Eclampsia 101

[AzariaJordan]

You know how sometimes you have a general sense of how something works, but then you hear another person describe the same process and their description seems so much easier to understand?
I'm looking for this description regarding the physiology behind pre-e/e/toxemia. Any takers?! (I suspect my problem is that I am describing it too in depth, losing myself and my poor clients along the way, so just keep it simple!)
Cheers!

[pamamidwife]

I don't know if anyone really completely understands the etiology or physiology well of pre-e. For one thing, it's wayyyyy overdiagnosed. it seems that any sort of rise in blood pressure (even a normal increase at the end of pregnancy) is considered pre-e.

Pre-eclampsia is a toxic disorder of the liver and kidneys that starts with a contracted blood volume (the blood volume expansion doesn't occur - for whatever reason: nutrition, salt restriction, dehydration, or just plain bad luck). This contracted blood volume does not meet the needs of the baby or the mother and takes its toll on the liver and the kidneys, causing the blood pressure to rise rapidly (typically at the start of the third trimester, rather than in the last month of pregnancy). The bp rises because the baby / placenta needs more blood and the volume contraction has kept that from happening.

Swelling in the tissues regularly occurs in pregnancy, but women with pre-eclampsia LOOK swollen in the face and neck. Swelling in the lower legs and feet is normal, especially in the last six weeks of pregnancy.

Protein in the urine is a very, very late sign of pre-e. Many things affect urine dipsticks picking up protein in the urine - usually it's concentrated urine or a lack of getting enough protein in the urine. If I had a woman that I was worried about pre-e with, I'd do a 24 hour urine collection, not a dipstick. Looking at her protein levels over a 24 hour period is more accurate than a one-time dipstick.

Women with pre-e often will have some upper abdomen pain - typically from the stress on the kidneys and/or liver.

here is something i wrote on my blog re: high blood pressure in pregnancy.

[mwherbs]

so from another direction - early on very early on like at implantation there is a difference in how the uterine spiral arteries and the placental circulation intertwine - now for the most part there is no blood mixing but mom's circulation and the placenta interlock so that there is blood gas and nutrient exchange as well as waste products being taken away and processed by mom's body- in order to do this optimally the placenta bed and the maternal arteries relax into loose curls-in response to nitric oxide and some other things(not completely understood) -- so in a preeclamptic mom/baby's circulation there is something wrong with implantation- not enough nitric oxide present or mother's finner circulation is dammaged (via oxidative stress like diabetes, high blood pressure, smoking) or placenta implants deeper into the uterus- instead of in the endometrium or more shallowly or something is wrong with the genetics of the placenta and it doesn't form right, there are other things but that would be a start... at some point the earlier the onset of symptoms the more severe PE is. On the placental level the oxidative stress gets worse and worse- the more oxidative stress the less of the relaxant-nutritive form of nitric oxide- so the more stress it makes--- because there are so many ways that this can happen there is no one simple answer to how to make repairs and fix the situation- back when Brewer was looking at improving diets- the standard of care was to starve moms- of course feeding mom would work- nowa days we probably have more of the too much exposure to oxidative foods, not just in pregnancy but whole life exposure -
the studies of diets of the Alaskan natives who ate a traditional diet compared to women of the same tribal origins eating modern diets- the pe rate was the same for the modern diets as we expect to see most places but the traditional diet women had way less PE- so what do they boil that all down to in differences eating fish- so then the researchers move onto fish oil- but not dramatic results from using fish oil... lets see- what could the real differences be besides the fact that fish was being eaten all the time not just in pregnancy- so just taking oil for a pregnancy is not the same at all- there is a collection of nutrients - as well as forms of oxidative stress-
I am not sure what all you are asking for but this is one of the pieces of the puzzle I have as far as PE goes--
for diagnosis and other info there was a published working group pamphlet that has some pretty good info and has a list of definers --
here is the web site
http://www.nhlbi.nih.gov/health/prof...p/hbp_preg.htm

[mwherbs]

so I was looking for a picture of maternal/placental circulation and pre-eclampsia and came across this older (2005) blog post by a biologist- and you know I have some bits of it but there were things I just didn't know-- so a good/health immune response by mom is part of what makes a healthier placentation and there is some reforming of maternal tissues which I didn't konw--- any how here is the web site- scroll down to read the article and look at the pics- if you click on the new page it doesn't have the info archived--

http://pharyngula.org/index/weblog/c..._preeclampsia/