Etiopathogenesis and Risk Assessment

**3**

**Chapter 1**

Introductory Chapter:

syndrome of hypertension, edema, and proteinuria.

the emphasis is on early detection and prevention of preeclampsia.

histology, so all cases cannot be attributed to a primary placental defect.

Preeclampsia

*Nidhi Sharma*

*2001;357:53e6.*

**1. Introduction**

The Multiple Etiologies of

*Preeclampsia is an "old" disease. "After more than a century of intensive research,* 

*Roberts JM, Cooper DW. Pathogenesis and genetics of preeclampsia. Lancet.* 

Preeclampsssia or "gestosis" or "toxemia of pregnancy" is any condition predisposing to eclampsia or convulsions during pregnancy. The word eclampsia is derived from a Greek word *eklampsis* meaning "lightening" or convulsions. Preeclampsia is speculated to be a heterogeneous group of disorders caused by multiple etiologies. Understanding the pathophysiology of this syndrome is important as different etiologies have different pathological mechanisms and different predictive markers. Though the defect could have arisen in the renin-angiotensin system, cardiovascular system, liver enzyme deficiency, coagulation cascade, oxidative stress, or placental bed, the clinical picture is usually oversimplified as the maternal

The third world countries will benefit from the provision of adequate antenatal care after these high-risk women are identified. In the developed world, however,

During pregnancy, the physiology of cardiovascular system, renin-angiotensin system, pancreas changes, different organ reserves are put to test. Understanding preeclampsia requires the understanding of physiology of pregnancy. The blood flow in multiple organs is increased (**Figure 1**). Numerous studies at the embryoendometrial interphase have also suggested the association of impaired spiral artery remodeling in preeclampsia, but how exactly is the impaired remodeling mediated and what is the pathogenesis of maternal syndrome are still to be elucidated. Some clinical cases of maternal syndrome of preeclampsia also have normal placental

Clinical, biochemical, and biophysical markers are used for prediction depending on the etiology of the maternal syndrome of preeclampsia in the pregnancy (**Figure 2a** and **b**). These biomarkers can specifically be used to diagnose the etiology of maternal syndrome as renal dysfunction (kallikrein-creatinine ratio, angiotensin sensitivity test), vascular resistance (uterine artery Doppler), coagulation disorders (platelet volume, fibronectin, prostacyclin, thromboxane), oxidative stress (lipid peroxidase, 8-isoprostane, antioxidants, anticardiolipin antibodies, homocysteine), vascular adaptation (placental growth factor, vascular endothelial growth factor, s-flut, sEng), and placental dysfunction and ischemia (placental CRH, CRH bp, activin, inhibin, hCG).

*preeclampsia and eclampsia remain an enigmatic set of conditions."*
