25 research outputs found
Uticaj faktora inflamacije na tok i ishod trudnoΔa komplikovanih preeklampsijom
Preeclampsia is a common disorder of pregnancy characterized by disturbed placentation and hemodynamic response to pregnancy. It remains to be a leading cause of maternal morbidity and mortality and is associated with a significant increase in perinatal mortality, a clear etiology and pathophysiology is still unknown. It occurs in 3-14% of all pregnancies in the world and to moderate pre-eclampsia by 75% and 25% severe preeclampsia.
Early prediction and prevention of pre-eclampsia is a dream of many obstetrician during generations. We used the number of tests (biophysical, biochemical ...) during the years of testing (more than 60 tests), but none of them gave the expected results of reliability as the sole test. More markers of inflammation and inflammatory responses has been studied in pre-eclampsia, in order to define their role in the pathogenesis and disease prediction.
Many studies have addressed the role of inflammation in the pathogenesis of preeclampsia. However, little is known about the relationship between the severity of inflammation and severity of preeclampsia due to insufficient testing on this topic.
Aim
Since prevention is not possible to estimate severity of disease intensive supervision during the further course of pregnancy should be the target.
1. To determine the effect of the levels of cytokines on the clinical parameters of pregnant women with preeclampsia.
2. Define the demographic and socio-economic characteristics of pregnant women with the risk of pre-eclampsia in Macedonia,.
3. Assessment the impact factors of inflammation in certain biophysical and biochemical markers for prediction of severe preeclampsia in relation to women in the general obstetric population.
4. Evaluate the diagnostic and prognostic test options concentration levels of inflammation factors in maternal serum as a test to assess the severity of preeclampsia in the third trimester of pregnancy.
5. Determinate the dependence of pregnancy, mode of completion and perinatal outcomes in relation to inflammatory response
Materials and methods
The study was conducted as prospective study at the University Clinic of Gynecology and Obstetrics, University "Ss. Cyril and Methodius" in Skopje, Macedonia. The study included 50 pregnant women with singleton pregnancies between 28 and 40 gestational weeks hospitalized with symptoms of pre-eclampsia, determined by standard clinical laboratory analysis.
The control group consisted of 50 normotensive pregnant women of the same gestational age (+ / - 1 Week), parity (primapara, parity 1 to 4 and parity> 4) and maternal age ( 35 years).
After obtaining consent for participation in the examination of every pregnant woman, we took a detailed history, perform cardiotocography, ultrasound biometry and Doppler of fetomatemal unit, we took a blood sample to determine the appropriate serum concentrations of appropriate markers. Clinical laboratory testing to assess the severity of pre-eclampsia (moderate or severe). Inflammatory cytokines were analyzed from peripheral blood 1-1,5ml by enzymatic amplification chemiluminescence on the device Immulite 1000, Siemens Healthcare Diagnostics, USA.
The duration of pregnancy, method of delivery, birth weight and length of the child at birth, Apgar score, are also analyzed.
The data were digitized and all statistical tests were performed using SPSS version 13.0. We used descriptive statistical analysis that we would display the following parameters: mean, standard deviation, coefficient of variation, variation interval. Categorical variables were tested using Chi square and Fisher exact tests and quantitative variables were analyzed with independent sample test and Mann-Whiteney's U test to determine the correlation between the variables we used Spearman Rank Correlation Orded test and Pearson's linear correlation coefficient. We used binary logistic regression to determine the predictive role of the parameters analyzed.
Results
The average age of pregnant women included in the study was 32.06 Β± 4.8 in the range of 20 to 40 years. Our data indicate a significant relationship between nulliparity, age, pregnant women, their nutritional status assessed by BMI and their religious convictions. History pregnant women about previous obstetric complications associated with hypertension, diabetes and smoking are important predictors of preeclampsia in our study.
Multiple analysis of this study as independent significant factors for severe pre-eclampsia, confirms the ages of pregnant women: a systolic blood pressure of 160 mmHg and higher diastolic blood pressure of 100 mmHg and higher, the existing proteinuria, serum LDH values of 450 and above, and reduced serum concentrations of IL-4 and IL-tenth.
Preeclampsia has a significant impact on the mode of delivery and newborn weight. The results of our study show that the birth by caesarean section is indicated in 10% of normotensive pregnant women and 46% in pregnant women with preeclampsia (52% severe, moderate 40%).
Pregnancy ended with preterm delivery at 20% of normotensive pregnant women and insignificantly higher percentage of 36% in the group with preeclampsia.
Tested differences between the analyzed groups in relation to the fetus (IUGR and SGA) show that pregnant women with preeclampsia often give birth with SGA, regardless of the severity of the disease, compared to normotensive pregnant women.
Conclusion
Comparison of changes in the profile of cytokines with increasing severity of preeclampsia may allow us to determine the level of compensation of pathological conditions that reflects the level of implementation and functional reserves of various mechanisms to maintain homeostasis. This happens in the background of increased concentrations of other proinflammatory cytokines and decreased levels of anti-inflammatory cytokines IL-4 and IL-10.
1. Multiple analysis of this study as independent significant factors for severe pre-eclampsia confirms: age β₯ 35 years, nulliparity and ethnicity, and as insignificant factors confirms smoking, Diabetes gestationes and preeclampsia in prior preegnancy.
2. In pregnant women with mild preeclampsia there is increase of IL 1Ξ², IL 2, IL 4, IL 8, IL 10, TNF and IL 6 (statistically significant) compared with normotensive pregnant woman.
3. In pregnant women with severe preeclampsia significantly reduces the levels of IL 4 and IL 10, and increasing the levels of IL 2, IL 6, IL 8, IL 1Ξ², and does not change significantly the level of TNF compared with normotensive pregnancies.
4. Preeclampsia has a significant impact on the way of delivery and newborns weight. In pregnant women with preeclampsia and low levels of factors of inflammation significantly higher percentage of deliveries were by Caesarean section, a significantly smaller percentage of vaginaldelivery.Preterm births insignificantly is in higher percentage in pregnant women with preeclampsia compared to control group.
5. The best statistical model for predicting the severity of preeclampsia is the correlation of the levels of serum interleukin (IL-4 and IL-10) with indicators of pre-eclampsia: LDH, creatinine, uric acid, and platelet count.
However, the study is only the beginning of this type of research in our population. Further research is needed in terms of evaluating the costs and benefits of using such a test in order to prevent subsequent unnecessary interventions in groups with low risk, and realizing the benefits of such interventions in high-risk groups, the patient is given
Biochemical Indicators as Predictive Markers by Combining Clinical Signs in Pre-eclampsia
AIM: To determine whether previously identified risk factors are associated with the development of a severe form of pre-eclampsia in a heterogeneous cohort of women, and the predictive values of these risk factors when combined with certain biochemical indicators.
MATERIALS AND METHODS: Systematic review of data collected for a doctoral case-control study plus an examination of the indicators of pre-eclampsia and maternal IL10 levels. This examination was conducted in 100 women with pregnancies complicated by varying degrees of pre-eclampsia and in 80 normotensive patients hospitalized at the University Clinic of Gynecology and Obstetrics, Skopje, Republic of Macedonia. Patients with pre-eclampsia were categorized into moderate (m PE) and severe (s PE) pre-eclampsia group according to the degree of pre-eclampsia. The severity of pre-eclampsia was determined according to the definition of the World Health Organization, Handbook for guideline development from 2010.
RESULTS: The regression analysis applied in this study showed that elevated systolic blood pressure of 160 mmHg or higher, diastolic blood pressure of 100 mmHg or higher, pregnancy at an older age, nulliparity, persistent proteinuria in pregnancy, the serum lactate dehydrogenase concentration of 450 U/L or higher, and reduced serum concentrations of IL10 as significant predictors of severe pre-eclampsia in pregnant women. While other variables predicted a higher likelihood for the development of severe pre-eclampsia, IL10 decreased such likelihood. IL10 was also found to be negatively correlated with proteinuria and positively correlated with blood platelets. Significantly higher concentration of IL10 was confirmed in patients with a higher number of platelets in the blood and vice versa. On the other hand, the serum concentration of IL10 was significantly lower in patients with a higher amount of proteins in the urine and vice versa.
CONCLUSIONS: Examination of clinical risk factors combined with biochemical markers can improve the predictive success of pre-eclampsia and has important clinical values in improving the prognosis of pregnant women and fetuses
ΠΠ½Π°Π»ΠΈΠ·Π° Π½Π° Π΅ΡΠΈΠΎΠ»ΠΎΡΠΊΠΈ ΡΠ°ΠΊΡΠΎΡΠΈ Π·Π° ΠΏΠΎΡΠ°Π²Π° Π½Π° Π΅Π½Π΄ΠΎΠΌΠ΅ΡΡΠΈΡΠ°Π»Π½Π° Ρ ΠΈΠΏΠ΅ΡΠΏΠ»Π°Π·ΠΈΡΠ° Π²ΠΎ ΠΏΠ΅ΡΠΈΠΌΠ΅Π½ΠΎΠΏΠ°ΡΠ·a
The aim of this study was to evaluate the possible reasons for the emergence of endometrial hyperplasia in perimenopause. Material and methods: A total of 71 patients with irregular bleeding were analyzed, at the age of 40-50 years, who should have undergone diagnostic curettage. Depending on the histopathological findings, we divided them into 2 groups: group 1-findings for endometrial hyperplasia, group 2 - atrophic or endometrium with deficient secretory changes. Body mass index (BMI) was determined (obesity defined with BMI >30 kg/m2); we measured blood pressure (cut-off value was 135/90 mmHg), waist circumference (cut-off value was 88 cm) as well as data of anamnesis (age, physical activity, type of diet, smoking cigarettes). All these data were analyzed as etiological factors in the emergence of endometrial hyperplasia.Results: The mean age of patients was 47 years, and the results obtained were very similar in both examined groups. BMI and waist circumference were increased, more than 60% of patients had hypertension, but not all had a statistical significance. Most of them were with completed secondary education, and city living statistically significantly increases the risk of endometrial hyperplasia (p <0.05). As for the lifestyle (physical activity, caloric diet, smoking), the results have shown that a small number of patients are active, almost half of them consume caloric food and smoke, but without a statistical significance.Conclusion: Increased body weight and elevated blood pressure have a major impact on the onset and progression of pathological changes in the endometrium. As clinicians, we should always think of hyperplasia in obesity and patients with hypertension who are irregularly bleeding. At the same time, we should educate them to change the lifestyle in order to prevent gynecological and internistic morbidity.Π¦Π΅Π»ΡΠ° Π½Π° ΠΎΠ²Π°Π° ΡΡΡΠ΄ΠΈΡΠ° Π±Π΅ΡΠ΅ Π΄Π° ΡΠ΅ Π΅Π²Π°Π»ΡΠΈΡΠ°Π°Ρ ΠΌΠΎΠΆΠ½ΠΈΡΠ΅ ΠΏΡΠΈΡΠΈΠ½ΠΈΒ Π·Π° ΠΏΠΎΡΠ°Π²Π° Π½Π° Π΅Π½Π΄ΠΎΠΌΠ΅ΡΡΠΈΡΠ°Π»Π½Π° Ρ
ΠΈΠΏΠ΅ΡΠΏΠ»Π°Π·ΠΈΡΠ° Π²ΠΎ ΠΏΠ΅ΡΠΈΠΌΠ΅Π½ΠΎΠΏΠ°ΡΠ·Π°. ΠΠ°ΡΠ΅ΡΠΈΡΠ°Π» ΠΈ ΠΌΠ΅ΡΠΎΠ΄ΠΈ: ΠΠ΅Π° Π°Π½Π°Π»ΠΈΠ·ΠΈΡΠ°Π½ΠΈ 71Β ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΊΠ°Β ΡΠΎ Π½Π΅ΠΏΡΠ°Π²ΠΈΠ»Π½ΠΎΒ ΠΊΡΠ²Π°Π²Π΅ΡΠ΅, Π½Π° Π²ΠΎΠ·ΡΠ°ΡΡ ΠΎΠ΄ 40-50 Π³ΠΎΠ΄ΠΈΠ½ΠΈ, ΠΊΠ°Ρ ΠΊΠΎΠΈ Π±Π΅ΡΠ΅ ΠΈΠ½Π΄ΠΈΡΠΈΡΠ°Π½Π° ΡΡΠ°ΠΊΡΠΈΠΎΠ½ΠΈΡΠ°Π½Π° ΠΊΠΈΡΠ΅ΡΠ°ΠΆΠ°. ΠΠ°Π²ΠΈΡΠ½ΠΎ ΠΎΠ΄ Ρ
ΠΈΡΡΠΎΠΏΠ°ΡΠΎΠ»ΠΎΡΠΊΠΈΠΎΡ Π½Π°ΠΎΠ΄ Π³ΠΈ ΠΏΠΎΠ΄Π΅Π»ΠΈΠ²ΠΌΠ΅Β Π²ΠΎ 2 Π³ΡΡΠΏΠΈ : Π³ΡΡΠΏΠ° 1- ΡΠΎ Π½Π°ΠΎΠ΄ Π·Π° Π΅Π½Π΄ΠΎΠΌΠ΅ΡΡΠΈΡΠ°Π»Π½Π° Ρ
ΠΈΠΏΠ΅ΡΠΏΠ»Π°Π·ΠΈΡΠ° , Π³ΡΡΠΏΠ° 2- Π°ΡΡΠΎΡΠΈΡΠ΅Π½ ΠΈΠ»ΠΈ Π΅Π½Π΄ΠΎΠΌΠ΅ΡΡΠΈΡΠΌ ΡΠΎ Π΄Π΅ΡΠΈΡΠΈΠ΅Π½ΡΠ½ΠΈ ΡΠ΅ΠΊΡΠ΅ΡΠΎΡΠ½ΠΈ ΠΏΡΠΎΠΌΠ΅Π½ΠΈ. ΠΠ΄ΡΠ΅Π΄ΠΈΠ²ΠΌΠ΅Β ΠΈΠ½Π΄Π΅ΠΊΡ Π½Π° ΡΠ΅Π»Π΅ΡΠ½Π° ΠΌΠ°ΡΠ° (ΠΠΠ), ΠΎΠ±Π΅Π·ΠΈΡΠ΅Ρ Π΄Π΅ΡΠΈΠ½ΠΈΡΠ°Π½ ΡΠΎ ΠΠΠ > 30 kg/m2, ΠΈΠ·ΠΌΠ΅ΡΠΈΠ²ΠΌΠ΅Β ΠΊΡΠ²Π΅Π½ ΠΏΡΠΈΡΠΈΡΠΎΠΊ (cut-off Π²ΡΠ΅Π΄Π½ΠΎΡΡ 135/90 mmHg), ΠΎΠ±Π΅ΠΌ Π½Π° ΡΡΡΡΠΊ (cut-off Π²ΡΠ΅Π΄Π½ΠΎΡΡ 88 ΡΠΌ), ΠΊΠ°ΠΊΠΎ ΠΈ ΠΏΠΎΠ΄Π°ΡΠΎΡΠΈ ΠΎΠ΄ Π°Π½Π°ΠΌΠ½Π΅Π·Π°ΡΠ° (Π²ΠΎΠ·ΡΠ°ΡΡ, ΡΠΈΠ·ΠΈΡΠΊΠ° Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡ, ΡΠΈΠΏ Π½Π° ΠΈΡΡ
ΡΠ°Π½Π°, ΠΏΡΡΠ΅ΡΠ΅ ΡΠΈΠ³Π°ΡΠΈ).Β Π‘ΠΈΡΠ΅ ΠΎΠ²ΠΈΠ΅ ΠΏΠΎΠ΄Π°ΡΠΎΡΠΈ Π±Π΅Π° Π°Π½Π°Π»ΠΈΠ·ΠΈΡΠ°Π½ΠΈΒ ΠΊΠ°ΠΊΠΎ Π΅ΡΠΈΠΎΠ»ΠΎΡΠΊΠΈ ΡΠ°ΠΊΡΠΎΡΠΈ Π²ΠΎ ΠΏΠΎΡΠ°Π²Π°ΡΠ° Π½Π° Π΅Π½Π΄ΠΎΠΌΠ΅ΡΡΠΈΡΠ°Π»Π½Π° Ρ
ΠΈΠΏΠ΅ΡΠΏΠ»Π°Π·ΠΈΡΠ°. Π Π΅Π·ΡΠ»ΡΠ°ΡΠΈ: Π‘ΡΠ΅Π΄Π½Π° Π²ΠΎΠ·ΡΠ°ΡΡ Π½Π° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΊΠΈΡΠ΅ Π±Π΅ΡΠ΅ ΠΎΠΊΠΎΠ»Ρ 47 Π³ΠΎΠ΄ΠΈΠ½ΠΈ, Π° Π΄ΠΎΠ±ΠΈΠ΅Π½ΠΈΡΠ΅ ΡΠ΅Π·ΡΠ»ΡΠ°ΡΠΈ Π±Π΅Π° ΠΌΠ½ΠΎΠ³Ρ ΡΠ»ΠΈΡΠ½ΠΈ Π²ΠΎ Π΄Π²Π΅ΡΠ΅ ΠΈΡΠΏΠΈΡΡΠ²Π°Π½ΠΈ Π³ΡΡΠΏΠΈ. ΠΠΠ ΠΈ ΠΎΠ±Π΅ΠΌ Π½Π° ΡΡΡΡΠΊ Π±Π΅Π° Π·Π³ΠΎΠ»Π΅ΠΌΠ΅Π½ΠΈ, Ρ
ΠΈΠΏΠ΅ΡΡΠ΅Π½Π·ΠΈΡΠ° ΠΈΠΌΠ°Π° ΠΏΠΎΠ²Π΅ΡΠ΅ ΠΎΠ΄ 60% ΠΎΠ΄ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΊΠΈΡΠ΅, Π½ΠΎ Π½Π΅ Π±Π΅ΡΠ΅ ΡΡΠ²ΡΠ΄Π΅Π½Π° ΡΡΠ°ΡΠΈΡΡΠΈΡΠΊΠ° Π·Π½Π°ΡΠ°ΡΠ½ΠΎΡΡ.Β ΠΠ°ΡΠ³ΠΎΠ»Π΅ΠΌ Π΄Π΅Π» Π±Π΅Π° ΡΠΎ ΡΡΠ΅Π΄Π½ΠΎ ΠΎΠ±ΡΠ°Π·ΠΎΠ²Π°Π½ΠΈΠ΅, Π° ΠΆΠΈΠ²Π΅Π΅ΡΠ΅ΡΠΎ Π²ΠΎ Π³ΡΠ°Π΄ ΡΡΠ°ΡΠΈΡΡΠΈΡΠΊΠΈ Π·Π½Π°ΡΠ°ΡΠ½ΠΎ Π³ΠΎ Π·Π³ΠΎΠ»Π΅ΠΌΡΠ²Π° ΡΠΈΠ·ΠΈΠΊΠΎΡ Π·Π° Π΅Π½Π΄ΠΎΠΌΠ΅ΡΡΠΈΡΠ°Π»Π½Π° Ρ
ΠΈΠΏΠ΅ΡΠΏΠ»Π°Π·ΠΈΡΠ° (p< 0,05). Π¨ΡΠΎ ΡΠ΅ ΠΎΠ΄Π½Π΅ΡΡΠ²Π° Π΄ΠΎ ΠΆΠΈΠ²ΠΎΡΠ½ΠΈΠΎΡ ΡΡΠΈΠ» (ΡΠΈΠ·ΠΈΡΠΊΠ° Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡ, ΠΊΠ°Π»ΠΎΡΠΈΡΠ½Π° ΠΈΡΡ
ΡΠ°Π½Π°, ΠΏΡΡΠ΅ΡΠ΅), ΡΠ΅Π·ΡΠ»ΡΠ°ΡΠΈΡΠ΅ ΠΏΠΎΠΊΠ°ΠΆΠ°Π° Π΄Π΅ΠΊΠ° ΠΌΠ°Π» Π΄Π΅Π» ΡΠ΅ Π°ΠΊΡΠΈΠ²Π½ΠΈ, ΡΠ΅ΡΠΈΡΠΈ ΠΏΠΎΠ»ΠΎΠ²ΠΈΠ½Π° ΠΎΠ΄ Π½ΠΈΠ² ΠΊΠΎΠ½Π·ΡΠΌΠΈΡΠ°Π°Ρ ΠΊΠ°Π»ΠΎΡΠΈΡΠ½Π° Ρ
ΡΠ°Π½Π° ΠΈ ΠΏΡΡΠ°Ρ, Π½ΠΎ Π±Π΅Π· ΡΡΠ°ΡΠΈΡΡΠΈΡΠΊΠ° ΡΠΈΠ³Π½ΠΈΡΠΈΠΊΠ°Π½ΡΠ½ΠΎΡΡ. ΠΠ°ΠΊΠ»ΡΡΠΎΠΊ: ΠΠ³ΠΎΠ»Π΅ΠΌΠ΅Π½Π°ΡΠ° ΡΠ΅Π»Π΅ΡΠ½Π° ΡΠ΅ΠΆΠΈΠ½Π° ΠΈ ΠΏΠΎΠΊΠ°ΡΠ΅Π½ΠΈΠΎΡ ΠΊΡΠ²Π΅Π½ ΠΏΡΠΈΡΠΈΡΠΎΠΊΒ ΠΈΠΌΠ°Π°Ρ Π³ΠΎΠ»Π΅ΠΌΠΎ Π²Π»ΠΈΡΠ°Π½ΠΈΠ΅ Π²ΡΠ· Π·Π°ΠΏΠΎΡΠ½ΡΠ²Π°ΡΠ΅ ΠΈ ΠΏΡΠΎΠ³ΡΠ΅ΡΠΈΡΠ° Π½Π° ΠΏΠ°ΡΠΎΠ»ΠΎΡΠΊΠΈ ΠΏΡΠΎΠΌΠ΅Π½ΠΈ Π½Π° Π΅Π½Π΄ΠΎΠΌΠ΅ΡΡΠΈΡΠΌΠΎΡ. ΠΠ°ΠΊΠΎ ΠΊΠ»ΠΈΠ½ΠΈΡΠΊΠΈ Π΄ΠΎΠΊΡΠΎΡΠΈ ΡΠ΅ΠΊΠΎΠ³Π°Ρ ΡΡΠ΅Π±Π° Π΄Π° ΠΏΠΎΠΌΠΈΡΠ»ΠΈΠΌΠ΅ Π½Π° Ρ
ΠΈΠΏΠ΅ΡΠΏΠ»Π°Π·ΠΈΡΠ°Β ΠΊΠ°Ρ ΠΎΠ±Π΅Π·Π½ΠΈ ΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΊΠΈ ΡΠΎ Ρ
ΠΈΠΏΠ΅ΡΡΠ΅Π½Π·ΠΈΡΠ°, ΠΊΠΎΠΈ Π½Π΅ΠΏΡΠ°Π²ΠΈΠ»Π½ΠΎ ΠΊΡΠ²Π°Π²Π°Ρ. ΠΠΎΠ΅Π΄Π½ΠΎ ΡΡΠ΅Π±Π° ΠΈ Π΄Π° Π³ΠΈ Π΅Π΄ΡΡΠΈΡΠ°ΠΌΠ΅ Π·Π° ΠΏΡΠΎΠΌΠ΅Π½Π° Π½Π° ΠΆΠΈΠ²ΠΎΡΠ½ΠΈΠΎΡ ΡΡΠΈΠ», ΡΠΎ ΡΠ΅Π» ΡΠΏΡΠ΅ΡΡΠ²Π°ΡΠ΅ Π½Π° Π³ΠΈΠ½Π΅ΠΊΠΎΠ»ΠΎΡΠΊΠΈ ΠΈ ΠΈΠ½ΡΠ΅ΡΠ½ΠΈΡΡΠΈΡΠΊΠΈ ΠΌΠΎΡΠ±ΠΈΠ΄ΠΈΡΠ΅ΡΠΈ
The Connection of the Level of Estradiol in Serum and Obesity with the Endometrial Bleeding in Postmenopausal Women
BACKGROUND: Postmenopausis is a period that begins one year after the last menstrual period. Abnormal uterine bleeding could be of different origins.
AIM: This study aimed to determine the association of serum estrogen hormone levels and obesity with the occurrence of endometrial bleeding in post-menopausal women.
MATERIAL AND METHODS: Prospective clinical study involving 120 postmenopausal patients treated at the University Clinic for Gynecology and Obstetrics-Skopje, divided into two groups: control and study. The control group consisted of 40 postmenopausal patients without endometrial bleeding, hospitalised and operated due to urogenital pathology. The study group consisted of 80 patients with endometrial bleeding who were divided into three subgroups according to the thickness of the endometrium: from 5-8 mm, 8-11 mm and above 11 mm. In all subjects, estradiol and BMI was determined.
RESULTS: Estradiol levels were statistically higher in the study group compared to control while statistically significant difference among the three subgroups according to the thickness of the endometrium about the levels of estradiol in blood is not found. About BMI, the results showed that there was no statistical significance between the two examined groups.
CONCLUSION: Patients with endometrial bleeding have increased levels of estradiol and are at increased risk of endometrial cancer about controls, the likelihood of endometrial cancer significantly increases by 1,108 times
Indicators of Moderate and Severe Preeclampsia in Correlation with Maternal IL10
AIM: The purpose of the actual study was to evaluate the relationship between the formation of anti-inflammatory cytokine IL10 and several indicators of moderate and severe preeclampsia in the third trimester of pregnancy.MATERIAL AND METHODS: Examination of the indicators of preeclampsia and maternal IL10 levels was conducted in 50 women with pregnancies complicated by varying degrees of preeclampsia in the third trimester of gestation as well as in 50 normotensive patients, hospitalized at the University Clinic of Gynecology and Obstetrics, Skopje, Republic of Macedonia. The levels of IL10 were determined with a commercial test developed by Orgenium Laboratories (Finland), using reagents from AviBion ELISA research kits. Patients with preeclampsia were categorized into moderate and severe preeclampsia group according to the degree of preeclampsia. Logistic regression analysis was used to determine the predictive value of different parameters for the occurrence of severe preeclampsia. Odds ratios and 95% Confidence Intervals were calculated in order to quantify independent associations.RESULTS: The regression analysis detected systolic blood pressure (160 mmHg or higher), diastolic blood pressure (100 mmHg or higher), persistent proteinuria in pregnancy, serum LDH concentration (450 U/L or higher) and reduced serum concentrations of IL10 as significant predictors of severe preeclampsia in pregnant women after adjusting for age. CONCLUSION: The findings of significantly lower serum IL10 concentrations in patients with severe preeclampsia in comparison with respective concentrations in patients with moderate preeclampsia can be considered as major pathognomonic laboratory sign of severe preeclampsia
Indicators of Preeclampsia in Correlation with Maternal Cytokines in Pregnancy
Aim: the purpose of the actual study was to evaluate, in the third trimester of pregnancy, the relationship between the formation of anti-inflammatory IL-10 cytokine and several indicators of moderate and severe preeclampsia. Materials and methods: in the third trimester of gestation, examination of the biochemical markers of preeclampsia (PE) and maternal IL-10 levels was conducted in 100 women with pregnancies complicated by varying degrees of preeclampsia and in 100 normotensive patients, hospitalized at the University Clinic of Gynecology and Obstetrics, Skopje, Republic of Macedonia. Patients with preeclampsia were categorized into moderate and severe preeclampsia groups according to the degree of preeclampsia. Logistic regression of the different parameters for the occurrence of severe preeclampsia analysis was used to determine the predictive value. Results: the regression analysis detected systolic blood pressure of 160Β mmHg or higher, diastolic blood pressure of 100Β mmHg or higher, persistent proteinuria in pregnancy, serum LDH concentration of 450Β U/L or higher, and reduced serum concentrations of IL-10 as significant predictors of severe preeclampsia. Conclusion: significantly, lower IL-10 concentrations in maternal serum in patients with severe preeclampsia in comparison with respective concentrations in patients with moderate preeclampsia can be considered as major pathognomonic laboratory sign of severe form of preeclampsia
Π£Π»ΠΎΠ³Π°ΡΠ° Π½Π° Π½Π΅ΠΊΠΎΠΈ ΠΈΠ½ΡΠ»Π°ΠΌΠ°ΡΠΎΡΠ½ΠΈ ΠΌΠ°ΡΠΊΠ΅ΡΠΈ, ΡΠΈΡΠΎΠΊΠΈΠ½ΠΈ ΠΈ ΡΡΠΌΠΎΡ ΠΌΠ°ΡΠΊΠ΅ΡΠΈ Π²ΠΎ Π΄ΠΈΡΠ°Π³Π½ΠΎΠ·Π° Π½Π° Π΅Π½Π΄ΠΎΠΌΠ΅ΡΡΠΈΠΎΠ·Π°ΡΠ°
Endometriosis is a multifactorial disease which etiopathogenesis has not been elucidated. One of the theories of etiopathogenesis is the inflammatory theory. Aims of the study: To develop a practical non-invasive test for the diagnosis of endometriosis by examining some inflammatory markers and cytokines; to compare the highly sensitive C-reactive protein (hsCRP), cytokines (interleukin-6-IL-6 and tumor necrotizing factor alpha) and the tumor marker cancer antigen 125 (CA-125) among healthy patients and patients with endometriosis; to determine the sensitivity and specificity of each biomarker separately in the diagnosis of endometriosis and to determine their role in the diagnosis of endometriosis. Materials and methods: In a prospective study conducted at the University Clinic for Gynecology and Obstetrics, Ss. Cyril and Methodius University in Skopje, North Macedonia 138 patients were included of a reproductive age between 18-50 years (83 with diagnosis endometriosis operated laparoscopically or with laparotomy) and a control group of 55 healthy women, in a period between 01.09.2018 to 01.05.2021. Serum levels of IL-6, TNF-Ξ±, hs-CRP and tumor marker CA-125 were evaluated in both groups. Results: Serum levels of CA-125, IL-6 and TNF-Ξ± and hs-CRP were significantly higher in patients with endometriosis compared to the control group. The surface under the ROC curve (AUC) for IL-6, CA-125, hs-CRP, and TNF-Ξ± has shown that as individual markers they all have a discriminatory capacity to diagnose patients with endometriosis. Conclusions: Results obtained in our study showed statistically significantly higher serum concentrations of CA-125, IL-6 and TNF-Ξ± and hs-CRP in patients with endometriosis compared to the control group of patients. However, none of these biomarkers showed a high sensitivity for diagnosis of endometriosis. It is necessary to find a panel combination of biomarkers with a high sensitivity of about 100% that will enable early diagnosis of endometriosis.ΠΠ½Π΄ΠΎΠΌΠ΅ΡΡΠΈΠΎΠ·Π°ΡΠ° Π΅ ΠΌΡΠ»ΡΠΈΡΠ°ΠΊΡΠΎΡΠ½ΠΎ Π·Π°Π±ΠΎΠ»ΡΠ²Π°ΡΠ΅, ΡΠΈΡΠ° Π΅ΡΠΈΠΎΠΏΠ°ΡΠΎΠ³Π΅Π½Π΅Π·Π° Π½Π΅ Π΅ ΡΠ°Π·ΡΠ°ΡΠ½Π΅ΡΠ°. ΠΠ΄Π½Π° ΠΎΠ΄ ΡΠ΅ΠΎΡΠΈΠΈΡΠ΅ Π·Π° Π΅ΡΠΈΠΎΠΏΠ°ΡΠΎΠ³Π΅Π½Π΅Π·Π°ΡΠ° Π΅ ΠΈΠ½ΡΠ»Π°ΠΌΠ°ΡΠΎΡΠ½Π°ΡΠ° ΡΠ΅ΠΎΡΠΈΡΠ°. Π¦Π΅Π»ΠΈ Π½Π° ΠΈΡΡΡΠ°ΠΆΡΠ²Π°ΡΠ΅ΡΠΎ: ΠΠ° ΡΠ΅ ΡΠ°Π·Π²ΠΈΠ΅ ΠΏΡΠ°ΠΊΡΠΈΡΠ΅Π½ Π½Π΅ΠΈΠ½Π²Π°Π·ΠΈΠ²Π΅Π½ ΡΠ΅ΡΡ Π·Π° Π΄ΠΈΡΠ°Π³Π½ΠΎΠ·Π° Π½Π° Π΅Π½Π΄ΠΎΠΌΠ΅ΡΡΠΈΠΎΠ·Π°ΡΠ° ΡΠΎ ΠΈΡΠ»Π΅Π΄ΡΠ²Π°ΡΠ΅ Π½Π°Π½Π΅ΠΊΠΎΠΈ ΠΈΠ½ΡΠ»Π°ΠΌΠ°ΡΠΎΡΠ½ΠΈ ΠΌΠ°ΡΠΊΠ΅ΡΠΈ ΠΈ ΡΠΈΡΠΎΠΊΠΈΠ½ΠΈ; Π΄Π° ΡΠ΅ Π½Π°ΠΏΡΠ°Π²ΠΈ ΡΠΏΠΎΡΠ΅Π΄Π±Π° Π½Π° Π²ΠΈΡΠΎΠΊΠΎΡΠ΅Π½Π·ΠΈΡΠΈΠ²Π½ΠΈΠΎΡ Π¦-ΡΠ΅Π°ΠΊΡΠΈΠ²Π΅Π½ ΠΏΡΠΎΡΠ΅ΠΈΠ½ (hsCRP), ΡΠΈΡΠΎΠΊΠΈΠ½ΠΈΡΠ΅ (ΠΈΠ½ΡΠ΅ΡΠ»Π΅ΡΠΊΠΈΠ½ 6 βIL-6 ΠΈ ΡΡΠΌΠΎΡ-Π½Π΅ΠΊΡΠΎΡΠΈΠ·ΠΈΡΠ°ΡΠΊΠΈ ΡΠ°ΠΊΡΠΎΡ Π°Π»ΡΠ° - TNF-Ξ±) ΠΈ ΡΡΠΌΠΎΡΡΠΊΠΈΠΎΡ ΠΌΠ°ΡΠΊΠ΅Ρ cancer antigen 125 (CA-125) ΠΊΠ°Ρ Π·Π΄ΡΠ°Π²ΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΊΠΈ ΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΊΠΈ ΡΠΎ Π΅Π½Π΄ΠΎΠΌΠ΅ΡΡΠΈΠΎΠ·Π°; Π΄Π° ΡΠ΅ ΡΡΠ²ΡΠ΄ΠΈ ΡΠ΅Π½Π·ΠΈΡΠΈΠ²Π½ΠΎΡΡΠ° ΠΈ ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ½ΠΎΡΡΠ° Π½Π° ΡΠ΅ΠΊΠΎΡ Π±ΠΈΠΎΠΌΠ°ΡΠΊΠ΅Ρ ΠΏΠΎΡΠ΅Π±Π½ΠΎ Π²ΠΎ Π΄ΠΈΡΠ°Π³Π½ΠΎΠ·Π°ΡΠ° Π½Π° Π΅Π½Π΄ΠΎΠΌΠ΅ΡΡΠΈΠΎΠ·Π°ΡΠ° ΠΈ Π΄Π° ΡΠ΅ ΡΡΠ²ΡΠ΄ΠΈ Π½ΠΈΠ²Π½Π°ΡΠ° ΡΠ»ΠΎΠ³Π° Π²ΠΎ Π΄ΠΈΡΠ°Π³Π½ΠΎΠ·Π° Π½Π° Π΅Π½Π΄ΠΎΠΌΠ΅ΡΡΠΈΠΎΠ·Π°ΡΠ°.
ΠΠ°ΡΠ΅ΡΠΈΡΠ°Π» ΠΈ ΠΌΠ΅ΡΠΎΠ΄ΠΈ: ΠΠΎ ΠΏΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½Π° ΡΡΡΠ΄ΠΈΡΠ° ΡΠΏΡΠΎΠ²Π΅Π΄Π΅Π½Π° Π½Π° Π£Π½ΠΈΠ²Π΅ΡΠ·ΠΈΡΠ΅ΡΡΠΊΠ°ΡΠ° ΠΊΠ»ΠΈΠ½ΠΈΠΊΠ° Π·Π° Π³ΠΈΠ½Π΅ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ° ΠΈ Π°ΠΊΡΡΠ΅ΡΡΡΠ²ΠΎ, Π£Π½ΠΈΠ²Π΅ΡΠ·ΠΈΡΠ΅Ρ βΠ‘Π². ΠΠΈΡΠΈΠ» ΠΈ ΠΠ΅ΡΠΎΠ΄ΠΈΡβ Π²ΠΎ Π‘ΠΊΠΎΠΏΡΠ΅, Π‘Π΅Π²Π΅ΡΠ½Π° ΠΠ°ΠΊΠ΅Π΄ΠΎΠ½ΠΈΡΠ° Π±Π΅Π° Π²ΠΊΠ»ΡΡΠ΅Π½ΠΈ 138 ΠΈΡΠΏΠΈΡΠ°Π½ΠΈΡΠΊΠΈ Π½Π° ΡΠ΅ΠΏΡΠΎΠ΄ΡΠΊΡΠΈΠ²Π½Π° Π²ΠΎΠ·ΡΠ°ΡΡ ΠΏΠΎΠΌΠ΅ΡΡ 18-50 Π³ΠΎΠ΄ΠΈΠ½ΠΈ (83 ΡΠΎ Π΄ΠΈΡΠ°Π³Π½ΠΎΠ·a Π΅Π½Π΄ΠΎΠΌΠ΅ΡΡΠΈΠΎΠ·Π°, ΠΎΠΏΠ΅ΡΠΈΡΠ°Π½ΠΈ ΡΠΎ Π»Π°ΠΏΠ°ΡΠΎΡΠΊΠΎΠΏΠΈΡΠ° ΠΈΠ»ΠΈ Π»Π°ΠΏΠ°ΡΠΎΡΠΎΠΌΠΈΡΠ°) ΠΈ ΠΊΠΎΠ½ΡΡΠΎΠ»Π½Π° Π³ΡΡΠΏΠ° ΠΎΠ΄ 55 Π·Π΄ΡΠ°Π²ΠΈ ΠΆΠ΅Π½ΠΈ, Π²ΠΎ ΠΏΠ΅ΡΠΈΠΎΠ΄ ΠΎΠ΄ 01.09.2018 Π³ΠΎΠ΄ΠΈΠ½Π° Π΄ΠΎ 01.05.2021. Π‘Π΅ΡΡΠΌΡΠΊΠΈΡΠ΅ Π²ΡΠ΅Π΄Π½ΠΎΡΡΠΈ Π½Π° ΠΈΠ½ΡΠ΅ΡΠ»Π΅ΡΠΊΠΈΠ½ 6 (IL-6), ΡΡΠΌΠΎΡ-Π½Π΅ΠΊΡΠΎΡΠΈΠ·ΠΈΡΠ°ΡΠΊΠΈ ΡΠ°ΠΊΡΠΎΡ Π°Π»ΡΠ° (TNF-Ξ±), Π²ΠΈΡΠΎΠΊΠΎΡΠΏΠ΅ΡΠΈΡΠΈΡΠ΅Π½ Π¦-ΡΠ΅Π°ΠΊΡΠΈΠ²Π΅Π½ ΠΏΡΠΎΡΠ΅ΠΈΠ½ (hsCRP) ΠΈ ΡΡΠΌΠΎΡΡΠΊΠΈΠΎΡ ΠΌΠ°ΡΠΊΠ΅Ρ CA-125 Π±Π΅Π° Π΅Π²Π°Π»ΡΠΈΡΠ°Π½ΠΈ Π²ΠΎ Π΄Π²Π΅ΡΠ΅ Π³ΡΡΠΏΠΈ. Π Π΅Π·ΡΠ»ΡΠ°ΡΠΈ: Π‘Π΅ΡΡΠΌΡΠΊΠΈΡΠ΅ Π²ΡΠ΅Π΄Π½ΠΎΡΡΠΈ Π½Π° CA-125, IL-6 ΠΈ TNF-Ξ± ΠΈ hsCRP Π±Π΅Π° ΡΠΈΠ³Π½ΠΈΡΠΈΠΊΠ°Π½ΡΠ½ΠΎ ΠΏΠΎΠ²ΠΈΡΠΎΠΊΠΈ ΠΊΠ°Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΊΠΈΡΠ΅ ΡΠΎ Π΅Π½Π΄ΠΎΠΌΠ΅ΡΡΠΈΠΎΠ·Π° Π²ΠΎ ΡΠΏΠΎΡΠ΅Π΄Π±Π° ΡΠΎ ΠΎΠ½ΠΈΠ΅ Π²ΠΎ ΠΊΠΎΠ½ΡΡΠΎΠ»Π½Π°ΡΠ° Π³ΡΡΠΏΠ°. ΠΠΎΠ²ΡΡΠΈΠ½Π°ΡΠ° ΠΏΠΎΠ΄ ROC ΠΊΡΠΈΠ²Π°ΡΠ° (AUC) Π·Π° IL-6, CA-125, hs-CRP ΠΈ TNF-Ξ± ΠΏΠΎΠΊΠ°ΠΆΠ° Π΄Π΅ΠΊΠ° ΠΊΠ°ΠΊΠΎ ΠΏΠΎΠ΅Π΄ΠΈΠ½Π΅ΡΠ½ΠΈ ΠΌΠ°ΡΠΊΠ΅ΡΠΈ ΡΠΈΡΠ΅ ΠΈΠΌΠ°Π°Ρ Π΄ΠΈΡΠΊΡΠΈΠΌΠΈΠ½Π°ΡΠΎΡΠ΅Π½ ΠΊΠ°ΠΏΠ°ΡΠΈΡΠ΅Ρ Π·Π° Π΄ΠΈΡΠ°Π³Π½ΠΎΠ·Π° Π½Π° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΊΠΈ ΡΠΎ Π΅Π½Π΄ΠΎΠΌΠ΅ΡΡΠΈΠΎΠ·Π°. ΠΠ°ΠΊΠ»ΡΡΠΎΡΠΈ: ΠΡΠ»Π΅Π΄ΡΠ²Π°ΡΠ°ΡΠ° Π²ΠΎ Π½Π°ΡΠ°ΡΠ° ΡΡΡΠ΄ΠΈΡΠ° ΠΏΠΎΠΊΠ°ΠΆΠ°Π° ΡΡΠ°ΡΠΈΡΡΠΈΡΠΊΠΈ ΡΠΈΠ³Π½ΠΈΡΠΈΠΊΠ°Π½ΡΠ½ΠΎ ΠΏΠΎΠ²ΠΈΡΠΎΠΊΠΈ ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΠΈ Π½Π° CA-125, IL-6 ΠΈ TNF-Ξ± ΠΈ hs-CRP ΠΊΠ°Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΊΠΈΡΠ΅ ΡΠΎ Π΅Π½Π΄ΠΎΠΌΠ΅ΡΡΠΈΠΎΠ·Π° Π²ΠΎ ΠΎΠ΄Π½ΠΎΡ Π½Π° ΠΊΠΎΠ½ΡΡΠΎΠ»Π½Π°ΡΠ° Π³ΡΡΠΏΠ° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΊΠΈ. ΠΠ΅ΡΡΡΠΎΠ°, Π½ΠΈΡΡ Π΅Π΄Π΅Π½ ΠΎΠ΄ ΠΎΠ²ΠΈΠ΅ Π±ΠΈΠΎΠΌΠ°ΡΠΊΠ΅ΡΠΈ Π½Π΅ ΠΏΠΎΠΊΠ°ΠΆΠ° Π²ΠΈΡΠΎΠΊΠ° ΡΠ΅Π½Π·ΠΈΡΠΈΠ²Π½ΠΎΡΡ Π·Π° Π΄ΠΈΡΠ°Π³Π½ΠΎΠ·Π° Π½Π° Π΅Π½Π΄ΠΎΠΌΠ΅ΡΡΠΈΠΎΠ·Π°ΡΠ°. ΠΠΎΡΡΠ΅Π±Π½ΠΎ Π΅ Π΄Π° ΡΠ΅ Π½Π°ΡΠ΄Π΅ ΠΏΠ°Π½Π΅Π» ΠΊΠΎΠΌΠ±ΠΈΠ½Π°ΡΠΈΡΠ° Π½Π° Π±ΠΈΠΎΠΌΠ°ΡΠΊΠ΅ΡΠΈ ΡΠΎ Π²ΠΈΡΠΎΠΊΠ° ΡΠ΅Π½Π·ΠΈΡΠΈΠ²Π½ΠΎΡΡ ΠΎΠ΄ ΠΎΠΊΠΎΠ»Ρ 100% ΠΊΠΎΠΈ ΡΠ΅ ΠΎΠ²ΠΎΠ·ΠΌΠΎΠΆΠ°Ρ ΡΠ°Π½Π° Π΄ΠΈΡΠ°Π³Π½ΠΎΠ·Π° Π½Π° Π΅Π½Π΄ΠΎΠΌΠ΅ΡΡΠΈΠΎΠ·Π°ΡΠ°
KONCENTRACIJA JODA U MOKRAΔI: PREDSKAZATELJ POROΔAJNE TEΕ½INE ILI BIOLOΕ KI BILJEG ZA PROCJENU JODNOG STATUSA SAMO U ZDRAVIH TRUDNICA?
Introduction: This study determined urine iodine concentration (UIC) during gestation, assessed the maternal iodine nutrition status and correlated it with gestational age at birth (GAB) and birth weight (BW).The measurement of UIC provides the best single measurement of the iodine nutritional status in population. Objective: Determination of UIC in pregnant women in North Macedonia. Methods: This prospective study assessed the iodine nutrition status during the course of pregnancy with reference of median UIC among 364 healthy pregnant women in different gestational age (in trimester and 5-week intervals). Results: The overall and the 1st to the 3rd trimester median UIC were: 183.7, 207, 189.75 and 169.28 [ΞΌg/L], respectively. The median UIC (ΞΌg/L) results according to 5-week interval in advancing gestation were: 232.34, 200.13, 152.81, 194.39, 181.28, 160.28, 169.41 and 175.24, respectively. We detected 5.22% (19/364) and 74.72% (272/364) with
the median UIC < 50 ΞΌg/L and UIC β₯ 100 ΞΌg/L, respectively. In multiple regression, the median UIC (Ξ² = 0.0000767, P = 0.929) had no statistically signifi cant prediction to the GAB. Disease prevalence results for mean UIC in detecting BW had no statistical signifi cance: area under curve (AUC) = 0.521, z-statistic (0.340), sensitivity (45.83%), specifi city (66.27%), predictive (6.59%) and P value (0.734). Conclusion: Iodine status of pregnant women in our study is generally suffi cient by World Health Organization recommendations. The median UIC in each trimester and 5-week interval has statistically insignifi cant decrease in accordance to the advancing gestation. The median UIC has no signifi cance in predicting GAB and BW.Uvod: Ova je studija utvrdila koncentraciju joda u mokraΔi (UIC) tijekom trudnoΔe, procijenila prehrambeni status joda kod majke i povezala ga s gestacijskom dobi pri roΔenju (GAB) i poroΔajnom teΕΎinom (BW). Mjerenje UIC-a omoguΔava najbolje pojedinaΔno mjerenje prehrambenog statusa joda u populaciji. Cilj: OdreΔivanje UIC-a trudnicama u sjevernoj Makedoniji. Metode: Ova prospektivna studija procjenjivala je prehrambeni status joda tijekom trudnoΔe, pozivajuΔi se na medijan UIC 364 zdrave trudnice u razliΔitoj gestacijskoj dobi (u intervalima tromjeseΔja i 5 tjedana). Rezultati: Ukupna i prosjeΔna UIC od 1. do 3. tromjeseΔja bila su: 183,7, 207, 189,75 i 169,28 [ΞΌg / L]. Srednji rezultati UIC (ΞΌg / L) prema intervalu od 5 tjedana u napredovanju trudnoΔe bili su: 232,34, 200,13, 152,81, 194,39, 181,28, 160,28, 169,41 i 175,24. Otkrili smo 5,22 % (19/364) i 74,72 % (272/364) s medijanom UIC <50 ΞΌg / L, odnosno UIC β₯ 100 ΞΌg / L. U viΕ‘estrukoj regresiji, medijan UIC (Ξ² = 0,0000767, P = 0,929) nije imao statistiΔki znaΔajno predviΔanje za GAB. Rezultati prevalencije bolesti za srednji UIC u otkrivanju BW nisu imali statistiΔku znaΔajnost: podruΔje ispod krivulje (AUC) = 0,521, z-statistika (0,340), osjetljivost (45,83 %), specifi Δnost (66,27 %), prediktivna (6,59 %) i P vrijednost (0,734). ZakljuΔak: Jodni status trudnica u naΕ‘em istraΕΎivanju u pravilu je dovoljan prema preporukama Svjetske zdravstvene organizacije. Medijan UIC-a u svakom tromjeseΔju i intervalu od 5 tjedana statistiΔki je beznaΔajno smanjen u skladu s napredovanjem trudnoΔe. Medijan UIC nema znaΔenje u predviΔanju GAB i BW
The outcome of Pregnancy with Fetal Primitive Neuroectodermal Tumor
BACKGROUND: Fetal intracranial tumours are very rare. The overall incidence is 0.34 per one thousand live birth newborns. According to the new classification of central nervous system tumour (2016), a primitive neuroectodermal tumour of (PNETs) is an embryonal tumour group; these are tumours with high malignancy and belong to group IV (WHO). In our case, we will present a case of PNETs in 28 gestation week old fetus, diagnosed antenatally and confirmed postnatally.CASE REPORT: We present the third pregnancy in 29 years old patient, with two previous term deliveries of healthy newborn. She came to University clinic at 27+3 gestational week for fetal hydrocephalus. After an ultrasound and MRI scan, possibilities were explained to the parents. During the medico-ethical counselling, explain to the parents the need for operation and the possibility of postoperative adjuvant therapy, quality of life with potential future disabilities. They choose to terminate the pregnancy. Postmortem the diagnosis was PNETs. Summary of analysis: peripheral neuroectodermal tumour with ganglion and neuronal differentiationCONCLUSION: Antenatal management depends on the gestational week in the time of diagnosis and the decision of parents. If the lesion is before viability fetus, it should be offered termination of pregnancy. Another important factor is the mode of delivery, because of increased intracranial pressure although this aggressive combined modality of treatment, recurrence is often. Tree year of survival is between 53% and 73% when the adjuvant radiotherapy is included. For that, they should be diagnosed as soon as possible before achieving fetal viability. Only 18% of those tumours presenting in the first year of life are diagnosed before or at delivery
Uticaj faktora inflamacije na tok i ishod trudnoΔa komplikovanih preeklampsijom
Preeclampsia is a common disorder of pregnancy characterized by disturbed placentation and hemodynamic response to pregnancy. It remains to be a leading cause of maternal morbidity and mortality and is associated with a significant increase in perinatal mortality, a clear etiology and pathophysiology is still unknown. It occurs in 3-14% of all pregnancies in the world and to moderate pre-eclampsia by 75% and 25% severe preeclampsia.
Early prediction and prevention of pre-eclampsia is a dream of many obstetrician during generations. We used the number of tests (biophysical, biochemical ...) during the years of testing (more than 60 tests), but none of them gave the expected results of reliability as the sole test. More markers of inflammation and inflammatory responses has been studied in pre-eclampsia, in order to define their role in the pathogenesis and disease prediction.
Many studies have addressed the role of inflammation in the pathogenesis of preeclampsia. However, little is known about the relationship between the severity of inflammation and severity of preeclampsia due to insufficient testing on this topic.
Aim
Since prevention is not possible to estimate severity of disease intensive supervision during the further course of pregnancy should be the target.
1. To determine the effect of the levels of cytokines on the clinical parameters of pregnant women with preeclampsia.
2. Define the demographic and socio-economic characteristics of pregnant women with the risk of pre-eclampsia in Macedonia,.
3. Assessment the impact factors of inflammation in certain biophysical and biochemical markers for prediction of severe preeclampsia in relation to women in the general obstetric population.
4. Evaluate the diagnostic and prognostic test options concentration levels of inflammation factors in maternal serum as a test to assess the severity of preeclampsia in the third trimester of pregnancy.
5. Determinate the dependence of pregnancy, mode of completion and perinatal outcomes in relation to inflammatory response
Materials and methods
The study was conducted as prospective study at the University Clinic of Gynecology and Obstetrics, University "Ss. Cyril and Methodius" in Skopje, Macedonia. The study included 50 pregnant women with singleton pregnancies between 28 and 40 gestational weeks hospitalized with symptoms of pre-eclampsia, determined by standard clinical laboratory analysis.
The control group consisted of 50 normotensive pregnant women of the same gestational age (+ / - 1 Week), parity (primapara, parity 1 to 4 and parity> 4) and maternal age ( 35 years).
After obtaining consent for participation in the examination of every pregnant woman, we took a detailed history, perform cardiotocography, ultrasound biometry and Doppler of fetomatemal unit, we took a blood sample to determine the appropriate serum concentrations of appropriate markers. Clinical laboratory testing to assess the severity of pre-eclampsia (moderate or severe). Inflammatory cytokines were analyzed from peripheral blood 1-1,5ml by enzymatic amplification chemiluminescence on the device Immulite 1000, Siemens Healthcare Diagnostics, USA.
The duration of pregnancy, method of delivery, birth weight and length of the child at birth, Apgar score, are also analyzed.
The data were digitized and all statistical tests were performed using SPSS version 13.0. We used descriptive statistical analysis that we would display the following parameters: mean, standard deviation, coefficient of variation, variation interval. Categorical variables were tested using Chi square and Fisher exact tests and quantitative variables were analyzed with independent sample test and Mann-Whiteney's U test to determine the correlation between the variables we used Spearman Rank Correlation Orded test and Pearson's linear correlation coefficient. We used binary logistic regression to determine the predictive role of the parameters analyzed.
Results
The average age of pregnant women included in the study was 32.06 Β± 4.8 in the range of 20 to 40 years. Our data indicate a significant relationship between nulliparity, age, pregnant women, their nutritional status assessed by BMI and their religious convictions. History pregnant women about previous obstetric complications associated with hypertension, diabetes and smoking are important predictors of preeclampsia in our study.
Multiple analysis of this study as independent significant factors for severe pre-eclampsia, confirms the ages of pregnant women: a systolic blood pressure of 160 mmHg and higher diastolic blood pressure of 100 mmHg and higher, the existing proteinuria, serum LDH values of 450 and above, and reduced serum concentrations of IL-4 and IL-tenth.
Preeclampsia has a significant impact on the mode of delivery and newborn weight. The results of our study show that the birth by caesarean section is indicated in 10% of normotensive pregnant women and 46% in pregnant women with preeclampsia (52% severe, moderate 40%).
Pregnancy ended with preterm delivery at 20% of normotensive pregnant women and insignificantly higher percentage of 36% in the group with preeclampsia.
Tested differences between the analyzed groups in relation to the fetus (IUGR and SGA) show that pregnant women with preeclampsia often give birth with SGA, regardless of the severity of the disease, compared to normotensive pregnant women.
Conclusion
Comparison of changes in the profile of cytokines with increasing severity of preeclampsia may allow us to determine the level of compensation of pathological conditions that reflects the level of implementation and functional reserves of various mechanisms to maintain homeostasis. This happens in the background of increased concentrations of other proinflammatory cytokines and decreased levels of anti-inflammatory cytokines IL-4 and IL-10.
1. Multiple analysis of this study as independent significant factors for severe pre-eclampsia confirms: age β₯ 35 years, nulliparity and ethnicity, and as insignificant factors confirms smoking, Diabetes gestationes and preeclampsia in prior preegnancy.
2. In pregnant women with mild preeclampsia there is increase of IL 1Ξ², IL 2, IL 4, IL 8, IL 10, TNF and IL 6 (statistically significant) compared with normotensive pregnant woman.
3. In pregnant women with severe preeclampsia significantly reduces the levels of IL 4 and IL 10, and increasing the levels of IL 2, IL 6, IL 8, IL 1Ξ², and does not change significantly the level of TNF compared with normotensive pregnancies.
4. Preeclampsia has a significant impact on the way of delivery and newborns weight. In pregnant women with preeclampsia and low levels of factors of inflammation significantly higher percentage of deliveries were by Caesarean section, a significantly smaller percentage of vaginaldelivery.Preterm births insignificantly is in higher percentage in pregnant women with preeclampsia compared to control group.
5. The best statistical model for predicting the severity of preeclampsia is the correlation of the levels of serum interleukin (IL-4 and IL-10) with indicators of pre-eclampsia: LDH, creatinine, uric acid, and platelet count.
However, the study is only the beginning of this type of research in our population. Further research is needed in terms of evaluating the costs and benefits of using such a test in order to prevent subsequent unnecessary interventions in groups with low risk, and realizing the benefits of such interventions in high-risk groups, the patient is given