Pathological Uterine Perfusion in the Second Trimester Is Not Associated with Neutrophil Activation

Abstract

Pathological uterine perfusion in the second trimester was not associated with maternal neutrophil activation. The measurement of the MPO and PMN elastase concentration suggested that neutrophil activation in preeclampsia or IUGR is a secondary effect of the disease rather than a primary pathophysiological factor.

Implication of Umbilical Cord in Preeclampsia

“…The maternal plasma levels of neutrophil elastase may serve as a possible cell-free marker to quantify neutrophil activation as demonstrated in women with PE. The neutrophil elastase levels were elevated in both early-and lateonset forms of PE [7,22] . Neutrophils, but not lymphocytes or monocytes, infiltrate maternal systemic vasculature causing the majority of vascular cell dysfunction in women with PE [23] .…”

“…Many investigators [5,6] reported sVEGFR-1 as a possible PE factor. Increased neutrophils have been demonstrated in women with PE, and neutrophil activation liberates neutrophil elastase [7] . Hence, in this study, we assessed these biochemical markers in the umbilical cord and placenta of preeclamptic patients, and evaluated their impact on the mother and fetus.…”

Preeclampsia – More than a pregnancy complication

“…Since the number of altered markers in maternal plasma as well as in the placenta is enormous and various metabolic, endocrine and neuro-vegetative axes are infl uenced, it is diffi cult at this stage of the disease to differentiate between etiological factors, relevant pathophysiological factors and secondary phenomena that are not linked to the cause of the disease. For instance, factors like neutrophil activation that have been discussed as relevant pathophysiological parameters are not present until clinical manifestation and thus are part of the syndrome and not the cause of the disease (Stepan et al 2003). As a consequence, this complex dysregulation of the maternal organism does not seem to be a promising target for preeclampsia research in terms of the etiology.…”

“…However, in a recent study of our group including 50 patients, pathological uterine perfusion in the second trimester was not associated with maternal neutrophil activation. The measurement of the MPO and PMN elastase concentration suggested that neutrophil activation in preeclampsia is a secondary effect of the disease rather than a primary pathophysiological factor (Stepan et al 2003).…”

“…But a few methods showed moderate predictive accuracy, one of them being Doppler ultrasound waveform analysis. As mentioned above this is a feasible and non-invasive method to identify women at risk and although sensitivity and predictive value are limited (Papageorghiou et al 2001), at present there is no better method available for early risk assessment (Albaiges et al 2000, Stepan et al 2003. However, only about 35% of patients with disturbed uterine perfusion as a result of a failed trophoblast invasion and the persistence of a high uteroplacental resistance develop these pregnancy complications (Trudinger et al 1985).…”