P1 A new book recommended

Abstract

In this book “New Concept of Hypertension in Pregnancy”, a brand new classification and pathophysiologic concept with clinical staging of hypertension in pregnancy has been raised. The book provides a theoretical and clinical explanation as well as a solution for this puzzlingly intricate problem. It reveals the solution from a new angle. Things that used to be difficult to understand or solve before are becoming easier to understand. 1. New Concept: Hypertension in pregnancy is caused by primary pathologic change of the placenta. It is a process of damage from clinical compensation to decompensation caused by chronic stress reactions and stress injuries. It is primarily caused by a developmental disorder of placental trophoblastic terminal villi (during the maturing process of the placenta), which in turn causes a decrease in the number of trophoblastic terminal villi arterioles. This decrease of the number of the trophoblastic terminal villi arterioles can cause fetal-placental circulation ischemia*. On the other hand, environmental factors (such as fatigue, tension, heavy work load, grief, fury etc.) also contribute to the damage process. 2. A New Classification: Endogenous (early-onset, placenta-derived) Mixed (both endogenous and exogenous) Exogenous (late-onset, non-placenta-derived, high pressure from the environment) 3. New pathophysiology and clinical staging of hypertension in pregnancy: Latent stage: Noradrenergic neurotransmitters raised in response to ischemia of the fetal–placental circulation and/ or in response to environmental factors. Clinical compensatory stage: Small arteries spasm and vascular endothelial cells are damaged. Clinical decompensation stage: Tissue injury and ischemic necrosis. Failure period: Systemic organ failure *The volume of the feto-placental circulation can be measured by the velocity of umbilical artery blood flow using Doppler Ultrasound. However if the absolute volume of blood flow to the placenta is decreased, ischemia can result, even though the systolic/ diastolic ratio might be normal. In this study, absolute volumes of fetoplacental blood flow are made by Doppler ultrasound as a means of predicting ischemia in low fetoplacental flow volumes.