In the pathophysiology of pre-eclampsia, failure of trophoblastic invasion of spiral arteries leads to which of the following hemodynamic consequences?

• A Increased placental perfusion with compensatory maternal vasodilation
• B Reduced placental perfusion causing placental ischemia and release of anti-angiogenic factors ✓
• C Direct activation of the maternal renin-angiotensin-aldosterone system causing primary hypertension
• D Increased prostacyclin production leading to systemic vasodilation

Explanation

In pre-eclampsia, shallow trophoblast invasion fails to remodel spiral arteries into low-resistance vessels, causing reduced placental perfusion. This placental hypoxia triggers release of anti-angiogenic factors like sFlt-1, which antagonize VEGF and PlGF, causing endothelial dysfunction. Option D is incorrect because prostacyclin is actually decreased relative to thromboxane in pre-eclampsia, contributing to vasoconstriction.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.