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