Preeclampsia and the 20th century: "Le siècle des Lumières".

The authors delineate seven quantum leap forward and, or revolutions having occurred during the 20th century in the understanding of the physiopathology of preeclampsia. First the discovery of the inflatable arm band permitting to measure blood pressure in 1896. Second, the discovery that eclamptic (convulsions), and later "pre"eclamptic (proteinuria) women presented hypertension in 1897 and confirmed in 1903, discovery of the hypertensive disorders of pregnancy. Third, the eight major textbooks published all along the 20th century by delineating risk factors of preeclampsia with the concept of "preeclampsia, disease of primigravidae". Fourth, the discovery in the 1970's that human trophoblast implantation was far deeper than in other mammalian species. Fifth, and a major step forward, description at the end of the 1980's that the maternal syndrome in preeclampsia (glomeruloendotheliosis, HELLP syndrome, eclampsia) could be unified in a global endothelial cell inflammation. Sixth, the epidemiological descriptions in the 1970-1990's that indeed preeclampsia was a disease of first pregnancies at the level of a couple ("primipaternity concept"), leading to an explosion in immunological research in the last decade, beginning in 1998. Seventh and finally, in the search for the "factor X" explaining the vascular inflammation in preeclamptic women (inositol phospho glycans P-type were described in 2000, while soluble Flt-1 and S-endoglins have been clearly predicted since 1997). The majority of the seeds or findings have been grounded or realized in the 20th century. Indeed, for preeclampsia, the 20th century has been le "Siècle des Lumières" (the Enlightments).

Historical evolution of ideas on eclampsia/preeclampsia: A proposed optimistic view of preeclampsia.

Eclampsia (together with epilepsy) being the first disease ever written down since the beginning of writings in mankind 5000 years ago, we will make a brief presentation of the different major steps in comprehension of Pre-eclampsia. 1) 1840. Rayer, description of proteinuria in eclampsia, 2) 1897 Vaquez, discovery of gestational hypertension in eclamptic women, 3) In the 1970's, description of the "double" trophoblastic invasion existing only in humans (Brosens & Pijnenborg,), 4) between the 1970's and the 1990's, description of preeclampsia being a couple disease. The "paternity problem" (and therefore irruption of immunology), 5) at the end of the 1980's, a major step forward: Preeclampsia being a global endothelial cell disease (glomeruloendotheliosis, hepatic or cerebral endotheliosis, HELLP, eclampsia), inflammation (J.Roberts.C Redman, R Taylor), 6) End of the 1990's: Consensus for a distinction between early onset preeclampsia EOP and late onset LOP (34 weeks gestation), EOP being rather a problem of implantation of the trophoblast (and the placenta), LOP being rather a pre-existing maternal problem (obesity, diabetes, coagulopathies etc…). LOP is predominant everywhere on this planet, but enormously predominant in developed countries: 90% of cases. This feature is very different in countries where women have their first child very young (88% of world births), where the fatal EOP (early onset) occurs in more than 30% of cases. 7) What could be the common factor which could explain the maternal global endotheliosis in EOP and LOP? Discussion about the inositol phospho glycans P type.

Hydatoxi lualba: the worm that wasn't!

Pre-eclampsia is a disorder that occurs only during pregnancy and the postpartum period and affects both the mother and the unborn child. Affecting at least 5-8% of all pregnancies, it can be a rapidly progressive condition characterised by hypertension and proteinuria. Oedema, sudden weight gain, headaches and changes in vision are important symptoms. However, some women with rapidly advancing disease report few symptoms.

A historical overview of preeclampsia-eclampsia.

Preeclampsia is a hypertensive, multisystem disorder of pregnancy whose etiology remains unknown. Although management is evidence-based, preventative measures/screening tools are lacking, treatment remains symptomatic, and delivery remains the only cure. Past hypotheses/scientific contributions have influenced current understanding of preeclampsia pathophysiology and guided management strategies and classification criteria. To provide insight into how past hypotheses/scientific contributions have shaped current practice trends, this article provides a historical overview of preeclampsia-eclampsia.

Genética de la preeclampsia / Genetics of preclampsia

La preeclampsia es un trastorno hipertensivo específico del embarazo y es una de las principales causas de morbilidad y mortalidad materna y neonatal en todo el mundo, afectando 5 a 7% de todos los embarazos. En Colombia es la primera causa de morbilidad y mortalidad materna, siendo un problema de salud pública. Muchas investigaciones coinciden en que su origen se relaciona con la interacción entre factores genéticos y ambientales. Múltiples estudios han explorado factores genéticos tratando de identificar regiones cromosómicas y genes candidatos cuyas variantes se relacionen con una mayor susceptibilidad a la enfermedad. La presente revisión ofrece una visión general de los factores genéticos asociados a la preeclampsia.

Preeclampsia is a hypertensive disorder that occurs only during pregnancy and is one of the main causes of maternal and neonatal morbidity and mortality, affecting 5-7% of pregnancies. In Colombia it is the primary cause of maternal morbidity and mortality, and an important public health issue. Many investigations agree that its origin is related to the interaction of genetic and environmental factors. Numerous studies have explored genetic factors in attempt to identify chromosomal regions and candidate genes, variants of which are related with increased susceptibility to the disease. This review offers a general vision of the genetic factors associated with preeclampsia.

A history of eclampsia, toxemia and the kidney in pregnancy.

Eclampsia, accompanied by convulsions, is one of the most dangerous complications of pregnant women. This condition was known to the ancient Greeks, who named it eclampsia. Prior to the 18th century, the term eclampsia was used only to refer to the visual phenomena which accompanied the neurologic aspects of the malady. Rayer's landmark contribution (1839-1841) provided evidence for renal involvement with the observation of protein in the urine of pregnant, edematous women. Lever (1843) reported finding proteinuria in eclampsia and concluded that disappearance of proteinuria after delivery of the child was evidence that eclampsia was different from Bright's disease.

Dietary sodium restriction during pregnancy; a historical review.

This article reviews the major milestones in obstetric research in the past 90 years, which have lead to the wide-spread use of salt restriction during pregnancy. Possibly the most ardent advocate of the view that salt plays a crucial role in eclampsia was De Snoo (1877-1949), a Dutch obstetrician. However, despite many enthusiastic clinical reports, no convincing evidence has ever been produced that salt restriction helps in the prevention of hypertension during pregnancy.

Aspectos epidemiologicos das sindromes hipertensivas na gravidez / Epidemiological aspects of the hypertensive syndromes in pregnancy

Foram analisados 1449 prontuarios de gestantes hipertensas na Clinica Obstetrica do HC-FMUSP no periodo de agosto de 1985 a agosto de 1990. A incidencia de sindromes hipertensivas foi de 27,6 por cento de todas as gestantes internadas no mesmo periodo. Segundo a forma clinica foi observada incidencia de 22,1 por cento de pre-eclampsia leve; 13,0 por cento de pre-eclampsia grave; 3,2 por cento de eclampsia; 43,8 por cento de hipertensao arterial cronica e 17,7 por cento de hipertensao arterial cronica com pre-eclampsia superposta. A proteinuria presente e em niveis acima de 2,0 g/24h, assim como a uricemia maior que 6 mg/dl foram mais evidentes nas formas de pre-eclampsia grave, eclampsia e hipertensao arterial cronica com pre-eclampsia superposta.

[Hypertensive disease in pregnancy in the history of medicine. 1:The old terminology, ancient history and the Middle Ages]. / Die hypertensive Schwangerschaftserkrankung in der Geschichte der Medizin. Teil: 1 Die alte Terminologie, Altertum und Mittelalter.

Toxemia of pregnancy resp. hypertensive disorder of pregnancy is a "disease of hypotheses". A historical review is given about the large number of hypotheses and the several trials of treatment in ancient time and middle age.