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Transcapillary fluid balance in pre-eclampsia.

P Oian, J M Maltau, H Noddeland

    British Journal of Obstetrics and Gynaecology
    |March 1, 1986
    PubMed
    Summary
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    In pre-eclampsia, reduced plasma colloid osmotic pressure (COPp) can cause fluid loss. Severe pre-eclampsia impairs the body's ability to reduce interstitial fluid colloid osmotic pressure (COPi), leading to edema.

    Area of Science:

    • Physiology
    • Pathophysiology
    • Obstetrics

    Background:

    • Fluid exchange between plasma and interstitial spaces is regulated by Starling forces.
    • Pre-eclampsia is associated with reduced plasma colloid osmotic pressure (COPp) and potential fluid shifts.
    • Interstitial fluid colloid osmotic pressure (COPi) acts as a buffer against increased capillary filtration.

    Purpose of the Study:

    • To investigate the role of interstitial fluid colloid osmotic pressure (COPi) in moderate versus severe pre-eclampsia.
    • To explore the relationship between plasma protein leakage and COPi in pre-eclampsia.

    Main Methods:

    • Interstitial fluid was collected from subcutaneous tissue (thorax and ankle) using implanted wicks.
    • Interstitial fluid hydrostatic pressure (Pi) was measured using the 'wick-in-needle' technique.

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  • Plasma colloid osmotic pressure (COPp) and interstitial fluid colloid osmotic pressure (COPi) were analyzed in patients with moderate and severe pre-eclampsia.

    • Main Results:

    • Patients with severe pre-eclampsia exhibited significantly higher COPi at both thoracic (8.3 vs 7.0 mmHg) and ankle (5.9 vs 3.9 mmHg) sites compared to those with moderate pre-eclampsia.
    • This occurred despite a significant reduction in COPp in severe pre-eclampsia (15.5 vs 19.9 mmHg).
    • The oedema-preventing mechanism of reduced COPi was ineffective in severe pre-eclampsia.

    Conclusions:

    • The homeostatic buffering capacity of COPi is compromised in severe pre-eclampsia.
    • Increased microvascular permeability to plasma proteins in subcutaneous tissue likely contributes to the reduced COPp observed in severe pre-eclampsia.
    • These findings highlight altered fluid dynamics in severe pre-eclampsia, contributing to edema formation.