Hypertensive disease in pregnancy Three causes of death in pregnancy: Traditional pre-eclampsia triad: Traditional pre-eclampsia triad: Central thesis of pre-eclampsia: symptoms are due to arterial, arteriolar in addition to capillary endothelial damage.

Hypertensive disease in pregnancy Three causes of death in pregnancy: Traditional pre-eclampsia triad: Traditional pre-eclampsia triad: Central thesis of pre-eclampsia: symptoms are due to arterial, arteriolar in addition to capillary endothelial damage. www.phwiki.com

Hypertensive disease in pregnancy Three causes of death in pregnancy: Traditional pre-eclampsia triad: Traditional pre-eclampsia triad: Central thesis of pre-eclampsia: symptoms are due to arterial, arteriolar in addition to capillary endothelial damage.

Vasquez, Lauren, Managing Editor has reference to this Academic Journal, PHwiki organized this Journal Hypertensive disease in pregnancy Tom Archer, MD, MBA UCSD Anesthesia Three causes of death in pregnancy: 1 Thromboembolism 2 Hemorrhage 3 Hypertensive disorders / pre-E Stroke Seizures DIC Traditional pre-eclampsia triad: Hypertension Proteinuria Edema

Concordia College, St. Paul US www.phwiki.com

This Particular University is Related to this Particular Journal

Traditional pre-eclampsia triad: Hypertension arteriolar constriction (endothelial dysfunction). Proteinuria leaky glomerulus (capillary) (endothelial dysfunction). Edema leaky capillaries in skin, muscle, liver, brain, airway, nose. (endothelial dysfunction). Central thesis of pre-eclampsia: symptoms are due to arterial, arteriolar in addition to capillary endothelial damage. Damage how Pre-E: endothelial damage Deranged (unbalanced) smooth muscle function, due to leaky, damaged endothelium overlying smooth muscle. Leaky capillary endothelium (no smooth muscle).

vasodilatory signals (NO, prostacyclin) vasoconstrictive signals (thromboxane, endothelin) Endothelial cells send molecular signals to surrounding smooth muscle Vessel lumen Insulin makes endothelium produce Pre-eclampsia mediators ( in addition to glucose) make endothelium produce Archer TL 2006 unpublished, Idea from D in addition to ona P 2004 Endothelial factors in pre-E: In health, there is a balance between vasodilatory factors: NO, PGI2 (Prostacyclin) in addition to vasoconstrictive factors: thromboxane, endothelin. This normal balance is messed up in pre-E. vasodilatory signals (NO, prostacyclin) vasoconstrictive signals (thromboxane, endothelin) Endothelial cells send molecular signals to surrounding smooth muscle Vessel lumen Insulin makes endothelium produce Pre-eclampsia mediators ( in addition to glucose) make endothelium produce Archer TL 2006 unpublished, Idea from D in addition to ona P 2004

Obesity, hyperglycemia, sepsis in addition to pre-eclampsia all “activate” (damage) endothelium, white cells in addition to platelets, leading to white cell adhesion in addition to infiltration, thrombosis in addition to edema (inflammation). Obesity, hyperglycemia, sepsis or pre-eclampsia WBC Platelet Protein (edema) WBC Platelets Archer TL 2006 unpublished Capillary endothelium (no underlying smooth muscle) Pre-E: disorder of endothelium Genetic polymorphism of endothelial NO synthase predisposes certain Japanese women to pre-E. In other words, generation of vasodilatory signal from endothelium to underlying smooth muscle is messed up. Endothelial damage causes problems in 3 sizes of blood vessels: Muscular arteries increased wave reflection (heart work, augmentation index). Arterioles increased SVR Capillaries proteinuria in addition to tissue edema (glomerulus, liver, skin, muscle, brain)

Wave reflection comes from muscular arteries (larger than arterioles). Strong, early wave reflection increases heart’s systolic workload (augmentation index). MT, 22 yo, healthy, in labor, epidural in place in addition to she is com as long as table. AIx = -1%. JM, 21 yo, in labor, recent onset lupus, on prednisone in addition to plaquenil. Could see this in Pre-E. AIx = 6%

Figure 1. Pt HB, PreE as long as CS, superimposed on CHTN in addition to CRF, 33 weeks. Hemodynamic parameters be as long as e in addition to after treatment with antihypertensive medication A. Labetalol 25 mg in addition to hydralazine 5 mg, B. Nicardipine 250 total in divided doses Posterior reversible encephalopathy syndrome (PRES): Occipital-parietal cortical in addition to white matter changes in pre-eclampsia. Is this due to capillary damage in the brain Port JD, Beauchamp RadioGraphics 1998; 18:353-36 ‘ Most SVR is provided by the arterioles (0.1-0.4 mm) rfumsphysiology.pbwiki.com/Characteristics+of

Edema– imagine same process in liver in addition to brain! Central thesis of pre-eclampsia: signs in addition to symptoms are due to arterial, arteriolar in addition to capillary endothelial damage. Damage by what Chemical mediators from placenta. Pre-eclampsia: Probably a disorder of placentation.

www.siumed.edu/~dking2/erg/images/placenta.jpg Say “OUCH!” Pre-E mediators Poor placentation Pre-eclampsia: ischemic chorionic villi release pre-E mediators into maternal blood. Proper placentation: Syncytiotrophoblast invades in addition to denervates maternal spiral arterioles to ensure a LOW RESISTANCE AV fistula in the intervillous spaces. This proper placentation FAILS in pre-eclampsia, leading to release of endothelium-damaging mediators from ischemic placenta Result is hypertension, proteinuria in addition to edema, plus IUGR (poor O2 in addition to nutrient transfer to fetus).

Vasquez, Lauren Professional Door Dealer Managing Editor www.phwiki.com

http://pharyngula.org/images/preeclampsia-model.jpg Poor-placentation theory of pre-E: Synciotrophoblast invades myometrium but does not denervate spiral arteries of mother properly. Hence, intervillous flow is sub-optimal. Chorionic villi are ischemic in addition to release mediators (VEGF, etc) which damage maternal endothelium. Gestational trophoblastic disease (hydatidi as long as m mole et al) often causes first trimester pre-eclampsia, presumably due to pre-E mediators coming from edematous chorionic villi. www.siumed.edu/~dking2/erg/images/placenta.jpg Say “OUCH!” Pre-E mediators Poor placentation Pre-eclampsia: ischemic chorionic villi release pre-E mediators into maternal blood.

www.hgsi.com/invest/annual99/prod-vegf2.htm http://members.aol.com/wayneheim/vegf.jpg VEGF– vascular endothelial growth factor. Is it good, or bad Both, of course. Helps to build new blood vessels in addition to breaks down basement membrane in the process. www.hgsi.com/invest/annual99/prod-vegf2.htm

The End

Vasquez, Lauren Managing Editor

Vasquez, Lauren is from United States and they belong to Professional Door Dealer and they are from  Phoenix, United States got related to this Particular Journal. and Vasquez, Lauren deal with the subjects like Building Supplies; Home Building

Journal Ratings by Concordia College, St. Paul

This Particular Journal got reviewed and rated by Concordia College, St. Paul and short form of this particular Institution is US and gave this Journal an Excellent Rating.