Die Bedeutung von Stickstoffmonoxid in der Pathophysiologie und Therapie der Präeklampsie*

The spectrum of the hypertensive disorders of pregnancy result from an imbalance between vasoconstrictive agglutinating substances and vasodilating anticoagulative substances. Nitric oxide is the most potent endogenous vasodilator and plays a central role in the regulation of vascular tone. Impaired synthesis of nitric oxide by endothelial cells is assumed to be a central mechanism in the pathophysiology of preeclampsia. Nitric oxide also decreases the sensitivity of thrombocytes to procoagulative substances, inhibits the adhesion of leucozytes. and reduces the release of endothelin and the proliferation of vascular smooth muscle cells. The role of the endothelial nitric oxide synthetase gene and the expression of endothelial nitric oxide synthetase in placental tissue and umbilical vessels in preeclampsia and normal pregnancy is unclear. Nitric oxide donors have been used experimentally in attempts to treat hypertensive disorders of pregnancy but their efficacy is unproved and there are no recommendations for clinical use.