Роль комплексной эхографии печени в ранней диагностике преэклампсии и HELLP-синдрома

Abstract

Objective. To study the possibilities of comprehensive ultrasound imaging with pulsed wave mode and Doppler color flow mapping in evaluation of hepatic blood flow and its compensatory capabilities in pre-eclampsia (PE) of different severity. Patients and methods. Complex liver ultrasonography combined with Doppler assessment of arterial and venous blood flow was performed in 87 pregnant women at 28–40 weeks’ gestation. The study group comprised 59 women with PE of varying severity and 12 women with HELLP syndrome. The control group included 30 women with normal pregnancy. Results. Doppler assessment of blood flow in the hepatic artery and in the maternal-placental-fetal system arteries in patients with moderate and severe PE revealed similar changes, which were manifested by elevated vascular resistance in these vessels and correlated with the severity of PE. The maximum values of pulsatility index and resistance index in the hepatic artery were observed in patients with HELLP syndrome – 1.6 ± 0.11 and 0.74 ± 0.08, respectively. Qualitative and quantitative characteristics of blood flow in the portal vein in patients with moderate PE did not statistically differ from those in the control group, while patients with severe PE and HELLP syndrome showed statistically significant disturbances of portal vein blood flow manifested by an increase in portal vein diameter and a decrease in maximum linear velocity of blood flow in the portal vein. Changes in hepatic arterial blood flow were found in patients with moderate PE in the absence of clinical and laboratory manifestations of liver dysfunction. Already in the early stages of PE, a shift of hemodynamic indices toward an increase in peripheral vascular resistance was determined. The increase in hepatic artery vascular resistance was observed in parallel with the increase of similar indices in the uterine-placental-fetal blood flow. Disturbance of blood flow in the portal vein was determined only in patients with severe PE and HELLP syndrome. Conclusion. Vascular disorders of the liver can serve as an additional diagnostic method for early diagnosis of liver involvement in the pathological process, while the signs of portal vein blood flow disorders are a criterion of extremely severe PE course, prognostically unfavorable regarding HELLP syndrome development. Key words: resistance index, liver dysfunction, hepatic artery, pre-eclampsia, hepatic blood flow, pulsatility index, HELLP syndrome