The Disturbance of Microcirculation and Hemostasis in Pregnant Women with Gestational Hypertension

Preeclampsia (PE) and gestational hypertension (GH) occupy leading positions in the structure of pregnancy pathology and adverse perinatal outcomes. The purpose of this study was to evaluate the state of microcirculation of peripheral tissues and the hemostasis system in conjunction with proper uteroplacental circulation in pregnant women with hypertensive disorders; to determinate the patterns of changes in regional hemodynamics, significant as predictors of the occurrence and progression of hypertensive conditions. Materials and methods . A clinical study of pregnant women with gestational hypertension (GH) (n = 36) and patients with preeclampsia (PE) (n = 12); control — women with physiologic pregnancy was performed. Clinical evaluation of the woman and newborn, assessment of peripheral microcirculation (laser Doppler flowmetry), determination of coagulation profile (thromboelastography), statistical analysis of data (Statistica 13.0) were performed. Results. There is an increase in formation and density of blood clot with a decrease in fibrinolytic processes (relative to control by 19.33 % (p < 0.050) in GH, by 38.24 % (p < 0.050) in PE). Changes in average laboratory values included an increase in number of platelets in GH and a decrease in PE. Assessment of peripheral tissues microcirculation demonstrated a statistically significant decrease in tissue perfusion in patients with GH and PE relative to the control by 23.1 % (p < 0.050) and 33.2 % (p < 0.050) respectively, which was accompanied by changes in the regulation of microhemodynamics. Conclusion. Development of GH and PE is accompanied by negative dynamics of microcirculation with regulation tension and an increase of contribution of systemic regulatory mechanisms of tissue perfusion, significant hypercoagulemic changes in the hemostasis system. Impaired microcirculation in pregnant women with GH is associated with a high frequency of surgical delivery and a life-threatening condition of the newborn.