Präeklampsie – Signatur und Pathophysiologie

Carmen Eppel, Bodo Grahlke, Angelika Maaser, Tatjana Mijic, Angela Kuck, Peter Zimmermann
Article-ID: DMS-20585-DE
DOI: https://doi.org/10.14271/DMS-20585-DE

  • Login
  • Get Access
  • Export Citation

Die Präeklampsie ist trotz ihrer denkbar einfachen Definition als Symptomkomplex von erhöhtem Blutdruck und Proteinurie in der Schwangerschaft ein höchst komplexes Krankheitsbild mit einer hohen Morbidität und Mortalität von Mutter und Kind. In ihrer klassischen Form mit einem Auftreten vor der 34. Schwangerschaftswoche ist die zentrale pathophysiologische Signatur eine Störung des Plazenta- Gefäßbettes mit fehlender Umwandlung des – außerhalb der Schwangerschaft physiologischen – uterinen Hoch-Widerstand-Strömungsbildes in ein Nieder-Widerstand-Strömungsbild. Die alleinige Kausaltherapie ist die Trennung von Mutter und Kind mit der Entfernung der Plazenta. Eine wirksame Prophylaxe gibt es bisher nicht. Die vorliegende Arbeit, entstanden aus einer Initiative während der frauenärztlichen Fortbildung in Kassel im Juni 2014, soll neben einer Übersicht zum gegenwärtigen Stand der Forschung Gedanken anregen, das Krankheitsbild der Präeklampsie geisteswissenschaftlich weiter zu verstehen.

Preeclampsia – signature and pathophysiology

In spite of a truly simple definition as the combined symptoms of elevated blood pressure and proteinuria during pregnancy, preeclampsia is a highly complex syndrome with high morbidity and mortality for mother and child. In the classic form, onset is before the 34th week, and the central pathophysiological signature is uteroplacental disorder, with failure to transform the uterine high-resistance flow image (physiological if outside pregnancy) into a low-resistance flow image. The only causal treatment is to separate mother and child and remove the placenta. So far there is no effective prophylaxis. The paper, resulting from an initiative during the gynaecological further training course in Kassel in June 2014, offers an overview of current research findings and is intended to encourage efforts to gain further spiritual-scientific insight into the conditions.

1 Duley L. The global impact of pre-eclampsia and eclampsia. Seminars in perinatology 2009;33(3):130–7. [Crossref]

2 WHO. The world health report: 2005: Make every mother and child count. Available at http://www.who.int/whr/2005/en/.

3 Vinatier D, Monnier JC. Pre-eclampsia: physiology and immunological aspects. Eur J Obstet Gynecol Rep Biol 1995;61:85–97. [Crossref]

4 Available at http://www. preeclampsia.org/component/content/article/53-healthinformation/257-history-of-preeclampsia.

5 Davey DA, MacGillivray I. The classification and definition of the hypertensive disorders of pregnancy. Am J Obstet Gynecol 1988;158:892–898. [Crossref]

6 Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013 Nov;122(5):1122–31. DOI: 10.1097/01.AOG. 0000437382.03963.88.

7 Available at http://www. awmf.org/uploads/tx_szleitlinien/015-018l_S1_Diagnostik_Therapie_hypertensiver_Schwangerschaftserkrankungen_2014-01.pdf.

8 Trogstad L, Magnus P, Stoltenberg C. Pre-eclampsia:Risk factors and causal models. Best Pract Res Clin Obstet Gynaecol 2011;25(3):329–42. [Crossref]

9 Mostello D, Kallogjeri D, Tungsiripat R, Leet T. Recurrence of preeclampsia: effects of gestational age at delivery of the first pregnancy, body mass index, paternity, and interval between births. Am J Obstet Gynecol 2008;199(1):55.e1–55.e7. [Crossref]

10 Triche EW, Harland KK, Field EH, Rubenstein LM, Saftlas AF. Maternal-fetal HLA sharing and preeclampsia: variation in effects by seminal fluid exposure in a case-control study of nulliparous women in Iowa. J Reprod Immunol 2014;101–102:111–119. [Crossref]

11 Saftlas AF, Rubenstein L, Prater K, Harland KK, Field E, Triche EW. Cumulative exposure to paternal seminal fluid prior to conception and subsequent risk of preeclampsia. J Reprod Immunol 2014 Mar;101–102:104–10. [Crossref]

12 Ness RB, Markovic N, Harger G, Day R. Barrier methods, length of preconception intercourse, and preeclampsia. Hypertens Pregnancy 2004;23(3):227–35. [Crossref]

13 Dekker G, Robillard PY. Preeclampsia: Is the immune maladaptation hypothesis still standing? An epidemiological update. J Reprod Immunol 2007 Dec;76(1–2):8–16. [Crossref]

14 Nagayama S, Ohkuchi A, Usui R, Matsubara S, Suzuki M. The role of the father in the occurrence of preeclampsia. Med J Obstet Gynecol 2014;2(2):1029. Open Access at http://www.jscimedcentral.com/Obstetrics/obstetrics-spid-predictionpreeclampsia-1029.pdf.

15 Saftlas AF, Levine RJ, Klebanoff MA, Martz KL, Ewell MG, Morris CD, Sibai BM. Abortion, changed paternity, and risk of preeclampsia in nulliparous women. Am J Epidemiol 2003 Jun 15;157(12):1108–14. [Crossref]

16 Trogstad LI, Eskild A, Magnus P, Samuelsen SO, Nesheim BI. Changing paternity and time since last pregnancy; the impact on pre-eclampsia risk. A study of 547 238 women with and without previous pre-eclampsia. Int J Epidemiol 2001 Dec;30(6):1317–22. [Crossref]

17 Bellamy L, Casas IP, Hingorany AD, Williams DJ. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and metaanalysis. BMJ 2007;335:974. [Crossref]

18 Davis EF, Newton L, Lewandowsky AJ et al. Preeclampsia and offspring cardiovascular health: mechanistic insights from experimental studies. Clin Sci 2012;123:53–72. [Crossref]

19 Irgens HU, Reisæter L, Irgens LM, Lie RT. Long term mortality of mothers and fathers after pre-eclampsia: population based cohort study. BMJ 2001;323:1213–17. [Crossref]

20 Kajantie E, Eriksson JG, Osmodn C, Thornburg K, Barker DJP. Preeclampsia is associated with increased risk of stroke in the adult offspring: The Helsinki Birth Cohort Study. Stroke 2009;40:1176–80. [Crossref]

21 Tuovinen S, Räikkönen K, Kajantie E et al. Depressive symptoms in adulthood and intrauterine exposure to preeclampsia: The Helsinki Birth Cohort Study. BJOG 2010;117:1236–42. [Crossref]

22 Kanter D, Lindheimer MD, Wang E et al. Angiogenic dysfunction in molar pregnancy. Am J Obstet Gynecol 2010;202:184.e1–5. [Crossref]

23 McCarthy FP, Kingdom JC, Kennz LC, Walsh SK. Animal models of preeclampsia: uses and limitations. Placenta 2011;32(6):413–419. [Crossref]

24 Thatcher CD, Keith JC. Pregnancy-induced hypertension: development of a model in the pregnant sheep. Am J Obstet Gynecol 1986;155:201–207. [Crossref]

25 Gerretsen G, Huisjes HJ, Elema JD. Morphological changes of the spiral arteries in the placental bed in relation to pre-eclampsia and fetal growth retardation. Br J Obstet Gynaecol 1981;88:876–81. [Crossref]

26 Pijnenborg R, Bland JM, Robertson WB, Brosens I. Uteroplacental arterial changes related to interstitial trophoblast migration in early human pregnancy. Placenta 1983;4:397–414. [Crossref]

27 Nelson PG, Nelson KB. Innervation of the placenta and uterus: competition between cytotrophoblasts and nerves? Placenta 2013;34(6):463–6. [Crossref]

28 Smith SD, Dunk CE, Aplin JD, Harris LK, Jones RL. Evidence for immune cell involvement in decidual spiral arteriole remodeling in early human pregnancy. Am J Pathol 2009;174(5):1959–1971. [Crossref]

29 Knofler M, Pollheimer J. IFPA Award in Placentology Lecture: Molecular regulation of human trophoblast invasion. Placenta 2012;33:55–62. [Crossref]

30 Khong TY, Dewolf F, Robertson WB, Brosens I. Inadequate maternal vascular-response to placentation in pregnancies complicated by pre-eclampsia and by small-for-gestational-age infants. Brit J Obstet Gynaec 1986;93(10):1049–1059. [Crossref]

31 Tsukimori K, Maeda H, Shingh M, Kozanagi T, Nobunaga M, Nakano H. The possible role of endothelial cells in hypertensive disorders during pregnancy. Obstet Gynecol 1992;80:229–233.

32 Lee H, Park H, Kim YJ, Kim HJ, Ahn YM et al. Expression of lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) in human preeclamptic placenta: Possible implications in the process of trophoblast apoptosis. Placenta 2005;26(2–3):226–233. [Crossref]

33 Demir B, Demir S, Pasa S, Guven S, Atamer Y et al. The role of homocysteine, asymmetric dimethylarginine and nitric oxide in preeclampsia. J Obstet Gynaecol 2012;32(6):525–528. [Crossref]

34 Chekir C, Nakatsuka M, Noguchi S, Konishi H, Kamada Y et al. Accumulation of advanced glycation end products in women with preeclampsia: possible involvement of placental oxidative and nitrative stress. Placenta 2006;27(2–3):225–233. [Crossref]

35 Maynard SE, Min JY, Merchan J, Lim KH, Li J et al. Excess placental soluble fms-like tyrosine kinase 1 (sFlt1) may contribute to endothelial dysfunction, hypertension, and proteinuria in preeclampsia. The Journal of Clinical Investigation 2003;111(5):649–658. [Crossref]

36 Rousseau A, Favier R, Van Dreden P. Elevated circulating soluble thrombomodulin activity, tissue factor activity and circulating procoagulant phospholipids: new and useful markers for preeclampsia? Eur Journal Obstet Gynecol Rep Biol 2009;146(1):46–49. [Crossref]

37 Duffus GM, MacGillivray I. The incidence of pre-eclamptic toxaemia in smokers and nonsmokers. Lancet 1968;1:994–995.

38 Hammoud AO, Bujold E, Sorokin Y, Schild C, Krapp M, Baumann P. Smoking in pregnancy revisited: findings from a large population-based study. Am J Obstet Gynecol 2005;192:1856–1863. [Crossref]

39 Mehendale R, Hibbard J, Fazleabas A, Leach R. Placental angiogenesis markers sFlt-1 and PlGF: response to cigarette smoke. Am J Obstet 2007;197:363.e1–363.e5. [Crossref]

40 Fitzgerald DJ, Rocki W, Murray R, Mayo G, Fitzgerald GA. Tromboxane A2 synthesis in pregnancy-induced hypertension. Lancet 1990;335:751–754. [Crossref]

41 Dekker GA, Sibai MB. Lowdose aspirin in the prevention of preeclampsia and fetal growth retardation: Rationale, mechanisms, and clinical trials. Am J Obstet Gynecol 1993;168:214–227. [Crossref]

42 Leeners B, Neumaier-Wagner P, Kuse S et al. Psychosomatische Aspekte in der Ätiologie hypertensiver Schwangerschaftserkrankungen. Geburtsh Frauenheilk 2002;62:26–31. [Crossref]

43 Vollebregt K, van der Wal M, Wolf H, Vrijkotte T, Boer K, Bonsel G. Is psychosocial stress in first ongoing pregnancies associated with pre-eclampsia and gestational hypertension? BJOG 2008;115:607–615. [Crossref]

44 Eicher W, Lammers H, Heinz F. Untersuchungen zur Persönlichkeitsstruktur bei EPH-Gestose-Patientinnen. In: Rippert C, Rippmann ET (Hg). EPH-Gestosis. Bern; 1974.

45 Braunstein GD, Rasor J, Hanser H et al. Serum human chorionic gonadotropin levels throughout normal pregnancy. Am J Obstet Gynecol 1976;126:678–681.

46 Schumacher A, Heinze K, Witte J, Poloski E, Linzke N, Woidacki K, Zenclussen AC. Human chorionic gonadotropin as a central regulator of pregnancy immune tolerance. J Immunol 2013;190:2650–2658. [Crossref]

47 Steiner R. Menschenwesen, Menschenschicksal und Welt- Entwicklung. GA 226. Vortrag vom 17.05.1923. 5. Aufl. Dornach: Rudolf Steiner Verlag; 1988.

48 Steiner R. Physiologisch-Therapeutisches auf Grundlage der Geisteswissenschaft. GA 314. Vortrag vom 23.04.1924. Dornach: Rudolf Steiner Verlag; 1989.

49 Åsvold BO, Vatten LJ, Tanbo TG, Eskild A. Concentrations of human chorionic gonadotrophin in very early pregnancy and subsequent pre-eclampsia: a cohort study. Hum Reprod 2014 Jun; 29(6):1153–60. DOI: 10.1093/humrep/deu068. [Crossref]

50 Hsu CD, Chan DW, Iriye B, Johnson TRB, Hong SF, Repke JT. Elevated serum human chorionic gonadotropin as evidence of secretory response in severe preeclampsia. Am J Obstet Gynecol 1994;170:1135–8. [Crossref]

51 Pecks U, Maass N, Neulen J. Eizellspende – ein Risikofaktor für Schwangerschaftshochdruck: Metaanalyse und Fallserie. Dtsch Arztebl Int 2011;108(3):23–31.

52 Girke M. Innere Medizin. Grundlagen und therapeutische Konzepte der Anthroposophischen Medizin. Berlin: Salumed; 2010.

53 Steiner R, Wegman I. Die Rolle des Eiweißes im Menschenkörper und die Albuminurie. In: Steiner R, Wegman I. Grundlegendes für eine Erweiterung der Heilkunst nach geisteswissenschaftlichen Erkenntnissen. GA 27. 9. Kap. 7. Aufl. Dornach: Rudolf Steiner Verlag; 1991.

54 Steiner R. Geisteswissenschaft und Medizin. GA 312. Vortrag vom 27.03.1920. 7. Aufl. Dornach: Rudolf Steiner Verlag; 1999.

55 Steiner R. Welche Bedeutung hat die okkulte Entwicklung des Menschen für seine Hüllen (physischen Leib, Ätherleib, Astralleib) und sein Selbst? Ein Zyklus von zehn Vorträgen gehalten in Den Haag vom 20. bis 29. März 1913. 4. Vortrag. Dornach: Rudolf Steiner Verlag; 1986.

56 Husemann A. Der musikalische Bau des Menschen: Entwurf einer plastisch-musikalischen Menschenkunde. Dornach: Verlag Freies Geistesleben; 2003.

Merkurstab Newsletter
Latest content with links to all articles.
Free of charge. Without obligation.
Open access to selected articles.
Sign up


J O B   M A R K E T

KRANKENHAUS LAHNHÖHE, LAHNSTEIN
Facharzt für Psychosom. Medizin (Chefarzt) (m/w/d) in Vollzeit und
Facharzt für Psychosom. Medizin und Psychotherapie (Stationsarzt, ggf. Oberarzt) (m/w/d) oder
Weiterbildungsassistent (m/w/d) 
Psycholog. Psychotherapeut (m/w/d) in Voll- oder Teilzeit
More details

TROXLER WERKSTÄTTEN, WUPPERTAL
Honorararzt (m/w/d) 
More details

INTEGRATIVE ALLGEMEINMEDIZIN TAUNUSSTEIN
Facharzt für Allgemeinmedizin (m/w/d) 
Weiterbildungsassistent Allgemeinmedizin (m/w/d)
More details