SEVERE PREECLAMPSIA AND ECLAMPSIA: CRITICAL CONDITIONS FOR THE MOTHER AND FETUS

Objective. To study the clinical and immunomorphological features of the severe forms of preeclampsia and eclampsia. Subject and methods. One hundred and seventy-six histories of pregnancy, labor, and delivery and postmortem protocols of women who had died from severe preeclampsia and its complications in Moscow, the Moscow Region, and individual regions of Russia were retrospectively analyzed. Immunohistochemical examination was made to visualize neurospecific enolase (NSE) in the organs and tissues of 8 women who had died from eclampsia. Results. The patients’ death due to severe preeclampsia/eclampsia was associated with multiple organ dysfunction (in almost 50%), cerebral edema (72.7%), acute disseminated intravascular coagulation and profuse bleeding (55.7%); moreover, the clinical evaluation made by obstetricians/gynecologists corresponded to their true severity in only 58.5%. Pathomorphological changes in the target organs suggest that the endothelial vessels display generalized injury (to the point of total desquamation of endotheliocytes, including the vessels of the blood-brain barrier), supporting the fact that there is a break in the above barrier. The identification of NSE in all target organs underlines the specif ic pattern of impairments in preeclampsia and eclampsia. Conlusion. Practical obstetrics requires that documents regulating the use unified terminology, classification, evaluation criteria for disease severity, and management tactics for women at high risk for preeclampsia and eclampsia should be elaborated

preeclampsia, eclampsia, endotheliosis, neurospecific proteins