foreign

clampsia is a disorder that only happens

in pregnant women
and it happens after 20 weeks gestation
and in some cases develops up to six
weeks after delivery
preeclampsia causes new onset
hypertension in proteinuria which is a
marker of kidney damage and can also
cause damage to other organs like the
brain and the liver
there can be a wide range of symptoms
for some women there might be no
symptoms or only mild ones whereas for
others it can turn into a
life-threatening illness
if a woman with pre-eclampsia develops
seizures she's then said to have
eclampsia
Risk factors
preeclampsia tends to happen more often
during a first pregnancy in pregnancies
with multiple gestations or in mothers
35 years or older
other risk factors include having
hypertension diabetes obesity or a
family history of preeclampsia
all right but why do these changes
Causes
happen in preeclampsia and eclampsia
well the exact cause is unclear but a
key pathophysiologic feature is the
development of an abnormal placenta
normally during pregnancy the spiral
arteries dilate to 5 to 10 times their
normal size and develop into large utero
placental arteries that can deliver
large quantities of blood to the
developing fetus
in preeclampsia these utero placental
arteries become fibrous causing them to
narrow which means less blood gets the
placenta
a poorly profused placenta can lead to
intrauterine growth restriction and even
fetal death in severe cases
this hypoperfuse placenta starts

releasing pro-inflammatory proteins

these then get into the mother's
circulation and cause the endothelial
cells that line her blood vessels to
become dysfunctional
endothelial cell dysfunction causes
vasoconstriction or narrowing of the
blood vessels and also affects the
kidneys in a way that makes them retain
more salt both of which result in
hypertension
Hypertension
when diagnosing preeclampsia
hypertension is defined as a systolic
blood pressure of 140 millimeters of
mercury or greater or diastolic blood
pressure of 90 millimeters of mercury or
greater
in severe preeclampsia systolic blood
pressure can be 160 millimeters of
mercury or greater and diastolic
pressure can be 110 millimeters of
mercury or greater
these extreme blood pressures can lead
to a hemorrhagic stroke or placental
abruption which is when the placenta
detaches prematurely from the uterine
wall
Kidneys
now there can also be local areas of
vasospasm which means that less blood
might reach certain parts of the body
for example reduced blood flow to the
kidneys which are particularly
susceptible can cause glomerular damage
leading to oliguria which is abnormally
low amounts of urine as well as protein
urea normally the glomeruli the kidney do a
pretty good job of preventing protein
from spilling into the urine so
proteinuria can be a sign of glomerular
damage and is classically seen in
preeclampsia
reduce blood flow to the retina can
cause blurred vision the sensation of
seeing flashing lights and the
development of a scotoma
escatoma is when a small part of the
visual field has slightly worse visual
Acuity which is kind of like having a
blurry spot on your computer monitor
reduce blood flow to the liver can cause
severe liver injury and swelling which
can cause an elevation in liver enzymes
and stretches out the capsule around the
liver
stretching of the liver capsule
typically causes right upper quadrant
pain or epigastric pain which is one of
the Cardinal symptoms of severe
preeclampsia
endothelial cell injury also leads to
the formation of lots of tiny thrombi in
the microvasculature which is a process
that uses up massive amounts of
platelets
having all these tiny blood clots in the
blood is a little like having dozens of
Boulders in the middle of a fast-moving
River
it becomes treacherous for red blood
cells to navigate through and before
long they slam up against a clot and get
destroyed which is a process called
hemolysis
together these make up the help syndrome
H for hemolysis El for elevated liver
enzymes an LP for low platelets
help syndrome develops in about 10 to 20
percent of women with severe
preeclampsia or eclampsia
endothelial injury
finally endothelial injury increases
vascular permeability which is when
water is allowed to slip out of blood
vessels between neighboring endothelial
cells and get into the tissues
because there's also a loss of protein
from the blood due to the proteinuria
even more fluid moves from the blood
vessels into the tissues
and this causes generalized edema which
is often seen in the legs the face and
the hands pulmonary edema which can
cause cough and shortness of breath and
cerebral edema which can cause headache
confusion and seizures
and these seizures I would Define the
onset of eclampsia
because all the problems of preeclampsia
treatment
5:13
and eclampsia stem from placental
5:15
dysfunction the ultimate treatment is
5:17
delivery of the fetus and placenta
5:20
the decision to induce delivery depends
5:22
heavily on the gestational age of the
5:24
fetus as well as the severity of the
5:26
disease and how it's affecting both
5:27
maternal and Fetal health
5:30
if the onset of symptoms comes after
5:31
delivery then the goal is to manage the
5:34
symptoms which slowly subside on their
5:36
own
5:37
additional measures are aimed at
5:39
managing any end organ damage by
5:41
offering supplemental oxygen as well as
5:43
medication to manage seizures and other
5:45
complications like stroke or placental
5:47
abruption
5:49
all right as a quick recap preeclampsia
5:51
is a disorder that happens after 20
5:53
weeks gestation and up to six weeks
5:56
following delivery
5:57
it's defined by a new onset of
5:59
hypertension and proteinuria but can
6:01
affect a lot of organs particularly the
6:04
kidneys eyes liver and brain
6:08
eclampsia is diagnosed when a patient
6:10
with pre-eclampsia develops seizures