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


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Abstract

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.

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About the authors

Pavel B. Tsyvian

Ural Research Institute of Maternal and Infant Care, Ministry of Health of Russia; Ural State Medical University, Ministry of Health of Russia

Email: pavel.tsyvian@gmail.com
MD, DSc, professor, leading researcher

Galina B. Malgina

Ural Research Institute of Maternal and Infant Care, Ministry of Health of Russia

Email: galinamalgina@mail.ru
MD, DSc, professor, Director

Natalia V. Kosovtsova

Ural Research Institute of Maternal and Infant Care, Ministry of Health of Russia

Email: kosovcovan@mail.ru
MD, DSc, Head of Ultrasound Department

Tatiana V. Markova

Ural Research Institute of Maternal and Infant Care, Ministry of Health of Russia

Email: ta.ma.vl@mail.ru
MD, PhD, leading researcher of Ultrasound Department

Natalia A. Salimova

Ural State Medical University, Ministry of Health of Russia

Email: pyatyshkinan@mail.ru
PhD, assistent of the Department of Physiology

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