Preeclampsia. Part 1: Clinical and Pathophysiologic Considerations

Abstract

Preeclampsia-eclampsia is still one of the leading causes of maternal and fetal morbidity and mortality. Despite active research for many years, the etiology of this disorder exclusive to human pregnancy is an enigma. Recent evidence suggests there may be several underlying causes or predispositions leading to the signs of hypertension, proteinuria, and edema, findings that allow us to make the diagnosis of the "syndrome" of preeclampsia. Despite improved prenatal care, severe preeclampsia and eclampsia still occur. Although understanding of the pathophysiology of these disorders has improved, treatment has not changed significantly in over 50 years. Although postponement of delivery in selected women with severe preeclampsia improves fetal outcome to a degree, this is not done without risk to the mother. In the United States, magnesium sulfate and hydralazine are the most commonly used medications for seizure prophylaxis and hypertension in the intrapartum period. The search for the underlying cause of this disorder and for a clinical marker to predict those women who will develop preeclampsia-eclampsia is ongoing, with its prevention the ultimate goal. This review begins with the clinical and pathophysiologic aspects of preeclampsia-eclampsia (Part 1). In Part 2, the experimental observations, the search for predictive factors, and the genetics of this disorder will be reviewed.

Examination of the Cellular Mechanisms by Which Marinobufagenin Inhibits Cytotrophoblast Function

“…Circulating levels of MBG have been reported to be increased in patients with volume expansion-mediated hypertension and preeclampsia (5)(6)(7)(8). Preeclampsia is a syndrome that occurs in 3-10% of pregnancies (9,10) and is a leading cause of maternal and fetal morbidity and mortality (9). Preeclampsia is characterized by the de novo development of hypertension and proteinuria after 20 weeks of gestation (9,11).…”

Soluble VEGF receptor Flt1: the elusive preeclampsia factor discovered?

“…In these and other causes of nephrolithiasis, the site of the initial solid phase has long been the subject of debate. Over 65 years ago, A. Randall demonstrated that interstitial crystals located at, or adjacent to, the papillary tip, Randall's plaques, were common in stone formers (2). He found that these crystals were composed not of calcium oxalate, the most common solid phase found in patients with nephrolithiasis, but of calcium phosphate (3).…”

“…Preeclampsia, or the condition preceding full-blown eclampsia, affects up to 5% of pregnant women and is diagnosed by the onset of hypertension and proteinuria in the second trimester (1). Preeclampsia may eventually progress to glomerular malfunction, thrombocytopenia, liver and brain edema, and associated lifethreatening seizures (2) (Figure 1). Preeclampsia has been sometimes termed the "disease of theories," as several models for its pathogenesis have been proposed.…”

Changes in Serum Calcium and Serum Magnesium Level in Preeclamptic vs Normal Pregnancy

“…It is specific to human pregnancy and complicate 6 -8 % of gestation after week 20 1 . Preeclampsia is still one of the leading causes of maternal and fetal morbidity and mortality 2 . The pathophysiological mechanism is characterized by a failure of the trophoblastic invasion of the spiral arteries which may be associated with an increased vascular resistance of the uterine artery and a decreased perfusion of the placenta 3 .…”