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Preeclampsia is one of the main causes of maternal and fetal mortality. We lack a reliable test that would identify the "at risk" group of pregnant women, thus allowing us to implement a specific prevention, management and treatment program. Recently, a number of theories regarding the pathophysiology of preeclampsia has been published. The role of vascular pathology as a result of an increase in homocysteine level is often mentioned. The aim of this paper is to review the current literature related to the pathology of preeclampsia and to evaluate the usefulness of assessment of homocysteine level and homocysteine metabolism disorders as a potential predictor of preeclamsia. Hiperhomocysteinemia is a known risk factor of cardiovascular diseases and hypertension. Different sources report a similar correlation between an increase in homocysteine level and the incidence of preeclampsia. As far as the topic of homocysteine in pregnancy is concerned, numerous questions and problems remain unanswered and unsolved. Although there exists a relationship between an increased values of homocysteine and the incidence of preeclampsia, there is not enough information about what group of patients should be included in the screening test to increase the rate of diagnosis and prevention of the most dangerous sequele.

Unlabelled: The aim of the study was to test hypothesis, that in placenta mast cells are significant source of iNOS., Material: Placentas were collected after term delivery from healthy (control, n=13) and preeclamptic (n=11) women. Mast cells and iNOS expression were detected in obtained samples with monoclonal anti-iNOS and anti-tryptase antibodies. Next, morphometric analysis were performed. There were no significant difference between iNOS expression and number of iNOS-positive cells in normal and preeclamptic placentas. There was a significant increase in mast cells number in preeclamptic placentas (8.32 +/- 1.3 SD vs 5.14 +/- 1.2 SD in control) and decrease in percentage of iNOS positive cells among them (68.1% vs 23.6%). We conclude, that in uncomplicated pregnancies, mast cells are the main source of iNOS in placenta while in preeclampsia they loss their potential to synthetase iNOS.

Unlabelled: Importance of angiogenesis in proper development of placenta is unquestioned. Abnormalities in vascular development are typical for complications of pregnancy: intrauterine growth retardation (IUGR) and preeclampsia (PE). As mast cells are involved in new vessels sprouting and development we tried to disclose if they can be involved in etiology or pathogenesis of IUGR and/or PE., Material and Methods: Placentas from PE-complicated pregnancies (n=11), IUGR-complicated pregnancies (n=10), and from healthy women--controls (n=13) were obtained after cesarean sections. Histamine concentration was measured and immunohistochemical staining for mast cell tryptase was performed. Microscopic slides of placental tissue were analyzed with morphometric software., Results: We disclosed increased histamine concentration in PE group--227.3 +/- 17.7 (in ng of histamine per 1 g of tissue) and decreased concentration in IUGR group 114.3 +/- 13.5 vs control--178.1+/- 18.9. Histamine concentration corresponded with density of mast cells in examined groups: PE group--8.32 cells/mm2 +/- 1.3, IUGR--3.07 +/- 1.05 and control--5.14 +/- 1.2. The mean area of mast cells identified in PE as well as in IUGR group was smaller than the mean area of mast cells in controls. V/EVT index was decreased in PE and IUGR group in comparison to controls, respectively: 0.15 +/- 0.018; 0.12 +/- 0.014; 0.23 +/- 0.029., Conclusions: We suggest that differences in mast cells density and corresponding differences in histamine concentration are associated with pathogenesis of PE and IUGR or are consequence of primary cause.

Objectives: Estimation of oxidative stress through the measurement of lipid peroxides and malondialdehyde serum concentration as well as serum antioxidants level expressed by total antioxidants status and its correlation with Doppler velocimetry in women with preeclampsia., Material and Methods: Thirty four patients with preeclampsia at third trimester of gestation: 19 with the mild form and 15 with the severe form of the disease, 21 women with uncomplicated pregnancy at third trimester of gestation served as a control group. Colorimetric methods were used to estimate lipid peroxides, malondialdehyde and antioxidants serum level. In each patient Pulsatility Index and Uterine Artery Score in uterine arteries was measured., Results: Serum concentration of lipid peroxides and malondialdehyde was the highest in patients with severe preeclampsia, but the statistical difference concerned only lipid peroxides level which was significantly higher in this group than in women with mild form of the disease and in the control group. Pulsatility index Uterine Artery Score values were significantly higher in women with severe preeclampsia in comparison to two other groups of patients. Lipid peroxides level significantly positively correlated with Pulsatility Index and Uterine Artery Score values in the whole studied population., Conclusions: Only severe form of preeclampsia is associated with oxidative stress which impaired placenta perfusion expressed by the increase of uterine arteries resistance.

It was found in our previous studies that EPH gestosis is accompanied by an extensive remodeling of the extracellular matrix of the umbilical cord. Studies were performed on the umbilical cord veins of 10 control and 10 newborns delivered by mothers with EPH gestosis. It was decided to determine umbilical cord vein ability to bind of labeled (125J)-basic fibroblast growth factor (bFGF), and FGF content by Western immunoblot and ELISA methods. Our experiments indicated that the extracts of umbilical cord vein contain endogenous bFGF and several soluble FGF-binding compounds of different molecular weight. It is of interest that EPH gestosis is associated with a decrease in bFGF content. It seems be possible that the decrease of bFGF amount may be one of the factors, which constrain the biosynthesis of collagen in EPH gestosis umbilical cord vein wall.

The paper is a survey of literature on the two hypotheses about preeclampsia: a) one according to which the endothelium injury is a key complication; b) another one according to which the injury is a side effect of inflammation and adhesive reaction. Those reactions consist in the activation of the endothelium and activation of blood platelets, as well as activation of neutrophils and monocytes/macrophages. That complex activation is induced by cytokines and integrins from the placenta, deported cytotrophoblast and procoagulant debris of the trophoblast. The two hypotheses are complementary rather than competitive.

Objective: Free radical induced lipid peroxidation (LP) in the placenta has been suggested as a possible pathogenetic factor of preeclampsia (PE)., Design: The aim of the study was to assess LP intensification by the measurement of lipid peroxidation products (LPP) content in placentas from normal and preeclamptic pregnancies., Materials and Methods: The investigations comprised placentas obtained immediately after delivery from 24 normal pregnancies [group K], 26 pregnancies complicated by severe PE without intrauterine growth restriction (IUGR) [group PE] and 23 pregnancies complicated by severe PE and IUGR [group PEI]. LPP content was measured by the quantitative determination of thiobarbituric acid reactive substances (TBA-RS) amounts in studied placentas. Used TBA test was calibrated with malondialdehyde (MDA) and results were expressed as MDA equivalent in nmol/mg protein. Comparative analysis was performed using U Mann-Whitney and median tests., Results: Mean placental level of LPP (MLPP) in the group PE-2.45 +/- 0.39 (M +/- SD) was significantly higher (p < 0.001) as compared to MLPP in the group K (1.58 +/- 0.24). MLPP in the PEI group (2.81 +/- 0.65) was higher (p < 0.001) than MLPP in the group K as well as MLPP in the group PE but statistical significance of the latter difference was lower (p = 0.032)., Conclusions: The intensification of LP in placentas from pregnancies complicated by severe PE is IUGR dependent and higher than in placentas from normal pregnancies. Obtained results may indicate that higher degree of LP intensification in preeclamptic placentas may be involved in PE pathogenesis.

This paper estimates the excretory kidneys activity in women with pregnancy complicated by EPH-gestosis and in women with a physiological pregnancy by denoting albuminuria, beta-2-microglobulinuria and beta-2-microglobulin in blood serum. It was claimed that the excretion of albumins with urine increases considerably in women with a pregnancy complicated by EPH-gestosis before the delivery in comparison with women with a pregnancy of a physiological course. The increase of albumins excretion with urine in a labour in two groups of tested pregnant women was also noticed. However, the increase in excretion of albumins with urine during delivery was much bigger in the group of women with pregnancy complicated by EPH-gestosis in comparison to the group of women with a physiological course of pregnancy. The albumins size before delivery as well as during the next 48 hours after the delivery did not differ statistically in both groups of tested women. Beta-2-microglobulin concentration in blood serum was bigger in the group of pregnant women with EPH-gestosis than women with a physiological pregnancy during the whole period of research. Bigger excretion of beta-2-microglobulin with urine was noticed among women with pregnancy complicated by EPH-gestosis before delivery, during delivery and during the next 48 hours after the delivery in relation to the group of women with a physiological pregnancy.

Objective: An increase in lipid peroxidation intensification in preeclamptic placentas leads to an increased level of lipid peroxidation products and increased reactive oxygen species activity which can be associated with increased activation of chemicals to electrophilic species that bind covalently to DNA and form adducts., Design: The aim of the study was the determination of DNA adducts (A-DNA) in placentas from normal and preeclamptic pregnancies., Materials and Methods: The investigations comprised placentas obtained immediately after delivery from 21 normal pregnancies [group K], 24 pregnancies complicated by severe preeclampsia-PE without intrauterine growth restriction (IUGR [group PE] and 21 pregnancies complicated by severe PE and IUGR [group PEI]. DNA adducts were determined using nuclease P1 digestion enhancement version of the 32P-postlabeling method. The results were expressed in numbers of DNA adducts per 10(8) nucleotides. Comparative analysis was performed using ANO-VA and median tests., Results: Mean level of A-DNA (MA-DNA) in the group PE--1.39 +/- 1.21 (M +/- SD) was similar (p = 0.57) to MA-DNA in group K (1.16 +/- 1.03). However MA-DNA in the PEI group (1.93 +/- 1.28) was significantly higher (p = 0.045) than MA-DNA in the group K as well as MA-DNA in the group PE (p = 0.025). MA-DNA level in all studied preeclamptic placentas (groups PE + PEI) was 1.65 +/- 1.26 and was similar (p = 0.152) to revealed in group K., Conclusions: The level of DNA adducts in placentas from pregnancies complicated by severe preeclampsia and IUGR is higher than in placentas from pregnancies complicated by severe preeclampsia without IUGR and higher than in placentas from normal pregnancies.

Total proteolytic activity, activity of cathepsin B, activity of cysteine cathepsins and contents of protein degradation products were determined in placentas of pregnancies complicated with mild, moderate and severe EPH-gestosis and in placentas from normal pregnancies. The highest activity of all the determined proteases was observed in placentas of pregnancies complicated with severe EPH-gestosis. The placentas of pregnancies complicated with severe EPH-gestosis also include the highest amounts of aminoacids and low-molecular peptides.

Unlabelled: Abnormal endocrine/paracrine function of the vascular endothelium seems to be of most important in the pathogenesis of preeclampsia. The present study aimed to assess plasma concentration of ET-1 and NOx in maternal (M) and umbilical cord blood (UC) in 15 pregnant women with moderately severe preeclampsia (gestosis index 6.1 +/- 0.4), 15 pregnant women with mild preeclampsia (gestosis index 2.3 +/- 0.1) and in 31 healthy pregnant women (in 15 of them elective cesarean section was done). The control group consisted of 10 nonpregnant healthy women (NC). Moderately severe preeclampsia was characterised by a normal or even reduced plasma ET-1 level in maternal (0.7 +/- 0.1 pg/ml and cord blood (1.3 +/- 0.2 pg/ml) but markedly elevated NOx concentration (maternal blood 36.7 +/- 4.2 mumol/l), cord blood 33.5 +/- 3.5 mmol/l). In pregnant women with mild preeclampsia elevated ET-1 levels were found both in cord (3.41 +/- 0.6 pg/ml) and maternal blood (2.62 +/- 0.5 pg/ml) which were accompanied by elevated NOx concentrations (31.2 +/- 2.9 mumol/l and 32.4 +/- 2.3 mumol/l in cord and maternal blood respectively). A significant negative correlation was found between plasma ET-1 and NO levels in cord blood from severely preeclamptic women, but a positive one between cord plasma ET-1 level and gestosis index., Conclusion: Participation of altered ET-1 and NOx levels in maternal and cord blood from preeclamptic women as compensatory mechanisms providing adequate perfusion of the utero-placental unit is likely.

Activity of cathepsin B using Bz-DL-Arg-pNA contents of SH-group by means of Ellman method, activity of cystatins against papain using casein as a substrate and contents of deoxyribonuclein acids by Burton method were determined in 64 placentas of pregnancies with EPH-gestosis and in 36 placentas of physiological pregnancies. The placentas from pregnancies with EPH-gestosis showed markedly higher activity of cathepsin B, no difference in the contents of SH-group, slightly higher activity of cystatins and they contain less deoxyribonucleic acids than the placentas from physiological pregnancies. The obtained results show that proteolytic--anti-proteolytic balance in placentas from pregnacies with EPH-gestosis is changed to the advantage of cathepsin B. This protease may in formation of structural and functional changes observed in placentas during EPH-gestosis.

Cysteine proteinase inhibitors (IPC) concentration was measured by the modified Barrett method using papaine in urine, amniotic fluid and serum obtained from the healthy labored women and from labored women in pregnancy complicated by EPH-gestosis. It was noticed the statistically significant increase in the IPC concentration in the material from the pregnant women with EPH-gestosis comparing to the women, which pregnancy had the physiologically normal course.

In serum, urine and amniotic fluid obtained from the 52. women divided into three groups the arylsulphatase A (EC 3.1.6.1) activity was measured by the modified Lee-Vaupel and Conzelmann method. It was noticed in serum from the pregnant women with EPH-gestosis the statistically significant (p < 0.05) increase in the enzyme activity comparing to the results from non-pregnant women and pregnant with normal course of pregnancy. It was no statistically significant differences in the urine from pregnant with EPH-gestosis and from the healthy pregnant, but there was the increase (p < 0.01) in the enzyme activity in amniotic fluid from pregnant women with EPH-gestosis comparing to the physiological course of pregnancy. According to our data, the arylsulphatase A activity assay could be recommended as a diagnostic marker in the EPH-gestosis.

The study was performed on 70 pregnant women, divided into two groups: normal or EPH gestosis. The concentration of serotonin in plasma was determined according to Manuchin et al., the activity of monoamine oxidase was determined using the radioisotope method of Yuodim. Daily urinary excretion of 5-hydroxyindoleacetic acid was established with the method of Udenfriend et al. It was found that women with EPH gestosis have significantly higher (p < 0.01) plasma concentration of serotonin and significantly lower activities of MAO (p < 0.001) in serum and in blood platelets and urinary excretion of 5-hydroxyindoleacetic acid (p < 0.05) than normal pregnant women.

We estimated in vitro degradation and consumption of glycogen by placental tissue derived from pregnancies complicated by gestosis and anemia. Placental tissue was incubated in suitable medium. Glycogen concentration either before or after incubation was assayed. Glycogen consumption was expressed as micromoles of glucose per 1 g of wet tissue, the percentage of glycogen consumption has been shown in tables. It is concluded that in advanced gestosis and severe anemia of pregnancy the consumption of native glycogen is increased, consequently it may lead to metabolic insufficiency of human placenta.

The study was carried out on 23 samples of amniotic fluid taken (by amniocentesis) between 35th and 39th week from pregnant women with arterial hypertension (13 cases of hypertension induced by pregnancy, 5 cases of primary hypertension and 5 cases of hypertension accompanying renal diseases). Seven women undergoing the study gave birth to newborns with symptoms of delayed intrauterine growth below 16 centiles (group examined), 16 mothers gave birth to eutrophic babies (control group). The amniotic fluid of the two groups was studied for the following biochemical indexes: alanine and aspartate aminotransferase alkaline total and thermostabile phosphatase, ceruloplasmin, alpha-amylase, general protein, beta-lipoproteins, cholesterol, uric acid, urea and creatinine. No significant changes were found in the parameters determined between the group examined and the control group.