Figura 2. Patogenia de la preeclampsia. Resumen de los mecanismos implicados en ella. Tomado de 7.

El síndrome materno en la preeclampsia, corresponde a un estado de disfunción endotelial generalizado secundario a un exceso de factores tóxicos para el endotelio (como el sFlt-1) los cuales son liberados por la placenta patológica o enferma. La comprensión de los mecanismos que conducen a la isquemia placentaria en la preeclampsia debería aclararnos sobre la patogenia de la misma. Los estudios futuros deberán caracterizar las diversas proteínas circulantes elaboradas por la placenta isquemica y comprender su interacción con los factores patológicos ya identificados tales como el AT1-AA, el ácido urico y el sFlt-1. Los estudios genéticos multicentricos en curso (como el GOPEC, Genetic of pre-eclampsia) nos podrían informar sobre la importancia de los factores de predisposición genética y la preeclampsia (49). Bien que los progresos de la obstetricia y neonatología han reducido considerablemente la morbi mortalidad de la preeclampsia (especialmente en los países desarrollados) no ha existido una verdadera revolución terapéutica en el tratamiento de la preeclampsia en los últimos 40 años. Los resultados iniciales prometedores del tratamiento por la aspirina y el suplemento de calcio no han sido confirmados en extensos estudios randomizados (50,51). Las tentativas terapéuticas con la intención de restaurar la función endotelial con agentes como el VEGF, el PIGF, las prostaciclinas, deberían utilizarse en las pacientes portadoras de una enfermedad severa para esperar retardar el parto sin poner en peligro la madre. Las complicaciones a largo plazo cardiovasculares y metabólicas en las mujeres con preeclampsia se deben clarificar.

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