Pathophysiology of Preeclampsia : The Role of Microcirculation

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From viewpoint of understanding the pathophysiology of preeclampsia, we attempted to assess the factors pertaining to change in tissue microcirculation.In normal pregnancy, the following findings were obtained : 1) The increases in the number of venules and aggregation of blood flow in conjunctiva bulbi were noted with advance in gestation under conditions of the Intra Vital Video Microscopic System (IVVMS) observation, 2) the values of whole blood viscosity tended to decrease in the second trimester of pregnancy, 3) the peripheral venous tone was found to decrease in the third trimester of pregnancy. These findings suggest that the maternal circulation can adjust itself by controlling the microcirculation, in accord with the increase of bloo volume during normal course of pregnancy.With regard to preeclamptic pregnancy, the findings were summarized as follows : 1) The decrease in thermal conductivity and disturbed vasodilatation was evident when studied after cooling in the skin and subcutaneous tissues, by means of the equipment measuring deep body temperature distribution, 2) The decrease in the number of venules and the increase of sludge of blood flow measured using IVVMS were observed, 3) the increase in the value of whole blood viscosity together with increase in the peripheral venous tone were noted when compared with those in normal pregnancy. These findings indicate that the disturbance in the tissue microcirculation and the disturbance of both vasodilatation and venodilatation were the determinant factors characterizing the pathophysiological changes in preeclamptic women.From the study on cell-biology, it was found that there exist the endogeneous factors in the serum of preeclamptic women, thereby making strong cytotoxic effect on endothelial cells.