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.
Introduction. Preeclampsia presents a medical condition in pregnancy that is manifested with increased blood pressure and protein urine. Ocular involvement is rare. Retinal detachment in preeclampsia is a rare complication; it only occurs in 1-2% of severe preeclampsia but in 10% of those with eclamptic seizures. Case report. A pregnant patient G1P0 visited the outpatient clinic of the University Clinic for Ophthalmology complaining on visual disturbances. The chief complaint was blurred vision and headaches. She was in 31 week of gestation and complained that she had increased blood pressure over the last month. After initial assessment she was suspected of central serous retinal ablation (CSCR). Ocular ultrasound and posterior segment OCT (optical coherence tomography) confirmed the diagnosis. Treatment and outcome. Obstetric examination confirmed high blood (TA180/130) pressure with dipstick urine showing(+++). Unfortunately, the ultrasound showed an eutrophic pregnancy in 31 g.w. with fetus mortus inutero. The patient was administered to the intensive care unit. She had an ophthalmologic check-upat 2 weeks and one month post-partum that showed regression and visual acuity was getting better. The final check-up after 6 months revealed that retina was in place with no subretinal substantial fluid and no macular edema. Conclusion. Serous retinal detachment is a rare complication of preeclampsia. In most case it resolves spontaneously few weeks post delivery.
Risk factors for pre-eclampsia that have been identified in previous studies include: both young and old maternal age, high BMI, prior pregnancy with pre-eclampsia, excessive weight gain during pregnancy, nulliparity, chronic hypertension, low socioeconomic status, prolonged birth interval, race and ethnicity, genetic predisposition, environmental and even seasonal influences. Ironically, although smoking during pregnancy causes various adverse pregnancy outcomes, when it comes to pre-eclampsia and hypertensive disorders in pregnancy, many studies have shown that it is associated with reduced risk.
Introduction. Heart function in pregnancy is a subject of many debates and studies. A large number of epidemiologic studies have found association between preeclampsia and cardiovascular morbidity/mortality. About 5-8% of deliveries are complicated with preeclampsia. Until recently, heart damage associated with preeclampsia has not been studied. A number of heart difficulties only appear long after the reproduction period has ended. Preeclampsia increases the risk for B stage (asymptomatic) of heart failure. Case report. A 37-year-old pregnant patient, G2P1 27 weeks of gestation, paid her first visit to the Gynecology Outpatient Clinic. She complained on heavy breathing, difficulty with movement and hypertension. She was referred for further evaluation to the Cardiology Outpatient Clinic with a suspicion of gestational hypertension and heart abnormalities. The pregnancy was evaluated several times at the Out-patient Clinics of Gynecology and Cardiology with the diagnosis of gestational hypertension. Echocardiography showed abnormal heart remodeling. In the 36 g.w laboratory findings showed urine dip stick ++,ТА160/110. The diagnosis was changed to preeclampsia. The patient was delivered with a re-caesarean section because of previous S.C and preeclampsia. Postpartum echocardiography confirmed left chamber hypertrophy with persistent hypertension. Results. Clinical cardiovascular complications in preeclampsia continue long after the pregnancy has ended. Studies show that pregnancies with both early and late preeclampsia have an increased risk for asymptomatic left chamber dysfunction/hypertrophy and essential hypertension in the next 2 years after delivery. If the damages are caught early prevention can be started sooner rather than later before patients become symptomatic (C stage of heart failure).
Introduction: Echocardiography as an imaging method is increasingly being used in obstetrics in the management of hemodynamic changes which occur in normal but also in pregnancies with gestational hypertension/preeclampsia. Aim: The aim of the study is to show that some of the heart changes in pregnancies complicated with gestational hypertension and preeclampsia are abnormal and further follow up of these patients is needed. Methods: A total of 81 patients were enrolled in the study. The patients were further divided in two groups. Pregnant women with gestational hypertension or preeclampsia (51) and a control group of normotensive pregnancies (30). A total of 3 echocardiograph exam were made, the first upon entry in the study (28 -34 g.w), the second 2 weeks after delivery and the last 6 months after delivery. Results and discussion: We found several statistically significant results that involve the IVS, PWLV, LKM, left chamber hypertrophy and diastolic function. Diastolic dysfunction usually shows up before systolic dysfunction in the evolution of ischemic/hypertensive cardiovascular disease and is of prognostic value in predicting long term cardiovascular morbidity. The changes seen 6 months after delivery on our last control mean that those changes are permanent and need further prevention strategies. Conclusion: From the noninvasive methods echocardiography is the most favorable method in identifying structural changes and functional changes in pregnancies with hypertension. Echocardiography allows fast, reproducible information and is both safe for mother and fetus.
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