PREDICTION OF HYPERTENSIVE PREGNANCY COMPLICATIONS BASED ON THE ASSESSMENT OF CARDIO REMODELING OF THE LEFT VENTRICLE MYOCARDIUM
Main Article Content
Abstract
Objective of the study – to assess the nature of myocardial remodeling of the left ventricle among pregnant women with chronic arterial hypertension (CAH), isolated and complicated by preeclampsia (PE), and its influence on the possibility of gestational and perinatal complications.
Materials and methods. The study included pregnant women with CAH (n = 376): group I – with isolated CAH (n = 172), group II – with preeclampsia (PE) being developed on the CAH background (n = 204). Methods used: sonography, dopplerometry of the uteroplacental and fetal-placental blood flow, echocardiography.
Results. The following conclusions were proved: high frequency of gestational (placental insufficiency, fetal growth retardation) and childbirth (miscarriage) complications among pregnant women with PE developed on the CAH background compared to isolated chronic hypertension, perinatal status (lower ratings on the Apgar scale, low weight and newborns’ morbidity). Peculiarities of cardioremodeling pregnant women with CAH were determined: comparable frequency of concentric remodeling in the II and III trimesters, an increase in left ventricle hypertrophy of a concentric type, with some prevalence in the group with PE. It was shown that there is prognostic significance of abnormal LV myocardial geometry patterns compared to normal: placental insufficiency (PI), fetal growth retardation, neonatal hypotrophy and low Apgar ratings (less than 7 points). Hemodynamic shifts in the mother-placenta-fetus system prevailed in the group of pregnant women with PE on the CAH background, with concentric geometry of the left myocardium ventricle.
Conclusion. Assessment of the LV myocardium geometry type allows to predict the risk of PE development among pregnant women with CAH, gestational complications, adverse perinatal outcomes (birth status and morbidity), the effectiveness of antihypertensive therapy.
Keywords
Article Details
Information about financing and conflict of interests
The author declares that there are no apparent or potential conflicts of interest related to the publication of this article.
This work is licensed under a Creative Commons Attribution 4.0 License.
How to Cite
References
Savel'eva GM, Suhih GT, Serov VN, Radzinskij VE. Obstetrics: national leadership. M.: GEOTAR-Media, 2008. 1090 p. Russian (Савельева Г.М., Сухих Г.Т., Серов В.Н., Радзинский В.Е. Акушерство: национальное руководство. М.: ГЭОТАР-Медиа. 2008. 1090 с.)
Apresyan SV, Radzinskij VE. Pregnancy and childbirth with extragenital diseases. M.: GEOTAR-Media, 2015. 536 p. Russian (Апресян С.В., Радзинский В.Е. Беременность и роды при экстрагенитальных заболеваниях. М.: ГЭОТАР-Медиа, 2015. 536 с.)
Milovanov AP. Maternal mortality analysis: a guide for physicians. M.: MDV, 2008. 228 p. Russian (Милованов А.П. Анализ причин материнской смертности: руководство для врачей. М.: МДВ, 2008. 228 с.)
Guryeva VM, Petruhin VA, Bashakin NF, Kotov YuB. Pregnancy and perinatal outcome in women with essential arterial hypertension. Materiali XI Vserossiiskogo nauchnogo foruma «Mat i ditya». M., 2010. P. 57-58. Russian (Гурьева В.М., Петрухин В.А., Башакин Н.Ф., Котов Ю.Б. Течение беременности и перинатальный исход у женщин с эссенциальной артериальной гипертензией //Материалы XI Всероссийского научного форума «Мать и дитя». М., 2010. С. 57-58)
Orazmuradov AA, Belkov SA, Karpova EV, Bratchikova TV, Litvinenko IA, Goncharova OV, Zorina EA. Uric acid as a predictor of adverse perinatal outcomes and gestational complications in pregnant women with hypertension. Vestnik RUDN. Seriya «Medicina». 2010; 6: 38-44. Russian (Оразмурадов А.А., Белков С.А., Карпова Е.В., Братчикова Т.В., Литвиненко И.А., Гончарова О.В., Зорина Е.А. Мочевая кислота как предиктор неблагоприятных перинатальных исходов и осложнений гестации у беременных с гипертонической болезнью //Вестник РУДН. Серия «Медицина». 2010. № 6. С. 38-44)
Taralenko SV, Dikke GB, Fedorenko OF, Gabitova NA, Vorob'ev YUO, Belova NG. Prevention and treatment of fetoplacental insufficiency in the background of vascular complications of pregnancy. Siberian Medical Journal (Tomsk). 2006; 21(5): 38-41. Russian (Тараленко С.В., Дикке Г.Б., Федоренко О.Ф., Габитова Н.А., Воробьев Ю.О., Белова Н.Г. Профилактика и лечение фетоплацентарной недостаточности на фоне сосудистых осложнений беременности //Сибирский медицинский журнал (Томск). 2006. Т. 21, № 5. С. 38-41)
Chappell LC, Enye S, Seed P, Briley AL, Poston L, Shennan AH. Adverse perinatal outcomes and risk factors for preeclampsia in women with chronic hypertension: a prospective study. Hypertension. 2008; 51(4): 1002-1009. doi:10.1161/HYPERTENSIONAHA.107.107565
Li N, Li Z, Ye R, Zhang L, Li H, Zhu Y et al. Preconception Blood Pressure and Risk of Low Birth Weight and Small for Gestational Age: A Large Cohort Study in China. Hypertension. 2016; 68(4): 873-879. doi:10.1161/HYPERTENSIONAHA.116.07838
Costantine MM. Physiologic and pharmacokinetic changes in pregnancy. Frontiers in Pharmacology. 2014; 5(65). doi: 10.3389/fphar.2014.00065
Cruz MO, Gao W, Hibbard JU. Obstetrical and perinatal outcomes among women with gestational hypertension, mild preeclampsia, and mild chronic hypertension. Am J Obstet Gynecol. 2011; 205(3): 260.E1-260.E9. doi: 10.1016/j.ajog.2011.06.033
Cong J, Yang X, Zhang N, Shen J, Fan T, Zhang Z. Quantitative analysis of left atrial volume and function during normotensive and preeclamptic pregnancy: a real-time three-dimensional echocardiography study. Int J Cardiovasc Imaging. 2015; 31(4): 805-812. doi: 10.1007/s10554-015-0628-8
Yanit KE, Snowden JM, Cheng YW, Caughey AB. The impact of chronic hypertension and pregestational diabetes on pregnancy outcomes. Am J Obstet Gynecol. 2012; 207(4): 333.e1-6. doi: 10.1016/j.ajog.2012.06.066
Gerdts E, Cramariuc D, de Simone G, Wachtell K, Dahlöf B, Devereux RB. Impact of left ventricular geometry on prognosis in hypertensive patients with left ventricular hypertrophy (the LIFE study). Eur J Echocardiogr. 2008; 9: 809-815. doi: 10.1093/ejechocard/jen155
Dvoryanskii IA, Makarova NV, Yagovkina SA. Clinical and expert evaluation of the course and outcome of pregnancy complicated by arterial hypertension of various origins. Kirov, 2011. 108 p. Russian (Дворянский С.А., Макарова И.А., Яговкина Н.В. Клинико-экспертная оценка течения и исхода беременности, осложненной артериальной гипертензией различного генеза. Киров, 2011. 108 с.)
Radzinskii VE. The importance of rethinking modern concepts of a healthy pregnancy. StatusPraesens. 2014; 2(19): 5-7. (Радзинский В.Е. О важности переосмысления современных представлений о здоровой беременности //StatusPraesens. 2014. № 2(19). С.5-7)