{"id":2614,"date":"2020-08-13T16:24:04","date_gmt":"2020-08-13T16:24:04","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=212"},"modified":"2021-05-09T20:38:48","modified_gmt":"2021-05-09T20:38:48","slug":"18-preeclampsia-eclampsia","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/pa_obgyn\/overview\/18-preeclampsia-eclampsia\/","title":{"rendered":"18. Preeclampsia-Eclampsia"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/tlD-wDEozfM\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration = 7:05<\/p>\n<input type='hidden' bg_collapse_expand='69e9b59ee25687090225719' value='69e9b59ee25687090225719'><input type='hidden' id='bg-show-more-text-69e9b59ee25687090225719' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9b59ee25687090225719' value='Hide Transcript'><button id='bg-showmore-action-69e9b59ee25687090225719' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9b59ee25687090225719' ><\/p>\n<p>00:00<br \/>\nAPGO educational topic number 18<br \/>\n00:02<br \/>\npreeclampsia preeclampsia is a<br \/>\n00:05<br \/>\nhypertensive disorder of pregnancy<br \/>\n00:07<br \/>\ndiagnosed after 20 weeks gestation it<br \/>\n00:10<br \/>\nclamps he has new onset seizures in a<br \/>\n00:12<br \/>\nwoman with preeclampsia hypertensive<br \/>\n00:15<br \/>\ndisorders of pregnancy complicate up to<br \/>\n00:17<br \/>\n10 percent of pregnancies worldwide and<br \/>\n00:20<br \/>\nthe incidence of preeclampsia in the<br \/>\n00:22<br \/>\nUnited States has increased by 25<br \/>\n00:24<br \/>\npercent in the last two decades<br \/>\n00:26<br \/>\npreeclampsia is a leading cause of<br \/>\n00:29<br \/>\nmaternal and perinatal morbidity and<br \/>\n00:30<br \/>\nmortality with an estimated 50,000 to<br \/>\n00:33<br \/>\n60,000 related deaths per year worldwide<br \/>\n00:36<br \/>\nthe objectives of this video are to<br \/>\n00:39<br \/>\ndefine the types of hypertension in<br \/>\n00:41<br \/>\npregnancy describe the pathophysiology<br \/>\n00:43<br \/>\nof preeclampsia list the risk factors<br \/>\n00:46<br \/>\nfor preeclampsia and describe the<br \/>\n00:49<br \/>\ndiagnosis management and complications<br \/>\n00:51<br \/>\nof preeclampsia the four types of<br \/>\n00:54<br \/>\nhypertension and pregnancy are<br \/>\n00:56<br \/>\npreeclampsia chronic hypertension<br \/>\n00:58<br \/>\nchronic hypertension with superimposed<br \/>\n01:01<br \/>\npreeclampsia and gestational<br \/>\n01:03<br \/>\nhypertension preeclampsia is defined as<br \/>\n01:06<br \/>\nnew onset hypertension after 20 weeks<br \/>\n01:09<br \/>\ngestation with proteinuria or and organ<br \/>\n01:12<br \/>\ndysfunction chronic hypertension<br \/>\n01:14<br \/>\npredates the pregnancy or is diagnosed<br \/>\n01:17<br \/>\nprior to 20 weeks gestation superimposed<br \/>\n01:20<br \/>\npreeclampsia involved signs and symptoms<br \/>\n01:22<br \/>\nof the disorder along with chronic<br \/>\n01:24<br \/>\nhypertension gestational hypertension is<br \/>\n01:27<br \/>\nan elevated blood pressure diagnosed<br \/>\n01:29<br \/>\nafter 20 weeks without the systemic<br \/>\n01:32<br \/>\nfindings of preeclampsia during normal<br \/>\n01:34<br \/>\npregnancy fetal e derived saito<br \/>\n01:37<br \/>\ntrophoblasts invade the maternal uterine<br \/>\n01:39<br \/>\nspiral arteries and replace their<br \/>\n01:41<br \/>\nendothelium converting the high<br \/>\n01:43<br \/>\nresistance small diameter vessels into<br \/>\n01:46<br \/>\nhigh capacitance low resistance vessels<br \/>\n01:48<br \/>\nto ensure adequate delivery of maternal<br \/>\n01:51<br \/>\nblood to the placenta as you can see in<br \/>\n01:54<br \/>\nthis healthy placenta the spiral artery<br \/>\n01:56<br \/>\nis lined with saito trophoblasts making<br \/>\n01:58<br \/>\nit nice and wide to ensure a lot of<br \/>\n02:00<br \/>\nblood flow in a woman destined to<br \/>\n02:02<br \/>\ndevelop preeclampsia later in her<br \/>\n02:04<br \/>\npregnancy this process does not occur<br \/>\n02:07<br \/>\ncorrectly and the UH th\u00e9r\u00e8se remain<br \/>\n02:09<br \/>\nnarrow decreasing blood flow to the<br \/>\n02:11<br \/>\nplacenta and causing hypoxemia<br \/>\n02:13<br \/>\nstudies have shown abnormalities in<br \/>\n02:15<br \/>\nvascular genic and angiogenic signaling<br \/>\n02:18<br \/>\npathways but the exact mechanism for<br \/>\n02:20<br \/>\nthis abnormal trophoblast invasion<br \/>\n02:22<br \/>\nremains unclear the biggest risk factor<br \/>\n02:25<br \/>\nfor preeclampsia is history of<br \/>\n02:27<br \/>\npreeclampsia in a previous pregnancy<br \/>\n02:28<br \/>\nwhich increases the risk Sevenfold<br \/>\n02:32<br \/>\npreeclampsia on a first-degree relative<br \/>\n02:34<br \/>\nPrime at parity and multiple gestation<br \/>\n02:36<br \/>\nare also important risk factors to<br \/>\n02:38<br \/>\nconsider the mother&#8217;s past medical<br \/>\n02:41<br \/>\nhistory should also be reviewed for risk<br \/>\n02:43<br \/>\nfactors including pre-existing<br \/>\n02:45<br \/>\nhypertension renal disease<br \/>\n02:47<br \/>\nhypercoagulability diabetes obesity<br \/>\n02:50<br \/>\nlupus and age greater than 40 years<br \/>\n02:53<br \/>\nnonetheless<br \/>\n02:54<br \/>\nit is important to note that most cases<br \/>\n02:56<br \/>\nof preeclampsia occur in healthy and<br \/>\n02:59<br \/>\nnulliparous women with no other obvious<br \/>\n03:01<br \/>\nrisks the diagnosis of preeclampsia can<br \/>\n03:04<br \/>\nonly be made with a combination of<br \/>\n03:06<br \/>\nelevated blood pressure and proteinuria<br \/>\n03:08<br \/>\nor systemic findings the blood pressure<br \/>\n03:12<br \/>\nmust be greater than 140 over 90 on two<br \/>\n03:15<br \/>\noccasions at least four hours apart<br \/>\n03:17<br \/>\nafter 20 weeks gestation proteinuria is<br \/>\n03:20<br \/>\ndefined as greater than 300 milligrams<br \/>\n03:22<br \/>\nper 24-hour urine collection a protein<br \/>\n03:25<br \/>\ncreatinine ratio greater than 0.3 or a<br \/>\n03:28<br \/>\ndipstick reading of 1 plus in the<br \/>\n03:31<br \/>\nabsence of protein Oriya severe features<br \/>\n03:34<br \/>\nincluding a platelet count less than a<br \/>\n03:36<br \/>\nhundred thousand serum creatinine<br \/>\n03:38<br \/>\ngreater than 1.1 elevated liver<br \/>\n03:41<br \/>\ntransaminases 2 twice normal<br \/>\n03:42<br \/>\nconcentration pulmonary edema or new<br \/>\n03:45<br \/>\nonset cerebral or visual symptoms can<br \/>\n03:48<br \/>\nalso make the diagnosis the management<br \/>\n03:51<br \/>\nof patients with preeclampsia involves<br \/>\n03:53<br \/>\nweighing the risks of maturity of the<br \/>\n03:55<br \/>\nfetus with the risks of maternal<br \/>\n03:56<br \/>\nmorbidity of worsening disease<br \/>\n03:58<br \/>\nprogression preeclampsia is managed by<br \/>\n04:01<br \/>\nclose surveillance until 37 weeks<br \/>\n04:03<br \/>\nestimated gestational age this involves<br \/>\n04:06<br \/>\nmonitoring the mother carefully with<br \/>\n04:08<br \/>\nfrequent blood pressure monitoring serum<br \/>\n04:10<br \/>\nand urine evaluation to watch for<br \/>\n04:12<br \/>\ndisease progression antihypertensives<br \/>\n04:15<br \/>\nsuch as hydralazine labetalol or<br \/>\n04:17<br \/>\nnifedipine should only be started if the<br \/>\n04:20<br \/>\nblood pressure exceeds one 60 systolic<br \/>\n04:22<br \/>\nor 110 diastolic ultrasound for fetal<br \/>\n04:26<br \/>\ngrowth should be<br \/>\n04:27<br \/>\noffered and if evidence of restriction<br \/>\n04:29<br \/>\nis found fetal placental assessment<br \/>\n04:31<br \/>\nincluding umbilical artery Doppler<br \/>\n04:33<br \/>\nvelocimetry is recommended the fetus<br \/>\n04:37<br \/>\nshould be monitored with twice weekly<br \/>\n04:39<br \/>\nnon stress tests as well betamethasone<br \/>\n04:42<br \/>\nshould be administered for fetal lung<br \/>\n04:44<br \/>\nmaturity prior to 34 weeks estimated<br \/>\n04:46<br \/>\ngestational age and delivery should be<br \/>\n04:49<br \/>\ninitiated at 37 weeks once the diagnosis<br \/>\n04:53<br \/>\nof preeclampsia with severe features is<br \/>\n04:55<br \/>\nmade delivery should be initiated after<br \/>\n04:57<br \/>\n34 weeks if there is concern for rapid<br \/>\n05:00<br \/>\ndisease progression then delivery will<br \/>\n05:02<br \/>\nneed to be initiated even prior to 34<br \/>\n05:05<br \/>\nweeks<br \/>\n05:06<br \/>\nmagnesium sulfate is administered for<br \/>\n05:08<br \/>\nseizure prophylaxis the mode of delivery<br \/>\n05:11<br \/>\nshould be decided by fetal presentation<br \/>\n05:13<br \/>\ncervical status fetal gestational age<br \/>\n05:16<br \/>\nand maternal fetal condition eclamptic<br \/>\n05:19<br \/>\nseizure czar scary occurrences and it is<br \/>\n05:22<br \/>\ncritically important to stabilize the<br \/>\n05:24<br \/>\nmom first for this will stabilise the<br \/>\n05:26<br \/>\nfetus women with the clamp Dixie&#8217;s<br \/>\n05:29<br \/>\nshould be treated with parenteral<br \/>\n05:31<br \/>\nmagnesium mode of delivery is again<br \/>\n05:34<br \/>\ndecided by maternal fetal condition and<br \/>\n05:36<br \/>\nvaginal delivery can often be attempted<br \/>\n05:38<br \/>\nwith labor induction even in the case of<br \/>\n05:40<br \/>\neclamptic seizure x&#8217; preeclampsia is a<br \/>\n05:44<br \/>\nprogressive disease the hypertension may<br \/>\n05:46<br \/>\nworsen or signs of end organ dysfunction<br \/>\n05:48<br \/>\nmay manifest over time including<br \/>\n05:51<br \/>\neclampsia help syndrome placental<br \/>\n05:54<br \/>\nabruption stroke liver or kidney injury<br \/>\n05:57<br \/>\nand a RDS ecliptics seizures may occur<br \/>\n06:02<br \/>\nbefore during or after labor and result<br \/>\n06:05<br \/>\nin high perinatal and maternal morbidity<br \/>\n06:07<br \/>\nand mortality help stands for hemolysis<br \/>\n06:10<br \/>\nelevated liver enzymes and low platelets<br \/>\n06:13<br \/>\nis usually diagnosed in the third<br \/>\n06:15<br \/>\ntrimester of a woman with preeclampsia<br \/>\n06:17<br \/>\nor gestational hypertension with<br \/>\n06:20<br \/>\nsymptoms of epigastric pain malaise<br \/>\n06:22<br \/>\nnausea and\/or headaches and can progress<br \/>\n06:26<br \/>\nto di c all of these issues are solved<br \/>\n06:29<br \/>\nby delivery of the baby and placenta<br \/>\n06:32<br \/>\nfetal complications include fetal growth<br \/>\n06:35<br \/>\nrestriction and the issues associated<br \/>\n06:37<br \/>\nwith increased risk of preterm delivery<br \/>\n06:40<br \/>\nand<br \/>\n06:40<br \/>\nSentell abruption this concludes the<br \/>\n06:43<br \/>\naapko video on preeclampsia we have<br \/>\n06:46<br \/>\nreviewed the definition clinical<br \/>\n06:48<br \/>\nfeatures and management techniques of<br \/>\n06:50<br \/>\nthis common condition in pregnant women<\/p>\n<p><\/div>\n<hr>\n","protected":false},"excerpt":{"rendered":"<p>Duration = 7:05<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":46,"menu_order":18,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-2614","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/2614","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/comments?post=2614"}],"version-history":[{"count":1,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/2614\/revisions"}],"predecessor-version":[{"id":2822,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/2614\/revisions\/2822"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/46"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/media?parent=2614"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}