Preeclampsia-Eclampsia-Jack Ludmir, M.D.课件.ppt

Preeclampsia - Eclampsia Maternal Mortality in the World 600,000 per year due to pregnancy-related causes Maternal Mortality USA: 15/100,000 live births Mali: 800/100,000 live births Hemorrhage Embolism Preeclampsia Infection PRE: History 2200 BC Egypt: pregnant women with fists 400 BC Hippocrates: pregnant women with convulsions Eclampsia: Greek word: suddenly, flash 1619: Varardus: first use of word eclampsia 1843: Lever. Proteinuria. Swelling and convulsions: Nephritic toxemia 1897: Vaquez. Hypertension 1899: Strogonov: treatment, sedation 1900s: prenatal care, preeclampsia New concept in the 20th century 1902: Ballantyne. Pro-maternity clinic. 1910: USA. Nursing visits at home. 1920: Prenatal visits: check for hypertension, swelling, proteinuria to detect : Preeclampsia Maternal mortality reduced in UK from 319/100,000 in 1936 to 15/100,000 in 1985 Preeclampsia - Eclampsia Hypertension after 20 weeks gestation Proteinuria than 300 mg/dl or +1 dipstick Convulsions: eclampsia Preeclampsia Incidence: 5 - 8% of all pregnancies. Etiology remains elusive. Major cause for maternal and perinatal mortality and morbidity. To date no treatment for prevention baby ASA or calcium or cure, except delivery. However, the maternal benefits must be weighed against the neonatal risks of preterm delivery. Etiology Multiple theories: toxins, nephritis, parasites, malnutrition, vitamin deficiency, immunologic, inflammation, oxidation, prostaglandin imbalance, angiogenic factors,…….. Pathophysiology Endothelial cell injury Generalized vasoconstriction Preeclampsia - Pathophysiology May be initiated by placental factors that enter the maternal circulation and cause endothelial dysfunction resulting in hypertension and proteinuria. Recently, soluble fms-like tyrosine kinase 1 sFlt-1 an antiangiogenic protein has been found to be increased in preeclampsia Maynard et al.J Clin Invest 2003 Angiogenic Factors Preeclampsia - Pathophysiology sFlt-1 acts by binding to placental g