ETIOLOGI DAN

PATOGENESIS PRE-
EKLAMSIA
Pembimbing:
Dr. CHRISTOFEL PANGGABEAN, SPOG (k) fm

Presentan:
FITRI NUR LAELI


Sebab bertambahnya frekuensi pada

primigravida
kehamilan ganda
Hidramnion
Penyakit
vaskular
sebelumnya
mola
hidatidosa
Riwayat
keluarga (+)
1. Abnormal trophoblastic invasion of uterine
vessels
2. Immunological intolerance between
maternal and fetoplacental tissue
3. Maternal maladaption to cardiovascular or
inflamatory changes of normal pregnancy
4. Dietary deficiencies
5. Genetic influences


Abnormal
trophoblastic invasion
of uterine vessels


Yang terjadi pada pre-eklamsia ??
Sumber : Camille P, Levine RJ, Karumachi A. Preeclampsia, a Disease of the
Maternal Endothelium. Circulation 2011; 123: 2856-2869.
Abnormal placentation in
preeclampsia In normal placental
development, invasive
cytotrophoblasts of fetal origin
invade the maternal spiral
arteries, transforming them from
small-caliber resistance vessels
to high-caliber capacitance
vessels capable of providing
placental perfusion adequate to
sustain the growing fetus. During
the process of vascular invasion,
the cytotrophoblasts differentiate
from an epithelial phenotype to
an endothelial phenotype, a
process referred to as
pseudovasculogenesis or
vascular mimicry (top). In
preeclampsia, cytotrophoblasts
fail to adopt an invasive
endothelial phenotype. Instead,
invasion of the spiral arteries is
shallow, and they remain small
caliber, resistance vessels
(bottom).
Wang A et al. Physiology 2009;24:147-158
2009 by American Physiological Society
TEORI DISFUNGSI ENDOTEL &
INFLAMASI

sFlt1 and sEng cause endothelial dysfunction by antagonizing VEGF and TGF-
signaling There is mounting evidence that VEGF and TGF-1 are required to
maintain endothelial health in several tissues, including the kidney and perhaps
the placenta.
Wang A et al. Physiology 2009;24:147-158
2009 by American Physiological Society
Teori intoleransi imunologik antara ibu
dan janin

Noris M et al. (2005) Mechanisms of Disease: pre-eclampsia
Nat Clin Pract Neprol 1: 98114 doi:10.1038/ncpneph0035
Figure 4 Unifying hypothesis of pre-eclampsia pathophysiology

T
E
O
R
i
Kelainan Vaskularisasi plasenta
PATOFISIOLOGI
Penyakit
Vaskular ibu
Trofoblas
Berlebihan
Gangguan
Plasentasi
Faktor genetik
Imunologik
inflamasi
Zat perusak:
Sitokin
Peroksidase lemak
Penurunan perfusi
Uteroplasenta
Zat vasoaktif:
Prostaglandin
Nitrat oksidase
endotelin
trombositopeni
proteinuria
hemokonsentrasi Edema
AKTIVASI
KOAGULASI
KEBOCORAN
KAPILER
AKTIVASI
ENDOTEL
VASOSPASME
Iskemia hepar
Solusio Oliguria
Kejang
Hipertensi