Gestational Hypertension (updated 2023) - CRASH! Medical Review Series 

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(On Thursday of March 30, 2023). On the Matter of Gestational Hypertension (Updated 2023) by MD Paul W. Bolin (CRASH! Medical Review Series Originator), a Matter of Alloimmunogeneicity And/or Obstetrics-Glycolysology: 1) Where Spectrum of Gestational Hypertension Disorders Follow: 1) Gestational Hypertension (GH); 2) Chronic Hypertension; 3) Pre-eclampsia: a) Mild Pre-eclampsia; b) Severe Pre-eclampsia; c) Chronic Hypertension with Superimposed Pre-eclampsia; 4) Eclampsia (Proteinuria, Hypertensions with Seizures); 5) HELLP Syndrome is Hemolysis Enzymes of the Liver Elevation and Thrombocytopenia (Low Platelets); 2) Aetiology is Idiopathic but Alloimmunogeneicity is Possible as Epidemiology shows Genetics and Rh Negative Reactivity of Mothers to be High And Associated with Human Leukocyte Antigen (MHC-I, MHC-II Proteins) of DR-1,3, 4 at a Minimum and Considerably Involved with this Endothelial Dysfunction and Vasospasms therein. GH is a Diagnosis Given to Simple Hypertension in a Female in Gestation with Possible Progression into Pre-eclampsia Diagnosis After the 20th Week with Sustained Hypertension (140/90 mm Hg), but no Proteinuria (Endothelial Dysfunction therein) in a Normally Normotensive Female. It is important to Understand Hypertensive Disorder of Gestation are the Leading Cause of Pre-Term Delivery (Usually at 37 Week Scheduled). Chronic Hypertension Presents without Proteinuria Before the 20th Week Mark; 2) Diagnosis (Dx) of GH: 1) CBC with Smear; 2) BMP (Microangiopathic Hemolytic Anemia Possibility) with the BUN and Creatinine Elements in Particular Focus; 3) Urinalysis (UA) for Proteinuria Element of GH; 4) Liver Function Testing (LFTs) for Possible Liver Involvement of Greater Pathology (Pre-eclampsia); 5) Prothrombin Time/Partial Thromboplastin Time (PT/PTT would be Prolonged and Signal Liver Injury of Acute Gravity), this however is not Necessary as the Pathological Features of Hypertension and Proteinuria have been Clear with Clinical and UA; 6) Uric Acid Levels in Serum is also Indicative of Liver Dysfunction; 3) Treatment (Tx): 1) Antihypertensive Labetalol (Non-Teratogenic and Effective in Clinical Studies) via Non-Selective Alpha-1 and Beta-2 Adrenergic Receptor Antagonisms; 2) Lifestyle Modification (Diet, Exercise, Better Sleep, and the Like) can be Tried; 3) If Severe GH (160/110 mm Hg), a) IV Labetalol or PO Nifedipine (Dihydropyridine Calcium Channel Inhibitors MOA and Drug Class), and b) Magnesium Sulfate (For CNS Seizures Possibility and Pathological Vasoconstriction) IV Hydralazine also Possible (Inositol Triphosphate-Induced Calcium Inhibition of the Sarcoplasmic Reticulum Therein; otherwise Muscle Relaxant Drug Class); 4) Precaution for Progression to Pre-eclampsia (Proteinuria), Eclampsia (CNS Seizures), or HELLP Syndrome (Hemolysis, Transaminemia, Thrombocytopenia); 5) Delivery at 37th Week is the Treatment for Pre-eclampsia and GH; 4) SSx of GH and Pre-eclampsia (Prodrome) of 1+ or Greater Proteinuria; 2) Ophthalmopathy or Vision Loss; 3) Headaches; 4) Right Upper Quadrant (RUQ); 5) Peripheral Edema; 6) CNS Involvement (Seizure or Loss Of Consciousness, Vertigo, Dizziness); 5) Management (Mx): 1) Delivery Before 37 Weeks Expectant Management with Glucocorticoids; 2) Before 37th Week and Indications for Delivery: a) Consider Induction of Labor and Corticosteroids (Pharmacologic Agents of Oxytocin or Misoprostol for Inducing Labor); b) Greater than 37th Week via Induction of Labor; 3) Induction of Labor Indications: 1) Abnormal Fetal Testing; 2) Intrauterine Growth Retardation (IUGR); 3) Development of Pre-eclampsia or Eclampsia; 4) Evidence of End-Organ Damage; 5) Placenta Abruptio (Labor or Rupture of Membranes); 6) Complications (Cx) of GH: 1) Premature Delivery; 2) Intrauterine Growth Retardation (IUGR); 3) Small for Gestational Age (SGA); 4) Pre-eclampsia Progression; 5) Abruptio Placentae; 6) Fetal Demise; 7) Maternal Malignant Hypertension: a) Cerebral Hemorrhage; b) Cardiac Decomposition; and c) Renal Failure; 7) Pathology overall is Idiopathic suggesting Hypersensitivity because Normal Blood Pressure of Pregnancy is actually Less than in Pre-Gestation Period. Homeostasis of BP in Pregnancy is actually Less with a Net BP Decrease of 20% due to Increased Circulatory Output (Cardiac Output) of 20%-50% and Decreased Peripheral Vascular Resistance of 20%. Blood Pressure nevertheless should never be Higher than Baseline Recordings (Pre-Pregnancy Blood Pressure). Goodness, My first Obstetrics with Possible Alloimmunity. Not Really, Just Kidding. The Alloimmunogeneicity was just the beginning of a Diathesis of Sheer, Purely Negligent Breeding Habits, where neither the Mother or the Father Actually Premeditate anything Good. IVIG of Prophylaxis, Induced Labor with HLA Modification via Genetic Vectors of both Lipoproteins and other Methods to Correct and Safe two Lives when simple Rationalization of Hybridization was Suffice. Autosomal Recessives are not the most Nitid of Breeders or are Dominant Genotypes Rational. MD Paul W. Bolin, es geht gut. Wir aufbauen Medizine aber Arzneistoff und Heilmittel werden auch verschieden soll sein. Heil!

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