Feto-Placental Imbalance -New DiseaseTheory about EPH, IUGR, IUFD,etc drmuresan !

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Reacti&e+ - EPH or intermediate phenotypes (such as

Gestational hy$ertension, !estational $roteinuria or $re-eclam$sia associated with mirror syndrome and molar $re!nancy)

(mother is sacri#ied, #etus is sa&ed)

,ee -" Es$ino.a /$inion Pre-eclampsia: a maternal manifestation of a fetal adaptive response? Hy$o'ia, %alnutrition etc Placental si!nal

Fetus e&entually su##ers

0es$ecially in early onset (early EPH)

%other has a &ariety o# res$onses

between these two e'tremities (!enoty$e di##erence $robably written in the e&olutionary model)

between su$$ly and demand

FetoPlacental Imbalance

Fetus res$onse

de$endin! on the de!ree o# F-P Imbalance, the mother*s reaction mode and #etus characteristics (!enoty$e)

le$tin

Fetal si!nal Non reacti&e+ (mother is sa&ed, #etus is sacri#ied)

Fetus disease+ - FGR 1,G2 - IUFD

and in the end

%aternal $lacental trans#er is de#icient (im$aired $lacentation, etc) ,UPP36

Placenta (ischemic)+
- antian!io!enic #actors
(sFlt-4 and s-En!, amon! others)

%aternal sym$toms
a ran!e o# $ossibilities between the two e'tremes o# maternal res$onsi&eness+ From absence o# sym$toms to se&ere EPH, HE33P etc

Feto-Placental Imbalance

55 (le$tin)

Fetal res$onse+
DE%2ND - adenosine

(7"Nicolaides1D"8ri!ht mathematical model+ 2t 9: !w all $re!nancies will de&elo$ EPH)

Fetal needs

Disorder+ Feto-Placental Imbalance (FPI)

%aternal sym$toms+ H;P (hi!h blood $resure), oedema, renal ($rotein-uria etc),

neurolo!ic (coma, sei.ure etc), haematolo!ic (anemia, trombocito$enia etc), li&er (cytolisis etc), &ascular etc 2ssociation o# sym$toms are <nown as syndromes+ $re-eclam$sia, eclam$sia, HE33P etc

Fetal sym$toms+ !rowth restriction (di##erent sta!es), ada$tati&e res$onse

IUGR, ,G2, IUFD etc

(cardio&ascular, ner&ous, metabolic etc)= #rom re&ersible to non-re&ersible #etal chan!es"

Placenta to %other+ antian!io!enic #actors, 5

,i!nals

Fetus to %other+ adenosine, 5 Fetus to Placenta+ le$tin, 5 Placenta to Fetus+ hy$o'ia, malnutrition, 5

Fields o# action

%other+ sym$tomatic treatment

Fetus+ monitorin! (Do$$ler, >TG etc) ? time to deli&ery

Research - Dia!nosis (maternal biolo!ical chan!es)+ P2PP 2, P3GF, sF3T-4, adenosine etc - %other !enoty$e+ di##erent sym$toms ? di##erent $ro!nosis (,NPs,5) - Fetus #eatures+ #etal si!nal to $lacenta and mother (le$tin,5)

>urati&e+ deli&ery (no imbalance) Treatment o# the disease+ Pro$hylactic+

Im$aired $lacentation+ low dose as$irin

Fetal needs+ 55555