Preeclampsia Definition
BP ≥ 140/90 after 20 weeks gestational age ± proteinuria (≥ 300 mg/24h)
Eclampsia Treatment
Magnesium sulfate IV (seizure prophylaxis and treatment; antidote is calcium gluconate)
Postpartum Hemorrhage #1 Cause
Uterine Atony (Tone) → Bimanual uterine massage + Oxytocin
Sacral Mechanics in Labor
Sacral base moves anterior (nutation) to widen the pelvic outlet during delivery
Hypertensive Disorders of Pregnancy Classification
Categorization based on gestational timing and end-organ damage:
| Disorder | Onset Timing | Blood Pressure Criteria | Defining End-Organ Features |
|---|---|---|---|
| Chronic Hypertension | Prior to pregnancy or < 20 weeks gestation | BP ≥ 140/90 mmHg | Persists > 12 weeks postpartum; no new proteinuria |
| Gestational Hypertension | Onset ≥ 20 weeks gestation | BP ≥ 140/90 mmHg | No proteinuria; no severe features; resolves postpartum |
| Preeclampsia | Onset ≥ 20 weeks gestation | BP ≥ 140/90 mmHg | Proteinuria (UPCR ≥ 0.3 or 300 mg/24h) or any severe feature |
| Preeclampsia with Severe Features | ≥ 20 weeks gestation | BP ≥ 160/110 mmHg on 2 occasions | Thrombocytopenia (< 100k), AST/ALT > 2x ULN, Cr > 1.1, pulmonary edema, persistent vision changes/headache |
| HELLP Syndrome | Late 2nd / 3rd trimester or postpartum | Hypertension present in 85% | Hemolysis (schistocytes, LDH > 600), Elevated Liver enzymes, Low Platelets (< 100k) |
| Eclampsia | ≥ 20 weeks or early postpartum | Hypertension | New-onset grand mal tonic-clonic seizures in preeclamptic patient |
Postpartum Hemorrhage (The 4 Ts)
Defined as blood loss ≥ 1000 mL or bleeding associated with signs of hypovolemia within 24 hours of birth:
1. Tone (Uterine Atony — 70% of Cases)
Soft, boggy, poorly contracted uterus above the umbilicus. Management: Bimanual uterine massage, high-dose IV Oxytocin, Methylergonovine (Methergine - contraindicated in hypertension), Carboprost (Hemabate - contraindicated in asthma), Misoprostol.
2. Trauma (Lacerations, Hematomas — 20%)
Firm contracted uterus with continuous trickling of bright red blood. Requires systematic speculum examination and surgical repair.
3. Tissue (Retained Placenta — 10%)
Missing cotyledons on placental inspection. Requires manual exploration or suction curettage.
4. Thrombin (Coagulopathy — 1%)
Failure of blood to clot. Associated with placental abruption, severe preeclampsia, amniotic fluid embolism.
COMLEX / OMM Integration
NBOME High-Yield Correlate
Pelvic and Uterine Osteopathic Correlates
- Autonomics: Uterine and ovarian sympathetics originate from
- Sacral Rocking: Gentle rhythmic articulatory rocking of the sacrum relaxes hypertonic pelvic floor musculature and relieves labor pains and dysmenorrhea.
- CV4 Technique: Compressing the 4th ventricle can stimulate uterine contractions in delayed labor or prolonged post-date pregnancies.
T10–L2 (inferior mesenteric ganglion). Parasympathetics arise from S2–S4 pelvic splanchnics.- Sacral Rocking: Gentle rhythmic articulatory rocking of the sacrum relaxes hypertonic pelvic floor musculature and relieves labor pains and dysmenorrhea.
- CV4 Technique: Compressing the 4th ventricle can stimulate uterine contractions in delayed labor or prolonged post-date pregnancies.
Board Traps & Common Distractors
- Trap: Using Methylergonovine (Methergine) for uterine atony in a patient with preeclampsia or hypertension. Methylergonovine causes profound vasoconstriction and can trigger hypertensive crisis or intracranial hemorrhage! Use Carboprost or Misoprostol instead.
- Trap: Using Carboprost (Hemabate) in a patient with asthma. Carboprost is a prostaglandin F2-alpha analogue that causes severe bronchospasm!