Old and new aspects in the pathophysiology of pre-eclampsia

  • Federico Prefumo
  • Melih Atahan Güven

Turk J Obstet Gynecol 2007;4(4):237-245

Pre-eclampsia is a condition affecting the feto-placental unit and the mother. Three to five percent of pregnancies are complicated by pre-eclampsia, a multisystem disorder characterized by hypertension and proteinuria that occurs after 20 weeks of pregnancy. Pre-eclampsia is associated with substantial risks. For the fetus, these include intrauterine growth restriction, death, and prematurity with attendant complications, whereas the mother is at risk for complications of widespread alterations in endothelial function such as seizures (eclampsia), renal failure, pulmonary edema, stroke, and death. The establishment of pathological uterine perfusion raises the problem of stage two. The problem at stage three describes pre-eclampsia as a syndrome with the global maternal endothelial damage as the central pathophysiological feature. It has been suggested that the pathophysiology of pre-eclampsia can be thought of as a ‘three-stage problem’, where each stage generates one, so far unsolved problem. An impaired trophoblast invasion is thought to be the central factor (first step) regarding the etiology of pre-eclampsia. An increased uterine artery Doppler findings (PI, RI), lower maternal serum PAPP-A and free ßhCG levels, ischaemia modified albumin (IMA) may be associated with pre-eclampsia.

Keywords: complication, pregnancy, pre-eclampsia