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Milosevic B, Likic Ladjevic I, Dotlic J, Beleslin A, Mihaljevic O, Pilic I, Kesic V, Gojnic M, Stefanovic A, Stefanovic K. Cancer during pregnancy: Twenty-two years of experience from a tertiary referral center. Acta Obstet Gynecol Scand 2024; 103:716-728. [PMID: 38216215 PMCID: PMC10993340 DOI: 10.1111/aogs.14756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 11/08/2023] [Accepted: 11/23/2023] [Indexed: 01/14/2024]
Abstract
INTRODUCTION Cancer complicating pregnancy is a rare but potentially life-threatening condition for both the mother and her child. The aim of the present study was to assess the outcomes for mothers and children after pregnancy complicated by malignancy and to investigate which parameters are important for their 1-year survival. MATERIAL AND METHODS The study included 84 pregnant women diagnosed with malignant tumors during pregnancy from 2001 to 2022. The pregnancy course and outcome, as well as parameters that could influence the survival and condition of the mother and child were evaluated. Mothers and children were followed up for 1 year after delivery to assess their condition/complications and overall survival. RESULTS Most malignancies were gynecological (31%) or hematological (23.8%) and were diagnosed and surgically treated in the second trimester. Most children (69%) showed adequate growth and development throughout pregnancy but were delivered before term (53.6%) to allow mothers to receive therapy. Adjuvant therapy during pregnancy mostly caused a transitory deterioration of the child's condition, while surgery did not significantly impact the pregnancy course. Deliveries, on average, occurred during the 33.01 ± 6.16 gestational week (range: 20-40) and mostly by cesarean section (76.2%). For mothers, the pregnancy survival rate was 95.2% and survival after 1 year was 87.5%. However, 37.5% of women were still ill and required additional therapy 1 year postpartum. The pregnancy survival rate for children was 94%, whereas the 1-year survival rate was 76.2%. Most children had a favorable condition (alive, adequately growing and developing, and without complications) at birth (81%) as well as at the 1-year follow-up (63.7%). Regression analysis identified the following predictors of favorable 1-year maternal condition: applying therapy during pregnancy, no progression of the malignancy during pregnancy, and delivery at a later gestational week. Predictors of favorable 1-year condition of children were lower histopathological grade of malignancy, surgery as therapy for malignancy, obtaining higher birthweight, and delivery by cesarean section. CONCLUSIONS If the malignancy is not progressing, pregnancy should be continued as long as possible for the child to obtain adequate birthweight. Both surgery and chemotherapy were safe therapeutic choices, as most pregnancies continued successfully after therapy.
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Affiliation(s)
- Branislav Milosevic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Ivana Likic Ladjevic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Jelena Dotlic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Aleksandra Beleslin
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
| | - Olga Mihaljevic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
| | - Igor Pilic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Vesna Kesic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Miroslava Gojnic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Aleksandar Stefanovic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Katarina Stefanovic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
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Jovandaric MZ, Dokic M, Babovic IR, Milicevic S, Dotlic J, Milosevic B, Culjic M, Andric L, Dimic N, Mitrovic O, Beleslin A, Nikolic J, Jestrovic Z, Babic S. The Significance of COVID-19 Diseases in Lipid Metabolism Pregnancy Women and Newborns. Int J Mol Sci 2022; 23:ijms232315098. [PMID: 36499427 PMCID: PMC9736562 DOI: 10.3390/ijms232315098] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/16/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022] Open
Abstract
Coronavirus disease (COVID-19) is an infectious disease caused by SARS-CoV-2. Elderly people, people with immunodeficiency, autoimmune and malignant diseases, as well as people with chronic diseases have a higher risk of developing more severe forms of the disease. Pregnant women and children can becomesick, although more often they are only the carriers of the virus. Recent studies have indicated that infants can also be infected by SARS-CoV-2 and develop a severe form of the disease with a fatal outcome. Acute Respiratory Distress Syndrome (ARDS) ina pregnant woman can affect the supply of oxygen to the fetus and initiate the mechanism of metabolic disorders of the fetus and newborn caused by asphyxia. The initial metabolic response of the newborn to the lack of oxygen in the tissues is the activation of anaerobic glycolysis in the tissues and an increase in the concentration of lactate and ketones. Lipid peroxidation, especially in nerve cells, is catalyzed by iron released from hemoglobin, transferrin and ferritin, whose release is induced by tissue acidosis and free oxygen radicals. Ferroptosis-inducing factors can directly or indirectly affect glutathione peroxidase through various pathways, resulting in a decrease in the antioxidant capacity and accumulation of lipid reactive oxygen species (ROS) in the cells, ultimately leading to oxidative cell stress, and finally, death. Conclusion: damage to the mitochondria as a result of lipid peroxidation caused by the COVID-19 disease can cause the death of a newborn and pregnant women as well as short time and long-time sequelae.
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Affiliation(s)
- Miljana Z. Jovandaric
- Department of Neonatology, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Correspondence: ; Tel.: +381-11-366-35-86
| | - Milan Dokic
- Department of Gynecology and Obstetrics, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
| | - Ivana R. Babovic
- Department of Gynecology and Obstetrics, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
| | - Srboljub Milicevic
- Department of Gynecology and Obstetrics, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
| | - Jelena Dotlic
- Department of Gynecology and Obstetrics, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
| | - Branislav Milosevic
- Department of Gynecology and Obstetrics, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
| | - Miljan Culjic
- Department of Gynecology and Obstetrics, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Luka Andric
- Department of Gynecology and Obstetrics, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Nemanja Dimic
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
- Clinic for Anesthesiology and Intensive Care, University Clinical Hospital Center “Dr Dragisa Misovic - DEDINJE”, 11000 Belgrade, Serbia
| | - Olga Mitrovic
- Department of Gynecology and Obstetrics, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Aleksandra Beleslin
- Department of Gynecology and Obstetrics, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Jovana Nikolic
- Department of Gynecology and Obstetrics, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Zorica Jestrovic
- Department of Gynecology and Obstetrics, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Sandra Babic
- Department of Gynecology and Obstetrics, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia
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Mostic Stanisic D, Kalezic N, Rajovic N, Ilic Mostic T, Cumic J, Stanisavljevic T, Beleslin A, Stulic J, Rudic I, Divac N, Milic N, Stojanovic R. Effect of regional vs general anesthesia on vital functions after cesarean section: a single center experience. Hypertens Pregnancy 2022; 41:198-203. [DOI: 10.1080/10641955.2022.2124417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Danka Mostic Stanisic
- Clinic for Gynecology and Obstetrics, Clinical Center “Dragisa Misovic–Dedinje”, Belgrade, Serbia
- Clinic of Gynecology and Obstetrics, Clinical Centre of Serbia, Belgrade, Serbia
| | - Nevena Kalezic
- Faculty of Medicine University of Belgrade, Belgrade, Serbia
- Department of Anesthesiology, Clinic of Gynecology and Obstetrics, Clinical Centre of Serbia, Belgrade, Serbia
| | - Nina Rajovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine University of Belgrade, Belgrade, Serbia
| | - Tatjana Ilic Mostic
- Department of Anesthesiology, Clinic of Gynecology and Obstetrics, Clinical Centre of Serbia, Belgrade, Serbia
| | - Jelena Cumic
- Department of Anesthesiology, Clinic for Cardiac Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Aleksandra Beleslin
- Clinic of Gynecology and Obstetrics, Clinical Centre of Serbia, Belgrade, Serbia
| | - Jelena Stulic
- Clinic for Gynecology and Obstetrics “Narodni Front”, Belgrade, Serbia
| | - Ivana Rudic
- Clinic for Gynecology and Obstetrics “Narodni Front”, Belgrade, Serbia
| | - Nevena Divac
- Institute for Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine University of Belgrade, Serbia
| | - Natasa Milic
- Institute for Medical Statistics and Informatics, Faculty of Medicine University of Belgrade, Belgrade, Serbia
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Radan Stojanovic
- Institute for Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine University of Belgrade, Serbia
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