Background. Poor placentation and systemic endothelial dysfunction have been identified as main events in Preeclampsia (PE). The relationship and chronology of these phenomena are important if we are to understand the pathophysiological mechanisms underlying this major clinical problem. Objectives. To compare the evolution of placentation and endothelial function in normotensive and preeclamptic pregnancies. Patients and methods. In a prospective cohort study, 59 pregnant women with a high risk of developing PE were subjected to flow-mediated dilation (FMD) and to Doppler velocimetry of uterine arteries in order to obtain their Pulsatility Index (UtA-PI). The variations in the FMD and UtA-PI values, between 16+0 and 19+6 and 24+0 and 27+6 weeks of gestation, were compared, taking PE development into consideration. Results. Nine patients developed PE and the other 50 women remained normotensive. At 16+0 to 19+6 weeks of pregnancy, patients that developed PE presented higher values of UtA-PI than the normotensive group, but there was no difference in FMD results between them. At 24+0 to 27+6 weeks, the patients that developed PE presented higher values of UtA-PI and lower values of FMD than the women that remained normotensive. Conclusions. These results corroborate the evidence that endothelial injury is secondary to poor placentation. 1. Introduction Preeclampsia (PE) is a multisystemic disorder that accounts for a large number of maternal deaths in developed and developing countries worldwide [1–3]. Although its etiology remains unclear, several events in PE physiopathology are well studied and can be evaluated using biochemical or biophysical methods. In order to prevent PE complications, there are many early detection markers, which include maternal demographics, past medical, obstetric, family history, and some current pregnancy characteristics [4–6]. Maternal factors and history alone can be used as a PE risk stratification method. Elevated body mass index, maternal age extremes and Afro-American ethnicity are associated with a higher risk of PE [7]. Some diseases such as diabetes and chronic hypertension also significantly increase the risk [8]. The patients that present these conditions are the ones who will most benefit from a satisfactory and specific level of care, once the risk of developing PE in this groups rises threefold, reaching a PE prevalence of 45% [3]. Preeclampsia is essentially an endothelial disease [9, 10]. Progressive endothelial dysfunction leads to arterial hypertension, glomerular lesion, hepatic failure, and cerebral edema
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