Friday, May 20, 2011

Hypertension in pregnancy - Patient Education

Hypertension (high BP) is a common complication of pregnancy. It occurs in later months of pregnancy. It's progressive, albeit the rate of progress varies. 

The cause of hypertension is inherent in pregnancy itself, due to variation in mother's immunological reaction to the pregnancy. Mother's immunological status changes in pregnancy, in order not to reject the fetus, and to facilitate it's growth. In pregnancies with hypertension, this immune modulation is abnormal, causing widespread immunological changes in mother, which in turn causes systemic changes in maternal body. The obvious changes are hypertension, leaky capillaries, activation of coagulation system. They cause tissue edema (not just in legs, but all tissues are edematous), albuminuria, tissue hypoxia, and organ dysfunction. It affects all organs, including kidney, liver, lungs and brain.

Hypertension is associated with restriction of baby's growth, to some degree. Mother may have swelling in her legs.

If severe, hypertension can affect mother's kidney, liver, lung and brain. It can cause these organs to fail, and mother may throw up convulsions. Her coagulation (blood clotting) is affected and she may bleed profusely. Baby's growth, if severely affected, may cause it's death. Needless to say, hypertension is a dangerous conditions, if not properly followed up, and actions taken in due time.

Anti-hypertensive (tablets for BP) are only temporarily effective, the underlying disease progresses despite treatment. As the condition is caused by the pregnancy itself, the ultimate treatment is it's removal, that's baby's delivery. The obstetrician may wait as much as possible, to allow the baby time to mature, but not allow it to go to full nine months.

Restricting salt intake or fluid intake is not the treatment of the condition. Though absolute rest is not required, some restriction of activity may help. The mother can lie down in any position, not necessarily, in later position. She has to note her baby's movements, though she need not count them exactly. The obstetrician will call her frequently, to check her BP, to carry out urine and blood investigations, to do baby's ultrasound to note it's growth and detect it's restriction.With such due treatment, complications are rare and to a great extent avoidable.

Saturday, May 7, 2011

Low BP - Patient Education

A large percentage of people consider themselves 'suffering' from 'low BP' (Blood Pressure). The symptoms of the conditions include a fainting attack or tiredness, and is often diagnosed by paramedical people or 'expert' layman. The treatment even includes excessive salt intake!

I devout consider amount of my consulting time, telling people that 'low BP' doesn't exist as a chronic disease. The BP  of a person can fall suddenly, even to dangerous levels, due to various reasons such as bleeding, dehydration, or allergic reaction. But the body takes adequate measures immediately, to maintain the Blood Pressure.

The body is capable of adjusting and maintaining the required blood pressure on second to second basis, otherwise, a sitting person won't be able to stand. The body should immediately raise the pressure, or the blood won't reach adequately to his brain, and he'll have a black out.

Body is not that much concerned with high blood pressure, because no sudden adverse events will occur due to it. So, while high blood pressure can occur as a chronic disease, not low blood pressure.

BP is variable between the patients. Normal blood pressure is considered as 120/80, but there are large number of people, whose normal is at 90/60. It's their normal blood pressure, not that they are hypotensive (low BP).

finally, I have a doubt, why no one complains of Low Temperature?

Friday, May 6, 2011

Abortion - Patient Education

Abortion early in pregnancy is very common. About 10% of diagnosed pregnancies end up in abortions (and many more pregnancies abort before they are diagnosed).

The main cause for early abortion (not late abortions, which occur after the first 3 months) is defective embryo. The formation of embryo, by fusion of male and female gametes, and the formation of the gametes themselves are delicate processes, and are prone to end up in chromosomally defective embryos. It's natures way to discard these defective embryos by means of abortion.

So, it's not the woman's defect, any problem with her uterus, any hormonal deficiencies (often cited cause), or any food or physical strain which causes the abortion. That means, the woman is not at risk of abortion, and if she aborts, it 's just a chance event. She is not at increased risk of abortion in her subsequent pregnancies.

Not knowing these people often unnecessarily get worried, and take a lot of precautions, which wont help, if the pregnancy is destined to abort.

Why  abortion is not caused by other causes

The early development of an embryo is a delicate process, with formation of all parts like brain, heart etc. After the initial few weeks, the embryo only gains in size, it's parts have been fully formed. At these delicate time, nature will present it with ideal controlled conditions. It leaves it least to the external factors, and it's mainly directed by it's internal processes themselves. So, maternal physical environment has least effect on embryo, and if the pregnancy fails, it's embryo's own fault. A pregnancy can be compared to a rocket. It's launch is a very delicate process, and the control of launch is mainly by internal arrangement. The base station takes over only after the rocket has managed to scale some to some altitude on it's own. If something goes wrong at the launch, they are not correctable, and the mission simply aborts.