Preeclampsia and Eclampsia Revisited

Abstract

Hypertensive disorders during pregnancy, which account for approximately 15% of pregnancy-related deaths, represent the second-leading cause of morbidity and mortality in the United States. New classifications recommended by the National Institutes of Health's Working Group on High Blood Pressure in Pregnancy have decreased the confusion often associated with these disorders. The cause of preeclampsia-eclampsia still remains elusive, but continued research has provided hope with regard to screening, improved diagnosis, and management. Risk factors that have recently gained attention include inherited thrombophilias, inherited metabolic disorders, and lipid disorders. Treatment and management of the hypertensive disorders of pregnancy have not changed substantially in the past 50 years. Prevention of preeclampsia-eclampsia has been unsuccessful, and recurrence risks remain high. Careful diagnosis, classification, and further investigation of the causes of hypertensive disorders in pregnancy are needed to achieve optimal management of affected women and their fetuses.

Postpartum Preeclampsia Occurring After Resolution of Antepartum Preeclampsia

“…Although preeclampsia in an earlier pregnancy is associated with a 1.4 -18% increased risk in a subsequent pregnancy, preeclampsia that seems to resolve with delivery and then to recur in the postpartum period is scarcely mentioned in the literature (3,4). An abstract by Matthys et al describes 151 women who were admitted to the hospital with postpartum preeclampsia; 24% of them had received magnesium either intrapartum or immediately postpartum in the same pregnancy (2).…”

“…She had antepartum preeclampsia and a recurrence of the classic signs of preeclampsia in the postpartum period. Although the most likely explanation is recurrence of preeclampsia after its apparent resolution with delivery of the infant, an alternative explanation is simply that some of the manifestations of preeclampsia, particularly hypertension, may take longer to resolve in some individuals (3).…”

“…Delivery of the infant is generally considered to be the definitive treatment. The presumed explanation is that placental factors are the cause of the endothelial dysfunction underlying preeclampsia, and that this source is no longer present after delivery of the infant and placenta (3). Although the hypertension associated with preeclampsia may persist for 4 to 6 weeks after delivery, the other components of the clinical picture-proteinuria and hyperreflexia-usually do not.…”

Efeitos da inibição da sintase induzida do óxido nítrico na fisiopatologia da pré-eclâmpsia experimental

“…Durante o início do segundo trimestre da gestação (18-20º semanas) ocorre a migração dos citotrofoblastos em direção as arteríolas uterinas espiraladas onde sofrem diferenciação em células com fenótipo endotelial (Longo, Dola et al, 2003). Os trofoblastos são as células precursoras da placenta humana, cujas funções (implantação embrionária, produção de hormônios gestacionais, proteção imunológica fetal, aumento do fluxo sanguíneo vascular materno na placenta, parto, etc.)…”

“…Nossos resultados sugerem que o 1400W atenua a hipertensão no modelo RUPP principalmente pela inibição da iNOS e formação de peroxinitrito. Estas alterações são resultantes de interações complexas entre hormônios, substâncias vasoativas e vários outros fatores (Pridjian e Puschett, 2002;Longo, Dola et al, 2003).…”