The management of pre-eclampsia.

London : University of London Audio-Visual Centre, 1979.

1 encoded moving image (34.20 min.) : sound, black and white.

00:34:20

University of London

Unrestricted

CC-BY-NC

Creative Commons Attribution-Non-Commercial 2.0 UK: England & Wales

In English

Discussed by Mr Geoffrey Chamberlain and Dr Gordon Stirrat, John Radcliffe Hospital, Oxford. Medical Editor: Mr Geoffrey Chamberlain, Institute of Obstetrics and Gynaecology. Produced by Jennie Smith. Made for British Postgraduate Medical Federation in association with the Blair Bell Research Society. Made by University of London Audio-Visual Centre.

This video is one of around 310 titles, originally broadcast on Channel 7 of the ILEA closed-circuit television network, given to Wellcome Trust from the University of London Audio-Visual Centre shortly after it closed in the late 1980s. Although some of these programmes might now seem rather out-dated, they probably represent the largest and most diversified body of medical video produced in any British university at this time, and give a comprehensive and fascinating view of the state of medical and surgical research and practice in the 1970s and 1980s, thus constituting a contemporary medical-historical archive of great interest. The lectures mostly take place in a small and intimate studio setting and are often face-to-face. The lecturers use a wide variety of resources to illustrate their points, including film clips, slides, graphs, animated diagrams, charts and tables as well as 3-dimensional models and display boards with movable pieces. Some of the lecturers are telegenic while some are clearly less comfortable about being recorded; all are experts in their field and show great enthusiasm to share both the latest research and the historical context of their specialist areas.

Segment 1 Chamberlain introduces the subject, describing how pre-eclampsia has always been a 'bugbear' of obstetrics. He then introduces Dr Gordon Stirrat. Stirrat explains how the traditional definition of pre-eclampsia, based on hypertension, oedema and proteinuria is inaccurate as these conditions alone are not enough to suspect the condition. He suggests, rather, that these symptoms be used as a screening test, defining the criteria for diagnosis. He outlines other predisposing features such as the link between pre-eclampsia and first pregnancies as well as a history of pre-eclampsia or cardiovascular disease in the family. Time start: 00:00:00:00 Time end: 00:06:23:00 Length: 00:06:23:00

Segment 2 Stirrat and Chamberlain discuss the logistics of a screening process to locate women susceptible to pre-eclampsia. They then talk about the relationship between women who smoke during pregnancy and pre-eclampsia. Stirrat goes on to describe some of the systems affected by pre-eclampsia, beginning with the vascular system, in particular hypertension - he shows a graph charting a patient's patterns of hypertension throughout the course of her pregnancy. Time start: 00:06:23:00 Time end: 00:10:54:21 Length: 00:04:31:21

Segment 3 Stirrat continues to discuss the effects of pre-eclampsia on the vascular system, now in relation to the placenta; he shows slides of placental infarcts in a woman with severe proteinuric pre-eclampsia. Chamberlain and Stirrat discuss pre-eclampsia and prematurity and the link between the renal system (kidneys) and pre-eclampsia. Time start: 00:10:54:21 Time end: 00:16:01:20 Length: 00:05:07:24

Segment 4 Stirrat talks further about renal complications during pre-eclampsia; this includes glomerular damage, increase in plasma creatinine and the most serious complication, proteinuria, which often ends fatally. Stirrat then moves on to talk about clotting system changes, in particular changes in intravascular coagulation caused by changes of factor VIII; he shows a graph detailing these. Chamberlain and Stirrat discuss pre-eclampsia without hypertension and the effects of pre-eclampsia on the immune system. Time start: 00:16:01:20 Time end: 00:20:16:00 Length: 00:04:15:05

Segment 5 Stirrat discusses the management of pre-eclampsia and stresses again that prediction is key; early diagnosis of those at risk can lead to admission to hospital, close monitoring of symptoms and delivery of the baby at the correct time. Chamberlain and Stirrat talk about whether or not bed rest has any effect on the pre-eclamptic patient. Other treatments are discussed - diuretics are thought to be dangerous for mother and baby but hypotensive agents help the mother and cause no harm to the baby; a table is shown listing the correct dose and type of drug to treat hypertension in pregnancy and Stirrat explains the function of each one. Time start: 00:20:16:00 Time end: 00:26:36:00 Length: 00:06:20:20

Segment 6 Stirrat talks about drugs to treat eclampsia and shows a table listing correct dose levels. Stirrat and Chamberlain discuss the use of magnesium sulphate, particularly in the US, to control eclampsia. Stirrat describes the future of research into pre-eclampsia; he focuses on the possibility of there being a recessive immune-response gene triggering an antigen from the placenta to affect the mother. The fact that most cases of pre-eclampsia occur in primagravidas (1st pregnancies) is discussed. It is pointed out that there is also a possibility that an antigen in sperm might trigger an immune response in the mother and that there seems to be a greater risk of pre-eclampsia when the mother is carrying a male foetus. Chamberlain sums up the lecture and thanks Stirrat. Time start: 00:26:36:00 Time end: 00:34:20:07 Length: 00:07:44:07