obstetrics case presentation 2:10

8/11/2019 Obstetrics Case Presentation 2:10

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PERSONAL DETAILS

Name : Z

Age : 34

Occupation : Company secretary

Relationship status : Married

Gestation : 39+6

Gravidity/Parity : G2 P1


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Presenting Complaint

High blood pressure

Admitted 3 times before

Started from week 7

BP on admission150/101

Headache

Frontal headache

Started 4 weeks ago

Relieved by paracetamol

Protein in urine

No PV bleeding, diabetes, anaemia, abdominal pain, visualdisturbance, fever, hand or feet swelling, show/SROM.


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HOPP

First day of LMP26/12/2013

EDD2/10/2014 (IOL today)

Menstrual cycleregular, 28 days

Symptoms of pregnancyAmenorrhea, increased urinaryfrequency, nausea

Problems during pregnancyHigh blood pressure and proteintrace (4 times), urinary tract infection (twice earlier inpregnancy)

TestsAll scans and blood tests were normal


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Past Med/Surg HistoryMedications

None

No allergy

Never been depressed (medically)

Taking Paracetamol for the headache

Took preconceptual folic acid starting 6 weeks beforepregnancy


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Family/Social History

Aunt has a twin, sister and 2 nephews had DDH.

Father has Type 2 DM

Non-smoker, social drinker3-6 units/week (not

during pregnancy)

Living with husband and son


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BMI27

BP at booking114/74

Singleton fetus in longitudinal lie with cephalic

presentation.


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What do you think she has?

APre-existing hypertension

B - Gestational/Pregnancy-induced hypertension (PIH)

C - Pre-eclampsia


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What is Pre-eclampsia?

Hypertension of 140/90 mmHg recorded on 2 separate

occassions of at least 4 hours apart and proteinuria 300mg

protein in a 24 hours urine colleection, arising de novo, in a

previously normotensive women, after 20thweek of pregnancy and

resolving completely by 6thpostpartum week.

Severe pre-eclampsia : BP 160/110 and proteinuria 1g/24 hours

or if maternal complications occur.


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What is eclampsia?

Occurence of tonic-clonic seizure in association witha diagnosis of pre-eclampsia

It is an obstetric emergency!


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What are the risk factors of pre-

eclampsia?

Primiparity

Multiparity with:

Pre-eclampsia in previous pregnancy

10 years since last baby

Age >40

BMI >30 (Obesity)

FH of pre-eclampsia

Multiple pregnancy

Pre-existing medical conditions:

Hypertension

Renal disease

DM

Antiphospholipid antibodies

Connective tissue diseases

Thrombophilia

Booking diastolic BP >90

Booking proteinuria >300mg/24hours


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SOME MCQs


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1 - Which is the most common sign/symptom experienced

by a woman with pre-eclampsia?

AEpigastric pain

BFrontal headache

CVisual disturbance

DFacial edema

EAsymptomatic


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2 - The following drugs can be used to treat her

EXCEPT:

AACE inhibitor

BHydralazine

CMethyldopa

DLabetolol

ECalcium channel blocker


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3Regarding Eclampsia/ Pre-Eclampsia, which of the

following is TRUE?

A - General oedema is a useful diagnostic feature

B - Pre-eclampsia always precedes eclampsia

C - A blood pressure of 160/110 gives a diagnosis of severe pre-eclampsia

D - Thrombocytopenia is a common finding in pre-eclampsia

EAll patients with pre-eclampsia must be treated in-patient


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4 - Regarding hypertension in pregnancy, which of the

following is true?

AThe combination of hypertension and proteinuria alwaysindicate pre-eclampsia

BThe presence of edema is a useful diagnostic sign

CPre-eclampsia may occur after birth

DPre-eclampsia is more common in multigravida

EProteinuria in pre-eclampsia is defined as the presenceof 200mg of protein in 24 hours urine collection


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5. Pre-eclampsia can be cured by:

AAntihypertensives

BMagnesium sulphate

CDiuretics

DTermination of pregnancy (TOP)

EDeliver the baby


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THANK YOU FORLISTENING

obstetrics case presentation 2:10

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