Perinatology and pediatric.Ukraine. 2017.4(72):70-77; doi 10.15574/PP.2017.72.70

Konkov D. G., Bulavenko O. V., Taran O. A.
National Pirogov Memorial Medical University, Vinnytsia, Ukraine
Objective: to evaluate the trimestral postural-depending vasotonic function of the endothelium as an important marker for the development of preeclampsia.
Material and methods. In the prospective study of the predictive significance of endothelium-dependent vasodilation (EDVD), 115 pregnant women with gestational endotheliopathy (GE) were enrolled. The trimesteral postural-dependent (lying-standing) vasotonic function of the endothelium was studied.
Results. Changes in the response of vessels to the occlusal test (EDVD), taking into account the position of the pregnant woman (lying-standing), showed the adequate hemodynamics during the physiological course of the gestational process. The EDVD indices in the preclinical form of endothelial dysfunction in pregnant women indicated the compensational adaptive changes of the endothelium-dependent component of vascular tone, especially the expressive dynamics was observed in the third trimester. In pregnant women with clinical manifestation of GE, critical violations of vasoregulative endothelial function in I and III trimesters were determined.
Conclusions. The decrease in EDVD values below 10% at the end of the first trimester, was a reliable marker for predicting preeclampsia. In the women with clinical manifestation of GE in I and III trimesters of pregnancy, the critical violations of the vasoregulative function of endothelium were determined, whereas in the preclinical GE, the EDVD indices indicated the compensational adaptive changes in the endothelium-dependent component of vascular tone. The functional status evaluation of the endothelium by means of EDVD, taking into account the anthropophysiological approach, is an adequate non-invasive method for assessing of the endothelial function in pregnant women and can be used as an early test for adequate correction of disturbances in vascular tone regulation mechanisms with the aim to prevent the development of possible perinatal pathology.
Key words: preeclampsia, endothelial dysfunction, gestational endotheliopathy, endothelium-dependent vasodilation, microalbuminuria.

References

1. Konkov DG, Galich SR, Belkaniya GS. (2013). Klinicheskoe znachenie gestatsionnoy endoteliopatii. Z turbotoiu pro zhinku. 2: 64—67.

2. Konkov DH. (2014). Osoblyvosti doplerometrychnoho doslidzhennia matkovo-platsentarnoho krovoplynu pry hestatsiinii endoteliopatii. Zbirnyk naukovykh prats asotsiatsii akusheriv-hinekolohiv Ukrainy: 182—186.

3. Zaporozhan VM, Halych SR, Konkov DH. (2012). Pat. No. 71862 A Ukraina, MPK G01N 33/48. Sposib doklinichnoi diahnostyky hestatsiinoi endoteliopatii. Zaiavnyk ta patentovlasnyk Vinnytskyi natsionalnyi medychnyi universytet im. M.I. Pyrohova. — No. U 201201377; zaiavl. 09.02.2012; opubl. 25.07.2012, Biul. No. 14.

4. Zaporozhan VM, Konkov DH, Halych SR, Lutsker OL. (2013). Pat. No. 77984 A Ukraina, MPK A61V 10/00. Sposib neinvazyvnoi diahnostyky funktsionalnoho stanu endoteliiu pry vahitnosti. Zaiavnyk ta patentovlasnyk Vinnytskyi natsionalnyi medychnyi universytet im. M.I. Pyrohova. — No. U 2012074361; zaiavl. 19.06.2012; opubl. 11.03.2013, Biul. No. 5.

5. Ali SM, Khalil RA. (2015). Genetic, immune and vasoactive factors in the vascular dysfunction associated with hypertension in pregnancy. Expert Opinion on Therapeutic Targets. 19: 1495—1515. https://doi.org/10.1517/14728222.2015.1067684; PMid:26294111 PMCid:PMC4640938

6. Tuzcu ZB, Asicioglu E, Sunbul M et al. (2015). Circulating endothelial cell number and markers of endothelial dysfunction in previously preeclamptic women. American Journal of Obstetrics and Gynecology. 213(533): e531—e537. https://doi.org/10.1016/j.ajog.2015.06.043

7. Jardim LL, Rios DR, Perucci LO et al. (2015). Is the imbalance between pro-angiogenic and anti-angiogenic factors associated with preeclampsia? Clinica Chimica Acta. 447: 34—38. https://doi.org/10.1016/j.cca.2015.05.004; PMid:25982781

8. Konkov D. (2017). The expression of sPECAM-1 and sVCAM-1 in the genesis of gestational endotheliopathy. The abstract book of the 17th World Congress of the Academy of Human Reproduction, (Rome, Italy. 15—18 March 2017). http://hr2017.humanrepacademy.org/abstractbook/pdf/abs5679.pdf.

9. Possomato-Vieira JS, Khalil RA. (2016). Mechanisms of endothelial dysfunction in hypertensive pregnancy and preeclampsia. Advances in Pharmacology. 77: 361-431. https://doi.org/10.1016/bs.apha.2016.04.008; PMid:27451103 PMCid:PMC4965238

10. Brandгo AHF, Evangelista AA, Martins RMF et al. (2014). Prediction of early and late preeclampsia by flow-mediated dilation of the brachial artery. Radiol Bras. 47(4): 206—209.