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Review ofLiterature
Pregnancy associated plasma proteins A and B (PAPP-A and
PAPP-B) and plasma protein S are found only in the serum of pregnant
women. PAPP-A was reported to acquire its highest level in P.I.H. (Toop
and Klopper 1981).
PAPP-A being an inhibitor of fibrinolysis and also ofcomplement
fixation, has been sugessted to play a role both in coagulation and in
immunological changes in P.E.T. (Bischnoff, 1986). PPS, also found to
be increased in pregnancy and further increased in P.E.T. and there is a
close resemblence between PPS and antithrombin III and the former may
be regarded as the placental equivelant ofthe latter. PPS could be well
involved in coagulation and immunological changes in P.E.T. (Davey,
1986).
(8) Hyperdynamic circulation:
Recent studies suggested that, the increased maternal cardiac
output rather than the increased peripheral vascular resistance is the more
common hemodynamic feature occuring with preeclampsia.
Esterling et al., (1990) demonstrated that cardiac output values
were significantly higher in preeclamptic patients than in normotensive
ones. This elevation in cardiac output is already appeamt at 11weeks and
remains in the puerperium despite resolution of Hypertension also they
found that systemic vascular resistance of pre-eclamptic patients was
always less than that of normotensive patients and remained lower in the
postpartum period.
The finding of hyperdynamic left ventricular function and
decreased peripheral vascular resistance in preeclampsia may have an
important role in selecting the best .approachto the treatment of severe
hypertension in these patients by B-adrenergic blockers, rather than
vasodilator drugs and open the possibility of screening patients at risk by
measuring cardiac output at early gestation (Arias, 1993).
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