The Disturbance of Microcirculation and Hemostasis in Pregnant Women with Gestational Hypertension
https://doi.org/10.52420/umj.24.2.30
EDN: BNVDTW
Abstract
Preeclampsia (PE) and gestational hypertension (GH) occupy leading positions in the structure of pregnancy pathology and adverse perinatal outcomes.
The purpose of this study was to evaluate the state of microcirculation of peripheral tissues and the hemostasis system in conjunction with proper uteroplacental circulation in pregnant women with hypertensive disorders; to determinate the patterns of changes in regional hemodynamics, significant as predictors of the occurrence and progression of hypertensive conditions.
Materials and methods. A clinical study of pregnant women with gestational hypertension (GH) (n = 36) and patients with preeclampsia (PE) (n = 12); control — women with physiologic pregnancy was performed. Clinical evaluation of the woman and newborn, assessment of peripheral microcirculation (laser Doppler flowmetry), determination of coagulation profile (thromboelastography), statistical analysis of data (Statistica 13.0) were performed.
Results. There is an increase in formation and density of blood clot with a decrease in fibrinolytic processes (relative to control by 19.33 % (p < 0.050) in GH, by 38.24 % (p < 0.050) in PE). Changes in average laboratory values included an increase in number of platelets in GH and a decrease in PE. Assessment of peripheral tissues microcirculation demonstrated a statistically significant decrease in tissue perfusion in patients with GH and PE relative to the control by 23.1 % (p < 0.050) and 33.2 % (p < 0.050) respectively, which was accompanied by changes in the regulation of microhemodynamics.
Conclusion. Development of GH and PE is accompanied by negative dynamics of microcirculation with regulation tension and an increase of contribution of systemic regulatory mechanisms of tissue perfusion, significant hypercoagulemic changes in the hemostasis system. Impaired microcirculation in pregnant women with GH is associated with a high frequency of surgical delivery and a life-threatening condition of the newborn.
Keywords
Supporting agencies: The authors would like to thank the staff and management of the Perinatal Center of the Mordovian Republican Central Clinical Hospital
About the Authors
T. I. Vlasova
National Research Ogarev Mordovia State University
Russian Federation
Competing Interests:
Russian Federation
Tatyana I. Vlasova — Doctor of Sciences (Medicine), Professor, Head of the Department of Normal and Pathological Physiology, Institute of Medicine.
Saransk
Competing Interests:
The authors declare the absence of obvious or potential conflict of interest
T. I. Shishkanova
National Research Ogarev Mordovia State University
Russian Federation
Competing Interests:
Russian Federation
Tatiana I. Shishkanova — Postgraduate Student of the Department of Normal and Pathological Physiology, Institute of Medicine.
Saransk
Competing Interests:
The authors declare the absence of obvious or potential conflict of interest
A. E. Markina
National Research Ogarev Mordovia State University
Russian Federation
Competing Interests:
Russian Federation
Alina E. Markina — Assistant of the Department of Obstetrics and Gynecology, Institute of Medicine.
Saransk
Competing Interests:
The authors declare the absence of obvious or potential conflict of interest
D. A. Kapitanova
National Research Ogarev Mordovia State University
Russian Federation
Competing Interests:
Russian Federation
Darya A. Kapitanova — Specialist’s Degree Student of the Institute of Medicine.
Saransk
Competing Interests:
The authors declare the absence of obvious or potential conflict of interest
O. V. Kirdyashkina
National Research Ogarev Mordovia State University
Russian Federation
Competing Interests:
Russian Federation
Olga V. Kirdyashkina — Senior Lecturer of the Department of Biological and Pharmaceutical Chemistry with Organization and Management of Pharmacy Course in, Institute of Medicine.
Saransk
Competing Interests:
The authors declare the absence of obvious or potential conflict of interest
References
1. Lo JO, Mission JF, Caughey AB. Hypertensive disease of pregnancy and maternal mortality. Current Opinion in Obstetrics & Gynecology. 2013;25(2):124–132. DOI: https://doi.org/10.1097/GCO.0b013e32835e0ef5.
2. Lisonkova S, Sabr Y, Mayer C, Young C, Skoll A, Joseph KS. Maternal morbidity associated with early-onset and late-onset preeclampsia. Obstetrics and Gynecology. 2014;124(4):771–781. DOI: https://doi.org/10.1097/AOG.0000000000000472.
3. Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, et al.; International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations for international practice. Hypertension. 2018;72(1):24–43. DOI: https://doi.org/10.1161/HYPERTENSIONAHA.117.10803.
4. Gaisin IR, Iskhakova AS. Diagnosis and treatment of hypertensive disorders of pregnancy: A narrative review. Arterial Hypertension. 2021;27(2):146–169. (In Russ.). DOI: https://doi.org/10.18705/1607419X-2021-27-2-146-169.
5. Chulkov VS, Syundyukova EG, Chulkov VlS, Tarasova OA, Romanyugo GD. Hypertensive disorders during pregnancy and risk of cardiovascular disease. Russian Journal of Preventive Medicine. 2021;24(12):97–104. (In Russ.). DOI: https://doi.org/10.17116/profmed20212412197.
6. Kaptilnyy VA, Reyshtat DY, Ageyev MB. Complications of preeclampsia: Etiology, pathogenesis and treatment. HELLP-syndrome (modern concepts and treatment). V. F. Snegirev Archives of Obstetrics and Gynecology. 2020;7(2):67–73. (In Russ.). EDN: https://elibrary.ru/HTZHFC.
7. Sidorova IS, Milovanov AP, Nikitina NA, Rzaeva AA, Bardachova AV. Specific features of placentation in preeclampsia and eclampsia. Russian Bulletin of Obstetrician-Gynecologist. 2014;14(3):4–10. (In Russ.). EDN: https://elibrary.ru/SVKLOP.
8. Boeldt DS, Bird IM. Vascular adaptation in pregnancy and endothelial dysfunction in preeclampsia. Journal of Endocrinology. 2017;232(1):R27–R44. DOI: https://doi.org/10.1530/JOE-16-0340.
9. Chiang YT, Seow KM, Chen KH. The pathophysiological, genetic, and hormonal changes in preeclampsia: A systematic review of the molecular mechanisms. International Journal of Molecular Sciences. 2024; 25(8):84532. DOI: https://doi.org/10.3390/ijms25084532.
10. Dikur ON, Kopylov FY. Clinical significance of endothelial dysfunction in pregnancy as a component of comprehensive evaluation of pre-eclampsia risk. V. F. Snegirev Archives of Obstetrics and Gynecology. 2014; 1(2):7–13. (In Russ.). EDN: https://elibrary.ru/SYSMHF.
11. Craici IM, Wagner SJ, Weissgerber TL, Grande JP, Garovic VD. Advances in the pathophysiology of pre-eclampsia and related podocyte injury. Kidney International. 2014;86(2):275–285. DOI: https://doi.org/10.1038/ki.2014.17.
12. Masini G, Foo LF, Tay J, Wilkinson IB, Valensise H, Gyselaers W, et al. Preeclampsia has two phenotypes which require different treatment strategies. American Journal of Obstetrics and Gynecology. 2022;226(2S): S1006–S1018. DOI: https://doi.org/10.1016/j.ajog.2020.10.052.
13. Tayyar A, Garcia-Tizon Larroca S, Poon LC, Wright D, Nicolaides KH. Competing risk model in screening for preeclampsia by mean arterial pressure and uterine artery pulsatility index at 30–33 weeks’ gestation. Fetal Diagnosis and Therapy. 2014;36(1):18–27. DOI: https://doi.org/10.1159/000360792.
14. Guedes-Martins L, Cunha A, Saraiva J, Gaio R, Macedo F, Almeida H. Internal iliac and uterine arteries Doppler ultrasound in the assessment of normotensive and chronic hypertensive pregnant women. Scientific Reports. 2014;4:3785. DOI: https://doi.org/10.1038/srep03785.
15. Arakaki T, Hasegawa J, Nakamura M, Hamada S, Muramoto M, Takita H, et al. Prediction of earlyand late-onset pregnancy-induced hypertension using placental volume on three-dimensional ultrasound and uterine artery Doppler. Ultrasound in Obstetrics & Gynecology. 2015;45(5):539–543. DOI: https://doi.org/10.1002/uog.14633.
16. Lidan H, Jianbo W, Liqin G, Jifen H, Lin L, Xiuyan W. The diagnostic efficacy of thrombelastography (TEG) in patients with preeclampsia and its association with blood coagulation. Open Life Sciences. 2019;14(1):335–341. DOI: https://doi.org/10.1515/biol-2019-0037.
17. Koloskov AV. Hemostasis in pregnancy and inherited bleeding disorders. The Journal of Scientific Articles Health & Education Millennium. 2017;19(6):50–54. EDN: https://elibrary.ru/XXYCNJ.
18. Schastlivtsev IV, Lobastov KV, Tsaplin SN, Mkrtychev DS. Modern view on hemostasis system: Cell theory. Medical Council. 2019;(16):72–77. (In Russ.). DOI: https://doi.org/10.21518/2079-701X-2019-16-72-77.
19. Katz D, Beilin Y. Disorders of coagulation in pregnancy. British Journal of Anaesthesia. 2015;115(Suppl 2): II75–II88. DOI: https://doi.org/10.1093/bja/aev374.
20. Bondar’ IA, Malysheva AS. Alterations in hemostasis associated with pregnancy in patients with glycemic disorders. Diabetes Mellitus. 2013;16(2):77–81. (In Russ.). DOI: https://doi.org/10.14341/2072-0351-3760.
21. Budykina TS, Gur’eva VM, Verkholomova FYu. An effective tool to evaluate the homeostasis during pregnancy: Dynamic thrombophotometry (thrombodynamics). Russian Bulletin of Obstetrician-Gynecologist. 2015;15(4):95–100. (In Russ.). DOI: https://doi.org/10.17116/rosakush201515495-100.
22. Khizroeva JKh, Babaeva NN, Makatsariya NA, Elalamy I, Gris JK. Clinical significance of hemostasiological screening for thrombophilia in pregnant women with former thrombosis. Obstetrics, Gynecology and Reproduction. 2022;16(5):528–540. (In Russ.). DOI: https://doi.org/10.17749/2313-7347/ob.gyn.rep.2022.361.
23. Tikhonova NB, Kuznetsova NB, Milovanov AP, Goufman EI, Fokina TV, Aleksankin AP, et al. Hemostasis system and plasminogen activity in retrochorial hematoma in the first trimester of pregnancy. Biomedicines. 2022;10(9):2284. DOI: https://doi.org/10.3390/biomedicines10092284.
24. Tarakanova AA, Tesakov IP, Podoplelova NA, Sveshnikova AN, Koltsova EM. Molecular mechanisms of changes in the hemostasis system in the third trimester of pregnancy. Uspekhi fiziologicheskih nauk. 2022; 2(53):67–82. (In Russ.). EDN: https://elibrary.ru/USPFHI.
25. Hellgren M. Hemostasis during normal pregnancy and puerperium. Seminars in Thrombosis and Hemostasis. 2003;29(2):125–130. DOI: https://doi.org/10.1055/s-2003-38897.
26. Othman M, McLintock C, Kadir R. Thrombosis and hemostasis related issues in women and pregnancy. Seminars in Thrombosis and Hemostasis. 2016;42(7):693–695. DOI: https://doi.org/10.1055/s-0036-1593416.
27. Momot AP, Molchanova IV, Semenova NA, Romanov VV, Serdyuk GV, Belozerov DЕ, et al. Dynamics of hemostatic parameters on pregnant women and after delivery. Laboratory Service. 2015;4(2):3–11. (In Russ.). DOI: https://doi.org/10.17116/labs2015423-11.
28. Byshevsky ASh, Polyakova VA, Rudzevich AYu. Hemostasis in physiological pregnancy, pregnancy with arterial hypertension and preeclampsia. Tromboz, gemostaz i reologiya. 2010;(4):13–30. (In Russ.). EDN: https://elibrary.ru/NDGJDP.
29. Armstrong S, Fernando R, Ashpole K, Simons R, Columb M. Assessment of coagulation in the obstetric population using ROTEM® thromboelastometry. International Journal of Obstetric Anesthesia. 2011; 20(4):293–298. DOI: https://doi.org/10.1016/j.ijoa.2011.05.004.
30. Xu C, Li Y, Zhang W, Wang Q. Analysis of perinatal coagulation function in preeclampsia. Medicine. 2021; 100(26):e26482. DOI: https://doi.org/10.1097/MD.0000000000026482.
31. Xie X, Wang M, Lu Y, Zeng J, Wang J, Zhang C, et al. Thromboelastography (TEG) in normal pregnancy and its diagnostic efficacy in patients with gestational hypertension, gestational diabetes mellitus, or preeclampsia. Journal of Clinical Laboratory Analysis. 2021;35(2): e23623. DOI: https://doi.org/10.1002/jcla.23623.
Review
For citations:
Vlasova TI, Shishkanova TI, Markina AE, Kapitanova DA, Kirdyashkina OV. The Disturbance of Microcirculation and Hemostasis in Pregnant Women with Gestational Hypertension. Ural Medical Journal. 2025;24(2):30–43. (In Russ.) https://doi.org/10.52420/umj.24.2.30. EDN: BNVDTW
Views:
137
Email this article 