Presse Med
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Continuous sedation until death (CSUD) is a practice which has developed recently in several countries, appearing more acceptable than euthanasia and medically assisted suicide, since more close to a "natural death". The French parliament has just adopted a law which stipulates CSUD on request of the patient in a definite number of circumstances, especially in incurable diseases near to the terminal stage with suffering refractory to treatments. Thus France has adopted a unique international position for the end-of-life care. ⋯ The primacy allocated to autonomy is questionable for the more vulnerable patients, who deserve mainly a social solidarity. The double-effect principle is replaced actually in CSUD by a co-intention both to relieve suffering and meanwhile eventually to hasten death, especially when stopping nutrition and hydration. CSUD is thus located in a grey zone between palliative care and euthanasia.
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Preeclampsia is a hypertensive disease of pregnancy due to abnormal utero-placental circulation. Hypoperfusion of the placenta and hypoxia/reoxygenation of the intervillous space are responsible of placental dysfunction. Trophoblastic factors are released in the maternal circulation and are responsible of the maternal endothelial dysfunction that characterize preeclampsia. Among those factors, the PlGF/sFlt-1 couple plays a major pathophysiologic role.