Sympathetic nerves and eclampsia

Abstract

A woman in whom the eclamptic syndrome does not manifest itself before the 38th week of her first pregnancy almost invariably has subsequent normal pregnancies. If, however, the pre-eclamptic syndrome occurs at or about the 30th week of pregnancy, notwithstanding adequate antenatal care, the same symptomatology is likely to recur in subsequent pregnancies and to manifest itself at about the same period of gestation. The foetus, moreover, is likely to be very small.Three successful pregnancies subsequent to denervation of the internal iliac vessels are reported. The first patient had had two stillbirths and the second three stillbirths. The third patient had had a fulminating attack of pre-eclampsia at the 22nd week of her first pregnancy and possessed but one kidney. It is suggested that adequate nutrition of the placenta, particularly when it is being formed, is essential to a normal pregnancy, and that in a very few cases the actual size of the internal iliac arteries makes this impossible in the presence of normal arterial tone. The fact that adequate nutrition of the placenta is essential to a normal pregnancy by no means excludes the necessity for the proper nourishment of the maternal organs, and in the vast majority of cases the one requisite is impossible apart from the other. No evidence was obtained to suggest that the preeclamptic syndrome can be attributed to afferent nerve, impulses arising in the uterus. The cases studied provide no support for the view that long-sustained hypertension and proteinuria during pregnancy cause either chronic nephritis or hypertension, or can be attributed to a “renal shunt”. © 1953, British Medical Journal Publishing Group. All rights reserved.