ABSTRACT
INTRODUCTION: Preeclampsia is a major complication affecting at least 3-4% of all pregnancies and is globally responsible for approximately 50,000 maternal deaths annually. Currently the main cause of preeclampsia is a shallow placentation, with abnormal invasion of cytotrophoblasts and incomplete remodeling of placenta-supplying maternal uterine spiral arteries. However, up to 20weeks, these processes are asymptomatic, although they are accompanied by the release of various macromolecules in the bloodstream of the mother, which are potential biomarkers of disease, needed to detect. Much progress has been made in recent years towards first-trimester models using combined factors that will be of realistic use in clinical practice.The ability to predict the most severe forms of preeclampsia would allow closer surveillance and earlier intervention to improve pregnancy outcomes. OBJECTIVES: To determine the significance of measuring the concentration of PlGF and sFlt-1 and their ratio in 11-13 weeks of pregnancy as early markers of preeclampsia. METHODS: The study included 85 pregnant women in 11-13 weeks with subsequent uncomplicated pregnancy and 11 patients which developed various hypertensive disorders, four of them have developed severe (n=2) and mild (n=2) preeclampsia later. Concentrations of markers were determined on automated analyzers Cobas E411 (Hoffmann La Roche) using test kits Elecsys PlGF and Elecsys sFlt-1. RESULTS: In the first trimester the concentration of sFlt-1 in healthy pregnant women was 1618,0±18,2pg/ml, PlGF - 47,5±3,5pg/ml, the sFlt-1/PLGF ratio - 35,9±3,2. In the second trimester parameters were as follows: sFlt-1 - 1898,0±29,8pg/ml, PlGF - 208,0±11,0pg/ml, the sFlt-1/PLGF ratio-11,2±2,6. Two patients with severe preeclampsia had sFlt-1 concentration at 11-12 weeks of 2185 and 14923pg/ml, PlGF - 12,8 and 61.3pg/ml, the ratio sFlt-1/PLGF - 170,7 and 243.4. In two patients with mild preeclampsia, these figures were in 1700 and 2312pg/ml, 38.2 and 37,6pg/ml, 44,4 and 61,4, respectively. CONCLUSION: The optimal prediction biomarker does probably not exist. Our preliminary results confirm the feasibility of determining concentrations of sFlt-1 and PlGF, and their ratio in the 1st trimester of pregnancy to assess the risk of preeclampsia in order to reduce the frequency of obstetric complications and perinatal loss. Effective prediction of PE can be achieved at 11-13weeks' gestation. Further studies on the development and implementation a modified integrated screening program for early diagnosis of PE at 11-14weeks of gestation should be based on the assessment of maternal factors, biophysical, biochemical, and molecular genetic markers are needed. Better individualised patient prediction will allow us to target existing prevention, as it is, and to also develop new treatments in future.
ABSTRACT
The paper considers the late sequels of preeclampsia that is one of the main causes of poor perinatal outcomes. The idea that this gestational complication shows no noticeable impact on the female health status in the late postpartum periods has long been prevalent. At the same time, recent studies suggest that this cohort of women will have a high cardiovascular risk in future life, which requires the formulation of their management strategy. Epidemiological data are given on late female morbidity and mortality due to coronary heart disease, stroke, and renal failure.
