[New aspects of the pathophysiology of gestosis/pre-eclampsia (author's transl)]

An increased pressor responsiveness is consistently found in nulliparous patients with gestosis. The following mechanisms may be able to influence arterial reactivity: sodium balance, factors of the kallikrein-bradykinin and the renin-angiotensin systems, an imbalance between vasoconstrictive and vasodilatatory prostaglandins, the sympathetic nervous system, and possibly prolactin, too. A mechanism which is involved in the regulation of uteroplacental blood flow seems to be important in the etiology of gestosis. The immunological changes found in patients with gestosis are insufficient to support the concept of a primary immunopathogenesis. The usefulness of the supine pressor ("roll-over") test, of the angiotensin sensitivity test and serum uric acid determination in predicting hypertensive disorders of pregnancy is evaluated. The supine pressor test is recommended as an appropriate and practical method for routine screening in nulliparous pregnant women.