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.

Background: Numerous studies have shown that high maternal pre-pregnancy body mass index is a strong, modifiable risk factor for preeclampsia. Overweight is associated with alterations in lipid concentrations and an activation of inflammatory markers and both of these metabolic abnormalities are characteristic of preeclamptic pregnancies before the onset of clinically evident disease. We investigated the relationship between early pregnancy and midpregnancy plasma lipid concentration and risk of mild and severe preeclampsia. Methods:The study included 400 participants, divided in three groups: control group (n=300 normotensive pregnancies); group with mild preeclampsia (n=67) and group with severe preeclampsia (n=33). Maternal serum collected at: 8-12; 20-24; and 28-32 weeks, was used to measure lipid profile. Results:The groups were similar with respect to age and parity. Women with mild preeclamsia had higher levels of total cholesterol and LDL than control subjects from the first trimester (4.28±0.53 vs. 4.74±0.74mmol/l; 1.37±0.3 vs.1.98±0.45mmol/l; p<0.05). HDL values were lower in preeclamptic group (1.38±0.21 vs. 1.16±0.24mmol/l; p<0.05). The values of cholesterol and LDL were most increased in the group with severe preeclampsia (5.48±0.91 and 2.36±0.6mmol/l), but HDL values were most increased (0.96±0.15mmol/l). This is in correlation with increased BMI, and this difference is maintained until the end of the pregnancy. Conclusion:Plasma lipid profile assay in first and second trimester of pregnancy is noticeable to predict probability and severity of preeclampsia, especially in combination with blood pressure values in the same periods.

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.

Pleural effusion is a general term for the accumulation of fluid in the pleural space. Incidence is approximately 1/15000 pregnancies. It is frequently associated with extra thoracic anomalies, abnormal karyotype and congenital heart disease. The mortality rate is 53 % but in cases with associated hydrops may be as high as 95%. Spontaneous resolution or regression has been reported in 9 to 22 % and has been associated with nearly 100 % of survival. Intrauterine interventions such as thoracocentesis and pleuroamniotic shunting are considered to avoid progression of an otherwise potentially fatal disease. The presence of hydrothorax does not influence the mode of delivery and cesarean section should be reserved for obstetrical indications. We present a case of 36-year-old woman (G2, P1) referred to University obstetrics and gynecology clinic due to bilateral fetal pleural effusion in 28 gestational weeks. Standard ultrasound biometric parameters were adequate, Doppler of the fetomaternal unit, TORCH and amniocentesis for fetal karyotype were normal. Serial ultrasounds follow up was performed and there was a total reduction of the pleural fluid in 34gw. She was delivered in 38gw by cesarean section due to polyhydramnios, pedalic fetal lie and macrosomia. Neonatal outcome was uneventful and there were no signs of neonatal respiratory distress. Fetal pleural effusion is a rare but potentially fatal condition. Spontaneous resolution is possible and most desirable occasion.

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Introduction: Echocardiography as an imaging method is increasingly being used in obstetrics in the management of hemodynamic changes which occur in normal but also in pregnancies with gestational hypertension/preeclampsia. Aim: The aim of the study is to show that some of the heart changes in pregnancies complicated with gestational hypertension and preeclampsia are abnormal and further follow up of these patients is needed. Methods: A total of 81 patients were enrolled in the study. The patients were further divided in two groups. Pregnant women with gestational hypertension or preeclampsia (51) and a control group of normotensive pregnancies (30). A total of 3 echocardiograph exam were made, the first upon entry in the study (28 -34 g.w), the second 2 weeks after delivery and the last 6 months after delivery. Results and discussion: We found several statistically significant results that involve the IVS, PWLV, LKM, left chamber hypertrophy and diastolic function. Diastolic dysfunction usually shows up before systolic dysfunction in the evolution of ischemic/hypertensive cardiovascular disease and is of prognostic value in predicting long term cardiovascular morbidity. The changes seen 6 months after delivery on our last control mean that those changes are permanent and need further prevention strategies. Conclusion: From the noninvasive methods echocardiography is the most favorable method in identifying structural changes and functional changes in pregnancies with hypertension. Echocardiography allows fast, reproducible information and is both safe for mother and fetus.

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