Browsing by Author "Plešinac, Snežana (55920049900)"

Objective: To compare the effects of antenatal administration of corticosteroids used in two different regimens, on fetal biophysical profile (BPP), baseline fetal heart rate (BFHR), nonstress test (NST) and perinatal outcomes. Study design: We evaluated the effects of single direct intramuscular (i.m.) fetal dose of dexamethasone (4 mg/kg), or four doses of 6 mg dexamethasone given to the mother 12 hours apart on the parameters of fetal BPP 0–4 hours before and after antenatal contraction stress (ACST). We evaluated two groups of 41 fetuses in the 31st gestation week at risk of fetal hypoxia at the Department of Gynecology/Obstetrics, Clinical Center of Serbia in 2013. Results: In fetal ACST group, we found significantly different changes in fetal breathing movement before (D0-f) and after therapy (D1-f), p = 0.019 (−11.75; −1.12), 95% confidence interval (CI), as well as in the maternal ACST group, p = 0.001; (−11.75; −1.12), 95% CI. We found significant difference between BPP 0-m and BPP1-m in the maternal group, p = 0.000. Neonatal asphyxia occurred more often with the increased frequency of fetal breath movements after both ACST (p = 0.04 versus p = 0.07). Conclusion: Fetal ACST results in increased fetal breathing movements. Maternal ACST can result in changes to BPP. The increase in fetal breathing movements determinates neonatal asphyxia regardless of the ACST. © 2015 Taylor & Francis.

Introduction/Objective Antenatal maternal anxiety (AMA) can have negative impact on a child’s preand postnatal development. The aim of the study was to examine the effect of AMA on changes in fetal blood flow through the middle cerebral artery (MCA) after acoustic stimulation, on birth outcome, and on early child development. Methods Forty-three women in the third trimester of pregnancy and their children were enrolled into a longitudinal prospective study. The AMA (state and trait) was assessed using Spielberger’s questionnaire. The MCA blood flow was assessed using Doppler ultrasound before and after the defined acoustic stimulus. The data regarding neonatal body weight, Apgar score, first step and word appearance, estimated speech-language (ESLD), sensory-motor (ESMD), and social-emotional (ESED) development at the age of three were collected. Results Fetuses from mothers with high state and trait anxiety had slower reaction time and higher relative pulsatility index after defined auditory stimulation. There are more preterm deliveries, lower scores on ESLD, ESMD, and ESED in mothers with high State-Trait Anxiety Inventory personality trait (STAI-T) compared to low. There is a negative correlation between reaction time, relative pulsatility index, STAI-T and ESLD. Conclusions High levels of antenatal maternal trait anxiety could have a negative effect on both fetal reactivity to sound stimulation and early child development. © 2019, Serbia Medical Society. All rights reserved.

Aim: We aimed to determine maternal hemoglobin A1c (HbA1c) levels and pregestational body mass index (BMI) as the predictors of glycemic control and its importance for fetal echography findings and perinatal outcomes in pregnancies complicated by diabetes mellitus (DM). Methods: Our intention was to evaluate how BMI and HbA1c levels might be used to predict fetal interventricular septum (IVS) thickness, atrioventricular inflow early diastole (E)/ atrial systole (A) velocity ratio, and perinatal outcomes. Patients in the 38th gestational week were divided into three groups according to their insulin therapy: (i) patients with gestational diabetes mellitus (GDM) treated only with dietary changes (GDM group, n = 32); (ii) patients with GDM treated with insulin therapy (DM2 group, n = 27); and (iii) patients with type 1 DM (DM1 group, n = 22). Results: In the DM1 group, we found statistically significant correlations between BMI and IVS thickness (P = 0.036), HbA1c and IVS thickness, as well as the mitral E/A velocity ratio (P = 0.013 vs P = 0.007). In this group, HbA1c showed a statistically significant correlation to neonatal birth weight (P = 0.037) and BMI influenced on appearance respiratory distress syndrome in neonates in DM1 group (P = 0.027). The values of HbA1c predict neonatal respiratory distress syndrome in DM2 and GDM groups (P = 0.036). Conclusion: As good predictors of maternal glycoregulation, BMI and HbA1c levels determine fetal echography findings as well as neonatal outcomes in pregnancies complicated by DM. © 2017 Japan Society of Obstetrics and Gynecology

Purpose: To assess the effectiveness of vaginal administration of the probiotic Lactobacillus rhamnosus BMX 54 in preventing the occurrence of abnormal vaginal flora and the alteration of parameters relevant to the progression of pregnancy. Methods: Sixty pregnant women were assigned randomly to the untreated arm of the study (n = 30) or received (n = 30) vaginal application of one tablet containing Lactobacillus rhamnosus BMX 54, once a week for 12 weeks. Every 4 weeks (T0-T3), vaginal and cervical swabs were collected and pH, and quantity and quality of vaginal discharge measured as well as consistency, length and dilatation of cervix, and level of the presenting part of the foetus relative to interspinous diameter. Results: In untreated women, there was a significant trend towards increase in the presence of pathogenic microorganisms in the vaginal and/or cervical swabs (p < 0.05), and in average pH values (p < 0.05), amount (p < 0.05) and "whiff test" positivity (p < 0.05) of vaginal discharge. Significant trend was also found for decrease in length (p < 0.0001) and increase in dilatation (p < 0.05) of cervix, as well as for lower position of the foetus (p < 0.0001). In the group treated with Lactobacillus rhamnosus BMX 54, none of these values significantly changed throughout the observation period, with the exception of cervical length that was significantly decreased at T3 (p < 0.01). Conclusions: During pregnancy, vaginal administration of Lactobacillus rhamnosus BMX 54 is effective in preventing the development of abnormal vaginal microflora, lowering of the presenting part of the foetus and modifying cervical parameters that could represent risk factors of vulnerability to preterm delivery. © Springer-Verlag 2012.

Aim: The aim of the study was to examine maternal age, parity, and estimated neonatal birth weight (BW) depending on the mode of a full-term breech presentation (BP) birth delivery and neonatal outcomes. Material and methods: One hundred and forty-six singleton term breech presentation pregnancies were included in a retrospective study conducted at the Department of Gynecology/Obstetrics, Clinical Center of Serbia in Belgrade in 2013. Statistical analysis: Student's-t test, χ2 likelihood ratio, and the Fisher's exact test. The level of statistical significance was set at p <0.05. Results: An ECS was the most common mode of delivery in (81.2%) nulliparous older than 35 years and most of the neonates (66.67%) with an estimated birth weight (BW) above 3500 grams were delivered by elective cesarean section (ECS). Perinatal asphyxia remained increased in the successful vaginal delivery (SVD) group (23.8%) compared with the urgent CS (UCS) group (13.3%) (p = 0.035). Birth asphyxia was the most common in neonates were delivered by SVD (23.8%). There were no cases of perinatal deaths. Conclusion: ECS remained the recommended mode of breech term delivery in nulliparous women older than 35 years, as well as in neonates with an estimated BW above 3500 grams. © 2015 Taylor & Francis.

Background/Aim. The optimal method of delivery for breech presentation at term still remains a matter of controversy. This is probably due to the fact that the skills of vaginal breech delivery are being lost. The aim of this study was to examine risk factors: mother's age, parity, labor's duration, estimated neonatal birth weight for the mode of breech presentation delivery at term as well as the influence of the delivery mode on neonatal outcome. Methods. A retrospecttive study of 401 terms (more than 37 week's gestation)breech deliveries at the Institute of Gynecology and Obstetrics, Belgrade, from 2007 to 2008 was made. The following groups with respect to mode of delivery were included: the group I - vaginal delivery (VD) in 139 patients; the group II - urgent cesarean section (UCS) in 128 patients; and the group III - elective cesarean section (ECS) in 134 patients. Mother's age, parity, duration of VD, neonatal birth weight (BW), the Apgar score at 5th minute, and duration of stay in a neonatal intensive care unit (NICU) vere determined. Neonatal mortality and major neonatal morbidity were compared according to the route of delivery. Fetuses and neonates with hemolytic disease and fetal and neonatal anomalies were excluded from the study. For statistical analyses we performed Student's t test, χ2 likelihood ratio, Kruskall-Wallis test, Mann Whitney test, and ANOVA. Results. The mean age of patients in the group I was 28.29 ± 4.97 years, in the group II 29.68 ± 5.92 years and in the group III 30.06 ± 5.41 years. Difference in mother's age between the group I and III was significant (p = 0.022). In the group III there were 73.9% nuliparous similarly to the gropu II (73.4%). We performed ECS in 54.6% of the nuliparous older than 35 years, and 54.4% multi parous younger than 35 years were delivered by VD. The use of oxytocin for stimulation of vaginal labor was not associated with its duration (p = 0.706). Lowset maneuver was performed in 88.5% of the VD. Mean BW of neonantes was 3189.93 ± 399.42 g in the VD group, 3218.59 ± 517.71 g in the UCS and 3427.99 ± 460.04 g in the ECS group. Neonates of the estimated BW below 2 500 g were delivered by UCS in 5.5% cases, vaginally in 3.6% cases and by ECS in 2.2% cases. Neonates of the estimated BW above 3 500 g were delivered by ECS in 44.8% cases, vaginally in 23.0% cases and by UCS in 30.5% cases. There was a statistically significant difference between the VD and UCS groups (p = 0.004). Neonatal well-being was diagnosed in 75.5% of the neonates in the VD group, in 72.4% of the neonates in the ECS group, and in 65.5% of the neonates in the UCS group. The A pgar score at 5th min ≥ 8 was observed in 96% of the neonates in the VD group, in 97.5% of the neo nantes in the ECS group and in 94.5% of the neonantesj in the UCS group. In breech presentation, perinatal asphyxia remained increased in the VD group by 9.4% as compared with the UCS group, 5.5% (p = 0.001) and the ECS group, 3.0% (p = 0.016). Neonates stayed in NICU significantly longer after UCS compared with VD or ECS (7.21 ± 10.74 days vs 3.99 ± 1.33 days and 5.34 ± 2.88 days, respectively; p = 0.001 and p = 0.037, respectively). There was no diagnosed intracranial hemorrhage, brachial plexus injury and birth trauma in any groups. Also, there was no early neonatal death. Conclusion. For breech presentation elective cesarean section remains the major delevery method in nuliparous older than 35 years, while vaginal delivery is considered to be the method of choice in younger multiparous with ultrasonographically estimated neonatal birth weight 2 500-3 500 grams.