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Title: | Maternal Venous Hemodynamic Dysfunction in Proteinuric Gestational Hypertension: Evidence and Implications | Authors: | GYSELAERS, Wilfried | Issue Date: | 2019 | Publisher: | MDPI | Source: | JOURNAL OF CLINICAL MEDICINE, 8(3) (Art N° 335) | Abstract: | This review summarizes current knowledge from experimental and clinical studies on renal function and venous hemodynamics in normal pregnancy, in gestational hypertension (GH) and in two types of preeclampsia: placental or early-onset preeclampsia (EPE) and maternal or late-onset (LPE) preeclampsia, presenting at <34 weeks and >= 34 weeks respectively. In addition, data from maternal venous Doppler studies are summarized, showing evidence for (1) the maternal circulation functioning closer to the upper limits of capacitance than in non-pregnant conditions, with intrinsic risks for volume overload, (2) abnormal venous Doppler measurements obtainable in preeclampsia, more pronounced in EPE than LPE, however not observed in GH, and (3) abnormal venous hemodynamic function installing gradually from first to third trimester within unique pathways of general circulatory deterioration in GH, EPE and LPE. These associations have important clinical implications in terms of screening, diagnosis, prevention and management of gestational hypertensive diseases. They invite for further hypothesis-driven research on the role of retrograde venous congestion in the etiology of preeclampsia-related organ dysfunctions and their absence in GH, and also challenge the generally accepted view of abnormal placentation as the primary cause of preeclampsia. The striking similarity between abnormal maternal venous Doppler flow patterns and those observed at the ductus venosus and other abdominal veins of the intra-uterine growth restricted fetus, also invites to explore the role of venous congestion in the intra-uterine programming of some adult diseases. | Notes: | [Gyselaers, Wilfried] Ziekenhuis Oost Limburg, Dept Obstet & Gynaecol, Schiepse Bos 6, B-3600 Genk, Belgium. [Gyselaers, Wilfried] Hasselt Univ, Dept Physiol, B-3590 Diepenbeek, Belgium. | Keywords: | gestational physiology;renal function;venous congestion;preeclampsia;gestational hypertension;small for gestational age;placentation;venous Doppler;maternal hemodynamics | Document URI: | http://hdl.handle.net/1942/30181 | e-ISSN: | 2077-0383 | DOI: | 10.3390/jcm8030335 | ISI #: | 000464439300005 | Rights: | 2019 by the author. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2020 |
Appears in Collections: | Research publications |
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gyselaers 1.pdf | Published version | 1.8 MB | Adobe PDF | View/Open |
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