Posted: May 19th, 2023

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DISCUSSION POST # 1 Reply to h

Preeclampsia is defined as hypertension that is new onset. Parameters for diagnosis include twenty weeks or greater gestation and two occurrences at least four hours apart of a systolic blood pressure of greater than 140 mmHg or a diastolic blood pressure of greater than 90 mmHg or systolic blood pressure of 160 mmHg and diastolic blood pressure of 110 mmHg or greater (Karrar & Hong, 2023). Other findings may include proteinuria, edema, headache, persistent abdominal pain, and other alterations in lab findings (Karrar & Hong, 2023).
The etiology of preeclampsia is not well-defined. Preeclampsia is thought to be caused by abnormal placentation, which is the arrangement of the placenta in the uterus, leading to dysfunction remodeling of the aberrant spiral arteries, oxidative stress, placental ischemia, or hypoxia (Karrar & Hong, 2023). As many as 50,000 maternal deaths worldwide may be attributed to preeclampsia and eclampsia every year and it is correlated to ethnicity and race, African American and Hispanics being the most prevalent (Karrar & Hong, 2023). Risk factors include advanced age, obesity, comorbidities, and family history (Karrar & Hong, 2023).
The pathophysiology involves multisystem dysfunction. Remodeling of the arteries leads to ischemia triggering the release of antiangiogenic and pro-inflammatory factors which causes abnormal vessel formation and inadequate blood supply to multiple organ systems (Karrar & Hong, 2023).
Early detection with a focus on blood pressure management is important in the treatment of preeclampsia. Maternal labs and fetal evaluation should be monitored closely. Ultrasound of the amniotic fluid index and fetal status are key to determining delivery or medical management of preeclampsia (Karrar & Hong, 2023). Complications of preeclampsia include eclampsia, HELLP syndrome, myocardial infarction, stroke, bleeding, or pulmonary edema. In severe cases with imminent delivery prior to thirty-four weeks gestation, administration of antenatal steroids is recommended however should not delay delivery (Magee et al., 2022). Intravenous medications for severe cases include labetalol, hydralazine, and magnesium sulfate (Magee et al., 2022). For pregnant women with a high risk for preeclampsia, exercise, low dose aspirin, and calcium in greater than twenty weeks gestation (Magee et al., 2022). Low molecular weight heparin is not recommended as it has not shown to impact outcomes (Magee et al., 2022).

Maternal and fetal morbidity and mortality associated with preeclampsia are decreased with early detection and medical management. Patient education is essential beginning with defining preeclampsia and the associated signs and symptoms. Recommendations for prevention of preeclampsia include exercise and healthy diet for all pregnant women. Provide patient education that includes signs and symptoms such as unrelieved headache, visual changes, and upper abdominal pain (Magee et al., 2022). Instruct the patient to monitor blood pressure in high-risk pregnancies and explain that preeclampsia can cause inappropriate fetal growth and decrease amniotic fluid (Magee et al., 2022). Provide information about treatment options and prevention.

Instruct patient to contact the doctor or nurse immediately with symptoms of severe preeclampsia. These symptoms include severe headache, vision disturbances such as seeing spots, blurred vision or flashes of light, abdominal pain, or new shortness of breath. Also contact the doctor is there is vaginal bleeding, reduced or no fetal movement or are in labor (Magee et al., 2022).

DISCUSSION POST # 2 Reply to k
Introduction
Uterine fibroids are benign uterus tumors that arise from the smooth muscle cells in the myometrium; they are common during childbearing age and are not associated with cancer formation, also called leiomyomas, fibromyomas, and myomas. Most are small and asymptomatic. (Lynne Dunphy et al., 2023)
Epidemiology:
According to Lynne Dunphy et al. (2023), Prevalence increases in 30–50-year females and decreases with menopausal females. By the age of 50 years, 50% of African American and Asian American females have leiomyomas, and 30% of European American females have them. Black race recurrently reports increased Uterine Fibroid risk by two–threefold compared to white races.
Etiology:
The cause of Leiomyomas is unknown. Genetic changes. Many fibroids contain changes in genes that differ from those in typical uterine muscle cells. (Lynne Dunphy et al., 2023)
Estrogen and progesterone appear to promote the growth of fibroids, evidenced by it containing more estrogen and progesterone receptors than typical uterine muscle cells and tend to shrink after menopause due to decreased hormone production. Lynne Dunphy et al., 2023)
Pathophysiology:
It develops from a single neoplastic smooth muscle cell with an abnormal chromosomal pattern and is classified according to its location subserosa, intramural, submucosal, or pedunculated. (Lynne Dunphy et al., 2023)
The location of fibroids within the uterus contributes to the symptoms presented. Pedunculated also grow out from the surface uterus or into the uterus cavity.
When leiomyomas outgrow their blood supply, they can become necrotic and ulcerate. (Lynne Dunphy et al., 2023)
Risk factors:
According to Peter Kovacs (2017),
• Black race is associated with a two- to threefold increased risk.
• Age is associated with a 10-fold increased risk when those aged 40 years and over or 50 years and above are compared with those aged 20-30.
• Family history
• Time since last birth is associated with a two- to threefold increase among those who gave birth more than five years ago.
• Higher parity is associated with reduced risk.
• More common among premenopausal women
• Smoking lowers the risk when the BMI is under 22.2 kg/m2 (by one-third compared with same-weight nonsmokers)
• Current oral or injectable contraception use is associated with a two-thirds reduced risk.
• Women with HT (fivefold increase).
• Intake of food additives and soybean increases the risk.

Signs and symptoms:

Bleeding between periods. (Peter Kovacs,2017).

Heavy bleeding during your period, sometimes with blood clots
Periods that may last longer than usual.
Needing to urinate more often.
Pelvic cramping or pain with periods. (Peter Kovacs,2017).
Feeling fullness or pressure in your lower belly
Pain during intercourse
Diagnosis:
CBC to identify Anemia, TSH, and prolactin level to evaluate the non-structural cause.
Beta-HCG Pregnancy test to rule out pregnancy. (Peter Kovacs,2017),
Endometrial Biopsy for an over-35-year-old female.
Magnetic Resonance Imaging MRI provides a better picture of the fibroids’ number, size, vascular supply, and boundaries related to the pelvis.
TVUS (Transvaginal ultrasound) is the gold standard for imaging uterine fibroids.
Hysterography (Saline infusion sonogram) or Hysteroscopy (to examine the inside of the uterus) (Peter Kovacs,2017).

Treatment:
The treatment of fibroids depends on the patient’s age, general health, symptoms, type of fibroids, pregnancy status, and if you want children in the future. Management in three categories starts at surveillance with progression to medical management or surgical therapy with increasing severity of symptoms. (Peter Kovacs,2017).
Surveillance: In this, the patient is asymptomatic and, according to current recommendations, does not require serial imaging.
Medical management:
Tranexamic acid reduces the amount of blood flow.
Iron supplements prevent or treat anemia due to heavy periods.
Pain relievers, such as ibuprofen or naproxen, for cramps or pain.
Birth control pills to help control heavy periods.
A type of IUD that releases a low dose of the hormone progestin into the uterus each day.
Hormone injections to help shrink the fibroids by stopping ovulation.
Surgical Therapy:
Endometrial Ablation for patients whose primary complaint is heavy or abnormal bleeding.
Uterine Artery Embolization: Minimum invasive procedures to decrease uterine blood supply and preserve fertility.
Myomectomy: the outcome is highly dependent on the location and size of the fibroid.
MRI-guided focused ultrasound surgery.
Hysterectomy. Remains the definitive treatment for fibroids.
Non-pharmacological intervention
Apply a hot water bottle or heating pad to your lower stomach. This will help blood flow and relax your muscles.
Lie down and rest. When resting, place a pillow under your knees when lying on your back, and if you are on your side, pull your knees up toward your chest. These help take the pressure off your back.
Regular exercise improves blood flow by triggering the body’s natural painkillers, called endorphins.
Eat a balanced diet to help maintain a healthy weight, improving overall health.
Watchful waiting and monitoring growth with pelvic exams or ultrasounds
Patient Education
When educating patients on Uterine Fibroids, the fact that it is noncancerous should be emphasized, as also the impact it can have on fertility and the quality of life. Educate on the different treatment modalities of symptomatic management and that there is little evidence of positive long-term outcomes.
Follow-up and Referral:
Patients with severe bleeding, Anemia, and palpable leiomyomas should be referred to a gynecologist for evaluation and treatment.
Small Uterine myomas should be re-examined at 3–6-month intervals or more if symptoms increase.
Hemoglobin and hematocrits are frequently monitored for Menorrhagia.
Conclusion:
Although Uterine Fibroids is a noncancerous disease, it can negatively impact the patient’s mental and physical health. The patient’s perception of the disease and treatment’s extent and possible consequences should be well explained. Treatment Primarily begins with NSAIDs and hormonal therapy trials, only escalating when symptoms are refractory or unmanageable by medication.

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DISCUSSION POST #1 Reply h

I appreciate your post on preeclampsia and the comprehensive information you provided. Preeclampsia is indeed a significant concern in pregnancy, and early detection is crucial for optimal management. You accurately highlighted the diagnostic parameters for preeclampsia, including the blood pressure thresholds and associated symptoms such as proteinuria, edema, and headache.

The etiology of preeclampsia remains uncertain, but you mentioned several factors that may contribute to its development, including abnormal placentation, oxidative stress, placental ischemia, and hypoxia. It’s also important to note that certain ethnicities, such as African American and Hispanic populations, have a higher prevalence of preeclampsia, as you mentioned.

Your discussion of the pathophysiology of preeclampsia involving multisystem dysfunction and inadequate blood supply to organs provides a clear understanding of the condition’s complexity. Additionally, you highlighted the potential complications associated with preeclampsia, including eclampsia, HELLP syndrome, and various cardiovascular events.

You provided valuable information on the management of preeclampsia, emphasizing the significance of blood pressure control and close monitoring of maternal labs and fetal status. The administration of antenatal steroids in severe cases before 34 weeks gestation and the use of medications such as labetalol, hydralazine, and magnesium sulfate for severe cases were also discussed.

Lastly, your emphasis on patient education and awareness regarding the signs and symptoms of severe preeclampsia is crucial. Prompt medical attention is necessary when experiencing severe headache, vision disturbances, abdominal pain, shortness of breath, vaginal bleeding, reduced fetal movement, or if in labor.

Overall, your response to Thalia’s post provides a comprehensive overview of preeclampsia, its etiology, pathophysiology, management, and patient education. Well done!

References:
Karrar, Z. A., & Hong, Y. (2023). Preeclampsia. In StatPearls [Internet]. StatPearls Publishing.
Magee, L. A., et al. (2022). Hypertension in pregnancy: Executive summary. Journal of Obstetrics and Gynaecology Canada, 44(9), 1272-1286. doi: 10.1016/j.jogc.2022.06.010

DISCUSSION POST #2 Reply to k

Thank you for your informative post on uterine fibroids. Your explanation of the prevalence of uterine fibroids among different racial and ethnic groups, with African American and Asian American females having higher rates, was well-supported by the scholarly reference you provided.

The etiology of uterine fibroids remains unclear, but you highlighted the role of genetic changes and the influence of estrogen and progesterone on fibroid growth. The classification of fibroids based on their location within the uterus and the potential complications, such as necrosis and ulceration when blood supply is compromised, were well-explained.

You also discussed the various risk factors associated with uterine fibroids, including age, family history, race, parity, smoking, hormonal factors, and dietary influences. These risk factors contribute to a better understanding of the condition and can guide healthcare providers in identifying individuals at higher risk.

The signs and symptoms you mentioned, such as abnormal bleeding, heavy periods, pelvic pain, urinary frequency, and pain during intercourse, align with the typical clinical presentation of uterine fibroids. The diagnostic methods you highlighted, including CBC, hormonal testing, imaging techniques like MRI and TVUS, as well as endometrial biopsy, are appropriate for confirming the diagnosis and evaluating the extent of fibroid involvement.

Regarding the treatment options

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