Browsing by Author "Mandic, Vesna (23991079100)"

The study was conducted to evaluate the effect of anticoagulant therapy in women with thrombophilia and to detect the possible differences among carriers of mutations (factor V [FV] Leiden and FIIG20210) and those with natural anticoagulant deficiency. The 4-year prospective investigation included 85 pregnant women, with a history of recurrent fetal loss (RFL). They were treated with prophylactic doses of low-molecular-weight heparin (nadroparin) starting from 6 to 8 weeks of gestation. Pregnancy outcomes were evaluated based on the thrombophilia type. Carriers of thrombophilic mutations had a live birth rate of 93%, compared to 41.6% for women with natural anticoagulant deficiencies. Significant differences between the groups were also observed for intrauterine fetal death, intrauterine growth restriction, and postpartum thrombosis. The optimal therapy for women with natural anticoagulant deficiency and RFL remains unclear and future prospective study with a large number of patients is required to determine the best treatment for these severe thrombophilic conditions. © The Author(s) 2013.

Objective: To determine if there is any difference in amniotic fluid erythropoietin (EPO) concentration between fetuses small for gestational age (SGA) and appropriate for gestational age (AGA), and between the constitutionally small (CSF) and growth-restricted (GRF) fetuses. Methods: EPO concentrations in the amniotic fluid samples were determined by EpoELISA test in 38 pregnancies with SGA and 15 pregnancies with AGA fetuses. In the SGA group we measured Ponderal index (PI) and skin-fold thickness (SFT). If PI and/or SFT were below 10th percentile the neonate was GRF. If both PI and SFT were above 10th percentile the neonate was CSF. Results: Higher levels of EPO were detected in the SGA in comparison to the AGA fetuses (p<0.01). EPO concentration was higher in GRF compared to CSF (p<0.05). The EPO cut-off level between SGA and AGA was 6.81IU/L (sensitivity 92.3%; specificity 73.3%), and between GRF and CSF was 9.8IU/L (sensitivity 81%; specificity 80%). Conclusion: The preliminary results of this study suggest that amniotic fluid erythropoietin concentration is elevated in growth-restricted fetuses and could potentially be used for distinction between growth restricted and constitutionally small fetuses. Confirmation of these results on a larger group of pregnant women is needed. © 2014 Informa UK Ltd.

[No abstract available]

Objective: The aim of this study was to evaluate the screening performances of abnormal ductus venosus (DV) blood flow for the detection of heart defects in chromosomally normal fetuses with increased nuchal translucency (NT) thickness at 11-13+6weeks' gestational in a population of singleton pregnancies. Methods: During an 8-year period, all singleton pregnancies from 11+0 to 13+6weeks were scanned for NT and DV blood flow assessment. Two groups of cases with abnormal NT were evaluated: NT≥95th and NT≥99th centile. DV waveforms were considered to be abnormal if the a-wave was reversed or absent (R/A). Results: Addition of DV R/A a-wave to either NT≥95th or NT≥99th percentile increased specificity (p<0.001 and p<0.001, respectively), but not screening performances in detection of major heart defects (p=0.73 and p=0.91, respectively). Combination of DV R/A a-wave with NT≥95th or NT≥99th centile correlated with right heart defects (p=0.024 and p=0.013, respectively). Conclusions: In chromosomally normal fetuses, addition of abnormal DV a-wave to increased NT does not improve screening performances of NT in detection of major hearts defects in first trimester. However, there is correlation of such parameter with right heart defects and AV septal defects. What's already known about this topic? Measurement of NT thickness in first trimester is a standard clinical practice of prenatal screening for heart defects. There are conflicting results whether the addition of qualitative assessment of ductus venosus flow improves screening performances of increased NT for heart defects. What does this study add? Addition of reduced or absent DV a-wave to increased NT improves its specificity for detection of major heart defects during the first trimester. Reduced or absent a-wave of DV flow in combination with increased NT correlates with increased risk of right heart defects and AV septal defects. © 2015 John Wiley & Sons, Ltd.

Background: Inherited antithrombin (AT) deficiency is a rare autosomal dominant disorder, caused by mutations in the SERPINC1 gene. The most common clinical presentation in AT deficient patients includes venous thrombosis and pulmonary embolism, while the association of AT deficiency and its effect on the development of pregnancy complications has been less studied. The aim of our research was to evaluate the effect of AT deficiency types, determined by genotyping, on pregnancy outcomes. Methods: A retrospective cohort study included 28 women with AT deficiency, and their 64 pregnancies were analyzed. Results: With regard to live birth rate, a significant difference was observed among women who were carriers of different SERPINC1 mutations, as the rate varied from 100% in cases of type I to the extremely low rate of 8% for women with type II HBS (AT Budapest 3) in the homozygous variant, P = 0.0005. All pregnancies from the type I group, even untreated ones, resulted in live births. In women with AT Budapest 3 in homozygous variant the overall live birth rate increased to 28.5% in the treated pregnancies. In this group the highest incidence of fetal death was observed of 62%; repeated fetal losses in 30%; fetal growth restriction in 22% and placental abruption in 7% of all pregnancies. Conclusion: Our study results indicate a difference between type I and type II AT deficiency. The risk of pregnancy related VTE was equally present in both groups, except for AT Budapest 3 in the heterozygous variant, while adverse pregnancy outcomes were strictly related to type II, especially AT Budapest 3 in the homozygous variant. © 2018 Elsevier Ltd