UTERINE ARTERY DOPPLER AND SERUM LEVEL OF IMMUNOBIOMARKERS IN PREECLAMPSIA - OUR EXPERIENCE

Abstract

Introduction. Important mechanisms are known to be involved in the immunomodulatory pathways which are crucial for maintaining an adequate utero-placental circulation in pregnancy. Its disbalance brings to impaired tolerance, which leads to inflammation and autoimmune processes in preeclampsia. Aim. The aim of this study was to find if inadequate uteroplacental hemodynamic was associated with improper feto-maternal immune adaptation. The risk of developing preeclampsia can be predicted by combining use of uterine artery flow and cytokine values. The aim was to show their combination as a predictive indicator of preeclampsia in the second trimester of pregnancy. Methods. This study enrolled 96 pregnant patients in the second trimester (patients were between the 14th and 20th gestational weeks). Their history data, routine foetal ultrasound, bilateral uterine artery Doppler ultrasound and cytokines were evaluated. All patients were followed up till the end of pregnancy. Half of the pregnant women consisted the study group (N=48), which had presence of notch of the uterine artery. In the control group (N=48), there was an absence of uterine artery notch. In all patients, Doppler of the uterine artery, pulsatility index (PI) and resistance index (RI) were made and determined. The pro-inflammatory cytokines (TNF-α, IL-1α, IL-2 and IL-6) and antiinflammatory cytokines (IL-4 and IL-10) from patient’s serum were analyzed. Results and Discussion. In the study group (N=48), 32 patients had changes in the cytokine serum levels. Increased pro-inflammatory biomarkers (IL-6, TNF-α, IL-1α) were with sensitivity of 78 to 91.2%. According to this, high predictive value was found. Of these 32 patients, 21 developed preeclampsia. When the sensitivity of pro- and anti-inflammatory biomarkers together with the uterine artery Doppler ultrasound was combined, a sensitivity resulted in 81.5%. Multivariate regression analysis detected that IL-6 was the most significant predictive parameter. This result is similar to that presented in the study by Teran and Hentschke et al. Conclusion. Using predictive tests is imporatnt to detect undeveloped preeclampsia in a timely manner that would prevent possible developmental complications. After abnormal Doppler results, cytokines should be investigated as a predictive method.