Peripartum cardiomyopathy: a case of patient with triplet pregnancy.

Peripartum cardiomyopathy (PPCM) is a rare but potentially devastating complication of pregnancy associated with heart failure due to left ventricular systolic dysfunction occurring within the last month of pregnancy and five month postpartum with no obvious other cause of heart failure and no pre-existing heart disease. In the present case report the authors present a woman who developed PPCM on the day after she delivered by cesarean section in 35th weeks of gestation of triplet pregnancy conceived after ovarian stimulation and insemination. A treatment with diuretics, ACE inhibitors, antiarrhythmics, low weight heparin, antibiotics and bromocriptine was applied and resulted in complete recovery. In conclusion, timely detection and initiation of treatment are important factors for complete recovery of patients with PPCM.

Asymptomatic isthmico-cervical uterine perforation with IUD - our experience and literature review.

PURPOSE: The study aim was to report an unusual case of a misplaced IUD in isthmico-cervical region causing partial uterine perforation and discuss literature data regarding such a condition. CASE REPORT: A 50-year-old women was referred to the present institution for IUD extraction. She was diagnosed with spontaneously misplaced IUD located in isthmico-cervical region of the uterus causing partial perforation. The time of dislocation was unknown, as she was completely asymptomatic for ten years after IUD application. More-over, she had no risk factors for device misplacement. The removal of IUD was uneventful. CONCLUSION: Isthmico-cervical misplacement of IUD, although rare, can occur at any time and can be asymptomatic. Thus, women with IUD should be annually checked-up in order to prevent possible IUD complications.

Platelet count as a predictive factor of neonatal outcome in twin pregnancy with fetal demise.

PURPOSE: During the last decade, the rate of twin pregnancies has increased and reached 3% of all pregnancies. MATERIALS AND METHODS: This study enrolled 36 twin pregnancies that were followed and delivered at the Clinic for Gynecology and Obstetrics, Clinical Center of Serbia over a five-year period. RESULTS: The first group included 15 patients with a monochorionic twin pregnancy, and the second group consisted of 21 patients with a dichorionic twin pregnancy. The platelet count was significantly lower in patients with APGAR scores of more than 8, with an average of 185,000/ml, and in patients with a score of less than 4, the average count was 221,000/ml. The perinatal mortality rate of the surviving twin was 33% in the monochorionic group and 0.4% in the dichorionic group. CONCLUSION: An increase in the maternal platelet count can be used as a predictor for a negative neonatal outcome of the surviving twin.

Perinatal outcome of singleton pregnancies following in vitro fertilization.

PURPOSE OF INVESTIGATION: To determine whether in vitro fertilization/intracytoplasmatic sperm injection (IVF/ICSI) singleton pregnancies are at increased risk for maternal and fetal complications than spontaneous singleton conceptions. MATERIALS AND METHODS: The pregnancy outcome of 634 singleton pregnancies after IVF/ICSI delivered at the Clinic for Gynecology and Obstetrics during the period January 2006 to January 2010 were compared to 634 matched singleton controls, matched one by one by age, parity, education, and body mass index (BMI). Differences in pregnancy outcomes between the groups were assessed using Student's t-test with Yates correction for continuous variables and Chi-squared test for categorical variables. RESULTS: The mean gestational age at delivery of the IVF group was 38.13 +/- 1.72 weeks, slightly shorter than spontaneously conceived singletons at 38.65 +/- 1.79 weeks. The diagnosis of gestational diabetes mellitus (GDM) was frequently made in the IVF group (11.82% vs 8.35%, t = 2.052, p < 0.05). Total preterm delivery rate of IVF pregnancies was 9.30%, significantly higher than the controls 5.85% (t = 2.33, p < 0.05), especially at the 30-32 weeks gestation period. The predominant mode of delivery after IVF pregnancy was cesarean section (80.75% vs 31.38% at spontaneously conceived, t = 17.71, p < 0.001), while vaginal route was the choice for naturally originated pregnancies 68.6% vs 19.24% (p < 0.01). No differences were found in the average birth weights, LBW, VLBW, SGA, and LGA regarding the pregnancy origin. Perinatal mortality rates were comparable among singletons with different pregnancy origin. CONCLUSIONS: Singletons from IVF/ICSI pregnancies have poorer perinatal outcome associated with higher rates of cesarean sections, preterm birth and prematurity, fetal malpresentation (breech presentation), and the occurrence of maternal GDM in pregnancy.

Evaluation of osteopontin and CA125 in detection of epithelial ovarian carcinoma.

The objective of this study was to determine the potential of osteopontin (OPN) and OPN + CA125 (cancer antigen 125) combination in differential diagnosis of the ovarian cancers and non-malignant ovarian disease. Serum and plasma samples were obtained preoperatively from 79 women undergoing surgery for pelvic mass; 48 of them had ovarian carcinoma, and 31 had benign cyst. The samples were analyzed for the levels of OPN and CA 125 (using ELISA and CMIA methods) and then compared with the final pathologic results. The median plasma level of OPN in patients with benign and malignant cysts was 356.33 ng/ml and 865.15 ng/ml, respectively (p < 0.001). Receiver operating characteristic (ROC) analysis for plasma OPN revealed the area under the curve (AUC) of 0.838. At the predefined specificity of 90%, OPN showed sensitivity of 62.5%, whereas the combination of OPN + CA125 reached 74.9% at the same specificity.