The features of haemodynamic pregnancy support witn gestational endotheliopathy

Abstract

The preeclampsia is a multisystem pregnancy-specific disease. The incidences of preeclampsia (PE) are 5 to 14% of all pregnancies in the world, contributes to 18% of preterm birth, and 10%-27% of global maternal deaths worldwide, while severe PE can develop to about 25% of all cases of preeclampsia. The aim of the study was an anthropophysiological analysis of the circulatory components of hemodynamic gestational support in physiological pregnancy (PhP) and women with gestational endotheliopathy who had high risk of PE and their association with the state of the pumping function of the heart. Multicentral description of “hemodynamic model” of the examined conditions was made basis on antropophysiological research of the circulatory state of the CVS, using the diagnostic system ANTROPOS-CAVASCREEN, which is an innovative diagnostic complex for analyzing the performance of various blood circulation sections using noninvasive methods (thoracal and regional tetrapolar rheography, electrocardiography, BP measurement). Results It is necessary to mean that in position upright taking into account expression of the hypertensive state totally with a normative increase of MAP the stake of the states of CVS of pressor orientation for women arrived at 90–92%, demonstrating actuality of the tense of pressure adjustment in adaptation of CVS to the gravitational factor of circulation of blood for a human as straight-walking creature. There was a background to examine it as physiological basis of forming of the hypertensive condition, including, for pregnant women. The optimization of the circulatory state of the CVS during pregnancy accompanied by the clear increase of systolic descriptions on the pumping function of heart (PFH) and shows up on all three trimesters, especially at PhP. On MVB such orientation simply shows up during all three trimesters as at PhP—lying and upright totally for 24 descriptions from 24 (P < 0.01) and at GEP—also for 18 from 24 (P < 0.05). The hypertensive state was absent only in the first trimester. It appears in the second and third trimesters, though at lower levels (3–5%; P ≤ 0.05) compared to nonpregnant women (10%). For GEP, the hypertensive states were presented in the lying position during all three trimesters, increasing three times (from 5% for nonpregnant women to 15% in GEP; P < 0.05). For gestational endotheliopathy in all modes of blood pressure, the representativeness of the hyperkinetic state in the PFH standing (type III) was significantly higher compared to PhP (P < 0.01). According to it, the marker of tension of hemodynamic alteration was a transition on the MVB to the hyperkinetic state in position from standing to lying-to type III of dynamic organization of the circulator state of CVS and system hyperresistance of arterial vessels, and by the predictor of insufficiency of adaptation of CVS was displayed mostly in the position upright by perfusion type, combining with circulatory syndromes limiting adaptive possibilities of arterial circulation. Conclusion. Expression of autonomic “slipping out” of arterial vessels of abdominal and pelvic circulation from under system vasoconstriction, probably because of endothelium-depending humoral mechanism, determine phenomenon of optimization of the circulatory state of CVS at the beginning of pregnancy, especially expressed at FP, and inhibition of pathological changes. The marker of tension of hemodynamic alteration was a transition to the hyperkinetic state in position from standing to lying - to III type of dynamic organization of the circulator state of СVS and system hyperresistance of arterial vessels, and by the predictor of insufficiency of adaptation of СVS was displayed mostly in the position upright by perfusion type, combining with circulatory syndromes limiting adaptive possibilities of arterial circulation.