medigraphic.com
Federación Mexicana de Ginecología y Obstetricia, A.C.

2005, Número 01

<< Anterior Siguiente >>

Ginecol Obstet Mex 2005; 73 (01)


Diferencias y similitudes de la preeclampsia y la hipertensión gestacional

Medina LJM, Medina CN

Idioma: Español
Referencias bibliográficas: 35
Paginas: 48-53
Archivo PDF: 58.99 Kb.


RESUMEN

Hoy en día, la hipertensión inducida por el embarazo se clasifica en una variante pura (hipertensión gestacional) y en otra que cursa con albuminuria (preeclampsia-eclampsia), con la pretensión de que se trata de dos enfermedades distintas. Sin embargo, los estudios de los últimos años informan que entre 15 y 46% de los casos de hipertensión gestacional evolucionan a preeclampsia. Este hecho plantea la posibilidad de que ambas afecciones representen estadios evolutivos distintos del mismo proceso mórbido. La albuminuria puede no estar presente, aun en casos graves de la enfermedad, como el síndrome HELLP y la eclampsia. Cabe entonces la siguiente reflexión: si la albuminuria no es condición indispensable para formular el diagnóstico de formas graves de la enfermedad, ¿por qué la hipertensión pura, es decir, sin albuminuria, ha de llevar a pensar en un diagnóstico distinto (hipertensión gestacional)? En este artículo se realiza una revisión de la bibliografía médica de las diferencias y similitudes entre ambas enfermedades a fin de reflexionar si se justifica sostener el concepto, aún vigente, que clasifica a la hipertensión inducida por el embarazo en dos padecimientos diferentes.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Report of the National High Blood Pressure Education Program Working Group on high blood pressure in pregnancy. Am J Obstet Gynecol 2000;183:S1-S22.

  2. Helewa ME, Burrows RF, Smith J, Williams K, Brian P, Rabkin SW. Report of the Canadian hypertension society consensus conference 1. Definitions, evaluation and classification of hypertensive disorders in pregnancy. CMAJ 1977;157:715-25.

  3. Salomon CG, Seely EW. Preeclampsia-serching for the cause. N Engl J Med 2004;350(7):641-2.

  4. Brosen IA, Robertson WB, Dixon HG. The role of the spiral arteries in the pathogenesis of preeclampsia. Obstet Gynecol Annu 1972;1:177-91.

  5. Fisher SJ, Roberts JM. Defects in placentation and placental perfusion. In: Linhheimer MD, Roberts JM, Cunningham FG, editors. Chesley’s hypertensive disorders in pregnancy. 2nd ed. Stanford: Appleton & Lange, 1999;pp:377-94.

  6. Roberts JM, Taylor RN, Goldfien A. Clinical and biochemical evidence of endothelial cell dysfunction in the pregnancy syndrome preeclampsia. Am J Hypertens 1991;4:700-8.

  7. Taylor RN, Roberts JM. Endothelial cell dysfunction. In: Linhheimer MD, Roberts JM, Cunningham FG, editors. Chesley’s hypertensive disorders in pregnancy. 2nd ed. Stanford: Appleton & Lange, 1999;pp:395-429.

  8. Carbillon L, Uzan M, Uzan S. Pregnancy, vascular tone, and maternal hemodynamics: a crucial adaptation. Obstet Gynecol Surv 2000;55(9):574-81.

  9. Cotter AM, Molloy AM, Scott JM, Daly SF. Elevated plasma homocysteine in early pregnancy: a risk factor for the development of severe preeclampsia. Am J Obstet Gynecol 2001;185:781-5.

  10. Madazli R, Budak E, Calay Z, Akzu MF. Correlation between placental bed biopsy findings, vascular cell adhesion molecule and fibronectin levels in preeclampsia. Br J Obstet Gynaecol 2000;107:514-8.

  11. Granger JP, Alexander BT, Llinas MT, Benett WA, Khalil RA. Pathophisiology of hypertension during preeclampsia linking placental ischemia with endothelial dysfunction. Hypertension 2001;38(3):718-22.

  12. Buchbinder A, Sibai BM, Caritis S, et al. Adverse perinatal outcomes are significantly higher in severe gestacional hypertension than in mild preeclampsia. Am J Obstet Gynecol 2002;186:66-71.

  13. Gofton EN, Capewell V, Natale R, Gratton RJ. Obstetrical intervention rates and maternal and neonatal outcomes of women with gestational hypertension. Am J Obstet Gynecol 2001;185:798-803.

  14. Silver HM, Seebeck MA, Carlson R. Comparison of total volume in normal, preeclamptic, and nonproteinuric gestational hypertensive pregnancy by simultaneous measurement of red blood cell and plasma volume. Am J Obstet Gynecol 1998;197(1):87-93.

  15. Easterling TR, Benedetti TJ, Schmucker BC, Millard SP. Maternal hemodinamics in normal and preeclamptic pregnancy: a longitudinal study. Obstet Gynecol 1990;76:1061-9.

  16. Yang JM, Yang Y Ch, Wang KG. Central and peripheral hemodinamics in severe preeclampsia. Acta Obstet Gynecol Scand 1996;75(2):120-6.

  17. Boslo P, O’Herlihy C, Conroy R, McKenna P. Maternal central hemodynamics in hypertensive disorders of pregnancy: a longitudinal study. Am J Obstet Gynecol 1998;178(1S):6S.

  18. Saudan P, Brown MA, Buddle ML, Jones M. Does gestational hypertension become preeclamsia? Br J Obstet Gynaecol 1998;105(11):1177-84.

  19. Barton J, O’Brien J, Bergauer N, et al. Mild gestational hypertension remote from term: progression and outcome. Am J Obstet Gynecol 2001;184:97-83.

  20. Klockenbush W, Hohlfeld T, Hafner D, Wilhelm M, Somville T, Schror K. Thrombocyte prostacyclin receptors in gestacional hypertension and preeclampsia. Z Geburtshilfe Neonatol 1996;200(3):96-99.

  21. Ros HS, Cnattingius S, Lipworth L. Comparison or risk factors for preeclampsia and gestacional hypertension in a population-based cohort study. Am J Epidemiol 1998;147(11):1062-70.

  22. Boff MC, Valsecchi L, Fausto A, et al. Predictive value of plasma thrombomodulin in preeclampsia and gestational hypertension. Thromb Haemost 1998;79(6):1092-5.

  23. Grandone E, Margoglione M, Colaizzo O, et al. Prothrombotic genetic risk factors and the ocurrence of gestational hypertension with or without proteinuria. Thromb Haemost 1999;81(3):349-52.

  24. Salonen RH, Lichtenstein P, Lipworth L,Cnattingius S. Genetic effects on the liability of developing preeclampsia and gestational hypertension. Am J Med Genet 2000;91(4):256-60.

  25. Gratacos E, Casals E, Gómez O, et al. Inhibin A serum levels in proteinuric and non proteinuric pregnancy induced hypertension: evidence for placental involvement? Hypertens Pregnancy 2000;19(3):315-21.

  26. Nemeth I, Talosi G, Papp A, Boda D. Xantine oxidase activation in mild gestational hypertension in pregnancy hypertension. Hypertens Pregnancy 2002;21(1):1-11.

  27. Frusca T, Saregaroli M, Platto C, Enterri L, Lojacono A, Valcamonico A. Uterine artery velocimetry in patients with gestational hypertension. Obstet Gynecol 2003;102(1):136-40.

  28. Hsu CP, Copel JA, Hong SF, Chan DW. Thrombomodulin levels in preeclampsia, gestational hypertension, and chronic hypertension. Obstet Gynecol 1995;86(6):897-9.

  29. Torres PJ, Escolar G, Palacio M, Gratacos E, Alonso PL, Ordinas A. Platelet sensitivity to prostaglandin E1 inhibition is reduced in preeclampsia but not in nonproteinuric gestational hypertension. Br J Obstet Gynaecol 1996;103(1):19-24.

  30. Higgins JJ, Papayianni A, Brady HR, Darling MR, Walshe JJ. Circulating vascular cell adhesion molecule-1 in preeclampsia, gestational hypertension and normal pregnancy: evidence of selective dysregulation of vascular cell adhesion molecule-1 homeostasis in preeclampsia. Am J Obstet Gynecol 1998;179(2):464-9.

  31. Caruso A, Ferrazzani S, De Carolis S, Luchese A, Lanzone A, De Santis L. Gestational hypertension but not preeclampsia is associated with insulin resistance syndrome characteristics. Hum Reprod 1999;14(1):219-23.

  32. Romero GG, Alvarez CJ, Ponce PA. Asociación entre resistencia a la insulina y la hipertensión inducida por el embarazo. Estudio de casos y controles. Ginecol Obstet Mex 2003;71:244-52.

  33. Roberts JM. Pregnancy related hypertension. In: Creasy RK, Resnik R, editors. Fetal maternal medicine principles and practice. 5th ed. Philadelphia: Saunders, 2004;pp:859-99.

  34. Sibai BM. Diagnosis, controversies and management of the syndrome of hemolysis, elevated liver enzymes and low platelet count. Obstet Gynecol 2004;103(5):981-91.

  35. Sibai BM. Diagnosis and management of gestational hypertension and preeclampsia. Obstet Gynecol 2003;102:181-92.




2020     |     www.medigraphic.com