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sue



Points : 42144
Join date : 2013-12-26

PostSubject: AMC Clinical discussion-recalls   Thu Dec 26, 2013 1:21 pm

A 19 year-old woman, 28/40 week pregnant, primigravida, found BP 170/110 mmHg and urine protein 2+ at ANC clinic. She also has frontal headache

Task: Relevant history

Important findings and investigation



Diagnostic criteria

Mild 140/90

Severe 160/110 (6 hours apart, 2 episodes)

Associated symptoms

Headache

Visual disturbance

Nausea/vomiting

Epigastric discomfort

RUQ pain  liver

Swelling

Signs

Hyperreflexia

Very excitable clonus

Edema

Liver enlargement




Investigations

FBE: platelet

Blood grouping

LFT: increase AST, ALT

Urine protein 24 hours

Uric acid

Coagulation

Urea, creatinine

CTG

U/S

HELLP Syndrome: Hemolysis

Elevate Liver enzyme

Low Platelet

Management

Explain to pt what is pre-eclampsia:

Pre-eclampsia is a serious disorder of pregnancy characterised by high maternal blood pressure, protein in the urine and severe fluid retention. mechanisms behind the condition are mysterious, but genetic factors and the placenta seem to play significant roles

If left untreated, pre-eclampsia can lead to convulsions, kidney failure, liver failure, clotting problems or death. baby has growth restriction, placenta separates from the uterine wall.-medical emergency.—from better health.




Admit to assessment unit for 2 hours, call the obstetrics and physician to review the patient.

Bed rest and repeat BP

Do blood test

Repeat urine or start urine 24 hours

CTG for fetus, U/S

If BP is still high, manage HT  Call physician to treat HT and find associated disease

If BP is settle down around 140/90 mmHg, normal LFT, urine, platelet, and baby is o.k., still admit until collect 24 hr-urine protein

Try not to give hydralazine in a hurry

D/C and follow up 2-3 times/week (home visit)

If continue HT  hydralazine  MgSO4 when impending eclampsia and then plan to delivery.

Continue MgSO4 (magnesium sulphate) until 24 hours post-partum. If everything tends to be normal and urine output is good  stop

If not, continue MgSO4 until everything tends to be normal
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