Penanganan Terkini Preeklamsia

 

PENANGANAN TERKINI PREEKLAMSIA dr. Yusri SpOG. MKes

 

INTRODUCTION

EARLY ONSET PREECLAMPSIA

The Diff Differenc erences es are: Biochemical Markers Clinical Manifestation Maternal and Fetal Outcome Progn Pr ognosis osis and Com Compli plicati cation on

LATE ONSET PREECLAMPSIA

RISK FACTOR  OVERLAP

 

EARLY-ONSET

LATE-ONSET

Fetus/ Placental Factor 

Maternal Constitution

PregnancySpecific Changes

PREECLAMPSIA

 

De Decid cidua uall Im Immu mun n Ad Adap apta tati tion on Pr Proc oces esss

 

Pathophysiology In normal placental development, invasive cytotrophoblasts of fetal or origin igin invade the maternal spiral arteries, transforming them from small-caliber resistance vessels to high-caliber capacitance vessels capable of  providing placental perfusion adequate to sustain the growing fetus. During the process of vascular invasion, the cytotrophoblasts differentiate from an epithelial phenotype to an endothelial  phenotype, a process referred referred to as  pseudovasculogenesis or vascular mimicry (top). “

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In preeclampsia, preeclampsia, cytotrophoblasts cytotrophoblasts fail to adopt an invasive endothelial phenotype. Instead, invasion of the spiral arteries is shallow, and they remain small caliber, resistance vessels (bottom).

 

Path Pa thop ophy hysi siol olog ogy y of L ate-Onse nset  t PE Predisposed Predispo sed mater maternal nal constitution reflecting microvascu micr ovascular lar disea disease se as occurs with long-term:

Norm No rmal al pl plac acen enta ta

Angiogenesis hypertension diabetes 

Endothelial Dysfunction

obesity

hyperlipidemia hyperhomosisteinemi maternal

genetic

metabolic

Preeclampsia

dysbalance

 

Pathophysiology of L ate-Ons nse et PE Late-onset PE is associated with the maternal pathway,  but that its its association with the plac placental ental pathwa pathway y is weak or non-existent.

The two-stage theory may thus be irrelevant for the  pathophysiology of late-onset late-onset PE

 

Pathophysiology of L ate-Onse nsett PE A weak or non-existent association between a dysfunctional/ hypoxic placenta (“the placental pathway”) and late-onset PE is supported by following findings:

Late-onset PE was not associated with small for gestational agee / IUG ag UGR  R