The impact of preeclampsia in pregnancy.

Objective. To observe the influence of preeclampsia during pregnancy. Materials and methods. 5711 patient's records of the year 2008 and 6188 patient's records of the year 2009 of Obstetric/Gynecologic hospital 'Queen Geraldina' have been consulted. The age of women that we studied in 2008 was between 23-35 and in 2009 was be-tween 25-34 years old. We have made a careful diagnose of inducted hypertension of pregnancy and preeclampsia. Results. The incidence of preeclampsia in the population was 4.1% (n =238) in 2008 and 3.1% (n=192) in 2009.The incidence of the cases that developed from preeclampsia to eclampsia were respectively 1.6% (n=4) and 1.5% (n=3) on 2009. Babies which have preeclamptic mothers were preterm in 13% (n=31) of cases, and 14.5% (n=28) of which have severe hypotrophia vs. 10% (n=24) and 11% (n=21) severe hypotrophia in 2009. Babies mortality on the preeclamptic population were respectively 8% (n=19) and 7.8% (n=15). Conclusions. From the survey resulted that patients diagnosed with preeclampsia manifested on a high rate hypertension and proteinuria. Prematurity, severe hypotrophy and baby's mortality were the major complications of preeclampsia. Women with preeclampsia were especially the youngest.

The value of the middle cerebral to umbilical artery Doppler ratio in the prediction of neonatal outcome in patient with preeclampsia and gestational hypertension.

OBJECTIVE: To investigate the diagnostic value of MCA/UA pulsatility index ratio for the prediction of adverse perinatal outcome in the fetuses with preeclampsia and gestational hypertension. MATERIALS AND METHODS: We included in the study 738 patients recovered in our Hospital with the diagnosis of preeclampsia and gestational hypertension, from January 2006 to December 2009. All the patients underwent accurate color Doppler velocimetry examination. The study population was divided into two groups depending on the normal or abnormal values of MCA/UA pulsatility index ratio.Outcome variables were intrauterine and early neo natal death, admission to the neonatal intensive care unit and the duration of treatment, Apgar score below 7 at 5 minutes,cesarean delivery for fetal distress, gestational age at delivery, neonatal birth weight, IUGR. RESULTS: We divided the study population into two groups depending on normal or abnormal value of MCA/UA pulsatility index ratio. In 314 patients we found abnormal values of MCA/UA pulsatility index ratio. Neonates of mothers with abnormal values of MCA/UA pulsatility index ratio had significantly lower gestational age at delivery (34.8 versus 38.4, P<0.0001), lower birth weight (2174.6 g versus 3215.0g, P<0.001), significantly greater risk for perinatal death (30.8% versus 0.23%, P<0.0001) significantly greater risk of admission to intensive care unit (77.8% versus 47.4%, P<0.0001), longer duration of treatment in NICU (10.6 days versus 6.5 days, P<0.0001), greater rate of cesarean delivery for fetal distress (76.7% versus 62.5%,P<0.0001), a great number of neonates with low Apgar score at 5 minute (61.9% versus 22.4%, P<0.0001) greater rate of cesarean delivery for fetal distress (71.9% versus 62.5%,P<0.0001), a great number of fetuses IUGR (7.18% versus 1.76%,P<0.0001). CONCLUSION: ACM/UA pulsatility index ratio is a very good predictor of adverse outcome in the fetuses of women with preeclampsia and gestational hypertension.

Prevalence of gestational trophoblastic disease in ectopic pregnancy.

OBJECTIVE: To describe the prevalence of gestational trophoblastic disease in ectopic pregnancy. STUDY DESIGN: Medical records of 105 patients from January 2007 to October 2009. We excluded of the study 5 cases (one case where the answer of the biopsy was not clear; 4 others with diagnosis of adhnexial mass where the pregnancy test had resulted positive but the answer of biopsy have been resulted ruptured ovary cyst and pyosalpingitis). So definitely the size of the sample was 100 patients. RESULTS: 79 patients with EP underwent surgery due to a (diagnosis of EP with hem peritoneum and enraptured ectopic pregnancy) and in 18 of them the answer of the biopsy was GTD. 4 of 75 cases admitted in our hospital with diagnosis of EP, (pregnancy test was used instead of estimation of the level of ß-hCG because our hospital couldn't offer estimation of the level of ß-hCG during 24 hours) have been not confirmed diagnosis of EP by biopsy, but ruptured ovary cyst with hem peritoneum, pyosalpingitis.31 cases with EP (enraptured EP) underwent medical treatment with methotroxate. In 10 cases last management was failed and surgical intervention was institutionalized and histological analysis revealed GTD in 6 of them (partial mole). ß-hCG level was detected in 31 cases with enraptured fallopian pregnancy; in all cases where treatment with methotroxate has been failed and GTD was confirmed, the level of ß-hCG was > 10.234 mUI/ml. 21 cases with enraptured fallopian pregnancy were successfully treated, and at this point we never learned the answer of biopsy. We registered one case with cervical pregnancy and one cornual (interstitial portion) pregnancy. CONCLUSION: we found 18 cases of GTD in EP /11.500 deliveries (1,56 per 1,000 deliveries), prevalence of the GTD in EP was about 18%.

Ectopic pregnancy comparison of different treatments.

OBJECTIVES: We would like to determine the best treatment option depending of ectopic pregnancy situation.Methods. This is a retrospective cohort study that registered all women admitted in Obstetrics and Gynecologic "Queen Geraldine" Hospital June 2003 until 2008 dicember. There were admitted 228 women diagnosed with Ectopic Pregnancy that were treated in our Hospital. RESULTS: Unruptured ectopic pregnancy is diagnosed in 5,2 week of pregnancy and ruptured ectopic in an average of 6,4 weeks. Surgical intervention is registered in 170 patients and we did tubectomy. Success rate of Methotrexate application was more successful if ß-hCG level was lower. If the ß-hCG level is higher over 10 000 the success rate will decrease in 83 % and in ß-hCG levels over 15 000 the success rate will be until 50%. CONCLUSIONS: The treatment will be determined by combination of clinical symptoms, ultrasound examination and ß-hCG levels. MTX is recommended for all women without hemodinamic problems, unruptured pregnancy and low ß-hCG level (ß-hCG < 5000 mlU/mL). It is confirmed that the reduction of 15% of ß-hCG in the fourth day after application of MTX is a success guide.

Mifepristone medical abortion in Albania: results from a pilot clinical research study.

OBJECTIVE: To explore the acceptability and feasibility of introducing mifepristone-misoprostol for early medical abortion in home and clinic settings in Albania. METHODS: This was a prospective study testing a simplified mifepristone-misoprostol regimen in two tertiary-level government health facilities in Tirana, Albania. Women (n = 409) with amenorrhea of 8 weeks or less received 200 mg mifepristone in the clinic and then chose whether to take 400 microg of oral misoprostol 2 days later either at home or in the clinic. RESULTS: Nearly 97% of women successfully terminated their pregnancies using the simplified regimen. Almost all women found the method either satisfactory (49.4%) or highly satisfactory (41.1%). Almost all women who were given the option selected the home use protocol. Women choosing home administration of misoprostol were able to manage the medical abortion process on their own. CONCLUSION: A reduced dose mifepristone medical abortion regimen with home administration of misoprostol is feasible for introduction into healthcare facilities in Albania.