Changes in the concentration of endothelin-1 and the state of blood flow in the uterine arteries of women in the third trimester of gestation with exacerbation of cytomegalovirus infection in the second trimester of pregnancy

Abstract

Aim. To assess the change in the concentration of endothelin-1 (ET-1) and the state of uteroplacental blood flow in women in the third trimester of gestation with exacerbation of cytomegalovirus infection (CMVI) in the second trimester of pregnancy.Materials and methods. A comprehensive examination of 120 women with pregnancies uncomplicated and complicated by exacerbation of CMVI in the second trimester of gestation was carried out. The first group consisted of 30 women with a seronegative CMVI normal pregnancy, the second group – 30 patients with a latent course of CMVI and the development of chronic compensated placental insufficiency (CCPI), the third – 30 women with exacerbation of CMVI and CCPI, and the fourth – 30 patients with exacerbation of CMVI and chronic subcompensated placental insufficiency (CSPI).Results. With the development of CCPI at 30-34 weeks of gestation in women of the second group, compared with the first, the concentration of ET-1 in blood serum increased to 1.16±0.09 fmol/L (in the control – 0.86±0.08 fmol/L, p<0,05). There was an increase in the systolic-diastolic ratio (SDR) in the right uterine artery (RUA) by 1.40 times (p=0.000001) and in the left uterine artery (LUA) by 1.46 times (p=0.000001), which illustrated the important role of endothelial activation in increasing resistance in the uterine artery basin. In the third group, in comparison with the first and second ones, an increase in the concentration of ET-1 was recorded to 1.57±0.13 fmol/L (p<0.001 and p<0.05, respectively), reflecting a more pronounced activation of the endothelium. In women of the third group, in comparison with the first and second groups, there was an increase in SDR in the RUA by 1.43 times (p=0.000001) and 1.01 times (p=0.046), respectively. Comparison of blood flow in the LUA in women in the third group in comparison with that in the first and second groups showed an increase in SDR by 1.47 times (p=0.000001) and 1.01 times (p=0.0462), respectively. At the same time, a strong positive correlation was recorded between the SDR in the RUA and the level of ET-1 (r=076; p<0.001), which is a marker of an endothelium-dependent increase in vascular resistance. In women of the fourth group, the level of ET-1 was 2.15±0.17 fmol/L, which is significantly higher compared with group 1 (5.08 times, p=0.000001), with the second group (4.08 times, p=0.000001) and in comparison with the third group (1.23 times, p=0.0029). SDR in RUA in the fourth group compared to the first one increased by 1.62 times (p=0.000001), and compared to the second – by 1.15 times (p=0.00002). At the same time, in patients of the fourth group in comparison with the third group, SDR in RUA increased by 1.13 times (p=0.024). In the fourth group, in contrast to the first one, there was an increase in SDR in LUA by 1.58 times (p=0.000001), and in comparison, with the second group, SDR in LUA was 1.07 times higher (p=0.00021). Patients of the fourth group, in comparison with the third one, had higher SDR indices in the LUA (1.06 times, p=0.0207). There was a stronger relationship between the SDR value in RUA and the concentration of ET-1 (r=0.86; p<0.001) and a weak correlation between SDR in LUA and ET-1 (r=0.47; p<0.01), which reflects the influence of endothelial dysfunction in response to an increase in the tone of the uterine arteries.Conclusion. The development of CSPI in the third trimester of gestation in women who underwent an exacerbation of CMVI in the second trimester of pregnancy, in contrast to CCPI with a similar infectious pathology in pregnant women, is characterized by a more pronounced increase in vascular resistance in the uterine artery basin against the background of endothelial dysfunction.