Compendium on the Pathophysiology and Treatment of Hypertension

PREECLAMPSIA PATHOPHYSIOLOGY,
CHALLENGES,
1 AND PERSPECTIVES
Sarosh Rana, Elizabeth Lemoine, Joey P. Granger, S. Ananth Karumanchi

SALEH NUR AZHARI,S.KED

BACKGROUND
• Hypertensive disorders are a common complication of
pregnancy → women and their fetuses at disproportionate
risk for further complications.

• Systolic blood pressure (BP) ≥140 mm Hg or diastolic

BP ≥90 mm Hg (chronic hypertension)

• Hypertension diagnosed after 20 weeks gestation without

concurrent proteinuria; preeclampsia-eclampsia (gestational
hypertension)
BACKGROUND
• Morbidity and mortality, preeclampsia → 5% to 7% of
all pregnant women but is esponsible for over 70 000 maternal
deaths and 500 000 fetal deaths worldwide every year.

• Delivery can resolve most signs and symptoms.

• Hypertensive disorders of pregnancy and in particular

preterm preeclampsia is also associated with substantial
risk for cardiovascular disease (CVD) and cerebrovascular
disease in the long-term
Epidemiology and Clinical Definition
of Preeclampsia
Risk Factors for Preeclampsia
Epidemiology and Clinical Definition of Preeclampsia
Risk Factors for Preeclampsia
 Epidemiology and Clinical Definition of Preeclampsia

Clinical Definition of Preeclampsia

American College of Obstetrics and Gynecology (ACOG)
“Hypertension and proteinuria occurring after 20 weeks of
gestation in a previously normotensive patient”

Systemic manifestations of preeclampsia :

Low platelets or elevated liver enzymes before the hallmark
of proteinuria is detectable resulting in delayed diagnoses.
Epidemiology and Clinical Definition
of Preeclampsia
Clinical Definition of Preeclampsia
Epidemiology and Clinical Definition
of Preeclampsia
 Pathogenesis of Preeclampsia
Two tages:

(1) Abnormal placentation early in
the first trimester followed by
 Oxidative stress
 Abnormal natural killer cells (NKs)
at the maternal-fetal interface
 Genetic
 Environmental factors
 though none have conclusive
evidence in humans.
(2) Maternal syndrome in the later 2-3
trimesters characterized by an excess
of antiangiogenic factors.
 Mechanism of abnormal placentation is
controversial
 Animal models have demonstrated that
uteroplacental ischemia
 Drives the hypertensive, multi-organ
failure response observed in the
maternal preeclamptic syndrome21
Pathogenesis of Preeclampsia
Pathogenesis of Preeclampsia
Thank You