Features of vascular stiffness in pregnancy complicated by preeclampsia and postpartum

Abstract

Actuality. Pre-eclampsia during pregnancy is a major cause of maternal mortality, intra- and neonatal pathology [1]. Sharply there is a question about the search method of determining the predictors of pre-eclampsia and the degree of influence on a woman’s body for the purpose of timely diagnosis and treatment. Interest in the method of determining the parameters of arterial stiffness is growing every year because of the availability and relative ease of use to determine the degree of maladjustment of the vascular system and assessing the risks of cardiovascular disease.Objective. Evaluation of indicators characterizing stiffness of the arterial wall in pre-eclampsia during pregnancy and after childbirth.Materials and Methods. In a prospective cohort comparative study included 62 pregnant women aged 19 to 35: 35 women with physiological pregnancy without physical abnormalities and 27 women with preeclampsia moderate, without preeclampsia history. Surveys were carried out in time for 22-24, 32-34 weeks of gestation and at 8 hours after delivery. To evaluate the rigidity of the vascular wall used complex BPLab.Results. In pregnant women with pre-eclampsia there is an increase of arterial stiffness parameters at 22 weeks of pregnancy in comparison with the original data at 12 weeks of gestation, IA uvelichilsyana 29.3%, 12.5% PWV. Most significantly in the intervention group to the third trimester have changed the following parameters: IA averaged – - 28% (± 5,5) + 37% from baseline, PWV – 8 m/s (± 0,9) + 12,5%, in the control group: IA – - 39,6% (± 8,1) + 12,2% in comparison with the data of 12 weeks’ gestation, PWV – 7.43 m/s (± 0,82) + 12,5%, demonstrating various adaptive features of the vascular wall in groups. In the early postpartum period significantly positive dynamics of arterial stiffness parameters in the group with physiological pregnancy, pre-eclampsia in the group with the values remain the same or change slightly. Conclusions. Thus, from the data of the pulse wave analysis is the best method for measuring vascular stiffness non-invasively in pregnant women. This method demonstrates the physiological adaptation of vessels to the gestational process, and shows the changes associated with preeclampsia as the background of pregnancy and after childbirth. Thus, this method makes it possible to evaluate the adaptive reserve of the vascular wall for the purpose of forecasting the development of cardiovascular complications.

Clinical and Prognostic Value of Vascular Wall Elasticity in Pregnant Women with Arterial Hypertension: A Review

“…A highly informative and safe method for determining outpatient blood pressure for the mother and fetus is ABPM (24-hour blood pressure monitoring) -a method of applanation tonometry that registers a pulse wave on the brachial artery, allows you to study the rigidity of the vascular wall, central aortic blood pressure (CAP), daily fluctuations in peripheral pressure and differentiate hypertensive disorders during pregnancy [34,35].…”

“…Further studies of vascular elasticity were conducted in pregnant women with preeclampsia (II-III trimester). In some studies, an increase in PWV and the augmentation index was shown in comparison with normotensive pregnant women [35], in others, an increase in PWV with an unchanged augmentation index [37], and in a number of studies, these parameters did not differ from physiological pregnancy [38]. There is also information in the literature where only an increase in the augmentation index was detected in women with preeclampsia, while other stiffness parameters were not studied [39].…”

“…The same authors examined women with a history of preeclampsia. Data were obtained on high values of the augmentation index, PWV, the time of propagation of the reflected wave and the index of arterial rigidity in the second trimester, which may indicate more rigid vessels compared to pregnant women without a history of preeclampsia [35].…”

The content of matrix metalloproteinase-12 in pregnancy complicated by preeclampsia

“…На сегодняшний день известно, что при преэклампсии наблюдается торможение миграции и глубины инвазии тро-фобласта. Поверхностное проникновение ци-тотрофобласта приводит к недостаточной пе-рестройке спиральных маточных артерий что, в свою очередь, запускает каскад изменений: нарушение строения плаценты, дисфункцию эндотелия, патологическую жесткость сосудов, генерализованный сосудистый спазм, гипово-лемию, гипоксию органов и тканей, в том числе маточно-плацентарного комплекса [3][4][5][6][7].…”