Question

A healthy 28 y.o.woman is admitted to L&D at 28 weeks gestation. She has symptoms of severe headaches and blurred vision. She has a BP of 190/115mmHg with protein found in her urine. On an earlier doctor visit her BP was 155/105. She has a normal hematocrit and platelets.Her 24 hour urine analysis shows 2.1 g of protein.   

1.What is the recommended treatment in this case?

2.If this patient entered the hospital at this stage with these signs and symptoms, what would be the course of action?

3.Discuss the reasoning behind the recommendations.

4.How does the gestational age affect the treatment options and what are the criteria for delivery?

Answer 1

The patient is having pre-eclampsia. It is a condition where there is an increase in the blood pressure and proteinuria after 20 weeks of gestation. The patient is 28 weeks pregnant and is having BP of 190/115 mm Hg with protein of 2.1g in 24 hours sample. She also has complaints of severe headaches and blurred vision. The patient is diagnosed with severe pre-eclampsia as her BP is more than 160/110 mm Hg.

Recommended treatment:

As the mother is having severe pre-eclampsia and is 28 weeks gestation, the baby has not yet near to the term, so the doctor will treat the condition and reduce the blood pressure of the patient until it is safe to deliver the baby. If patient’s or baby’s condition worsens, delivery is conducted.

Course of action:

The doctor will prescribe anti-hypertensive drugs to reduce the blood pressure, corticosteroids to improve the lung maturity and anti-convulsive medication like magnesium sulphate to prevent seizures. The patient is advised to take complete bed rest, hospitalization and delivery of the baby if the blood pressure is not controlled.

Reason for the above recommendations:

The patient’s gestational age is 28 weeks which means the baby if delivered will be preterm and will have its own complications. The lung of the baby will not be matured and it will be a challenging task to survive the baby.

Criteria for delivery:

• Observe the patient in labour and delivery room for 24-48 hours
• Give betamethasone and magnesium sulphate if gestational age is 24-32 weeks. Wait till 32 weeks to deliver the baby. Fetal and maternal monitoring to be done.
• If gestational age more than 32 weeks, deliver the baby.