Cancer during pregnancy: Twenty-two years of experience from a tertiary referral center

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.

Intrauterine Fetal Death in Term Pregnancy-A Single Tertiary Clinic Study

INTRODUCTION

Intrauterine fetal death (IUFD) is defined as death of the fetus after the 20th week of gestation. Despite regular monitoring the incidence of IUFD remains high. This study aims to assess the incidence and maternal conditions associated with IUFD over term pregnancies in a twelve-year period.

MATERIALS AND METHODS

A retrospective descriptive study was conducted on a population of women in whom IUFD was diagnosed in a term pregnancy during the period from January 2010 to December 2022. The study was at the Clinic for Obstetrics and Gynecology, University Clinic Centre of Serbia. The analyses included the number of deliveries, live births, and stillbirths, as well as maternal, fetal, and placental conditions associated with the risk of IUDF. The statistical analysis involved descriptive statistical methods and one sample proportion.

RESULTS

The average age of the patients was 30 years. Most patients had secondary and higher education, and 70% of patients had regular pregnancy monitoring; 53.33% were primiparous and pregnancies occurred spontaneously. IUFD mainly occurred in the 39th week of gestation. In total, 38.3% had one to two associated diseases, 5% more than three, and 58.33% were healthy. Recurrence of IUFD was reported by 10% of patients, while 8.33% had a history of spontaneous abortion. Over 80% of placental histopathological findings indicated some pathology (e.g., infarction, infections, placental abruption).

CONCLUSIONS

The most significant risk factors for IUFD in term pregnancies in our population during the study period were hypertensive syndrome in pregnancy, obesity and gestational diabetes. Pathological findings on the placenta were more common in our study group than is usually reported with infractions of placental tissue being the most common, even in healthy women.

Highlighting early detection of thyroid pathology and gestational diabetes effects on oxidative stress that provokes preterm delivery in thyroidology: Does that ring a bell?

OBJECTIVES

Ad fontes, the status of the thyroid gland, and metabolic disturbance lead to the alteration of oxygenation. In pregnancy, it is particularly crucial to possess all predictive parameters.

METHODS

This cross-sectional study was conducted at the Clinic of Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia, between 2017 and 2021 which study included a total of 99 women who had been admitted for preterm delivery and had undergone thyroid analysis, detected Hashimoto thyroiditis, and Oral Glucose Tolerance Test (OGTT) 40 days after delivery and had pathological Homeostatic Model Assessment for Insulin Response (HOMA IR) indices. In the group of urgent patients with preterm delivery, we looked after not only routine Doppler of the umbilical artery, but we measured specific ratios such as the Cerebroplacental ratio (CP).

RESULTS

The mean maternal age was 32.23 ± 5.96 years and the mean gestational age was detected as 35.40 ± 2.39 weeks. The delivery was completed vaginally in 77 women (78%) and surgically in 22 (22%). The Mean APGAR score was 8.44 ± 1.18, the mean birth weight was 2666.87 ± 622.17g and the cases undergoing cesarean section had significantly higher values of pulsatility index (1.85 ± 0.27 vs. 1.34 ± 0.31) and CP (1.22 ± 0.26 vs. 0.47 ± 0.17).

CONCLUSIONS

The introduction of Doppler sonography for blood flow assessment helps to form a complete clinical description of the patient, particularly in conditions where oxidative stress became provocative by the thyroid gland antibodies and gestational diabetes in Thyroidology.

Hereditary thrombophilia and low -molecular -weight heparin in women: useful determinants, including thyroid dysfunction, incorporating the management of treatment and outcomes of the entity

OBJECTIVE

Our study purposed to examine the complex relationship between low-molecular-weight heparin therapy, multiple pregnancy determinants, and adverse pregnancy outcomes during the third trimester in women with inherited thrombophilia.

METHODS

Patients were selected from a prospective cohort of 358 pregnant patients recruited between 2016 and 2018 at the Clinic for Obstetrics and Gynecology, University Clinical Centre of Serbia, Belgrade.

RESULTS

Gestational age at delivery (β=-0.081, p=0.014), resistance index of the umbilical artery (β=0.601, p=0.039), and D-dimer (β=0.245, p<0.001) between 36th and 38th weeks of gestation presented the direct predictors for adverse pregnancy outcomes. The model fit was examined using the root mean square error of approximation 0.00 (95%CI 0.00-0.18), the goodness-of-fit index was 0.998, and the adjusted goodness-of-fit index was 0.966.

CONCLUSION

There is a need for the introduction of more precise protocols for the assessment of hereditary thrombophilias and the need for the introduction of low-molecular-weight heparin.

Revisiting type II diabetes mellitus in pregnancy and pregnancy outcomes such as in thyroidology: do you mind?

OBJECTIVE

There is an increase in the prevalence of pre-gestational diabetes in the past decades, mainly due to the increase in the prevalence of obesity in the general population and consequently type 2 diabetes among women of reproductive age.

METHODS

This study purposed to describe the delivery characteristics, pregnancy complications, and outcomes among women in Serbia with the pre-gestational type 2 diabetes in the past decade, as well as their pregnancy complications, deliveries, and neonatal outcomes. The study included data from all the pregnant women with pre-gestational type 2 diabetes in Belgrade, Serbia during the period between 2010 and 2020. The final sample consisted of 138 patients.

RESULTS

More than half, i.e., 70 (50.7%) had a vaginal delivery, while 48 (34.8%) had elective and 20 (14.5%) had emergency caesarean sections. Throughout the period, there was 1 patient with preeclampsia (0.7%), 5 with pregnancy-induced hypertension (3.6%), 7 had newborns with small for gestational age (5.1%), 28 with macrosomia (20.3%), 12 (8.7%) had preterm births, and one-fifth, i.e., 28 (20.3%) of the newborns had Apgar score under 8.

CONCLUSION

The present study revealed that women with type 2 diabetes in pregnancy have a significant burden of pregnancy complications, related to pregnancy, delivery, and newborns.

Metabolism of the mother, placenta and fetus in diabetes

Metabolic changes occur due to the effects of placental hormones such as human chorionic gonadotropin and human placental lactogen in normal pregnancies. These effects enable the development of insulin resistance among all pregnant women that is them ost significantly pronounced in the third trimester. In pregnancies complicated with pre-gestational or gestational diabetes mellitus these changes are more intensive as they affect fetoplacental unit. In pregnancies complicated with diabetes the increased number of placental macrophages leads to the increased production of different cytokines which include leptin, tumour necrosis factor alpha and interleukins. This review addresses placental vascular changes that lead to adverse pregnancy outcomes, along with the effects of the maternal hyperglycemia and fetal hyperinsulinemia.

Trends of the Prevalence of Pre-gestational Diabetes in 2030 and 2050 in Belgrade Cohort

The aim of this study was to analyze the trends in diabetes in pregnancy in Belgrade, Serbia for the period of the past decade and forecast the number of women with pre-gestational diabetes for the years 2030 and 2050. The study included the data on all pregnant women with diabetes from the registry of the deliveries in Belgrade, by the City Institute of Public Health of Belgrade, Serbia for the period between 2010 and 2020 and the published data on the deliveries on the territory of Belgrade. During the examined period the total number of live births in Belgrade was 196,987, and the prevalence of diabetes in pregnancy was 3.4%, with the total prevalence of pre-gestational diabetes of 0.7% and overall prevalence of GDM of 2.7%. The average age of women in our study was significantly lower in 2010 compared to 2020. The forecasted prevalence of pre-gestational diabetes among all pregnant women for 2030 is 2% and 4% for 2050 in our cohort. Our study showed that the prevalence of pre-gestational diabetes has increased both among all pregnant women and among women with diabetes in pregnancy in the past decade in Belgrade, Serbia and that it is expected to increase further in the next decades and to further double by 2050.

Maternal and Fetal Outcomes among Pregnant Women with Diabetes

The aim of this study was to examine the differences in pregnancy complications, delivery characteristics, and neonatal outcomes between women with type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), and gestational diabetes mellitus (GDM). This study included all pregnant women with diabetes in pregnancy in Belgrade, Serbia, between 2010 and 2020. The total sample consisted of 6737 patients. In total, 1318 (19.6%) patients had T1DM, 138 (2.0%) had T2DM, and 5281 patients (78.4%) had GDM. Multivariate logistic regression with the type of diabetes as an outcome variable showed that patients with T1DM had a lower likelihood of vaginal delivery (OR: 0.73, 95% CI: 0.64–0.83), gestational hypertension (OR: 0.47, 95% CI: 0.36–0.62), higher likelihood of chronic hypertension (OR: 1.88, 95% CI: 1.55–2.29),and a higher likelihood ofgestational age at delivery before 37 weeks (OR: 1.38, 95% CI: 1.18–1.63) compared to women with GDM. Multivariate logistic regression showed that patients with T2DM had a lower likelihood ofgestational hypertension compared to women with GDM (OR: 0.37, 95% CI: 0.15–0.92).Our results indicate that the highest percentage of diabetes in pregnancy is GDM, and the existence of differences in pregnancy complications, childbirth characteristics, and neonatal outcomes are predominantly between women with GDM and women with T1DM.

Cancer during pregnancy - clinical characteristics, treatment outcomes and prognosis for mothers and infants

OBJECTIVE

To assess which obstetrical characteristics and treatment improved outcomes and prognosis of pregnant women with malignancy.

METHODS

A prospective study, undertaken between 2005 and 2014, involving 35 pregnant women who were diagnosed with malignant tumors during pregnancy. Patients were followed-up for 1 year after delivery. The pregnancy course and outcome and parameters that could influence the condition of mother and fetus were evaluated.

RESULTS

Most malignancies were hematological, diagnosed in the second trimester and treated with combined therapy (surgery/adjuvant) after pregnancy. Most fetuses were in good state throughout pregnancy, but were delivered by caesarean section (CS) before term. Adjuvant therapy during pregnancy mostly caused transitory deterioration of fetal conditions. The majority of both mothers and infants were in a good state 12 months postpartum, although numerous mothers were still ill and on therapy. Surviving pregnancy and preventing tumors progression during pregnancy were the best predictors of mothers' future condition (P=0.022). High birthweight and term delivery were the most important factors for good outcome of the infants (P=0.001).

CONCLUSIONS

If the tumor is not progressing, pregnancy should be continued as long as possible to obtain adequate birthweight of the infant. Second trimester surgery is safe, while other therapies should preferably be applied after delivery.

Relationship between mid-trimester ultrasound fetal liver length measurements and gestational diabetes mellitus

BACKGROUND

The aim of the present study was to investigate the relationship between mid-trimester ultrasound fetal liver length (FLL) and gestational diabetes mellitus (GDM) in a high-risk population.

METHODS

A prospective study was performed in 331 women with singleton pregnancies who were at high risk of GDM and were undergoing a mid-trimester ultrasound examination. The ultrasound scan at 23 weeks gestation was followed by a 100-g oral glucose tolerance test (OGTT) at 24 weeks gestation. Correlations between FLL and OGTT results at different time points were tested. Receiver operating characteristic (ROC) analysis of FLL as a potential prognostic factor for GDM was also performed.

RESULTS

In GDM patients, there was a significant positive correlation (P < 0.01) between FLL and OGTT glycemia immediately before and 60, 120, and 180 min after glucose intake. Mean FLL in GDM was significantly higher than in healthy subjects (41.04 vs 31.09 mm, respectively; P < 0.001). When tested as a potential prognostic factor for GDM, fetal liver measurements showed excellent diagnostic performance. The ROC analysis established a cut-off value of FLL of 39 mm for the prediction GDM, with sensitivity of 71.76%, specificity 97.56%, positive predictive value 91.0%, and negative predictive value 90.9%. The usefulness of FLL measurements was supported by a high area under the ROC curve (90.5%).

CONCLUSION

In conclusion, there is a strong correlation between FLL and OGTT results, with FLL possibly serving as a valid marker for the prediction of GDM in high-risk populations.

The effects of adjuvant insulin therapy among pregnant women with IGT who failed to achieve the desired glycemia levels by diet and moderate physical activity

OBJECTIVE

Evaluation of adjuvant insulin therapy effects on glycemic control, perinatal outcome and postpuerperal glucose tolerance in impaired glucose tolerance (IGT) pregnant women who failed to achieve desired glycemic control by dietary regime.

METHODS

A total of 280 participants were classified in two groups: Group A patients continued with dietary regime and Group B patients were treated with adjuvant insulin therapy. Glycemic control was assessed by laboratory and ultrasonograph means. Pregnancy outcomes were evaluated by prevalence of pregnancy induced hypertension (PIH), high birth weight, neonatal hypoglycemia and caesarean section rates. Postpuerperal glucose tolerance was assessed by oral glucose tolerance test (oGTT).

RESULTS

All laboratory and ultrasound indicators of glycemic control had significantly lower values in Group B. Group A women were more likely to develop the EPH (Edema, Proteinuria, Hypertension) syndrome, 20% versus 7.86% (p = 0.003). High birth weight occurred more frequently in Group A, but the difference was not significant (p = 0.197). Higher rate of caesarean delivery was in Group A than in Group B, 16.43% versus 26.43% (p = 0.041). The difference in neonatal hypoglycemia was not significant (p = 0.478). Pathological oGTT results were observed in 73 Group A patients and in 15 Group B patients.

CONCLUSION

Lower caesarean section rates and the EPH syndrome incidence are the benefits of adjuvant insulin therapy in IGT patients.

Prediction of fetal macrosomia with ultrasound parameters and maternal glycemic controls in gestational diabetes mellitus

PURPOSE OF INVESTIGATION

Evaluation of ultrasound measurements of fetal adipose subcutaneous tissue (ASCT), abdominal circumference (AC), liver length (LL), and amniotic fluid index (AFI) in prediction of fetal macrosomia (FM) and gestational diabetes mellitus (GDM).

MATERIALS AND METHODS

In a prospective clinical trial, 280 pregnant women underwent 100 g oral glucose tolerance test (oGTT) at 28th week of gestation (wg) and measurements ofAC, LL, AFI, and ASCT at 32nd, 34th, 36th, and 38th wg.

RESULTS

For GDM, the best sensitivity was achieved by ACST at 32nd and 34th wg, the best specificity by LL at 32nd wg (90.6%), the best area under the curve (AUC) by LL at 34th wg (0.944). For FM the best sensitivity was achieved by AC at 32th, 34th, 36th, and 38th wg and by ASCT at 34th wg (94.2%), and the best AUC at 38th wg for AC (0.974).

CONCLUSION

Ultrasound parameters of glycemic control were good predictors of FM and GDM.

Comparison of electrolytic status (Na+, K+, Ca2+, Mg2+) in preterm and term deliveries

PURPOSE OF INVESTIGATION

The objective of this study was to evaluate the electrolytic status of Na+, K+, Ca+, and Mg2+ in serum and red blood cells in idiopathic preterm and term deliveries.

METHODS

The study included 105 pregnant women diagnosed with idiopathic premature delivery (study group) and 36 pregnant women with physiologically term delivery (controls). Samples of mother's blood were collected and analyzed for the level of electrolytes in the serum/plasma and red blood cells.

RESULTS

Measured values of magnesium in red blood cells in the study group were far lower than physiological values, intracellular calcium levels were higher in the study group compared to levels measured in the controls. Sodium concentrations in cells were significantly lower in subjects with premature delivery.

CONCLUSION

The magnesium intracellular level is the best representative value of magnesium in the body.

New insights into the pathogenesis of perinatal hypoxic-ischemic brain injury

BACKGROUND

Pathogenesis of perinatal hypoxic-ischemic brain injury (HIE) is complex. In this study, we examined the role of neuroinflammation, oxidative stress and growth factors in perinatal hypoxic-ischemic brain damage.

METHODS

Ninety neonates (>32 weeks' gestation) with perinatal HIE were enrolled prospectively. Perinatal HIE was categorized into three stages according to the Sarnat and Sarnat clinical scoring system and changes seen on amplitude integrated electroencephalography. Cerebrospinal fluid (CSF) for interleukin-6 (IL-6) and glutathione peroxidase analysis was taken in the first 48 h of life and subsequent CSF for neuron-specific enolase (NSE) and vascular endothelial growth factor (VEGF) analysis 72 h after birth. Neurodevelopmental outcome was assessed at 12 months of corrected gestational age using the Denver Developmental Screening Test.

RESULTS

Concentrations of NSE in CSF correlated with severity of HIE (P < 0.0001) and corresponded well with subsequent neurodevelopmental outcome. Concentrations of IL-6 in CSF were markedly increased in neonates with severe HIE (P < 0.0001) and those with subsequent neurological sequels, but were normal in the majority of neonates with mild and moderate HIE. Glutathione peroxidase activity in CSF was significant with the stage of HIE (P < 0.0001) and gestational age (P < 0.0001) and corresponded well with subsequent neurodevelopmental outcome. Advanced stage of HIE was associated with increased concentrations of VEGF in CSF (P < 0.0001). Neurological outcomes at 12 months of age correlated best with CSF level of NSE (P < 0.001) and IL-6 (P < 0.001).

CONCLUSION

Our results suggest that neuroinflammation plays a principal role in perinatal hypoxic-ischemic brain damage and we postulate that oxidative stress and upregulation of VEGF might be important contributing factors in the pathogenesis of hypoxic-ischemic brain injury, particularly in preterm neonates.

Is insulin-dependent diabetes and obesity a predisposition for endometrial and pancreatic carcinoma?

Among 178 patients operated for endometrial carcinoma during a five-year period, 17 were re-operated at the Institute of Surgery (9.5%) because of pancreatic head carcinoma. The frequency of insulin-dependent diabetes was pointed out in patients-- 28% of those who were first diagnosed with endometrial carcinoma. Moreover in the same group diagnosed with endometrial carcinoma, we found 17 to have pancreatic carcinoma, and among those there were 12 cases that had diabetes (70.58%).

Bone metastasis arising from a polyp of the cervix as the first symptom in generalized multi-organ adenocarcinoma

Our patient was a 40-year-old female with a positive familial history for malignancies but no chronic diseases. After two vaginal deliveries without any reported difficulties, the patient had no intermenstrual bleeding, postcoital bleeding, leucorrhea or hypermenorrhea, abnormal vaginal bleeding, or postmenstrual bleeding, except during the past five-year period when a polyp-like change in the cervix was found. There was no indication for polypectomy, considering the fact that the patient had no symptoms, had an iodine positive Schiller test, as well as regular cytological smears on Papanicolaou testing. It is noteworthy that the patient had no symptoms until changes in the stool and painful sensation in the hip area. The patient was subjected to extensive surgery by a team composed of a gynecologist, surgeon and orthopedist. During Werthaim-Meigs surgery, four positive glandules and cervical adenocarcinoma Stage II were found. The colon was removed, as a right hemicolectomy, as well as the iliac bone upper segment. Unfortunately, considering the changes in the tissue of the colon and cervix, we considered the condition to be "generalized" adenocarcinoma.

Cerebrovascular diseases during pregnancy and puerperium

OBJECTIVE

We have studied 37 women with all forms of cerebrovascular diseases. Our aim was to study the etiology, clinical manifestations and prognosis of such conditions during pregnancy or puerperium.

METHODS

We analyzed the most common causes of cerebrovascular diseases during the given period.

RESULTS

The most common causes of cerebrovascular diseases during pregnancy or puerperium are hematological coagulation disorders, cardio embolism and eclampsia, whereas other causes ara rarer.

CONCLUSIONS

The incidence of cerebrovascular diseases during pregnancy or puerperium is 11%. Cerebrovascular diseases are more frequent in puerperium than during pregnancy, being 1.8:1. Etiology remains undetermined in 35% of the cases.

Ovulation stimulation after treatment for a molar pregnancy for or against?

The case of a 29-year-old patient who underwent invitro fertilization due to secondary sterility, after a spontaneous but molar pregnancy, is described. Afterwards there was no spontaneous conception for five years. With the couple's consent, we decided to perform in vitro fertilization, i.e., ovulation induction and the ICSI (intracytoplasmic sperm injection) method.

Uterine sarcoma diagnosed during colon surgery--a complete precise diagnosis

Uterine sarcomas are very rare tumors with the greatest malignant potential of all uterine tumors, and they differ significantly from endometrial carcinoma by their specific course, propagation and prognosis. A 54-year-old patient, after three vaginal deliveries and negative personal and family history, as well as regular cycles, presented with secondary problems related to occasional constipation with sporadic diarrhea and bloody stools. Colonoscopy revealed a colon tumor.

Postoperative complications--massive transfusions in radical malignant gynecological surgeries

At the Institute of Gynecology and Obstetrics we examined 24 women who were radically operated on and received massive transfusions during the intraoperative and postoperative period. Twelve developed massive transfusion complications such as urticaria, fever, and respiratory insufficiency known as TRALI (transfusion-related acute lung injury).

Cervical and duodenal polyps and their malignant alterations--case report

During routine examination of a 32-year-old patient, a cervical polyp was found and CIN III was confirmed by biopsy. After performing colposcopy, biopsy and establishing CIN III as well as performing gastroscopy where a duodenal polyp was found, thorough diagnostic exams and therapy were carried out. Complete duodenal resection and conization were performed. The medical board decided that neither further radiation nor chemotherapy was needed.

Increased AFP as an indicator of ovarian carcinoma and fetal kidney carcinoma--case report

We examined a young primipara with increased alpha-fetoprotein (AFP) values and cystic tumefaction of the right ovary. Having in mind a mild decrease in ovarian artery resistance index (RI) and suspected findings of fetal kidney, this situation was delicate due to its double pathology which was later confirmed. Wilms' tumor is the most common urogenital tumor in childhood, and it is detectable in the prenatal period by ultrasound examination. In utero kidney biopsy confirms diagnosis and facilitates decisions concerning the course of pregnancy. Relative risk of intervention limits this diagnostic procedure for indicated cases.

Torsion of carcinomatous ovarian cyst and polycystic omental diseases--case report

A middle-aged patient, without any positive personal or familial history was urgently hospitalized and, after primary diagnostic procedures, treated by surgery for torsion and acute abdomen. During the procedure, torsioned ovarian cyst and a probable perforated omental cyst were found. Primary ovarian cancer and secondary polycystic metastatic echoes of the omentum were established by histopathology.

Treatment for infertility and risk of invasive epithelial ovarian cancer--a case report

A 30-year-old women was admitted to the Institute of Gynecology and Obstetrics, Clinical Center of Serbia in April 2004 with the following diagnosis: adnexal mass soon after in vitro fertilization. Her history revealed salpingo-oophorectomy for mucinous cystadenofibroma of the left ovary eight years before and cystectomy of the right ovary three years before. At admission, the most remarkable findings were high temperature and elevated white blood cells with erythrocyte sedimentation rate. After the antibiotic treatment, laparatomy was performed and a multilocular right adnexal tumor was found. The right salpingo-oophorectomy was performed and pathological diagnosis was mucinous ovarian adenocarcinoma. Two weeks later, radical surgery was carried out and chemotherapy was applied. There is an urgent need for clear interpretation of the link between ovarian stimulation and ovarian cancer. An association between ovarian stimulation treatment and ovarian cancer has still not been completely proven.

Treatment of choriocarcinoma metastases by surgery and polychemotherapy - case report

Choriocarcinoma is present in one out of every 40,000 pregnancies. There is a great risk for incidence of the disease in women who become pregnant after 45 years of age. The clinical picture may vary and is related to the destruction of tissue and bleeding. New chemo protocols containing etoposide, cisplatin, ifosfamide, together with a resection of the focus resistant to chemotherapy, lead in most cases to the complete recovery.

The incidence of vulvar pathology and vulvectomy within risk and non-risk groups

At the Institute of Gynecology and Obstetrics over a period of five years, more than 180,000 women were examined; 580 simple and 178 radical vulvectomies were performed.

Placental site trophoblastic tumor: a case report

Patient K.N., age 30, nulliparous deliveries and with one miscarriage, was admitted to the Institute of Gynecology and Obstetrics, Clinical Center of Serbia, in December 2000 with the following diagnosis: Uterine myoma and adnexal mass.

Endometrial carcinoma and hormonal disturbances in middle-aged women--an overview

Endometrial hyperplasias and endometrial adenocarcinomas present a morphological continuity. In 1,150 cases of patients admitted to two hospitals over the past two years with diagnosed irregular bleeding, suspected ultrasonography findings and positive family history, we performed, not only hormonal examinations, but also fractioned explorative curettage after receiving patient consent.

Endometriosis and possible malignant transformation

By examining the cause of infertility for a the period of three years in the two largest hospitals in Belgrade, we found 453 cases of endometriosis out of 683 cases of laparoscopy. During the procedure, removal of endometrial foci, histological examination of the sample and removal of genital and peritoneum abnormalities by laser were carried out. Interestingly, in only 8% of the cases were cancerous changes of the ovary diagnosed. Out of 36 patients with established diagnoses, hysterectomy and bilateral salpingo-oophorectomy were performed in four cases.

Metastases of the digestive tract and ovarian tumors--or vice versa: an analysis

Ovarian carcinoma may appear regardless of age, including during childhood. Predisposing factors for the development of ovarian carcinoma are age (usually over 40), positive family history, mumps parotitis, small number of deliveries, environmental factors, persistant ovulation, etc. Metastases may appear in the ovary from almost all primary sites.

Vaginal malignant melanoma in a healthy pregnancy--a case report

Vaginal melanomas account for fewer than 2% of vaginal malignancies. The mean age at diagnosis is 55 years and the prognosis is poor, with an overall 5-year survival rate of 5% to 10%.

Progesterone and pregnancy

PURPOSE OF REVIEW

Progesterone is an essential hormone in the process of reproduction. Although the pharmacokinetics and pharmacodynamics of progesterone have been well studied, its use in the pathophysiology of pregnancy remains controversial. One of these concerns is the way in which the hormone is administered.

RECENT FINDINGS

In obstetrics the most frequent uses of progesterone are in the treatment of threatened abortion, prevention of recurrent miscarriage, or in the support of the luteal phase in assisted reproduction programmes, and in threatened preterm labour. Randomized, controlled trials showed that women who received progesterone were statistically significantly less likely to have recurrent miscarriages before 34 weeks, to have an infant with birth weight of 2.5 kg or lower, or to have an infant diagnosed with intraventricular haemorrhage. There is currently, however, insufficient information to allow recommendations regarding the optimal dose, route and timing of administration of progesterone supplementation.

SUMMARY

Progesterone has shown to be efficacious when continuation of pregnancy is hampered by immunological factors, luteinic and neuroendocrine deficiencies and myometrial hypercontractility. This may explain the reduction in the incidence of preterm birth in high-risk pregnant women using high-dosage prophylactic progesterone.

New approach of the treatment of von Willebrand’s disease during pregnancy

AIM

The aim of the study was to analyze the effectiveness of the application of DDAVP (desmopressin) and Hemate P with cryoprecipitate pre- and postpartum in patients with von Willebrand disease.

METHODS

We monitored 32 patients with von Willebrand disease during the study period 1993-2003. DDAVP was applied in the 36th/37th week of gestation and cryoprecipitate and fresh frozen plasma were applied 1 day before and 3 days after delivery. DDAVP treatment continued for 4 weeks. Factor VIII (Hemate P) at the day of delivery

RESULTS

No complications occurred in the studied population.

CONCLUSION

Precipitation of DDAVP, Hemate P, and cryoprecipitate may help in the treatment of pregnant women with von Willebrand disease.

The changing role of progesterone in preterm labour

Progesterone is an essential hormone in the process of reproduction. It is involved in the menstrual cycle, implantation and is essential for pregnancy maintenance. Although the pharmacokinetics and pharmacodynamics of progesterone have been well studied, and since 1935 it has been synthesised and is now available commercially, its use in the pathophysiology of pregnancy remains controversial. One of these concerns is the way in which the hormone is administered, with parenteral use proving the best way to obtain optimal plasma levels. Another concern is the paucity of randomised controlled trials and the different dosages and populations studied. As a result, the therapeutic application of progesterone in pregnancy is restricted to the prevention and treatment of threatened miscarriage, recurrent miscarriage and preterm birth. Progesterone is efficacious when continuation of pregnancy is hampered by immunological factors, luteinic and neuroendocrine deficiencies and myometrial hypercontractility. This may explain the reduction in the incidence of preterm birth in high risk pregnant women using high-dosage prophylactic progesterone.

The significance of Doppler flow in early detection of uterine sarcoma in older primigravida pregnancies

During a four-year period we analyzed the significance, sensitivity and sensibility of myoma Doppler flow during pregnancy in relation to the course and outcome of the pregnancy and to later histopathological findings. By following 36 older primigravidas with determined myomas, we observed the course of the pregnancies in all trimesters and analyzed myoma Doppler flow. In conditions where the resistance index showed the possibility of uterine sarcoma, the pregnancy was ended by surgery; not only was myomectomy performed but also complete uterine hysterectomy with the previous consent of the patient. Doppler flow was accepted as the authoritative parameter for non-invasive detection of a malignant process. Considering the obstetrical findings, other patients were delivered vaginally or operatively, but after puerperium they were subjected to control examinations and myomectomy because Doppler flow findings did not show any indications of sarcoma. By histopathological analysis, we received benign results in 31 cases, while in four cases where we decided on hysterectomy and surgical delivery, we received malignant results, i.e. leiomyosarcoma. In four cases of performed hysterectomy immediately after cesarean section, the resistance index (RI) of revascularization within the myoma was in the range between RI 0.30 +/- 0.02. Flows within the uterine artery were 0.54 +/- 0.03.

Ultrasound and surgery for gall bladder carcinoma during pregnancy

Gall bladder carcinoma is the most common carcinoma of the biliary tract and the fifth most common malignant tumor of the gastrointestinal tract. The patients usually have no symptoms at all or non-specific symptoms are present. The therapy for gall bladder carcinoma is complete removal. Unfortunately, in 80% of the cases the survival period is less than one year.

Cervical carcinoma and pregnancy in a young primipara

Cervical carcinoma is the fourth most common malignant disease in women, after breast, lung and colon cancer. It is present in two-thirds of all malignant diseases of the genital tract. Although in most of Europe patients are subjected to regular health screening, diagnoses of severe life-threatening alterations are often made when they are already in late stages.

Pancreatic tumor in a pregnant woman: a rare case report

We have analyzed a case of pancreatic carcinoma in a pregnant woman, 37 years old, in the second trimester of the pregnancy. She had a positive family history of digestive tract carcinoma. The delivery ended surgically and hysterectomy was performed at the same time.

The significance of detailed examination of hemorrhoids during pregnancy

In the population of pregnant women in Serbia and Montenegro, hemorrhoids are present in 85% of the cases during the second and third pregnancy. Urged by the complications of non-treated hemorrhoids, we carried out a routine diagnostic procedure to examine hemorrhoids during pregnancy, i.e. a differential diagnosis with other possible complications was performed. Fifty patients, aged between 36 and 38, were examined by anoscope and rectoscope during the second trimester. Rectal carcinoma was found in three cases, which is a disturbing number. The patient with the most serious clinical picture was subjected to urgent artificial fetal lung maturation and surgical delivery. One of the patients had clinical cachexia, and in view of the fact that the magnetic resonance imaging during pregnancy showed infiltration and that the patient was 38 years old, with the patient's consent, surgery was performed together with hysterectomy and salpingo-oophorectomy and immediate removal of the rectum and anus. In the other two cases, the delivery ended vaginally between the 35th and 38th week of gestation, after which the patients were moved to the surgery ward. Besides a positive family history for digestive tract carcinoma (95%), smoking and increased body mass index, there were no significant parameters distinguishing these three patients from others with hemorrhoids. Interesting data were obtained from the fact that there was no increase in body mass during pregnancy which patients correlated with their already present obesity. Moreover, pain was correlated with the fact that the patients did not follow a healthy dietary regime. In all 50 patients, the following procedures were performed: anoscope, rectoscope and digestive tract tumor markers. Observing the results of the biopsies, we found rectal carcinoma Stage C according to Dukes staging (tumor included serosa) in one case. In the other two cases, Stage B1 carcinomas were found (which included all layers except serosa). Magnetic resonance imaging was performed and confirmed progression of the disease. The delivery ended per vias naturalis in two cases in view of the fact that it was the third pregnancy for both patients. Surgery was performed 40 days after delivery. Postoperative recovery was unremarkable in all described cases.

Bacterial infections--the cause of preterm delivery

Within diagnostic procedures protocols in preterm delivery, the objective of the study was to examine bacterial causes of preterm deliveries in relation to term deliveries. The study included 106 patients delivered before term (24 to 37 weeks of gestation) and 126 patients with term delivery after 37 to 42 weeks of gestation. Bacterial analysis included hospital material: cervix smear in patients before the delivery and protective and functional fetal elements.

Artificial fetal lung maturation--prevention of antenatal complications in premature deliveries

Keeping in mind the frequency of preterm deliveries as well as the morbidity and mortality of the newborn population, many ways of bringing about faster maturation of the fetus have been. Today, we can say that after the 24th week of gestation, when the pneumocites time 2 are anatomically formatted, medical treatment of the fetus for maturation not only of the lungs but all the vulnerable organs is available. By stimulating the pneumocites to make surfactant and sphingomyeline and phosphatidilinositol and phosphatidilglycerol, we can reduce respiratory distress syndrome. Moreover, the frequency of intracranial haemorage is lowered. We have performed many studies with all of their positive and negative effects, including: use of corticosteroids, thyroxine, aminophilline, surfactant, inositole and beta adrenergic agonist.

The significance of C-reactive protein in the diagnosis of fetal tachycardia and therapy of chorioamnionitis

BACKGROUND

[corrected] Pregnant woman with fetal tachycardia have a risk of chorioamnionitis as cause of tachycardia. Different studies have supported or refuted the use of C-reactive protein (CRP) to diagnose chorioamnionitis. The goal of this study was to evaluate serial serum CRP levels for diagnosis of chorioamnionitis.

METHODS

The study included 60 woman with chorioamnionitis confirmed after measuring the levels of CRP. Patients were monitored by CRP determination, white blood cell (WBC) count, maternal temperature, maternal and fetal heart rate.

RESULTS

Elevated CRP level was present in 93.33% of cases. Fetal tachycardia was present in 91,67 cases, all associated with elevated CRP level. Increased WBC count was present in 63.33%. A statistically significant difference was found in the level of CRP in pregnant women with increased WBC count compared with those without (p < 0.01).

CONCLUSION

Elevated C-reactive protein levels were more sensitive than other standard laboratory or clinical tests in predicting chorioamnionitis. Also, recent reports indicate that serial CRP levels during this interval may be useful for monitoring antibiotic treatment.

The significance of Doppler flow and anamnesis in the diagnosis of fallopian tube cancer

By following Doppler flow of the small pelvis with laboratory parameters and anamnesis data, we obtained more precise diagnostic possibilities for timely discovering of malignant processes in adnexal region and fallopian tube. By following patients who had come for routine check ups, prompted by a positive family history for malignant processes, resistant indexes of blood vessels in the adnexal region and vascularisation pattern were determined. Out of 78 women observed in the postmenopausal period with diagnosed adnexal masses, we found two cases of fallopian tube cancer. Resistance indexes ranged between 0.20 and 0.30 during a one-month period. Hystopathological analysis pointed to fallopian tube cancer. Besides Doppler flow, only patient history of amber extract use was significant. By CA 125 marker analysis, we found an increased value but not signifiant enough. Both patients had a positive family history according to the female hereditary line.