Control of vascular reactivity in pregnancy |
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| Authors: | N F Gant P J Whalley R B Everett R J Worley P C MacDonald |
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| Affiliation: | 1. Department of Chemical Engineering, Kyung Hee University, Yongin, Gyeonggi-do 17104, South Korea;2. Department of Chemical and Biolomolecular Engineering, University of Pennsylvania, Philadelphia, PA 19104, USA;1. University Grenoble Alps – Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France;2. University Grenoble Alps, CNRS UMR 5525, TIMC-IMAG Laboratory, Team PRETA, Grenoble, France;3. INSERM U1042, HP2 Laboratory, University Grenoble Alps, Grenoble, France;4. Fire Department, SDIS 38, Fontaine, France;5. University Grenoble Alps – Center for Clinical Investigation, CHU Michallon, Grenoble, France;1. Communications Engineering Department, University of the Basque Country UPV/EHU, Alameda Urquijo S/N, 48013 Bilbao, Spain;2. Department of Applied Mathematics, University of the Basque Country UPV/EHU, Rafael Moreno “Pitxitxi”, 3, 48013 Bilbao, Spain;3. Department of Emergency Medicine, Oregon Health & Science University, 97239-3098 Portland, OR, United States;4. Department of Emergency Medicine, Medical University of Vienna, 1090 Wien, Austria;1. Ambulance Victoria, Melbourne, VIC, Australia;2. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia;3. The Intensive Care Unit, The Alfred Hospital, Melbourne, VIC, Australia;4. Department of Emergency Medicine, University of Western Australia, Perth, WA, Australia;5. College of Health and Biomedicine, Victoria University, Melbourne, VIC, Australia;1. Department of Anesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Denmark;2. Urgences et Samu 93, AP-HP, Hôpital Avicenne, Inserm U942, 93000 Bobigny, France;3. Sorbonne Paris Cité, Equipe Nanomédecine Biomarqueurs Détection, Laboratoire de Chimie, Structures et Propriétés de Biomateriaux et d’Agents Therapeutiques, UMR CNRS 7244, University Paris 13 Bobigny, France;4. Service des Urgences, Hopital Ballanger, 93600 Aulnays, France;5. Intensive Care Unit, AP-HP, Hôpital Avicenne, Inserm U942, 93000 Bobigny, France;1. Division of Pediatric Surgery, University of Iowa, Iowa City, IA;2. Department of Surgery, Mayo Clinic Rochester, Rochester, MN;3. Mayo Clinic Medical Transport, Mayo Clinic Rochester, Rochester, MN |
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| Abstract: | Human pregnancy is characterized by a blunted pressor responsiveness to vasopressor substances. This was first reported by Dieckmann and Michel in 1937 in experiments in which they measured vascular reactivity to the pressor effects of a crude preparation of vasopressin. Recently, this has been reported to occur in response to epinephrine, norepinephrine (NE), and angiotensin II (AII). Gant and associates reported that the increasing vascular sensitivity to infused AII not only was characteristic of women who developed pregnancy-induced hypertension, but in fact preceded the development of pregnancy-induced hypertension. Although a variety of factors may mediate this blunted pressor responsiveness, the most likely candidate appears to be the localized production within endothelium and/or vascular smooth muscle of prostaglandins. Indeed, administration of indomethacin or aspirin results in an increased sensitivity to infused AII in normotensive previously AII-refractory women. Administration of the steroid hormone 5 alpha-dihydroprogesterone reverses this apparent prostaglandin-mediated response. In addition, administration of the phosphodiesterase inhibitor, theophylline, results in a restoration of vascular refractoriness to infused AII in women with pregnancy-induced hypertension or in women destined to develop pregnancy-induced hypertension. Although a variety of known and possibly unknown compounds might also effect the control of vascular reactivity during human pregnancy, the prostinoids appear to play a pivotal role in mediation of control of vascular reactivity during human pregnancy. |
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