Pre-eclampsia: pathophysiology and clinical implications.

Pre-eclampsia is a common disorder that particularly affects first pregnancies. The clinical presentation is highly variable but hypertension and proteinuria are usually seen. These systemic signs arise from soluble factors released from the placenta as a result of a response to stress of syncytiotrophoblast. There are two sub-types: early and late onset pre-eclampsia, with others almost certainly yet to be identified. Early onset pre-eclampsia arises owing to defective placentation, whilst late onset pre-eclampsia may center around interactions between normal senescence of the placenta and a maternal genetic predisposition to cardiovascular and metabolic disease. The causes, placental and maternal, vary among individuals. Recent research has focused on placental-uterine interactions in early pregnancy. The aim now is to translate these findings into new ways to predict, prevent, and treat pre-eclampsia.

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Déclaration de conflit d'intérêts

Competing interests We have read and understood the BMJ policy on declaration of interests and declare the following interests: GJB, CR and AM, none. JMR is a consultant to Metabolomics Diagnostics Limited, a company attempting to develop a predictor of pre-eclampsia.