Аnal Incontinence after Vaginal Delivery, Risk Factors and Quality of Life in Patients in North Macedonia

The aim of this study is to determine the impact of individual obstetric risk factors on occurrences of anal incontinence in patients after vaginal delivery, and its impact on quality of life.  We designed the study as a cross-sectional, and developed the research at the University Clinic for Obstetrics and Gynecology, University of "Ss. Cyril and Methodius" in Skopje, Macedonia, over a period of one year. In this study, we engaged patients in their reproductive age, who had undergone at least one vaginal delivery (spontaneous or assisted vaginal delivery). The degree of incontinence was determined using St. Mark's Anal Incontinence Score (SMIS). We used a specific questionnaire related to anal incontinence to assess quality of life Fecal Incontinence Quality of Life Scale (FIQLS) Four hundred and seventy (470) patients were included in the study, 30% of which (141 patients) had St. Mark’s scores ≥8. The following factors were found to influence the St. Mark’s score: number of vaginal deliveries, delivery mode, fetal macrosomia, use of episiotomy and the existence of perineal lacerations Results of this study show consistency with data published so far on the influence of obstetric risk factors on occurrences of anal incontinence in patients after vaginal delivery. Changes in anal continence are expressed in increased St. Mark’s score. Our study showed that the following factors had statistically significant impact on the score value: multi-parity, delivery mode, use of episiotomy, fetal macrosomia and perineal injury (grades 3 and 4)

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 160 mmHg or higher, diastolic blood pressure of 100 mmHg or higher, persistent proteinuria in pregnancy, serum LDH concentration of 450 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

Acute Inflammatory Changes of the Placenta in Patients with Preterm Delivery Syndrome

Preterm delivery is one of the most serious challenges of contemporary perinatology. Considering the multi factorial etiology of this issue, contemporary scientific approach addresses this topic as a Preterm Delivery Syndrome. If we exclude the congenital anomalies of the female reproductive system and iatrogenic causes, we can pinpoint infections, as one of the most important etiological factor for preterm delivery. The aim of the study is to determine the frequency of the histopathological changes of the placenta in patients with preterm delivery, to determine their stage and grade, according to the classification proposed by the Amniotic Fluid Infection Nosology Committee of the Perinatal Section of the Society of Pediatric Pathology (AFINCPSPP).  Finally, to define the correlation between those changes and the gestational age, as well as the correlation between the degree of the histopathological changes and the time passed from the preterm premature rupture of the fetal membrane and the delivery. This cohort prospective study includes 30 patients delivered at the University clinic for Ob/Gyn in Skopje. We’ve selected the patients according to the previously determined inclusion and exclusion criteria: gestational age between 24+0-34+0 weeks of gestation (w.g), premature preterm rupture of the fetal membranes (pPROM), presence of uterine contractions, cervical dilatation of ≥ 2 cm determined by vaginal examination or shortening of the cervical length by > 50% determined by vaginal ultrasound.For the evaluation of the histopathological changes of the placenta, 6 samples were provided from four (4) zones of the placentas of the delivered women: chorionic plate, umbilical cord, border between amnion and chorion, and fetal membranes. Statistical analysis was performed on IBM SPSS Statistics software package, version 23.0. Probability of p≤0.05 was considered statistically significant. Differences between descriptive variables were determined using Chi square and Fisher exact tests. For determination of correlation between variables, we used Kendall tau correlation coefficient. Of all the patients included in the study, 14 (46,7%) were at gestational age of 32+0-34+0 w.g, 7 (23,3%) were at gestational age of 28+0-31+6 w.g, and 9 (30 %) were at gestational age of 24+0-27+6 w.g. PPROM was registered in 14 (46,7%) of the patients, out of which almost half, 42,8 % were delivered in less than 24 hours after the rupture of the membranes. In 42,8% of the patients delivered between 32+0-34+0 w.g, histopathological analysis of the placenta did not detected presence of inflammatory response. On the other side, in patients delivered between 24+0-27+6 w.g,histological chorioamnionitis was present in all cases. Even more, in as high as 66,7% of these cases, inflammatory changes of the placenta were categorized as Stage 3, which is highest or most advanced stage of inflammatory response. Results of our study are consistent with previously published data. They confirm the inversely proportional relationship between gestational age at the time of delivery, and the stage and grade of histopathological changes of the placenta, defined as acute chorioamnionitis. Additional evaluation of the data showed that, there is no correlation between the degree of the inflammatory response, and the time passed from the pPROM and delivery, expressed in hours

Maternal cytokines and biochemical markers as indicators of moderate and severe preeclampsia

Preeclampsia is considered as a failure of body’s adaptive mechanisms. Maternal immune system is involved in maternal endothelial dysfunction and the subsequent systemic reaction seen in preeclampsia. Further arguments to support the idea of the involvement of the maternal immune system in the development of preeclampsia come from the primipaternity theory. This hypothesis holds that the risk of developing preeclampsia is highest in the first pregnancy, and a previous normal pregnancy is associated with a lowered incidence of preeclampsia in the subsequent pregnancy. Studying production of pro-inflammatory (IL-1β, IL- 8), anti-inflammatory (IL-10), CRP and TNF alpha in moderate and severe preeclampsia in third trimester of pregnancy