Fetal hydrops and middle cerebral artery Doppler in prediction degree of fetal anemia and the best timing for therapy.

PURPOSE: To determine the role of fetal multiples of the median of middle cerebral artery peak systolic velocity (MoM MCA-PSV), in predicting the degree of fetal anemia for determination of the best timing for the second intrauterine intravascular transfusion (IUIVT) in hydropic fetuses with Rh alloimmunization. MATERIALS AND METHODS: Prospective study of 30 monofetal pregnancies with maternal Rh D alloimmunization and hydrops fetalis, from 2005 to 2012 that underwent first and second IUIVT were assessed. RESULTS: Thirty IUIVT were performed at 26.9 weeks (standard deviation, SD 4.3). Mean interval to the second procedure was 11.23 (SD 6.21) days and average hematocrit decline rate was 1.45%/day. The study did not demonstrated statistical significance between MCA-MoM-3 before the second IUIVT, and the mean decline rate in fetal hematocrit levels (expressed in percentage/day) r = 0.220; p = 0.242, and between MCA-MoM-3 and the time interval between both procedures (T) r = -0.157; p = 0.408. CONCLUSION: The measurements fetal MoM-MCA before every IUIVT cannot be useful as predictor for the best timing for the next IUIVT, but it can be useful in predicting severity of fetal anemia.

Pregnancy after heart surgery--challenges.

PURPOSE: Advances in cardiac surgery significantly improve life expectancy and quality of life of patients with congenital or acquired heart disease. MATERIALS AND METHODS: The present study included 146 pregnant women who had antenatal care and gave birth at the Institute of Gynecology and Obstetrics in an interval of ten years from 1994-2004. Patients were divided in four groups according to the type of heart surgery. Group I included four patients with surgically corrected coarctation of the aorta. Group II included 27 patients with correction of the ostial stenosis. Group III had 68 patients with correction of congenital heart diseases, and group IV had 47 patients with artificial heart valves. RESULTS: There was 4% of heart failure after delivery. The incidence of hemorrhagic complications during pregnancy was 2.7% and 4.1% after delivery. The incidence of thromboembolic complications after delivery was 6%. Four newborns died; one of hydrocephalus and three of hypoxic ischemic encephalopathy. Two patients died. CONCLUSION: Patients with artificial heart valves need an enhanced level of medical care during pregnancy and labor.

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.

Predictive factors of malignancy in patients with adnexal masses.

INTRODUCTION: Good preoperative tumor triage is essential for choosing the appropriate approach. OBJECTIVE: The study aim was to identify factors from standard preoperatively collected data, which could predict the nature of adnexal masses prior surgery. MATERIAL AND METHODS: The study involved all women treated in the Clinic for Gynecology and Obstetrics Clinical Center of Serbia for adnexal tumors throughout a period of 18 months. On admission, detailed anamnestical and laboratory data were obtained and ultrasound scans were performed. Obtained data were compared with hystopathological findings of tumors. Methods of correlation and logistic regression were applied to create association models. RESULTS: Three new models for predicting tumor nature were achieved from anamnestical data, characteristics of women and tumors, and laboratory analyses. Two statistically significant (p = 0.000) equations were obtained for anamnestical data and characteristics of women and tumors, while three were made for laboratory analyses. Sensitivity of anamnestical malignancy index (AMI) was 73.33%, specificity 72.87%, positive predictive value (PPV) 39.49% and negative predictive value (NPV) 91.88%. Sensitivity of characteristic malignancy index (CMI) was 92.38%, specificity 67.36%, PPV 40.59% and NPV 97.34%. Sensitivity of laboratory malignancy index (LMI) was 56.45%, specificity 90.24%, PPV 68.63%, and NPV 84.57%. CONCLUSIONS: The best predictors of malignancy are menopausal status, body mass index (BMI), age, metastases, ascites, tumor marker CEA level, and erythrocyte sedimentation rate (ESR). Along with the risk of malignancy index (RMI), for more reliable triage and preoperative tumor evaluation the authors propose introduction of another three indexes (AMI, CMI, LMI) in clinical practice.

Conservative management of massive hematoperitoneum caused by ovulation in a patient with severe form of von Willebrand disease--a case report.

Von Willebrand disease (VWD) is the most common inherited bleeding condition that involves extended or excessive bleeding, caused by the deficiency or defect of von Willebrand factor (VWF). Hematoperitoneum as a complication of gynecologic diseases represents acute condition which is usually caused by the hemorrhagic corpus luteum or a rupture of either ectopic pregnancy or a hemorrhagic ovarian cyst. The authors present a unique case of conservatively managed massive hematoperitoneum caused by ovulation in a patient with severe form of von Willebrand disease who had right adnexectomy due to hemorrhagic corpus luteum four months prior. This conservative management by blood product and factor concentrate support could be a method of choice in selected hemodynamically stable patients. Furthermore, recurrent bleeding episodes following ovulation could be prevented by suppression of ovulation using oral contraceptive pills.

Intramuscular fetal corticosteroid therapy short-term effect on maternal-fetal Doppler velocimetry.

AIM: The aim of the study was to assess the short-term effects of intramuscular (IM) corticosteroid therapy (CST) on fetoplacental and fetal circulation in high-risk pregnancies of preterm labor. METHOD: We evaluated the effect of IM fetal single-dose dexamethasone (4 mg/kg) on fetoplacental and fetal circulation two hours before and 0-4 hours after CST in 38 fetuses after the 32nd week of gestation. RESULT: Changes in the umbilical artery (UA) resistance index (RI) after fetal CST (AU RI1) were significantly correlated with gestational age after the 32nd week at recording r = 0.354; p < 0.05. There was a statistically significant difference of RI in the descending aorta (DAo) before and after therapy; p < 0.001 (-0.04-0.01), 95% confidence interval (CI) for differences. CONCLUSION: Short-time effects after fetal IM CST include an increased index resistance in DAO as well as decreased RI in UA after the 32nd week.