Diuretics in the Management of Preeclampsia Associated with High Blood Volume

Short Communication

Austin Hypertens. 2017; 2(1): 1012.

Diuretics in the Management of Preeclampsia Associated with High Blood Volume

Peter Tamas*

Department of Obstetrics and Gynecology, Medical School, University of Pécs, Hungary

*Corresponding author: Peter Tamas, Department of Obstetrics and Gynecology, Medical School, University of Pécs, Hungary

Received: August 16, 2017; Accepted: September 12, 2017; Published: September 25, 2017

Short Communication

Accumulating data suggest preeclampsia, determined as gestational hypertension with organ failure (e. g. proteinuria), is not a homogenous disease [1-3]. Recently, early- or late-onset types are distinguished according to the gestational week when clinical symptoms first appear. While early-onset preeclampsia (clinical manifestation prior to the 34th gestational week) is thought of a placental disease, most likely due to an immunological imbalance between the mother and her embryo, the late-onset type (clinical manifestation at or following the 34th week) is rather a maternal disease. The pregnancy outcome is much better in the late-onset type.

During normal pregnancy, generalized vasorelaxation allows a cc. 2 l of blood volume augmentation without blood pressure elevation; the sufficient sodium and water retentions are prerequisites for normal fetal development. Taking account the simplified form of the Poiseuille-Hagen equation: Cardiac Output (CO) = (blood) Pressure/ Resistance, pressure increases as either resistance or blood volume (measured as CO) increases. Otherwise, CO is determined as stroke volume x pulse rate.

Classical central hemodynamic examinations showed low CO in preeclamptic patients; fetal growth restriction, secondary to placental insufficiency, has been stated as an ordinary complication [4,5]. However, others reported high CO in preeclampsia [6]. This controversy was further augmented by investigations in which high fetal birth weights were also reported in cases admitted with the diagnosis of preeclampsia [3,7].

Whether early- and late-onset types are conditions in which different maternal answers are given to the same progenitor, or gestational hypertension with organ damage develops in different pathways secondary to different progenitor, remains in question.

The different pathogenesis of gestational hypertension + proteinuria is an attractive theory; it can explain all the controversies found, thus far, in studies with preeclamptic patients. In classical preeclampsia, endothelial dysfunction due to agents originating from an under-perfused placenta, and worsened rheological properties of the blood diminishes the microcirculation [8,9]. Organ dysfunctions (e. g. proteinuria), vasoconstiction, platelet activation, and intrauterine growth restriction with oligohydramnios are reasonable consequences of this under-perfused condition; CO is low in the absence of vascular capacity expansion (Figure 1). These symptoms use to develop prior to the 34th gestational week and quickly worsen, in which this condition could correspond with earlyonset preeclampsia.

Citation:Tamas P. Diuretics in the Management of Preeclampsia Associated with High Blood Volume. Austin Hypertens. 2017; 2(1): 1012.