DUGi

La Preeclàmpsia : etiologia, evolució i tractament

http://dugi.udg.edu/item/http:@@@@hdl.handle.net@@10256@@26295

Preeclampsia is a significant maternal health problem with the presence of hypertension and proteinuria or other end-organ damage after twenty weeks of gestation, increasing the risk of several serious complications. Its etiology is unclear, as it is a heterogeneous syndrome with various clinical and pathophysiological presentations. The leading cause is believed to be placental malperfusion resulting from the abnormal remodelling of the spiral arteries, leading to a hypoxic environment and impaired nutrient and oxygen transfer. Cytokines released due to hypoxia alter the maternal vascular response, affecting immune homeostasis. Genetic events, particularly the FLT-1 gene, play an essential role in developing preeclampsia, as do multiple cardiometabolic factors. Preeclampsia develops in two stages: placental development in early pregnancy, and systemic maternal endothelial dysregulation and inflammation. Preeclampsia has two subtypes: early-onset, before the thirty-seventh week; and late-onset, from the thirtyfourth week of gestation. The risks are greater in early-onset preeclampsia. For prevention, the use of aspirin at low doses (50-150 mg daily) before 16 weeks of gestation reduces the risk of preeclampsia. Regarding detection, the Bayes theorem developed by the Fetal Medicine Foundation makes it possible to estimate the specific individual risks of preeclampsia, showing a high detection rate. The most significant biomarkers in preeclampsia include serum placental growth factor (PIGF) and soluble fms-like tyrosine kinase-1 ratio (sFLT-1). High levels of sFLT-1 and low levels of PIGF are associated with a greater risk of preeclampsia. Endocan-1 is also a proposed biomarker, as its levels increase in preeclampsia maternal plasma. At the moment, the only definitive treatment for preeclampsia is delivery, but early detection allows better intervention. Low-dose aspirin and curcumin have been proposed as therapeutic options, as they reduce the risk of development. Finally, treatment with magnesium sulfate reduces the occurrence of convulsions in eclampsia. Despite all these advances, more research is still needed to understand the molecular mechanisms better, discover new biomarkers, and contribute to improving diagnosis and treatment

3