Thank you for this succint description of preeclampsia and eclampsia. I has HELLP syndrome at 22 weeks and the doctors delivered my baby but they refused to save him because he was 22 weeks and had IUGR. They 100 % believed he would not survive. This happened three weeks ago and we had his funeral service yesterday. I have been tying to understand why this happened when I had no history of hypertension before pregnancy and not until my checkup at 22 weeks. The placenta was never studied so I don’t know if the blood vessels were abnormal. And I was not tested for any placental factors. But I had every symptom of preeclampsia you described. I had a BMI of 29 before peeganancy. I gained four pounds by 21 weeks and gained 10 pounds by 22 weeks definitely from edema. I had incredible neck pain and stiffness since week 20. I had really bad lower ligament pain since 15 weeks. I felt bloaded right between my chestbone by my stomach throughout pregnancy. Everything was completely back to normal two weeks after delivery. Do you know what I can do to decrease my risk of abnormal placental formation and preeclampsia in the future?
The criterion for Pre-Eclampsia here is not the same as current ABFP guidelines. ABFP guidelines require 300mg of protein in a 24 hour urine collection. That is, 1+ protein and the elevated blood pressure after 20 weeks is defined as gestational hypertension and not pre-eclampsia as he states here. Also--for the blood pressure--the systolic blood pressure need not be over 140 after 20 weeks of gestation if the diastolic blood pressure is over 90 at that time. The systolic blood pressure can be less than 140 if the diastolic BP is over 90 with a 24 hr. urine protein of 300mg or higher to qualify as pre-eclampsia. However, pre-eclampsia can exist if the systolic blood pressure is over 140 and the diastolic BP less than 90 as long as there is the elevated 300mg of protein in the 24 hour urine collection. According to the American Board of Family Practice, ABFP.
Wonderful Lecture sir. I have something to say. You have mentioned that Pre-eclampsia may come from the mother in law of the woman who is pregnant - It reminds me that X chromosomes have something to do with immunity - woman have 2 X chromosomes, this is probably one of the reasons why women are more likely to develop auto-immune diseases - for eg - Grave' s disease; Hashimoto's thyroditis; Multiple sclerosis; Myasthenia Gravis; Systemic Lupus Erythematosus(SLE)(Lupus); Rheumatoid arthritis; Sjögren's syndrome. It adds up because the husband of the woman who is pregnant has his X chromosome from his mother.
Imo you are right, acc. to the uptodate: "Preeclampsia is a multisystem progressive disorder characterized by the new onset of hypertension and proteinuria or the new onset of hypertension and significant end-organ dysfunction with or without proteinuria in the last half of pregnancy or postpartum" (but then again keep in mind the vid here is 3y old, so not a mistake I guess but rather changing defs)
According to my textbooks, severe pre-eclampsia is diagnosed when SBP is more than or equal to 160 mmHg OR DBP is more than or equal to 110 mmHg. Also, according to the new guidelines, is proteinuria no longer mandatory for diagnosis of pre-eclampsia IF signs of organ damage are present in absence of proteinuria?
Yes, the definitions he gives here to diagnose pre-eclampsia are not correct or are at least out-dated. Read my comment above. I've found other errors in his lectures, also.
I just want to be sure...I read that 10% of pre-eclamptic patients do not exhibit proteinuria...is it absolutely mandatory? Or is one of the criteria enough- so long as it fits in the schema of pregnancy, and presentation after 20 weeks gestation?
Definitely need to have proteinuria to be diagnosed with pre-eclampsia. Pre-eclampsia, by definition, is sustained hypertension and >300mg/d proteinuria after 20 weeks. It's possible to be diagnosed with **eclampsia** without having had (detected) proteinuria, but I've only read about this in one study. For test-taking purposes, you need a history of hypertension (chronic or gestational) and proteinuria after 20 weeks to make the diagnosis of pre-eclampsia. In practice, however, if a pregnant or postpartum woman is seizing and has no history of epilepsy, I would give mag sulf even if there is no known history of proteinuria or hypertension. Then give dilantin.. or ativan provided she's postpartum. That's just my clinical instincts though... ask an OB about it for their input.
ah! I was reading the Merck Professional guide with respect to pre-eclampsia dx and it had mentioned that absence of proteinuria could still lead to dx in the presence of other sx including those you'd find in HELLP/ general cerebral/visual disturbances- but I'll double check! Thank you!!!!!! Your videos are a life-line :D
@@blackdragon482 from my notes from cardio: pre-eclampsia = new HTN (syst >/= 140mmHg OR diast. >/= 90mmHg) + proteinuria; OR: HTN + EOD after 20w of gestation uptodate: "Preeclampsia is a multisystem progressive disorder characterized by the new onset of hypertension and proteinuria or the new onset of hypertension and significant end-organ dysfunction with or without proteinuria in the last half of pregnancy or postpartum"
The ICD-10 still distinguishes between mild to moderate, and severe pre-eclampsia. icd.who.int/browse10/2016/en#/O14 It is true that this lecture is from May 2017. If you feel you can create a more modern lecture, please feel free to do so. 500+ lectures don't update themselves.
For the updated video on pre-eclampsia: ua-cam.com/video/TbZHCZ2aMZ4/v-deo.html
You make me fall in love with medicine Dr.
What a role model you are!
Thank you for this succint description of preeclampsia and eclampsia. I has HELLP syndrome at 22 weeks and the doctors delivered my baby but they refused to save him because he was 22 weeks and had IUGR. They 100 % believed he would not survive. This happened three weeks ago and we had his funeral service yesterday. I have been tying to understand why this happened when I had no history of hypertension before pregnancy and not until my checkup at 22 weeks. The placenta was never studied so I don’t know if the blood vessels were abnormal. And I was not tested for any placental factors. But I had every symptom of preeclampsia you described. I had a BMI of 29 before peeganancy. I gained four pounds by 21 weeks and gained 10 pounds by 22 weeks definitely from edema. I had incredible neck pain and stiffness since week 20. I had really bad lower ligament pain since 15 weeks. I felt bloaded right between my chestbone by my stomach throughout pregnancy. Everything was completely back to normal two weeks after delivery. Do you know what I can do to decrease my risk of abnormal placental formation and preeclampsia in the future?
please tell me now i was survived in preclamsia with hellp so please tell me about you.....you got safe pregnant or not.
Did they give you ASPIRIN during pregnancy?
amazing video!! you've made my clinical years so much easier. thank you sir!!
your obs videos helped a lot during my rotationin class
This is awesome and concise. Thank you makes sense
Thank you for the lectures starting my obs rotatation tomorrow
The criterion for Pre-Eclampsia here is not the same as current ABFP guidelines. ABFP guidelines require 300mg of protein in a 24 hour urine collection. That is, 1+ protein and the elevated blood pressure after 20 weeks is defined as gestational hypertension and not pre-eclampsia as he states here. Also--for the blood pressure--the systolic blood pressure need not be over 140 after 20 weeks of gestation if the diastolic blood pressure is over 90 at that time. The systolic blood pressure can be less than 140 if the diastolic BP is over 90 with a 24 hr. urine protein of 300mg or higher to qualify as pre-eclampsia. However, pre-eclampsia can exist if the systolic blood pressure is over 140 and the diastolic BP less than 90 as long as there is the elevated 300mg of protein in the 24 hour urine collection. According to the American Board of Family Practice, ABFP.
Thank you very much!
23:13 in severe pre-eclampsia, '24-32 weeks and stable', I thought the condition is already unstable in severe pre-eclampsia?
Wonderful Lecture sir.
I have something to say.
You have mentioned that Pre-eclampsia may come from the mother in law of the woman who is pregnant - It reminds me that X chromosomes have something to do with immunity - woman have 2 X chromosomes, this is probably one of the reasons why women are more likely to develop auto-immune diseases - for eg -
Grave' s disease; Hashimoto's thyroditis; Multiple sclerosis; Myasthenia Gravis; Systemic Lupus Erythematosus(SLE)(Lupus); Rheumatoid arthritis; Sjögren's syndrome.
It adds up because the husband of the woman who is pregnant has his X chromosome from his mother.
Thank you for this conclusive simplified discussion. Yet it would be much more helpful if you state the doses and dosages of the drugs. Many thanks.
Thaaaaaaaanks alooooooot; I like ur videos soooooo much, I depend on them to understand and summarize , appreciate ur work... all the best
Awesome videos..Ty for making our study easy...
Thank you ... you are so helpful.. this video is amazing
Wouldn´t administering Aspirin in pregnancy induce a closure of ductus arteriosus?
Possibly. But the benefits outweigh the risks according to the USPSTF.
www.aafp.org/news/health-of-the-public/20140910lowdoseasa.html
Thank you
Excellent question
Do you rly need proteinuria if you have some other type of organmanifestaion like elevated liverenzymes
Imo you are right, acc. to the uptodate: "Preeclampsia is a multisystem progressive disorder characterized by the new onset of hypertension and proteinuria or the new onset of hypertension and significant end-organ dysfunction with or without proteinuria in the last half of pregnancy or postpartum"
(but then again keep in mind the vid here is 3y old, so not a mistake I guess but rather changing defs)
According to my textbooks, severe pre-eclampsia is diagnosed when SBP is more than or equal to 160 mmHg OR DBP is more than or equal to 110 mmHg.
Also, according to the new guidelines, is proteinuria no longer mandatory for diagnosis of pre-eclampsia IF signs of organ damage are present in absence of proteinuria?
can you please tell me what's your textbook?
Yes, the definitions he gives here to diagnose pre-eclampsia are not correct or are at least out-dated. Read my comment above. I've found other errors in his lectures, also.
IUGR, PROTEINURIA (>5gm/24hrs), OLIGOURIA are no more criteria of Pre-Eclampsia. They may be findings in Pre-Eclampsia, but not criteria.
Your right
Thanks a lot
I like your videos, thanks doc
Why he stopped making videos?
thank u....
I just want to be sure...I read that 10% of pre-eclamptic patients do not exhibit proteinuria...is it absolutely mandatory? Or is one of the criteria enough- so long as it fits in the schema of pregnancy, and presentation after 20 weeks gestation?
Definitely need to have proteinuria to be diagnosed with pre-eclampsia. Pre-eclampsia, by definition, is sustained hypertension and >300mg/d proteinuria after 20 weeks. It's possible to be diagnosed with **eclampsia** without having had (detected) proteinuria, but I've only read about this in one study. For test-taking purposes, you need a history of hypertension (chronic or gestational) and proteinuria after 20 weeks to make the diagnosis of pre-eclampsia.
In practice, however, if a pregnant or postpartum woman is seizing and has no history of epilepsy, I would give mag sulf even if there is no known history of proteinuria or hypertension. Then give dilantin.. or ativan provided she's postpartum. That's just my clinical instincts though... ask an OB about it for their input.
ah! I was reading the Merck Professional guide with respect to pre-eclampsia dx and it had mentioned that absence of proteinuria could still lead to dx in the presence of other sx including those you'd find in HELLP/ general cerebral/visual disturbances- but I'll double check! Thank you!!!!!! Your videos are a life-line :D
That's right great videos but should update that information
@@blackdragon482 from my notes from cardio: pre-eclampsia = new HTN (syst >/= 140mmHg OR diast. >/= 90mmHg) + proteinuria; OR: HTN + EOD after 20w of gestation
uptodate: "Preeclampsia is a multisystem progressive disorder characterized by the new onset of hypertension and proteinuria or the new onset of hypertension and significant end-organ dysfunction with or without proteinuria in the last half of pregnancy or postpartum"
Good stuff, May Allah bestow His peace upon your generous heart
Simply excellent. Very grateful for clear, concise and well presented video. Thank you for the great channel. 😊😊 6/9/2019
Thank you!
twice in labor, twice pre ekslampsia, twice induction, pain like hell, trauma to pregnant again
At 4:00 criteria of PE there is BP>140/90, but is it single measurement or two separate measurement 6 hrs apart?
amina ashrafi raised BP should be evident at least on two occasions at least 6 hours apart!
between 4 to 6 hours apart but not more than 7 days apart
great video. thanks a lot:)
They don’t use “mild” and “severe” anymore... i am hearing sporadic outdated info throughout
The ICD-10 still distinguishes between mild to moderate, and severe pre-eclampsia.
icd.who.int/browse10/2016/en#/O14
It is true that this lecture is from May 2017. If you feel you can create a more modern lecture, please feel free to do so. 500+ lectures don't update themselves.
Here's the 2020 version of the ICD-10, in case you're interested.
icd10cmtool.cdc.gov/?fy=FY2020&q=O14
Wish I found this earlier
thank youuu
Thank you! :D
are there any studies to support the theory of parental ethnic discordance?
Interesting.
much useful
❤️😘