Анализа на етиолошки фактори за појава на ендометријална хиперплазија во перименопаузa

The aim of this study was to evaluate the possible reasons for the emergence of endometrial hyperplasia in perimenopause. Material and methods: A total of 71 patients with irregular bleeding were analyzed, at the age of 40-50 years, who should have undergone diagnostic curettage. Depending on the histopathological findings, we divided them into 2 groups: group 1-findings for endometrial hyperplasia, group 2 - atrophic or endometrium with deficient secretory changes. Body mass index (BMI) was determined (obesity defined with BMI >30 kg/m2); we measured blood pressure (cut-off value was 135/90 mmHg), waist circumference (cut-off value was 88 cm) as well as data of anamnesis (age, physical activity, type of diet, smoking cigarettes). All these data were analyzed as etiological factors in the emergence of endometrial hyperplasia.Results: The mean age of patients was 47 years, and the results obtained were very similar in both examined groups. BMI and waist circumference were increased, more than 60% of patients had hypertension, but not all had a statistical significance. Most of them were with completed secondary education, and city living statistically significantly increases the risk of endometrial hyperplasia (p <0.05). As for the lifestyle (physical activity, caloric diet, smoking), the results have shown that a small number of patients are active, almost half of them consume caloric food and smoke, but without a statistical significance.Conclusion: Increased body weight and elevated blood pressure have a major impact on the onset and progression of pathological changes in the endometrium. As clinicians, we should always think of hyperplasia in obesity and patients with hypertension who are irregularly bleeding. At the same time, we should educate them to change the lifestyle in order to prevent gynecological and internistic morbidity.Целта на оваа студија беше да се евалуираат можните причини  за појава на ендометријална хиперплазија во перименопауза. Материјал и методи: Беа анализирани 71  пациентка  со неправилно  крвавење, на возраст од 40-50 години, кај кои беше индицирана фракционирана киретажа. Зависно од хистопатолошкиот наод ги поделивме  во 2 групи : група 1- со наод за ендометријална хиперплазија , група 2- атрофичен или ендометриум со дефициентни секреторни промени. Одредивме  индекс на телесна маса (БМИ), обезитет дефиниран со БМИ > 30 kg/m2, измеривме  крвен притисок (cut-off вредност 135/90 mmHg), обем на струк (cut-off вредност 88 см), како и податоци од анамнезата (возраст, физичка активност, тип на исхрана, пушење цигари).  Сите овие податоци беа анализирани  како етиолошки фактори во појавата на ендометријална хиперплазија. Резултати: Средна возраст на пациентките беше околу 47 години, а добиените резултати беа многу слични во двете испитувани групи. БМИ и обем на струк беа зголемени, хипертензија имаа повеќе од 60% од пациентките, но не беше утврдена статистичка значајност.  Најголем дел беа со средно образование, а живеењето во град статистички значајно го зголемува ризикот за ендометријална хиперплазија (p< 0,05). Што се однесува до животниот стил (физичка активност, калорична исхрана, пушење), резултатите покажаа дека мал дел се активни, речиси половина од нив конзумираат калорична храна и пушат, но без статистичка сигнификантност. Заклучок: Зголемената телесна тежина и покачениот крвен притисок  имаат големо влијание врз започнување и прогресија на патолошки промени на ендометриумот. Како клинички доктори секогаш треба да помислиме на хиперплазија  кај обезни и пациентки со хипертензија, кои неправилно крвават. Воедно треба и да ги едуцираме за промена на животниот стил, со цел спречување на гинеколошки и интернистички морбидитети

Obstetric Outcome in Pregnant Patients with Low Level of Pregnancy-Associated Plasma Protein A in First Trimester

BACKGROUND: Pregnancy-associated plasma protein A (PAPP-A), is a protease which releases Insulin-like growth factor. The role of this factor is stimulation of cell mitosis, differentiation and trophoblastic invasion of deciduas. Identification of patients with low PAPP-A (under 0.4 MoM in the first trimester has an influence on birth weight, attenuation of fetal growth, preeclampsia, birth and fetal demise.AIM: The main issue in the study is evaluating an influence of PAPP-A, calculated in the first trimester on the unfavourable outcome of pregnancy.MATERIAL AND METHODS: Seventy pregnant women with singleton pregnancy underwent first-trimester biochemical screening. The target group were women with PAPP-A below 0.4 MoM, and in control group, PAPP-A were оver 0.4 MoM. There was an assessment of the influence on the mode of delivery, gestational week, the presence of intrauterine growth restriction, preeclampsia, temporary birth, intrauterine fetal demise and newborn condition.RESULTS: In target group, consisted of 35 patients, 16 were delivered at term. From 28 to 37 g.w.- were 7 patient, 22-28 g.w.- 4 and 8 patients were under the 22 g.w (all with fetal demise) there were 19 pretemporary deliveries - 9 with Cesarean Section (SC). In the target group: 5 newborn wеre with IUGR, 6 women had preeclampsia, 1 had placental abruption. In control group were 35 patients: 28 delivered at term, 9 with SC, 26 vaginal deliveries; with IUGR were 4 newborns. Two newborns were hypertrophic.CONCLUSION: There is a significant difference in unfavourable outcome in the cases with PAPP-A under 0.4 Mom, particular in the group, with a PAPP-A value under 0.2 MoM. The patients delivered with SC with the main indications in utero hypoxia, growth restriction and elevated blood pressure had PAPP-A between 0.3-0.4 MoM. The patients with intrauterine fetal death and placental abruption in the most of the cases have PAPP-A value under 0.2 MoM. There is a need to be aware in these pregnancies to achieve the preventions of adverse outcome, to decrease perinatal morbidity and mortality

Maternal and Neonatal Outcomes in Pregnant Women with Gestational Diabetes Mellitus Treated with Diet, Metformin or Insulin

AIM: Aim of the study was to compare outcomes of pregnancy in gestational diabetes mellitus (GDM) treated with metformin, insulin, or diet.MATERIAL AND METHODS: The study included 48 women with GDM treated with metformin, 101 with insulin, and 200 women on a diet from the Outpatient Department of Endocrinology and University Clinic of Obstetrics and Gynecology in Skopje.RESULTS: The groups were comparable in age, smoking cigarettes and positive family history of diabetes. Mean glycosylated haemoglobin (HbA1c) at 37 gestation week, mean fasting, postprandial glycaemia, and gestational age at delivery were lower in diet and metformin than insulin group. No differences in mode of delivery were observed between the metformin and insulin group. Women in metformin group had a significantly lower incidence of LGA newborns than diet and insulin groups. The percent of SGA new-borns was higher in insulin group than diet and metformin groups. The incidence of neonatal hypoglycemia was statistically significantly higher in the insulin group than in the metformin and diet group.CONCLUSION: Metformin in women with GDM can improve maternal and neonatal outcomes compared with those treated with diet or insulin

The outcome of Pregnancy with Fetal Primitive Neuroectodermal Tumor

BACKGROUND: Fetal intracranial tumours are very rare. The overall incidence is 0.34 per one thousand live birth newborns. According to the new classification of central nervous system tumour (2016), a primitive neuroectodermal tumour of (PNETs) is an embryonal tumour group; these are tumours with high malignancy and belong to group IV (WHO). In our case, we will present a case of PNETs in 28 gestation week old fetus, diagnosed antenatally and confirmed postnatally.CASE REPORT: We present the third pregnancy in 29 years old patient, with two previous term deliveries of healthy newborn. She came to University clinic at 27+3 gestational week for fetal hydrocephalus. After an ultrasound and MRI scan, possibilities were explained to the parents. During the medico-ethical counselling, explain to the parents the need for operation and the possibility of postoperative adjuvant therapy, quality of life with potential future disabilities. They choose to terminate the pregnancy. Postmortem the diagnosis was PNETs. Summary of analysis: peripheral neuroectodermal tumour with ganglion and neuronal differentiationCONCLUSION: Antenatal management depends on the gestational week in the time of diagnosis and the decision of parents. If the lesion is before viability fetus, it should be offered termination of pregnancy. Another important factor is the mode of delivery, because of increased intracranial pressure although this aggressive combined modality of treatment, recurrence is often. Tree year of survival is between 53% and 73% when the adjuvant radiotherapy is included. For that, they should be diagnosed as soon as possible before achieving fetal viability. Only 18% of those tumours presenting in the first year of life are diagnosed before or at delivery

Multidisciplinary approach to management of hypofibrinogenaemia in pregnancy: A case report

Inherited fibrinogen disorders introduce risk for recurrent abortions, sub-chorionic haematoma, placental abruption and postpartum haemorrhage. This is a case report of a successful pregnancy outcome in a 37-year old woman with hypofibrinogenaemia. She was referred to a coagulation test in the first trimester because of history of preeclampsia and HELLP syndrome in previous pregnancy. Hypofibrinogenaemia was diagnosed with fibrinogen level of 0.7 g/L. During the pregnancy she was regularly monitored for fibrinogen levels and multiple cryoprecipitate concentrates were given. She delivered at 39th gestation week, with elective caesarean section under general anaesthesia. There was one episode of postpartum haemorrhage treated with 2 units of red blood cells, repeated infusions of cryoprecipitate to obtain the level of fibrinogen of 2 g/L. She was discharged on the 6th postpartum day in a good condition. In these disorders levels of fibrinogen should be higher than 1 g/L during pregnancy or 2 g/L in case of caesarean section for successful prenatal and peripartal management

Maternal lipids may predict fetal growth in type 2 diabetes mellitus and gestational diabetes mellitus pregnancies

Aim: During diabetic pregnancy, complex metabolic changes occur in the lipid profile. The aim of the study was to determine the predictive values of maternal serum lipid levels on large-for-gestational age newborns during the third trimester in pregnancies of women with type 2 diabetes mellitus (DM2) and gestational diabetes mellitus (GDM). Material and methods: Data of forty-three pregnancies of women with DM2 and two hundred women with GDM were analyzed. The analysis encompassed the following parameters: age, body mass index (BMI), lipid parameters, HbA1c in first, second and third trimester of pregnancy, preeclampsia and baby birth weight. Results: DM2 and GDM groups showed statistically significant differences in the following variables: total lipids, triglycerides, total cholesterol, BMI, age, baby birth weight, incidence of SGA and preterm delivery (9.4 ± 2.3 vs. 11.0 ± 2.3 mmol/L, 2.4 ± 1.4 vs. 3.4 ± 1.6 mmol/L, 5.5 ± 1.2 vs. 6.4 ± 1.4 mmol/L, 30.6 ± 5.4 vs. 26.9 ± 5.2 kg/m2, 34 ± 7.8 vs. 31.5 ± 5.6 years, 3183 ± 972 vs. 3533 ± 699 g., 20% vs. 7.5%, 27.9 vs. 14%, respectively, p < 0.05). Linear multiple regression analysis demonstrated that triglycerides, LDL-C and total cholesterol were independent predictors of LGA (p < 0.05). Conclusion: Triglycerides and LDL-C in the third trimester of pregnancy are independent predictors for fetal macrosomia in DM2 and GDM pregnancies. Thus, the maternal serum triglycerides and LDL-C levels determined in the maternal blood taken in the third trimester of pregnancy may indentify women who will give birth to LGA newborns

Maternal 75-g OGTT glucose levels as predictive factors for large-for-gestational age newborns in women with gestational diabetes mellitus

ABSTRACT Objective Our goal was to investigate which glucose measurement from the 75-g oral glucose tolerance test (OGTT) has more capability of predicting large for-gestational-age (LGA) newborns of mothers with gestational diabetes mellitus (GDM). Subjects and methods The study group consisted of 118 consecutively pregnant women with singleton pregnancy, patients of Outpatients Department of the Endocrinology, Diabetes, and Metabolic Disorders Clinic. All were prospectively screened for GDM between 24th and 28th week of pregnancy and followed to delivery. Outcome measures included: patients’ ages, pre-pregnancy BMI, BMI before delivery, FPG, 1 and 2 hour OGTT glucose values, haemoglobin A1c at third trimester, gestational week of delivery, mode of delivery and baby birth weight. Results From 118 pregnancies, 78 (66.1%) women were with GDM, and 40 (33.9%) without GDM. There were statistically significant differences (30.7 versus 5.0%, p < 0.01) between LGA newborns from GDM and control group, respectively. Gestation week of delivery and fasting glucose levels were independent predictors for LGA (Beta = 0.58 and Beta = 0.37 respectively, p < 0.01). Areas under the receiver operator characteristic curve (AUC) were compared for the prediction of LGA (0.782 (0.685-0.861) for fasting, 0.719 (0.607-0.815) for 1-hour and 0.51 (0.392-0.626) for 2-hour OGTT plasma glucose levels). Conclusion Fasting and 1-hour plasma glucose levels from OGTT may predict LGA babies in GDM pregnancies

Maternal 75-g OGTT glucose levels as predictive factors for large-for gestational age newborns in women with gestational diabetes mellitus

Objective: Our goal was to investigate which glucose measurement from the 75-g oral glucose tolerance test (OGTT) has more capability of predicting large for-gestational-age (LGA) newborns of mothers with gestational diabetes mellitus (GDM). Subjects and methods: The study group consisted of 118 consecutively pregnant women with singleton pregnancy, patients of Outpatients Department of the Endocrinology, Diabetes, and Metabolic Disorders Clinic. All were prospectively screened for GDM between 24th and 28th week of pregnancy and followed to delivery. Outcome measures included: patients’ ages, pre-pregnancy BMI, BMI before delivery, FPG, 1 and 2 hour OGTT glucose values, haemoglobin A1c at third trimester, gestational week of delivery, mode of delivery and baby birth weight. Results: From 118 pregnancies, 78 (66.1%) women were with GDM, and 40 (33.9%) without GDM. There were statistically significant differences (30.7 versus 5.0%, p < 0.01) between LGA newborns from GDM and control group, respectively. Gestation week of delivery and fasting glucose levels were independent predictors for LGA (Beta = 0.58 and Beta = 0.37 respectively, p < 0.01). Areas under the receiver operator characteristic curve (AUC) were compared for the prediction of LGA (0.782 (0.685-0.861) for fasting, 0.719 (0.607-0.815) for 1-hour and 0.51 (0.392-0.626) for 2-hour OGTT plasma glucose levels). Conclusion: Fasting and 1-hour plasma glucose levels from OGTT may predict LGA babies in GDM pregnancies

Perinatal Outcome in Gestational Diabetes Melitus Vs Normoglycemic Women

Introduction: Gestational Diabetes Mellitus (GDM) is glucose intolerance diagnosed for the first time in pregnancy. It may lead to potentially serious short term and longterm complications for both mother and fetus or newborn. Material and Methods: Prospective study was conducted at the University clinic for gynecology and obstetrics, Skopje for the period of one year. 100 pregnant women in the second trimester which performed oral glucose tolerance test (75g OGTT) were evaluated. The study included 50 women with GDM and control group of 50 women with negative OGTT at the same gestational age, parity and maternal age. Gestational weight gain, blood pressure and urine analysis for proteinuria were recorded monthly. Patients with GDM were more often followed according to the clinical protocol. Maternal and neonatal data was collected after birth from medical records during discharge from the clinic. The perinatal outcome of pregnant women with or without GDM was analysed. Results: There was a significant difference in BMI between the women with GDM and normoglycemic women. Hypertensive disorders of pregnancy, preterm labour and delivery by caesarean section were significantly more often in GDM pregnancies vs control group. Respiratory distress, hypoglycemia, pH <25, lower Apgar score in the first minute and admission in the neonatal intensive care unit was significantly more often in the neonates from mothers with GDM vs controls. Conclusion: Many parameters of the perinatal outcome were significantly associated with GDM in our study. Adequate treatment can achieve better maternal and neonatal outcome