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Pre-Eclampsia as a Multi-System Disease

  • John M. Davison
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 252)

Abstract

Hypertension complicates 1 in 10 pregnancies. Approximately 50–60% of these women have pre-eclampsia, which occurs primarily in first pregnancies, usually after the twentieth gestational week and most often near term. of the various systemic changes in pre-eclampsia, hypertension, oedema and proteinuria have been given significant status for the purpose of definition.1 Indeed, other clinical labels include pregnancy-induced hypertension(PIH), hypertension peculiar to pregnancy and pregnancy associated hypertension, perhaps mistakenly reflecting the exclusive importance of raised blood pressure (BP). Hypertension, oedema and proteinuria are merely conveniently accessible clinical signs which are not specific or characteristic of the disorder but secondary features of whatever comprises the primary pathology. Furthermore, in clinical terms, there is difficulty distinguishing between pre-eclampsia, essential or secondary hypertension, renal disease or combinations of these entities. 2

Keywords

Obstet Gynecol Normal Pregnancy Spiral Artery Hypertensive Encephalopathy Renal Haemodynamics 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Redman, C. W. G., 1987, The definition of pre-eclampsia. “Hypertension in Pregnancy”, F. Sharp & E. M. Symonds (Eds), Perinatology Press, N.Y., 3.Google Scholar
  2. 2.
    Fisher, K. A., Ahuja, S., Luger, A., et al., 1977, Nephrotic proteinuria with preeclampsia, Amer. J Obst Gynec. 129:643.Google Scholar
  3. 3.
    Dunlop, W. and Davison, J. M., 1987, Renal haemodynamics and tubular function in human pregnancy, Clin Obstet Gynae, 1:269.Google Scholar
  4. 4.
    Hughes, E. C., 1972, In: Obstetric-Gynecologic Terminology, Davis, Philadelphia, 422.Google Scholar
  5. 5.
    MacGillivray, I., Rose, G. A. and Rowe, B., 1969, Blood pressure survey in pregnancy, Clin Sci, 37:395.PubMedGoogle Scholar
  6. 6.
    Redman, C. W. G., and Jefferies, M., 1988, Revised definition of preeclampsia. Lancet 1:809.PubMedCrossRefGoogle Scholar
  7. 7.
    Nelson, T. R., 1955, Aclinical study of preeclampsia, J Obs Gynae, Br.Enp. 62:48.CrossRefGoogle Scholar
  8. 8.
    Brosens, I. A., Robertson, W. B. and Dixon, H.G., 1972, The role of the spiral arteries in the pathogenesis of preeclampsia. In: Obstetrics and Gynecology Annual. Ed. R. M. Wynn, Appleton-Century-Crofts, New York, 177.Google Scholar
  9. 9.
    Robertson, W. B., Brosens, I. and Dixon H.G., 1967, The pathological response of the vessels of the placental bed to hypertensive pregnancy, J Path Bact, 93:581.PubMedCrossRefGoogle Scholar
  10. 10.
    Fox, H., 1987, Histopathology of pre-eclampsia and eclampsia. In: “Hypertension in Pregnancy” F. Sharp & E. M. Symonds (Eds), Perinatology Press, N.Y. 119.Google Scholar
  11. 11.
    Chesley, L. C., 1978, Hypertensive Disorders in Pregnancy, New York: Appleton-Century-Crofts.Google Scholar
  12. 12.
    Lindheimer, M. D., and Katz, A. I., 1986, The Kidney in Pregnancy. In B. M. Brenner and R. O. Rector Jr., (eds.). The Kidney (3rd ed.). Philadelphia: Saunders, 1986.Google Scholar
  13. 13.
    MoDre, L. G., Hersye, D. W., Jahnigen, D. et al, 1982, The incidence of pregnancy-induced hypertension is increased among Colorado residents at high altitude. Am.J.Obstet Gynecol, 144:423.Google Scholar
  14. 14.
    Editorial, 1980, Genetic control of pre-eclanpsia. Lancet 1:34.Google Scholar
  15. 15.
    Birkeland, S. A., and Kristofferson, K., 1979, Preeclanipsia: A state of niother-fetus imnune imbalance. Lancet 2:720.PubMedCrossRefGoogle Scholar
  16. 16.
    Froidart, J. M., Hunt, J., Lapiere, C. M., et al, 1986, Kidney Int. Antibodies to laminin in preeclampsia, 29;1050.Google Scholar
  17. 17.
    Beer, A. E., 1978, Possible itnnunologic basis of pre-eclampsiaeclampsia, Semin. Perinatol, 2:39.Google Scholar
  18. 18.
    Redman, C. W. G., Bodner, J. G., Bodner, W. F., et al, 1978, HLA antigens in severe pre-eclampsia, Lancet 2:397.PubMedCrossRefGoogle Scholar
  19. 19.
    Chesley, L. G., and Cooper, D. W., 1986, Genetics of hypertension in pregnancy: Possible single gene control of pre-eclampsia and eclampsia in the descendants of eclamptic women, Br J Obstet Gynaecol 93:898.Google Scholar
  20. 20.
    Cooper, D. W., and Liston, W. A., 1979, Genetic control of preeclampsia, J Med Genet 16:409.PubMedCrossRefGoogle Scholar
  21. 21.
    Scott, J. S., Jenkins, E. M., and Need, J.A. 1978, Inmunology of pre-eclampsia. Lancet 1:704.PubMedCrossRefGoogle Scholar
  22. 22.
    Gant, N. F., Daley, G. L., Chand, S., et al, 1973, A study of angiotensin II pressor respone throughout primigravid pregnancy, J Clin Invest, 52:2682.PubMedCrossRefGoogle Scholar
  23. 23.
    Weir, R. J., Doig, A., Eraser, R., et al, 1976, Studies of the Renin-Angiotensin-Aldosterone Sstem, Cortisol, EXX and ADH in Normal and Hypertensive Pregnancy. In M. D. Lindheimer, A. I. Katz, and F. P. Zuspan (eds). Hypertension in Pregnancy. New York, Wiley.Google Scholar
  24. 24.
    Broughton-Pipkin, F., Craven, D. J., and Symonds, E. M., 1981, The uteroplacental renin-angiotensin system in normal and hypertensive pregnancy, Contrib Nephrol 25:49.PubMedGoogle Scholar
  25. 25.
    Gant, N. F., and Pritchard, J. A., 1984, Pregnancy-induced hypertension, Semin Nephrol 4:260.Google Scholar
  26. 26.
    Deirers, J. M., and Gabbe, S. G., 1976, Placental prostaglandin levels in pre-eclampsia. Am J Obstet Gynecol 126: 137.Google Scholar
  27. 27.
    Editorial, 1982, Pregnancy and the arachidonic acid cascade. Lancet 1:997.Google Scholar
  28. 28.
    Lamming, G. D., Broughton-Pipkin, F., and Symonds, E. M., 1980, Comparison of the alpha and beta blocking drug, labetalol, and methldopa in the treatment of moderate and severe pregnancy-induced hypertension. Clin Exp Hypertens 2:865.PubMedCrossRefGoogle Scholar
  29. 29.
    Wallenburg, H. C. S., Dekker, G. A., Makovitz, J. W., et al, 1986, Low-dose aspirin prevents pregnancy-induced hypertension and pre-eclampsia in angiotensin-sensitive Primigravidae, Lancet 1:3.Google Scholar
  30. 30.
    Makila, U. M., Joupilla, P., Kirkinen, P., et al, 1983, Relation between umbilical prostacyclin production and blood flow on the fetus. Lancet 1:728.PubMedCrossRefGoogle Scholar
  31. 31.
    Moodley, J., Norman, R. J., and Reddi, K, 1984, Central venous concentrations of ininunoreactive prostaglandins E, F, and 6-keto-prostaglandin Fla in eclampsia, Br Med J, 288:1487.CrossRefGoogle Scholar
  32. 32.
    Walsh, S. W., 1985, Preeclampsia: An imbalance in placental prostacyclin and thronboxane production. Am J Obstet Gynecol, 152:335.PubMedGoogle Scholar
  33. 33.
    Ongari, M. A., Ritter, J.M., Orchard, M. A., et al, 1984, Correlation of prostacyclin synthesis by human umbilical artery with status of essential fatty acids. Am J Obstet Gynecol, 149:455.PubMedGoogle Scholar
  34. 34.
    Wickens, D., Wilkins, M. H., Lunec, J., et al, 1981, Free-radical oxidation (peroxidation) products in plasma in normal and abnormal pregnancy, Ann Clin Biochem, 18:158.PubMedGoogle Scholar
  35. 35.
    Gant, N. F., and Pritchard J. A., 1984, A pregnancy-induced hypertension, Semin Nephrol, 4:260.Google Scholar
  36. 36.
    Spitz, B., Deckmyn, H., Van Bree, R., et al, 1985, Influence of a vitamin-E-deficient diet on prostcyclin production by mesometrial triangles and aortic rings from non diabetic and diabetic pregnant rats. Am J Obstet Gynecol, 151:116.PubMedGoogle Scholar
  37. 37.
    Aladjem, S., Lueck, J., and Brewer, J. I., 1983, Experimental induction of a toxemia-like syndrome in the pregnant bragle. Am J Öbstet Gynecol, 145:27.PubMedGoogle Scholar
  38. 38.
    Long, E. G., Tsin, T., Reinarz, J. A., et al 1984, “Hydatoxoi lualba” identified. Am J Obstet Gynecol 16:274.Google Scholar
  39. 39.
    Gau, G. S., Bhundia, J. P., Napier, K. A., et al, 1984, Observations on an organism reported to be associated with gestational pathology, J Obstet Gynaecol, 4:209.CrossRefGoogle Scholar
  40. 40.
    Davison, J. M., and Lindheimer, M. D., 1987, Hypertension and Prengancy In: “Diseases of the Kidney” R W Schrier & C W Gottschalk Eds. Little Brown & Co. Boston 1653.Google Scholar
  41. 41.
    Naumann, R. O., and Weinstein, L., 1985, Disseminated intravascular coagulation - The clinican’s dilemma, Obstet Gynecol Surv, 40:487.PubMedCrossRefGoogle Scholar
  42. 42.
    Kelton, J. G., Hunter, D. J. S., and Neasme, P. B., 1985, A platelet function defect in preeclampsia, Obstet Gynecol 65:107.PubMedGoogle Scholar
  43. 43.
    Goldenberg, R. L., Huddleston, J. F., Davis, R. O., et al, 1983, Toxaemia of pregnancy masquerading as idiopathic thrombocytopenic purpura, Obstet Gynecol, 62:325.Google Scholar
  44. 44.
    Schwartz, M. L., and Brenner, W. E., 1983, Pregnancy-induced hypertensin presenting with life-threatening thrombocytopenis, Am J Obstet Gynecol, 146:757.Google Scholar
  45. 45.
    Weinstein, L., 1985, Preeclampsia/eclampsia with hemolysis, elevated liver enzymss and thrombocytopenia, Obstet Gynecol, 66:657.PubMedGoogle Scholar
  46. 46.
    Pritchard, J. A., 1980, Management of pre-eclampsia and eclampsia. Kidney Int, 18–259.Google Scholar
  47. 47.
    Fisher, K. A., Luger, A., Sparto, B. H., et al, 1981, Hypertnesion in pregnancy: Clinical pathological correlations and late prognosis. Medicine 60:267.PubMedCrossRefGoogle Scholar
  48. 48.
    Gaber, L. W., Spargo, B. M., Lindheimer, M. D., 1987, Renal pathology in preeclampsia, Clin Obstet Gynae 1:971.Google Scholar
  49. 49.
    De Swiet, M, 1985, Some rare medical cotplications of pregnancy, Br Med J, 290:2.CrossRefGoogle Scholar
  50. 50.
    Redman, C. W. G., 1984, The management of hypertension in pregnancy, Semin Nephrol, 4:270.Google Scholar
  51. 51.
    McKay, G. G., 1981, Chronic intravascular coagulation in normal pregnancy and pre-eclampsia, Contrib Nephrol, 25:108.PubMedGoogle Scholar

Copyright information

© Plenum Press, New York 1989

Authors and Affiliations

  • John M. Davison
    • 1
  1. 1.Medical Research Council Human Reproduction GroupPrincess Mary Maternity HospitalNewcastle upon TyneEngland

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