Obstetrics Eclampsia The medical Education



in this lecture we're going to discuss hypertension in an obstetrics patient the major thing you have to do is differentiate between chronic transient hypertension that is the hypertension that comes before 20 weeks and the hypertension that sets in after 20 weeks because the hypertension that begins before 20 weeks is a chronic medical condition the hypertension that begins after 20 weeks of gestation is likely to be preeclampsia or eclampsia that is fetal parts it released into the bloodstream leading to vasospasm and thrombosis a medical emergency so we're going to compare all forms of hypertension in the obstetrics patient against one another we're going to use a table it's going to compare the disease blood pressures timing of onset what's going on with the urinalysis what's going on with symptoms and what you need to do to treat first we're going to begin with transient hypertension because most OB patients are younger they shouldn't have full-blown chronic hypertension and it is possible that you have a patient who has one high blood pressure reading nothing else so in order to be diagnosed with hypertension the blood pressure reading has to be greater than 140 / greater than 90 remember to be diagnosed with hypertension you have to have two separate high blood pressure readings on two separate occasions because it is a medical disease the timing is going to be a non sustained elevation the blood pressure non sustained because it's transient that occurs before 20 weeks gestation there hasn't been enough time to cause any damage to the kidneys so there's going to be nothing on your analysis and being normal hypertension the patient will feel nothing the only thing you have to do for this patient is keep a log see if she develops full hypertension if you compare that now to chronic hypertension this is what most medical doctors deal with all the time someone who comes in has an elevated blood pressure that means their blood pressure is greater than 140 over 80 I'm sorry greater than 140 / greater than 90 and they had hypertension before they got pregnant and they still have hypertension now that is they have a sustained blood pressure elevation that occurs before 20 weeks of gestation now in a real hypertensive patient over time they can develop hypertensive nephropathy and other problems in the body like myocardial infarctions but for the sake of comparing chronic and transit hypertension against the eclampsia diseases let's just assume she only has isolated hypertension which means that there this will show nothing and being hypertension she won't feel anything the only difference between normal chronic hypertension as a medical disease and treating it in the obstetrics patient is that you have to use medications that are different than the normal patient we talked about this in medical disease of OB lecture alpha methyldopa hydralazine and metoprolol are all Class C but they don't hurt baby and they can be used to control mom's blood pressure this is very important because if she has chronic hypertension begins to develop preeclampsia and she's not well controlled under medications you won't know if the elevation in the blood pressure is preeclampsia or just worsening of her hypertension disease and at this point I want you to put a big line through the chart because above this line is chronic hypertension not associated with obstetric disease and below this line marks the medical emergency of the range of diseases include preeclampsia and eclampsia so mild preeclampsia actually all preeclampsia and eclampsia is a product of the central contents being released and as that happens vasoconstriction occurs the vado constriction causes hypertension and also causes thrombosis there boces causes clots mild pre e that is mild preeclampsia is going to be defined by an elevation in the blood pressure greater than 140 or greater than 90 that is sustained but because it is the obstetric disease it will occur after 20 weeks of gestation because it's only mild urinalysis is going to have only a little bit of protein less than 300 milligrams per deciliter and she won't have any of the alarm symptoms what you do about mild pre II is dependent on gestational age was right now mild mild free mom's not in danger she set up to being a dangerous spot but right now the only risk is too baby so if baby is at term mag and deliver and you're going to see magnesium as the treatment for all of these conditions if ever you suspect preeclampsia or eclampsia you're going to use magnesium bag and delivery of that term into less than 36 weeks well now you have to weigh the risk benefit so you're probably going to let baby develop but if she shows any sign of clinical worsening mag and deliver and what are those clinical signs of worsening severe pre e is going to see a worsening of all of the conditions you're going to see a worsening of the blood pressure greater than 160 or greater than 110 it is going to also be sustained after 20 weeks which is the definition of our obstetrics disease but now rather than simple micropro tenaria you're going to have greater than 5 grams per deciliter a protein full-on nephrotic syndrome and the patient is going to have the alarm symptoms I'll talk about alarm symptoms in a minute she only needs to have one alarm symptom or blood pressure and protein elevations to be diagnosed with severe PP severe pre e at this point it does not matter what's happening to baby baby doesn't matter mom is about to seize mom is about to die so you have to get baby out you're going to give her magnesium to prevent seizures and you're going to deliver often by c-section you can induce with pitocin the mom is right around the corner from death so you're going to have to probably do a c-section to get baby out once baby is out the clamp see symptoms will stop now if mom begins to cease and has not had history of epilepsy it does not matter what her blood pressure is when the blood pressure started to go up what her urine shows if she is seizing she is eclamptic and she is actively dying and so is baby this is a no-brainer mag and deliver this will be by c-section usually a crash and because it is tested against all these other diseases I want to talk about hellp syndrome as it presents just like eclampsia hellp syndrome is hemolysis elevated liver enzymes and low platelets the treatment for help syndrome is mag and deliver gently by c-section so we never mentioned once amala sis elevated liver or low platelets so why are we talking about help syndrome relative to a clamp SIA severe PE and mild pre e let's talk about some of the symptoms of these diseases and show how they will overlap let's talk about those alarm symptoms first you may be checking routine labs and if you see hemo concentration especially in the presence of edema that is the sign of third spacing remember this patient is losing tons of protein through her urine protein holds your fluid in your blood vessels so if all of the fluid that was in her blood ends up in her interstitial all of a sudden it looks like she's got a higher hemoglobin remember a normal hemoglobin for a pregnant female as 10am adequate is 30 if she goes back towards normal then it's a sign of hema concentration and especially in the setting of edema it's a product of that nephrotic range proteinuria she may have preeclampsia epigastric abdominal pain is often written off as after all pregnant women often have GERD which will present as an epigastric abdominal pain but in help syndrome for the swelling of the liver which is why you get some elevated liver enzymes which is also true in preeclampsia and eclampsia because of that vasoconstriction and thrombosis what you'll get is Gleason's capsule stretching do not write off epigastric or right upper quadrant abdominal pain as no big deal it could be the sign of Gleason's capsule stretching and they will happy having help syndrome or preeclampsia worst of all if people begin to have headaches or vision changes this is a sign of vasospasm the fundamental pathology of preeclampsia and so if you are suspecting either pre e or hellp syndrome based on some of the overlapping symptoms what you're going to do is go ahead and get some labs you need CBC and lft and a UA and based on the abnormalities here anemia thrombocytopenia and elevated liver enzymes you have helped syndrome chemo concentration elevated liver enzymes and prone area now you're worried about preeclampsia and obviously as we already discussed if anyone is seizing presume that they have full-on eclampsia so in this lecture we compared hypertensive disease and obstetrics patient the thing you must be able to do is separate chronic hypertension which is a medical disease that occurs before she gets pregnant pregnant women can be hypertensive and stay hypertensive through pregnancy versus the obstetrics complication of preeclampsia and eclampsia if they develop elevated blood pressure after 20 weeks of gestation you must assume their preeclamptic any closer monitoring always being ready to pull the trigger on magnesium to prevent seizures and emergent delivery to prevent eclampsia that is obstetric complications hypertension and eclampsia we make these videos for free and we need your help please donate because without your donations we can't make any more videos please donate

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