EXPRESSION OF ENDOTHELIAL DYSFUNCTION AS OBJECTIVE CRITERION OF SEVERITY OF PREECLAMPSIA

Abstract

Preeclampsia remains one of the most significant obstetric problems due to its high prevalence, high incidence of maternal and perinatal morbidity and mortality, as well as the need for significant economic costs for the management and delivery of pregnant women with this pathology. In recent years, a number of authors have proven the most important role of vascular endothelial dysfunction in initiating disorders of vascular tone and blood coagulation potential, which underlie the formation of multiple organ failure in pregnant women with preeclampsia. The aim of the study was to establish new objective criteria for assessing the severity of preeclampsia based on the study of the functional state of the vascular wall by various methods, both invasive and non-invasive. 118 women with 28-37 weeks of pregnancy were examined. The 1st observation group consisted of 58 pregnant women with moderate preeclampsia, the 2nd observation group included 20 pregnant women with severe preeclampsia. The control group consisted of 40 women with a physiological course of pregnancy. The functional activity of the vascular wall was assessed by the level of endothelin-1, thrombospondin, intercellular adhesion molecules and nitric oxide metabolites in the blood by enzyme immunoassay. In patients with moderate preeclampsia, the content of nitric oxide metabolites significantly decreased, and the content of endothelin-1, thrombospondin, and intercellular adhesion molecules increased relative to patients in the control group. These changes were significantly more pronounced in patients with severe preeclampsia. At the same time, to study the function of the endothelium in pregnant women with preeclampsia, we used a non-invasive method - an ultrasonic cuff test according to the Celermajer D.S. In patients with moderate preeclampsia, the degree of endothelium-dependent arterial expansion during the cuff test decreased by more than 2 times compared with the parameters of pregnant women in the control group. In pregnant women with severe preeclampsia of the group, an even more pronounced decrease in the degree of dilatation of the brachial artery was noted. Thus, the determination of markers of endothelial dysfunction in the blood, as well as the use of an ultrasonic cuff test, made it possible to identify violations of the vasomotor function in pregnant women with preeclampsia, which correlate with the severity of preeclampsia. The use of an ultrasonic cuff test and the determination of endothelial dysfunction markers can be recommended as additional objective diagnostic criteria for the severity of preeclampsia, the transition from moderate preeclampsia to severe preeclampsia.