Dissertaties - Rijksuniversiteit Groningen
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The uteroplacental circulation in hypertensive disorders of pregnancy; Doppler ultrasound and histopathological studies

(2000) Aardema, Margriet Willemien


In the past fifty years, mother and child care in many parts of the world has
developed to a high standard, and maternal and perinatal mortality figures have
declined dramatically. As complications of illegal abortions, infections and death
from postpartum haemorrhage are rarely seen these days in developed countries,
hypertensive disorders of pregnancy and their complications now rank as the major
cause of maternal mortality in this part of the world. In addition, hypertensive
disorders of pregnancy are strongly associated with fetal growth restriction and
prematurity, contributing largely to perinatal morbidity and mortality.
Over the past decades, our understanding of this unique clinical syndrome has
changed dramatically. In the past, hypertension was seen as the hallmark of the
clinical picture. All other clinical features were considered as merely secondary to
increased arterial pressure. Today, our view of hypertensive disorders of pregnancy
is of a systemic disease characterised by widespread endothelial damage which
originates from the uteroplacental circulation but ultimately involves a variety of
other organs such as the kidney, liver and brain.
Despite the progress made in the past decades, the pathophysiology remains largely
elusive. Maladaptation of the vasculature of the uteroplacental unit due to impaired
trophoblast invasion has often been implicated as the main causal factor, and this
view is now widely accepted. Based on this theory, it should be possible to predict
which pregnancies are at risk of developing hypertensive disorders of pregnancy by
using Doppler ultrasonography to analyse the uteroplacental circulation in the
second trimester. However, Doppler screening studies which have been conducted
in the past with this objective show variable and often disappointing results.
In recent years, a new theory has emerged regarding the etiology of hypertensive
disorders of pregnancy. Maladaptation of the uteroplacental vasculature is still seen
as an important factor, but it may not play a role in all cases of hypertensive
disorders of pregnancy. Especially milder forms, in which the onset of symptoms is
at or near term, could be the result of underlying (latent) maternal disorders such as
essential hypertension, renal disease or diabetes mellitus which render the
uteroplacental vasculature vulnerable to accelerated atherosclerosis or increased
vascular tone.

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file:complete thesis

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