CLASIFICACION Y FISIOPATOLOGIA DE LA HIPERTENSION EN EL EMBARAZO





CLASIFICACION Y FISIOPATOLOGIA DE LA HIPERTENSION EN EL EMBARAZO

(especial para SIIC © Derechos reservados)
Existen cuatro trastornos hipertensivos principales que complican, aproximadamente, el 10% de todos los embarazos. La preeclampsia se clasifica en leve o grave; la eclampsia y el síndrome HELLP son variantes de la preeclampsia grave. La hipertensión crónica se presenta antes de las 20 semanas del embarazo. La preeclampsia superpuesta se diagnostica en mujeres con hipertensión crónica. La hipertensión gestacional es la hipertensión sin proteinuria.
cetin9.jpg Autor:
Ali Cetin
Columnista Experto de SIIC

Institución:
Cumhuriyet University School of Medicine


Artículos publicados por Ali Cetin
Recepción del artículo
5 de Agosto, 2007
Aprobación
7 de Enero, 2008
Primera edición
12 de Diciembre, 2008
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
Existen cuatro trastornos hipertensivos principales que complican aproximadamente el 10% de todos los embarazos. La preeclampsia, que se clasifica en leve o grave, se manifiesta como hipertensión y proteinuria de reciente comienzo, después de la semana 20 de gestación, en una mujer previamente normotensa. La eclampsia, una variante de la preeclampsia grave, se manifiesta por la presentación de convulsiones generalizadas que no se atribuyen a otra causa. El síndrome HELLP (hemólisis, incremento de las enzimas hepáticas y disminución del recuento de las plaquetas), también es una forma grave de preeclampsia. La hipertensión crónica se define por el registro de valores de presión sistólica > 140 mm Hg, o de presión diastólica > 90 mm Hg, o de ambas, que precede al embarazo, o está presente antes de la semana 20 de la gestación o persiste más allá de la semana 12 posparto. La preeclampsia superpuesta se diagnostica cuando en una mujer con hipertensión preexistente surge proteinuria de reciente comienzo después de la semana 20 del embarazo. La hipertensión gestacional es la hipertensión (usualmente leve) sin proteinuria (u otros signos de preeclampsia) que aparece en el último tramo del embarazo. Debe normalizarse antes de la semana 12 posparto. La preeclampsia es un síndrome caracterizado por la disfunción endotelial materna. Tanto el estrés oxidativo, como la inflamación y la falta de adaptación circulatoria, junto con diversas anomalías humorales, minerales o metabólicas, tienen una función en la patogénesis de la preeclampsia. Las últimas investigaciones sugieren que la placenta libera factores circulantes cuyo papel es interferir la acción del factor de crecimiento endotelial vascular y del factor de crecimiento placentario, que tendrían una misión central en la presentación de la enfermedad. En esta revisión, se analiza la clasificación y la fisiopatología de la preeclampsia junto con sus formas graves, la eclampsia y el síndrome HELLP.

Palabras clave
preeclampsia, eclampsia, síndrome HELLP, hipertensión


Artículo completo

(castellano)
Extensión:  +/-10.74 páginas impresas en papel A4
Exclusivo para suscriptores/assinantes

Abstract
There are four major hypertensive disorders complicating approximately 10% of all pregnancies. Preeclampsia classified as mild or severe refers to the new onset of hypertension and proteinuria after 20 weeks of gestation in a previously normotensive woman. Eclampsia, a variant of severe preeclampsia, refers to the development of grand mal seizures that should not be attributable to another cause. HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) is also a severe form of preeclampsia. Chronic hypertension is defined as systolic pressure = 140 mm Hg, diastolic pressure = 90 mm Hg, or both, that antedates pregnancy, is present before the 20 weeks of pregnancy, or persists longer than 12 weeks postpartum. Superimposed preeclampsia is diagnosed when a woman with preexisting hypertension develops new onset proteinuria after 20 weeks of gestation. Gestational hypertension refers to hypertension (usually mild) without proteinuria (or other signs of preeclampsia) developing in the latter part of pregnancy. It should resolve by 12 weeks postpartum. Preeclampsia is a syndrome characterized by maternal endothelial cell dysfunction. Oxidative stress, inflammation, circulatory maladaptation, as well as humoral, mineral, or metabolic abnormalities all appear to play a role in the pathogenesis of preeclampsia. Newer studies suggest that placental release of circulating factors that interfere with the action of vascular endothelial growth factor and placental growth factor plays a central role in its presentation. In this review, classification and pathophysiology of preeclampsia with its severe forms, eclampsia and HELLP syndrome, are discussed.

Key words
preeclampsia, eclampsia, HELLP syndrome, hypertension


Full text
(english)
para suscriptores/ assinantes

Clasificación en siicsalud
Artículos originales > Expertos del Mundo >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Obstetricia y Ginecología
Relacionadas: Bioquímica, Cardiología, Diagnóstico por Laboratorio



Comprar este artículo
Extensión: 10.74 páginas impresas en papel A4

file05.gif (1491 bytes) Artículos seleccionados para su compra



Enviar correspondencia a:
Ali Cetin, Department of Obstetrics and Gynecology, Cumhuriyet University School of Medicine, 58140, Sivas, Turquía
Bibliografía del artículo
1. Aarnoudse JG, Houthoff HJ, Weits J, et al. A syndrome of liver damage and intravascular coagulation in the last trimester of normotensive pregnancy. A clinical and histopathological study. Br J Obstet Gynaecol 93:145-55, 1986.
2. ACOG Committee on Obstetric Practice. ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet 77:67-75, 2002.
3. Barton JR, Sibai BM. Diagnosis and management of hemolysis, elevated liver enzymes, and low platelets syndrome. Clin Perinatol 31:807-33, 2004.
4. Belfort MA. Effect of magnesium sulfate on maternal brain blood flow in preeclampsia: a randomized, placebo-controlled study. Am J Obstet Gynecol 167:661-6, 1992.
5. Belfort MA, Saade GR, Grunewald C, Dildy GA, Abedejos P, Herd JA, Nisell H. Association of cerebral perfusion pressure with headache in women with pre-eclampsia. Br J Obstet Gynaecol 106:814-21, 1999.
6. Brown MA, Hague WM, Higgins J, Lowe S, McCowan L, Oats J, Peek MJ, Rowan JA, Walters BN; Austalasian Society of the Study of Hypertension in Pregnancy. The detection, investigation and management of hypertension in pregnancy: full consensus statement. Aust NZJ Obstet Gynaecol 40:139-55, 2000.
7. Cetin A. Eclampsia. In Mohler III ER, Townsend RR. Advanced therapy in hypertension and vascular disease. Ontario: B. C. Decker Inc. pp. 407-415, 2006.
8. Cetin A. Hemolysis, elevated liver enzymes, and low platelets (HELLP). In Mohler III ER, Townsend RR. Advanced therapy in hypertension and vascular disease. Ontario: B. C. Decker Inc. pp. 416-420, 2006.
9. Cetin M, Pinarbasi E, Percin FE, Akgun E, Percin S, Pinarbasi H, Gurlek F, Cetin A. No association of polymorphisms in the glutathione S-transferase genes with pre-eclampsia, eclampsia and HELLP syndrome in a Turkish population. J Obstet Gynaecol Res 31:236-41, 2005.
10. Chassoux F, Meary E, Oswald AM, Koziak M, Devaux B, Meder JF, Mas JL. Eclampsia in the late postpartum. Contribution of x-ray computed tomography and magnetic resonance imaging. Rev Neurol (Paris) 148:221-4, 1992.
11. Cunningham FG, Gant NF, Leveno KJ, et al. Hypertensive disorders in pregnancy, in Williams Obstetrics. New York, McGraw-Hill Health Professions Division, Ed 21, pp. 567-618, 2001.
12. Davison JM, Homuth V, Jeyabalan A, Conrad KP, Karumanchi SA, Quaggin S, Dechend R, Luft FC. New aspects in the pathophysiology of preeclampsia. J Am Soc Nephrol 15:2440-8, 2004.
13. Dekker GA, Sibai BM. Etiology and pathogenesis of preeclampsia: current concepts. Am J Obstet Gynecol 179:1359-75, 1998.
14. Feinberg BB. Preeclampsia: the death of Goliath. Am J Reprod Immunol 55:84-98, 2006.
15. Fisher SJ. The placental problem: linking abnormal cytotrophoblast differentiation to the maternal symptoms of preeclampsia. Reprod Biol Endocrinol 2:53, 2004.
16. Graves JC, Vandergriff JV. Atypical eclampsia: a case report and review. Tenn Med 94:173-75, 2001.
17. Greene MF. Magnesium sulfate for preeclampsia. N Engl J Med 348:275-6, 2003.
18. Hauth JC, Ewe11 MG, Levine RJ, Esterlitz JR, Sibai B, Curet LB, et al. Pregnancy outcomes in healthy nulliparas who developed hypertension. Calcium for Preeclampsia Prevention Study Group. Obstet Gynecol 95:24-8, 2000.
19. Kaplan PW. The neurologic consequences of eclampsia. Neurologist 7:357-63, 2001.
20. Kaufmann P, Black S, Huppertz B. Endovascular trophoblast invasion: implications for the pathogenesis of intrauterine growth retardation and preeclampsia. Biol Reprod 69:1-7, 2003.
21. Knapen MF, Mulder TP, Bisseling JG, et al. Plasma glutathione S-transferase alpha 1-1: a more sensitive marker for hepatocellular damage than serum alanine aminotransferase in hypertensive disorders of pregnancy. Am J Obstet Gynecol 178:161-5, 1998.
22. Lindheimer MD. Hypertension in pregnancy. Hypertension 22:127-37, 1993.
23. Lipstein H, Lee CC, Crupi RS. A current concept of eclampsia. Am J Emerg Med 21:223-6, 2003.
24. Lopez-Llera MM. Main clinical types and subtypes of eclampsia. Am J Obstet Gynecol 166:4-9, 1992.
25. Lubarsky SL, Barton JR, Friedman SA, Nasreddine S, Ramaddan MK, Sibai BM. Late postpartum eclampsia revisited. Obstet Gynecol 83:502-5, 1994.
26. MacKay AP, Berg CJ, Atrash HK. Pregnancy-related mortality from preeclampsia and eclampsia. Obstet Gynecol 97:533-38, 2001.
27. Magann EF, Martin JN Jr. Critical care of HELLP syndrome with corticosteroids. Am J Perinatol 17:417-22, 2000.
28. Mattar F, Sibai BM. Eclampsia. VIII. Risk factors for maternal morbidity. Am J Obstet Gynecol 182:307-12, 2000.
29. McCrae KR. Thrombocytopenia in pregnancy: differential diagnosis, pathogenesis, and management. Blood Rev 17:7-14, 2003.
30. McMahon LP, O'Coigligh S, Redman CW. Hepatic enzymes and the HELLP syndrome: a long-standing error? Br J Obstet Gynaecol 100:693-95, 1993.
31. Merviel P, Carbillon L, Challier JC, Rabreau M, Beaufils M, Uzan S. Pathophysiology of preeclampsia: links with implantation disorders. Eur J Obstet Gynecol Reprod Biol 115:134-47, 2004.
32. Mutter WP, Karumanchi SA. Molecular mechanisms of preeclampsia. Microvasc Res [Epub ahead of print], 2007.
33. Noris M, Perico N, Remuzzi G. Mechanisms of disease: Pre-eclampsia. Nat Clin Pract Nephrol 1:98-114, 2005.
34. Ohno Y, Kawai M, Wakahara Y, Kitagawa T, Kakihara M, Arii Y. Transcranial assessment of maternal cerebral blood flow velocity in patients with pre-eclampsia. Acta Obstet Gynecol Scand 76:928-32, 1997.
35. Page NM, Lowry PJ. Is 'pre-eclampsia' simply a response to the side effects of a placental tachykinin? J Endocrinol 167:355-61, 2000.
36. Percin FE, Cetin M, Pinarbasi E, Akgun E, Gurlek F, Cetin A. Lack of association between the CYP11B2 gene polymorphism and preeclampsia, eclampsia, and the HELLP syndrome in Turkish women. Eur J Obstet Gynecol Reprod Biol 127:213-7, 2006.
37. Pinarbasi E, Percin FE, Yilmaz M, Akgun E, Cetin M, Cetin A. Association of microsomal epoxide hydrolase gene polymorphism and pre-eclampsia in Turkish women. J Obstet Gynaecol Res 33:32-7, 2007.
38. Raps EC, Galetta SL, Broderick M, Atlas SW. Delayed peripartum vasculopathy: cerebral eclampsia revisited. Ann Neurol 33:222-5, 1993.
39. RCOG. Management of eclampsia. London: Royal College of Obstetricians and Gynaecologists. 1999.
40. Redman CW, Sargent IL. Latest advances in understanding preeclampsia. Science 308:1592-4, 2005.
41. Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 183:S1-S22, 2000.
42. Roberts JM, Cooper DW. Pathogenesis and genetics of pre-eclampsia. Lancet 357:53-6, 2001.
43. Rugarn O, Carling Moen S, Berg G. Eclampsia at a tertiary hospital 1973-99. Acta Obstet Gynecol Scand 83:240-5, 2004.
44. Salas SP. What causes pre-eclampsia? Baillieres Clin Obstet Gynaecol 13:41-57, 1999.
45. Sargent IL, Borzychowski AM, Redman CW. Immunoregulation in normal pregnancy and pre-eclampsia: an overview. Reprod Biomed Online 13:680-6, 2006.
46. Sibai BM. Preeclampsia: an inflammatory syndrome? Am J Obstet Gynecol 191:1061-2, 2004.
47. Sibai BM, Schneider JM, Morrison JC, Lipshitz J, Anderson GD, Shier RW, Dilts PV Jr. The late postpartum eclampsia controversy. Obstet Gynecol 55:74-8, 1980.
48. Smyth B. Pre-eclampsia. In Mohler III ER, Townsend RR. Advanced therapy in hypertension and vascular disease. Ontario: B. C. Decker Inc. pp. 394-406, 2006.
49. Solomon CG, Seely EW. Hypertension in pregnancy. Endocrinol Metab Clin North Am 35:157-71, 2006.
50. Stricker RB, Main EK, Kronfield J. Severe post-partum eclampsia: response to plasma exchange. J Clin Apheresis 7:1-3, 1992.
51. Tetzschner T, Felding C. Postpartum eclampsia. Impossible to eradicate? Clin Exp Obstet Gynecol 21:74-6, 1994.
52. Van Runnard Heimel PJ, Franx A, Schobben AF, Huisjes AJ, Derks JB, Bruinse HW. Corticosteroids, pregnancy, and HELLP syndrome: A Review. Obstet Gynecol Surv 60:57-70, 2005.
53. Veltkamp R, Kupsch A, Polasek J, Yousry TA, Pfister HW. Late onset postpartum eclampsia without pre-eclamptic prodromi: clinical and neuroradiological presentation in two patients. J Neurol Neurosurg Psychiatry 69:824-7, 2000.
54. Villar J, Bergsjo P. Scientific basis for the content of routine antenatal care. Acta Obstet Gynecol Scand 76:1-14, 1997.
55. Visser N, Van Rijn BB, Rijkers GT, Franx A, Bruinse HW. Inflammatory changes in preeclampsia: current understanding of the maternal innate and adaptive immune response. Obstet Gynecol Surv 62:191-201, 2007.
56. Wagner LK. Diagnosis and management of preeclampsia. Am Fam Physician 70:2317-24, 2004.
57. Weinstein L. Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy. Am J Obstet Gynecol 142:159-67, 1982.
58. Wicke C, Pereira PL, Neeser E, et al. Subcapsular liver hematoma in HELLP syndrome: evaluation of diagnostic and therapeutic options-a unicenter study. Am J Obstet Gynecol 190:106-12, 2004.
59. Widmer M, Villar J, Benigni A, Conde-Agudelo A, Karumanchi SA, Lindheimer M. Mapping the theories of preeclampsia and the role of angiogenic factors: a systematic review. Obstet Gynecol 109:168-80, 2007.

 
 
 
 
 
 
 
 
 
 
 
 
Está expresamente prohibida la redistribución y la redifusión de todo o parte de los contenidos de la Sociedad Iberoamericana de Información Científica (SIIC) S.A. sin previo y expreso consentimiento de SIIC.
ua31618