#gestational hypertension

[mcatmemoranda]

I have a pt who came in from clinic with elevated BPs at 35 weeks. If BPs are elevated above 140/90 on 2 separate occasions at least 4 hours apart at greater than 20 weeks gestation, it’s gestational HTN.

Once you get to that point, you check urine protein to creatinine ratio to see if the pt meets criteria for preeclampsia. So if the urine protein:creatinine (the OBs keep calling it “P to C”) is greater than or equal to 0.3, then the pt meets criteria for preeclampsia.

We talked to the pt about giving betamethasone to help with fetal lung maturity. You give 12 mg IM once and then a second dose 24 hours later (alternative dosing is 6 mg q12 for a total of 24 mg over the course of 2 days). It takes 24 hours after the second dose of betamethasone for it to provide maximum benefits to the fetus. So you have to note whether the pt is “beta complete,” meaning that it was at least 24 hours after the second dose before you started induction of labor. For women farther along in their pregnancy, this isn’t as important as it is for women earlier on in their pregnancy—so at 35 weeks, if you really needed to deliver before beta complete, the baby would have better outcome than a a 24 weeker, who you’d want to wait as long as possible to get to beta complete before inducing.

For pts with preeclampsia without any severe features, you should deliver at 37 weeks. If severe features, deliver at 34 weeks.

[wellhealthhub]

Exploring the Intricacies of Type 4 Diabetes: Gestational Diabetes Mellitus

Greetings, esteemed readers, and welcome to this all-encompassing, highly detailed guide centered on the elucidation of Type 4 Diabetes, an intriguing and somewhat less ubiquitous entity compared to its better-known counterparts, Type 1 and Type 2 Diabetes. Our paramount objective within the confines of this article is to embark on a comprehensive exploration, traversing the labyrinthine…

[ginontherox]

Pregnancy Rox: Facing Reality

First, let me take the time to wish all mothers a very happy & blessed Mother’s Day! My challenges with my current pregnancy began when I was about 4-5 months gestation. My first diagnosis was gestational diabetes. Naturally I became anxious and nervous, however my Ob/Gyn was very thorough and detailed so we began the process of monitoring my sugar levels 4 times a day everyday and I was…

[thisisthevoice]

alsoooo even in my own cohort i know theres at least one person whos pro-life and, last i knew, wanted to go into labor & delivery. i mean if youre a fucking nurse you shouldnt be "pro-life" (pro forced birth, anti maternal health) but im fucking scared for her patients if she goes down that route

[melted-heart-of-ice]

Reblogging to add pre-eclampsia and hyperemesis gravidarum

wild how like PCOS, endometriosis, vaginismus & hell, even frequent yeast infections are “mysterious” with no well known cause and little to no decent treatment, but we have tons of supposedly well researched body fat removal methods, about 20 different kinds of breast implants, laser hair removal, and 100 different dermatologist recommended anti aging creams. we sure had the money and brainpower to cure those “diseases”

[vs-griffin]

Pregnancy Rox: Positive Progress

I am over the moon excited. So last night, I was moved from my room in L&D to the extended stay antepartum wing. That means that I am not at risk for immediate delivery and that my outlook for reaching 34 weeks is higher in probability. All I can say is THANK GOD! This pregnancy has been a total journey into the unknown for sure. No, it’s not my first pregnancy however, it is my first pregnancy…

[mariacallous]

There is an inherent tension between two basic facts about childbirth. On the one hand, it has happened billions and billions of times in the course of human history and it has been successful in a wide range of settings, from neolithic caves to state-of-the-art hospitals. On the other, it is objectively dangerous in many cases.

This tension can be felt in much of the modern popular discourse on birth. On my Instagram feed, there are depictions of unmedicated home births in a bathtub surrounded by flowers and a caption about how birth has got too medicalised. Some commenters are quick to note that, in their case, having that medical help was life-saving. To put it most starkly: yes, people have been giving birth at home for millions of years, but a lot of them died.

I wrestle with this tension in my writing on pregnancy. I’m an economist and have written two books designed to help women navigate their pregnancy experience by giving them a better understanding of what the data says. In the first, Expecting Better, I cover largely uncomplicated pregnancy. I talk about the decisions that arise when all is going well – whether to eat sushi, for example, and how to write a birth plan for an uncomplicated delivery. In the second, The Unexpected, I cover complicated pregnancy. With my co-author, Dr Nathan Fox, we talk about miscarriage, pre-eclampsia, stillbirth, gestational diabetes, postpartum depression, and other tough things.

These are issues I care passionately about largely because I think we do not discuss complicated pregnancy enough. Perhaps 50% of pregnancies are affected by at least one of the complications covered in the book – that’s half of pregnancies, but more than half of people who have been pregnant. In many cases, until this complication happens to someone they have no idea that it could. They feel alone, sometimes dismissed, scared.

A core problem with lack of discussion is it leads to lack of treatment or preventive activities. The lead pregnancy organisation in the US, the American College of Obstetricians and Gynecologists, has put out a recent push for more discussion of pre-eclampsia, a serious complication that affects 5 to 8% of pregnancies. The risk of pre-eclampsia can be brought down about 20% with the use of baby aspirin beginning in the second trimester of pregnancy. This treatment has virtually no risks, so it’s increasingly clear that pregnant women with any risk factors – older age, higher weight, hypertension and many others – should be treated. If people are unaware of this risk, they are less likely to seek treatment. Even if offered treatment, if they do not understand the condition, they may be reluctant to take it up.

A lack of attention given to these complications leads to a lack of information, and without a basic understanding of what happened to them (or is happening to them) in their pregnancy, patients are not able to engage as much as they should with their condition. In doing interviews when this book came out, one mother told me: “I had a postpartum haemorrhage with my second child, but until I read your book I didn’t really understand what that was, let alone how to treat or prevent it.”

I want to shout this information from the rooftops. I want to tell everyone I know that, yes, your uterus can fall into (or even come partially out of) your vagina, and that if that happens there is help. And yet: I can see the danger of focusing too much on these complications. If 50% of pregnancies are affected, then 50% are not. Where should we draw the line between making sure pregnant women are well-informed without scaring them to death? After all, a lot of times, everything does go smoothly. Giving birth in a tub at home can be a good option for some people. And I would hate more than anything for someone to decide not to have a wanted family because they are worried about pregnancy and birth.

We need to find a balance between giving women the information they need, telling them the truth about risks, and not creating unnecessary panic. I wish I could say I knew for sure what this balance looks like. What I do believe strongly is that keeping information hidden, and doling it out only after it is needed – or never – is not the right answer. We need to strike a balance between giving people information and allowing them to put the risks in context. So they can take solace in the hope – and likelihood – that all will be well, but prepared if it is not.

[covid-safer-hotties]

Also preserved in our archive

"Just a cold" that increases intercranial abnormalities

By Nikhil Prasad

Medical News: A groundbreaking study conducted at San Marco University Hospital in Catania, Sicily, Italy, has revealed new insights into the potential impacts of SARS-CoV-2 on newborns. Researchers from this hospital and the University of Ferrara carried out an ultrasonographic analysis on newborns exposed to the virus, highlighting a significant incidence of minor intracranial abnormalities compared to unexposed infants. The findings raise important questions about the long-term neurological implications for children born during the COVID-19 pandemic.

The Study at a Glance This Medical News report delves into the research conducted by Bruna Scalia, Marco Andrea Nicola Saporito, and their colleagues, investigating cranial ultrasonography (cUS) findings in infants born to mothers who tested positive for SARS-CoV-2 during pregnancy or at delivery. The team analyzed data from 278 newborns, evenly split between exposed and unexposed cohorts. The study adhered to stringent observational protocols to ensure the reliability of results.

Key Findings Among the 139 newborns exposed to SARS-CoV-2, 23% exhibited intracranial abnormalities on cUS, compared to 16.5% in the unexposed group. Minor abnormalities were most prevalent and included subependymal cysts (SEPCs), choroid plexus cysts (CPCs), frontal horn cysts (FHCs), and lenticulostriate vasculopathy (LV). Major abnormalities, such as cerebellar hemorrhages and arachnoid cysts, were rare but noteworthy.

Interestingly, infants exposed to SARS-CoV-2 during pregnancy had a higher rate of abnormalities (38.4%) than those exposed at birth (19.5%). The second trimester emerged as a particularly critical period, with the majority of abnormalities observed in this subgroup.

Why These Findings Matter The study's results are alarming for public health professionals and expectant mothers. While SARS-CoV-2's immediate risks to newborns have been considered minimal, this research suggests subtle yet significant neurological effects. These abnormalities, although classified as minor, may carry long-term implications for cognitive and behavioral development.

The link between maternal inflammation and fetal development is not new, but the cytokine storm induced by SARS-CoV-2 appears to heighten this risk. The researchers hypothesize that inflammatory markers like interleukin-6 could cross the placenta, affecting the fetal brain and potentially disrupting synaptogenesis.

Methodology Details All newborns in the study underwent cranial ultrasonography within their first week of life. The scans were conducted using standardized equipment by experienced neonatologists. The findings were categorized as normal, minor, or major abnormalities. To exclude confounding factors, the study excluded infants with other infections or genetic disorders.

Demographic factors, such as gestational age and birth weight, were comparable across both groups. However, premature birth and maternal complications, such as gestational diabetes and hypertension, were noted as potential contributors to the observed abnormalities.

Implications for Future Research The findings call for more extensive, longitudinal studies to understand the long-term effects of these abnormalities. Current evidence suggests a potential association between minor abnormalities like SEPCs and neuropsychiatric conditions such as autism and ADHD. Further investigation could clarify whether these cUS findings are precursors to such outcomes.

What Experts Are Saying The study's authors emphasize caution, noting that minor intracranial abnormalities do not necessarily predict adverse outcomes. However, they recommend routine cranial ultrasonography for newborns exposed to SARS-CoV-2 as a precautionary measure. "The cost-effectiveness and non-invasive nature of cUS make it a valuable tool in monitoring these infants," said lead researcher Bruna Scalia.

Limitations and Strengths of the Study One limitation of the study was its relatively small sample size, particularly for subgroups like prenatally exposed infants. Additionally, the lack of serological testing for unexposed mothers could have introduced undetected cases into the control group. However, the study's rigorous methodology and use of a well-matched control group lend credibility to its conclusions.

Study Conclusions The research underscores a statistically significant increase in minor intracranial abnormalities among SARS-CoV-2-exposed newborns. These findings are particularly pronounced in infants exposed during the second trimester of pregnancy. While the abnormalities observed in the study were predominantly minor, their potential impact on long-term neurological outcomes cannot be overlooked. The researchers advocate for the following:

-Routine cUS Screening: Cranial ultrasonography should be performed on all newborns exposed to SARS-CoV-2 to identify abnormalities early.

-Long-Term Follow-Up: Exposed infants should be enrolled in neurodevelopmental follow-up programs to monitor their progress and intervene if necessary.

-Expanded Research: Larger, multicenter studies are needed to confirm these findings and explore the mechanisms behind SARS-CoV-2's impact on fetal brain development.

By highlighting these abnormalities, the study adds a critical layer to our understanding of COVID-19's broader implications, particularly for future generations.

The study findings were published in the peer-reviewed Italian Journal of Pediatrics. link.springer.com/article/10.1186/s13052-024-01826-3

[ottovonruthie]

Pregnancy complications can include conditions such as anemia, cholestasis of pregnancy, gestational diabetes, preeclampsia, ectopic pregnancy, placenta previa, placental abruption, preterm labor, hyperemesis gravidarum, miscarriage, stillbirth, infections, Rh incompatibility, gestational hypertension, and cervical insufficiency. And this isn’t even all of it. It’s beyond disrespectful to suggest a woman would go through all of that just to wait nine months to abort. No one endures the physical, emotional, and mental toll of pregnancy for nine months only to make that decision at the end.

[allthebrazilianpolitics]

Premature birth rate above global average in Brazil

The commonly cited "nine months" of pregnancy oversimplifies a much more complex process: human gestation lasts about 40 weeks, with a "full-term" pregnancy considered to be between 37 and 42 weeks. However, in 2023, nearly 12 percent of births in Brazil occurred before reaching this milestone, totaling around 300,000 premature babies. These infants face varying health risks, depending on how early they were born. Brazil not only exceeds the global average of around 10 percent but is also one of the top ten countries with the highest number of premature births annually.

According to Denise Suguitani, executive director of the Brazilian Association of Parents, Families, Friends, and Carers of Premature Babies, most of these cases are preventable. She explains, "In Brazil, these rates are closely linked to social factors, including access to healthcare and education. Adolescent pregnancy, for instance, is a risk factor for premature birth because the girl’s body is not yet fully prepared. On the other hand, a planned pregnancy is less likely to result in premature birth, making family planning crucial. And, of course, access to prenatal care is essential. It’s not just the number of appointments that matters, but the quality of care and the information provided."

Obstetrician Joeline Cerqueira, a member of the Prenatal Care Commission of the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo), highlights some conditions that can be detected and treated during prenatal care to prevent premature birth and other complications. She explains, "Infections, premature rupture of the amniotic sac, and hypertensive disorders during pregnancy are among the leading causes of premature birth."

Continue reading.

[wishingforatypewriter]

Pregnant Lin head cannons ? Was conceiving easy for her or was she infertile ? What symptoms does she experience ? What cravings does she have ? Any complications ? How does the birth go ? After birth what is her postpartum experience like ? Does she experience ppd ? Is breastfeeding easy for her ?

Hi! Thanks for the ask! (I'd like to preface this post with a disclaimer that I have never been pregnant, so this may not be entirely accurate)

Lin conceived relatively easily and never had any fertility issues. Her pregnancy was actually unplanned.

She had pretty bad morning sickness during her first trimester. She was especially sensitive to smells and sometimes the scent of certain ingredients cooking would make her queasy. She also experienced a lot of fatigue during her pregnancy and needed a lot more sleep than she was used to.

Lin's biggest craving was for citrus fruits like tangerines and pomelos Her partner would always make sure the apartment was well stocked with them, and peel them for her when she wanted a snack. (I wrote a linzolt oneshot called Tangerines around this idea). Her pre-existing love of spicy foods was intensified while she was pregnant, so she ate a lot of fire noodles and fire flakes.

Because she was having twins, Lin was at a higher risk for preterm labor and gestational hypertension. However, her medical team (including Katara) monitored the situation and she ultimately didn't experience those effects.

Lin has a pretty high threshold for pain, but nothing could have prepared her for childbirth. She was in labor for fourteen hours and it was a bit of an ordeal. Her partner was with her the whole time, holding her hand and feeding her ice chips and sips of water.

When she came home from the hospital, Lin's partner did not let her lift a finger. She got to rest and recover from the birth, taking naps and listening to probending on the radio and just bonding with her new babies. Her partner took care of everything around the house so she could relax.

Lin doesn't have postpartum depression, but she does experience some anxiety around being a new mom.

Breastfeeding is relatively easy for her, but after a few weeks she switches to bottle feeding because she wants to start checking in with Saikhan at the RCPD.

[ginontherox]

Pregnancy Rox: Positive Progress

I am over the moon excited. So last night, I was moved from my room in L&D to the extended stay antepartum wing. That means that I am not at risk for immediate delivery and that my outlook for reaching 34 weeks is higher in probability. All I can say is THANK GOD! This pregnancy has been a total journey into the unknown for sure. No, it’s not my first pregnancy however, it is my first pregnancy…

[coochiequeens]

Ladies, being a surrogate carries a higher risk for complications. Don't let anyone try to guilt or pay you into being one if you don't want to.

By Will Pass September 26, 2024

Gestational carriers face a significantly higher risk for severe maternal morbidity and other pregnancy complications than those conceiving naturally or via in vitro fertilization (IVF), according to a recent Canadian study.

These findings suggest that more work is needed to ensure careful selection of gestational carriers, reported lead author Maria P. Velez, MD, PhD, of McGill University, Montreal, Quebec, Canada, and colleagues.

"Although a gestational carrier should ideally be a healthy person, with a demonstrated low-risk obstetric history, it is not clear whether this occurs in practice," the investigators wrote in Annals of Internal Medicine. "Moreover, the risk for maternal and neonatal adversity is largely unknown in this group."

Study Compared Gestational Carriage With IVF and Unassisted Conception

To address these knowledge gaps, Velez and colleagues conducted a population-based cohort study in Ontario using linked administrative datasets. All singleton births at more than 20 weeks' gestation with mothers aged 18-50 years were included from April 2012 to March 2021. Multifetal pregnancies were excluded, as were women with a history of infertility diagnosis without fertility treatment, and those who underwent intrauterine insemination or ovulation induction.

Outcomes were compared across three groups: Unassisted conception, IVF, and gestational carriage. The primary maternal outcome was severe maternal morbidity, defined by a validated composite of 41 unique indicators. The primary infant outcome was severe neonatal morbidity, comprising 19 unique indicators.

Secondary outcomes were hypertensive disorders, elective cesarean delivery, emergent cesarean delivery, preterm birth at less than 37 weeks, preterm birth at more than 32 weeks, and postpartum hemorrhage.

Logistic regression analysis adjusted for a range of covariates, including age, obesity, tobacco/drug dependence, chronic hypertension, and others. The final dataset included 846,124 births by unassisted conception (97.6%), 16,087 by IVF (1.8%), and 806 by gestational carriage (0.1%).

The weighted relative risk (wRR) for severe maternal morbidity was more than three times higher in gestational carriers than in those conceiving naturally (wRR, 3.30; 95% CI, 2.59-4.20) and 86% higher than in those conceiving via IVF (wRR, 1.86; 95% CI, 1.36-2.55). These stem from absolute risks of 2.3%, 4.3%, and 7.8% for unassisted, IVF, and surrogate pregnancies, respectively.

Moreover, surrogates were 75% more likely to have hypertensive disorders, 79% more likely to have preterm birth at less than 37 weeks, and almost three times as likely to have postpartum hemorrhage.

These same three secondary outcomes were also significantly more common when comparing surrogate with IVF pregnancies, albeit to a lesser degree. In contrast, surrogate pregnancies were associated with a 21% lower risk for elective cesarean delivery than IVF pregnancies (wRR, 0.79; 95% CI, 0.68-0.93).

Severe neonatal morbidity was not significantly different between the groups. These findings add to a mixed body of evidence surrounding both maternal and neonatal outcomes with gestational carriers, according to the investigators.

"Prior small studies [by Söderström-Anttila et al. and Swanson et al.] reported varying risks for preterm birth in singleton gestational carriage pregnancies, whereas a recent large US registry reported no increased risk for preterm birth compared with IVF, after accounting for multifetal pregnancy," they wrote. "This study excluded multifetal pregnancies, a common occurrence after IVF, with reported higher risks for adverse outcomes. Accordingly, adverse maternal and newborn outcomes may have been underestimated herein."

Causes of Worse Outcomes Remain Unclear

While the present findings suggest greater maternal morbidity among surrogates, potential causes of these adverse outcomes remain unclear.

The investigators suggested that implantation of a nonautologous embryo could be playing a role, as oocyte donation has been linked with an increased risk for hypertensive disorders of pregnancy.

"We don't know exactly why that can happen," Velez said in an interview. "Maybe that embryo can be associated with an immunological response that could be associated with higher morbidity during pregnancy. We need, however, other studies that can continue testing that hypothesis."

In the meantime, more care is needed in surrogate selection, according to Velez.

"In our study, we found that there were patients, for example, who had more than three prior C-sections, which is one of the contraindications for gestational carriers, and patients who had more than five [prior] pregnancies, which is also another limitation in the guidelines for choosing these patients," she said. "Definitely we need to be more vigilant when we accept these gestational carriers."

But improving surrogate selection may be easier said than done.

The quantitative thresholds cited by Velez come from the American Society for Reproductive Medicine guidelines. Alternative guidance documents from the Canadian Fertility and Andrology Society and American College of Obstetricians and Gynecologists are less prescriptive; instead, they offer qualitative recommendations concerning obstetric history and risk assessment.

And then there is the regulatory specter looming over the entire field, evidenced by the many times that these publications cite ethical and legal considerations — far more than the average medical guidance document — when making clinical decisions related to surrogacy.

Present Study Offers Much-Needed Data in Understudied Field

According to Kate Swanson, MD, a perinatologist, clinical geneticist, and associate professor at the University of California San Francisco, the present study may help steer medical societies and healthcare providers away from these potential sand traps and toward conversations grounded in scientific data.

"I think one of the reasons that the Society for Maternal-Fetal Medicine and the maternal-fetal medicine community in general hasn't been interested in this subject is that they see it as a social/ethical/legal issue rather than a medical one," Swanson said in an interview. "One of the real benefits of this article is that it shows that this is a medical issue that the obstetric community needs to pay attention to."

These new data could help guide decisions about risk and candidacy with both potential gestational carriers and intended parents, she said.

Still, it's hard — if not impossible — to disentangle the medical and legal aspects of surrogacy, as shown when analyzing the present study.

In Canada, where it was conducted, intended parents are forbidden from paying surrogates for their services beyond out-of-pocket costs directly related to pregnancy. Meanwhile, surrogacy laws vary widely across the United States; some states (eg, Louisiana) allow only altruistic surrogacy like Canada, while other states (eg, California) permit commercial surrogacy with no legal limits on compensation.

Swanson and Velez offered starkly different views on this topic.

"I think there should be more regulations in terms of compensating [gestational carriers]," Velez said. "I don't think being a gestational carrier should be like a job or a way of making a living."

Swanson, who has published multiple studies on gestational carriage and experienced the process as an intended parent, said compensation beyond expenses is essential.

"I do think it's incredibly reasonable to pay someone — a woman is taking on quite a lot of inconvenience and risk — in order to perform this service for another family," she said. "I think it's incredibly appropriate to compensate her for all of that."

Reasons for compensation go beyond the ethical, Swanson added, and may explain some of the findings from the present study.

"A lot of these gestational carriers [in the present dataset] wouldn't necessarily meet criteria through the American Society of Reproductive Medicine," Swanson said, pointing out surrogates who had never had a pregnancy before or reported the use of tobacco or other drugs. "Really, it shows me that a lot of the people participating as gestational carriers were maybe not ideal candidates. I think one of the reasons that we might see that in this Canadian population is…that you can't compensate someone, so I think their pool of people willing to be gestational carriers is a lot smaller, and they may be a little bit less selective sometimes."

Velez acknowledged that the present study was limited by a shortage of potentially relevant information concerning the surrogacy selection process, including underlying reasons for becoming a gestational carrier. More work is needed to understand the health and outcomes of these women, she said, including topics ranging from immunologic mechanisms to mental health.

She also called for more discussions surrounding maternal safety, with participation from all stakeholders, including governments, surrogates, intended parents, and physicians too.

This study was funded by the Canadian Institutes of Health Research. The investigators disclosed no conflicts of interest. Swanson disclosed a relationship with Mitera.

Will Pass, DVM, is a veterinarian and freelance medical writer from Colorado.

[vague-humanoid]

After the Supreme Court overturned Roe v. Wade in June 2022, 14 states have imposed near-total abortion bans. (Arizona may soon join them.) While all of these states include exemptions to save the life of the mother, the language is inherently vague. The abortion bans typically allow for emergency abortions to prevent "serious risk of substantial and irreversible impairment of a major bodily function" or "serious, permanent impairment of a life-sustaining organ." But the laws do not address "expectations regarding the most common obstetric complications that can lead to late-stage pregnancy loss, such as previable premature rupture of membranes, excessive bleeding, gestational hypertension, preeclampsia, or placental abruption."

The American College of Obstetricians and Gynecologists says that it is critical that hospitals "provide guidance that permits treatment to the full extent of applicable state law and support and defend their clinicians when they provide care to patients." 

In many hospitals, that is not happening. The result is that pregnant women are showing up at emergency rooms and are not receiving the care they need. An Associated Press report last week, based on federal documents, found that "[c]omplaints that pregnant women were turned away from U.S. emergency rooms spiked in 2022 after the U.S. Supreme Court overturned Roe v. Wade." Sara Rosenbaum, a professor of health law at George Washington University, says that pregnant patients have “become radioactive to emergency departments.” 

[beyoursledgehammer]

Having gestational diabetes and hypertension issues in the hospital means all the stuff everyone wants to offer to make things easier is the opposite of what I need. I can't have snacks or candy because my blood sugar is monitored and I'm on insulin. Visitors are too stimulating and get my BP up too high and even if I'm enjoying them being here, I'm having anxiety simultaneously and then people get kicked out.

So instead I'm just sleeping a lot and eating sugar free jello and listening to the construction work going on outside my window.

[plant-bot]

Leech

Exhibit: Point Blue, Point Green

Beloved for their ability to cleanly store vast quantities of blood from different species, leeches have been a staple part of culinary and medicine for over 300 Mysteries. Leeches use a ring of microscopic teeth that ring the banded muscular mouth opening to pierce the flesh and also secrete a powerful compound that acts as anticoagulant, hypertensive and euphoriant all at once. Leeches do not understand the concept of "too much" and will gorge themselves on blood, much to their hosts detriment if not removed promptly.

They are found in areas that are sufficiently humid enough to accommodate their moist flesh. The limbs of the leech are covered in a highly vascularized pink tissue which constantly pumps and oxygenates the stored blood to keep it "fresh" as the creature relies on blood meals for digestion, gestation, and even as a hydraulic fluid that powers the limbs.

Leeches have been known to show individual preferences when it comes to blood - some will prefer to feed on sea dwelling animals, another may prefer cattloids, and some, may even be brave enough to feed off the blood from a rosebush.