Zusammenfassung
Präeklampsie und intrauterine Wachstumsrestriktion (IUWR) gehören zu den maßgeblichen Schwangerschaftspathologien und sind damit die führenden Ursachen für Mortalität und Morbidität von Mutter und Kind. Interessanterweise sind die Ätiologien beider Syndrome bis heute ungeklärt, sodass zahllose Hypothesen existieren. Das gemeinsame Auftreten beider Syndrome in einer Schwangerschaft hat negative Auswirkungen für Mutter und Kind. Ausgehend von Studien schwerer Fälle mit Präeklampsie und assoziierter IUWR sind Hypothesen entwickelt worden, die versucht haben, die entsprechenden klinischen und morphologischen Veränderungen beider Syndrome gemeinsam zu erklären. Das führte zu der falschen Annahme, dass eine Invasionsbeeinträchtigung des plazentaren invasiven Trophoblasten kausal mit der Entstehung einer Präeklampsie verbunden ist. Doch jüngste Untersuchungen zu prädiktiven Biomarkern zur Vorhersage der Präeklampsie haben ein neues Bild auf die Entstehung der Präeklampsie geworfen. Es hat sich gezeigt, dass eine Invasionsbeeinträchtigung direkt mit einer IUWR assoziiert ist, während einer Präeklampsie die Schädigung des Zottentrophoblasten vorausgeht.
Abstract
Preeclampsia and intrauterine growth restriction (IUGR) are major pregnancy pathologies and the leading causes of maternal and perinatal mortality and morbidity. Interestingly the etiologies of both syndromes are still unclear which is why a large number of hypotheses have been developed. The joint occurrence of both syndromes in a single pregnancy has deleterious effects on both mother and child. Studies dealing with such severe cases of preeclampsia with associated IUGR have led to the development of hypotheses attempting to explain all clinical and morphological alterations in a single hypothesis. This in turn has resulted in the general misconception that a failure in invasion of the placental trophoblast is directly linked with the etiology of preeclampsia. However, recent progress in the identification of new biomarkers to predict preeclampsia has changed views on the etiology of preeclampsia. It has become clear that a failure in trophoblast invasion is directly linked to IUGR while a defect of the villous trophoblast precedes preeclampsia.
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Huppertz, B., Schneider, H. Implantationsstörungen, Präeklampsie und intrauterine Wachstumsrestriktion. Gynäkologe 45, 514–519 (2012). https://doi.org/10.1007/s00129-011-2933-1
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DOI: https://doi.org/10.1007/s00129-011-2933-1