Normalization of vasoactive changes in preeclampsia precedes clinical recovery

The objective of this study is to compare the serum levels of fibronectin, nitric oxide (NO), cyclic guanosine-monophosphate, endothelin-1, and 6-keto-prostaglandin-F 1alpha in women with and without preeclampsia before and after delivery.

We studied 20 singleton pregnancies complicated by preeclampsia, and 20 women undergoing elective cesarean delivery were selected as controls. The normalization of circulating concentrations of maternal plasma NO, cyclic guanosine-monophosphate, fibronectin, endothelin-1, thromboxane-B 2 and renin, and urinary 6-keto-prostaglandin-F 1alpha after delivery was evaluated.

Mean systolic and diastolic blood pressure (BP) in the puerperium of preeclamptic women remained high after discharge from hospital, and only circulating fibronectin levels were found to be elevated in affected women at the end of hospital stay 5 days after delivery. Normalization of the imbalance in vasoactive substances and renal impairment in preeclampsia occur more rapidly than the patient's clinical recovery, within 2-3 days postpartum.

Slow normalization of circulating fibronectin concentrations reflects slow recovery of endothelial damage in preeclampsia, which may play a major role in maintaining high BP in the puerperium. Plasma levels of endothelin-1 declined to normal levels by the third postpartum day and the finding is consistent with the hypothesis that endothelin-1 is not the major vasoconstrictor in the pathophysiology of preeclampsia.