Abstract

Preeclampsia is considered as a disease of the maternal endothelium and the proper function of the microvascular endothelium includes maintenance of a barrier and regulation of vascular tone. However, the extent to which microvascular dysfunction results from endothelial dysfunction, sympathetic influence, neuronal or myogenic disturbance, increased permeability or microangiopathy, at different levels of risk for preeclampsia and in different vascular beds, remains uncertain. Summarizing, it is hypothesized that in preeclampsia a preexisting endothelial dysfunction and a consequently increased permeability results in a disturbed microvascular reactivity and autoregulation that also affects the placenta. Beyond the persistent peripheral vasoconstriction, due to sympathetic overactivity, the microcirculation exhibits blood flow regulative competence to counteract the impaired macrovascular endothelial function. The disruption of this microvascular autoregulatory competence, with further disease progression and the resulting atherosclerotic changes, which are partially genetically determined, indicate an increased risk for future cardiovascular disease. The analysis of the microcirculation, at different risk for preeclampsia and in different vascular beds, might be important to detect women susceptible to preeclampsia, by unmasking preexisting differences and to enable therapeutic strategies. Pathological microvascular findings after and during preeclampsia and screening strategies for preeclampsia, detected with different assessment methods, are summarized in this chapter.