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Preeclampsia and endometriosis - denervation and reinnervation ?
- Martin Quinn (24 February 2006)
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Taking a Syndemic Perspective
- Deborah A Kraut (28 February 2006)
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Martin Quinn, Consultant in Obstetrics & Gynaecology Hope Hospital, M6 8HD.
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Some similarities between the severe forms of preeclampsia and endometriosis may be of interest. Both conditions affect nulliparae, teenagers and over-35's, first degree relatives, and, they may recur. Intensive immunogenetic studies reveal no strong associations in either condition though if you achieve pregnancy with "endometriosis" then there is an increased risk of pre- eclampsia/IUGR. Neuro-immunohistochemical studies of the myometrium in nulliparous endometriosis are associated with denervation and reinnervation at the endometrial-myometrial interface secondary to sustained constipation (1). In pre-eclampsia the second wave of trophoblast invasion is arrested at the endometrial (deciduo-) myometrial interface. Disruption of the nerve plexus at the endometrial-myometrial interface may prevent appropriate implantation and the sequence of events that leads to severe, early-onset pre-eclampsia and intra-uterine growth retardation (2) ? Is there any epidemiological evidence that women with severe pre- eclampsia may have suffered a denervatory injury to the endometrial- myometrial interface through straining to defaecate (persistent constipation), straining as a consequence of their occupation, or, through uterine curettage ? Is there any evidence that pre-eclampsia is associated with subsequent menstrual problems (reinnervation) over the medium term ? (1) Atwel GSS, Duplessis D, Armstrong G, Slade R, Quinn M Uterine innervation after hysterectomy for chronic pelvic pain with, and without, endometriosis. Am J Obstet GHynecol 2005; 193:1658-63. (2) Quinn MJ. Cytokines, preeclampsia and partial uterine denervation. Am J Obstet Gynecol 2005; 193:896-7. Competing interests: None declared |
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Deborah A Kraut, independent -
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A syndemic is defined as two or more afflictions or co-morbidities, and socio-economic factors combine to meet a threshold of a burden of disease. Perhaps, this model 'fits' the emergence of pre-eclampsia. Physicians should be alert to the presence in the patient of autoimmune disease (e.g., hypothyroidism), gestational diabetes, and familial history that indicates that paternal and maternal relatives have experienced the pregnancy complications and losses. A second note, written with the exasperation of one who "rested" for 30 weeks in 1980-1981. You will get far better compliance from your patients if you explain to them that maintaining an appropriate positioning on one's left side (lateral recumbent positioning) is not REST, but hard work. A woman who understands that she is effecting a complementary therapy will have some sense of purpose during the duration of a complicated pregnancy. And, please, all of you, remember that magnesium sulfate has some nasty side effects; lying alone in a hospital bed in a quiet room will also promote the feelings of sensory deprivation. In a few hours, your patient is going to standing at the doorway, telling the nurses that she feels she's going crazy. If you tell your patient about the effects of the medication and that ALL patients initially experience some sensory distortions, again, you may get better compliance. I am very sad to read how little has changed in a quarter century since my pre-eclampsia was treated. Competing interests: None declared |
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