Abstract:Objective: The aim of this study was to establish the physiologic changes in hemostasis during pregnancy and to fi nd the association between the factor V Leiden mutation and adverse pregnancy outcome. Methods: We investigated blood samples of 148 pregnant women during each trimester of pregnancy. We measured their serum concentrations of factors I, II, V, VII, VIII, IX, X, XI, XII, D-dimers, prothrombin time, INR, aPTT, activity of protein C and S, antithrombin III and platelet count. The pregnancy outcome of women with factor V Leiden mutation was compared to those without congenital thrombophilia. Results: Prothrombin time, INR and aPTT were signifi cantly shorter. We found signifi cantly higher plasma concentrations of fi brinogen and d-dimers and higher levels of activity of factor VII and X in the third trimester. No signifi cant difference was found in protein C and antithrombin III activity. The protein S activity was lower in the second trimester and it increased in the third trimester. Although most of the clotting factors were rising during the pregnancy, there was no evidence of fi brinolytic overactivation. In our study, the carriership of factor V Leiden mutation did not affect the incidence of preeclampsia, eclampsia, intrauterine fetal death and venous thromboembolism. Placental abruption was rare. Conclusion: Hemostatic changes in pregnancy are signifi cant and essential, and have the potential to cause adverse pregnancy outcome. In addition, hypercoagulable state during pregnancy is considered to be physiological (Tab. 4, Ref. 36). Text in PDF www.elis.sk.

Pregnancy loss (abortion) and pre-eclampsia represent the most common disorders in pregnant women. Besides infection, there are anatomical, endocrinological, genetic and immunological factors that can induce pregnancy disorders. Because the exact mechanisms of physiological pregnancy maintenance are still not clearly understood, the search for genes and proteins fulfilling this role is still in progress. One of the immune molecules that plays a beneficial role in pregnancy is the nonclassical HLA-G molecule. The molecule is mainly expressed on trophoblast cells in the foetal placenta and induces the immune tolerance of the foetus via its interaction with inhibitory receptors on maternal NK cells and CD8+ T lymphocytes. In relation to pregnancy disorders, associations between HLA-G polymorphism, HLA-G level and HLA-G function were described. Thus, the HLA-G molecule can be used as a new diagnostic marker and, potentially, for the future therapy of pregnancy disorders.

OBJECTIVES: To identify possible association between the selected HLA-G gene polymorphisms and risk of pre-eclampsia. BACKGROUND: Pre-eclampsia is a serious multisystem disorder that affects women during pregnancy. Despite many research studies, the pathology of pre-eclampsia is not fully understood. Human leukocyte antigen G (HLA-G) belongs to the molecules that induce fetal acceptance by the maternal immune system. HLA-G expression was found to be impaired in the women suffering from pre-eclampsia suggesting its involvement in the development of pre-eclampsia. METHODS: 123 women with pre-eclampsia and 102 women with normotensive pregnancy were included in the study.

Over the last two to three decades, there has been a 15-25 % increase in many countries in the number of women giving birth to large infant. Fetal macrosomia is associated with an increased risk of complications both for the mother and the newborn. In current obstetrics, the macrosomic fetus represents a frequent clinical challenge. The early detection and identifi cation of the risks associated with fetal macrosomia is important to managing the pregnancies and at last the timing and mode of delivery. This article provides possibilities of ultrasound diagnosis throughout the pregnancy and investigates the effectiveness of fetal measurements in identifying the large fetus (Tab. 1, Ref. 24). Text in PDF www.elis.sk.

Summary:Objective: The aim of this prospective study was to find the association between the factor V Leiden mutation and adverse pregnancy outcomes. Methods: This study is an analysis of a prospective observational study of the frequency of placenta-mediated complications of factor V Leiden mutation carriers. We compared pregnancy outcomes of 11 women with a heterozygous form of the factor V Leiden mutation with 41 women of a control group. Results: All pregnancies ended with delivery of a living infant. None of the 52 pregnancies were complicated by venous thromboembolism. There were a few significant differences regarding placenta-mediated complications. The gestational age at delivery showed small significant differences. There was a significant difference in the birth weight deviation in percentage between FVL carriers and controls. The incidence of blood loss exceeding 1000 ml was higher in the control group. Conclusions: Carriership of the factor V Leiden mutation did not affect the incidence of preeclampsia. Adverse pregnancy outcomes such as placental abruption were rare. Eclampsia, intrauterine fetal death and venous thromboembolism did not occur. Our results provide evidence that the maternal heterozygous FVL mutation did not increase the risk of an adverse pregnancy outcome.

OBJECTIVES: The objective of this study was to identify the impact of the selected HLA-G gene polymorphisms in the 5′URR region on the risk to develop pre-eclampsia. BACKGROUND: Pre-eclampsia (PE) is a serious multisystem disorder that affects women during pregnancy. Despite many research studies, the pathology of PE is not fully understood. Human leukocyte antigen G (HLA-G) belongs to the molecules that induce immune tolerance at the fetal-maternal interface. HLA-G expression was found to be impaired in the women suffering from PE suggesting its involvement in the development of PE. METHODS: 116 women with pre-eclampsia and 130 women with normotensive pregnancy were included in the study. The 16 gene polymorphisms in the HLA-G 5′URR region (promoter) affecting HLA-G expression were typed by direct sequencing. RESULTS: The -201AA genotypes in recessive model were signifi cantly more frequent in women with preeclampsia than in the controls (p = 0.047). Furthermore, the analysis of HLA-G 5′URR variants with clinical fi ndings of PE showed a signifi cant association of the -533delA-/+ genotype with a higher mean level of diastolic blood pressure (p = 0.02). CONCLUSION: Our results suggest a genetic association of selected HLA-G 5′URR variants with a risk of developing pre-eclampsia and possible contribution of HLA-G to disease pathology (Tab. 4, Ref. 51).

Objective:The aim of the present study was to evaluate the effects of fetal gender on serum human chorionic gonadotropin (hCG) and testosterone in normotensive and preeclamptic pregnancies. Materials and Methods:The study consisted of 139 women with singleton pregnancies in the third trimester. Seventy-one pregnancies were uncomplicated; among those were 35 male and 36 female fetuses. Sixty-eight pregnancies were complicated by preeclampsia; among those were 35 male and 33 female fetuses. Human chorionic gonadotropin and total testosterone were measured in maternal peripheral blood. Detailed ultrasonographic structural examinations of the fetuses were performed. Results: In male-bearing pregnancies, maternal hCG and testosterone serum levels were significantly higher in preeclamptic than normotensive mothers (P < 0.001 and P < 0.001, respectively) in female-bearing pregnancies testosterone levels were significantly higher in preeclamptic than normotensive mothers (P < 0.001) whereas the hCG levels were not significantly different. Male-bearing preeclamptic women had significantly higher testosterone levels than female-bearing preeclamptic women (P < 0.001) whereas the hCG levels were not significantly different. In uncomplicated pregnancies the hCG levels were significantly higher in female-bearing than in male bearing mothers (P < 0.001). Whereas the testosterone levels were not significantly different. Discussion and Conclusion: In preeclamptic pregnancies with male fetuses, the maternal serum hCG levels were significantly higher than in uncomplicated pregnancies. Total testosterone levels were significantly higher in pregnancies with either gender and significantly higher in male-bearing than in female-bearing pregnancies. Objective: Mirror syndrome (Ballantyne's syndrome) refers to the association of fetal hydrops and maternal preeclampsia. The aim of this study was to determine the relation and incidence between fetal hydrops and preeclampsia in our clinic. Methods: A retrospective review of patients associated with fetal hydrops and findings with preeclampsia was used. 75 cases with single pregnancy and diagnoses with nonimmune hydrops fetalis were found. According to the data 4 cases were found related with preeclampsia. Results: Mirror syndrome is rarely encountered and underdiagnosed. We found a frequency of 5.3% (4 cases in 75 affected pregnancies) for single non-immune hydrops cases in which maternal hypertension occurred. Fetal outcome is depending on etiology and mainly very low. Maternal symptoms and laboratory findings are resolving after intrauterine fetal death or delivery. Conclusion: Hydrops fetalis must be considered as a potential risk factor for pre-eclampsia. It is important that this clinical condition has a potential of about 5% for proceeding pre-eclampsia. P23.03Supporting information can be found in the online version of this abstract.

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