Chesley's Hypertensive Disorders in Pregnancy (eBook)

Front Cover 1
CHESLEY’S HYPERTENSIVE DISORDERS IN PREGNANCY 5
COPYRIGHT 6
Contents 7
List of Contributors 9
Preface 11
CHAPTER 1 Introduction, History, Controversies, and Definitions 13
HISTORY 13
SIGNS 16
HYPOTHESES AND RATIONAL MANAGEMENT 18
PROPHYLAXIS 20
CLASSIFICATION OF THE HYPERTENSIVE DISORDERS IN PREGNANCY 21
EDITORS’ UPDATE 23
DENOUEMENT 26
References 32
CHAPTER 2 The Clinical Spectrum of Preeclampsia 37
INTRODUCTION 37
CLINICAL MANIFESTATIONS OF PREECLAMPSIA SYNDROME 38
DIFFERENTIAL DIAGNOSIS 44
References 46
CHAPTER 3 Epidemiology of Pregnancy-Related Hypertension 49
FREQUENCY OF OCCURRENCE 49
DISCUSSION OF DIFFERENTIAL FREQUENCY ESTIMATES 50
RISK FACTORS 51
CLINICAL PREDICTORS 52
FIRST BIRTH AND OTHER PLACENTAL FACTORS 53
NATURAL HISTORY 54
CRITIQUE OF STUDIES 57
CONCLUSION 58
References 58
CHAPTER 4 Genetic Factors in the Etiology of Preeclampsia/Eclampsia 63
DEDICATION 63
INTRODUCTION 63
BIOLOGICAL PATHWAYSOF PREECLAMPSIA 66
TYPES OF GENETIC STUDIES CONDUCTED 68
PROBLEMS WITH STUDYING THE GENETICS OF PREECLAMPSIA 73
A GENOMICS APPROACH TO PREECLAMPSIA 74
ESSENTIAL VARIABLES TO CONSIDER 75
THE FUTURE OF PREECLAMPSIA GENETIC RESEARCH 78
CONCLUSIONS 79
References 80
CHAPTER 5 The Placenta in Normal Pregnancy and Preeclampsia 85
INTRODUCTION 85
THE MICROANATOMY OF NORMAL HUMAN PLACENTATION 85
THE MICROANATOMY OF ABNORMAL HUMAN PLACENTATION IN PREECLAMPSIA 87
THE ROAD TO PREECLAMPSIA 88
OXYGEN TENSION REGULATES HUMAN CYTOTROPHOBLAST PROLIFERATION AND DIFFERENTIATION IN VITRO 89
DURING NORMAL PREGNANCY, INVASIVE CYTOTROPHOBLASTS MODULATE THEIR ADHESION MOLECULE REPERTOIRE TO MIMIC THAT OF VASCULAR CELLS 92
IN PREECLAMPSIA, INVASIVE CYTOTROPHOBLASTS FAIL TO SWITCH THEIR ADHESION MOLECULE REPERTOIRE TO MIMIC THAT OF VASCULAR CELLS 94
NOVEL UNBIASED APPROACHES FOR ADDRESSING THE COMPLEXITIES OF THE PREECLAMPSIA SYNDROME 94
SUMMARY AND FUTURE DIRECTIONS 95
References 96
CHAPTER 6 Angiogenesis and Preeclampsia 99
INTRODUCTION 99
PLACENTALVASCULAR DEVELOPMENT IN HEALTH 99
ANGIOGENIC IMBALANCE IN PREECLAMPSIA 104
PERSPECTIVES 110
References 110
CHAPTER 7 Metabolic Syndrome and Preeclampsia 117
INTRODUCTION 117
METABOLIC SYNDROME 118
METABOLIC SYNDROME AND CARDIOVASCULAR DISEASE 118
PREGNANCY-INDUCED CHANGES IN INSULIN AND LIPID METABOLISM 123
PREECLAMPSIA AND METABOLIC SYNDROME 124
METABOLIC SYNDROME: A CAUSE OF PLACENTAL DYSFUNCTION? 130
SUMMARYAND PERSPECTIVES 132
References 133
CHAPTER 8 Immunology of Normal Pregnancy and Preeclampsia 141
INTRODUCTION 141
MATERNAL IMMUNE PRIMING FOR PREGNANCY– ADAPTING TO A FOREIGN FETUS 141
INNATE AND ADAPTIVE IMMUNITY 141
THE SYSTEMIC INFLAMMATORY NETWORK AND RESPONSE 142
ENDOTHELIAL CELLS ARE INFLAMMATORY CELLS 143
CYTOKINES, CHEMOKINES, GROWTH FACTORS, ADIPOKINES, AND ANGIOGENIC FACTORS 143
ACUTE PHASE RESPONSE 143
METABOLISM AND THE SYSTEMIC INFLAMMATORY RESPONSE 144
PREECLAMPSIA IS ATWO-STAGE DISEASE 144
MATERNAL–FETAL IMMUNE INTERFACES AND MATERNAL RECOGNITION OF FETAL (PATERNAL) ANTIGENS 144
STAGE 1 PREECLAMPSIA, INTERFACE 1, AND MATERNAL IMMUNE RESPONSES TO TROPHOBLAST 146
STAGE 2 PREECLAMPSIA AND INTERFACE 2 147
THE TH1/TH2 HYPOTHESIS 147
PREECLAMPSIA AND THE MATERNAL SYSTEMIC INFLAMMATORY RESPONSE 148
THE ROLE OF THE PLACENTA AND NONPLACENTAL FACTORS 148
TROPHOBLAST MICROPARTICLES 149
SYSTEMIC IMMUNOREGULATION IN PREECLAMPSIA 150
THE CONTINUUM BETWEEN NORMAL PREGNANCYAND PREECLAMPSIA 150
MATERNAL PREDISPOSING FACTORS 150
CLINICAL IMPLICATIONS AND CONCLUSIONS 151
References 151
CHAPTER 9 Endothelial Cell Dysfunction and Oxidative Stress 155
INTRODUCTION 155
PART I: ENDOTHELIAL CELL HYPOTHESIS 156
PART II: PLASMA FACTORS INDUCE ENDOTHELIAL CELL ACTIVATION 159
PART III: OXIDATIVE STRESS: A POINT OF CONVERGENCE FOR ENDOTHELIAL CELL DYSFUNCTION 166
PART IV: SUMMARY, SPECULATIONS, AND DIRECTIONS OF FUTURE INVESTIGATIONS 169
References 170
CHAPTER 10 Animal Models 181
INTRODUCTION 181
PARALLELS BETWEEN HUMAN AND ANIMAL PREGNANCY 181
ANIMAL STUDIES DESIGNED TO EXPLORE HYPOTHETICAL CAUSES OF PREECLAMPSIA 184
UTEROPLACENTAL HYPOPERFUSION 184
MODELS OF PREECLAMPSIA EMPLOYING DIETARY DEPRIVATION 186
ENDOTHELIAL DYSFUNCTION AND PREECLAMPSIA 188
OTHER MODELS OF PREECLAMPSIA 190
THE STUDY OF ANTIANGIOGENIC FACTORS 191
VOLUME-EXPANDED MODEL OF PREECLAMPSIA 192
ANIMALS WITH PREEXISTING DISEASES THAT MAY PREDISPOSE TO PREECLAMPSIA 192
CONCLUSION 193
References 193
CHAPTER 11 Tests to Predict Preeclampsia 201
INTRODUCTION 201
PRINCIPLES OF PREDICTION TESTS 201
PLACENTAL PERFUSION AND VASCULAR RESISTANCE DYSFUNCTION-RELATED TESTS 203
FETAL AND PLACENTAL UNIT ENDOCRINOLOGY DYSFUNCTION-RELATED TESTS 205
RENAL DYSFUNCTION-RELATED TESTS 207
ENDOTHELIAL DYSFUNCTION AND OXIDANT STRESS-RELATED TESTS 208
FETUS-DERIVED PRODUCTS 211
COMBINATION OF TESTS 212
PROTEOMICS 213
PERSPECTIVES AND CONCLUSIONS 213
References 215
CHAPTER 12 Prevention of Preeclampsia and Eclampsia 225
INTRODUCTION 225
DIETARY MANIPULATIONS 225
CARDIOVASCULAR DRUGS 227
ANTIOXIDANTS 228
ANTITHROMBOTIC AGENTS 229
PREVENTION OF ECLAMPSIA 230
TREATMENT FOR ECLAMPSIA 233
References 235
CHAPTER 13 Cerebrovascular (Patho)Physiology in Preeclampsia/Eclampsia 239
INTRODUCTION 239
NEUROANATOMICAL FINDINGS WITH ECLAMPSIA 239
CEREBRAL LESIONS WITH PATHOGENESIS OF ECLAMPSIA 240
References 254
CHAPTER 14 Cardiovascular Alterations in Normal and Preeclamptic Pregnancy 261
INTRODUCTION 261
HEMODYNAMICS AND CARDIAC FUNCTION IN NORMAL PREGNANCY 261
HEMODYNAMICS AND CARDIAC FUNCTION IN PREECLAMPSIA 267
FACTORS THAT MAY EXPLAIN VASCULAR CHANGES IN PREGNANCY 272
References 275
CHAPTER 15 Normal and Abnormal Volume Homeostasis 281
INTRODUCTION 281
BODY FLUID VOLUMES 281
CONCLUSIONS 293
References 293
CHAPTER 16 Agonistic Autoantibody-Mediated Disease 299
INTRODUCTION 299
GENESIS OF ANTIBODIES DIRECTED AGAINST RECEPTORS 299
AGONISTIC ANTI-AT1 RECEPTOR ANTIBODIES 301
References 307
CHAPTER 17 The Kidney in Normal Pregnancy and Preeclampsia 309
INTRODUCTION 309
RENAL HEMODYNAMICS AND GLOMERULAR FILTRATION RATE DURING NORMAL PREGNANCY 309
RENAL HEMODYNAMICS AND GLOMERULAR FILTRATION RATE IN PREECLAMPSIA 318
RENAL HANDLING OF URIC ACID 323
RENAL HANDLING OF PROTEINS 329
RENAL MORPHOLOGY IN HEALTH AND DISEASE 334
References 338
CHAPTER 18 Platelets, Coagulation, and the Liver 347
INTRODUCTION 347
PLATELETS 347
COAGULATION 351
SUMMARY OF PLATELETS AND THE COAGULATION CASCADE CONTRIBUTIONS TO PREECLAMPSIA 356
THE LIVER IN PREECLAMPSIA 357
References 359
CHAPTER 19 Chronic Hypertension and Pregnancy 365
INTRODUCTION 365
BACKGROUND 365
SPECIFIC HYPERTENSIVE DISORDERS 368
MANAGEMENT PRINCIPLES 375
References 377
CHAPTER 20 Antihypertensive Treatment 381
INTRODUCTION 381
GOALS OF ANTIHYPERTENSIVE DRUG THERAPY 381
GENERAL PRINCIPLES IN THE CHOICE OF ANTIHYPERTENSIVE AGENTS 382
FETAL SAFETYAND DRUGUSE IN PREGNANT WOMEN 383
CHOICE OFAN ANTIHYPERTENSIVE DRUG FOR USE IN PREGNANCY 384
DRUG USE WHILE BREASTFEEDING 391
EVIDENCE FROM RANDOMIZED TRIALS 391
CONCLUSION 394
References 395
CHAPTER 21 Management 401
INTRODUCTION 401
PREECLAMPSIA 401
ECLAMPSIA 409
MANAGEMENT OF SEVERE HYPERTENSION 413
PREVENTION OF ECLAMPSIA 417
DELIVERY 419
PERSISTENT SEVERE POSTPARTUM HYPERTENSION 421
References 421
Index 427