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Pre-Eclampsia

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Pre-eclampsia and Eclampsia

Topics This afternoon, I’l be discussing the obstetrical problems of pre-eclampsia and eclampsia. Hypertensive Issues During Pregnancy… View Text Here Free Links: OBGYN-10 OBGYN-101 Gray Haired Note Pre-eclampsia and Eclampsia, in the Global Library of Women’s Medicin Chronic Hypertension in Pregnancy, in the Global Library of Women’s Medicin Brookside Associates Medical Education Division  
Mike Hughey, MD
about 9 years ago
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Hypertension in pregnancy & Pre-eclampsia

A comprehensive summary on the effects of elevated blood pressure during pregnancy and pre-eclampsia.  
Hannah Oliver
over 7 years ago
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227

Pre-Eclampsia and Hypertensive Disease in Pregnancy

Based on presentation I gave as a medical student doing Obstetrics and Gynaecology in 2009. More details pertaining to each slide are in the Notes sections.  
Tariq Shafi
over 6 years ago
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Hypertension in Pregnancy

Summary of NICE guidelines issued in August 2010 on "Hypertensive disorders during pregnancy" with a particular focus on pre-eclampsia and anaesthetic considerations.  
Zara Edwards
almost 6 years ago
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Pre-eclampsia and Eclampsia

Pre-eclampsia and eclampsia are different stages of the same condition. Pre-eclampsia can result in eclampsia at any time. Eclampsia is immediately life-threatening and often symptomatic.   Pre-eclampsia is a condition characterised by increased blood pressure, proteinuria and often oedema during pregnancy. It is typically asymptomatic, and occurs after 20 weeks, although it rarely presents before 32 weeks – but when it does, it is associated with a worse prognosis.  
almostadoctor.com - free medical student revision notes
over 5 years ago
Www.bmj
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Chronic hypertension during pregnancy

Hypertensive disorders of pregnancy are among the leading causes of fetal and maternal morbidity and mortality. Worldwide, 50 000 to 60 000 women die from pre-eclampsia each year, corresponding to 12% of all maternal deaths.1 2  
bmj.com
over 5 years ago
Www.bmj
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Chronic hypertension during pregnancy | The BMJ

Hypertensive disorders of pregnancy are among the leading causes of fetal and maternal morbidity and mortality. Worldwide, 50 000 to 60 000 women die from pre-eclampsia each year, corresponding to 12% of all maternal deaths. - currently located behind a paywall. Your institution may have access through Athens/Elservier or similar.  
bmj.com
over 5 years ago
Www.bmj
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Chronic hypertension during pregnancy

Hypertensive disorders of pregnancy are among the leading causes of fetal and maternal morbidity and mortality. Worldwide, 50 000 to 60 000 women die from pre-eclampsia each year, corresponding to 12% of all maternal deaths.1 2  
bmj.com
over 5 years ago
Www.bmj
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Chronic hypertension during pregnancy

Hypertensive disorders of pregnancy are among the leading causes of fetal and maternal morbidity and mortality. Worldwide, 50 000 to 60 000 women die from pre-eclampsia each year, corresponding to 12% of all maternal deaths.1 2  
www.bmj.com
over 5 years ago
Www.bmj
2
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Diagnosis and management of subclinical hypothyroidism in pregnancy

In prospective studies, the prevalence of undiagnosed subclinical hypothyroidism in pregnant women ranges from 3% to 15%. Subclinical hypothyroidism is associated with multiple adverse outcomes in the mother and fetus, including spontaneous abortion, pre-eclampsia, gestational hypertension, gestational diabetes, preterm delivery, and decreased IQ in the offspring. Only two prospective studies have evaluated the impact of levothyroxine therapy in pregnant women with subclinical hypothyroidism, and the results were mixed. Subclinical hypothyroidism is defined as raised thyrotropin combined with a normal serum free thyroxine level. The normal range of thyrotropin varies according to geographic region and ethnic background. In the absence of local normative data, the recommended upper limit of thyrotropin in the first trimester of pregnancy is 2.5 mIU/L, and 3.0 mIU/L in the second and third trimester. The thyroid gland needs to produce 50% more thyroid hormone during pregnancy to maintain a euthyroid state. Consequently, most women on levothyroxine therapy before pregnancy require an increase in dose when pregnant to maintain euthyroidism. Ongoing prospective trials that are evaluating the impact of levothyroxine therapy on adverse outcomes in the mother and fetus in women with subclinical hypothyroidism will provide crucial data on the role of thyroid hormone replacement in pregnancy.  
bmj.com
about 5 years ago
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A Guide to Preeclampsia: Hand-drawn Tutorial

All credit for this video goes to professor May. If there is anything on it that sounds inspirational, it most likely came from her.  
YouTube
almost 5 years ago
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LWW: Case Of The Month - April 2013

This month’s case is by David R Bell PhD, co-author of Medical Physiology: Principles for Clinical Medicine, 3e (ISBN: 9781451110395) For more information, or to purchase your copy, visit: http://tiny.cc/Rhoades4e, with 15% off using the discount code: MEDUCATION. The case below is followed by a quiz question, allowing you a choice of diagnoses. Select the one letter section that best describes the patient’s condition. The Case A 28-year old woman has an unremarkable pregnancy through her first 28 weeks of gestation, with normal weight gain and no serious complications. She has no previous history of diabetes, hypertension of other systemic disease before or during her current pregnancy. During her 30-week checkup, her blood pressure measures 128/85, and she complains about feeling slightly more “bloated” than usual with swelling in her legs that seems to get more uncomfortable as the day goes on. Her obsterician recommends that she get more bed rest, stay off her feet as much as possible and return for evaluation in one week. At the one-week follow-up, the patient presents with noticable”puffiness” in her face, and a blood pressure of 145/95. She complains she has been developing headaches, sporadic blurred vision, right-sided discomfort and some shortness of breath. She has gained more than 10 lb (4.5kg) in the past week. A urinalysis on the patient revelas no glucose but a 3+ reading for protein. Her obstetrician decides to admit her immediately to a local tertiary care hospital for further evaluation. Over the next 24 hours, the patient’s urine output is recorded as 500mL and contains 6.8 grams of protein. Her plasma albumin level is 3.1 g/dl, hemacrit 48%, indirect bilirubin 1.5mg/dl and blood platelets=77000/uL, respectively. Her blood pressure is now 190/100. It is decided to try to deliver the foetus. The expelled placenta is small and shows signs of widespread ischmic damage. Within a week of delivery, the mother’s blood pressure returns to normal, and her oedema subsides. One month later, the mother shows no ill effects of thos later-term syndrome. Question What is the clinical diagnosis of this patient’s condition and its underlying pathophysiology? A. Gestational Hypertension B. Preeclampsia C. Gestational Diabetes D. Compression of the Inferior Vena Cava Answer The correct answer is "B. Preeclampsia". The patient’s symptoms and laboratory findings are consistent with a diagnosis of Preeclampsia, which is a condition occurring in some pregnancies that causes life-threatening organ and whole body regulatory malfunctions. The patient’s negative urine glucose is inconsistent with gestational diabetes. Gestational hypertension or vena caval compression cannot explain all of the patient findings. The patient has three major abnormal findings- generalised oedema, hypertension and proteinuria which are all common in preeclampsia. Although sequalae of a normal pregnancy can include water and salt retention, bloating, modest hypertension and leg swelling (secondary to capillary fluid loss from increased lower limb capillary hydrostatic pressure due to compression of the inferior vena cava by the growing foetus/uterus), oedema in the head and upper extremities, a rapid 10 pound weight gain and shortness of breath suggests a generalized and serious oedematous state. The patient did not have hypertension before or within 20 weeks gestation (primary hypertension) and did not develop hypertension after the 20th week of pregnancy with no other abnormal findings (gestational hypertension). Hypertension with proteinuria occurring beyond the 20th week of pregnancy however is a hallmark of preeclampsia. In addition, the patient has hemolysis (elevated bilirubin and LDH levels), elevated liver enzyme levels and thrombocytopenia. This is called the HELLP syndrome (HELLP = Hemolysis, Elevated Liver enzymes and Low Platelets.), and is considered evidence of serious patient deterioration in preeclampsia. A urine output of 500 ml in 24 hours is 1/2 to 1/4 of normal output in a hydrated female and indicates renal insufficiency. Protein should never be found in the urine and indicates loss of capillaries integrity in glomeruli which normally are not permeable to proteins. The patient has substantial 24 urine protein loss and hypoalbuminemia. However, generally plasma albumin levels must drop below 2.5 gm/dl to decrease plasma oncotic pressure enough to cause general oedema. The patient’s total urinary protein loss was insufficient in this regard. Capillary hyperpermeability occurs with preeclampsia and, along with hypertension, could facilitate capillary water efflux and generalized oedema. However myogenic constriction of pre-capillary arterioles could reduce the effect of high blood pressure on capillary water efflux. An early increase in hematocrit in this patient suggests hemoconcentration which could be caused by capillary fluid loss but the patient’s value of 48 is unremarkable and of little diagnostic value because increased hematocrit occurs in both preeclampsia and normal pregnancy. PGI2, PGE2 and NO, produced during normal pregnancy, cause vasorelaxation and luminal expansion of uterine arteries, which supports placental blood flow and development. Current theory suggests that over production of endothelin, thromboxane and oxygen radicals in preeclampsia antagonize vasorelaxation while stimulating platelet aggregation, microthrombi formation and endothelial destruction. These could cause oedema, hypertension, renal/hepatic deterioration and placental ischemia with release of vasotoxic factors. The patient’s right-sided pain is consistent with liver pathology (secondary to hepatic DIC or oedematous distention). Severe hypertension in preeclampsia can lead to maternal end organ damage, stroke, and death. Oedematous distension of the liver can cause hepatic rupture and internal hemorrhagic shock. Having this patient carry the baby to term markedly risks the life of the mother and is not considered current acceptable clinical practice. Delivery of the foetus and termination of the pregnancy is the only certain way to end preeclampsia. Read more This case is by David R Bell PhD, co-author of Medical Physiology: Principles for Clinical Medicine, 3e (ISBN: 9781451110395) For more information, or to purchase your copy, visit: http://tiny.cc/Rhoades4e. Save 15% (and get free P&P) on this, and a whole host of other LWW titles at (lww.co.uk)[http://lww.co.uk] when you use the code MEDUCATION when you check out! About LWW/ Wolters Kluwer Health Lippincott Williams and Wilkins (LWW) is a leading publisher of high-quality content for students and practitioners in medical and related fields. Their text and review products, eBooks, mobile apps and online solutions support students, educators, and instiutions throughout the professional’s career. LWW are proud to partner with Meducation.  
Lippincott Williams & Wilkins
over 6 years ago
Www.bmj
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Is early induction or expectant management more beneficial in women with late preterm pre-eclampsia?

This is one of a series of occasional articles that highlight areas of practice where management lacks convincing supporting evidence. The series adviser is David Tovey, editor in chief, the Cochrane Library. This paper is based on a research priority identified and commissioned by the National Institute for Health Research’s Health Technology Assessment programme on an important clinical uncertainty. To suggest a topic for this series, please email us at uncertainties@bmj.com.  
feeds.bmj.com
over 4 years ago
Www.bmj
0
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Is early induction or expectant management more beneficial in women with late preterm pre-eclampsia?

This is one of a series of occasional articles that highlight areas of practice where management lacks convincing supporting evidence. The series adviser is David Tovey, editor in chief, the Cochrane Library. This paper is based on a research priority identified and commissioned by the National Institute for Health Research’s Health Technology Assessment programme on an important clinical uncertainty. To suggest a topic for this series, please email us at uncertainties@bmj.com.  
feeds.bmj.com
over 4 years ago
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Potential cause of preeclampsia may share links with disorders such as Alzheimer's

New research has identified a potential cause of and a better diagnostic method for preeclampsia, one of the most deadly and poorly understood pregnancy-related conditions in the world.  
medicalnewstoday.com
over 4 years ago
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New transitional stem cells discovered - may help advance research on pre-eclampsia

Pre-eclampsia is a disease that affects 5 to 8 percent of pregnancies in America.  
medicalnewstoday.com
over 4 years ago
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Pre-Eclampsia Management

 
thewomens.r.worldssl.net
over 4 years ago
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Briefs: Migraine management meets magnesium

Migraines are a common sight during any shift in the ED. I have written about them before, and the benefits of antiemetics and depakote are reasonably well documented. A treatment for refractory headaches that seems to be gaining favor recently is IV magnesium. You may be familiar with Mag and its use in asthma exacerbation, or (gasp) preeclampsia – but emerging evidence suggests that magnesium may help with migraines as well.  
pemcincinnati.com
over 4 years ago
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Preeclampsia Pathophysiology

What happens in the pregnant woman with preeclampsia  
youtube.com
over 4 years ago
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Bedside Obstetrics & Gynecology

The second edition of Bedside Obstetrics & Gynecology brings postgraduate trainees fully up to date with the most recent advances in the field. The first section covers obstetrics, discussing normal and abnormal presentations (such as normal labour versus breech presentation), complications in pregnancy (including early pregnancy bleeding and ante- and postpartum haemorrhage), and medical disorders related to pregnancy (such as preeclampsia and gestational diabetes). Section two covers numerous gynaecological abnormalities. This new edition has been fully revised but continues to emphasise the importance of history taking and clinical examination. New chapters have been added to cover topics such as preterm pregnancy, post-dated pregnancy and intrauterine death, bleeding due to miscarriage, menopause and contraception. Nearly 1100 images, illustrations and tables enhance learning, and each chapter includes questions and answers related to case studies. Key points Fully revised, new edition providing recent advances in obstetrics and gynaecology Many new chapters added Includes 1100 images, illustrations and tables Previous edition published in 2010  
books.google.co.uk
over 4 years ago