Is it possible to have individualized teaching using the Common Core?

My primary field of research for this final project will be medicine. The theme would be gestational hypertension, which usually refers to hypertensive cases that occur during pregnancy and then vanish after the pregnant mother gives birth. My study proposal would focus on determining the root cause of hypertensive emergencies in pregnant women, whether the hypertension is preventable, and whether cases during pregnancy appear to decrease after childbirth.

According to a study, hypertension risks affect 5% to 7% of all births (Ness RB, Roberts JM, 2009). The following research paper will majorly address young women planning to get pregnant, women who are already pregnant and also medical practitioners so that they can get a general view on the basis of hypertension. The major research questions that will be dealt with will include;

Identify what causes hypertensive emergency?

Identify whether hypertension in pregnancy is preventable

Identify treatment methods for treatment of gestational hypertension

Identify whether gestational hypertension disappears after childbirth

There have been a number of research studies that have been carried out about gestational hypertension. These studies have been done individually, have been carried out by a group of researchers and later been published in journals, articles or books. One of the research journals include American Society of Hypertension published by Marshall D. Lindheimer, MDa, Sandra J. Taler, MDb, and F. Gary Cunningham, MD. Other researchers include RB, Roberts JM. Epidemiology of hypertension: In: Lindheimer MD, Roberts JM, and Cunningham FG, who researched about the same problem.

There have also been a number of groups who have published a number of documents that aim in providing diagnosis and management of hypertensive cases in pregnancy. One of them includes National High Blood Pressure Education program report that was updated in 2000 and 2010 and a bulletin of the American College of Obstetricians and Gynecologists.

Literature review

Hypertension during pregnancy is one of the leading causes of maternal and fetal death (Ness RB, Roberts JM, 2009). The hypertensive cases witnessed on pregnant mothers may be caused by preeclampsia which is the increase of protein in urine, may develop on its own or may also be caused by other chronic cardiovascular illnesses (Von Dadelszen P, 2003). It is a common thing for various alternations in cardiovascular functions and volume homeostasis to occur during pregnancy (Ness RB, Roberts JM, 2009). Physicians and clinical practitioners need to be aware of these alterations so that they can detect preexisting and also detect new onset of disease.

Increase in cardiac input of either systolic or diastolic pressure at any one time during pregnancy may be a sign of developing gestational hypertension (Ness RB, Roberts JM, 2009). Studies involving two women have been done that have shown that diastolic pressure of 85mm Hg or arterial pressures with a mean of 90mm Hg at any trimester during pregnancy lead to fetal mortality (ASH, 2008). Decrease in creatinine and urea nitrogen lead to preeclampsia when the glomerular filtration rate raises causing renal diseases (Lindheimer MD, Conrad KP, Karumanchi SA, 2008).

How to measure hypertension

In order to measure hypertension it is important to understand what this term stands for. Hypertension is generally the increase in systolic levels to a value of 140mm Hg and diastolic levels of 90 mm Hg and that are read and confirmed 4 to 6 hours apart (Ness RB, Roberts JM, 2009). However, if patients have blood pressures below 140/90 mm Hg cut off and who have generally experienced a 30 or 15 mm Hg increase in systolic and diastolic pressures should be a case of concern and such patients should be treated as high risk patients (Ness RB, Roberts JM, 2009).

To measure blood pressure during pregnancy it is best that the woman is sitting quietly for some few minutes while having their arm cut off at heart level. Diastolic pressure is measured at the 5th sound known as Korotkoff sound (Ness RB, Roberts JM, 2009). However, pregnant women tend to have a general difference in the fourth and fifth Korotkoff sound (Ness RB, Roberts JM, 2009).

How hypertension is classified during pregnancy

Hypertension cases in pregnancy have been quite confusing for various caregivers and physicians for a long time. There have been several terms that have been used to classify the disorder and include pregnancy induce hypertension, gestosis, preeclamptic toxemia (Zeeman GG, Vollaard ES, Alexander JM, McIntire, 2007) and a final term for gestational hypertension is given as preeclampsia as published by the National High Blood Pressure Education program. According to the publication blood pressure in pregnancy is classified into; chronic hypertension of any cause, preeclampsia, gestational hypertension and preeclampsia that is superimposed on chronic hypertension (Ness RB, Roberts JM, 2009).

Preeclampsia that is pure or superimposed may have severe effects on the mother and baby (Von Dadelszen P, 2003). Women that suffer hypertension from any cause have mostly mild hypertension at 105mm/ Hg and their pregnancies are generally uncomplicated (Ness RB, Roberts JM, 2009). Increase in blood pressure will be caused by various reasons such as renal diseases, endocrine tumors and renal artery stenosis (Lindheimer MD, Conrad KP, Karumanchi SA, 2008). There is blood pressure that is present for the first time during pregnancy and is quite dangerous when not diagnosed (Ness RB, Roberts JM, 2009). However, when diagnosed it can be easily managed to successful levels either surgically or through use of drugs and this is dependent on the stage of gestation (Ness RB, Roberts JM, 2009).

High blood pressure may also be caused by Cushing syndrome and may cause poor fetal outcomes (Ness RB, Roberts JM, 2009). However, this is rare occurrence. Increase in progesterone hormones in pregnancy may also cause the blood pressure in pregnant women to rise (Ness RB, Roberts JM, 2009). Mild to moderate rise in levels of blood pressure after mid gestation with normal levels of protein in urine has been reported and this majorly occurs when the expectant mother is near term (Lindheimer MD, Conrad KP, Karumanchi SA, 2008). More severe forms of hypertension involve the increase of urine in the blood (Lindheimer MD, Conrad KP, Karumanchi SA, 2008). There have been unclear causes of hypertension in pregnancy, but this development has been used to classify women who are likely to develop hypertension later in life and is very common to the development of gestational diabetes (Ness RB, Roberts JM, 2009). The elevated high blood pressure in pregnant women is seen to return to normal after delivery and this is clinically known as transient hypertension (Ness RB, Roberts JM, 2009). This kind of hypertension may affect some women during one or even during subsequent pregnancy periods (Ness RB, Roberts JM, 2009).

It is a good thing to note that most of the women who suffer from chronic hypertension will have normal pregnancy periods so long as their blood pressure remains moderate or mild (Von Dadelszen P, 2003). However, the development of preeclampsia during pregnancy will cause so many pregnancy complications (Von Dadelszen P, 2003). Therefore, it is important that preeclampsia is diagnosed early enough so that it is treatable and differentiated from other causes of blood pressure in pregnancy (Von Dadelszen P, 2003). Research has however not really ruled out various causes of blood pressure in pregnancy and therefore physicians are encouraged to manage pregnant mothers with blood pressure as though she is suffering from preeclampsia (Ness RB, Roberts JM, 2009).

Research paper on preeclampsia

According to a number of obstetricians and gynecologists, preeclampsia has been defined as a protein disorder that normally involves a number of organ systems and is characterized by proteinuria and hypertension (ASH, 2008). Proteinuria is normally characterized by the excretion of 300mg per 24 hours of urine protein or a creatinine amount of 0.3 (Lindheimer MD, Conrad KP, Karumanchi SA, 2008). This is defined as 1 dipstick reading. It has however been noted that dipstick values of 1 normally show results of false-positive and false-negative values because it is difficult to have accurately timed urine collections and that is why the urine/ creatinine or protein ration is used to eliminate such errors (Lindheimer MD, Conrad KP, Karumanchi SA, 2008). Research on the urine/creatinine and protein ratios are however still under investigation.

Rapid weight gain and edema and also the appearance of coagulation and liver function abnormalities are some of the symptoms of preeclampsia (Von Dadelszen P, 2003). According to research preeclampsia majorly develops after a 20 week gestational period or most often when the mother is about to deliver her baby (ASH, 2008). There have been attempts to categorize preeclampsia as either mild or severe (Von Dadelszen P, 2003). For a long time, preeclampsia was labeled a disease of theories, however, according to recent research has been able to open pathways in which it can accurately be predicted, prevented and this has led to development of better treatment of the disease (Von Dadelszen P, 2003). However, the article will not focus on etiological theories of preeclampsia but will focus on the placenta and thus focus on research done on the placenta and in the long run be able to categorize the disorder in two ways.

The first categorization is that the placenta is majorly involved in production of various substances such as certain proteins and trophoblastic debris that are able to find their way into the maternal circulation system (Von Dadelszen P, 2003). The second categorization is known as maternal and it depends on various factors some being the circulating factors and others been the health of the mother and genetic factors (Von Dadelszen P, 2003). A research carried in 2008 showed various interpretations of various antiangiogenic substances that are produced by the placenta during the development of the condition (ASH, 2008). The research also showed that women likely to develop preeclampsia have placentas that produce antiangiogenic proteins (ASH, 2008). These proteins are later shown to reach high levels in the maternal circulation (Von Dadelszen P, 2003).

It has however not been researched on the exact cause leading to overproduction of the proteins from the placenta. However, there is ongoing research on the various immunological mechanisms that will be able to reduce and counteract the effects of placenta protein. The research been carried out is quite promising.

Prediction of preeclampsia

A number of research studies have been carried out to help in the prediction of preeclampsia and to try and rule out benign hypertensive disorders. Some of these research studies include the evaluation of various urinary markers and various imaging techniques (Lindheimer MD, Conrad KP, Karumanchi SA, 2008). In 2004, some studies were carried out but did not exactly predict preeclampsia. Therefore, researchers sought out a various combination of methods to help in the prediction of preeclampsia (Von Dadelszen P, 2003). There have been more recent studies that have been used in prediction of preeclampsia and these have proven to be more successful. They include combinations of PIGF, sEng, sFlt and they also help in the diagnosis of the condition (Von Dadelszen P, 2003).

Most of these studies carried out have been able to demonstrate prediction of preeclampsia that has very high sensitivities (ASH, 2008). They include various combinations of serum such as PIGF, sEng, SFlt-1 (Von Dadelszen P, 2003). However, there has been a number of data appearing from analysis of various banked specimens used in earlier trials (ASH, 2008). A number of progressive studies were carried out from 2008 (ASH, 2008).

Ways of preventing preeclampsia

There have been various studies on the prevention of preeclampsia (Von Dadelszen P, 2003). The studies revolve around the fact that administration of drugs, vitamins or minerals can be used to inhibit or reverse the causal mechanisms of preeclampsia (Von Dadelszen P, 2003). Research carried out in early 2008 identified two major interventions that could be used in providing preventive effects against preeclampsia; one of the interventions included the administration of aspirin in low doses that was shown to reduce preeclampsia by 10% (ASH, 2008). However, the major challenge was the large number required to treat the condition was quite large (ASH, 2008).

Another preventive intervention strategy was the use of calcium supplementation that was used in a population with low dietary calcium intake. When calcium was used as a preventive method, preeclampsia was shown not to decrease but various adverse effects such as fetal death were cabbed. Other studies showing preventive factors for preeclampsia was the supplementation with vitamins C and E. There was still no effect in the prevention of preeclampsia and harmful effects in various high risk populations were noted. There were other large trials carried out by National Institute of Child Health and Development in conjunction with Maternal Fetal Medicine Trials and were later completed in late 2008 and were later supposed to be reported early the next year.

Treatment

When a pregnant mother is diagnosed with preeclampsia or with hypertensive pregnancy at any stage of pregnancy, hospitalization is often the best alternative (Ness RB, Roberts JM, 2009). This is due to the fact that hypertension in pregnancy can rapidly escalate (Ness RB, Roberts JM, 2009). With hospitalization, diagnostic errors are minimized while incidences following hypertension such as convulsions are diminished (Ness RB, Roberts JM, 2009). All these are able to prevent fetal morbidity. In all cases, hypertension in pregnancy and also hypertension caused by preeclampsia is only treatable through delivery and in this case, maternal and fetal disease outcomes are shown to change in a very fast way (Von Dadelszen P, 2003).

Physicians majorly recommend induction of labor when the baby is near term or alternatively, temporization of pregnancy if it is at an early stage (Zeeman GG, Vollaard ES, Alexander JM, McIntire, 2007). When termination of pregnancy is recommended and during this period of termination the blood pressure rises to uncontrolled levels, the physician may recommend various antihypertensive agents that are considered safe in pregnancy (Ness RB, Roberts JM, 2009). The physician may also recommend delivery at any stage of pregnancy if the hypertension is shown to remain uncontrolled for a period of 24 to 48 hours if certain risk signs are shown such as liver abnormalities, decreasing renal functions and convulsive signs and symptoms (Zeeman GG, Vollaard ES, Alexander JM, McIntire, 2007).

Hospitalization for close monitoring is still the best alternative for close monitoring of patients (ASH, 2008). Pregnant women are then observed throughout their pregnancy period and gestation is allowed to continue as long as the blood pressure in a pregnant mother remains controlled (ASH, 2008).

Conclusion

Looking closely at the studies that have been carried out, it is right to conclude that research has not made a way to determine the exact causes of gestational hypertension more so hypertension caused by preeclampsia. They have also not been able to come up with various preventive measures that need to be taken to control this condition. However, there has been very good research in terms of management of gestational hypertension and this has been shown through the successful births even from pregnant mothers suffering from the condition.

Bibliography

ASH. (2008). American Society of Hypertension.

Lindheimer MD, Conrad KP, Karumanchi SA. (2008). Renal Physiology and disease iin Pregnancy. The Kidney; Physiology and Pathophysiology.

Ness RB, Roberts JM. (2009). Epidemiology of hypertension. Chesley’s Hypertensive Disorders in Pregnancy, 3, 43-65.

Von Dadelszen P, M. L. (2003). Subclassification of preeclampsia. Hypertensive Pregnancy, 143.

Zeeman GG, Vollaard ES, Alexander JM, McIntire. (2007). “Delta preeclampsia”—a hypertensive encephalopathy in ”normotensive” women.