What happens biologically during Pre-E

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alexis
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Re: What happens biologically during Pre-E

Postby alexis » Tue May 31, 2011 12:35 am

caryn wrote: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?
Chronic hypertension
Aliza - 01/05/2007 - Severe preeclampsia, emergency CS 37 weeks
Isaac - 09/26/2011 - controlled on 150mg Toprol, NO PE, 39 weeks!

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caryn
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Re: What happens biologically during Pre-E

Postby caryn » Wed Feb 16, 2011 07:37 pm

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!
Science! The articles you don't want to miss:
The Preeclampsia Puzzle (New Yorker) and Silent Struggle: A New Theory of Pregnancy (New York Times)
Looking for recent articles and studies?
A chance to participate in research? For us on Facebook or Twitter?

Caryn, @carynjrogers, who is not a doctor and who talks about science stuff *way* too much
DS Oscar born by emergent C-section at 34 weeks for fetal indicators, due to severe PE
DD Bridget born by C-section after water broke at 39 weeks after a healthy pregnancy

wels0069
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Re: What happens biologically during Pre-E

Postby wels0069 » Wed Feb 09, 2011 09:48 pm

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
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Re: What happens biologically during Pre-E

Postby blythe » Wed Jan 19, 2011 09:11 am

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!
Heather, mom to
#1 7-18-03 - 5#8oz 37 weeks PE/PIH
#2 8-11-06 - 6#14oz 37 weeks PE/PIH
#3 9-10-09 - 5#10oz 37 weeks PE/PIH

MaggieLu1
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Re: What happens biologically during Pre-E

Postby MaggieLu1 » Wed Jan 19, 2011 08:38 am

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.

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caryn
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Re: What happens biologically during Pre-E

Postby caryn » Tue Dec 14, 2010 09:35 pm

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.
Science! The articles you don't want to miss:
The Preeclampsia Puzzle (New Yorker) and Silent Struggle: A New Theory of Pregnancy (New York Times)
Looking for recent articles and studies?
A chance to participate in research? For us on Facebook or Twitter?

Caryn, @carynjrogers, who is not a doctor and who talks about science stuff *way* too much
DS Oscar born by emergent C-section at 34 weeks for fetal indicators, due to severe PE
DD Bridget born by C-section after water broke at 39 weeks after a healthy pregnancy

veronica44
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Re: What happens biologically during Pre-E

Postby veronica44 » Mon Dec 13, 2010 08:17 pm

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.

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caryn
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Re: What happens biologically during Pre-E

Postby caryn » Sat Dec 04, 2010 11:45 am

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!)
Science! The articles you don't want to miss:
The Preeclampsia Puzzle (New Yorker) and Silent Struggle: A New Theory of Pregnancy (New York Times)
Looking for recent articles and studies?
A chance to participate in research? For us on Facebook or Twitter?

Caryn, @carynjrogers, who is not a doctor and who talks about science stuff *way* too much
DS Oscar born by emergent C-section at 34 weeks for fetal indicators, due to severe PE
DD Bridget born by C-section after water broke at 39 weeks after a healthy pregnancy

miamibunnie
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Re: What happens biologically during Pre-E

Postby miamibunnie » Sat Nov 27, 2010 11:00 pm

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


rusah wrote: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!
Lisette 37 Hubby 37
Lisette 36 / Luis 36
1996 25 weeker due to Eclampsia with seizures daughter alive today 15 yrs old " Julyzah Caridad"
2010 23 weeker due to severe preeclampsia my angel left us

2011/27/July we beat preeclampsia and made it to 36.5 weeks 6lbs 1oz baby girl "Kendall Lauren " pe-free just bp started acting up.
Thanks to God, my doctor, Lovenox and Lda.

rusah
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Re: What happens biologically during Pre-E

Postby rusah » Fri Nov 26, 2010 12:01 am

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!


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