Preeclampsia: multiple approaches for a multifactorial disease

Abstract

Preeclampsia is a pregnancy-specific disorder characterized by hypertension and excess protein excretion in the urine. It is an important cause of maternal and fetal morbidity and mortality worldwide. The disease is almost exclusive to humans and delivery of the pregnancy continues to be the only effective treatment. The disorder is probably multifactorial, although most cases of preeclampsia are characterized by abnormal maternal uterine vascular remodeling by fetally derived placental trophoblast cells. Numerous in vitro and animal models have been used to study aspects of preeclampsia, the most common being models of placental oxygen dysregulation, abnormal trophoblast invasion, inappropriate maternal vascular damage and anomalous maternal-fetal immune interactions. Investigations into the pathophysiology and treatment of preeclampsia continue to move the field forward, albeit at a frustratingly slow pace. There remains a pressing need for novel approaches, new disease models and innovative investigators to effectively tackle this complex and devastating disorder.

Vascular corrosion casting of normal and pre‑eclamptic placentas

“…The difference between the original and final volumes was recorded as the placental vascular volume. To calculate the artery-to-vein ratio per cm 2 and examine the peripheral vascular network, 10 spots were selected along the edge of the placentas, and a further 10 spots were selected in between the umbilical cord and the edge of the placenta. The levels of branching and the diameters of placental veins and arteries were also recorded.…”

“…The exact etiology of pre-eclampsia is unclear. It is considered to be a multifactorial disease caused by complex interactions between genetic and environmental factors affecting the immune and vascular functions (2). Early diagnosis is critical for improving the placental function, preventing life-threatening complications, and reducing maternal and fetal mortality.…”

“…Early diagnosis is critical for improving the placental function, preventing life-threatening complications, and reducing maternal and fetal mortality. Despite the multifactorial characteristics of pre-eclampsia, the majority of cases are associated with abnormal maternal uterine vascular remodeling by variant placental trophoblastic cells (2,3). Placental abnormalities, including alterations in the uteroplacental vasculature, have been identified in pre-eclampsia research (4)(5)(6)(7).…”

Evaluación de las características operativas de la relación proteína / creatinina en orina ocasional para la detección de proteinuria significativa en gestantes con sospecha de preeclampsia

“…La proteinuria refleja la alteración de la filtración renal causada por la endoteliosis glomerular, la cual consiste en edema de las células endoteliales y el depósito de fibrina a nivel de la membrana glomerular (5). Es una de las manifestaciones cardinales de esta enfermedad y constituye uno de los criterios para su diagnóstico.…”

Função endotelial, perfusão uterina e fluxo central em gestações complicadas por Pré-Eclampsia

“…The physiopathological mechanisms that trigger the clinical symptoms of PE are not yet fully elucidated, and the syndrome etiology remains one of the great mysteries of Medicine 4,5 . The most widely accepted theory postulates that a defective process of trophoblastic invasion in the uterine spiral arteries creates a localized hypoxic environment, having as physiological response the release of several factors that are hazardous to the systemic vascular endothelium, including reactive oxygen species (ROS) 6 .…”