Introduction new developments in preeclampsia (original) (raw)
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Reproductive Sciences, 2007
Development of the National Institutes of Health sponsored a 2-day workshop titled "Preeclampsia-A Pressing Problem." The purpose of the workshop was to bring together leaders in the field to present and discuss their diverse research areas, which ranged from basic science to clinical trials and management, and to identify scientific gaps. This article is a summary of the proceedings of that workshop. Although much progress is being made in understanding the underpinnings of preeclampsia, a number of research gaps are identified that, if filled, would hasten progress in the field. It is the overall consensus that preeclampsia is a multifactorial disease whose pathogenesis is not solely vascular, genetic, immunologic, or environmental but a complex combination of factors. In addition, a number of specific scientific gaps are identified including insufficient multidisciplinary and collaborative research, clinical trials and studies of patient management, and a lack of in-depth mechanistic research. The research community needs to focus on these gaps to better understand the disease, with the ultimate goal of preventing the disorder.
Preeclampsia: Narrative Review for Clinical Use
SSRN Electronic Journal
Preeclampsia is a very complex multisystem disorder characterized by mild to severe hypertension. Methods: PubMed and the Cochrane Library were searched from January 1, 2002 to March 31, 2022, with the search terms "pre-eclampsia" and "hypertensive disorders in pregnancy". We also look for guidelines from international societies and clinical specialty colleges and we focused on publications made after 2015. Results: The primary issue associated with this physiopathology is a reduction in utero-placental perfusion and ischemia. Preeclampsia has a multifactorial genesis, its focus in prevention consists of the identification of high and moderate-risk clinical factors. The clinical manifestations of preeclampsia vary from asymptomatic to fatal complications for both the fetus and the mother. In severe cases, the mother may present renal, neurological, hepatic, or vascular disease. The main prevention strategy is the use of aspirin at low doses, started from the beginning to the end of the second trimester and maintained until the end of pregnancy. Conclusion: Preeclampsia is a multisystem disorder; we do not know how to predict it accurately. Acetylsalicylic acid at low doses to prevent a low percentage, especially in patients with far from term preeclampsia. There is evidence that exercising for at least 140 min per week reduces gestational hypertension and preeclampsia. Currently, the safest approach is the termination of pregnancy. It is necessary to improve the prediction and prevention of preeclampsia, in addition, better research is needed in the long-term postpartum follow-up.
Review Article, 2023
Preeclampsia is a pregnant hypertension condition. It has a significant negative impact on maternal and perinatal health and affects 2-8% of pregnancies worldwide. The disease's main features are hypertension and proteinuria, though systemic organ damage could follow. The aberrant placentation that precedes the release of antiangiogenic markers, which is predominantly mediated by soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin, is the first sign of the clinical condition.(sEng). Every maternal organ system, including the fetus, may be adversely affected by high levels of sFlt-1 and sEng due to endothelial dysfunction, vasoconstriction, and immunological dysregulation. With an emphasis on the mechanisms underlying the clinical symptoms, this article thoroughly investigates the pathogenesis of preeclampsia. The only permanent remedy is delivery. In high-risk populations, low-dose aspirin is advised for prophylaxis. There are few other therapy alternatives. The pathophysiology of this common disease has to be clarified in order to find possible therapeutic targets for better treatment and, ultimately, outcomes. The three most common causes of maternal morbidity and mortality worldwide are preeclampsia and eclampsia. Rates of eclampsia, maternal mortality, and maternal morbidity in wealthy nations have significantly decreased during the past 50 years. In contrast, maternal mortality, problems during pregnancy, and eclampsia rates are still high in developing nations. In industrialised nations, preeclampsia-eclampsia patients are properly managed, and prenatal care is widely accessible. These discrepancies are mostly attributable to these factors.
Journal of reproductive immunology, 2015
This workshop had four main objectives: (A) Trying to look at the preeclampsia (PE) problem "from the Space Shuttle": why preeclampsia has emerged in humans (a specific human reproductive feature among 4300 mammal species)? (B) Epidemiology: there are major geographical differences concerning early onset PE and late onset PE throughout the world. (C) Vascular: The very promising use of pravastatin in the treatment of the vascular maternal syndrome (based on the metabolism of carbon monoxide (CO), the role of inositol phosphate glycans P-type (IPG-P), a major role in comprehending the insulin resistance phenotype in preeclampsia. (D) Immunology: the specialty of these workshops since their start in 1998; our understanding of the role of the immune system and the regulation of the deep implantation of the human trophoblast (and the obligatory compromises between the fetal/placental unit and the mother) have reached a kind of "maturity," following the pivotal studie...
2014
Preeclampsia remains a major problem worldwide for mothers and babies. It is estimated that yearly 50 000 women die in developing countries from preeclampsia. Careful maternal observation for the signs of preeclampsia and delivery of women with increasingly severe preeclampsia is the cornerstone of management (as it has been for the past 100 years). Maternal mortality is, therefore, much less in developed countries with the capacity for careful perinatal observation, but morbidity is considerable and remains the leading cause of admissions to intensive care for pregnant women. Also, the appropriate delivery of women who develop increasingly severe preeclampsia early in gestation accounts for 8% of all preterm births.
Preeclampsia: A danger growing in disguise
The International Journal of Biochemistry & Cell Biology, 2008
Preeclampsia occurs in 3-14% of pregnancies and is defined by maternal hypertension with proteinurea, generally associated with edema, coagulation abnormalities, and disseminated intravascular coagulation. The conditions can lead to eclampsia, characterized by hyperreflexia and convulsions. Several organs are afflicted by the condition, most importantly the liver and kidneys. The direct cause of preeclampsia is unknown, but the initial events are linked to abnormalities of placentation. This implies abnormalities in trophoblast invasion and in physiological alterations of placental vessels required for adequate perfusion of the placenta, which leads to ischemia. The mechanisms that link the ischemic placenta to endothelial lesions and to stimulation of vasoconstrictors and inhibition of vasodilators are still subject of speculation. The only treatment of preeclampsia is delivery. Lowering of blood pressure and prevention of eclampsia with magnesium sulfate is indicated in severe preeclampsia. Despite numerous studies attempting to elucidate the exact etiopathogenesis of this complex multifactorial disease, prediction or prevention methods of preeclampsia are not available.
Preeclampsia in 2018: Revisiting Concepts, Physiopathology, and Prediction
The Scientific World Journal, 2018
Preeclampsia currently remains one of the leading causes of death and severe maternal morbidity. Although its prevalence is still underestimated in some places due to underreporting, preeclampsia is a disease that health professionals need to know how to deal with and take action. For this reason, the studies about the theme remain along with the advances in their understanding that often implies improvement and change of concepts and conducts. The complexity of its etiology is a challenge and requires further studies for its full understanding. Apparently, poor adaptation of the maternal organism to the conceptus, marked by the nonoccurrence of changes in the uterine spiral arteries, determines a series of systemic repercussions that compound the various forms of preeclampsia presentation. In recent years, the use of acetylsalicylic acid to prevent cases of early onset of the disease has been consolidated and, alongside, studies have advanced the development of accessible and effec...
Pre-eclampsia--still a disease of theories
Fukushima Journal of Medical Science, 2003
Pre-eclampsia is still one of the leading causes of maternal and fetal morbidity and mortality. Despite active research for many decades, 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 endothelial dysfunction and causing the signs of hypertension, proteinuria, and edema-findings that allow us to make the diagnosis of the "syndrome" of pre-eclampsia. It is obvious that a single mechanism responsible for the syndrome pre-eclampsia does not exist. Instead, several mechanisms can act together and even multiply each other. The search for the underlying cause of this disorder and for a clinical . marker to predict which women will develop pre-eclampsia is ongoing, with its prevention being the ultimate goal.