The Ukrainian Experience for Effective Management of Severe Preeclampsia

Abstract

Hypertensive disorders of pregnancy are a leading cause of maternal morbidity and mortality worldwide, accounting for more than 70,000 maternal deaths each year. Of all maternal deaths, 10–15% are directly associated with preeclampsia (PE) and eclampsia. The new version of the Ukrainian National Clinical Guideline and Clinical Protocol «Hypertensive disorders during pregnancy, childbirth and the postpartum period» 2022 presents a synthesis of the scientific evidence that is relevant to the concerning severe PE treatment strategies. It was presented the new algorithm of clinical management for severe pre-eclampsia «CALM DOWN» that implemented to the new Ukrainian clinical protocol of primary, secondary (specialized) and tertiary (highly specialized) medical care. CALM DOWN is the special mnemonic that means «step by step strategy» for the medical teamwork. Conclusions. The algorithm «CALM DOWN» have been proposed for the optimal timing of severe PE, offers to systematize the participation of each member of the team in the provision of emergency care and should be implemented in clinical practice based on the peculiarities of the specifics of work, resources, functioning and localization of the maternity facilities when forming personal route of the patient.

Possibilities of Correcting Cellular-Humoral Immune Disorders and Cytokine Status in High-Risk Pregnant Women for the Development of Preeclampsia

“…This is associated with increased synthesis. In women with PE, we observed a signifi cant decrease in Ig G. We hypothesize that this decrease is caused by exhaustion of the reactivity of the humoral part of the general immune system in PE [17].…”

“…We hypothesize that the excessive release of proinfl ammatory cytokines in the presence of defi cient antiinfl ammatory cytokines, along with increased levels of T-suppressor/killer cells and increased production of IgM, indicates an exaggerated infl ammatory response in the maternal organism, likely directed against foreign fetal antigens [16][17][18]. This response leads to incomplete invasion of trophoblast cells into the spiral arteries of the uterus, resulting in systemic endothelial dysfunction and the development of pre-eclampsia [18][19][20].…”

“…In this case, the vascular endothelium remains sensitive to the action of numerous pressor factors, and a high-resistance blood fl ow prone to vasospasm is formed in the uteroplacental complex [11][12][13][14][15]. Immunological factors and changes in cytokine balance play an important role in this process [16][17][18].…”

“…During physiological pregnancy, trophoblast cells, which are foreign to the mother's body, initiate a series of immunological reactions, during which the level of production of proinfl ammatory cytokines of the Th1 type by monocytes decreases [19][20][21] and, on the contrary, the production of Th2 cytokines increases [16][17][18][19][20][21][22].…”

Pathogenetic Prerequisites for Early Pregnancy Loss

“…За даними O. Laba (2011 р. ), частота передчасних пологів у жінок із підвищеним рівнем фосфоліпази А2 в піхві становила 15,6%, аналогічний показник у жінок із низькою концентрацією вагінальної фосфоліпази А2 становив 8,5% [11].…”