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own experience essay Hypertensive disorders are a viagra online bestellen test major cause of maternal morbidity and mortality, accounting for 15% to 20% of maternal deaths worldwide. In the united states, hypertensive disorders are the second leading cause of maternal mortality after thrombotidhemorrhagic complications. Beyond 20 weeks' gestation, preeclampsia complicates 5% to 8% of pregnancies, and severe preeclampsia complicates < 1% of pregnancies. Eclampsia itself is much less frequent, occurring in 0.1% of pregnancies. Several risk factors have been identified, as outlined in table 4.1. Ill. Preeclampsia has been called the "disease of theories," and many etiologies have been proposed. What is dear, however, is that it is a condition of dysfunction within the maternal endothelium. Increased levels of the soluble receptors sfltj and endoglin within the maternal circulation for vascular endothelial growth factor (vegf) and transforming growth factor-beta (tgf-,8), respectively, may be associated with preeclamptic pathology. Higher circulating levels of these soluble receptors reduce the bioavailable levels ofvegf, placental growth factor (plgf), and tgf-,8, resulting in endothelial dysfunction within the maternal circulatory system. This dysfunction can manifest as both increased arterial tone (hypertension) and increased capillary leak (edema/proteinuria/pulmonary congestion). It is unclear what insult prompts the initial increase in sflt1 and endoglin in some women versus others. One suggestion has been that abnormal trophoblastic invasion of both the maternal decidual arteries with an accompanying abnormal maternal immune response is at the root of this condition. This abnormal placentation is believed to lead to a reduction in placental perfusion and relative placental ischemia. Both sflt1 and endoglin are 39 40 i. Preeclampsia and related conditions. - .. ~ risk factors for hypertensive disorders risk factor risk ratio nulliparity 3 age >40 3 african american race 1.5 family history of pih 5 chronic htn 10 chronic renal disease 20 antiphospholipid antibody syndrome 10 diabetes 2 twin gestation 4 angiotensinogen gene t235 homozygous 20 heterozygous 4 htn = hypertension. Pih = pregnancy-induced hypertension. Source.

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