Faculty of Medicine
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Item type:Publication, Placental abruption as the first manifestation of severe preeclampsia: A case report(APROFEMA, 2025-09-26) - Some of the metrics are blocked by yourconsent settings
Item type:Publication, CASE OF A PATIENT WITH POSTPARTUM ECLAMPSIA(Македонско лекарско друштво = Macedonian medical association, 2025); - Some of the metrics are blocked by yourconsent settings
Item type:Publication, UTERINE ARTERY DOPPLER AND SERUM LEVEL OF IMMUNOBIOMARKERS IN PREECLAMPSIA - OUR EXPERIENCE(Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2024); ; ; 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. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, DIASTOLIC DYSFUNCTION IN GESTATIONAL HYPERTENSION/ PREECLAMPSIA(DEPARTMENT OF ANAESTHESIA AND REANIMATION, FACULTY OF MEDICINE, “SS. CYRIL AND METHODIUS” UNIVERSITY, SKOPJE, MACEDONIA, 2024-03); ; ; Introduction: Hypertensive disorders in pregnancy including preeclampsia are present in 10% of pregnancies and are one of the biggest reasons for both maternal and fetal morbidity and mortality. Materials and Methods: The study was undertaken at the University Clinic for Gynecology and Obstetrics in Skopje, North Macedonia. After initial assessment, 81 patients were enrolled in the study after signing a written consent. Patients were divided into two groups depending on whether they had hypertension or not. In the hypertensive group 51 patients were enrolled and 30 normotensive pregnancies were used as controls. Results: Based on the values of the parameters of diastolic function obtained with PDA of the transmittance flow and the values of the parameters obtained with TDI of the longitudinal movement of the mitral ring, diastolic dysfunction was found in 17 (33.2%) pregnant women of the studied population, LV function (p <0.001). In the pregnant women from the examined group in whom the presence of LV diastolic dysfunction was identified, the disorders were of mild degree, that is type of delayed relaxation of LV in all 17 pregnant women. Conclusion: Early recognition and management of symptoms are essential. Women who suffer from hypertensive disorders in pregnancy require close monitoring after delivery. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, CORRELATION BETWEEN SFLT/PLGF RATIO HIGHER THAN 200 AND ALTERED LABORATORY PARAMETARS OF PREECLAMPSIA IN HOSPITAL SETTINGS PATIENTS(SHMSHM - AAMD, 2024); ; ; ; Milkovski, DanielPreeclampsia affects 2–7% of all pregnancies. Worldwide it is responsible for 500,000 fetal/neonatal deaths and 70,000 maternal deaths every year. Anti-angiogenic factor, soluble fms-like tyrosine kinase 1 (sFlt-1) and the pro-angiogenic factor, placental growth factor (PlGF) are usefull markers for screening, diagnosis and prognosis of preeclampsia. Aim: To show our experience about the correlation between angiogenic levels and laboratory blood and urine parametars in hospital settings patients with preeclampsia. Material and methods : Retrospective clinical study was performed in 2 years period. One hundred pregnant women with preeclampsia hospitalized in University clinic for obstetrics and gynecology in peripartal intensive care unite were evaluated .SFLT/PLGF ratio (Elecsys sFlt-1 and PlGF immunoassays), differential blood count, AST, ALT, LDH, uric acid, urine analysis (qualitative, quantitative proteinuria) were evaluated in all patients. Questionaire about sociodemographic data, age, parity, BMI, poor obstetric history, cigarette smoking, use of Aspirin or Clexane during actual pregnancy was taken during admission. Related to the sFlt-1/PIGF ratio (< 200 or ≥ 200) women were divided into two groups with 50% participants each. Results: Our patients with SFLT/PLGF ratio >200 were significantly younger, had significantly higher proteinuria (++,+++ and quantitative), had significantly higher levels of LDH and AST and were admitted at hospital treatment at significantly lower gestational week compared to ratio < 200. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, RECURRENT PREECLAMPSIA IN THE SAME PATIENT(DEPARTMENT OF ANAESTHESIA AND REANIMATION, FACULTY OF MEDICINE, “SS. CYRIL AND METHODIUS” UNIVERSITY, SKOPJE, MACEDONIA, 2022); ; Introduction: Preeclampsia is a complex disease that occurs in 5-7% of the entire population. Preeclampsia is an important cause of maternal and perinatal mortality. The etiology of preeclampsia is unknown, but recent research suggests that these disorders originate in the placenta and are characterized by extensive maternal endothelial dysfunction. This leads to inadequate blood supplementation and oxidative stress. Placental factors such as soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble receptor for vascular endothelial growth factor (VEGF), are released into the maternal circulation, where they stimulate the inflammatory response and endothelial dysfunction. Objective: To demonstrate the possibility of preventing severe preeclampsia in the same patient by determining the ratio of angiogenic factors sFlt-1/ PLGF. With early detection of angiogenic factors, the patient is monitored more closely when the growth of angiogenic factors begins without clinical manifest symptoms and timely termination of pregnancy in the interest of the patient’s health. Case Report: Monitor the clinical form of preeclampsia in a patient in her two pregnancies. In the first pregnancy, the patient develops the most severe form of preeclampsia (Eclampsia and HELLP Syndrome) at 29.1 weeks gestation. The postpartum patient is in serious condition with a stay in the Intensive Care Unit. During the first pregnancy, in 2014, angiogenic factors were not examined. In the second pregnancy, 2020/ 2021, in the second trimester (in the 24th week of gestation), the angiogenic factors are started to be examined. Along with the ultrasound examination and measurement of the mean arterial pressure, the danger of developing severe preeclampsia is detected early in pregnancy and with careful monitoring of the patient it ends in time before the patient’s health is seriously endangered. Conclusion: Preeclampsia is a unique health condition that occurs only in pregnancy and that can seriously endanger the health of both mother and fetus. With the development of medicine, many tests are being developed that try to diagnose the occurrence of preeclampsia very early. Recent studies of angiogenic factors and the correlation between sFlt-1/ PLGF have been shown to be sensitive in predicting preeclampsia, as well as in patient’s case studies. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, The Role of Endothelial Dysfunction in the Pathogenesis of Pregnancy-Related Pathological Conditions: A Review(Walter de Gruyter GmbH, 2023-07); ; ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Factor V Leiden, Prothrombin and MTHFR Mutation in Patients with Preeclamsia, Intrauterine Growth Restriction and Placental Abruption(Scientific Foundation Spiroski, 2015-12-15); ; ; BACKGROUND: Factor V Leiden, Prothrombin and MTHFR gene mutation, could have an influence in pregnancy with adverse outcome Preeclamsia, IUGR and Placental abruption. AIM: The aim of this study is to investigate the presence of above mentioned inherited thrombophilias and its statistical significance, distribution among the complicated and normal pregnancy, and relative risk for carrier of mutation to develop preeclampsia, IUGR and placental abruption. MATERIAL AND METHODS: Prospective cohort study is implemented at University Clinic for Obstetric and Gynecology in Skopje, Republic of Macedonia. The study included 109 delivered patients: 40 with preeclapmsia, 22 with IUGR, 17 with placental abruption and 30 as control group with normal pregnancy. The amount of 3 ml venous blood has been used for detection of these point mutations using ThromboStrip -Opegen, QIAGEN kit manufactured for thrombotic risk. RESULTS: The highest frequency was found: in the group with preeclampsia 35% were MTHFR homozygous, IUGR -MTHFR heterozygous 45%, Placental abruption- 52.9% MTHFR heterozygous, and in the control group without thrombophilia 56.7%. There were combined thrombophilia in 3 patients. There aren`t statistical significance in presence of thrombophilia among groups (p > 0.05). Statistical significance (p < 0.05) was found between carriers of MTHFR homozygous in preeclampsia and group with placental abruption and control group. Relative risk in IUGR group for MTHFR homozygous was 5.54 (1.37<RR<22.4). Relative risk in placental abruption for Factor V Leiden heterozygous was 4.50 (0.47<RR<42.75). CONCLUSION: The presence of mutation MTHFR homozygous could increase the risk for development of IUGR and mutation of Factor V Leiden for placental abruption. Further investigations with more patients are warranted. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, The role of the circulating placental angiogenic factors SFLT-1/PLGF ratio in patients with preeclampsia-a review(SHMSHM/AAMD, 2018); ; ; ; Preeclampsia (PE), a progressive, multisystem disease of pregnant women, is the leading cause of maternal and fetal / neonatal morbidity and mortality with an incidence of 3-8% at a global level. PE is defined as de novo occurrence of hypertension and proteinuria after the 20th gestation week of pregnancy. The diagnosis of PE has long been based on the measurement of those two non-specific signs the diagnostic value of which is often insufficient given the clinical diversity of the disease as well as the different impact on the mother and the fetus. In the absence of specific preeclampsia therapy, clinical management consists of symptomatic / substitution therapy and monitoring for the detection of worsening of the maternal or fetal state and delivery as the ultimate remedy. The fact that only the delivery, or more precisely, the removal of the placenta leads to a definitive stop of PE, puts the placenta at a central place in the pathogenesis of the disease. More and more studies have suggested the connection of placental angiogenic factors with preeclampsia. These factors include circulating angiogenic proteins such as soluble fms-like tyrosine kinase-1 (sFlt-1), the anti-angiogene responsible for vasoconstriction, and the placental growth factor (PLGF) pro-angiogene responsible for placental pseudo-vasculogenesis and vasodilatation. In preeclampsia patients, the anti-angiogene sFlt-1 predominates due to increased production in the placenta, which reduces the effect of pro-angiogene PLGF whose concentrations in the serum are significantly reduced. All this leads to the clinical expression of PE with hypertension due to vasoconstriction and multisystemic involvement due to systemic endotheliosis, i.e. microvasculopathy. The determination of the serum sFlt-1 / PLGF rate is recommended as a possible useful test for diagnosis of PE and the determination of the severity of the clinical picture, and as a useful tool in its management. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Connection between cytokines and complications derived from preeclampsia pregnancies(ScopeMed Publishing, 2020-05)Preeclampsia is a condition of multiorgan involvement that can cause severe complications for the mother’s health and endanger the intrauterine development of the fetus. Purpose: The purpose is to detect the risk of developing preeclampsia in the second trimester, by examining cytokines and closely monitoring the pregnancy for complications from preeclampsia, whether they are affected by the same cytokines. Material and methods A total of 100 patients were monitored in the second trimester between 14 and 20 weeks of gestation. Values of immune biomarkers of their serum were analyzed after obtaining anamnestic data and performing ultrasound examination. With the help of the ELISA methodology, cytokines were verified: TNF-a, IL-1a, IL-2, and IL-6 versus IL-4 and IL-10. Results Of the 100 patients examined, 21 patients developed clinical symptoms and were diagnosed with preeclampsia in the third trimester. The interaction of proinflammatory interleukins is in favour of a mutual increase, and a decrease in the values of antiinflammatory interleukins is a significant predictive parameter in the second trimester for the development of preeclampsia. The increase in IL-6 is the largest statistically significant variable in the prediction of preeclampsia. The correlation between IL-6 and pregnancy complications is also with statistical significance (p=0.012). Conclusion The impaired immune response can result in consequences such as multiple organic disorders that occur in the clinical preeclampsia syndrome and problems with fetal development. The benefit of analyzing cytokines is highly significant for early diagnose and prevention of further complications.