Irena Todorovska

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Irena Todorovska

irena.todorovska@medf.ukim.edu.mk

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RECURRENT PREECLAMPSIA IN THE SAME PATIENT
(Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2022-12)
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Introduction: Preeclampsia is a complex disease that occurs in 5-7% of the entire population. Preeclampsia is an important cause of maternal and perinatal mortality. The etiology of preeclampsia is unknown, but recent research suggests that these disorders originate in the placenta and are characterized by extensive maternal endothelial dysfunction. This leads to inadequate blood supplementation and oxidative stress. Placental factors such as soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble receptor for vascular endothelial growth factor (VEGF), are released into the maternal circulation, where they stimulate the inflammatory response and endothelial dysfunction. Objective: To demonstrate the possibility of preventing severe preeclampsia in the same patient by determining the ratio of angiogenic factors sFlt-1/ PLGF. With early detection of angiogenic factors, the patient is monitored more closely when the growth of angiogenic factors begins without clinical manifest symptoms and timely termination of pregnancy in the interest of the patient’s health. Case Report: Monitor the clinical form of preeclampsia in a patient in her two pregnancies. In the first pregnancy, the patient develops the most severe form of preeclampsia (Eclampsia and HELLP Syndrome) at 29.1 weeks gestation. The postpartum patient is in serious condition with a stay in the Intensive Care Unit. During the first pregnancy, in 2014, angiogenic factors were not examined. In the second pregnancy, 2020/ 2021, in the second trimester (in the 24th week of gestation), the angiogenic factors are started to be examined. Along with the ultrasound examination and measurement of the mean arterial pressure, the danger of developing severe preeclampsia is detected early in pregnancy and with careful monitoring of the patient it ends in time before the patient’s health is seriously endangered. Conclusion: Preeclampsia is a unique health condition that occurs only in pregnancy and that can seriously endanger the health of both mother and fetus. With the development of medicine, many tests are being developed that try to diagnose the occurrence of preeclampsia very early. Recent studies of angiogenic factors and the correlation between sFlt-1/ PLGF have been shown to be sensitive in predicting preeclampsia, as well as in patient’s case studies.
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Recurrent Severe Polyhydramnios in Bartter Syndrome: A Case Report
(Journal of Biomedical Science Networks+ LLC, 2023)
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Arsov, Todor
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SHpishikj Pushevska, Anamarija
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Gurzanova, Tatjana
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Repetitive severe polyhydramnios is a potentially serious obstetric condition which requires detail evaluation. We present a case of a 35-year-old pregnant woman referred due to extreme repetitive polyhydramnios in 19 gestational week. She had history of two missed abortions and premature labor in 23 gestational weeks with extreme polyhydramnios and death. Pat histology report didn’t show any anomaly of the organs and systems of that neonate. The actual pregnancy was conceived with IVF procedure and went uneventful until 19 GW. Combined first trimester screening and the noninvasive prenatal test went with low risk for aneuploidies. Gestational diabetes was excluded. Second trimester morphology scan and TORCH infections were within normal. She was hospitalized in 26 GW as a result of premature contractions, received tocolytic therapy on several occasions. Amnioreduction was performed twice, amniotic fluid for quantitative karyotype was done and came negative for aneuploidies (13,18,21 and sex chromosomes). Consultation with genetics and pediatric nephrologist was made due to suspicion of Bartter syndrome. Amniotic fluid as well as blood from both partners was sent to referent genetic laboratory and the molecular findings were in line with the diagnosis of SLC12A1 associated Bartter syndrome type 1 in the fetus. Corticosteroid therapy for fetal lung maturation was given and delivery was made by caesarean section in 31 gestational weeks. The neonate with weight 1180g, length 30cm, Apgar score 6/6/7, was admitted to neonatal intensive care unit. On the 7th day there was a gradual worsening in the general condition with cardiopulmonary failure and no response to reanimation resulted in neonatal death. Conclusion: Bartter syndrome is an autosomal recessive disease characterized by severe fetal polyuria and extreme polyhydramnios. It can be cause of preterm labor and should be suspected in cases of repetitive polyhydramnios.
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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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The vein of Galen aneurysmal malformation associated with Turner syndrome mosaicism -a case report
(Creative Commons Attribution License, MSD Publications, 2024-11-21)
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Ristovska, Sanja
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Dimitrovska, Renata
Prenatal diagnosis of the vein of Galen aneurysmal malformation. Congenital malformation develops during weeks 6-11 of fetal development as a persistent embryonic prosencephalic vein of Markowski. The incidence of this malformation is estimated to be high. The true incidence is unknown but estimated to be 1 in 10,000 to 1 in 25,000 births. malformation accounts for 30% of pediatric congenital vascular malformations and about 1% of all pediatric congenital anomalies. Infants often die of high-output congestive heart failure [1,2]. The presenting case report’s main aim is to illustrate the disease with ultrasound performed during pregnancy and Magnetic resonance characteristics, postnatal evaluation, parenteral counseling, and their decision for further treatment in the neighboring country [3]. It should be stressed that the fetus has mosaicism of Turner Syndrome, two lines, normal and unusual abnormal form. The pregnancy was 34 gestational weeks with intrauterine growth restriction. The limitation in the precision of prenatal diagnosis at primary care obstetricians and the use of additional diagnostics tools for improving the diagnosis can lead to unwanted events of pregnancy, like intrauterine fetal demise. This does not happen in this case
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VITAMIN D AND BODY MASS INDEX IN GESTATIONAL DIABETES MELLITUS
(Department of Anaesthesia and Reanimation, Faculty of Medicine, “Ss. Cyril and Methodius” University in Skopje, R.N.Macedonia, 2021)
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ABSTRACT Gestational diabetes mellitus (GDM) is a glucose intolerance established for the first time in pregnancy. Vitamin D deficiency is common in pregnant women. Deficiency is connected with risk for preeclampsia, GDM and macrosomia. Aim Aim of the study was to evaluate vitamin D status in GDM pregnancies and normoglycemic women and to establish whether body mass index in normoglycemic and GDM pregnant women has impact on vitamin D deficiency. Material and Methods Prospective study was conducted at the University Clinic for Gynecology and Obstetrics, Skopje in a period of one year. One hundred pregnant women in the second trimester were evaluated: 50 women with GDM and a control group of 50 women with negative OGTT with BMI more or less than 25. Vitamin D levels (Advia Centaur) were performed from periphery blood specimens from the pregnant women. Results Significantly lower values of vitamin D were found in GDM women vs control group (16.91 ± 6.2 nmol/l vs 24.54 ± 11.7 nmol/l). Vitamin D deficiency was found in 82.5% of the women with GDM and 54.76% of the women with negative OGTT. Vitamin-mineral supplementation received 82% of the normoglycemic pregnant women and 66% of the pregnant women with GDM, p=0.036. In pregnant glucose tolerant women vitamin D was significantly lower in overweight vs normal weight women. Women with GDM and normal weight had significantly lower vitamin D levels vs normoglycemic women with normal weight. Conclusion We can conclude that gestational diabetes mellitus in our study is associated to lower values of vitamin D. Pregnant women with GDM less often received vitamin supplementation. Lower vitamin D levels were found in normoglycemic overweight women. In GDM women body mass index didn’t have impact on vitamin D deficiency – normal weight GDM women had significantly lower vitamin D levels than normoglycemic women with normal weight. However, vitamin D supplementation is essential for overweight pregnant women in order to possibly achieve better perinatal outcome.
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Rare concomitant myxoid and cystic degeneration of uterine leiomyoma: Case report
(Centre for Evaluation in Education and Science (CEON/CEES), 2021)
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Paneva, Iva
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The uterine leiomyomas are monoclonal tumours of myometrial smooth muscle cells that are oestrogen dependent. A 43-year-old patient was referred by her gynaecologist under a suspected diagnosis of ovarian tumour. She complained of prolonged and profuse, regular menstrual bleeding that leaded to anaemia. The ultrasound examination showed a complex tumour mass with dimensions 68 x 85 mm, with several cystic formations fulfilled with clear fluid, which protrudes from the posterior wall of the uterus. Therefore, the diagnosis of leiomyoma with a cystic degeneration was considered preoperatively. In the case of cystic degeneration of the myoma, the ultrasound shows a combination of cystic and solid components with irregular shape and variable echogenicity. The ovarian malignancy should be ruled out in the presence of a large cystic mass with irregular septa and solid nodular parts filling the small pelvis. Ultrasound characteristics of degenerative myomas should always be considered, so as not to replace it with an ovarian mass, especially if it is subserosal and on the loop.
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The outcome of Pregnancy with Fetal Primitive Neuroectodermal Tumor
(ID Design 2012/DOOEL Skopje, 2018-08-20)
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Stefanija, Adela
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Josheva, Jasminka
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Fetal intracranial tumours are very rare. The overall incidence is 0.34 per one thousand live birth newborns. According to the new classification of central nervous system tumour (2016), a primitive neuroectodermal tumour of (PNETs) is an embryonal tumour group; these are tumours with high malignancy and belong to group IV (WHO). In our case, we will present a case of PNETs in 28 gestation week old fetus, diagnosed antenatally and confirmed postnatally.
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Human papillomavirus infections in women with and without squamous cell abnormalities of the uterine cervix
(Medical Society of the Republic of Srpska, Banja Luka and University of Banja Luka - Faculty of Medicine, Banja Luka, 2019)
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Dabeski, Ana
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Trajanova, Milka
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Background: Human papillomavirus infections are one of the most common sexually transmitted infections with viral aetiology. The aim of the study was to confirm the existence of an association between human papillomavirus infection and squamous cell abnormalities of the uterine cervix. Methods: Cohort study, conducted in the period from January 2017 to June 2018 of 768 sexually active women, age groups of 20 to 59 years, divided into two groups: examined and control, who came to their annual gynaecological exam at University Clinic for Gynaecology and Obstetrics in Skopje. In all patients was done human papillomavirus-deoxyribonucleic testing. Human papillomavirus detection and typing was done using a polymerase chain reaction and reverse hybridisation. Results: Data analysis showed an association between human papillomavirus infection and squamous cell abnormalities of the uterine cervix (p=0.00001). Human papillomavirus infection was detected in 22.91% of all patients, in 75.00% of patients with abnormal cervical cytology and in 12.50% of patients with normal cervical cytology. A single human papillomavirus infection was detected in 13.67% of all patients (in 59.66% of human papillomavirus positive patients). Mixed human papillomavirus infection was detected in 9.24% of all patients (in 40.34% of human papillomavirus positive patients). Human papillomavirus type 16 was the most common genotype with 40.91%. Conclusion: This study confirmed that there is an association between human papillomavirus infection and squamous cell abnormalities of the uterine cervix and the young population under the age of 30 years is the most affected.
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PRENATAL DIAGNOSIS OF REPETITIVE ELLIS-VAN CREVELD SYNDROME ACCOMPANIED BY DANDY WALKER MALFROMATION - CASE REPORT
(ScopeMed, 2021-01)
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Ellis-van Creveld syndrome is known as chondroectodermal dysplasia or mesoectodermal dysplasia. It is a rear genetic disorder with autosomal recessive inheritance resulting from these patients’ malformations. Case Report: A repetitive syndrome is reported in the present article. Pregnant woman with a fetus with Ellis-van Creveld syndrome is described with a rare concomitant abnormal findings of Dandy-Walker malformation. The aim is to emphasize the importance of the ultrasound differentiation of prenatal diagnosis in patients who have fetuses with congenital anomalies. A 26-year-old pregnant woman was diagnosed with a fetus with congenital anomaly Ellis-van Creveld Syndrome associated with Dandy-Walker malformation. In her history of diseases, previously she has had three indicated abortions due to central nervous system and limbs deformities. She has only one healthy child. The patient was examined clinically, paraclinical, digitally, and has had genetic examinations performed on her, her partner, and fetus. The patient prenatally was diagnosed with caring a fetus with shortening of the long bones, thoracic dysplasia, hexadactyly of the hand, arterial septal defect in addition to Ellis-van Creveld accompanied by Dandy-Walker syndrome. From the results obtained it has been deducted that the pregnancy needs to be terminated. Conclusion: A multidisciplinary approach is needed in prenatal diagnosis and family genetic counselling for the wellbeing of a fetus and the entire family.
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Low Pregnancy Associated Plasma Protein A as a Predictive Tool for Pregnancy Outcome
(Biomedical Research Network, New York, 2023-08-04)
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Aliu, Nurije
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Objective: The objective of this study is to identify the predictive value of pregnancy-associated plasma protein A using univariate and multivariate regression analysis in identification of patients with low values (less than 0.4 MoM) in combined first-trimester screening for predicting disadvantaged perinatal outcome after exclusion of aneuploidy. Methods: A study was conducted at the University clinic for gynecology and obstetrics in Skopje, over a one-year period (2018 y). Those with PAPP-A values (<0.4 MoM) of 64 and a control group of 50 patients with values ≥0.4 MoM. The concentration of PAPP-A was measured from peripheral blood and determined by Immulite 2000 HPi Systems Analyzer. Results: Univariate and multivariate logistic regression analyses were used to assess the predictive role of PAPP-A. The unadjusted OR for PAPP-A for preterm delivery was 0.225, for antepartum complications was 0.138, for intrauterine growth restriction of 0.049. In the adjusted logistic regression analysis, PAPP-A was not found to be a significant predictor of respiratory distress syndrome, newborn infections, NICU stay and pH≤7.2. The adjusted OR for antepartum complications was 0.131, for intrauterine growth restriction was 0.053. Conclusion: It can be concluded that PAPP-A levels in the first trimester are associated with intrauterine growth restriction and antepartum complications. The study suggests that caution is needed in pregnancies with PAPP-A values below 0.3 MoM.

Irena Todorovska

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