[Glucooxidative stress and spontaneous abortion in pregnant women with diabetes mellitus type 1].

UNLABELLED: The pregnancies in women with Diabetes mellitus are in condition of increased glucooxidative stress, which could be toxic for the developing embryo. END-POINTS: To evaluate the levels of selenium and glutation peroxidase in pregnant women with Diabetes mellitus type 1 in the first trimester of pregnancy and to establish whether there is a correlation between the diabetic glycemic control and occurrence of spontaneous abortions. STUDY DESIGN: Prospective study of 75 women for 1 year period. he pregnant women were divided in 3 groups as follows: 1st group--30 pregnant women with Diabetes mellitus type 1 with normal outcome; 2nd group--16 pregnant women with Diabetes mellitus type 1 with spontaneous abortion; 3rd group--29 healthy pregnant controls. The activity of GI-Px in red blood cells was measured in hemolysat of EDTA plasma in Germany. The levels of glucosylated haemoglobin were also evaluated. RESULTS: 1. In all pregnant women the levels of selenium were lower without significant difference between them 1st group--0.12 +/- 0.6 mmol/l, 2ndd group 0.13 +/- 0.1 mmol/l, 3rd group 0.13 +/- 0.7 mmol/l (P > 0.05). 2. There is an increase in the activity of GI-Px, which is statistically significant in the healthy pregnant women 47.8 +/- 13.3 U/g Hb and diabetic pregnant women with normal outcome 48. 6 +/- 8.4 U/g Hb. There is no statistically significant difference in the activity of GI-Px in diabetic pregnant women with spontaneous abortions and the healthy controls (P > 0. 05). 3. Negative correlation between the levels of selenium and the activity of GI-Px was proved in healthy pregnant women (r = - 0.4; P < 0.05). No correlation was found between the level of the selenium and the activity of GI-Px into the two groups of diabetic pregnant women. 4. There is a correlation in the levels of diabetic pregnant women with spontaneous abortions (r = -0.38; P < 0.001). CONCLUSIONS: The increased activity of GI-Px in diabetic pregnant women with spontaneous abortions is a result of increased antioxidative defense of the cell. Probably the ineffective antioxidant defense, leading to a spontaneous abortion is due to the low levels of selenium and high level of pre-prandial glycaemia.

[The frequency of mild and severe fetal malformations in diabetic women with high values of glycosilated hemoglobin in early pregnancy].

PURPOSE: To evaluate the correlation between maternal hyperglycemia in early pregnancy and the risk of fetal abnormalities in pregnant women with type 1 diabetes mellitus. STUDY DESIGN: A retrospective study over 124 pregnant women with diabetes mellitus type 1 hospitalized in High Risk Pregnancy Department--SHATOG "Maichin dom" has been done from January. 1998 to January 2004. The diabetic pregnant women were divided in two groups: first group pregnant women without malformations n = 105 and second group pregnant women with malformations n = 19. The pregnant women with fetal malformations were divided into two subgroups: with major malformations n = 13 and with minor malformations n = 6. The diabetic pregnant women were divided in classes according to Whites Classification: Class B - 38, Class C - 35; Class D - 39 and Class R/F - 12. The values of preprandial glucose, postprandial glucose and glycosilated hemoglobin has been measured at 13 week of gestation. RESULTS: 104 pregnancies of total 124 pregnancies were without abnormalities. The fetal malformations were observed in 19 (15.3%) of total 124 pregnancies. The rate of major abnormalities were - 13 (10.4%) and minor abnormalities were - 7 (5.6%). The highest rate of abnormalities there has been within the complicated diabetic women of class D - n = 7 (17.9 %) and class R/F n = 3 (25%). The initial values of preprandial glucose 9.54 (SD +/- 3.59) mmol/l and postprandiai glucose 10.52 (SD +/- 1.81) mmol/l between the women whit pregnancies with abnormalities were significantly higher then those values of preprandial glucose 7.39 (SD +/- 2.82) mmol/l (P - 0.021) and values of postprandial glucose 10.52 (SD +/- 1.81) mmol/l (P = 0.014) between the women without fetal malformations. The mean values of glycosilated hemoglobin were significantly higher HbA 1 c = 9. 01% (SD +/- 1.53) in pregnancies complicated with malformations than those values measured in pregnancies without fetal malformations 8.06% (SD +/- 1.64, P = 0.022). A positive correlation between the observed abnormalities and metabolic control in the early pregnancy exist. The values of Hbeta A1-c is significantly higher Hbeta A1-c - 9.9% (SD +/- 1.2) in pregnancies complicated with fetal malformations than those measured in pregnancies without malformations. Hbeta A1-c 8.2% (SD +/- 1.5) n = 125. Significant differences in the value of Hbeta A1-c between pregnancies with mild and those with severe abnormalities have not been established. A correlation between the levels of Hbeta A1-c in early pregnancy and the rate of the observed abnormalities exist. Within the values of Hbeta A1-c < 7.9%, the rate of malformations is 6.9%, Hbeta A1-c > 8.0% < 10%, the rate of malformations is 19.0% and within the values of Hbeta A1-c > 10%, the rate of the observed abnormalities is 31.5%. A logistic regression between the higher values of postprandial glucose and Hbeta A1-c values and the relative risk of congenital malformations has been observed. The relative risk is evaluated by odds ratio (OR) When the levels of Hbeta A1-c rise with 1% the relative risk of congenital malformations is evaluated by odds ratio OR = 2.02 (limited in 1.46 - 2.81 by 95% conf. interval) and when the levels of postprandial glucose rise with 1 mmol/l the relative risk OR = 1.21 (limited in 1.06 - 1.37: 95% conf. interval). CONCLUSION: Fetal abnormalities are more frequent in pregnant women with long lasting diabetes complicated with vasculopathy. Fetal abnormalities are associated with higher levels of Hbeta A1-c in the first trimester of pregnancy. In diabetic women who planed their pregnancy an optimal metabolic control must been established.

[Serum homocysteine levels in pregnant women with preeclampsia].

Preeclampsia is one of the most common and severe pregnancy complications, which ethiology remains unclear. It is certain that endothelial dysfunction plays a key role in the development of preeclampsia. Homocysteine is an important independent cardiovascular risk factor, which might induce the endothelial dysfunction observed in preeclampsia. 26 pregnant women--14 with preeclampsia (group 1) and 12 healthy term pregnant controls (group 2) were enrolled in the study between December 2003 and August 2004. Six of the women in this group had a superimposed preeclampsia. The mean homocysteine level in the first group was 11,04 mol/l, while in the control group it was 6,24 micromol/l (p < 0.05). The women with a severe preeclampsia had a significantly higher serum homocysteine levels than those with mild form (F = 0.025). Seven of the patients (50%) gave birth before 34th weeks of gestation. The study finds a link between the serum homocysteine as an endothelial dysfunction marker and the development of preeclampsia and a relation between the severity of preeclampsia and the degree of the elevation of the serum homocysteine levels.

[Increased nuchal translucency at 11-14 weeks of gestation in congenital heart disease, genetic syndromes and adverse pregnancy outcome].

Nuchal translucency (NT) measurement between 11-14 weeks of gestation is an'effective method of ultrasound screening for chromosomal fetal anomalies, congenital heart disease, some other structural abnormalities, rare genetic syndromes, skeletal dysplasia and adverse pregnancy outcome (spontaneous abortion and intrauterine fetal demise). The aim of the present study is to assess the prognostic value of increased first trimester NT in fetuses with normal karyotype in relation to pregnancy outcome.

[Ultrasound screening for Down syndrome and other chromosomal abnormalities by fetal nuchal translucency measurement between 11-14 weeks of gestation].

AIM: To assess the feasibility of nuchal translucency [NT] measurement as a screening tool for Down syndrome [DS] and other chromosomal anomalies [ChA] between 11-14 weeks of gestation [w.g.]. MATERIALS AND METHODS: A longitudinal prospective follow up study was carried out at a tertiary referral center including 408 singleton pregnancies between 11+0 and 14+0 w.g. Three experienced sonographers performed transabdominal and/or transvaginal scans using high-resolution ultrasound equipment. The ultrasound examinations included assessment of fetal number and viability, NT measurement and fetal anatomy survey. Down syndrome [DS] risk was calculated using the specialized computer program provided by the Fetal Medicine Foundation [FMF], UK. In cases of estimated DS risk > or = 1:300 invasive prenatal diagnosis was offered--chorionic villus sampling [CVS] between 11-14 w.g. or amniocentesis [AC] after 15 w. g., as well as follow-up scans including fetal echocardiography. The samples were tested by cytogenetic analysis, DNA analysis and/or FISH. When chromosomal fetal abnormality was detected termination of pregnancy was an option. Pregnancy outcome was ascertained from hospital records, referring physicians or the patients themselves. RESULTS: 108 (26%) out of the 408 women were ?35 years and 300 (74%)--below that age. A total number of 9 fetal chromosomal anomalies [ChA] were found including 6 cases with DS, 2--with trisomy 18 [T18] and 1--with Turner syndrome. The overall sensitivity for DS was 66.7% for a false-positive rate [FPR] of 13.4%. The figures for all ChA were 77.7% and 12.8%, respectively. All three cases of ChA other than DS were in the screen-positive group. The overall sensitivity and FPR for ChA for patients > or = 35 years was 80% and 35%, while for patients < 35 years it was 75% and 5.1 %, respectively. Diagnostic invasive procedures were performed in 50 out of 58 screen-positive cases, including 7 of the cases with ChA. In all 7 cases with prenatal diagnosis of fetal ChA the parents chose to terminate the pregnancy. CONCLUSIONS: First trimester DS screening by NT measurement has high sensitivity and specificity. Screening for other chromosomal abnormalities missed by second trimester biochemical serum tests is also possible. Invasive prenatal diagnosis is performed at an early gestational age when termination of affected pregnancies by D&C is still an option. Other important advantages are the possibility of screening for ChA in multiple gestations, as well as early diagnosis of major fetal anomalies.

[Attitude of pregnant women towards prenatal screening for chromosomal and structural fetal anomalies between 11-14 weeks of gestation].

AIM: The aim of the present survey is to analyze the attitude of pregnant women towards the possibilities of prenatal screening and diagnosis between 11-14 weeks of gestation (w.g.). MATERIAL AND METHODS: Overall 109 pregnant women, hospitalized in SBALAG "Maichin dom", received written information about the possibilities for prenatal screening and diagnosis between 11-14 w.g. and 16-20 w.g., as well as a comprehensive description of the potential advantages and disadvantages of the different approaches/methods of screening/diagnosis. Consequently, the patients were asked to answer 13 closed and semi-closed questions in an anonymous enquiry. RESULTS: Overall 97,2% (106/109) of the women agreed to perform an ultrasound examination for fetal nuchal translucency measurement as a screening tool for chromosomal anomalies between 11-14 w.g. Furthermore, 82,6% (90/109) preferred the option of first trimester biochemical screening, rather than screening in the second trimester. On the other hand only 62,4% (68/109) accepted chorionic villous sampling between 11-14 w.g. in comparison to 83,5% (91/109) who agreed to perform an amniocentesis between 16-20 w.g. CONCLUSION: The vast majority of women prefer prenatal screening programs to be scheduled in the first, rather than in the second trimester. However, most women would still choose for a relatively safer second trimester invasive procedure instead of the option of earlier prenatal diagnosis.

[Vaginal candidiasis--treatment protocols using miconazole and fluconazole]. / Vaginalna kandidoza--protokoli na lechenie s myconazol i fluconazol.

The incidence of fungal infections is growing in the last 20 years. The epidemiological studies show that 45% of all vaginal infections are caused by Candida albicans or other Candida species. 7 out of 10 women suffer from yeast infection at least once in a lifetime and 4 out of 10 have multiple recurrences. 20-55% of women have asyptomatic vaginal colonization with Candida species. It is strongly believed that fungal infection is not sexually transmitted disease. The route of transmission is oral and it is estrogene dependant. The diagnosis is based on macroscopic, microscopic examination (KOH preparation), culture and rarely Pap test. Treatment of vaginal candidiosis is based on two principles: elimination of predisposing factors antifungal treatment Local treatment is the first line of choice in cases of acute vaginal yeast infection with 84-90% success rate. There are a variety of local preparations on our market including Nizoral, Clotrimazole, Canesten, Gyno-Daktarine, Gyno-Pevaryl, Miconazole. Different groups of broad spectrum oral antimycotics are also used including Nystatine, Ketoconazole (Nizoral), Fluconazole (Diflucan, Fungolon, Mycosyst), itraconazole (Orungal). The treatment of chronic, recurrent and resistant forms of vaginal candidosis is carried out with prolonged local and/or systemic therapy for a period of at least 6 months. Different regimes of therapy are proposed. Fluconazole is an oral drug of choice for continuous treatment of vaginal yeast infection with the least toxicity.

[Antenatal ultrasonographic and Doppler color diagnosis of placenta previa/accreta focalis]. / Antenatalna diagnoza na placenta previa/accreta focalis chrez ultrazvuk i tsveten Dopler.

A case of placenta previa/accreta focalis was diagnosed at 29 weeks gestation in a 40 year-old patient using color Doppler ultrasound. A picture of intense blood flow within the placental sonolucent spaces, with vessels crossing from the placenta into the uterine wall was evident. A Cesarean section was performed. The macroscopic examination of the uterus during the operation revealed a focal invasion of the placental villi throughout the myometrium.

[Prenatal ultrasonographic diagnosis of four cases of sacrococcygeal teratoma]. / Antenatalna ultrazvukova diagnoza na chetiri sluchaia na sakro-koktzigealen teratom.

Four cases of SCT, diagnosed antenatally by the authors are reported. The reasons for referal to the department, the sonographic findings, the obstetric management, the outcome for the fetus and the histologic findings are summarized for each particular case. In the first case y 23 years old primigravida was admitted to the Hospital because of hydramnious and threatened premature labour in 30 w.g. The ultrasound examination revealed an AGA fetus with y tumor mass with y mixed structure protruding from the sacrococcygeal region. Despite the tocolytic therapy two days after admission to the department y 2400 grams severely asphyxiated fetus was born. Neonatal death occurred 15 minutes after delivery. In the second case y 28 years old primigravida was referred to the hospital because of acute hydramnios in 31 w.g. The ultrasound examination revealed an AGA fetus with y predominately solid mass with calcifications, 110/120 mm in dimentions in the sacrococcygeal region. Despite the indomethacin therapy on day 4th of admission spontaneous labour started. During a vaginal examination avulsion of the presenting "mass" occurred followed by rapid exsanguination of the fetus. In the third case the anomaly was diagnosed in the second trimester and genetic counseling of the couple was offered. The karyotype of the fetus was normal but the parents chose termination of pregnancy despite the advanced gestational age (29 w.g. by that time). A 1900 gramas live female infant was born and was emergently referred to the Neonatal Surgery Department and operated on 4th day after delivery. Unfortunately the baby died 24 hours after the operation from an accident, not related to the operation. In conclusion y protocol for obsteric management of pregnancies with SCTs of the fetus is proposed by the authors.

[Prophylaxis of postabortion endometriosis with Cedax]. / Profilaktika na postaborten endometrit s preparata Cedax.

The authors investigate the possibilities for antibiotic prophylactics of postabortion endometritis with the drug Cedax in high risk patients.

[Can education duning pregnancy improve the perinatal outcome in diabetic pregnancies?]. / Mozhe li obuchenieto prez bremennostta da podobri perinatalnata prognoza na diabetnata bremennost?

UNLABELLED: The aim of the study was to define the role of education for the complex treatment plan of diabetes during pregency and to estimate the impact of education for the reduction of the incidence of maternal and neonatal complications. STUDY DESIGN: A retrospective study of 56 pregnant women with diabetes was carried out. They were hospitalized in the High-risk pregnancy Department from January 1999 till January 2000. All pregnant women were admitted to the hospital in each trimester of pregnancy for control of carbohydrate metabolism and follow-up of pregnancy. All pregnant women were treated by intensified Insulin regime-type basal-prandial. The diet was set according to the needs during pregnancy. 30 pregnant women (group 1) were educated according to the specificity of diabetes during pregnancy. The education was repeated every time the patient was admitted to the hospital. The aim of education was to reach and maintain good metabolic control (HbA1c < 7.5%) in the course of pregnancy. The values of HbA1c before education in group 1 and after final education in group 2 (not educated) were determinated. The incidence of some maternal and perinatal complication-the progress from diabetic nonproliferative retinopathy into proliferative retinopathy, the development of preeclampsia as a causative factor for delivery before 37 g.w, the development of RDS and perinatal deaths were evaluated. RESULTS: There was a significant difference in the mean values of glycosylated Hb. In the group of educated women a good metabolic control was achieved--HbA1c = 7.5%. In the non-educated group the metabolic control was poor--HbA1c = 8.4%, irrespective of the insulin and diet treatment. 25 (84.4%) of the babies born to educated mothers had normal birthweight between 3000 and 4000 grams. 2 (6.6%) of the newborn had birthweight under 3000 gr. and 3 (10%) over 4000 gr. In the group of educated women there was no progress of nonproliferative retinopathy into proliferative type. There was such a progression in 3 women from the noneducated group. There were 22 cases of preeclampsia in both groups. In the group of educated women the preeclampsia was mild, compared to the noneducated group where the form was severe. All women with severe form of preeclampsia (n=8) delivered before 37g. w. There were no perinathal deaths in the educated group, compared to 3 (11.5%) deaths in group 2. 2 babies died antenatally and one after an operative correction for severe congenital heart defect. There were 6 (6.6%) cases of RDS from the educated group compared to 99 (16.6%) from group 2. CONCLUSIONS: The education is a key factor in the complex plan of treatment of pregnant women with diabetes. It creates a positive motivation for the achievement and maintenance of good metabolic control during pregnancy. The incidence of maternal and neonatal complications is higher in the group of non-educated women. The education significantly reduces the incidence of maternal and neonatal complications, thus improving the perinatal outcome.

[Role of glycemic control and incidence of spontaneous abortions pregnant in women with type 1 diabetes mellitus]. / Efekt na glikemichniia kontrol vurkhu chestotata na spontanite aborti pri zheni sus zakharen diabet tip 1.

UNLABELLED: Pregnant women with diabetes mellitus type 1 and poor metabolic control are with high frequency of spontaneous abortion. PURPOSE: To determine the correlation between the poor glycaemic control of diabetes in early pregnancy and the risk of spontaneous abortion. DESIGN OF STUDY: A prospective study over 116 women with type 1 diabetes mellitus who have been hospitalized in SHATOG "Maichin dom" during the period: January 1998-January 2004 have been done. The pregnant women have been divided in two groups. Pregnant women with pre-planned pregnancy n = 44 and pregnant women with unplanned pregnancy n = 72. The levels of pre- and postprandial blood glucose and those of glycosylated hemoglobin Hb A1c at first trimester have been measured. RESULTS: In 20 of all pregnant women (17.2%) spontaneous abortion have been observed. In those women with abortion the initial glycaemia has been significantly higher-preprandial glucose is 10.2 +/- 3.4 mmol/l and postprandial glucose is 12.2 +/- 4.2 mmol/l in contrast to those in women without abortions--preprandial glucose 6.6 +/- 1 mmol/l postprandial glucose is 7.9 +/- 1.9 mmol/l. The mean values of Hb A1c at first trimester have been higher in those women with abortions--10.1% +/- 1.5 in contrast to those without abortions 7.0% +/- 0.7. CONCLUSION: The pregnant women with diabetes type 1 and higher initial levels of blood glucose and glycosylated hemoglobin in the first trimester of pregnancy have a higher risk of spontaneous abortions. The rate of spontaneous abortions in diabetic women with pre-planned pregnancy and optimized metabolic control before conception is lower.

[Pentalogy of Cantrell associated with increased nuchal translucency at 12+1 w.g]. / Pentalogiia na Cantrell asotsiirana s uvelichena nukhalna translutseniia v 12+1 g.s.

Pentalogy of Cantrell is a rare sporadic syndrome with unknown etiology including five major system organ malformations. We present a case of pentalogy of Cantrell associated with increased nuchal translucency [NT] which was diagnosed at 12+1 weeks of gestation [w.g]. Termination of pregnancy was performed at 12+3 w.g.

[Effect of antioxidants in women with increased risk of preeclampsia. The role of oxidative stress in preeclampsia]. / Efekt na antioksidantite pri zheni s povishen risk ot preeklampsiia. Rolia na oksidantniia stres pri preeklampsiia.

New frontiers have been opened lately in the understanding of the patho-phisiology of preeclampsia thus giving new directions in the process of therapy of this condition. Oxidative stress is a condition characterized by peroxidants predominating over antioxidants. Numerous intensive studies are carried out to reveal the role of oxidative stress in the pathogenesis of preeclampsia.

[The obstetrical management of pregnant patients with spontaneous rupture of the fetal membranes after 37 weeks' gestation]. / Akushersko povedenie pri bremenni sus spontanno puknat okoloploden mekhur sled 37 g.s.

The purpose of the study was to analyze the obstetric management in pregnancies with spontaneous rupture of membranes (RM) after 37 w.g. and to find out is there a correlation between the cervical status and the pregnancy outcome. The study includes 66 primiparous women divided into two groups depending on the cervical status(CS) at admission: Group 1-44 patients with unfavourable cervix (PS < 4) according to the Bishop's original scoring system and Group 2-22 patients with favourable cervix (PS > 4). The delivery started spontaneously within the first 8 hours after the RM in 59% of the pregnant women with favourable cervix compared to 50% of women with PS < 4. There is no significant difference in the mean duration of the latent period between group 1 and 2-6.3 and 6.2 hours, respectively. The mean duration of delivery was 14.08 hours in Group 1 compared to 14.03 hours in Group 2. 72.7% of the pregnant women in Group 1 had normal vaginal delivery compared to 86.44% of the patients in Group 2. There were 3 newborn (one in Group 1 and 2 in Group 2) with signs of infection. There were no perinatal deaths. Postpartal endometritis was diagnosed in 2 of the patients with unfavourable cervix. There is no motivation to fear the development of ascendant infection in pregnancies with RM after 37 w.g. even if the time elapsed from the very beginning of the RM to the start of delivery is more than 24 hours. We favour both active and passive management of delivery in pregnancies with favourable cervix at the time of RM. We have to reevaluate the active approach in pregnancies with unfavourable cervix and ruptured membranes because of the higher incidence of operative deliveries because of non-progress of labour in these cases.

[Therapeutic regimens for treating bacterial vaginosis in pregnant women]. / Terapevtichni rezhimi za lechenie na bakterialnata vaginoza pri bremenni zheni.

The study comprises 128 pregnant women examined at different gestational weeks. The diagnosis of bacterial vaginosis was made using: a) the complex clinical criteria--vaginal discharge, vaginal pH, amine test and "clue cells" b) Nugent scoring system c) Spiegel criteria. Two therapeutic regimens were compared--intravaginal 2% clindamycin creme (Dalacin V) 5 g three consecutive days and intravaginal metronidazole (Flagyl) 500 mg once daily for 5 consecutive days. Control examination was carried out 5-7 days after completion of therapy using the same protocol. 28 women from the first group and 31 women from the second group had the control examination. Bacterial vaginosis was eradicated in 93% of women using intravaginal clindamycin and in 87% of women using intravaginal metronidazole. Both regimes were more effective compared to treatment with oral ampicillin for 7 days, where the cure rate was 62%.

[Retrospective study of the pregnancy course in preeclamptic patients]. / Retrospektivno prouchvane na bremennostta pri zheni, razvili preeklampsiia.

105 women had been evaluated using a retrospective analysis for the period 1999-2000. Clinical and laboratory data indicated development of preeclampsia and the pregnancy progress, antenatal complications, mode of delivery and perinatal outlet has been observed. The group has been divided using the following criteria: preexisting disease, severity of preeclampsia, mode of delivery, gestational age and prematurity rate. The present trial is important for optimizing management of women with preexisting disease before, during pregnancy and after delivery.

[The effect of the duration of the dry period and of the use of antibiotics on the development of congenital infection in the newborn infant during premature rupture of the fetal membranes]. / Vliianie na produlzhitelnostta na bezplodiia period i prilozhenieto na niakoi antibiotitsi vurkhu razvitieto na vrodena infektsiia u novorodenoto pri prezhdevremenno predterminno puknat okoloploden mekhur.

A retrospective study including 41 patients with preterm premature rupture of the membranes (PPROM) was carried out to investigate the influence of some factors (interval between PPROM and delivery, antibiotic administration) on the development of congenital infections of the newborn. When the PPROM--delivery interval exceeds 168 hours the infection rate is very high. The latter is lower when cephalosporin antibiotics instead of ampicillin are administered to the pregnant patient with PPROM.

[Hemodynamic measurements with the Swan-Ganz catheter (in the pulmonary artery) in severe preeclampsia patients]. / Khemodinamichni izmervaniia sus Swan-Ganz (katetur v art. pulmonalis) pri patsientki s tezhka preeklampsiia.

We compared the results of Swan-Ganz measurements in 11 preeclamptic women and report of the hemodynamic profile in severe preeclampsia. Measurements were performed between 28-36 weeks of gestation.

[Second trimester Down syndrome serum screening--results from a pilot study]. / Serumen skrining za sindrom na Daun vuv vtori trimestur na bremennostta--rezultati ot pilotno prouchvane.

The results from a pilot prospective study--second trimester Down syndrome [DS] serum screening between 15 and 21 w.g. with two markers (alpha-fetoprotein and free bb-hCG)--were summarised. Sensitivity, false-positive rate [FPR], positive predictive value [PPV] of the screen positive and negative predictive value [NPV] of the screen negative result for the sbgroups II and below 35 years of age were analysed. The uptake for invasive prenatal testing in screen positive patients and the percentage of terminated pregnancies with prenatally diagnosed DS fetuses as well as the ratio "lost unaffected pregnancies/1 DS fetus diagnosed antenatally" were also calculated. High sensitivity of the DS serum screening was achieved--75% and 87.5% in the subgroups below and II the age of 35 respectively with 6.6 and 31.7% FPR. With higher DS age risk the PPV of the screen positive test was higher and the NPV of the screen negative result--lower. The percentage of invasive prenatal testing in screen positive patients was high (average 83.4%) without significant differences in the two age subgroups. Pregnancy was terminated in all cases with antenatally diagnosed DS fetuses. The ratio "lost unaffected pregnancies/1 DS fetus diagnosed antenatally" for serum screening was lower compared to the same ratio when screening by age. The results from our pilot study (serum screening sensitivity and FPR, uptake for invasive testing in screen-positive cases) are comparable to the ones reported in literature. This is an important prerequisite for introduction of mass DS screening for our population.