Markers of endothelial dysfunction and regulation of angiogenesis in women with complicated monochorionic pregnancy
The urgency of the problem of monochorial multiple pregnancy is due to the significant frequency of the development of gestational complications, antenatal losses at different periods of pregnancy. The objective. To assess the indices of endothelial dysfunction and markers for the regulation of angiogenesis in women with complicated monochorial multiple pregnancy to optimize the management tactics of patients. Materials and methods. 52 pregnant women with monochorial diamniotic twins were examined, among them: Group 1 - 16 pregnant women with feto-fetal transfusion syndrome (FFTS); 2nd group - 15 pregnant women with selective fetal growth retardation (FGR); Group 3 (comparisons) - 21 pregnant women with monochorial diamniotic twins without the above complications. Results and discussion. In all patients with a complicated monochorial pregnancy, an imbalance in angiogenic and antiangiogenic factors was found (a reduced PLGF content against the background of increased endoglin concentration). In pregnant women with FFTS, there is a pronounced endothelial dysfunction associated with increased levels of endothelin-1 in the absence of changes in the production of stable nitric oxide metabolites, in women with FGR, the initial manifestations of dysfunction (decrease at the level of trends in total NO2, NO3 and no increase in endothelin-1). Conclusion. The implementation of pathological conditions (feto-fetal transfusion syndrome, selective developmental delay) in monochorial pregnancy is caused by impaired production of the main regulators of angiogenesis associated with endothelial dysfunction. The definition of the above indicators of endothelial dysfunction and markers of angiogenesis can be used to assess the effectiveness of therapy, which dictates the need for further research.