Some historical aspects of toxaemia of pregnancy. A review

Loudon, Irvine

doi:10.1111/j.1471-0528.1991.tb13505.x

Cited by 395 publications

(18 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These observations imply that it is largely reductions in mortality associated with infection and haemorrhage which have led to the decline in maternal mortality overall in Latin America and the Caribbean. They also support other evidence suggesting that deaths associated with hypertensive disorders of pregnancy are the most difficult to prevent in developing, as welJ as developed, countries (Moodley 1990; Loudon 1991). Hypertensive disorders of pregnancy are thus likely to become a problem of increasing importance in the future, as deaths from other causes are reduced, particularly in the developing world.…”

Section: Discussionsupporting

confidence: 86%

See 1 more Smart Citation

Maternal mortality associated with hypertensive disorders of pregnancy in Africa, Asia, Latin America and the Caribbean

Duley¹

1992

BJOG

496

303

View full text Add to dashboard Cite

Objective To present estimates of maternal mortality associated with hypertensive disorders of pregnancy in Africa, Asia, Latin America and the Caribbean, and to discuss strategies to prevent these deaths Design Retrospective review of all available data. Setting Database of the World Health Organization's Maternal Health and Safe Motherhood Programme. Main outcome measures Estimates of the total maternal mortality and the proportions of deaths associated with hypertensive disorders of pregnancy. Results Estimates of mortality associated with hypertensive disorders of pregnancy were similar in Africa, Latin America and the Caribbean, despite considerably higher total mortality in Africa. Variations in both overall mortality and that associated with hypertensive disorders of pregnancy were greatest in Asia. Despite their limitations, these data suggest that between 10–15% of maternal deaths are associated with hypertensive disorders of pregnancy, and that 10% are associated with eclampsia. Conclusions Where maternal mortality is relatively high, the excess is likely to be due to a high mortality associated with haemorrhage and infection and reductions are most likely to come from reductions in these deaths. Evidence from both developed and developing countries suggests that deaths associated with hypertensive disorders of pregnancy are the most difficult to prevent. More rigorous assessment of interventions designed to prevent these deaths is urgently required.

show abstract

Section: Discussionsupporting

confidence: 86%

“…Until the 1940s, infection, hypertension, and haemorrhage were the main causes of maternal mortality in western countries, accounting for more than three‐quarters of all maternal deaths (Loudon 1991). Maternal mortality in developed countries has declined dramatically over the last 60 years, and is now very low.…”

mentioning

confidence: 99%

Maternal mortality associated with hypertensive disorders of pregnancy in Africa, Asia, Latin America and the Caribbean

Duley¹

1992

BJOG

496

303

View full text Add to dashboard Cite

show abstract

“…Notwithstanding these many inconsistencies, the central role of the placenta as a source of “toxin,” in a condition regarded, and indeed often named, as “toxemia of pregnancy” (90–92) cannot be refuted. The uncertainty regarding the nature of the toxin continues, and other placental sources of endothelial dysfunction include syncytiotrophoblast basement membrane fragments (STBM) (93) and endothelial progenitor cells (EPC) (94); an increase of reactive oxygen species over scavenging by antioxidants (95, 96) has also been promoted.…”

Section: Introductionmentioning

confidence: 99%

A Dormant Microbial Component in the Development of Preeclampsia

Kell

Kenny

2016

Front. Med.

View full text Add to dashboard Cite

Preeclampsia (PE) is a complex, multisystem disorder that remains a leading cause of morbidity and mortality in pregnancy. Four main classes of dysregulation accompany PE and are widely considered to contribute to its severity. These are abnormal trophoblast invasion of the placenta, anti-angiogenic responses, oxidative stress, and inflammation. What is lacking, however, is an explanation of how these themselves are caused. We here develop the unifying idea, and the considerable evidence for it, that the originating cause of PE (and of the four classes of dysregulation) is, in fact, microbial infection, that most such microbes are dormant and hence resist detection by conventional (replication-dependent) microbiology, and that by occasional resuscitation and growth it is they that are responsible for all the observable sequelae, including the continuing, chronic inflammation. In particular, bacterial products such as lipopolysaccharide (LPS), also known as endotoxin, are well known as highly inflammagenic and stimulate an innate (and possibly trained) immune response that exacerbates the inflammation further. The known need of microbes for free iron can explain the iron dysregulation that accompanies PE. We describe the main routes of infection (gut, oral, and urinary tract infection) and the regularly observed presence of microbes in placental and other tissues in PE. Every known proteomic biomarker of “preeclampsia” that we assessed has, in fact, also been shown to be raised in response to infection. An infectious component to PE fulfills the Bradford Hill criteria for ascribing a disease to an environmental cause and suggests a number of treatments, some of which have, in fact, been shown to be successful. PE was classically referred to as endotoxemia or toxemia of pregnancy, and it is ironic that it seems that LPS and other microbial endotoxins really are involved. Overall, the recognition of an infectious component in the etiology of PE mirrors that for ulcers and other diseases that were previously considered to lack one.

show abstract

“…Pre-eclampsia is a life threatening complication of pregnancy characterised by high blood pressure and proteinuria1; it occurs in about 3% of all pregnancies 2. The aetiology of pre-eclampsia is still obscure, despite many attempts to identify possible causes.…”

Section: Introductionmentioning

confidence: 99%