Browsing by Author "Radunovic, N. (7003538030)"

The authors present sonographically detected foetal malformations of the central nervous system registered over a three-year period (1981-1983). In the mentioned period about 25,000 sonographic examinations were carried out. Of 19 congenital malformations of the central nervous system sonographically diagnosed in 15 cases ultrasound diagnosis was postnatally confirmed, and four foetal malformations were not diagnosed (2 cases of spina bifida, 1 meningomyelocele and 1 hydrocephalus). The authors illustrated ultrasound findings and included comparative postnatal pictures of detected anomalies. In their opinion properties of ultrasound examination (speed, simplicity, non-invasivity, comfort and harmlessness) enable sonographic detection which excludes the presence of malformations of the central nervous system during each routine examintion. Special attention should be paid to patients with possible malformated foetuses.

Objective: To evaluate maternal and fetal apolipoprotein A-I and B (Lp A-I and Lp B) concentrations in uncomplicated pregnancies across the second half of pregnancy. Study design: Paired (n = 55) maternal and fetal umbilical venous samples were obtained at diagnostic cordocenteses from 20 to 36 weeks. Levels of Lp A-I and Lp B were measured by turbimetric assay. Results: Maternal Lp B (r = 0.30; p = 0.03) but not Lp A-I (r = -0.02, p = 0.5) levels displayed a significant correlation with gestational age. Moreover, the ratio of Lp B to Lp A-I significantly increased across gestation in maternal plasma (r = 0.30; p = 0.04). Fetal Lp A-I and Lp B values did not correlate with gestational age, or maternal Lp A-I or Lp B levels. Moreover, no significant correlation was found between the ratio of fetal plasma Lp B to Lp A-I and gestational age. The mean (± SD) maternal plasma Lp A-I concentration was significantly higher than the corresponding mean fetal Lp A-I level [1.55 (0.48) versus 0.78 (0.5); p < 0.001]. Similarly, the mean maternal Lp B level was significantly higher than the corresponding fetal value [1.28 (0.33) versus 0.46 (0.30); p < 0.001]. Conclusion: Fetal Lp A-I and Lp B levels were significantly lower than maternal levels and did not correlate with gestational age.

This study was conducted to determine whether fetal blood sampling during the second trimester is associated with changes in circulating fetal beta-endorphin (BE) concentrations. We measured BE concentrations in 68 paired fetal and maternal blood samples obtained between 18 and 28 weeks' gestation. Patients were divided into a control group (n = 50), if the fetal blood samples were obtained by a single umbilical cord puncture, or multiple insertion group (n = 18), if multiple cord punctures were required to obtain a sample. The mean (± SE) fetal BE value for the multiple insertion group was significantly higher than BE levels from the control group (771.2 ± 79.2 pg/ml versus 107.1 ±11.7 pg/ml; p<0.001]. This elevation did not appear to be related to acidosis, since no differences in fetal umbilical pH were observed between the two groups. Fetal BE levels from the control but not from the multiple insertion group significantly correlated with maternal values (Spearman rank r = 0.59; p <0.001 vs r = -0.08; p <0.5). In neither group did fetal BE levels correlate with gestational age. These findings indicate that multiple cord punctures at the time of fetal blood sampling are associated with significant increases in BE release. Furthermore, although a maternal or placental contribution to steady state circulating fetal BE cannot be excluded, it would seem that the fetus itself is the primary source of elevated circulating BE levels following multiple cord punctures. © 1993, by Thieme Medical Publishers, Inc. All rights reserved.

This study investigated maternal hemodynamic influence on uteroplacental oxygen distribution and neonatal outcome during cesarean section (CS). CS was performed on 80 parturients using two anaesthetic techniques: spinal anaesthesia (SA) and general balanced anaesthesia (GBA). Indications for CS were exclusively obstetric related. Monitored maternal parameters were: ECG, heart rate (HR), non-invasive blood pressure (NIBP), saturation (SaO2). Gas parameters in umbilical artery, vein, and neonatal capillary blood were sampled. Vitality was assessed by the Apgar scoring, first breath-taking time and the first breastfeeding attempt. Hypotension was the most common finding after SA induction. GBA group presented changes such as QT inversion (12.5%), tachycardia (55%), and bradycardia (2.5%). SA group experienced higher rates of sinus tachycardia (45%) and ventricular dysrhythmias (2.5%). Neonatal oxygenation was significantly higher in SA group. Higher quality of early neonatal adaptation in the SA group confirms it as the technique with the least neonatal risk during CS.

Purpose of investigation: Assesment of biomarkers of the ovarian reserve for ovarian response prediction using different controlled ovarian stimulation (COS) treatments. Materials and Methods: A retrospective cohort study included 363 patients who underwent assisted reproduction at the Clinic of Gynecology and Obstetrics, Belgrade, Serbia. Antral follicle count (AFC), serum AMH, inhibin B, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and progesterone were measured on the second cycle day prior to stimulation commencement. Three types of ovulation stimulation protocols were used. The number and quality of obtained oocytes were used for evaluation of the ovarian response. Results: Patients' age, number of antral follicles, AMH level, and FSH/LH ratio were confirmed as predictors of the number of obtained oocytes. The AFC was the main parameter that influenced the number of obtained oocytes regardless of selected stimulation protocol. Conclusion: The individualization of stimulation protocols may be further improved by using both AFC- and AMH-tailored approach.

Purpose of investigation: To determine whether in vitro fertilization/intracytoplasmatic sperm injection (IVF/ICSI) singleton pregnancies are at increased risk for maternal and fetal complications than spontaneous singleton conceptions. Materials and Methods: The pregnancy outcome of 634 singleton pregnancies after IVF/ICSI delivered at the Clinic for Gynecology and Obstetrics during the period January 2006 to January 2010 were compared to 634 matched singleton controls, matched one by one by age, parity, education, and body mass index (BMI). Differences in pregnancy outcomes between the groups were assessed using Student's t-test with Yates correction for continuous variables and Chi-squared test for categorical variables. Results: The mean gestational age at delivery of the IVF group was 38.13 ± 1.72 weeks, slightly shorter than spontaneously conceived singletons at 38.65 ± 1.79 weeks. The diagnosis of gestational diabetes mellitus (GDM) was frequently made in the IVF group (11.82% vs 8.35%, t = 2.052, p < 0.05). Total preterm delivery rate of IVF pregnancies was 9.30%, significantly higher than the controls 5.85% (t = 2.33, p < 0.05), especially at the 30-32 weeks gestation period. The predominant mode of delivery after IVF pregnancy was cesarean section (80.75% vs 31.38% at spontaneously conceived, t = 17.71, p < 0.001), while vaginal route was the choice for naturally originated pregnancies 68.6% vs 19.24% (p < 0.01). No differences were found in the average birth weights, LBW, VLBW, SGA, and LGA regarding the pregnancy origin. Perinatal mortality rates were comparable among singletons with different pregnancy origin. Conclusions: Singletons from IVF/ICSI pregnancies have poorer perinatal outcome associated with higher rates of cesarean sections, preterm birth and prematurity, fetal malpresentation (breech presentation), and the occurrence of maternal GDM in pregnancy.

[No abstract available]

Objective To evaluate the effect of Rh alloimmunization and intrauterine transfusion on fetal stress hormone levels. Method Umbilical venous samples were obtained immediately prior to transfusion in 51 anemic fetuses and in a control group of 30 non-anemic fetuses. In 16 of the anemic fetuses a repeat sample was obtained post-transfusion. Samples were assessed for hematocrit, pH and levels of β-endorphin, cortisol and adrenocorticotropin. Results The mean initial hematocrit was significantly lower, while the median concentrations of β-endorphin and cortisol were higher in anemic compared with non-anemic fetuses at initial sampling. In contrast, fetal adrenocorticotropin levels did not differ between the groups. Among anemic fetuses, both serum β-endorphin and cortisol levels displayed a strong negative correlation with fetal hematocrit (r =- 0.46, p = 0.006 and r = - 0.54, p < 0.001, respectively). Among anemic fetuses sampled before and after transfusion, levels of β-endorphin were significantly lower, while cortisol levels were significantly higher post-transfusion. Maternal cortisol levels also increased post-transfusion. Conclusion Fetal anemia is associated with increased β-endorphin and cortisol levels. While intrauterine transfusion is associated with a decline in β-endorphin concentrations, fetal cortisol levels increase following transfusion, potentially reflecting transplacental passage of post-transfusion increases in maternal cortisol.

Thyroid hormones, thyroxine-binding globulin (TBG) and thryrotropin (TSH) concentrations were measured in 46 paired fetal and maternal blood samples collected between 17 and 36 weeks of gestation. The samples were selected retrospectively from fetuses that had undergone cordocentesis for prenatal diagnosis, had been found to be unaffected and confirmed healthy at birth. In maternal serum, total thyroxine (TT4) and triiodothyronine (TTj) concentrations were high, but free thyroxine (FT4) and free triiodothyronine (FT-*) were within normal adult ranges: reverse T3 (RT3) increased and TSH levels decreased towards term. Fetal TT4, FT4, TT3. FT3, TBG and TSH levels significantly increased whereas RT3 sharply decreased with gestational age. The ratio of fetal TSH/FT4 significantly decreased, suggesting that the set point for negative feedback of pituitary TSH secretion is changing while the sensitivity of the thyroid gland to TSH increases throughout gestation. There was no significant correlation between the maternal and fetal TBG, TSH, TT4 and FT4, whereas maternal TT3 was positively correlated with fetal TT4. FT4, TT3 and FT3. Normal reference values for maternal and fetal iodothyronines, TBG and TSH throughout the second half of gestation provide insight into fetal thyroid development and may be useful for prenatal diagnosis. © 1991 S. Karger AG, Basel.

Thyroid hormones, thyroxine-binding globulin (TBG) and thryrotropin (TSH) concentrations were measured in 46 paired fetal and maternal blood samples collected between 17 and 36 weeks of gestation. The samples were selected retrospectively from fetuses that had undergone cordocentesis for prenatal diagnosis, had been found to be unaffected and confirmed healthy at birth. In maternal serum, total thyroxine (TT4) and triiodothyronine (TTj) concentrations were high, but free thyroxine (FT4) and free triiodothyronine (FT-*) were within normal adult ranges: reverse T3 (RT3) increased and TSH levels decreased towards term. Fetal TT4, FT4, TT3. FT3, TBG and TSH levels significantly increased whereas RT3 sharply decreased with gestational age. The ratio of fetal TSH/FT4 significantly decreased, suggesting that the set point for negative feedback of pituitary TSH secretion is changing while the sensitivity of the thyroid gland to TSH increases throughout gestation. There was no significant correlation between the maternal and fetal TBG, TSH, TT4 and FT4, whereas maternal TT3 was positively correlated with fetal TT4. FT4, TT3 and FT3. Normal reference values for maternal and fetal iodothyronines, TBG and TSH throughout the second half of gestation provide insight into fetal thyroid development and may be useful for prenatal diagnosis. © 1991 S. Karger AG, Basel.