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Occupational and environmental exposure of skin to chemicals

endothelial cells and sub-endothelial fibrinoid deposits. Pre-eclampsia is considered the most common cause of nephrotic proteinuria occurring during pregnancy. These factors may also explain the impaired ability of the kidney to excrete a sodium load resulting in fluid retention, as well as the oliguria observed in severe cases. Acute renal failure complicating pre-eclampsia is a rare but serious event. Acute tubular or cortical necrosis follows severely decreased plasma flow, particularly when placental abruption complicates established pre-eclampsia. Cerebral involvement is the most frequent cause of death in preeclampsia. Pathologic features include cortical and subcortical haemorrhages and microinfarcts, cerebral oedema, subarachnoid haemorrhage and large intracerebral haematomas. The altered cerebral blood flow autoregulation, leading to cerebral oedema and/or hypoperfusion, accounts for the two models hypothesised to explain the pathogenesis of eclamptic seizures and cortical blindness. In the last confidential enquiries into maternal deaths 1997-1999, there were 15 confirmed deaths from eclampsia or pre-eclampsia. Seven cases were from intracranial haemorrhage, three from intraabdominal haemorrhage, one from eclampsia, one from acute respiratory distress syndrome, two from multi-organ failure and one from septicaemia while the patient was undergoing intensive care management. Substandard care was featured in 80% of these cases; intracranial haemorrhage, as the single largest cause of death, indicates a failure of effective antihypertensive therapy. Although most frequently presenting as hypertension and proteinuria, multisystem involvement may be an important feature of the disease. Until delivery, which is the only definitive therapy for pre-eclampsia, the maternal complications of intracerebral haemorrhage and eclampsia may be prevented by judicious use of antihypertensive medications and magnesium sulphate, respectively. More recently, pre-eclampia was shown to be associated with long-term health problems. Irgens et al 6 carried out a population based cohort study of the Norwegian registry of data; they found that women who developed pre-eclampsia and consequently delivered preterm, had a 2.71-fold higher risk of death than in women who did not have the disease and whose pregnancies went to term. In particular, the risk of death from cardiovascular causes among women with pre-eclampsia and a preterm birth was 8.12-fold higher. It was concluded that genetic factors that increase the risk of cardiovascular disease, such as dyslipidaemia and thrombophilia, may also be linked to pre-eclampsia.