, or death. The secondary outcome was a composite measure of adverse perinatal outcome, including miscarriage, fetal loss, neonatal and perinatal death, and admission to the neonatal intensive care unit. All outcomes were assessed in high- and low-risk pregnancies. Pregnancies were considered high risk in case of either preexisting chronic medical conditions in pregnancy or obstetrical disorders occurring in pregnancy. The Fisher exact test and logistic regression analysis were used to analyze the data. RESULTS A total of 887 singleton pregnancies who tested positive for severe acute respiratory syndrome coronavirus 2 infection using reverse transcription-polymerase chain reaction of nasal and pharyngeal swab specimens were included in the study. The risk of composite adverse maternal outcomes was higher in high-risk pregnancies than in low-risk pregnancies (odds ratio, 1.52; 95% confidence interval, 1.03–2.24; P=.035). In addition, women carrying high-risk pregnancies were at higher risk of hospital admission (odds ratio, 1.48; 95% confidence interval, 1.07–2.04; P=.002), presence of severe respiratory symptoms (odds ratio, 2.13; 95% confidence interval, 0.41–3.21; P=.001), admission to the intensive care unit (odds ratio, 2.63; 95% confidence interval, 1.42–4.88), and invasive mechanical ventilation (odds ratio, 2.65; 95% confidence interval, 1.19–5.94; P=.002). When exploring perinatal outcomes, high-risk pregnancies were at high risk of adverse perinatal outcomes (odds ratio, 1.78; 95% confidence interval, 0.15–2.72; P=.009). However, such association was mainly because of the higher incidence of miscarriage in high-risk pregnancies compared with that in low-risk pregnancies (5.3% vs 1.6%, P=.008); furthermore, there was no difference in other explored outcomes between the 2 study groups. At logistic regression analysis, maternal age (odds ratio, 1.12; 95% confidence interval, 1.02–1.22; P=.023) and high-risk pregnancy (odds ratio, 4.21; 95% confidence interval, 3.90–5.11; P<.001) were independently associated with adverse maternal outcomes. CONCLUSION High-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection were at higher risk of adverse maternal outcomes than low-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection.
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    Pregnancy in End-stage Renal Disease Patients on Long-term Hemodialysis: Two Case Reports
    (Macedonian Society of Nephrology, Dialysis, Transplantation and Artifical Organs, Department of Nephrology, 2010)
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    Tozija, Liljana
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    Gelev, Saso
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    Adamova, Gordana
    Although still uncommon, pregnancy in haemodialysis (HD) patients does occur and frequency has been increased in the past 20 years. But unfortunately, the rates for premature delivery, neonatal death, maternal hypertension, and preeclampsia in the pregnant HD patient are much higher than in the general population. Infants are often born both prematurely and small for gestational age. We report here two cases of pregnancy in women on long-term HD, one successfully and the other unsuccessfully managed, despite the same treatment strategy. Case 1 was a 43-year-old female patient, 10th gravida, after six years of maintenance HD whose pregnancy was successfully managed up to the 33rd week of gestation with a delivery of a healthy boy weighing 2,100 g. Case 2 was a 32-year-old female patient, 2nd gravida, after five years of maintenance HD, whose pregnancy ended in spontaneous abortion with intrauterine death at week 19 of gestation. Maternal hypertension and anemia contributed partly to the unsuccessful outcome. A successful pregnancy in HD patients requires multidisciplinary management, but considering the previous nephrological/ prenatal/gynaecological/obstetric recommendations, many open questions remain when it comes to the best treatment and management of pregnancy in these women.
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    ESTABLISHMENT OF LOCAL POPULATION-BASED REFERENCE INTERVALS FOR THYROID FUNCTION TESTS IN PREGNANCY
    (Medical Faculty, Ss Cyril and Methodius University Skopje, R.Macedonia, 2019)
    Thyroid stimulating hormone (TSH) and free thyroxin (FT4) are first-line thyroid function tests (TFTs) for detecting thyroid abnormalities in general population and pregnant women (PW) as well. Our objective was to validate the proposed manufacturer’s reference range in pregnancy for TSH and FT4 and to obtain reliable reference intervals for our PW. The reference population was selected from PW without personal or family history of thyroid disorders. For the validation of the manufacturer’s reference intervals we followed the 20-sample CLSI protocol and the large-sample protocol including 267 pregnant women from all trimesters. TFTs were assessed by IMMULITE 2000 chemiluminescence immunoassay system. Trimester values were expressed as median. To compare the trimester differences, Mann-Whitney U test was used. Reference intervals (RIs) were obtained by nonparametric method. Following the CLSI protocol, we could not accept manufacturer’s RI for TSH, while our median was higher in comparison with manufacturer’s (1,9 mIU/L vs 1,1 mIU/L). For FT4 our findings indicated significant differences between the first and second / third trimester and lower medians (11.6 pmol/L vs 16.1 pmol/L and 10.3 pmol/L vs 13.9 pmol/L). Therefore, we established own RIs according to the large sample protocol. The median for TSH was 1,6 mIU/L and the new RI was 0,34– 3,4 mIU/L. For FT4, first trimester RI was 7.9-16.0 pmol/L, and second/third RI was 6.4-14.6 pmol/L. These specific RI should be considered by clinicians for an accurate interpretation of TFTs in pregnancy and adequate patient treatment.
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    PRIMARY HYPERPARATHYROIDISM IN PREGNANCY
    (Department of Anaesthesia and Reanimation, Faculty of Medicine, “Ss. Cyril and Methodius” University, Skopje, Macedonia, 2018-05)
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    Shukarova, Emilija
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    In this article, we report a case of a primary hyperparathyroidism in a young woman, as a result of the adenoma of a parathyroid gland, detected few days after delivery. Suspicion for primary hyperparathyroidism was achieved after different clinical features had been seen in the newborn (respiratory insufficiency, neonatal hypocalcaemia and recurrent convulsions). The aim of this article is to emphasize the importance of the early detection of hyperparathyroidism in pregnancy with adequate control of calcium, phosphates and magnesium, in order to additionally prevent disturbances of the neuromuscular feasibility and other changes in the newborn. Even though, the early treatment of hyperparathyroidism in pregnant woman, needs to be individualized for every case (conservative or surgical treatment), in this article we also present the surgical treatment postpartum and the aspects of how calcium metabolism is changed in pregnancy and why this state may be overviewed by clinicians.