Preeclampsia is a Syndrome of Intra-Abdominal Hypertension in Pregnancy - would a Hypothesis become a Theory?

Recent studies offer new hypotheses of the development of preeclampsia (PE), which emphasizes the importance of intra-abdominal hypertension (IAH). IAH is an important factor in the alteration of intestinal perfusion) that can theoretically increase its permeability in pregnant women, cause bacterial and endotoxin translocation, systemic inflammation, and lead to PE symptoms developing; however, all existing hypotheses are based on empirical data and logical conclusions. This study was designed to corroborate a relation between the PE development, IAH and a violation of the barrier function of the intestine. Investigation of the dynamics of intra-abdominal pressure (IAP) was performed in 343 pregnant women in the period from 6 to 40 weeks of gestation. They were divided into 3 groups: Group I-215 patients with uncomplicated singleton pregnancy; Group II–patients with the risk factors of complications of pregnancy and childbirth outcomes without PE developing (n = 97); Group III - patients with PE (n=31). To determine the relationship between PE and affected intestinal barrier function, along with the study of IAP, starting from the second trimester of pregnancy, the intestinal permeability and the level of bacterial endotoxin were examined in parallel. We measured IAP indirectly by measuring the intravesical pressure, and calculated the compliance of the abdominal wall. The “lactulose/mannitol” test was used to assess the barrier function of the intestinal mucosa. Endotoxin levels were determined in serum by activated particles method (IRA - Endotox spp.).