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Personal or family history of PEC Primigravid state Pregestational diabetes Existing hypertension (GHTN, cHTN) Prolonged interval between pregnancies Renal disease (focal glomerulosclerosis) Advanced maternal age (greatest risk >40 years of age) Collagen vascular disease Antiphospholipid syndrome Other coagulation abnormalities (protein C or S deficiency, factor V Leiden mutation, and hyperhomocysteinemia) Note: smoking is not a risk factor In the setting of cHTN, how is PEC diagnosed With the onset of proteinuria or other signs and symptoms of endorgan disease In hypertensive nephrosclerosis, protein excretion is typically <1 g/day In the setting of new onset PEC protienuria is typically >1+ on urine dip What are the two types of PECs What percent of cases are mild in the United States How is severe PEC defined Mild and severe 75% PEC with any of the signs or symptoms of severe eclampsia, that are mentioned below Endothelial damage Severe hypertension >160 mm Hg systolic or >100 mm Hg diastolic Pulmonary edema because of capillary leak Liver abnormalities Elevated transaminases Epigastric or right upper abdominal pain, because of hepatic congestion and pressure on the capsule

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This distinction between production and development creates two different kinds of career ladder, one kind for production and another kind for development As I m describing them, you ll find it helpful to refer to Figure 6-1, which shows their relative degrees of authority in a project or company You ll notice there s also a third kind in between production and development, for game design It s something of a special case, and I ll discuss it separately A career ladder is not the same as an organization chart A career ladder shows you how you are likely to be promoted as you gain skill and experience in the job, not

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Hematologic abnormalities Hemoconcentration Thrombocytopenia because of formation of microthrombi, platelets <100,000 Microangiopathic hemolysis, with schistocytes and helmet cells Increased serum lactate dehydrogenase and bilirubin CNS manifestations Brisk deep tendon reflexes Persistent headache, which does not resolve with medication, hydration, or rest Visual changes (scotoma, blurring, cortical blindness) Renal dysfunction Nephritic range proteinuria (>5 g/day) because of the impaired integrity of the glomerular barrier Glomerular capillary endotheliosis because of deposition of proteinaceous material Oliguria <400 mL in 24 hours What percentage of women with a history of PEC have a recurrence in subsequent pregnancies What are considered to be maternal complications of PEC 25 65% in severe PEC 5 7% in mild PEC Cerebral hemorrhage Disseminated intravascular coagulation (DIC) Eclamptic seizure Pulmonary edema Oliguria and renal failure Rupture of the hepatic capsule What is considered to be the most severe manifestation of PEC, without the onset of eclampsia (without seizures) HELLP syndrome (hemolysis, elevated liver function tests, low platelets), it is speculated that GHTN and eclampsia occupy a spectrum of hypertensive disorders that involve endothelial damage 2% of patients

FIGURE 6-1

Can a woman develop HELLP without a prior diagnosis of PEC What laboratory abnormalities are associated with HELLP

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who you report to An artist will be promoted to senior artist, but doesn t necessarily report to one; it s more likely that they both report to the lead artist As I warned earlier, not every company will have all these positions, and not all of them will call them by the same name

Yes, a small percentage of women do not exhibit hypertension or proteinuria Lactate dehydrogenase >600 IU/mL Bilirubin >12 mg/dL Platelets <150 Elevated alanine and aspartate aminotransferase (AST and ALT)

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