Pathophysiology of preeclampsia: links with implantation disorders.
The phenomenon of implantation anchors the embryo into the uterine wall and produces a hemochorial placenta that maintains the pregnancy and fetal growth. Implantation and placentation are intimately linked and cannot be dissociated either in time or in space. Preeclampsia is characterized by hypertension and proteinuria. It is secondary to an anomaly of the invasion of the uterine spiral arteries by extra-villous cytotrophoblast cells, associated with local disruptions of vascular tone, of immunological balance and inflammatory status, and sometimes with genetic predispositions. Preeclampsia is a disease of early pregnancy, a form of incomplete spontaneous abortion, but is expressed late in pregnancy. Aspirin may play a favorable role in implantation which is related to the genesis of preeclampsia and some cases of intra-uterine growth restriction. The most important points in obtaining a preventive effect from low-dose aspirin during the pregnancy are early treatment (before 13 weeks of gestation) and the prescription of a sufficient dose (more than 100 mg per day).
Merviel
Philippe
P
Department of Gynecology, Obstetrics and Reproductive Medicine, Hospital Tenon, 4 rue de la Chine, 75020 Paris, France. philippe.merviel@fcvnet.net
Carbillon
Lionel
L
Challier
Jean-Claude
JC
Rabreau
Michèle
M
Beaufils
Michel
M
Uzan
Serge
S
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D010064:Embryo Implantation / Q000276:immunology* / Q000502:physiology; D005260:Female; D006801:Humans; D011225:Pre-Eclampsia / Q000276:immunology* / Q000503:physiopathology* / Q000517:prevention & control; D011247:Pregnancy; D014327:Trophoblasts / Q000276:immunology* / Q000502:physiology
D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin