Avaliação longitudinal da perfusão uterina, função endotelial e fluxo sanguíneo central em pacientes com fatores de risco para pré-eclâmpsia precoce

Abstract

Background: Physiopathological mechanisms that trigger clinical manifestations in preeclampsia (PE) remain unclear, and management is still a challenge. The identification of tools to predict the onset of PE and prevent its complications is of great interest. Objectives: The aim of this study was to evaluate the behaviour of placental perfusion, endothelial function and central nervous system perfusion in patients with a high risk for PE development in three distinct moments of pregnancy.Results obtained from the methods applied will be compared between a group of patients who developed early-onset PE and a control group of patients who remained normotensive, in an attempt to evaluate the potential of PE prediction using such investigative methods. Patients and methods: Sixty-two patients were recruited from the high-risk prenatal service of Hospital das Clínicas of Federal University of Minas Gerais, and followed throughout gestation. Patients were submitted toDopplervelocimetry of uterine and ophthalmic arteries and flow-mediated dilation (FMD) between 16+0 and 19+6 weeks, 24+0 and 27+6 weeks and in hospital admission to delivery. Results: Ten pregnancies were complicated by early-onset PE, and these patients presented a significantly higher pulsatility index of uterine arteries between16+0 and 19+6 weeks of gestation, compared with control group (p=0,016). FMD values were lower in affected patients at 24+0 to 27+6 weeks (p=0,001), and both FMD and ophthalmic artery resistance index presented lower values by the time of delivery (p<0,002). Conclusion: These results demonstrate that impaired placental perfusion, systemic endothelial dysfunction and central hyperperfusion temporarily precede the clinical manifestations in high-risk patients who develop early-onset PE.