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Obstetrics and Gynegology2021№4
On systemic pathophysiology of preeclampsia:...

On systemic pathophysiology of preeclampsia: the role of maternal venous hemodynamic disorders and renal dysfunction

DOI
https://dx.doi.org/10.18565/aig.2021.4.5-11

Tsyvian P.B., Malgina G.B., Kosovtsova N.V., Markova T.V., Salimova N.A.

1) Ural Research Institute of Maternal and Infant Care, Ministry of Health of Russia, Yekaterinburg, Russia; 2) Ural State Medical University, Ministry of Health of Russia, Yekaterinburg, Russia
The review summarizes the results of current clinical and experimental studies of renal function and venous hemodynamics in physiological pregnancy and in two types of preeclampsia (PE): early-onset PE that occurs between 20 and 34 weeks’ gestation and late-onset PE that is observed after 34 weeks’ gestation. It is shown that the trophoblast cells not only invade into the uterine spiral arteries, but also into the lymphatic vessels and veins to create an open channel of communication with the intervillous space. As this takes place, remodeling occurs earlier in the venous segment than in the arterial one, which is of great importance for the development of pregnancy pathology. Ultrasound Doppler studies show that the venous system works close to the peak of its capabilities even in physiological pregnancy. The pathological type of venous blood flow signals is more frequently observed in early-onset PE than in late-onset PE, but is not seen in gestational hypertension. This type is characterized by the appearance of wave A that is associated with retrograde pressure through the vein in the right atrial systole, and is a sign of increased pressure in the venous system of a woman.
Conclusion. The authors show the relationship between venous hypertension and renal dysfunction in PE. They discuss the commonness of maternal and fetal venous system and kidney dysfunctions in PE, which could be important for the programming of fetal cardiovascular and renal diseases in later life.

Keywords

pathophysiology of pregnancy
renal function
venous insufficiency
preeclampsia
venous Doppler
maternal hemodynamics
Full text (in Russian)

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Received 17.06.2020

Accepted 11.01.2021

About the Authors

Pavel B. Tsyvian, MD, DSc, professor, leading researcher, Mother and Child Care Research Institute, Ministry of Health of Russia; Head of the Department of Physiology,
Ural State Medical University, Ministry of Health of Russia. Tel.: +7(343)371-52-74. E-mail: Pavel.tsyvian@gmail.com. 620028, Russia, Yekaterinburg, Repin str., 1.
Galina B. Malgina, MD, DSc, professor, Director of Mother and Child Care Research Institute, Ministry of Health of Russia. Tel.: +7(343)371-87-68.
E-mail: galinamalgina@mail.ru. 620028, Russia, Yekaterinburg, Repin str., 1.
Natalia V. Kosovtsova, MD, DSc, Head of Ultrasound Department, Mother and Child Care Research Institute, Ministry of Health of Russia.
Tel.: +7(343)371-52-74. E-mail: kosovcovan@mail.ru. 620028, Russia, Yekaterinburg, Repin str., 1.
Tatiana V. Markova, MD, PhD, leading researcher of Ultrasound Department, Mother and Child Care Research Institute, Ministry of Health of Russia. Tel.: +7(343)371-52-74. E-mail: ta.ma.vl@mail.ru. 620028, Russia, Yekaterinburg, Repin str., 1.
Natalia A. Salimova, PhD, assistent of the Department of Physiology, Ural State Medical University, Ministry of Health of Russia.
Tel.: +7(343)214-86-97. E-mail: pyatyshkinan@mail.ru. 620028, Russia, Yekaterinburg, Repin str., 3.

For citation: Tsyvian P.B., Malgina G.B., Kosovtsova N.V., Markova T.V., Salimova N.A. On systemic pathophysiology of preeclampsia: the role of maternal venous hemodynamic disorders and renal dysfunction.
Akusherstvo i Ginekologiya /Obstetrics and Gynecology. 2021; 4: 5-11 (in Russian)
https://dx.doi.org/10.18565/aig.2021.4.5-11

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