Vera Milenkovic

Hypersensitivity to Etoposide in case of metastatic gestational choriocarcinoma.

Etoposide is commonly used in the treatment of a variety of neoplasms. Hypersensitivity reactions to etoposide are infrequently reported and include hypotension, hypertension, flushing, diaphoresis, chest discomfort, dyspnea, bronchospasm and loss of consciousness. We report the case of a 39-year-old woman who experienced acute bronchospasm, tachycardia, hypoxia and hypotension. The symptoms resolved within an hour after administration of intravenous fluids, methylprednisolone, diphenhydramine and oxygen. Subsequently, the patient was given etoposide phosphate without incident.

Clinical outcome of a FIGO stage IV gestational choriocarcinoma

Choriocarcinoma is the most malignant tumor of gestational trophoblastic disease arising from any gestation. It has a tendency toward relapse as well as metastasis. Here, a case of relapsed high-risk choriocarcinoma (FIGO stage IV, WHO score 12) in a 37-year-old female presenting with vaginal bleedings is described. Relapse developed at the site of the surgical scar from hysterectomy that had been performed 2 years earlier. Although the patient was treated with aggressive chemotherapy, she was in a bad general condition and died from infection and liver insufficiency.

Incidence of postpartum post-cesarean hysterectomy at the Institute of gynecology and obstetrics, Clinical center of Serbia, Belgrade

INTRODUCTION Postpartum hysterectomy means hysterectomy at least 6 weeks after delivery or cesarean section. It is usually performed in life-threatening situations. Incidence of postpartum hysterectomy varies from 0.02% to 0.3% of total number of deliveries. OBJECTIVE The aim of this study was to show and compare the incidence of postpartum hysterectomy after the cesarean section at the Institute of Gynecology and Obstetrics, Clinical Center of Serbia. We compared two five-year periods: the first period 1987-1982 and the second 2000-2004. METHOD The retrospective study analyzed all patients treated at the Institute of Gynecology and Obstetrics who had had hysterectomy until six weeks after vaginal delivery or cesarean section. We analyzed the number of deliveries and the number of postpartum hysterectomies. RESULTS There were 50,467 deliveries (3542 cesarean sections) and 91 postpartum hysterectomies (70 or 76.92% after cesarean section) in the first period. In the second period, there were 34,035 deliveries (7105 cesarean sections) and 64 hysterectomies (39 or 60.94 % after cesarean section). The overall incidence of postpartum hysterectomy was 1.98/1000 in the first and 1.88/1000 deliveries in the second period. The incidence of post-cesarean hysterectomy decreased from 19.76/1000 in the first period to 5.49/1000 in the second period. CONCLUSION It is crucial for each obstetrician to cautiously distinguish and reach an appropriate decision about the exact indications for cesarean delivery having in mind growing incidence of cesarean sections, which is the main risk factor for puerperal morbidity and mortality.

Fertility sparing therapy for metastatic gestational trophoblastic disease in young patients.

[1] Lemos NA, Arbo E, Scalco R, Weiler E, Rosa V, Cunha-Filho JS. Decreased antiMüllerian hormone and altered ovarian follicular cohort in infertile patients with mild/minimal endometriosis. Fertil Steril 2008;89(5):1064–8. [2] Corson SL, Gutmann J, Batzer FR, Wallace H, Klein N, Soules MR. Inhibin B as a test of ovarian reserve for infertile women. Hum Reprod 1999;14(11):2818–21. [3] Coric M, Barisic D, Pavicic D, Karadza M, Banovic M. Electrocoagulation versus suture after laparoscopic stripping of ovarian endometriomas assessed by antral follicle count: preliminary results of randomized clinical trial. Arch Gynecol Obstet 2011;283(2):373–8. [4] Hansen KR, Hodnett GM, Knowlton N, Craig LB. Correlation of ovarian reserve tests with histologically determined primordial follicle number. Fertil Steril 2011;95(1): 170–5.

Pulmonary metastasis in patients with gestational trophoblastic disease

The medical records of 82 women who were admitted to the Institute of Obstetrics and Gynecology, Clinical Center of Serbia, Belgrade, Serbia, between January 1, 2000, and October 31, 2007, for the treatment of gestational trophoblastic disease (GTD) were reviewed. The diagnosis of metastasis was based on clinical and radiologic evidence (chest X-ray and computed tomography) and on whether the women had elevated levels of serum human chorionic gonadotropin. Particular attention was paid to previous abortions, the interval between previous abortions and the diagnosis of metastasis, the mortality rate, and the need for hysterectomy. Ethics approval was not required for the present study. Of the 82 women, 9 (10.9%) had metastasis: 6 (7.3%) had pulmonary metastasis and 3 (3.6%) had vaginal metastasis. The present study focused on the 6 patients with pulmonary metastasis, 5 of whom were multiparous and had experienced a molar pregnancy within 1 year of the abortion of a preceding pregnancy. The ages of the women ranged from 25 to 51 years (mean, 36 years). A 39-year-old woman had primary GTD with pulmonary metastasis. The diagnosis of pulmonary metastasis was made using chest X-ray and, when the radiologic findings were deemed inconclusive, confirmed using computed tomography. All 6 women with pulmonary disease displayed non-specific signs of chest metastasis (periodic cough, dyspnea, and pleuritic pain), which they had ignored.

Intrapartal resection of the bicornuete uterus for placenta membranacea percreta

Placenta membranacea is a rare anomaly characterized by failure of villous atrophy during early gestation, and 30% of cases involve some form of placental adherence. Placenta percreta is infrequent, but life-threatening condition. Antenatal diagnosis of these placental anomalies is very difficult, but essential for reduction of the number and extent of possible complications. A 19-year-old primigravida was referred to us with 31-week pregnancy complicated by preeclampsia. Upon admission, ultrasound scan revealed eutrophic fetus in breech presentation, without any signs of retroplacental clot. At laparotomy, hemoperitoneum without any trophoblastic tissue emerging to the peritoneal cavity was found and placental abruption with uteroplacental apoplexy was suspected. In addition, unicervical symmetric bicornuate uterus with pregnancy in the left uterine horn was found. The lower segment uterine section was performed and 1800 grams live baby was delivered. Delivery of the placenta was unusually difficult. It was very large and densely adherent to the posterior uterine wall, which appeared to be composed of serosa in that area only. After removal of placenta, the hemorrhage could not be controlled, and resection of the left uterine horn was performed. Placenta accreta, increta and percreta ought to be considered in all cases of uterine anomalies in pregnancy and in cases of prenatal diagnosis of placenta membranacea.

Novel surgical procedure for the treatment of female stress urinary incontinence by using transobturator vaginal tape

INTRODUCTION/AIM Current method in the treatment of female urinary incontinence implies the placement of tension-free suburethral vaginal tape, using a retropubic or transobturator approach. Considering numerous complications related to retropubic approach, we reported the results of transobturator procedure in prospective study. METHODS We used a non-absorbable polypropylene tape with the outside-in (Herniamesh) or in-outside (Johnson & Johnson) transobturator approach. RESULTS During the period from October 2004 to September 2005 the procedure was carried out in 10 patients. In only 2 cases urinary stress incontinence occured as isolated problem managed with transoburator tape, whereas in 8 patients this procedure was associated with other operative gynecologic events. No perioperative complication was encountered. In 80% of the patients a satisfactory result was obtained, while one patient failed to demonstrate any amelioration, and the other developed subsequently urge incontinence. CONCLUSION Transobturator tesion-free vaginal tape represents a very simple, safe and, in the large percent of cases, successful procedure in the management of urinary stress incontinence, with rare perioperative complications.

Changes in the Incidence of Gestational Trophoblastic Disease - 2000-2010 - Our Experience

Changes in the Incidence of Gestational Trophoblastic Disease - 2000-2010 - Our Experience Gestational trophoblastic disease (GTD) is a group of rare tumors that involve abnormal growth of cells inside a womans uterus. The aim of the paper was to report the incidence of GTD in the University Hospital Center during a ten-year period. The retrospective analysis involved all medical records of women who were treated for GTD in our clinic. Histopathologic report of abortion specimen with gestational trophoblastic disease was registered and we calculated the incidence of births, abortions and total pregnancies. There were 104 patients who were treated in our clinic. The overall incidence of GTD was 1,26 per 1000 deliveries. According to our experience, a lower socio economic status may be a risk factor for GTD, apart from younger age, at least one delivery and more abortions in anamnesis. Trend kretanja incidence gestacijskih trofoblastnih bolesti u periodu 2000-2010 - naše iskustvo Gestacijske trofoblastne bolesti (GTB) predstavljaju grupu retkih tumora koji nastaju abnormalnim rastom trofoblasta. Cilj rada je da se utvrdi kolika je incidenca GTB u desetogodišnjem periodu u Univerzitetskoj klinici za ginekologiju i akušerstvo. Retrospektivnom studijom obuhvaćene su sve bolesnice koje su lečene od GTD u našoj klinici u desetogodišnjem periodu. Analizom je obuhvaćena godišnja incidenca i ukupna incidenca u odnosu na broj porođaja. Ukupno su lečene 104 bolesnice. Incidenca GTB bila je 1,26 na 1000 porođaja. Na osnovu našeg iskustva, faktori rizika za nastanak GTB su niži socioekonomski status, godine starosti i barem jedan porođaj i veći broj pobačaja u anamnezi.