The 8th Romanian "Ian Donald” Course
Al XII-lea Congres Națíonal de Medicină Perinatală
Preeclampsia, A Pathology Of The Maternal Endothelium
Gabriela Caracostea 1,2
1 Obstetrica-Ginecologie I Department, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-
Napoca, Romania
2 . IMOGEN Research Center, Cluj-Napoca, Romania
Abstract
It is common knowledge that cardiovascular diseases continue to be the leading cause of death
in industrialised countries. Recent research however, include among patients at risk for cardiovascular
disease development, patients with history of preeclampsia. With a global incidence of approximately
2-8% in the general population, preeclampsia selects roughly 300 million high risk patients found at
risk of postpartum cardio-vascular complications.
The starting point today in every research initiative targeting preeclampsia is that of
addressing a multisystemic pathology, mediated by the placenta. Placental malfunction owed to yet
incompletely elucidated causes, eventually leads to systemic endothelial dysfunction. In fact, all the
symptoms characteristic of this pathology may be attributed to the generalised vascular functional
alterations. Perhaps the aberrant uteroplacental Flow remodelling is inFluenced by a certain maternal
preexistent vascular phenotype responsible for the cardiovascular outcome of preeclamptic patients.
This process is validated in a clinical context in two phases: the First phase is represented by a
functional alteration of the endothelial layer occuring in endothelial dysfunctions and, respectively, a
second phase, which comences once the muscular layer of the arterial wall is altered. This is translated
by the development of arterial stiffness which gradually leads to all the end organ damage speciFic for
preeclampsia.
It has been proven that, once the endothelial dysfunction primed, the postpartum evolution of
the patient will be part of the cardio-vascular continuum, leading in time to a hypertensive-type organ
damage. In practical terms, it is this apparently irreversible functional change in the arterial wall that
makes the physiopathological sequence of events to continue post-partum.
Our study aimed to evaluate vascular malfunction in preeclamptic patients found in the third
trimester of pregnancy. Endothelial dysfunction was objectiFied clinically by the non-invasive
evaluation of Flux-mediated vasodilation (FMD) – a vascular endothelium dependent parameter which
reFlects the dilation of a arterial conduct subject to increased blood Flow. Arterial stiffness indices were
calculated by the photoplethysmographic analysis of the pulse wave. The results obtained showed a
signiFicant alteration of FMD as well as the arterial stiffness indices studied in preeclamptic patients
compared to healthy normotensive patients found in the third trimester of pregnancy.
Obstetrica și Ginecologia
1
27 - 30 Septembrie 2017