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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PREGNANCY AND ORAL PARAFUNCTIONAL HABIT – BRUXISM
(Shoqëria Stomatologjike Shqiptare | Albanians’ Stomatological Society, 2024-12)
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Budima Pejkovska Shahpaska
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Burim Kiseri
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Genc Demjaha
Aim: The aim of this study is to represent pregnant patients with an existing parafunctional habit- bruxism in pregnancy, its diagnosis, evaluation and treatment. Methods: Three pregnant patient came to the University Clinic for Gynecology and Obstetrics, with severe headaches, tinnitus, earaches, dizziness, and problems in opening of the mouth in their first trimester. They were clinically examined, diagnosed and treated for the parafunctional habit – bruxism. In the second and third semester, the symptomatology from bruxism was alleviated in two patients. The third patient did not finish the study. Conservative treatment with producing individually designed splints was carried out. Results: Parafunctional habits that are present in pregnant patients worsen due to many physiological changes occurring in pregnancy. The patients were diagnosed with a horizontal type of bruxism, not treated. Pregnancy has a direct correlation with the entire body and thus affecting the stomatognathic system, which is proven in this study. Conclusion: Pregnancy can affect the entire health of the patients. That is why besides all of the accompanied examinations, particular attention must be paid on the oral health for enabling these patients a better quality of life.
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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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UTERINE ARTERY DOPPLER AND SERUM LEVEL OF IMMUNOBIOMARKERS IN PREECLAMPSIA - OUR EXPERIENCE
(Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2024)
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Paneva, Iva
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Introduction. Important mechanisms are known to be involved in the immunomodulatory pathways which are crucial for maintaining an adequate utero-placental circulation in pregnancy. Its disbalance brings to impaired tolerance, which leads to inflammation and autoimmune processes in preeclampsia. Aim. The aim of this study was to find if inadequate uteroplacental hemodynamic was associated with improper feto-maternal immune adaptation. The risk of developing preeclampsia can be predicted by combining use of uterine artery flow and cytokine values. The aim was to show their combination as a predictive indicator of preeclampsia in the second trimester of pregnancy. Methods. This study enrolled 96 pregnant patients in the second trimester (patients were between the 14th and 20th gestational weeks). Their history data, routine foetal ultrasound, bilateral uterine artery Doppler ultrasound and cytokines were evaluated. All patients were followed up till the end of pregnancy. Half of the pregnant women consisted the study group (N=48), which had presence of notch of the uterine artery. In the control group (N=48), there was an absence of uterine artery notch. In all patients, Doppler of the uterine artery, pulsatility index (PI) and resistance index (RI) were made and determined. The pro-inflammatory cytokines (TNF-α, IL-1α, IL-2 and IL-6) and antiinflammatory cytokines (IL-4 and IL-10) from patient’s serum were analyzed. Results and Discussion. In the study group (N=48), 32 patients had changes in the cytokine serum levels. Increased pro-inflammatory biomarkers (IL-6, TNF-α, IL-1α) were with sensitivity of 78 to 91.2%. According to this, high predictive value was found. Of these 32 patients, 21 developed preeclampsia. When the sensitivity of pro- and anti-inflammatory biomarkers together with the uterine artery Doppler ultrasound was combined, a sensitivity resulted in 81.5%. Multivariate regression analysis detected that IL-6 was the most significant predictive parameter. This result is similar to that presented in the study by Teran and Hentschke et al. Conclusion. Using predictive tests is imporatnt to detect undeveloped preeclampsia in a timely manner that would prevent possible developmental complications. After abnormal Doppler results, cytokines should be investigated as a predictive method.
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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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Prevalence of thyroid dysfunction and autoimmunity in pregnant women with gestational diabetes and diabetes type 1
(Macedonian Academy of Sciences and Arts/De Gruyter, 2010-12)
Velkoska Nakova, Valentina
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Dimitrovski, Chedomir
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The aim of the present study was to determine the prevalence of abnormal thyroid function and antithyroid antibodies during pregnancy in women with diabetes type 1 and gestational diabetes mellitus (GDM).
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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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SUCCESSFULLY COMPLETED PREGNANCY IN A PATIENT WITH KLIPPEL FEIL SYNDROME (KFS) - CASE REPORT
(Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2024-09-15)
Todorovska, Irena
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Klippel-Feil syndrome is a congenital anomaly characterized by fusion of two or more cerebral vertebrae. The three main manifestations are a low hairline, a short neck and limited neck movement. This syndrome can cause chronic headaches and neck and back pain. Klippel-Feil syndrome is diagnosed by clinical evaluation, identification of characteristic physical findings and specialized tests. Diagnosis begins with X-rays or other advanced imaging techniques, such as Magnetic Resonance, which shows the fusion of the cervical vertebrae and the open spaces (interspaces) between the vertebrae. Treatment: Therapy is symptomatic and supportive. Careful evaluation, continuous follow-up, and coordination of multiple specialists are required to improve the outcome. The patient is thirty years old, with a fixed diagnosis of Klippel-Feil syndrome, thoracis scoliosis, pre-existential hypertension, deafness. During the examination, it was established that it is a eutrophic fetus, without major anomalies, orderly fetoplacental flow, orderly fetal movements. A recommendation was given to do control examinations at the Clinic for Pulmonology, Orthopedics, Cardiology and Nephrology. The next two controls were on a weekly basis until the 27th gestational week, when, due to malignant hypertension, admission was done to PHI GAK. During hospitalization, high values of the angiogenic factors sFLT/PLGF up to 793.05, proteinuria 0.79g/L and malignant hypertension regulated by double antihypertensive therapy were determined. NST was reactive. The ultrasound finding was normal, the fetus had a normal fetoplacental flow. After detailed anesthetic preparation, the patient was delivered by elective caesarean section at 28.5 weeks of gestation and a live female fetus was obtained with RTM=920g/35cm and AS=6/7/7. The intervention went smoothly
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Use of ultrasound in pregnancy -opportunities and challenges for assessment of neurological development
(AD ZEGIN, 2024-11-13)
Advances in ultrasound technology and development of 4d have enabled evaluation of fetal movement and facial expressions in fetus.The purpouse of this test is to observe tne intrauterine neurological behavior of the fetus to predict developemnetal disorders.

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