Prediction and prevention of pregnancy-induced hypertensive disorders : a clinical and pathophysiologic study

pregnancyinduced hypertensive disease depends on a functional imbalance between two eicosanoid substances with opposing physiologic effects, it may be attempted to correct the putative imbalance by means of pharmacologic manipulation. The demonstration that such a pharmacologic intervention would result in preventing, halting or retarding the clinical signs of the disease (secondary prevention) would strongly support the hypothesis; on the other hand, the absence of a preventive effect of such an approach would cast significant doubt on the validity of the hypothesis. The description of the design, the execution and the results of such a clinical pathophysiologic study, using low-dose Aspirin, forms the core of this thesis. During the preparation of that study the need arose for a reliable method to define a population of pregnant women at risk. A survey of the pertinent literature revealed that a multitude of predictive tests for pregnancy-induced hypertensive disease has been proposed, but that their validity is ill-defined or controversial. On the basis of a critical search of the available literature we selected the two most promising predictive tests and determined their validity in an additional clinical study.