The physiology of pre-eclampsia

Clinical and Experimental Pharmacology & Physiology
M A Brown

Abstract

1. Pre-eclampsia is a multisystem disorder of human pregnancy with a genetic predisposition. It occurs more commonly in first pregnancies and primarily affects maternal renal, cerebral, hepatic and clotting functions while elevating blood pressure. The foetus is affected through placental insufficiency arising from abnormal 'placentation', that is, failure to adequate trophoblast invasion of maternal vasculature, and possible from abnormal autacoid production. 2. Pre-eclampsia is caused by the placenta; delivery of the placenta is the only known cure. Its manifestations are considered secondary to organ hypoperfusion which arises as a result of vasoconstriction, intravascular coagulation and reduced maternal blood volume. 3. Current hypotheses propose that pre-eclampsia is due to widespread maternal endothelial cell damage, perhaps secondary to a cytotoxic factor released by the placenta. This hypothesis has gained wide acceptance, but scientific evidence is lacking. 4. Defining the abnormal balance of vasoactive factors in pre-eclampsia has proved a difficult task. There is enhanced pressor activity to infused angiotensin II (AII) despite reduced plasma concentrations of AII, renin and aldosterone. Prostacyclin production appe...Continue Reading

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