Pathogenesis-wise substantiation of early diagnostic criteria for severe pre-eclampsia

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OBJECTIVE

To develop the early diagnostic criteria for severe pre-eclampsia taking into account the revealed significant pathogenesis-wise features of this pregnancy’s complication.

MATERIAL AND METHODS

In the prospective observational study a clinical and laboratory examination of 180 pregnant women with independent high risk factors of pre-eclampsia was carried out. 89 examined patients with realized pre-eclampsia of moderate and severe degree was the group 1. The group 2 consisted of 30 apparently healthy pregnant women with a physiological gestation.

RESULTS

The changes in metabolic, hormonal, pro-inflammatory, endothelial-hemostasis, placental parameters characterizing the mechanisms of energy-plastic support for fetal growth in uncomplicated pregnancy increase significantly in pre-eclampsia. Development the pathological types of daily blood pressure profile (non-dipper, night-picker) in pregnant women of the 1^st group, also insomnia, gestational sleep apnea, visceral fat deposition in the abdominal wall, pathological insulin resistance and hyperinsulinemia associated with atherogenic, immuno-metabolic and pro-inflammatory disorders, hyperuricemia, hyper-leptinemia, pro-thrombotic status, antiangiogenic state and endothelial dysfunction reflect the pronounced pathogenic similarity of pre-eclampsia and metabolic syndrome. Evaluation of the revealed clinical and laboratory features of pre-eclampsia development using the methods of one- and multidimensional logistic regression made it possible to develop the criteria for the early diagnosis of severe pre-eclampsia.

CONCLUSION

The usage of a pathogenesis-wise justified diagnostic index (insulin ÷ placental growth factor), reflecting the totality of systemic (pathological insulin resistance and hyperinsulinemia) and local changes associated with the development of the fetal-placental complex, and a model of early diagnosis of severe preeclampsia, comprehensively combining laboratory (diagnostic index) and clinical (pathological types of daily variability in blood pressure) features of this complication of gestation, optimizes the choice of medical tactics that would reduce the frequency of complicated forms of preeclampsia and provide an improvement in gestational and perinatal outcomes.

Keywords:

severe pre-eclampsia

metabolic syndrome

insulin resistance

hyperinsulinemia

pathogenesis

diagnostic index

diagnostic model

Authors:

Azamatov A.R.

Samara State Medical University

Tezikov Yu.V.

Samara State Medical University

Lipatov I.S.

Samara State Medical University

Received:

28.09.2020

Accepted:

30.10.2020

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