A.R. AZAMATOV, Yu.V. TEZIKOV, I.S. LIPATOV, O.B. KALINKINA

Samara State Medical University of the Ministry of Health of the Russian Federation, Samara

 Contact:

Azamatov A.R. ― postgraduate student of the Department of Obstetrics and Gynecology No. 1

Address: 89 Chapaevskaya Str., 4430099, Samara, Russian Federation, tel. +7-927-90-60-332, e-mail: azamatov.amir@yandex.ru

 Objective. To conduct a comparative analysis of the clinical and laboratory features of the course of early and late pre-eclampsia.

Material and methods. A single-center, one-stage, observational clinical study was conducted in parallel groups: group I consisted of 44 pregnant women with early PE, group II consisted of 58 pregnant women with late PE, and group III (control) consisted of 30 healthy women with physiological gestation. Pregnant women with complicated severe PE were not included in the study. We measured metabolic parameters, hormones, markers of endothelial and hemostasiological dysfunction, pro-inflammatory state, decidualization and placental angiogenesis, as well as the type of daily variability of blood pressure, the episodes of nocturnal apnea and sleep quality in all pregnant women.

Results. An analysis of the features of the course of PE without multiple organ failure showed that early and late PE have a similar severity of clinical manifestations (level of blood pressure and proteinuria, the occurrence of pathological types of daily variability of blood pressure, insomnia, episodes of gestational sleep apnea) and pathogenetically significant laboratory changes (diabetic and atherogenic disorders with the formation of pathological insulin resistance and hyperinsulinemia, pro-inflammatory and prothrombogenic status, hyperuricemia, endothelial dysfunction, oxidative stress, antiangiogenic state). This indicates the clinical and pathogenetic homogeneity of PE regardless of the term of manifestation. At the same time, fetal growth restriction of stage II-III severity was diagnosed more frequently and there were statistically significant differences in indicators associated with placental dysfunction. This reflects a greater pathogenetic involvement of structural and functional disorders of fetoplacental complex in early PE, which as an additional catalyst accelerates the formation and increase of general PE mechanisms.

Conclusion. Early and late PE are a single clinical category, the term of manifestation of which is individual and determined by the presence of gestational and periconceptional factors, pathology of the embryo(feto)placental system, and their involvement in the implementation of a single pathogenetic mechanism of PE.

Key words: early preeclampsia, late preeclampsia, pathogenesis, a single clinical category.

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