Browsing by Author "Babovic, I. (14828590600)"

Purpose: The study aim was to report an unusual case of a misplaced IUD in isthmico-cervical region causing partial uterine perforation and discuss literature data regarding such a condition. Case Report: A 50-year-old women was referred to the present institution for IUD extraction. She was diagnosed with spontaneously misplaced IUD located in isthmico-cervical region of the uterus causing partial perforation. The time of dislocation was unknown, as she was completely asymptomatic for ten years after IUD application. Moreover, she had no risk factors for device misplacement. The removal of IUD was uneventful. Conclusion: Isthmico-cervical misplacement of IUD, although rare, can occur at any time and can be asymptomatic. Thus, women with IUD should be annually checked-up in order to prevent possible IUD complications.

Aim: The relation between placental histopathological examination, umbilical cord pathology and abnormal umbilical and cerebral Doppler as a predictor of stillbirth at later gestations was evaluated. Materials and Methods: A retrospective study of 55 monofetal pregnancies complicated with late fetal death from 2005-2008 was conducted at the Institute of Gynecology and Obstetrics, Belgrade. Statistical analysis: chi-square likelihood ratio test and Spearman's coefficient correlation. Results: Intrauterine fetal demise occurred most frequently at term -32.7% of the time. Changes in the umbilical artery resistance index were not significantly different from placental histopathology findings, p = 0.363. There was a significant correlation between neonatal birth weight and weeks of gestation at delivery, r = 0.796; p = 0.001. Conclusion: Umbilical artery Doppler is a relatively poor predictor of stillbirths due to placental dysfunction. It seems that neonatal birth weight is the best predictor of late stillbirth in high-risk pregnancies.

Aim: The relations between abnormal umbilical and cerebral Doppler, cerebral-umbilical (C/U) ratio, and outcomes in pregnancies complicated by gestational hypertension and fetal intrauterine growth retardation were evaluated. Materials and Methods: A retrospective study of 53 monofetal pregnancies in 2010 was conducted at the Institute of Gynecology and Obstetrics, Belgrade. Statistical analysis: chi-square likelihood ratio test, Student's t-test and Spearman's coefficient correlation. Results: There was not a significant correlation between the timing of registration of abnormal umbilical Doppler to delivery and outcomes of high-risk pregnancies. There was a significant correlation between C/U ratio and APGAR-5 (p = 0.003). We found a significant correlation between neonatal birth weight and APGAR-5 (p = 0.000), neonatal asphyxia (p = 0.000), intracranial hemorrhage (p = 0.000) and respiratory distress syndrome (p = 0.000). Conclusion: Umbilical and cerebral artery Doppler is a relatively poor predictor of neonatal outcome. It seems that neonatal birth weight is the best predictor of neonatal outcome in high-risk pregnancies.

Purpose: The study aim was to report diagnostic and therapeutic challenges in treatment of a patient with cervical dysplasia and congenital uterine anomaly. Case Report: A 53-year-old women with Mullerian anomaly - uterus duplex (bicorporal septate uterus) and Yshaped endocervical canal was referred due to repeated abnormal Pap smears. She underwent endocervical curettage of both canals and the endocervical septum biopsy which revealed presence of cervical intraepithelial neoplasia (CIN) III. Cervical conization was considered technically unfeasible because of abnormal cervical anatomy (lesions deep in the cervical canal on the cervical bifurcation where the cervical wall is the thickest). Classical open abdominal hysterectomy was performed. Patient had two almost equally-sized, symmetrical uterine bodies connected in the isthmico-cervical region, with normal left and obstructed right hemi-vagina. Postoperative histopathological findings confirmed that dysplasia was located in the region where two endocervical canals conjoined. Conclusion: Diagnostic and therapeutic approach to patients with uterine anomalies has to be individualized, based on anomaly type, patient's age, reproductive history, and patient's preferences.

Aim: The analyze the potential influence between obesity in pregnancy and the abdominal delivery-cesarean section and to establish the possibility of its prevention. Materials and Methods: A prospective study examined 200 patients, delivered by cesarean section in a oneyear period. The study included a structured questionnaire; the body weight at the end of pregnancy was measured and it was analyzed against all available medicine documentation. Statistical analysis included: x2 test, Student's t-test, and Fisher's test, as well the Pearson's and Spearman's test of correlation rank. Results: From all 200 (100%) patients delivered by cesarean section, 67 (33.5%) were overweight and obese. Body mass index at the beginning of pregnancy was significantly associated with cesarean section (x2 = 69.141;p < 0.001), along with the appearance of eventual pregnancy complications, and also with the neonatal birth weight (p = 0.224;/p < 0.001). Conclusion: The nutritive status, both at the beginning and at the end of pregnancy is the important factor for the pregnancy outcome.

Aim: The relation between biophysical profile (BPP), cerebroplacental (C/P) ratio, and lecithin/sphingomyelin (L/S) ratio as a predictor perinatal outcome in term intrauterine growth restricted (IUGR) neonates was evaluated. Materials and Methods: A retrospective study of the perinatal outcome of 77 term monofetal pregnancies complicated with IUGR fetuses (< 10 percentile) who were terminated by cesarean section in 2010 was performed at the Institute of Gynecology and Obstetrics, Belgrade. Results: The most frequent early neonatal complication was asphyxia. The authors found a strong correlation between the L/S ratio and birth weight (BW) r = 0.609, as well as between BPP and Apgar score 5 r = 0.583. Significant negative correlation was found between asphyxia and BPP r = -0.398, as well as between asphyxia and C/P ratio r = -0.379. Conclusion: In serous IUGR neonates, low values of BPP and L/S ratios predicted asphyxia.

Velamentous insertion of the cord, or vasa previa, is a malady where fetal vessels tranverse membranes ahead of the fetal part. The incidence of vasa previa is 1: 2000-3000 deliveries. Fetal mortality is over 50-75%. Early diagnosis is needed because these deliveries require emergency cesarean section; it is especially more common with placenta percreta, uterine atony and hemorrhage. Intravascular infusion of red blood cells (RBCs) into the fetus is one of the most successful means of in utero therapy for severe fetal anemia caused by RBC alloimmunization. We performed four fetal intrauterine intravascular transfusions (IVT) as therapy for severe fetal anemia. The patient underwent elective cesarean section. After delivery, profound uterine atony and vaginal hemorrhage were noted and the patient underwent hysterectomy. Pathological examination of the placenta and umbilical cord documented velamentous insertion of the cord. Before intrauterine IVT a detailed US examination is necessary to exclude vasa previa or placenta previa. Uterine atony may be result after a diagnosis of placenta previa or vasa previa. Intrauterine IVT is an irreplaceable diagnostic procedure in the treatment of severe fetal anemia.