Preeclampsia - abdominal hypertension syndrome in pregnancy. whether a hypothesis will become a theory?

Abstract

Based on the analysis of literature and their own data the authors presented modern aspects of the etiology and pathogenesis of preeclampsia from the perspective of intra-abdominal hypertension syndrome. The data are collected from a large representative sample of 647 patients at various stages of gestation. It was shown that elevated levels of intra-abdominal pressure at 20-24 weeks of pregnancy in some cases preceded the development of preeclampsia. The level of intra-abdominal pressure, preceding the development of preeclampsia in pregnant women with obesity, was significantly higher than that of normal-weight patients (p <0.001). Along with the level of intra-abdominal pressure, the rate of its increase plays an important role in the preeclampsia development, with a greater degree than the absolute value of the intra-abdominal pressure. Pregnant women with a rapid and substantial increase in intra-abdominal pressure (more than 4 mm Hg for 2 weeks of gestation) are more likely to have complications of pregnancy than patients with an increase in intra-abdominal pressure less then 2 mm Hg in a given time interval (p <0.001), while the higher the increase in intra-abdominal pressure, at the earlier stages complication develops. The article also provides information about the dynamics of intra-abdominal pressure during pregnancy, relationships of intra-abdominal hypertension with parameters of utero-placental blood flow, renal hemodynamics, intestinal perfusion and permeability, level of endotoxemia in pregnant women. Based on the results of their own investigations, the authors suggest a model of preeclampsia development as a consequence of intra-abdominal hypertension syndrome.

Monitoring intra-abdominal pressure for early detection of preeclampsia among pregnant women

“…It limited the venous return, so measuring IAP could be useful in prenatal care. Similarly, the findings confirmed by pre-eclampsia study Marshalov, et al, (2016) in which the data was a large representative sample of "more than six hundred" patients at various stages of gestation and demonstrated that an increase in intra-abdominal pressure at 20-24 weeks of pregnancy preceded the development of preeclampsia with significantly as higher than regular patients (p <0.001) and the rate of its elevation considered as an essential part in the development of preeclampsia.…”

Effects of intra-abdominal hypertension on maternal-fetal outcomes in term pregnant women: A systematic review

“…Some Authors have reported that IAH can cause venous congestion, hypertension, hypoperfusion, and systolic cardiac dysfunction [ 2 , 5 , 10 – 13 ], and multiple organs dysfunction similar to that seen in pre-eclampsia (PE) [ 14 ].…”

“…Although some studies [ 2 , 10 , 11 , 15 – 18 ] have observed the effects of IAH on adverse maternal-fetal outcomes, the assessment of IAP during pregnancy is underestimated and neglected [ 2 ]. Therefore, the present study aims to conduct a systematic review of the literature to assess the effects of IAH on maternal-fetal outcomes.…”

The association between maternal intra-abdominal pressure and hypertension in pregnancy

“…Genetic factors and immune factors have also been established as contributors to the development of preeclampsia. Additionally, increased IAP may serve as a contributing factor [ 5 ]. The extent of each factor’s contribution to the pathogenesis may vary depending on individual circumstances.…”