INTRODUCTION TO PRE ECLAMPSIA Although many pregnant women with high blood pressure have healthy babies without

serious problems, high blood pressure can be dangerous for both the mother and the fetus. Women with pre-existing, or chronic, high blood pressure are more likely to have certain complications during pregnancy than those with normal blood pressure. However, some women develop high blood pressure while they are pregnant (often called gestational hypertension). The effects of high blood pressure range from mild to severe. High blood pressure can harm the mother's kidneys and other organs, and it can cause low birth weight and early delivery. In the most serious cases, the mother develops preeclampsia-or "toxemia of pregnancy"-which can threaten the lives of both the mother and the fetus. WHAT IS PRE ECLAMPSIA? Preeclampsia is a condition that typically starts after the 20th week ofpregnancy and is related to increased blood pressure and protein in the mother's urine (as a result of kidney problems). Preeclampsia affects the placenta, and it can affect the mother's kidney, liver, and brain. When preeclampsia causes seizures, the condition is known as eclampsia-the second leading cause of maternal death in the U.S. Preeclampsia is also a leading cause of fetal complications, which include low birth weight, premature birth, and stillbirth. There is no proven way to prevent preeclampsia. Most women who develop signs of preeclampsia, however, are closely monitored to lessen or avoid related problems. The way to "cure" preeclampsia is to deliver the baby. You are at increased risk of developing pre-eclampsia if: This is your first pregnancy. Your mother or sister had pre-eclampsia or eclampsia during pregnancy. You are carrying more than one baby. You are a teenager. You are over 40 years old. You already have high blood pressure, kidney disease or diabetes. You are a smoker. You are obese. You suffer from malnutrition. You carry a baby with so-called "non-immune hydrops." If you are pregnant, increasing blood pressure may not make you feel different until it is dangerously high. So you should watch for signs of pre-eclampsia. If you develop pre-eclampsia, the first thing you notice may be rapid weight gain, on the order of two to five pounds in a single week. Many pregnant women have swelling of their feet or legs; however, swelling of your face or arms may be a sign of preeclampsia. If pre-eclampsia progresses from mild to moderate or severe, you may begin to notice other symptoms. Headache, vision changes and abdominal pain should prompt concern. It is dangerous to allow blood pressure to stay high during pregnancy. High blood pressure may interfere with the placenta's ability to deliver oxygen and nutrition to your fetus, so your baby may be born weighing less than normal and may have

other health problems. If your blood pressure continues to get higher and higher, your kidneys may have trouble functioning. You may have changes in the makeup of your blood, such as destruction of red blood cells (causing anemia), disturbed liver function, and decreased platelets (blood cells involved in clotting). Too few platelets can increase your risk of bleeding uncontrollably during delivery or even spontaneously. Your blood pressure may continue to climb, and you may develop seizures. Once you begin to have seizures, you are considered to have eclampsia. This is a life-threatening situation for both you and your baby. During a seizure, you and your baby are at risk of being deprived of oxygen. In addition, the high blood pressure may cause the placenta to begin to separate from the wall of the uterus (called abruptio placentae). This can cause severe bleeding and death of the fetus and possibly the mother. SIGNS AND SYMPTOMS Rapid weight gain Swelling of the arms or face Headache Changes in vision (blurred vision, seeing double, seeing spots of light) Dizziness, faintness Ringing in the ears Abdominal pain Decreased production of urine Nausea, vomiting Blood in vomit or urine Confusion Seizures TREATMENTS AND DRUGS The only cure for preeclampsia is delivery. You're at increased risk of seizures, placental abruption, stroke and possibly severe bleeding until your blood pressure decreases. Of course, if it's too early in your pregnancy, delivery may not be the best thing for your baby. If you've had preeclampsia in one or more previous pregnancies, some experts recommend more frequent prenatal visits than normally recommended for pregnancy. Your doctor may ask you to come in every two weeks between the 20th and 32nd week of your gestation, and weekly after that until delivery. Medications Your doctor may recommend the following: Medications to lower blood pressure. These medications, called antihypertensives, are used to lower your blood pressure until delivery. Corticosteroids. If you have severe preeclampsia or HELLP syndrome, corticosteroid medications can temporarily improve liver and platelet functioning to help prolong your pregnancy. Corticosteroids can also help your baby's lungs become more mature in as little as 48 hours an important step in helping a premature baby prepare for life outside the womb.

Anticonvulsive medications. If your preeclampsia is severe, your doctor may prescribe an anticonvulsive medication, such as magnesium sulfate, to prevent a first seizure. Bed rest If you aren't near the end of your pregnancy and you have a mild case of preeclampsia, your doctor may recommend bed rest to lower your blood pressure and increase blood flow to your placenta, giving your baby time to mature. You may need to lie in bed, only sitting and standing when necessary. Or you may be able to sit on the couch or in bed and strictly limit your activities. Your doctor may want to see you a few times a week to check your blood pressure, urine protein levels and your baby's well-being. If you have more severe preeclampsia, you may need bed rest in the hospital. In the hospital, you may have regular nonstress tests or biophysical profiles to monitor your baby's well-being and measure the volume of amniotic fluid. A lack of amniotic fluid is a sign of poor blood supply to the baby. Delivery If you're diagnosed with preeclampsia near the end of your pregnancy, your doctor may recommend inducing labor right away. The readiness of your cervix whether it's beginning to open (dilate), thin (efface) and soften (ripen) also may be a factor in determining whether or when labor will be induced. In more severe cases, it may not be possible to consider your baby's gestational age or the readiness of your cervix. If it's not possible to wait, your doctor may induce labor or schedule a C-section earlier in your pregnancy. During delivery, you may be given magnesium sulfate intravenously to increase uterine blood flow and prevent seizures. After delivery, expect your blood pressure to return to normal within a few weeks. ANATOMY AND PHYSIOLOGY CARDIOVASCULAR SYSTEM The heart weighs between 7 and 15 ounces (200 to 425 grams) and is a little larger than the size of your fist. By the end of a long life, a person's heart may have beat (expanded and contracted) more than 3.5 billion times. In fact, each day, the average heart beats 100,000 times, pumping about 2,000 gallons (7,571 liters) of blood.

Your heart is located between your lungs in the middle of your chest, behind and slightly to the left of your breastbone (sternum). A double-layered membrane called the pericardium surrounds your heart like a sac. The outer layer of the pericardium surrounds the roots of your heart's major blood vessels and is attached by ligaments to your spinal column, diaphragm, and other parts of your body. The inner layer of the pericardium is attached to the heart muscle. A coating of fluid separates the two layers of membrane, letting the heart move as it beats, yet still be attached to your body. Your heart has 4 chambers. The upper chambers are called the left and right atria, and the lower chambers are called the left and right ventricles. A wall of muscle called the septum separates the left and right atria and the left and right ventricles. The left ventricle is the largest and strongest chamber in your heart. The left ventricle's chamber walls are only about a half-inch thick, but they have enough force to push blood through the aortic valve and into your body. The Heart Valves Four types of valves regulate blood flow through your heart: The tricuspid valve regulates blood flow between the right atrium and right ventricle. The pulmonary valve controls blood flow from the right ventricle into the pulmonary arteries, which carry blood to your lungs to pick up oxygen. The mitral valve lets oxygen-rich blood from your lungs pass from the left atrium into the left ventricle. The aortic valve opens the way for oxygen-rich blood to pass from the left ventricle into the aorta, your body's largest artery, where it is delivered to the rest of your body.

The Conduction System Electrical impulses from your heart muscle (the myocardium) cause your heart to contract. This electrical signal begins in the sinoatrial (SA) node, located at the top of the right atrium. The SA node is sometimes called the heart's "natural pacemaker." An

electrical impulse from this natural pacemaker travels through the muscle fibers of the atria and ventricles, causing them to contract. Although the SA node sends electrical impulses at a certain rate, your heart rate may still change depending on physical demands, stress, or hormonal factors. The Circulatory System Your heart and circulatory system make up your cardiovascular system. Your heart works as a pump that pushes blood to the organs, tissues, and cells of your body. Blood delivers oxygen and nutrients to every cell and removes the carbon dioxide and waste products made by those cells. Blood is carried from your heart to the rest of your body through a complex network of arteries, arterioles, and capillaries. Blood is returned to your heart through venules and veins. If all the vessels of this network in your body were laid end-to-end, they would extend for about 60,000 miles (more than 96,500 kilometers), which is far enough to circle the earth more than twice! EXOCRINE SYSTEM The exocrine systems main function is to regulate the volume and composition of body fluids excrete the unwanted materials, but it is not the only system in the body that is able to excreted unnecessary substances. Kidneys The kidneys resemble the lima beans in shape. The average- sized kidney measures around 11cm by 7 cm by 3cm. The left kidney is often larger than the right. The kidneys are highly ascular organs.

Approximately, one-fifth of the blood pumped from the heart goes to the kidneys. The kidneys process blood plasma and form urine from waste to be excreted and removed from the body. Theses functions arevital because they maintain the hemostatic balance of the body. The kidneys maintain the fluid-electrolyte and acidbase balance. In addition, they also influence the rate of secretion of the hormones ADH and aldosterone. Microscopic functional units called nephrons make up the bulk of the kidney. The nephron is uniquely suited to its function of blood plasma processing and urine function. A nephron contains certain structures in which fluid flows through them

and they are as follows: renal corpuscle, Bowmans capsule, proximal convulted tubule, Loop of Henle, distal convoluted tubule and the collecting tube. The Bowmans capsule is a cup-shaped mouth of a nephron. It is usually formed by two layers of epithelial cells. Fluids, electrolytes and waste products that pass through the porous glomerular capillaries and enter the space that constitute the glomerular filtrate, which will be processed in the nephron to form urine. The Glomerulus is the bodys well-known capillary network and is surely one of the most important ones for survival. Glomerulus and Bowmans capsule together are called renal corpuscle. The permeability of the glomerular endothelium increases sufficiently to allow plasma proteins to filter out into the capsule. ENDOCRINE SYSTEM The endocrine system performs their regulatory functions by means of chemical messenger sent to specific cells. The endocrine system, secreting cells send hormones by way of the bloodstream to signal specific target cells throughout the body. Hormones diffuse into the blood to be carried to nearly every point in the body. The endocrine glands secrete their products, hormones directly into the blood. There are two classifications of hormones: steroid hormones and non-steroid hormones. The steroid hormones which are manufactured by the endocrine cells from cholesterol, is an important lipid in the human body. Non-steroid hormones are synthesized primarily from amino acids rather from the cholesterol. Non-steroid hormones are further subdivided into two: protein hormones and glycoprotein hormones. Aldosterone Its primary function is the maintenance of the sodium homeostatsis in the blood by increasing the sodium reabsorption in the kidneys. It is secreted from the adrenal cortex; it triggers the release of ADH which results to the conservation of water by the kidney. Aldosterone secretion is controlled by the rennin- angiotensin mechanism. Estrogen It is secreted by the cells of the ovarian cells that promote and maintain the female sexual characteristics. Progesterone It is secreted by the corpus luteum. It is also known as a pregnancy- promoting steroid and it prevents the expulsion of the fetus in the uterus. Anti-diuretic hormone (ADH) It is secreted in the neurohypophysis (posterior pituitary); it literally opposes the formation and production of a large urine volume. It helps the body to retain and conserve water from the tubules of the kidney and returned to the blood. REPRODUCTIVE SYSTEM The female reproductive system produces gametes may unite with a male gamete to form the first cell of the offspring. The female reproductive system also provides protection and nutrition to the developing offspring. The most essential organ is the ovary which carries the ova. The uterus, the fallopian tubes and the vulva are accessory organs.

Ovaries It is an almond-shape organ. It contains the ova and is responsible in expelling the ova. It also produces estrogen and progesterone. Fallopian Tubes It usually measures approximately 10- 12 cm. It has two parts: the ampullae and the fimbriae. The ampullae which is the largest part is where the fertilization takes place. The fimbriae on the other hand, are responsible for the transportation of the ovum from ovary to uterus. It holds the ovary. Uterus The uterus is a pear-shaped organ and has three parts: the fundus (upper), corpus (body), and the isthmus (lower). It is known as the organ for menstruation. When pregnant, it gives nourishment to the growing fetus. BOOK BASED PATHOPYSHIOLOGY