Question

Marguerite is a 16-year-old African-American, G1P0 female. She was diagnosed with gestational diabetes at 26 weeks gestation. Now at 35 weeks gestation, she calls the office with complaints of “a blinding headache,” “seeing spots before her eyes,” and RUQ “pain.”

1. What could these manifestations be related to and what do they indicate?

Answer 1

Gestational diabetes.

it is the diabetes type that occurs during pregnancy in which the level of blood glucose increases and can have a deleterious effect on the health of the mother and the fetus.

THE MANIFESTATION THAT IS SEEN IN THE PATIENT ON THE BASIS OF THE ABOVE CONDITIONS ARE RELATED TO PREECLAMPSIA or SEVERE PREECLAMPSIA

PREECLAMPSIA is the condition that occurs only in pregnancy and affects the health of pregnant women,

it occurs after 20 weeks of pregnancy or after 6 weeks of delivery of the fetus.

it causes blood pressure increases up to 140 / 90 mm of Hg, that causes proteinuria and started damaging other organs as well,

there are various risk factors theta can cause preeclampsia are;

(a) DIABETES --- That is mentioned in the question.

(b) hypertensive mother -- the mother who possesses the history of being hypertensive.

(c) primigravida or first pregnancy --- as the patient is pregnant for the first time.

(d) multiple pregnancies, age of mother above 35years of age.

(e) family history.

why these changes are seen in preeclampsia

the exact known cause is not known but some pathophysiologic features say that it may occur due to the abnormal development of the placenta

in normal pregnancy, the spiral arteries which are ten times wider than normal arteries deliver blood to the fetus for its normal growth and the development, but in preeclampsia, the arteries become extremely narrow and fibrous and the proper blood delivery to the fetus get affected, poorly perfused placenta can lead to various complications such as IUGR ( INTRAUTERINE GROWTH RESTRICTION ) and sometimes death,

the hypoperfused placenta starts releasing pro-inflammatory protein that causes endothelial cell of mother dysfunctional which lead to narrowing of blood vessels or vasoconstriction and also hinders kidney function that retains more salt into the body causes preeclampsia.

hypertension that occurs in preeclampsia causes blood pressure to rise up to 140 mm of Hg systolic and up to 90 mm of Hg diastolic,

In severe preeclampsia, systolic blood pressure rises up to 160 mm of Hg and diastolic up to 110 mm of Hg

preeclampsia can cause narrowing of the blood vessels to the various parts of the body's such as

1. kidney--- less blood supply to the kidney lead to damage to the glomerulus causes oliguria and proteinuria (glomerular damage sign)

2. eyes or vision -less blood supply to the retina causes flashing of the light, blurry vision and also one of the conditions that are scotoma that is feeling of a spot on a white wall.

3. less blood supply to the liver causes inflammation and damage to the liver cells which causes elevation of the liver enzyme which causes stretching and pain to the right upper quadrant of the stomach.

4. injury to the endothelial cells leads to the thrombus formation which utilizes platelets in order to break the thrombus, the RBCs that moves in the blood get hit by the thrombus and causes hemodialysis, and it Is called HELLP syndrome that is hemolysis elevated liver enzyme and low platelets, and HELLP SYNDROME IS SEEN IN SEVERE PREECLAMPSIA or eclampsia.

injury to the endothelial cells causes vascular permeability to allow more water to slip and flow to the side tissues of the neighboring cells, also proteinuria causes movement in the fluid from the vessels of blood to the tissues, which causes edema such as;

cerebral edema--- confusion, BLINDING headache ( mentioned in the condition of the client), and sometimes seizures.

Generalized edema,---- edema to the hand, face and the feet.

and Pulmonary edema-- difficulty maintaining a patent airway.

the above-mentioned condition indicates that the patient is having SEVERE PREECLAMPSIA.