Legal and medical aspects of the ethics committee’s work relating to abortion

This paper analyses the legal and medical aspects of the work of ethics committees on abortion. According to the legislation of the Republic of Serbia, these committees are competent to determine justifiable terms for abortion after the twentieth week of the fetus. It is well known that abortion is not only a medical but a legal, ethic, social and demographic problem as well. A liberal solution in view of abortion in the first trimester has been accepted in most European countries, as by the legislature of the Republic of Serbia. Since prenatal diagnosis cannot always determine the fetus state with certainty but at times may do so at a later stage, abortion is then required when the child is already capable of extrauterine life. The necessity for performing abortion in the third trimester is thus a result of good knowledge of techno-medicine but also from the limited information it provides. In such situations, the physician needs confirmation and justification of his standpoint with respect to abortion through a legal formulation which should contain "minimum moral". Society has found a way to protect and help him through moral and ethic forms of prevention without anybody’s emotions being affected. Ethics committees should thus help the physician in view of determining the terms for performing late abortion, since the rules of doctor’s ethics are not sufficient in this case. The article especially analyses the work of the Ethics Committee of the Clinical Center in Kragujevac in the period 2000-2010. It is stated that the largest number of cases referred to determined diseases or fetus anomalies while only a negligible number (11.29%) to the illness of the mother. There were no requests for abortions due to legal reasons (pregnancies from criminal offences). A significant number (40.28%) of requests submitted to the Ethics Committee related to pregnancies under the 24th week of pregnancy. Since a pregnancy of 24 weeks represents a boundary line between a miscarriage and preterm birth, the paper proposes a shift in the boundary line of pregnancies which must be terminated according to the Ethics committee, from 20 weeks of gestation to 24 weeks of gestation. At the same time, the requirement for narrowing legal conditions for abortion in later phases of pregnancies is pointed out as well as abolition of legal indications

The impact of physical activity on the level of chromosome aberrations

During the lifetime, people are constantly exposed to the chemicals and agents of exogenic and endogenic sources, which through reaction with a molecule of DNA can cause the damage of genomes and their instability. The formation of micronuclei is a consequence of chromosomal aberrations caused by the influence of different genetic and environmental factors. Micronuclei are cytoplasmic chromatin masses that look like small nuclei and can originate from whole or parts of chromosomes. Micronucleus test ( MN test ) is used to detect genotoxic effects of various chemical , physical or biological mutagens, as well as the test for determination of chromosomal instability in a variety of cell types. Micronucleus frequency is directly proportional to the degree of chromosomal aberrations. It has been shown that genome damage may occur as a result of environmental exposure to genotoxins and medical procedures, due to deficiency of micronutrients and under the influence of various lifestyles and genetic factors. Unbalanced diet, lack of physical exercise, lack of sleep and overwork contribute significantly to increased frequency of micronuclei. It was also shown that strenuous exercise causes DNA damage, which results in the formation of micronuclei. As a professional athlete conduct highly Intensive physical training, these populations are at risk for the development of genomic instability and carcinogenesis. A healthy lifestyle, the optimal intake of antioxidants and regular moderate physical activity significantly reduced the frequency of micronuclei, and contribute to the stability of the genome

DIAGNOSIS OF GASTROSCHISIS IN THE FIRST TRIMESTER OF PREGNANCY - CASE REPORT

Gastroschisis (gastroshisis) represents evisceration of the abdominal organs, most commonly small bowels, stomach and gonads through the front abdominal wall defect, almost always to the right of the umbilicus (90%) from which it is separated by thin skin bridge. The incidence of this anomaly is 0.5 to 4 per 10.000 liveborn babies. We presented a patient, aged 27 years, who had gastroschisis of the fetus in the 13th week of gestation diagnosed by ultrasound. Ultrasound examination is the method of choice for prenatal detection of fetal anomalies. By differential diagnosis, the possible existence of omphalocele should be eliminated using (2D, 3D) and power Doppler technology which significantly makes the assessment of gynecologist easier during establishment of the final diagnosis

Correlation Between Serum Biochemical Markers and Early Amniocentesis in Diagnosis of Congenital Fetal Anomalies

A combined test performed at the 12th week of gestation enables us to classify the pregnancy as high risk (risk higher than 1:300) or low risk (risk lower than 1:300) for congenital foetal anomalies, with great accuracy of 85 - 90%. According to the available data, the frequency of false positive results is estimated at around 5%. The objective of the study was to examine possible correlation between the serum marker values and amniocentesis results in prenatal diagnostics of congenital foetal anomalies. The study included 745 pregnant women monitored by the Genetic Counselling Service of the Clinic of Gynaecology and Obstetrics of the Clinics Centre Kragujevac. The subjects were included in the study under condition that CRL (embryonic crown-rump length) was from 45 to 84 mm and that the gestational age was at 11-13+6 weeks. Free β HCG and PAPP-A were determined from venous blood using commercial DPS-USA tests. Tests were based on the analytic principle of the immuno-chemiluminescence technique and were performed by application of the automatic Immulite 2000 analyzer by DPC-USA. The foetal nuchal translucency thickness (NT) and CRL were measured by Colour Doppler. The chromosome identification was performed after a certain number of cell divisions by stopping the cell division in metaphase of mitosis when the chromosomes were the most distinguishable. The foetal karyotype was prepared using G bands. In the total sample of pregnant women (n=745), there were six cases of pathological foetal karyotype. A statistical paradox in the frequency of congenital foetal anomalies in favour of younger population was noticed. A high coefficient of Spearman’s rank correlation suggests great importance of the combined test in the detection of congenital foetal anomalies (p<0,05). A high consistency was also proved for components of biochemical screening and ultrasonographic markers. The combined test, as a method of prenatal screening in the first trimester of pregnancy, if used at 11 - 13+6 weeks’ gestation and for CRL of 45-84 mm, has a great importance in the detection of congenital foetal anomalies

Zuclopenthixol decanoate in pregnancy: Successful outcomes in two consecutive off springs of the same mother

Introduction. Almost all individual antipsychotics are classified into the intermediate pregnancy risk category as no or limited data exist about human pregnancy outcomes. We presented the case of zuclopenthixol decanoate using in two successive pregnancies of the same woman, which had not been published in the available peer-reviewed literature. Case report. A middle-age female subject who suffered from schizophrenia received zuclopenthixol decanoate injection during her two consecutive pregnancies. About four and a half months before diagnosis of the first pregnancy (~3.5 years after psychosis emergence), zuclopenthixol decanoate (400 mg every other week, im injection) was introduced to the treatment protocol (due to previous non-compliance with haloperidol and risperidone). A significant clinical improvement was achieved and the dose during pregnancy was reduced to 200 mg once monthly and maintained to date. In both pregnancies the women gave birth to healthy girls who have been developing normally until now, at their ages of 6 months and of 3.5 years. During pregnancy and after giving birth to children the mothers’ psychiatric status and her social functioning were significantly improved and are still stable. Close monitoring of the mother’s health, a multidisciplinary approach to both her treatment and the monitoring of pregnancies as well as the complete compliance with the prescribed drug protocol were likely to be crucial for the therapeutic success. Conclusion. A favorable outcome of the present case suggests that the zuclopenthixol decanoate is a rational therapeutic option for pregnant women suffering from psychosis when the expected benefit exceed the potential risk, but a definitive evidence for its safety requires large, controlled studies. [Projekat Ministarstva nauke Republike Srbije, br. 175014