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V.

ANATOMY AND PHYSIOLOGY

These are the organs affected by preeclampsia:


VI. PATHOPHYSIOLOGY
Preeclampsia is a characterized, by vasospasms, changes in the coagulation system,
and disturbances in systems related to volume and BP control. Vasospasms results
from an increased sensitivity to circulating pressors, such as angiotensin II, and possibly
an imbalance between the prostaglandins prostacyclin and thromboxane A1.
Endothelial cell dysfunction, believed to result from decreased placental perfusion, may
account for many changes in preeclampsia. Arteriolar vasospasm may cause
endothelial damage and contribute to an increased capillary permeability. This increase
edema and further decreases intravascular volume, predisposing the woman with
preeclampsia to pulmonary edema.

Immunologic factors may play an important role in the development of preeclampsia.


The presence of a foreign protein, the placenta, or the fetus maybe perceived by the
mothers immune system as an antigen. This may then trigger an abnormal
immunologic response. This theory is supported by the increased incidence of
preeclampsia or eclampsia in first-time mothers or to multiparous woman pregnant by a
new partner. Preeclampsia maybe an immune complex disease in which the maternal
antibody system is overwhelmed from excessive fetal antigens in the maternal
circulation. This theory seems compatible with the high incidence of preeclampsia
among women exposed to a large mass of trophoblastic tissue as seen in twin
pregnancies or hydatidiform moles.

Genetic predisposition may be another immunologic factor. Dekker reported a greater


frequency of preeclampsia and eclampsia among daughters and granddaughters of
women with a history of eclampsia, which suggests an autosomal recessive gene
controlling the maternal immune response. Paternal factors are also examined.

Diets in inadequate nutrients, especially protein, calcium, sodium, magnesium, and


vitamin E and C, maybe an etiologic factor in preeclampsia. Some practitioners
prescribed high-protein diets (90 mg supplemental protein) without caloric restriction
and moderate sodium intake in the prevention and treatment of this disorder. However,
data are limited regarding the association between diet and preeclampsia.
Preeclampsia progresses along a continuum from mild disease to severe
preeclampsia, HELLP syndrome, or eclampsia. The pathophysiology of preeclampsia
reflects alteration in the normal adaptations of pregnancy. Normal physiologic
adaptations to pregnancy include increase blood plasma volume, vasodilation, and
decreased systemic vascular resistance, elevated cardiac output, and decreased colloid
osmotic pressure. Pathologic changes in the endothelial cells of the glomeruli are
uniquely characteristic of preeclampsia, particularly in nulliparous women. The main
pathogenic factor is not an increase in BP but poor perfusion as a result vasospasm.
Arteriolar vasospasm diminishes the diameter of blood vessels, which impedes blood
flow to all organs and raises BP. Function in organs such as the placenta, kidneys, liver
and brain is deceased by as much as 40% to 60%.