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Author: search.filters.author.Paneva, IvaSubject: search.filters.subject.pregnancy

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    UTERINE ARTERY DOPPLER AND SERUM LEVEL OF IMMUNOBIOMARKERS IN PREECLAMPSIA - OUR EXPERIENCE
    (Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2024)
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    Paneva, Iva
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    Introduction. Important mechanisms are known to be involved in the immunomodulatory pathways which are crucial for maintaining an adequate utero-placental circulation in pregnancy. Its disbalance brings to impaired tolerance, which leads to inflammation and autoimmune processes in preeclampsia. Aim. The aim of this study was to find if inadequate uteroplacental hemodynamic was associated with improper feto-maternal immune adaptation. The risk of developing preeclampsia can be predicted by combining use of uterine artery flow and cytokine values. The aim was to show their combination as a predictive indicator of preeclampsia in the second trimester of pregnancy. Methods. This study enrolled 96 pregnant patients in the second trimester (patients were between the 14th and 20th gestational weeks). Their history data, routine foetal ultrasound, bilateral uterine artery Doppler ultrasound and cytokines were evaluated. All patients were followed up till the end of pregnancy. Half of the pregnant women consisted the study group (N=48), which had presence of notch of the uterine artery. In the control group (N=48), there was an absence of uterine artery notch. In all patients, Doppler of the uterine artery, pulsatility index (PI) and resistance index (RI) were made and determined. The pro-inflammatory cytokines (TNF-α, IL-1α, IL-2 and IL-6) and antiinflammatory cytokines (IL-4 and IL-10) from patient’s serum were analyzed. Results and Discussion. In the study group (N=48), 32 patients had changes in the cytokine serum levels. Increased pro-inflammatory biomarkers (IL-6, TNF-α, IL-1α) were with sensitivity of 78 to 91.2%. According to this, high predictive value was found. Of these 32 patients, 21 developed preeclampsia. When the sensitivity of pro- and anti-inflammatory biomarkers together with the uterine artery Doppler ultrasound was combined, a sensitivity resulted in 81.5%. Multivariate regression analysis detected that IL-6 was the most significant predictive parameter. This result is similar to that presented in the study by Teran and Hentschke et al. Conclusion. Using predictive tests is imporatnt to detect undeveloped preeclampsia in a timely manner that would prevent possible developmental complications. After abnormal Doppler results, cytokines should be investigated as a predictive method.
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    Perinatal complications and their association with maternal hypothyroidism
    (Bulgarian Association of Young Surgeons (ScopeMed), 2022-05)
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    Paneva, Iva
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    Introduction. Hypothyroidism in pregnant patients is more often associated with pregnancy complications. It increases the risk of obesity, diabetes, and hypertensive disorders, and has an impact on perinatal outcomes. There is a greater risk of congenital hypothyroidism or so-called cretinism, manifested by growth restriction, mental retardation and other neurophysiological defects. Iodine supplementation and proper administration of thyroxine preparations in the first and second trimesters significantly reduce neurological abnormalities. Purpose. Evaluation of pregnancies in patients with hypothyroidism and its impact on perinatal complications. Material and methods. The patients with hypothyroidism were analyzed from the total deliveries at the University Clinic for Gynecology and Obstetrics in Skopje. Patients are divided into two study groups: study and control groups. The study group includes patients with hypothyroidism. The control group includes patients without hypothyroidism. Results. The likelihood of obesity was assessed, and during the third trimester, the likelihood of developing diabetes, gestational hypertension, and preeclampsia as a single risk, was compared between the two groups. Patients with hypothyroidism are 3.49 times more likely to have obesity and 5.57 times higher risk of developing diabetes in pregnancy than those without hypothyroidism. The relative risk of developing gestational hypertension is 3.1 and OR 3.22 in patients with hypothyroidism, which means that 3.22 times more likely to develop gestational hypertension in this group. Preeclampsia develops in 2 patients (3.33%) with a relative risk of 2.07 and OR 2.11, or 2.11 times higher risk of developing preeclampsia in the hypothyroidism group. Conclusion. Early detection of thyroid disorders in a pregnant patient as well as in newborns postpartum allows for proper treatment of both mother and child, while uncontrolled hypothyroidism leads to adverse pregnancy outcomes and has fatal consequences.