The role of oxidative stress markers in pregnancy induced hypertension/Znacajmarkera oksidativnog stresa kod hipertenzije u trudnoci.
Pregnancy induced hypertension (PIH) is one of the most common and serious conditions in obstetrics. It puts in danger both the mother and the fetus [1-11]. Up to now, the etiology and pathogenesis of PIH are still unclear. Even today, the most significant cause of maternal death, apart from hemorrhages and infections, is pregnancy induced hypertension. According to many authors, PIH accounts for about 12% of total maternal mortality [11-13], whereas according to Shapiro it is about 11% . The highest mortality is associated with the most severe complications such as Hemolysis, Elevated, Liver Ensimes, Low Plateles (HELLP) syndrome, placental abruption, eclampsia, edema and pulmonary embolism, kidneys failure, disseminated intravascular coagulation (DIC), and brain hemorrhages [15-17]. High maternal mortality and morbidity is followed by high fetal mortality and morbidity. Perinatal mortality is mostly associated with iatrogenic preterm birth, intrauterine growth retardation, as well as acute or chronic fetal stress [18, 19].
Nowadays, the role of oxidative stress in the etiology of PIH is being researched, and the results show that it may have a significant role in the development of pre-eclampsia, since it damages the endothelium of placenta, its vascularization and immune response [20-23]. In normal pregnancy, oxidative stress increases a bit, but there is no increase in free radicals. Recently, a great attention is being paid to lipid peroxidation, which actually is oxidative damage of lipids and increased formation of lipid peroxides, and its final product is malondialdehyde. Nowadays, malondialdehyde (MDA) is used in many expert researches as an oxidative stress marker, i.e. in the assessment of lipid peroxidation [24-27]. In accordance with the current literature findings, it is presumed that PIH is a condition of extremely increased oxidative stress . This study was conducted to analyze the existence and degree of oxidative stress, i.e. lipid peroxidation, correlation of these parameters with clinical parameters of maternal and fetal outcomes in patients with pregnancy induced hypertension. Current medical literature does not contain a comprehensive analysis of all these parameters together.
The aim of this research was to determine levels of thiobarbituric acid reactive substance (TBARS) in blood of pregnant women with pregnancy induced hypertension and to analyze the correlation of TBARS parameters with clinical parameters during pregnancy and delivery in pregnancies with pregnancy induced hypertension.
Material and Methods
The study was performed at the Clinic of Gynecology and Obstetrics (CGO), of the University Hospital, Clinical Centre of Banja Luka (CCBL), according to current standards and regulations of the Ethics Committee. It included 200 pregnant women, 28-40 weeks of gestation, who were admitted to the Department of Perinatology of the CGO in Banja Luka. All pregnant women gave birth at the Maternity Ward of the CGO in accordance with medical indications. These were single pregnancies, accurately dated, with no other pathology. Test results were performed at the Institute of Laboratory Diagnosis and the Pediatric Clinic, of the University Hospital, CCBL in Banja Luka.
The pregnant women were divided into two groups: the study group of 100 pregnant women with the diagnosis of pregnancy induced hypertension based on clinical, laboratory and ultrasound evidence; the control group of 100 pregnant women without clinical, laboratory and ultrasound evidence of pregnancy induced hypertension.
During hospital stay, all the pregnant women were treated in the same way: they were advised to reduce salt intake by half, eat protein-rich food, have strict rest and oxygenation, blood pressure and respiratory rate were measured every 4 hours, unless unregulated blood pressure required more frequent measurement, filled in a blood pressure chart for each patient. PIH is classified as mild hypertension if it equals or is higher than 140/90 mmHg, and severe hypertension if it equals or is higher than 160/110 mmHg. Selection of pregnant women of the control group was performed after collection of data for the study group, and the groups were matched in terms of maternal age and gestational age as much as possible.
The 4 most common complications associated wit PIH were analyzed in all patients: HELLP syndrome, eclampsia, placental abruption and hemorrhages. After delivery, the most common maternal complications were: hemorrhages, infections, kidney damages, central nervous system damage, etc.
Fetal outcome was assessed based on the Apgar score at the first and fifth minute (0 to 7 is considered low--dead fetus, severe and mild asphyxia, and 8 to 10 is excellent).
Thiobarbituric acid reactive substance (TBARS) is an oxidative stress marker, which quickly and strongly reacts to malondialdehyde. Due to the simplicity of this oxidative stress marker, i.e. being a lipid peroxidation marker, it was used in this research. Blood tests were performed in all pregnant women, with PIH and the control group, for biomarkers of oxidative stress, TBARS levels, using the spectrophotometric method based on the concentration of MDA, product of lipid peroxidation, at the Institute of Laboratory Diagnosis and Pediatric Clinic, of the University Hospital, Clinical Centre of Banja Luka. TBARS is a very sensitive method for quantitative determination of lipid peroxidation. The principle of this screening method is that two molecules of thiobarbituric acid reactive substance react with one molecule of malondialdehyde, creating a compound, which is determined by spectrophotometry. Five milliliters of venous blood were collected from the cubital vein of each patient and put into a sterile tubes. TBARS levels were determined as an equivalent of MDA standard, in accordance with recommendations of the producer (Oxi Select TBARS Analisa Kit (MDA quantification), and results were acquired by spectrophotometry at 532 nm. In accordance with the recommendations, and minimal and maximal values, the results were divided into intervals for detailed analysis and comparison: low level interval up to 20 [micro]mol, medium level interval from 20 to 40 [micro]mol, and high level interval of TBARS over 40 [micro]mol.
Results were analyzed and presented through descriptive statistics and adequate statistical tests using the SPSS analytic-statistical software kit. In normal division, t-test of independent samples was used, and in cases where the basic group significantly deviated from the normal division, we applied the Mann-Whitney U-test. We used Hi-square ([[chi].sup.2]) and Fisher test, and contingency 2 x 2 table, and Yates' correction was made for continuity of smaller samples .
All the gathered results of pregnant women with PIH and the control group of healthy pregnant women, were analyzed in detail in accordance with anthropometric parameters of pregnancy and delivery.
The mean gestational age at delivery in pregnant women with PIH was 261.9 days, whereas in the control group it was 273.9 days. The Mann-Whitney U test showed a high statistical significance p=0.00; a significantly lower gestational age was found in pregnant women with PIH in comparison to the control group. In regard to age distribution, hypertensive pregnant women were statistically significantly older compared to the control group, p=0,005; the mean age of hypertensive pregnant women was 31.2 years, whereas in the control group it was 28.9 years. In regard to parity, there was no statistically significant difference between the two groups: there was an equal number of primiparas and multiparas. Regarding the number of abortions, there was no statistically significant difference between the two groups: there was an equal number of pregnant women without abortions and pregnant women with one or more abortions in both groups. The fetal outcomes and Apgar scores at the first minute showed a high statistical significant difference, p=0.002; pregnant women with PlH delivered children of significantly lower Apgar score (0-7) in comparison to healthy pregnant women. The analysis of arterial tension, showed that the mean systolic pressure of pregnant women with PIH was 160 mmHg, and, in the control group it was 120 mmHg, whereas the mean diastolic pressure of pregnant women with PIH was 110 mmHg, and 70 mmHg in the control group. The percentage of pregnant women with severe PIH was 59%, whereas 49% had mild PIH.
Complications during pregnancy and delivery in pregnant women with PIH and the control group
Table 1 shows the most common complications during pregnancy and delivery. In pregnant women with PIH, there was a total of 18 complications present in 14 women. Four women had 2 complications each. In pregnant women with PIH, there were 8 with placental abruption, 4 with hemorrhages, 2 with eclampsia and 4 with HELLP syndrome. In the control group, on the other hand, there were no complications whatsoever.
We analyzed the presence of complications during pregnancy and delivery related to the height of blood pressure. Out of 100 women with PIH, 59 women had severe PIH, and 41 had mild PIH.
Table 2 shows complications in patients with mild and severe PIH. There were four pregnant women having two complications each. The Fisher test showed a high statistically significant difference (p = 0.007) related to the presence of complications in pregnant women with PIH, those with mild and severe PIH. Pregnant women with severe PIH, presented with a significantly larger number of complications.
The analysis of the maternal outcome showed that there were no lethal outcomes in either group, being the worst complication after delivery. There were no complications after delivery in the control group, whereas there were 5 women with PIH with complications.
TBARS--an oxidative stress marker in pregnant women with PIH and in the control group
We compared the levels of oxidative stress marker--TBARS, byproduct of lipid peroxidation in pregnant women with PIH, and in the control group. The Mann Whitney U test showed a high statistically significant difference in levels of TBARS in pregnant women with PIH (Md = 36.75, n = 100) in comparison to the control group (Md = 13.20, n = 100), U = 6.000, z = -12.203, p = 0.000 with r = 0.863. Pregnant women with PIH had significantly higher levels of TBARS oxidative stress marker. The mean value was 36.7 [micro]mol in PIH group, in comparison to 13.2 [micro]mol in the control group. The highest TBARS level was found in women with PIH and it was 61.7 [micro]mol, whereas in the group of healthy pregnant women, it was 25.8 [micro]mol. The lowest level of TBARS in women with PIH was 21.7 [micro]mol, and 9.10 [micro]mol in the control group, which is highly statistically significant (Table 3).
We also analyzed the levels of TBARS related to the height of blood pressure in women with mild and severe PIH. The Mann-Whitney U test showed a high statistically significant difference in TBARS levels in women with mild PIH (Md = 29.20, n = 41) and women with severe PIH (Md = 41.80, n = 59), U = 272.000, z = -6.571, p = 0.000 with r = 0.657. The pregnant women with severe PIH had significantly higher levels of TBARS in comparison to pregnant women with mild PIH: TBARS in mild PIH--30.30 [micro]mol, and in severe PIH--41.12 [micro]mol (Table 4). TBARS--an oxidative stress marker in pregnant women with PIH and in the control group related with complications during pregnancy and delivery
The Mann-Whitney U test revealed a high statistically significant difference in TBARS levels in women with PIH presenting with complications (Md = 35.95, n = 86) and women with PIH without complications (Md = 43.35, n = 14), U = 334.000, z = -2.663, p = 0.008 with r = 0.266. The pregnant women with PIH accompanied with complications, had significantly higher levels of TBARS; the mean TBARS level was 41.6 [micro]mol, i.e. in high level interval of TBARS, in comparison to pregnant women without complications (Table 5).
The analysis of the most common complications in pregnant women with PIH and their comparison with the mean levels of TBARS showed the highest level of 43.9 [micro]mol in pregnant women with HELLP syndrome. All pregnant women with complications had mean level of TBARS in the high level interval, i.e. over 40 [micro]mol (Table 6). We got positive correlation of these pregnancy and delivery parameters with levels of TBARS.
Former studies dealing with oxidative stress indicate that pregnancy is a state of physiological, slightly increased oxidative stress in comparison to healthy non-pregnant women [20,21,29,30]. Oxidative stress may have a significant role in the development of pre-eclampsia since it starts damaging the endothelium of placenta, vascularization, and immune response [24-27].
Complications associated with PIH are very difficult and severe; they can put at risk the maternal and the fetal life. The gathered results show that there were no complications during pregnancy and delivery in the control group. On the other hand, in the group of pregnant women with PIH, including a total of 100 pregnant women, there were 18 complications in 14 women, 4 women had 2 complications each. Most complications referred to placental abruption--8, hemorrhages--4, HELLP-syndrome--2, and eclampsia--2. Our results are in agreement with literature data -. The latest findings on the pathogenesis and etiology of PIH , indicate that there are different views on the beginning of the disease, severity of symptoms and complications. The analysis of the occurrence of complications in regard to the height of blood pressure showed a high statistically significant difference in the group of pregnant women with mild or severe PIH. The pregnant women with severe PIH had significantly higher number of complications--a total of 17 in 14 pregnant women, while 4 women with severe PIH had 2 complications each. Only 1 pregnant woman with mild PIH presented with 1 complication. These results are also in agreement with literature data [34-37].
The analysis of maternal outcome in women with PIH and in the control group shows that there was no statistically significant difference between the examined groups. In the group of women with PIH, 5 had complications, whereas in the control group there were no complications whatsoever. It is important to say that there were no cases of maternal lethal outcome, which is the worst complication after delivery. Although the difference was not statistically significant, the Fisher test, p=0.059, value was at the limit of statistical significance between women with PIH and the control group. The obtained results indicate that the patients were provided with good prenatal diagnosis, pregnancy and delivery management, as well as timely delivery.
In the control group, the mean systolic pressure was 120 mmHg, and diastolic 70 mmHg. In the group of women with PIH, the mean systolic pressure was 160 mmHg, and diastolic 110 mmHg. The highest systolic pressure was measured in women with PIH--220 mmHg, and diastolic 160 mmHg.
In regard to the levels of TBARS, as an oxidative stress marker, there was a high statistical difference of p regnant women with PIH had a significantly higher mean value of TBARS in comparison to the control group. The highest level of TBARS in the group with PIH was 61.7 [micro]mol, whereas in the control group it was 25.8 [micro]mol. The lowest level of TBARS in women with PIH was 21.7 [micro]mol, and in the control group it was 9.10 [micro]mol. The mean level of TBARS in the control group was 13.2 [micro]mol, whereas in women with PIH, it was 36.7 [micro]mol. The obtained results of this research clearly indicate to extremely increased oxidative stress in PIH, i.e. we proved increased level of lipid peroxidation and hence the possibility of its prevention in pregnancy.
We also analyzed the mean levels of TBARS, which proved to be extremely high in hypertensive pregnant women, especially in women with the most severe PIH. Previous analyses showed that the most severe complications and the highest number of complications were found in women with severe pre-eclampsia (PIH). TBARS may be used as a pre-clinical parameter in hypertensive pregnant women for the purpose of timely diagnosis and in the best maternal and fetal interests.
The analysis of TBARS and complications in the examined groups shows a high statistically significant difference (p=0.008) of TBARS levels in pregnant women with PIH with complications, and in pregnant women with PIH without complications. The mean level of TBARS in pregnant women with PIH with complications was 41.62 [micro]mol. The pregnant women with PIH and accompanied complications had significantly higher levels of TBARS in comparison to pregnant women with PIH without complications. Our results show that the highest level of TBARS of 43.92 [micro]mol was found in pregnant women with HELLP syndrome, which is one of the most severe complications of PIH, whereas women with hemorrhages come next with 42.15 [micro]mol.
In conclusion, our research shows that pregnant women with pregnancy induced hypertension have extremely high levels of oxidative stress and lipid peroxidation. Pregnant women with pregnancy induced hypertension and the most severe complications during pregnancy and delivery had extremely high levels of thiobarbituric acid reactive substance, and the highest levels were found in pregnant women with Hemolysis, Elevated, Liver Ensimes, Low Plateles syndrome.
This study shows that thiobarbituric acid reactive substance, as an oxidative stress marker, may be used in clinical practice in the assessment of the severity of complications and as an indicator for timely delivery in women with pregnancy induced hypertension. Surely, further studies with larger study samples of pregnant women with severe hypertension are needed to confirm this conclusion.
Abbreviations PIH --pregnancy induced hypertension TBARS --thiobarbituric acid reactive substance CGO --Clinic of Gynecology and Obstetrics CCBL --Clinical Centre of Banja Luka DIC --dissmeninated intrascular coagulation MDA --malondialdehyde
Rad je primljen 15. XI 2016.
Recenziran 19. XI 2016.
Prihvacen za stampu 22. XI 2016.
[1.] Roberts JM, Pearson GD, Cutler JA, Lindheimer MD; National Heart Lung and Blood Institute. Summary of the NHLBI Working Group on Research on Hypertension During Pregnancy. Hypertens Pregnancy. 2003; 22(2):109-27.
[2.] Sibai BM, Dekker G, Kupferminc M. Preeclampsia: an update on its causation, diagnosis, prevention and management. Lancet. 2005; 365:785-99.
[3.] National Institute of Health (NIH): National Heart, Lung, and Blood Institute. National High Blood Pressure Education Program: working group report on high blood pressure in pregnancy. Publication No. 00-3029. Bethesda: NIH; 2000.
[4.] Sibai BM. Best practices for diagnosis and management of preeclampsia. Part 1 of 3. Preeclampsia: 3 preemptive tactics. Obstet Gynecol Manage. 2005; 17(2):20-32.
[5.] Koonin LM, Mackay AP, Berg CJ, et al. Pregnancy-related mortality surveillance, United States, 1987-1990. MMWR CDC Surveill Summ. 1997; 46(4):17-36.
[6.] Zhang J, Meikle S, Trumble A. Severe maternal morbidity associated with hypertensive disorders in pregnancy in the United States. Hypertens Pregnancy. 2003; 22:203.
[7.] Martin JA, Hamilton BE, Ventura SJ, et al. Births: final data for 2001. Nat Vital Stat Rep. 2002; 51(2):1-102.
[8.] Berg CJ, Chang J, Callaghan WM, et al. Pregnancy-related mortality in the United States 1991-1997. Obstet Gynecol. 2003; 101:289.
[9.] Vaten Lj, Skjaeven R. Is preeclampsia more than one disease? J Obstet Gynecol. 2004; 111:298.
[10.] Backes CH, Markham K, Moorehead P, Cordero L, Craig A, et al. Maternal preeclampsia and neonatal outcomes. J Pregnancy. 2011; 2011:214365.
[11.] Milasinovic LJ. Monitoring zena sa oboljenjem kardiovaskularnog sistema. 6. Kongres perinatalne medicine sa medunarodnim ucecem. Zbornik radova. Beograd: Izdavac; 2007. s. 45-55.
[12.] Rochat RW, et al. Maternal mortality in the United States-Report from the Maternal Mortality Colaborative. J Obst Gynecol. 1998; 72:91.
[13.] Milasinovic LJ i sar. Klinicka fiziologija trudnoce. Beograd: IP SKK Kosmos; 2005.
[14.] Shapiro JM. Critical care of the obstretic patient. J Intensive Care Med. 2006; 21:278-86.
[15.] Why mothers die 2000-2002. The sixth report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. London: RCOG Press; 2004.
[16.] Lindheimer MP, Davison JM. The renal response to preeclampsia. Semin Nephrol. 2004; 24:588.
[17.] Shah AK, Rajamani K, Whitty JE. Eclampsia: a neurological perspective. J Neurol Sci. 2008; 271:158.
[18.] Friedman SA, Schiff E, Kao L, Sibai BM. Neonatal outcome after preterm delivery for preeclampsia. Am J Obstet Gynecol. 1995; 172:1785.
[19.] Haddad B, Kayem G, Deis S, Sibai BM. Are perinatal and maternal outcomes different during expectant management of severe preeclampsia in the presence of intrauterine growth restriction? J Obstet Gynecol. 2007; 196:237.
[20.] Sies H. Oxidative stress: oxidants and antioxidants. Exp Physiol. 1997; 82:291-5.
[21.] Eukic M, Ninkovic M, Jovanovic M. Oxidative stress: clinical diagnostic significance. Journal of Medical Biochemistry. 2008; 27(4):409-25.
[22.] Stevanovic I, Mihajlovic R. Mesto i uloga slobodnih radikala u signalnoj transdukciji. U Eukic M, urednik. Oksidativni stress: Klinicko dijagnosticki znacaj. Beograd: Mono i Manjana; 2008.
[23.] Gupta S, Aziz N, Sekhon L, Agarwal R, Mansour G, Li J, et al. Lipid peroxsidation and antioxsidant status in preeclampsia; a systematic review. Obstet Gynecol Surv. 2009; 64 (11):750-9.
[24.] Novakov Mikic A, et al. Thiobarbituric acid reactive substances in pre-eclampsia. Med Pregl. 2011; 64(7-8):377-80.
[25.] Suhail M, Suhail MF. Koncentracije malondialdehida i antioksidativnih vitamina pupkovine kod majki oboljelih od preeklampsije i zdravih majki. Biochemia Medica. 2009; 19 (2):182-91.
[26.] Huber C, Robertson J, Taylor R, et al. Lipid peroxidation in pregnancy: new perspectives on preeclampsia. Am J Obstet Gynecol. 1989; 161:1025-34.
[27.] Morris JM, Gopaul NK, Endersen MJ, et al. Circulating markers of oxidativestres are raised in normal pregnancy and preeclampsia. British J Obstet Gynecol. 1998; 105(11):1195-9.
[28.] Eric-Marinkovic J, Dotlic R, Janosevic S, Kocev N, Gajic M, Ille T, et al. Statistika za istrazivace u oblasti medicinskih nauka. Beograd: Medicinski fakultet Univerziteta u Beogradu; 2001.
[29.] Irashad M, Chaudhuri PS. Oxidant-antioxidant system: role and significance in human body. Indian J Exp Biol. 2002; 40:1233-9.
[30.] Jozanov-Stankov O, Dobutovic B, Euric J, Isenovic E. Oksidativni stres kao cinilac kod oboljevanja patoloskih poremecaja ljudi. Apollinem medicum et aesculapium. 2007; 5(1-2):31-6.
[31.] Sibai BM. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstet Gynecol. 2004; 103(5):981-91.
[32.] Sibai BM, Taslimi MM, El-Nazer A, et al. Maternal-perinatal outcome associated with the syndrome of hemolysis, elevated liver enzymes, and low platelets in severe preeclampsia eclampsia. Am J Obstet Gynecol. 1986; 155:501.
[33.] Sibai BM. The HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets). Much ado about nothing? Am J Obstet Gynecol. 1990; 162:311-6.
[34.] Egic A. Predikcija preeklampsije u prvom trimestru. Imaging biomarkeri-perspektive i ocekivanja. Tara: Udrzenje za perinatalnu medicinu Srbije; 2013. s. 101-4.
[35.] Magee L, Helewa M, Moutquin JM, Dadelszen P. Diagnosis evaluation and managment of the hypertensive disorders of pregnancy. J Obstet Gynecol Canada. 2008; 30(3 Suppl):S1-48.
[36.] Sibai, BM, Barton, JR. Expectant management of severe preeclampsia remote from term: patient selection, treatment, and delivery indications. Am J Obstet Gynecol. 2007; 196(6):514.e1-9
[37.] Sibai BM. Diagnosis, prevention, and management of eclampsia. J Obstet Gynecol. 2005; 102(2):402-10.
Dragica DRAGANOVIC (1), Branka CANCAREVIC DAJIC (1) and Dragica JOJIC (2)
University Clinical Centre of the Republic of Srpska, Banja Luka Clinic of Gynecology and Obstetrics (1) Pediatric Clinic (2)
Table 1. Complications in the group with PIH and in the control group Tabela 1. Prisustvo komplikacija kod trudnica sa TIH * i kontrolne grupe Complications/Komplikacije Placental Eclampsia HELLP Hemorrhage abruption Eklamsija Hemoragija Abrupcija placente Group with PIH/ No/Ne 92 98 96 96 Trudnice sa TIH Yes/Da 8 2 4 4 Control group/ No/Ne 100 100 100 100 Kontrolna grupa * TIH = Trudnocom indukovana hipertenzija Table 2. Complications in the group with PIH Tabela 2. Prisustvo komplikacija kod pacijentkinja sa TIH * Group with PIH/Trudnice sa TIH Mild/Blaga Severe/Teska Total Ukupno Complications Komplikacije No/Ne 40 46 86 Yes/Da 1 13 14 Total/Ukupno 41 59 100 * TIH--trudnocom indukovana hipertenzija Table 3. TBARS levels in the group with PIH and and in the control group Tabela 3. Vrednosti TBARS * kod trudnica sa TIH ** i kontrolne grupe Study group/ N Min Max. Range Median Mean Ispitivane grupe Group with PIH/ 100 21.7 61.70 40.00 36.7500 36.6860 Trudnice sa TIH Control group/ 100 9.10 25.80 16.70 13.2000 13.4220 Kontrolna grupa Total/Ukupno 200 9.10 61.70 52.60 21.7500 25.0540 Study group/ SD Ispitivane grupe Group with PIH/ 8.29359 Trudnice sa TIH Control group/ 2.74493 Kontrolna grupa Total/Ukupno 13.18904 * TBARS--reaktivne supstancije tiobarbiturne kiseline; ** TIH--trudnocom indukovana hipertenzija Table 4. TBARS levels in the group with PIH in regard to the height of blood pressure Tabela 4. Vrednosti TBARS * kod trudnica sa TIH ** prema visini krvnog pritiska Group with PIH/ N TBARS p Trudnice sa TIH ([x.sup.-]) Mild PIH/ 41 30.3000 0.000 Blaga TIH Severe PIH/ 59 41.1237 Teska TIH Total/Ukupno 100 36.6860 Table 5. TBARS levels in the group with PIH in comparison to pregnancy and delivery complications Tabela 5. Vrednosti TBARS * kod trudnica sa TIH ** u odnosu na komplikacije trudnoce i porodaja Complications/ N TBARS p Komplikacije ([x.sup.-]) No/Ne 86 35.8826 0.008 Yes/Da 14 41.6214 Total/Ukupno 100 36.6860 * TBARS--reaktivne supstancije tiobarbiturne kiseline; TIH--trudnocom indukovana hipertenzija Table 6. TBARS mean levels in the group with PIH in comparison to complications Tabela 6. Srednje vrijednosti TBARS * kod trudnica sa TIH ** u odnosu na komplikacije Complication/ N TBARS Komplikacije ([x.sup.-]) Placental abruption/ 8 40.8125 Abrupcija placente Eclampsia/ 2 40.9500 Eklamsija HELLP 4 43.9250 Hemorrhage/ 4 421500 Hemoragija Total/Ukupno 18 36.6860 * TBARS--reaktivne supstancije tiobarbiturne kiseline; ** TIH--trudnocom indukovana hipertenzija
|Printer friendly Cite/link Email Feedback|
|Title Annotation:||Professional article/Strucni clanak|
|Author:||Draganovic, Dragica; Dajic, Branka Cancarevic; Jojic, Dragica|
|Date:||Jan 1, 2017|
|Previous Article:||Evaluation of knowledge on doping in sports among serbian general practitioners/ Procena nivoainformisanostisrpskih lekara opstemedicine o dopingu u...|
|Next Article:||Bilateral simultaneous anterior cruciate ligament rupture: a case report and literature review/Istovremeno obostrano kidanje prednjeg ukrstenog...|