Мать и дитя в Кузбассе (Aug 2020)
PREDICTION OF HYPERTENSIVE PREGNANCY COMPLICATIONS BASED ON THE ASSESSMENT OF CARDIO REMODELING OF THE LEFT VENTRICLE MYOCARDIUM
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.
