What happens biologically during Pre-E

[alexis]

This is very difficult to study, but it's an ongoing, very intriguing, area of research. One thing that I find fascinating about it is that some chronics have babies who are *big* for gestational age, which might suggest that even though the placenta is shallowly implanted it's developing a decent blood supply anyway, or might suggest that implantation is deep enough to grow a big baby but at the same time the maternal immune response to it is creating hypoxia and triggering the same downstream effects that a shallow implantation would cause. There are multiple pathways operating here, multiple placental strategies for maximising bloodflow, so you could simultaneously have shallow implantation and then other strategies that compensated somewhat for that shallow implantation, like upregulation of maternal respiration rate and heart rate and appetite (so the little blood that does make it 'round to perfuse the placenta is still packed with supplies. (I think this is a useful way to explain tachycardia and breathlessness in some PE patients.)

Ok - this intrigues me.

Baby #1 - 8lbs1oz at 37 weeks. I had fewer growth scans, but I remember she was measuring a week ahead at 12 and 20 weeks (and I'm sure about my dates)
Baby #2 - EFW over 1 lb at 20 weeks; I forgot to ask percentiles, but I think I saw something on-screen about 95th percentile. Currently 22 weeks, so outcome is open. On Toprol this pregnancy but not with #1.

Everyone (my providers included) seems concerned about IUGR and blood flow to the fetus. But I wonder: If my history is that I manage to both have superimposed PE and grow a very nicely sized baby in the past, how should I apply that to my current pregnancy? Does it have any relevance at all?

[caryn]

This test is in development in the US. A similar one (not as accurate as what will be needed to meet regulatory requirements here) is available now in Europe.

Since you've already had PE, your care providers will already be on high alert, so I'm not certain that this test has a whole lot of value for women with a history. There's no treatment yet, and what this test does is alert you to the likelihood of complications. But you're already alert!

[wels0069]

So if I wanted to have another baby and risk our lives could I request a blood test that tells the levels of this anti-agent that does not allow the repair of leaky vessels in the 1st trimester?
Maybe with that information me and my dr. could plan for a rocky road.
Let me know.

[blythe]

Hi MaggieLu1, welcome! We just had a quick technical discussion about post-partum PE on this thread -
http://www.preeclampsia.org/forum/viewt ... 12&t=41617
Congratulations on your new pregnancy!

[MaggieLu1]

Amazing stuff has been shared here. I am wondering if anyone can expand on preeclampsia post partum? I had difficult to control blood pressure for three months following the delivery of my little girl. And the fact that the disease is not ''cured'' with delivery really worries me...as I am expecting again It just seems so uncontrollable and unforeseeable.

[caryn]

The research isn't specific to this point yet -- in other words, no one knows for certain -- but chronic hypertension is an immune characteristic as well, an activation of the innate immune response. Implantation could by dysregulated in chronic hypertensives because of their genetic tendency to hypertension. If that's true, my guess is that implantation can't proceed normally in chronics because other chemical responses unique to chronics are operating at the same time and interfere with a clean line of communication between the maternal and paternal cells -- like noisy crosstalk on a radio.

This is very difficult to study, but it's an ongoing, very intriguing, area of research. One thing that I find fascinating about it is that some chronics have babies who are *big* for gestational age, which might suggest that even though the placenta is shallowly implanted it's developing a decent blood supply anyway, or might suggest that implantation is deep enough to grow a big baby but at the same time the maternal immune response to it is creating hypoxia and triggering the same downstream effects that a shallow implantation would cause. There are multiple pathways operating here, multiple placental strategies for maximising bloodflow, so you could simultaneously have shallow implantation and then other strategies that compensated somewhat for that shallow implantation, like upregulation of maternal respiration rate and heart rate and appetite (so the little blood that does make it 'round to perfuse the placenta is still packed with supplies. (I think this is a useful way to explain tachycardia and breathlessness in some PE patients.)

The chemicals that are upregulated in PE, sFlt-1 and sEng, are upregulated in patients regardless of their predisposing underlying conditions, so hypoxia has to be a player in chronics, which suggests that chronics have shallow placentation going on, in some fashion.

[veronica44]

To people's knowledge, is the mechanism for PE different for someone with chronic hypertension than for patients with normal or low blood pressure? It seems confusing that the chronic hypertensives have such a greater predisposition towards PE if the main explanation is implantation phenomena.

[caryn]

I don't know of any connection between retroverted uterus and preeclampsia, no. I don't think there would be one, because when implantation goes wrong in the way that predisposes to PE, it's not really because of gravity -- it's because of a biochemical miscommunication between paternal and maternal cells. Although I suppose if it's retroverted because of endometriosis, and endo lowers risk of PE, that might lower your risk of PE somewhat. (Only somewhat -- we have plenty of posters with endo histories!)

[miamibunnie]

Rusah good one...I also have been told that have a slightly tilted uterus, and wondered the same thing.

I'm not sure if this is active anymore, but I thought I'd add my thoughts

I'm just wondering if there's any relation between having a tilted/retroverted (not sure of the proper term!) uterus and getting preeclampsia. I was thinking that if what causes it is a not properly attached placenta (among other things!), could it be that having a tilted uterus increases your risk of the placenta not attaching properly?

I have a tilted uterus and I had preeclampsia with my other pregnancy, and am right on the verge of getting it with this one, which is why I'm wondering!

Thanks!

[rusah]

I'm not sure if this is active anymore, but I thought I'd add my thoughts

I'm just wondering if there's any relation between having a tilted/retroverted (not sure of the proper term!) uterus and getting preeclampsia. I was thinking that if what causes it is a not properly attached placenta (among other things!), could it be that having a tilted uterus increases your risk of the placenta not attaching properly?

I have a tilted uterus and I had preeclampsia with my other pregnancy, and am right on the verge of getting it with this one, which is why I'm wondering!

Thanks!