Imitators of severe preeclampsia: on differential diagnosis and multidisciplinary management
https://doi.org/10.17749/2313-7347.2019.13.1.070-078
Abstract
Preeclampsia (PE) is not only a disease of pregnant women, but also a disease with lifelong consequences for mother and child. Making an early diagnosis and differential diagnosis of PE is crucial yet challenging, since PE can be mistaken for other internal diseases or surgical conditions. Despite the variety of clinical symptoms of thrombotic microangiopathy that may manifest in a non-typical picture of PE, progressive multiple organ failure develops in all cases. It seems promising to study the role of matrix metalloproteinases and determine the genetic predisposition to early and severe PE. The forecast and prevention attempts must begin from the fertile cycle. A better knowledge of biochemical and genetic markers along with the clinical and instrumental tests will reduce the morbidity and mortality in PE patients.
About the Authors
A. N. Strizhakov
I.M. Sechenov First Moscow State Medical University, Health Ministry of Russian Federation
Russian Federation
Russian Federation
Alexander N. Strizhakov - MD, PhD, Professor, Academician of RAS, Head of Department of Obstetrics and Gynecology, Faculty of General and Preventive Medicine, I.M. Sechenov First MSMU HM of RF.
8/2, Trubetskaya St., Moscow 119991.
Scopus Author ID: 7005104683
I. V. Ignatko
I.M. Sechenov First Moscow State Medical University, Health Ministry of Russian Federation
Russian Federation
Russian Federation
Irina V. Ignatko - MD, PhD, Professor of RAS, Corresponding Member of RAS, Professor, Department of Obstetrics and Gynecology, Faculty of General and Preventive Medicine, I.M. Sechenov First MSMU HM of RF.
8/2, Trubetskaya St., Moscow 119991.
Tel.: +7(499)7823045.
Researcher ID: H-2442-2018
Scopus Author ID: 15118951800
E. V. Timokhina
I.M. Sechenov First Moscow State Medical University, Health Ministry of Russian Federation
Russian Federation
Russian Federation
Elena V. Timokhina - MD, PhD, Professor, Department of Obstetrics and Gynecology, Faculty of General and Preventive Medicine, I.M. Sechenov First MSMU HM of RF.
8/2, Trubetskaya St., Moscow 119991.
Tel.: +7(499)7823045.
Scopus Author ID: 25958373500
References
1. American College of Obstetricians and Gynecologists, Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013;122:1122-31.
2. Lisonkova S., Sabr Y., Mayer C. et al. Maternal morbidity associated with early-onset and late-onset preeclampsia. Obstet Gynecol. 2014;124(4):771-81.
3. Bitsadze V.O., Makatsariya A.D., Strizhakov A.N., Chervenak F.A. Life-threatening conditions in obstetrics and perinatology. [Zizneugrozhayushchie sostoyaniya v akusherstve i perinatologii]. Moskva: MIA, 2019. 672 s. (In Russ.).
4. Lain K.Y., Roberts J.M. Contemporary concepts of the pathogenesis and management of preeclampsia. JAMA. 2002;287(24):3183-6.
5. Strizhakov A.N., Timokhina E.V., Pitskhelauri E.G., Belousova V.S., Yakushina N.I. Pre-eclampsia today: pathogenesis and the ability to predict and treat. [Preeklampsiya segodnya: patogenez i vozmozhnosti prognozirovaniya i lecheniya]. Voprosyginekologii, akusherstva iperinatologii. 2016;15(3):24-31. (In Russ.). DOI: 10.20953/1726-1678-2016-3-24-31.
6. Ignatko I.V., Strizhakov L.A., Timokhina E.V., Afanasyeva N.V., Ryabova S.G. Peripartal cardiomyopathy and "clinical masks" of severe preeclampsia: issues of differential diagnosis and tactics of reference. [Peripartal'naya kardiomiopatiya i «klinicheskie maski»tyazheloj preklampsii: voprosy differencial'noj diagnostiki i taktiki vedeniya]. Akusherstvo iginekologiya. 2017;(11):114—22. (In Russ.).
7. Korotchayeva Yu.V., Kozlovskaya N.L., Bondarenko T.V., Veselov G.A. Features of the course and treatment of "obstetric" atypical hemolytic-uremic syndrome (aGUS). [Osobennosti techeniya i lecheniya «akusherskogo» atipichnogo gemolitiko-uremicheskogo sindroma (aGUS)]. Nefrologiya. 2015;19(2):76—81. (In Russ.).
8. Lisonkova S., Joseph K.S. Incidence of preeclampsia: risk factors and outcomes associated with early-versus late-onset disease. Am J Obstet Gynecol. 2013;209(6):544.e1—12. DOI: 10.1016/j.ajog.2013.08.019.
9. Brosens I., Pijnenborg R., Vercruysse L., Romero R. The "Great Obstetrical Syndromes" are associated with disorders of deep placentation. Am J Obstet Gynecol. 2011;204(3):193-201.
10. Myatt L., Webster R.P. Vascular biology of preeclampsia. J Thromb Haemost. 2009;7(3):375-84.
11. Roberge S., Nicolaides K., Demers S. et al. The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction: systematic review and meta-analysis. Am J Obstet Gynecol. 2017;216(2):110—20.
12. Ignatko I.V., Strizhakov L.A., Florova V.S., Martirosova A.L. Personalized approach to antihypertensive therapy in pregnant women in terms of clinical pharmacogenetics. [Personalizirovannyj podhod k antigipertenzivnoj terapii u beremennyh s tochki zreniya klinicheskoj farmakogenetiki]. VestnikRAMN. 2018;3(73):149-56. (In Russ.).
13. Zhu M., Ren Z., Possomato-Vieira J.S., Khalil R.A. Restoring placental growth factor-soluble fms-like tyrosine kinase-1 balance reverses vascular hyper-reactivity and hypertension in pregnancy. Am J Physiol Regul Integr Comp Physiol. 2016;311(3):R505—21. DOI: 10.1152/ajpregu.00137.2016.
14. Baptista F.S., Bortolotto M.R., Bianchini F.R. et al. Can thrombophilia worsen maternal and perinatal outcomes in cases of severe preeclampsia? Pregnancy Hypertens. 2018;11:81-6. DOI: 10.1016/j.preghy.2017.12.012.
15. Ovcharova V.S. The role of genetic polymorphisms of matrix metalloproteinases in the development of preeclampsia. [Rol' geneticheskih polimorfizmov matriksnyh metalloproteinaz v razvitii preeklampsii]. Avtoref. dis. kand. biol. nauk. Belgorod, 2016. 18 s. (In Russ.).
16. Van Lint P., Libert C. Chemokine and cytokine processing by matrix metalloproteinases and its effect on leukocyte migration and inflammation. J Leukoc Biol. 2007;82(6):1375-81. DOI: 10.1189/jlb.0607338. PMID: 17709402.
17. Sarno L., Tufano A., Maruotti G.M. et al. Eculizumab in pregnancy: a narrative overview. J Nephrol. 2019;32(1):17-25. DOI: 10.1007/s40620-018-0517-z.
18. Gately R., San A., Kurtkoti J., Parnham A. Life-threatening pregnancy-associated atypical haemolyticuraemic syndrome and its response to eculizumab. Nephrology (Carlton). 2017;22(Suppl 1):32-35. DOI: 10.1111/nep.12938.
19. Fakhuri F., Vercel C, Fremeaux-Bacchi V. Obstetric nephrology: AKI and thrombotic microangiopathies in pregnancy. Clin J Am Soc Nephrol. 2012;7(12):2100-6. DOI: 10.2215/CJN.13121211.
20. Noris M., Caprioli J., Bresin E. et al. Relative role of genetic complement abnormalities in sporadic and familial aHU and their impact on clinical phenotype. Clin J Am Soc Nephrol. 2010;5:1844-59.
21. Arustamyan R.R., Lyashko E.S., Kuzmin V.N. Treatment of cerebrovascular pathology during pregnancy. [Lechenie cerebrovaskulyarnoj patologii vo vremya beremennosti]. Problemyreprodukcii. 2016;22(5):36-8. (In Russ.).
Review
For citations:
Strizhakov A.N., Ignatko I.V., Timokhina E.V. Imitators of severe preeclampsia: on differential diagnosis and multidisciplinary management. Obstetrics, Gynecology and Reproduction. 2019;13(1):70-78. (In Russ.) https://doi.org/10.17749/2313-7347.2019.13.1.070-078
Views:
1074
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Email this article 
