Introduction. Preeclampsia (PE) is a life-threatening condition for the mother, the fetus, and the newborn. Matrix metalloproteinases (MMP) participate in the two primary stages of PE: remodeling of blood vessels at the stage of placental formation and the development of hypertension due to damage to the basement membrane of blood vessels. The object of the present study was to reveal the role of MMP-2 and MMP-9 in the development of severe preeclampsia. Materials and Methods. We conducted a retrospective study that included 92 pregnant women at a gestational age of 26-38 weeks, of which the principal group consisted of 61 patients with severe PE. We divided the principal group into two subgroups: the first subgroup was designated the severe early-onset preeclampsia (EO-PE) group and consisted of 30 pregnant women. The second group was designated the severe late-onset preeclampsia (LO-PE) group, comprising 31 patients. We determined the plasma concentrations of MMPs 2 and 9 in the groups with an ELISA. Results. In the group of PE patients with both EO-PE and LO-PE, the level of MMP-2 was significantly higher compared to the women undergoing normal pregnancy; and we observed no significant differences when we compared the levels of MMP-2 in the subgroups with EO-PE and LO-PE. Analysis of the concentrations of MMP-9 in EO-PE and LO-PE subgroups revealed attenuated levels of MMP-9 in both groups relative to the control group. We also noted a diminished level of MMP-9 in the EO-PE group compared to the LO-PE group. Conclusions. The significantly increased levels of MMP-2 in women—both in the EO-PE and LO severe PE subgroups—explain the participation of this enzyme in endothelial dysfunction in the second stage of severe PE. A diminution in MMP-9 in the EO-PE group confirmed the participation of MMP-9 in the process of spiral artery transformation.

Introduction. The aim of this study is to assess maternal cardiac function in the postpartum period, after 2 and 6 months in the parturient with preeclampsia and eclampsia. Materials and Methods. Prospective study: 90 postpartum women after preeclampsia and eclampsia and 55 patients after an uncomplicated pregnancy. The parameters of maternal hemodynamics were recorded on days 1, 3, 5, 9, and 14 of postpartum period, after 2 and 6 months. The cardiac parameters were assessed. Results. PE is accompanied by increased peripheral vascular resistance. The indicator of vascular resistance, SVR, is elevated for both mild and severe PE. With mild PE, a significant increase in SVR is observed up to 5 days of postpartum period, with severe PE/E up to 9 days. We found that in case of severe PE, SVR remains elevated to 6 months after delivery. The parameters of the contractile function of the heart (ESV, EDV, SV, SI, CO, СI, MVCF) were significantly decreased: with mild PE up to 5-9 days, with severe up to 9-14 days of puerperia. ESV, SV, SI, CO, and CI remain low with severe PE up to 6 months. The revealed decreasing of contractile function of the heart is a sign of asymptomatic heart failure. Conclusions. The hemodynamics of the puerperas after PE and E is characterized by impaired contractility of the myocardium and an increase in the indices of peripheral resistance. The degree of deviation in the parameters of cardiac hemodynamics and vascular resistance depended on the severity of hypertensive complications of pregnancy.

In the present review, a new approach to studying the pathogenesis and predicting the development of preeclampsia (PE) – namely, the determination of matrix metalloproteinases (MMPs) – is discussed. Currently, the major cause of PE is thought to be an incomplete remodeling of spiral arteries because of an insufficient number of invading cytotrophoblasts or the absence/inactivation of crucial lysing enzymes, i.e. matrix metalloproteinases. The role of MMP-1, MМP-2, MМP-3, MМP-7, MМP-9 in the placenta formation, the development of oxidative stress and endothelial dysfunction is described. We propose that in the future, the MMPs may be used for differentially predicting early and late PE.

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Aim. Provide evidence for the connection between placental insufficiency and preeclampsia and rationalize a unified approach to the prevention of placenta associated disorders. Materials and methods. The study was carried out in two stages. At the first (clinical statistical) stage, the incidence rates of preeclampsia (PE) and placental insufficiency (PI) were compared based on the data from Rosstat and from a regional perinatal center for the past 25 years; the most informative predictors of PI and PE were compared using the known clinical epidemiological tests. At the second stage, a prospective study of 140 high-risk pregnant patients with severe PI was carried out to confirm and generalize the hypothesis on the common predictors of PI and PE. Two groups of patients were compared: I – 68 women with isolated PI and II – 72 women with PI combined with earlyor late-onset PE. The control group included 30 women with uncomplicated pregnancy. Immunoenzyme assays, immunofluorescence, biochemical analyses, and morphological studies of placenta were used. Results. The incidence rates of PI and PE, both in the communities and in the tertiary care hospital, pointed to their intercorrelation. This similarity of informative values of PI and PE predictors related to the most important operational characteristics of clinical epidemiology indicates the lack of pathognomonic significance of the early predictors and, on the other hand, supports the concept of the common mechanisms of placenta-associated pregnancy complications. In pregnant women with a high risk of PI decompensation, PE developed in 51% of cases (early-onset – 72%, late-onset – 28%); of those, 18% were diagnosed with severe PE, and 33% – with moderate PE. The obtained data confirm that the manifestation of early-onset PE is pathogenetically related to structural and functional disorders of the early fetoplacental complex (FPC), while late-onset PE is associated with FPC changes in the subsequent stages of pregnancy, and with a synergistic effect of extragenital and obstetrical pathology. The proposed predictive model of PE connects the manifestation of PE with the status of the placenta. Conclusion. The knowledge of pathogenetically significant risk factors allows for stratifying pregnant women in order to conduct a common preventive monotherapy of placenta associated disorders. The present approach to the management of high-risk pregnancy is in line with the principles of 4Р-medicine.