Potential of Therapeutic Apheresis for Prolongation of Pregnancy in Early-Onset Preeclampsia

ABSTRACT Preeclampsia with onset between 20 and 34 weeks is conditioned by the development of endothelial dysfunction caused by increased secretion of antiangiogenic factors, activation of the immune system, and the synthesis of inflammatory mediators. This complication is responsible for the progression of multiple organ failure in the mother, and more than 60,000 maternal deaths annually worldwide. The only method of therapy at present is early delivery. Such tactics lead to high neonatal morbidity and mortality.

AIM OF STUDY To evaluate the possibilities of safely prolonging pregnancy using therapeutic apheresis methods in the development of early-onset preeclampsia.

MATERIAL AND METHODS A prospective randomized study was conducted involving 58 patients diagnosed with early-onset severe preeclampsia. The patients were divided into three groups. The patients of the first group underwent 2 sessions of cascade plasma filtration with a total processed plasma volume of 4810 (3250; 5680) ml. In the second group, hemoperfusion was performed with a perfusion volume of 18,460 (16.890; 21.350) ml in two sessions. At the stages of the study, the dynamics of clinical and laboratory parameters of the mother and newborn were assessed in comparison with the control group.

The use of cascade plasma filtration statistically significantly reduced the sFlt-1/PIGF ratio (p=0.017), pregnancy was prolonged by 32.5 (5.5; 42.5) days, the gestational age at delivery was 34.1 (29.6; 36.0) weeks. When using hemoperfusion, the level of neutrophil extracellular traps decreased statistically significantly. Pregnancy was prolonged by 26.5 (8; 52) days, the patients gave birth at a gestational age of 34.3 (33.5; 36.8) weeks. In the control group, the duration of pregnancy prolongation was 5.5 (2;7) days, p<0.017 compared with other groups. In this group, progression of laboratory signs of multiple organ failure and deterioration of fetal blood flow were noted. Newborns from the control group showed a statistically significantly greater need for surfactant: OR 7.3 95%CI [1.81; 29.6], p=0.005. Resuscitation bed-day and treatment in the department of premature infants for newborns from the control group were 12.5 (8.5; 16.8) and 15 (7; 22) days, respectively, p<0.017 compared with other groups.

CONCLUSION The use of therapeutic apheresis techniques in patients with early-onset preeclampsia may allow for safe prolongation of pregnancy in the interests of the fetus, which requires further study.

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