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6 results on '"Plećaš, Darko"'

1. Congenital anomalies: Occurrence and potential risk factors

Author

Pavlović Ivan, Plećaš Darko, Plešinac Snežana, Dotlić Jelena, and Stojanović Nemanja

Subjects
age factors, congenital abnormalities, diagnosis, incidence, pregnancy, prognosis, risk factors, ultrasonography, Medicine (General), R5-920
Abstract

Background/Aim: Congenital malformations still represent one of the most important causes of prenatal and infant death. The study goal was to analyze occurrence and outcomes of different types of congenital anomalies from the tertiary referral center during a ten-year period. Moreover, study aimed at examining potential predictors of congenital anomalies based on patients’ characteristics and medical history data. Methods: Study included all pregnant women directed to Clinic of Obstetrics and Gynecology Clinical Center of Serbia due to prenatally diagnosed congenital fetal anomalies during past ten years. Upon admission to our clinic a detailed general medical and obstetrical history were taken from every patient. All women underwent genetic testing. Ultrasonography and magnetic resonance were diagnostic methods for fetal malformations confirmation. Results: Study included 773 pregnant women aged from 18 to 46 years. Out of registered nine different groups of fetal anomalies/malformations, the most common were malformations of the central nervous system, while majority of fetuses had combined multiple anomalies. Genetic cause for congenital anomalies was present in 25.2% of pregnancies. Medical pregnancy abortion was performed in 71.8% of cases. Only 10.2% of pregnancies ended in term. The best outcome for children was obtained in case of gastrointestinal anomalies (52% live-born). Contrary only one child with neck and thorax malformations could be saved. According to logistic regression the most important predictor of having a child with combined multiple anomalies was mother’s age, while predictor of central nervous system anomalies was gestational diabetes. The significant predictor of genetic anomalies was mother’s age. Conclusion: In our sample neurological congenital anomalies were the most common, although abnormalities of all organ systems were registered. Majority of pregnancies had to be discontinued due to combined multiple anomalies caused by genetic disorders. Older mother’s age and diabetes can imply on the increased risk for fetal malformations.

Published
2020
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4. Congenital fetal heart disease — course and outcome of pregnancies.

Author

Plešinac, Snežana, Plećaš, Darko, Ljubić, Aleksandar, Parezanović, Vojislav, and Terzić, Milan

Abstract

The aim of the study was to analyze the course and outcome of pregnancies with congenital heart disease of the fetus, diagnosed and terminated at the Institute of gynecology and obstetrics Clinical Center of Serbia over four years. The study included 71 patients, divided into 3 groups according to the fetal outcome. Group 1 had consisted of 9 pregnancies terminated artificially, Group 2 of 48 patients who delivered live fetuses, and Group 3 of 14 pregnancies terminated as fetal intrauterine death. The types congenital heart diseases were categorized as follows: 40 had L-R shunting type, 18 R-L shunting type, 8 coartacion of aorta, and 7 valvular diseases. Intrauterine fetal death occurred in 11 pregnancies in Group 3 after 28 weeks of gestation. In 13 cases karyotypisation were done, because of maternal age or intrauterine growth retardation diagnosed with ultrasound, and 9 of them had genetic disorders. Forty-eight fetuses were born alive. Fourteen died in the first 2–7 days and 12 had successful heart surgery. Twenty-two needed no surgical correction. Ultrasound findings were false negative in 3 cases. The diagnosis of fetal heart disease should be done by fetal echocardiogram, which can be preformed early in the beginning of the pregnancy. [ABSTRACT FROM AUTHOR]

Published
2007
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5. Fetal biochemical markers in prediction of adverse maternal and fetal pregnancy outcome

Author

Kocijančić Belović, Dušica M., Plešinac, Snežana, Plećaš, Darko, Savić Radojević, Ana, and Grujić, Zorica

Subjects
marker, complications, AFP, HCG, inhibin, PAPP-A, trudnoća, pregnancy, estriol, komplikacije
Abstract

Biohemijski markeri prvog i drugog trimestra, osim u skriningu hromozomopatija, pokazuju vaţnu i nesumnjivu povezanost sa maternalnim i fetalnim ishodom trudnoće kod pacijentkinja gde se radi o fetusu sa euplodnim brojem hromozoma. Smatra se da u osnovi najozbiljnijih komplikacija trudnoće, kao što su hipertenzija, abrupcija placente, intrauterusna restrikcija rasta ploda, mala telesna masa za gestacijsku dob i intrauterusna smrt ploda, osim sliĉnih faktora rizika, postoji i ishemijska bolest placente. Morfološke promene u graĊi placente direktno utiĉu na promenu u nivoima sekrecije biohemijskih markera:βHCG-a(beta humanog horionskog gonadotropina), PAPP-a (plasma protein A u vezi sa trudnoćom) u periodima od 11.do 14. nedelje, kao i HCG-a, AFP (alfa feto proteina), uE3 (nekonjugovanog estriola) i inhibina A u periodu od 16.do 19. nedelje gestacije. Raznolikost biohemijskih markera je velika, ali se prednost daje onima koji se rutinski rade u kliniĉkoj praksi, ranije detektuju nego što je pojava prvih kliniĉkih manifestacija bolesti, kao i to da su u dobroj korelaciji sa ozbiljnošću komplikacija, uz što veću senzitivnost i specifiĉnost i manje troškove analize. Cilj:Cilj rada je bio utvrditi korelaciju vrednosti biohemijskih markera skrininga prvog i drugog trimestra sa razliĉitim komplikacijama trudnoće, analizirati period trudnoće kada se komplikacije javljaju, ispitati maternalni i fetalni morbiditet u vezi sa markerima, kao i neonatalni ishod trudnoća gde su pacijentkinje imale razliĉite kategorije vrednosti navedenih markera. Materijal i metod: Studija je bila kliniĉka i prospektivna, sprovedena u periodu od 1.1.2013. do 01.07.2014.godine na Klinici za ginekologiju i akušerstvo (KGA) Kliniĉkog centra Srbije. U studiju su bile ukljuĉene 104 trudnice, sa monofetalnom trudnoćom nastalom prirodnim putem. U prvoj studijskoj grupi su bile 54 ispitanice kod kojih su jedan ili više fetalnih biohemijskih markera prvog ili drugog trimestra imali vrednosti ispod 0,5 i preko 2 MoM-a, a u drugoj studijskoj grupi je bilo 50 ispitanica kod kojih su vrednosti ovih markera bile u opsegu od 0,5 do 2 MoM-a... Biochemical markers of the first and second trimester of pregnancy, show an important and indisputable correlation with the maternal and fetal outcome of pregnancy in patients with euploid chromosomic fetuses. It is believed that, in the basis of the most severe complications of pregnancy, such as hypertension, placental abruption, intrauterine restriction of fetal growth, low birth weight for gestational age and intrauterine fetal death, besides similar risk factors, there is also ischemic placental disease. Morphological changes of placental structure directly affect the changes in the secretion levels of the biochemical markers: βHCG (beta human chorionic gonadotrophin), PAPP-A(pregnancy associated plasma protein A) in the period of 11.th-14.th gestational weeks, and HCG, AFP (alpha-feto protein), uE3 (unconjugated estriol) and inhibin A in the period from 16.th to 19.th weeks of gestation. The diversity of biochemical markers is high, but the advantage is given to those who are routinely being done in clinical practice, those who are previously detected than the onset of the first clinical manifestations of the disease, and which correlate with the seriousness of complications, with greater sensitivity and specificity and less analysis costs. Objective: The aim of this study was to determine the correlation of the biochemical markers values of the first and second trimester screening with different complications of pregnancy, to analyze the period of pregnancy when complications occurred, to examine maternal and fetal morbidity related to markers, as well as the neonatal outcome of pregnancy, where the patients had different categories of markers values. Material and method: The study was clinical and prospective, conducted in the period from 01.01.2013.th until 01.07.2014.th at the Clinic for Gynecology and Obstetrics of the Clinical Center of Serbia...

Published
2018

6. The role of prenatal noninvasive fetal screening in the control of twin pregnancies achieved after in vitro fertilization

Author

Pilić, Igor Ž., Plećaš, Darko, Plešinac, Snežana, Kontić Vučinić, Olivera, and Vejnović, Tihomir

Subjects
blizanci, ultrazvuk, biochemical markers, IVF, ultrasound, trudnoća, pregnancy, biohemijski markeri
Abstract

Ishod postupka savremenih tehnika asistirane reprodukcije, a pre svega in vitro fertilizacije i intracitoplazmatske injekcije spermatozoida (ICSI) predstavlja, u velikom broju slučajeva, multifetalna trudnoća sa dva i više embriona. Multifetalne trudnoće sa dva fetusa su povezane sa visokim perinatalnim morbiditetom i mortalitetom, jer je verovatnoća povoljnog ishoda multiple trudnoće (ţivo i zdravo novoroĎenče), trajanje gestacije i telesna masa novoroĎenčeta obrnuto proporcionalna broju fetusa1. Kod blizanačkih trudnoća je daleko veći procenat prevremenog poroĎaja, spontanog pobačaja, komplikacija u vidu pojave gestacijske hipertenzije, gestacijskog dijabetes melitusa, krvarenja u drugom, a posebno trećem trimestru (veća incidenca placente previje i abrupcije posteljice), kao i pojave antepartalne i postpartalne hemoragije, intrauterusne smrti jednog ili oba ploda (FMU - 17%). Prenatalni neinvazivni fetalni skrining kod pacijentkinja sa blizanačkim trudnoćama nastalim postupkom vantelesne oplodnje vrši se putem ultrasonografskog pregleda oba fetusa i analizom vrednosti hormona u serumu pacijentkinje izraţenih u MoM ima, ustanovljenih prilikom standardnog biohemijskog skrininga hromozomopatija fetusa putem Double, Triple ili Quadriple testa. Biohemijski markeri su povezani sa različitim spoljašnjim faktorima, kao što su ţivotna dob pacijentkinje i partnera, demografski podaci, tok i ishod prethodnih trudnoća, posebno prevremenih poroĎaja, spontanih pobačaja, perinatalnog morbiditeta i mortaliteta, podaci o vantelesnom oploĎenju, vrstu vantelesnog oploĎenja (IVF, ICSI), broj prethodnih neuspelih pokušaja, (eventualna donacija oocita), tok aktuelne trudnoće, kao i prisustva simptoma koji ukazuju na preteći pobačaj ili poroĎaj. I dalje su veoma aktuelna istraţivanja koja ispituju korelaciju izmeĎu vrednosti hormona u krvi pacijentkinja sa navedenim entitetima. Prenatalni neinvazivni fetalni skrining ima značajnu ulogu u predikciji kongenitalnih anomalija fetusa, kao i u predikciji nepovoljnog toka i ishoda blizanačkih trudnoća nastalih postupkom vantelesnog oploĎenja. Ciljevi studije su da se ispita da li postoji korelacija izmeĎu spoljašnjih faktora i vrednosti neinvazivnog fetalnog skrininga (hormoni u serumu trudnica sa blizanačkim trudnoćama) sa pojavom kongenitalnih anomalija fetusa, kao i pojavom komplikacija u toku blizanačke trudnoće i nepovoljnim ishodom trudnoće... The outcome of the process of modern techniques of assisted reproduction, and above all in vitro fertilization and intracytoplasmic injections of spermatozoids (ICSI), is in many cases multifetal pregnancy with two or more embryos. Multifetal pregnancies with two fetuses are associated with high perinatal morbidity and mortality, as the probability of a favorable outcome for multiple pregnancies (live and healthy newborns), the duration of gestation and the body weight of the newborn are reversely proportional to the number of fetuses. In twin pregnancies, the percentage of premature birth, spontaneous abortion, complications in the form of gestational hypertension, gestational diabetes mellitus, bleeding in the second, and especially in the third trimester (higher incidence of placenta and abruption of the placenta), and the occurrence of antepartum and postpartum haemorrhage, intrauterine deaths of one or both fetuses (FMU - 17%). Prenatal non-invasive fetal screening in patients with twin pregnancies resulting from under-fertilization is performed by ultrasonographic examination of both fetuses and the analysis of the hormone value in the serum of the patient expressed in MoM has been established during the standard biochemical screening of fetus chromosome analysis through the Double, Triple or Quadriple test. Biochemical markers are associated with a variety of external factors, such as the patient's and partner's lifespan, demographic data, the flow and outcome of previous pregnancies, especially premature births, spontaneous abortion, perinatal morbidity and mortality, fertilization data, insemination (IVF, ICSI), the number of previous unsuccessful attempts, (possible donation of the oocyte), the current pregnancy, and the presence of symptoms that indicate a predominant abortion or birth. There are still very current research that examines the correlation between the hormone values in the patient's blood with the indicated entities. Prenatal non-invasive fetal screening plays an important role in the prediction of congenital fetal anomalies, as well as in the prediction of adverse flow and outcome of twin pregnancies caused by the method of in vitro fertilization. The aims of the study are to examine whether there is a correlation between external factors and the value of non-invasive fetal screening (hormone in the pregnant woman with twin pregnancies) with the appearance of congenital fetal anomalies, as well as the occurrence of complications during twin pregnancy and adverse pregnancy outcome...

Published
2018

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