Преэклампсия является одним из очень серьез-ных осложнений беременности. Частота ее достигает 6-8% и занимает второе место среди всех причин материнской смертности после тромбоэмболиче-ских осложнений. В случаях тяжелой преэклампсии возникают такие системные нарушения, как пора-e-mail: t-ivanets@oparina4.ru жения почек, печени, сердечно-сосудистой систе-мы, церебральные нарушения [1].Существует около 30 гипотез причин возникно-вения преэклампсии, и одной из наиболее вероят-ной в настоящее время представляется предположе- Цель исследования -разработка референсных интервалов плацентарного фактора роста (PlGF) и растворимой fms-подобной тирозинкиназы-1 (sFlt-1) и значений их соотношения, а также выявление особенностей продукции этих маркеров при преэклампсии различной степени тяжести. Материал и методы. В исследование включены 374 женщины в динамике физиологической беременности (11-40 нед) и 148 пациенток с преэклампсией различной степени тяжести, развившейся в сроки 20-40 нед беременности. Группу сравнения составили 14 беременных с артериальной гипертензией, развившейся в срок 37-40 нед беременности. Концентрацию PlGF и sFlt-1 определяли на автоматическом электрохемилюминесцентном анализаторе Cobas e411 («Hitachi», Япония). Результаты. Полученные результаты позволили сформировать референсные интервалы концентрации PlGF и sFlt-1 и их соотношения в динамике I (c 11 нед), II и III триместров беременности. Показано, что у пациенток с преэклампсией отмечается повышение концентрации sFlt-1 и снижение концентрации PlGF. Причем выявленные особенности наиболее ярко выражены при тяжелой преэклампсии. Выводы. Сделан вывод о перспективности использования этих тестов при диагностике преэклампсии и решении вопроса о целесообразности пролонгирования беременности. Objective. To study the development of PlGF and sFlt-1 reference intervals and their ratios as well as to assess its production in preeclampsia of different severity. Material and methods. The study included 374 women with normal pregnancy (11-40th gestational weeks) and 148 patients with preeclampsia of dufferent severity (20-40th gestational weeks). The comparison group consisted of 14 pregnant women with arterial hypertension developed at 37-40th gestational weeks. The concentration of PlGF and sFlt-1 was measured with help of automatic electrochemiluminescence analyzer Cobas e411 («Hitachi», Japan). Results. The obtained results allowed to establish the reference intervals of PlGF and sFlt-1 concentrations and their ratio in the dynamics I (11 weeks, II and III trimesters of pregnancy). It is shown that women with preeclampsia has increased sFlt-1concentration, increased sFlt/PlGF ratio and decreased PlGF concentrations. The identified features are the most expressed for severe pre-eclampsia. Conclusion. Studied markers of pre-eclampsia can be used in clinical practice for taking decision about pregnancy prolongation.

The objective was to determine the presence and severity of placental apoptosis in pre-eclampsia. The study included 31 patients. All patients were divided into 2 groups: group I (treatment) included 11 pregnant women with preeclampsia, group II (control) - 20 healthy patients. Gene expression was evaluated with qPCR assay, and placental apoptosis was assessed by the TUNEL method. It was found that the level of placental apoptosis in preeclampsia patients was significantly higher compared to that of apparently healthy females, and in some cases stem villi are destroyed due to programmed cell death in the villous stroma and syncytiotrophoblast. In preeclampsia, oxidative stress leads to increased levels of apoptosis in placental villi. Both trophoblast cells and, in certain cases, cells of the villous stroma are subject to apoptosis.

The occurrence and development of such complications of pregnancy as preeclampsia, placental insufficiency, fetal growth restriction can be mediated by the systemic vascular damage. Understanding the pathophysiological mechanisms in the mother-placenta-fetus system contributes to the improvement of diagnostic methods and the selection of pathogenetically valid therapy for certain obstetric complications. In the systemic inflammatory response syndrome accompanying obstetric complications, the uncontrolled and excessive activation of proinflammatory mediators occurs, which leads to generalized tissue damage and development of multiple organ failure.The use of antiplatelet agents at a preventive dose in pregnant women with high risk of placental insufficiency and fetal growth restriction contributes to the reduction of systemic and placental blood flow disorders by affecting the vascular endothelium, increasing the synthesis of prostacyclin and nitric oxide, thereby implementing its angioprotective properties and increasing blood flow in the arteries and existing collaterals.The obtained data showed that adding of dipyridamole to the algorithm for managing pregnant women with high risk of placental insufficiency and fetal growth restriction, starting from the II trimester of gestation allows to reduce the risk of endotheliopathy and thrombophilia, improve obstetric and perinatal outcomes.

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Inflammatory diseases of the female genitals are an actual problem of obstetrics and gynaecology, as there is no tendency towards decline in the prevalence of these diseases despite improvements in treatment methods. An inadequate assessment of the severity of the infection process and an incorrectly chosen therapy scheme leads to the recurring chronic course.