Albumin solution as an important component of intensive infusion therapy in women with preeclampsia

Authors

DOI:

https://doi.org/10.26641/2307-0404.2022.4.271184

Keywords:

albumin solution, preeclampsia, infusion therapy, body water compartments, hemodynamics, markers of inflammation

Abstract

The aim of the study is to determine the efficiency and effectiveness of albumin solution in intensive infusion therapy for pregnant women with preeclampsia based on measuring indicators of central and peripheral hemodynamics, body water compartments, and markers of inflammation. 60 women were divided into two groups and examined. The first group (n=30) included women whose average age was 30.06±5.13 years, gestation period – 260.18±6.34 days. 16.7% of women in this group had moderate preeclampsia, 83.3% – severe preeclampsia. Patients of this group received standard intensive infusion therapy according to approved treatment protocols. The second group (n=30) included women, whose average age was 30.62±6.02 years, and pregnancy period 258.75±5.74 days. The patients of this group received intensive infusion therapy, like the women of the first group but in combination with a continuous infusion of a 20% albumin solution (8 ml/h – on the 1 st day; 4 ml/h – on the 2nd and 3rd day) and furosemide (0.05 mg/kg/h – on the 1st day; 0.025 mg/kg/h – on the 2nd and 3rd day) for 72 hours starting from the moment of the end of vaginal delivery or Cesarean section surgery. The comparative analysis showed that the dynamics of changes in the main indicators of homeostasis, hemodynamics, body water compartments and markers of inflammation in parturient women with preeclampsia strongly depend on the type of intensive infusion therapy. In women with preeclampsia, continuous administration of a 20% albumin solution immediately after delivery ensures the normalization of body water compartments till the 7th day of the postpartum period. It is the result of a rapid decrease in the total volume of fluid (by 17.2%, p<0.001 from the baseline) and interstitium (by 31.8%, p<0.001 from the prenatal level). The provided treatment in parturient women with preeclampsia helps to ensure a eukinetic type of blood circulation from the 5th day of the postpartum period already. It is also accompanied by the restoration of adaptation mechanisms that participate in maintaining the proper functioning of the cardiovascular system. The use of albumin and furosemide solution infusion reduces the degree of the background inflammatory process by 3.8 times (according to the index of inflammatory activity IL-6/IL-10) which comes along with preeclampsia.

References

Gestational Hypertension and Preeclampsia ACOG Practice Bulletin, Number 222. Obstetrics & Gynecology. 2020 June;135(6). doi: https://doi.org/10.1097/AOG.0000000000003891

Cater JH, Kumita JR, Zeineddine Abdallah R, Zhao G, Bernardo-Gancedo A, Henry A, et al. Human pregnancy zone protein stabilizes misfolded proteins including preeclampsia- and Alzheimer's-associated amyloid beta peptide. Proc Natl AcadSciUSA. 2019;116:61016110. doi: https://doi.org/10.1073/pnas.1817298116

Süleyman Serkan Karaşin, Tayfur Çift. The Role of Ischemia-modified Albumin as a Biomarker in Preeclampsia. Rev Bras Ginecol Obstet. 2020 Mar;42(3):133-9. doi: https://doi.org/10.1055/s-0040-1709662

Regitz-Zagrosek V, Roos-Hesselink JW, Bauer-sachs J, et al. 2018 ESC guidelines for the management of cardiovascular diseases during pregnancy. Eur. Heart J. 2018;39(34):3165-241. doi: https://doi.org/10.1093/eurheartj/ehy340

Burton GJ, Redman CW, Roberts JM, et al. Preeclampsia: pathophysiology and clinical implications. BMJ. 2019;366:l2381. doi: https://doi.org/10.1136/bmj.l2381

Ridder A, Giorgione V, Khalil A, et al. Preeclam-psia: the relationship between uterine artery blood flow and trophoblast function. Int. J. Mol. Sci. 2019;20(13):3263. doi: https://doi.org/10.3390/ijms20133263

Staff AC, Fjeldstad HE, Fosheim IK, et al. Failure of physiological transformation and spiral artery atherosis: their roles in preeclampsia. Am. J. Obstet. Gynecol. 2020;S0002-9378(20):31116-9. doi: https://doi.org/10.1016/j.ajog.2020.09.026

Alnaes-Katjavivi P, Roald B, Staff AC. Utero-placental acute atherosis in preeclamptic pregnancies: rates and clinical outcomes differ by tissue collection methods. Pregnancy Hypertens. 2020;19:11-17. doi: https://doi.org/10.1016/j.preghy.2019.11.007

Than NG, Romero R, Tarca AL, Kekesi KA, Xu Y, Xu Z, et al. Integrated systems biology approach identifies novel maternal and placental pathways of preeclampsia. Front Immunol. 2018;9(1661). doi: https://doi.org/10.3389/fimmu.2018.01661

McCarthy FP, Adetoba A, Gill C, Bramham K, Bertolaccini M, Burton GJ, et al. Urinary congophilia in women with hypertensive disorders of pregnancy and preexisting proteinuria or hypertension. Am J Obstet Gynecol. 2016;215:464.e1-e7. doi: https://doi.org/10.1016/j.ajog.2016.04.041

Aouache R, Biquard L, Vaiman D, Miralles F. Oxidative stress in preeclampsia and placental diseases. Int J Mol Sci. 2018;19(1496). doi: https://doi.org/10.3390/ijms19051496

Brown MA, Magee LA, Kenny LC, Karuman-chi SA, McCarthy FP, Saito S, et al. The hypertensive disorders of pregnancy: ISSHP classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens. 2018;13:291-310. doi: https://doi.org/10.1016/j.preghy.2018.05.004

Francisco C, Wright D, Benkő Z, Syngelaki A, Nicolaides KH. Competing-risks model in screening for preeclampsia in twin pregnancy according to maternal factors and biomarkers at 11-13 weeks' gestation. Ultrasound Obstet Gynecol. 2017;50:589-95. doi: https://doi.org/10.1002/uog.17531

Poon LC, Shennan A, Hyett JA, Kapur A, Ha-dar E, Divakar H, et al. The international federation of gynecology and obstetrics (FIGO) initiative on preeclam-psia: A pragmatic guide for first-trimester screening and prevention. Int J Gynaecol Obstet. 2019;145(Suppl 1):S1-S33. doi: https://doi.org/10.1002/ijgo.12802

Webster K, Fishburn S, Maresh M, Findlay SC, Chappell LC. Diagnosis and management of hypertension in pregnancy: Summary of updated NICE guidance. BMJ. 2019;366(l5119). doi: https://doi.org/10.1136/bmj.l5119

Artiomenko VV, Berlinskaya LI. [Risk factors of preeclampsia development]. Visnyk morskoi medytsyny. 2018;1(78):108-114. Ukrainian. doi: https://doi.org/10.5281/zenodo.1240781

Klygunenko EN, Zozulya ОА. [Human serum albumin (past and future)]. Meditsina neotlozhnykh sostoianii. 2017;5(84):26-30. Russian. doi: https://doi.org/10.22141/2224-0586.5.84.2017.109356

Klygunenko EN, Volkov AO. [Correlation of pro- and anti-inflammatory cytokines in pregnant women in the third trimester]. Meditsina neotlozhnykh sostoianii. 2013;6(53):162-4. Russian.

Klygunenko EN, Marzan OO. [The influence of pregnancy that is complicated by preeclampsia on the main parameters of central and peripheral hemodynamics and body water compartments volume]. Ukrainskyi medychnyi chasopys. 2021;2(142):71-73. Ukrainian. doi: https://doi.org/10.32471/umj.1680-3051.142.203830

[On approval of the protocol «Hypertensive disorders during pregnancy, childbirth and the postpartum period»]. Order of the Ministry of Health of Ukraine from 2022, Pub. No. 151. (Jan 24, 2022). Ukrainian. Available from: https://www.dec.gov.ua/mtd/gipertenzyvni-rozlady-y-vagitnyh/

Whittier N, Wildhagen T, Gold H. Statistics for Social Understanding With Stata and SPSS. Rowman & Littlefield Pub. 2019;(17):210-45.

Published

2022-12-29

How to Cite

1.
Klygunenko O, Kravets O, Marzan O. Albumin solution as an important component of intensive infusion therapy in women with preeclampsia. Med. perspekt. [Internet]. 2022Dec.29 [cited 2024Dec.27];27(4):115-22. Available from: https://journals.uran.ua/index.php/2307-0404/article/view/271184

Issue

Section

CLINICAL MEDICINE