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

KONCENTRACIJA JODA U MOKRAĆI: PREDSKAZATELJ POROĐAJNE TEŽINE ILI BIOLOŠKI 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 [μg/L], respectively. The median UIC (μg/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 μg/L and UIC ≥ 100 μg/L, respectively. In multiple regression, the median UIC (β = 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 mokraći (UIC) tijekom trudnoće, procijenila prehrambeni status joda kod majke i povezala ga s gestacijskom dobi pri rođenju (GAB) i porođajnom težinom (BW). Mjerenje UIC-a omogućava najbolje pojedinačno mjerenje prehrambenog statusa joda u populaciji. Cilj: Određivanje UIC-a trudnicama u sjevernoj Makedoniji. Metode: Ova prospektivna studija procjenjivala je prehrambeni status joda tijekom trudnoće, pozivajući se na medijan UIC 364 zdrave trudnice u različitoj gestacijskoj dobi (u intervalima tromjesečja i 5 tjedana). Rezultati: Ukupna i prosječna UIC od 1. do 3. tromjesečja bila su: 183,7, 207, 189,75 i 169,28 [μg / L]. Srednji rezultati UIC (μg / L) prema intervalu od 5 tjedana u napredovanju trudnoće 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 μg / L, odnosno UIC ≥ 100 μg / L. U višestrukoj regresiji, medijan UIC (β = 0,0000767, P = 0,929) nije imao statistički značajno predviđanje za GAB. Rezultati prevalencije bolesti za srednji UIC u otkrivanju BW nisu imali statističku značajnost: područje ispod krivulje (AUC) = 0,521, z-statistika (0,340), osjetljivost (45,83 %), specifi čnost (66,27 %), prediktivna (6,59 %) i P vrijednost (0,734). Zaključak: Jodni status trudnica u našem istraživanju u pravilu je dovoljan prema preporukama Svjetske zdravstvene organizacije. Medijan UIC-a u svakom tromjesečju i intervalu od 5 tjedana statistički je beznačajno smanjen u skladu s napredovanjem trudnoće. Medijan UIC nema značenje u predviđanju GAB i BW

Cervical length and phosphorylated IGFBP-1 in prediction of preterm birth

Preterm birth before completed 37th gestational week is extremely important clinical problem as it produces neonatal mortality and morbidity, as well as many negative short-term and long-term consequences to newborns, especially to the extremely preterm ones. The objective of our study was to determine the relationship between cervical length (CL), phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) and spontaneous preterm births

Ratio of middle cerebral artery/umbilical artery Doppler velocimetry and status of newborn in preeclampsia

Doppler velocimetry studies of placental and fetal circulation can provide important information regarding fetal well-being providing an opportunity to improve fetal outcome. The present study was undertaken to evaluate the role of middle cerebral to umbilical artery blood velocity waveform's systolic/diastolic ratio (MCA/UA) as a predictor of perinatal outcome in post term pregnant women

Twin pregnancy: a comparison study of preterm labor, preterm premature rupture of membranes, gestational age at delivery, maternal age and length of hospital stay

To determine the difference between twin pregnancies at a single tertiary institution, in regards to preterm labor, preterm premature rupture of membranes, gestational age at delivery, maternal age and length of hospital stay

Sonographic cervical length and biochemical markers in spontaneous preterm birth (SPTB) up to 14 days from sampling

Preterm delivery (PTD) before completed 37 gestational weeks, remains one of the most important clinical problems in obstetrics throughout the world, as it is the leading cause of neonatal mortality and morbidity. Preterm delivery exerts numerous negative long-term effects on the neonate, which is especially true for extremely preterm neonates delivered before 28 gestational weeks. But, despite numerous studies, the detailed mechanisms and biological pathways that lead to PTB still remain elusive. The aim of our study was to determine the relationship between sonographic cervical length (CL), fetal fibronectin (fFN), phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1), cytokines, such as interleukine-6 (IL-6), interleukine-2R (IL-2R) as well as tumor necrosis factor-alpha (TNF alpha), and spontaneous preterm birth (SPTB) up to 14 days from sampling. The studied biochemical markers in our study were only moderately successful in the prediction of preterm delivery. Further research is required in terms of the evaluation of cost-benefit of using such test to prevent subsequent unnecessary interventions in the low-risk group, as well as to achieve the benefits from such intervention in the high risk groups of patients

Cervical length and phosphorilated insulin like growth factor binding protein-1 as the predictors of spontaneus preterm delivery in symptomatic women

Objective: To assess the combined use of cervical length and cervical phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) in the prediction of preterm delivery in symptomatic women in next 14 days. Methods: Cervical length was prospectively measured in 58 consecutive singleton pregnancies with intact membranes and regular contractions at 24–36 weeks, and phIGFBP-1 was assessed. Demographic data was evaluated (history of previous preterm delivery, history of spontaneous abortion, parity, BMI, maternal age, Orthodox or Muslims). Results: Values of all variables were evaluated (demographic data, cervical length and values of phIGFBP-1) alone and in combination with cervical length of ≤15 mm and more than 15 mm. In women with cervical length less than 15 mm/phIGFPB-1 was positive in 30 patients (22 of them delivered in 14 days). In women with cervical length less than 15 mm/phIGFBP-1 was positive in 9 of delivered pregnant women in 14 days. In women with cervical length less than 25 mm/phIGFBP-1was positive in 26 patients (2 of them delivered in 14 days). In patients with cervical length more than 25 mm/ph IGFBP-1 was positive in 4 patients (2 of them delivered in 14 days). With logistic regression we confirmed that with OR 0.117 and CI 95% (0.046–0.295) and p < 0.01 odds for preterm birth among patients with negative phIGFBP-1 is 0.117 lower than the odds for preterm birth among patients with positive test results. With same test for p = 0.009 (p < 0.01) we confirmed with OR and CI 95% (0.06 to 0.671) that cervical length less than 25 mm is good predictor of preterm delivery with symptomatic patients. Probability for delivery in the following 14 days with patients with positive phIGFBP-1and cervical length ≤ 15 mm is 0.88 or probability for not delivering in those patients is 0.12. In 88% patients with positive phIGFBP-1 and cervical length ≤ 15 mm will deliver in the following 14 days. Conclusions: In symptomatic women phIGFBP-1 may significantly improve the risk assessment for preterm delivery with cervical length and help to plan subsequent pregnancy management

REPRODUCTIVE OUTCOME, DURATION OF PREGNANCY AND MODE OF DELIVERY AFTER HYSTEROSCOPIC METROPLASTY IN PATIENTS WITH INFERTILITY

Introduction: Reproductive outcome can be negatively affected in patients with congenital uterine anomalies (CUA), increasing the number of unsuccessful pregnancies and obstetric complications. Standard, safe and minimally invasive method for the treatment of correctible types of congenital uterine anomalies is hysteroscopic metroplasty (HM). The aim of the study was to analyze the reproductive outcome, duration of pregnancy and mode of delivery in group of patients with infertility after hysteroscopic metroplasty. Material and methods: We analyzed 48 patients with previous history of fetal loss (abortion) to whom hysteroscopy was done in the period of 01.11.2009 to 01.05.2013 year at the University Clinic of Obstetrics and Gynecology in Skopje. In patients who were diagnosed having CUA hysteroscopic metroplasty was done. Patients and their reproductive outcome were followed for a period of at least 2 years after the intervention. Reproductive outcome was followed considering pregnancy rate, fetal loss (abortion) up to 22 gestational week, rates of preterm and term deliveries, live births and mode of delivery. Statistical analysis was performed using computer software and value for the confidence interval (± 95% CI) was considered to be statistically significant with level of p<0.05. Results: After hysteroscopic metroplasty, there was a significant decrease of the abortion rate to 13.9%, and significant increase in pregnancy rates of 86.1%. Overall pregnancy rate was 75%, and term delivery was noted in 93,6 % of the patients, with spontaneus deliveries in 58,6 %. There were no complications during the hysteroscopic metroplasty, nor during the deliveries. Conclusion: Hysteroscopic metroplasty has a significant effect on the reproductive outcome, resulting in a large number of live births and no significant complication during consecutive pregnancy and delivery

Prediction of preterm birth with different biochemical markers and cervical length

Preterm labor and delivery is a multifactorial entity that has serious medical, health-related, economical and personal implications. Its worldwide incidence ranges from around 5%-15%, depending on the population. Over half of the preterm deliveries are spontaneous. The worldwide rates of preterm birth have increased in the past couple of decades in spite of the efforts to alleviate the problems associated with preterm delivery and the medical advances made. Preterm deliveries and associated complications account for over 75% of the neonatal mortality rates and for around half of the neurological sequels in newborn children

Interleukin 6 and fetal fibronectin as a predictors of preterm delivery in symptomatic patients

Preterm delivery is the leading cause of neonatal mortality and morbidity. The rate of preterm births has been estimated to be about 15 million, which accounts for 11.1% of all live births worldwide. The purpose of this study was to evaluate the cervico-vaginal (CVF) cytokine IL-6 and fetal fibronectin (fFN) status as predictors of preterm delivery in patients with symptoms of preterm labor. Patients with symptoms suggestive of preterm labor were recruited from September 2013 to March 2014. Vaginal swabs were taken for fetal fibronectin test (fFN) and CVF IL-6. Antibiotics, steroids and tocolytics were administered, where appropriate. The outcome was measured by the occurrence of preterm delivery within 14 days from the day of hospital admission. Cut-off value of 1305 pg/mL for the concentration of IL-6 in the CVF was the best predictor of preterm delivery, with the sensitivity of 69.4% and specificity of 68.2%. Patients with positive fFN test had the OR of 6.429 (95%CI 1.991-20.758) to deliver prematurely. The multivariate analysis of combined fFN and CVF IL-6 tests resulted in risk of 86.7% to deliver prematurely, if both tests were positive. The combination of both tests performed better than the individual tests and decreased the false positive rate, which in turn reduced the chances for inappropriate patient treatment, bringing down the costs