Pathophysiology of Preeclampsia | Pregnancy induced Hypertension | Nursing Lecture

Aug 24, 2023

Pathophysiology of Preeclampsia | Pregnancy induced Hypertension | Nursing Lecture

Pathophysiology of Preeclampsia involves the 2 stage disorder, in this video 2nd stage of the disorder is explained, in which the major organs are involving and causing signs and symptoms in a woman.

1. Kidney
- RBF \u0026 GFR is decreasing
- Glomerular endotheliosis
- Oliguria
- Proteinuria
- Blood urea, uric acid \u0026 creatinine levels are rising.

2. Liver
- Periportal Haemorrhagic necrosis
- Increases liver transaminase enzymes (AST, ALT / SGOT, SGPT)
- Subcapsular Haematoma
- Epigastric pain or right hypochondriac pain

3. Placenta
- Abruptio Placenta
- Oligohydramnios
- IUGR

4.CV \u0026 Lungs
-Oedema
- Haemoconcetration
-Thrombocytopenia

5. CNS
- Vasogenic oedema
- Headache
- Visual disturbances (Blurring of vision, scotomata, convulsions, retinal detachment)

Click here to watch Part - 1 of Pathophysiology of Preeclampsia here -
• Pathogenesis of Preeclampsia | Pregna…

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Content

0.27 -> Hello, everyone. In this lecture I'm going to talk

3.15 -> about the pathophysiology in preeclampsia. So in

6.9 -> the previous part of this video, I already told

9.21 -> you that it is a two stage disorder. And in stage

12.84 -> one disorder, what happens? The problem begin in

15.66 -> the placental area, right? And now these

19.26 -> inflammatory mediators enters into the maternal

22.05 -> systemic circulation, and involving major organs

25.89 -> in a woman and affecting these organ and causing

29.64 -> various signs and symptom. Right. So in this

32.82 -> video, we'll discuss what all organs are

35.64 -> affecting, because of this, pathogenesis of

38.73 -> preeclampsia, that is vasospasm and the

41.46 -> endothelial dysfunction and what symptoms women

45.03 -> may have with this pre eclampsia. So, in

48.75 -> preeclampsia the organ which is affecting most is

60.63 -> the kidney. See, the basic pathogenesis behind all

71.07 -> this preeclampsia is vasospasm and the endothelial

74.97 -> dysfunction right. But if you compare with the

78 -> normal pregnancy what happened there is an

79.92 -> increase in blood volume and because of that,

82.92 -> there is a good amount of the renal blood flow as

85.35 -> well as good filtration rate as well right. But

88.41 -> here what happened because of this vasospasm

92.61 -> right, because of this vasospasm, the afferent

95.64 -> arterioles are not carrying that much of blood

98.19 -> toward the glomeruli right. So, because of this

101.34 -> vasoplasm there is a decreased blood flow right

105.18 -> what is happening there is a decreased renal blood

109.14 -> flow and as the flow is decreases along with that,

114.18 -> there is a decrease glomerular filtration rate as

117.69 -> well right. And along with that, what is happening

120.84 -> there is endothelial dysfunction, and because of

123.96 -> this dysfunction, the endothelial lining is

126.78 -> damaging as well as they are swollen up and

129.93 -> because of this swollen up endothelial lining of

133.14 -> glomeruli here it is called as glomerular

142.68 -> endotheliosis. So, because of this what is

149.07 -> happening, the endothelial linings become swollen

152.25 -> up and because of this reason only, the urine is

156.21 -> not able to comes out or filter out right. So, the

160.02 -> urine production is decreases in this condition,

163.35 -> and that will lead into the oliguria that is

167.43 -> decreased urine production it isabout less than

170.19 -> 400 ml in 24 hours urine collection right. So, why

176.49 -> it is happening, because the fenestra or the

179.04 -> opening in the endothelial lining remain occluded,

182.43 -> because of this swelling in the endothelium right.

186.06 -> So, urine is not able to come out and as the waste

190.26 -> product that is the uric acid what all waste

192.81 -> products are there, which comes out with this

194.79 -> urine the uric acid as well as the urea and the

201.33 -> creatinine also not come out with this urine. So,

208.92 -> if they are not able to come out with this urine,

211.38 -> then what happened, the serum level of these waste

215.22 -> products remain high right. So, what all clinical

220.11 -> features women may have in preeclampsia, the woman

222.84 -> may have oliguria that is the urine is not

225.18 -> producing well, because the endothelial lining is

228.78 -> damaging, they are swollen and there is a

231.72 -> vasvasospasm because of this the flow is reduced

234.78 -> the filtration is also reduced as well as the

237.3 -> urine is not able to comes out right. Now, this

241.41 -> was about the kidney, then what happened with the

244.92 -> liver, when this vasospasm and endothelial

248.37 -> dysfunction takes place. So, in the liver, because

254.7 -> of thrombosis in the arterioles What happened?

257.94 -> There is a periportal hemorrhagic necrosis

270.33 -> periportal haemorrhagic necrosis is there why it

274.5 -> is happening because of this vasospasm and the

276.99 -> endothelial dysfunction that causes thrombosis in

279.69 -> the arterioles and that will lead into the

282.57 -> periportal hemorrhagic necrosis and because the

286.8 -> parenchymal tissues are now damaging, so, the

290.01 -> liver enzymes are elevating so what all liver

293.4 -> enzymes are there, the AST as well as the ALT

297.33 -> levels are increasing. Aspartate transaminase and

303.06 -> Alanine transaminase and these are also known as

306.6 -> SGOT and SGPT. So, serum glutamic oxaloacetic

314.16 -> transaminase and serum glutamic pyruvic

316.68 -> transaminase the level of these liver enzymes is

320.04 -> also increasing because of this necrosis right.

324.69 -> And if this periportal hemorrhagic necrosis is

327.69 -> exceeding and that will causing the bleeding

331.08 -> beneath the subcapsular lining that the blood is

334.77 -> collecting between the capsule of liver as well as

337.89 -> the parenchymal tissues of the liver that will

340.71 -> causes the subcapsular

345.58 -> hematoma. So, because of this bleeding which is

354.97 -> accumulating beneath this capsule and the

358.54 -> parenchymal tissues that may causes stretching of

361.93 -> the capsule and causes pain in a woman. So, the

366.28 -> pain is in the epigastric region or you can say

373.54 -> the right upper quadrant pain or the right

376.87 -> hypochondriac pain because it is situated in the

383.89 -> right hypochondriac region. So, because of the

387.1 -> stretching of the capsule the woman may have

389.85 -> epigastric

390.57 -> pain as well as the right hypochondriac pain, and

394.35 -> that indicative of that the liver are also

396.87 -> involving and the woman is having severe

399.51 -> preeclampsia. Now what all changes will take place

403.5 -> in the placenta by this vasospasm and the

407.55 -> endothelial dysfunction. See the problem begin in

412.14 -> the placenta only. And we know that there is a

415.02 -> vasospasm in the spiral arterioles. So, the

418.65 -> maternal blood is not going well toward the

421.26 -> placental side and because of this vasospasm, so,

424.77 -> placenta is not able to extract oxygen as well as

427.89 -> nutrients from this blood for the foetus as well

431.58 -> as for their tissues itself. So, because of that,

434.82 -> what happens the placenta gets separated slowly

439.08 -> and there is a feature of early separation of

441.84 -> placenta because the tissues are not receiving

446.43 -> that much of nutrient and they are necrosed or

449.07 -> they are ischemic. So, because of that, what

452.28 -> happens the placenta get separated and there is a

455.52 -> feature of abruptio placenta. So, because of this

461.22 -> vasospasm and endothelial dysfunction, what will

463.71 -> happen, there may be a feature of abruption

468.18 -> placenta,

470.67 -> that is,

472.2 -> the early separation of placenta and along with

474.66 -> that, the woman may have oligohydramnios

485.55 -> and, because of this oligohydramnios because the

489.18 -> amniotic fluid volume is not that much, that is

493.38 -> decreased amniotic fluid, the foetus is also not

497.37 -> able to extract their nourishment. So, the foetus

501.18 -> will have intrauterine growth retardation right.

505.62 -> So, with this dysfunction, the foetus may retarded

508.5 -> and there may be chance of early separation of

510.96 -> placenta. Now, with this pathogenesis, if the

516.81 -> cardiovascular as well as the lungs are involving,

520.74 -> then what happened. So, in this because of this

524.1 -> vasospasm, what happened the peripheral vascular

526.98 -> resistance is also increasing and that may lead

531.06 -> into the increased blood pressure in a woman. And

534.9 -> once the endothelial dysfunction occurs, then what

538.35 -> happened the capillaries become more leaky and

542.34 -> with this leakage the intravascular plasma right

546.12 -> the intravascular plasma is now leaking toward the

549.75 -> interstitial spaces and start collecting inside

552.51 -> these cell. So, with this damaging endothelial

556.62 -> lining and the leaky capillaries what happened,

559.53 -> the plasma leaks out and start collecting inside

563.16 -> the interstitial spaces and that may lead into the

566.49 -> oedema right. So, women may have edema,

571.08 -> physiological edema is quite common with this

573.66 -> normal pregnancy and it is limited up to the ankle

576.99 -> region only. And that can subside with the rest

580.08 -> only. But here, these pathological edema can

584.1 -> extend up to the legs as well as it can involve

587.46 -> the abdominal wall it can involve the face as

590.61 -> well. So, with this pathological edema, the woman

593.64 -> may have weight gain. So if the woman is getting

597.99 -> more than five pounds, In a month, or if she's

603.03 -> having more than one pound in each week, then we

607.89 -> can call it as very dangerous for a woman. So, as

612.27 -> the fluid is shifting to interstitial spaces what

615.18 -> happened the RBC's count in the blood is

618.81 -> increasing. So, there is a hemo concentration. So,

625.38 -> there is a hemoconcentration and there is a

628.26 -> increase in hematocrit level. So, as the level of

635.37 -> RBC's are rising in these women they are more

638.4 -> sensitive to blood loss because the woman with a

642.21 -> normal pregnancy in a state of hemodilution right.

645.48 -> So, as the blood loss occur in these women, then

648.51 -> they can easily tolerate because the plasma is

650.73 -> also losing, but here what happens plasma is

654.9 -> already shifting towards the interstitial spaces

657.57 -> right. So, once the blood loss occurs, the more

660.9 -> RBC's will be lost and there will be chance that

664.17 -> the woman may have shock right. So, they are more

667.11 -> sensitised to blood loss. So, after this rise in

670.14 -> RBC what happens with the platelet because we

673.59 -> already know that there is an endothelial

675.69 -> dysfunction. So, once the lining become damages,

679.44 -> now, the role of platelet become high and they are

682.44 -> consuming and they are used up there right because

686.37 -> they need to form a clot because of this damage

690.24 -> right? So, platelets are used up so, that that's

693.54 -> why the free circulating platelets count is

697.59 -> decreasing. So, because of decrease in platelet

701.01 -> count in blood, there is a thrombocytopenia right.

712.05 -> So, platelet count is also decreasing. So, if we

715.74 -> talk about the lungs then again there is a leaky

718.2 -> capillaries and the fluid is shifting toward the

720.9 -> interstitial spaces and that causes the fluid

725.13 -> around the lungs and that may lead into the

728.25 -> pulmonary edema So, a woman with this edema may

734.46 -> have breathlessness right so, she may have

737.31 -> difficulty in breathing because of this fluid

739.89 -> collection. Now, what happened when the CNS is

746.07 -> involving that is the central nervous system is

748.68 -> involving see before that what normally happens

752.79 -> there is a cerebral auto regulatory mechanism that

755.91 -> helps in maintaining the constant level of

759.03 -> cerebral blood flow right. So, if, whether there

762.6 -> is increase in blood pressure or whether is drop

765.06 -> in blood pressure, the blood flow remains constant

768.39 -> because of this autoregulatory mechanism, but here

773.52 -> with this pathogenesis because of vasospasm and

776.79 -> the endothelial dysfunction, and because of the

780.21 -> increase in mean arterial pressure, this auto

783.48 -> regulatory mechanism disrupted right. So, with

787.92 -> this disruption, there is a hyperperfusion and

791.28 -> with this hyperperfusion and along with this

793.69 -> endothelial damage, what happened again there is a

797.2 -> leaky capillaries. So, with this leaky

799.69 -> capillaries, what happened the intravascular fluid

802.75 -> is now shifting towards the interstitial spaces

805.96 -> okay. So, because the fluid is shifting, that may

809.71 -> cause the vasogenic edema.

818.87 -> So, depending on how much the area is involving,

822.95 -> that brings about changes in woman that may cause

826.22 -> headache as well as visual disturbances headache

832.46 -> and visual disturbances in a woman. So, mainly it

837.92 -> is involving the occipital lobe as well as the

840.26 -> parietal lobe and once the occipital region is

843.68 -> involving, because we are knowing that the This

847.7 -> region is responsible for the vision. So, once the

850.85 -> occipital region is involving and there is a

854.21 -> vasogenic edoema there, then it can cause the

857.66 -> visual disturbances in woman like that may cause

861.2 -> blurring of vision as well as this can cause

868.73 -> scotometa or scotoma that is the partial loss of

874.16 -> field of vision, right. And that may even cause

878.99 -> diplopia that is the double vision. Right? But

884.6 -> blindness is very rare. It is not happen oftenly

889.85 -> but it is happened so severely that it involves

893.06 -> many of the region and it excites many of the

896.15 -> neurotransmitters with this edema especially the

899.24 -> glutamate Then it can cause convulsion in a woman.

905.12 -> So this preeclampsia can be complicated with the

908.48 -> convulsion if the edema is so severe, and that may

913.01 -> ultimately change into the eclampsia right. But

917.33 -> along with that, if the vasospasm is takes place

920.66 -> in the retinal vessels, that can also cause the

924.56 -> retinal detachment. So, there are many

930.77 -> manifestations that indicate that the CNS is

934.7 -> involving right. So basic are the headache as well

939.44 -> as the visual disturbances right. So in this

942.77 -> lecture, we have seen with this vasospasm and the

946.16 -> endothelial dysfunction how these organs are

948.86 -> involving and what all changes these brings about.

953.45 -> Thank you.

Source: https://www.youtube.com/watch?v=MG6BuklNAhI