Abstract
Aim: to determine prognostic criteria of severe preeclampsia based on the assessment of endothelium-dependent (ED) flow-mediated dilation (FMD) of the brachial artery (BA). Patients and Methods: 97 pregnant women (>28 weeks of pregnancy) with moderate preeclampsia were enrolled. These women were retrospectively divided into two groups. Group 1 included 42 pregnant women (mean age 30.0±0.5 years) in whom the severity of preeclampsia increased after treatment. Group 2 included 55 pregnant women (mean age 31.0±0.7 years) whose severity of preeclampsia did not increase after treatment. Group 3 (control group) included 20 women with a healthy pregnancy. ED FMD of BA was assessed by vascular ultrasound using a reactive hyperemia test. In addition, BA diameter and peak systolic velocity (PSV) 15 sec and 1 min after cuff deflation were measured. These measurements were performed at enrollment and after one week (or in feeling worse). Results: healthy pregnancy was characterized by a gradual increase in BA diameter in response to cuff inflation (by 15.7% and 23.9% after 15 sec and 1 min, respectively, at baseline and by 17.8% and 21.3% after 15 sec and 1 min, respectively, after one week). In pregnant women with preeclampsia, baseline changes in BA diameter were less significant. Meanwhile, after one week, a reduction in BA diameter was reported in group 1, and close-to-normal BA diameter was reported in group 2. In group 3, BA PSV increased by 5.2% and 16% in 15 sec and 1 min, respectively, after cuff inflation. In pregnant women with preeclampsia, BA PSV, in contrast, was reduced (more significant after 1 min). Conclusion: increased BA diameter and PSV by less than 10% 15 sec and 1 min after cuff inflation indicate endothelial dysfunction. A negative pattern of changes in these parameters suggests an unfavorable course of preeclampsia and its transition to severe disease. KEYWORDS: preeclampsia, endothelial dysfunction, vasodilation, brachial artery, peak systolic velocity, prognosis. FOR CITATION: Shavaeva R.Kh., Murashko A.V., Zuev V.M. et al. Predicting preeclampsia course based on endothelium-dependent dilation. Russian Journal of Woman and Child Health. 2021;4(4):317–321 (in Russ.). DOI: 10.32364/2618-8430-2021-4-4-317-321.
Highlights
Aim: to determine prognostic criteria of severe preeclampsia based on the assessment of endothelium-dependent (ED) flow-mediated dilation (FMD) of the brachial artery (BA)
В настоящее время доминирующей концепцией возникновения ПЭ является недостаточность инвазии цитотрофобласта с отсутствием ремоделирования маточно-плацентарных артерий и развитием ишемии плаценты [7, 8]
2. Изменение пиковую систолическую скорость кровотока в ПА (ПСС ПА) через 15 с и через 1 мин в ответ на пробу с манжетой исходно (A) и при повторном исследовании через 1 нед
Summary
У всех женщин проводили оценку ЭЗВД ПА на основании данных ультразвукового исследования кровотока при пробе реактивной гиперемии. Результаты исследования: физиологическое течение беременности характеризовалось последовательным увеличением диаметра ПА в ответ на пробу с манжетой — на 15,7% через 15 с и на 23,9% через 1 мин исходно и на 17,8% и 21,3% соответственно через 1 нед. В группах беременных с ПЭ исходно изменение диаметра ПА было гораздо менее выраженным, а через 1 нед. При оценке ПСС ПА в 3-й группе отмечен прирост показателя на 5,2% и 16% в ответ на пробу через 15 с и через 1 мин соответственно, у беременных с ПЭ, напротив, наблюдалось снижение, причем более выраженное через 1 мин. Заключение: прирост диаметра ПА и ПСС ПА менее чем на 10% сразу после компрессии и через 1 мин может указывать на наличие эндотелиальной дисфункции.
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