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If you go from
pathology to pathophysiology, you find that there’s a reduction of blood flow to
virtually all of the organs of the preeclamptic woman: not just her uterus, but her brain,
her liver, her kidneys. That’s due to increased sensitivity to pressors. The blood
pressure increase and the narrowing of blood vessels are not because of mysterious toxins
or even increased concentrations of usual pressors, but because the vessels are
exquisitely sensitive to any agent you administer. In addition to vasoconstriction, you
can demonstrate activation of coagulation cascade, which is going to suggest that the
women are clotting their blood in vivo, and those little clots further compromise blood
flow. Then, the perfusion is reduced because fluid leaks out of the vascular compartment,
again, a further compromise of perfusion. |