The immunologic concept of EPH-gestosis.

Edema proteinuria hypertension gestosis represents a disease syndrome that is defined by its occurrence in association with pregnancy and by its patient population. Although the difference between true and superimposed EPH-gestosis remains poorly defined clinically, a clearer definition seems feasible if epidemiological data, which have been developed in long-term follow-up studies, are utilized. These circumstances permit the identification of a well-defined, young, primiparous population that is afflicted during pregnancy with a disease syndrome of unknown etiology. Among many suggested theories, the immunologic concept of EPH-gestosis has attracted increasing attention over the recent past. Assuming an immunologic etiology for this disease syndrome, EPH-gestosis is understood to represent a partial or total malfunction or maladaptation of the immune system of the mother and/or the fetus. According to this concept, EPH-gestosis is considered to represent partial rejection of the fetal allograft. In the present review evidence for an immunologic etiology of EPH-gestosis has been summarized. It may be concluded that, in spite of a large body of available information, no definitive proof for an immunologic etiology of EPH-gestosis has yet been presented. Only the further clarification of the immunologic processes involved in the tolerance of normal pregnancy will allow the detection in those mechanisms of abnormalities associated with EPH-gestosis. Until then, EPH-gestosis will remain a condition of unknown etiology. The immunologic concept, similar to other concepts, needs further clarification until the "concept" can become an etiology.