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MS WordPerinatologist Corner - C.E.U/C.M.E. Modules
Hypertension in Pregnancy
Sponsored by The Indian Health Service Clinical Support Center
Part 2: Severe Pre-Eclampsia
2. Case Scenarios
Scenario #1
Mary Tall Boy is a 23 y/o G2P0 at 35 weeks 3 days by her LMP and an early ultrasound who has had a normal prenatal course to date. She presents to your level I facility complaining of a severe retro-orbital headache of 2 days duration and states she is seeing spots in front of her eyes. Exam reveals a BP of 172/112, 3+ proteinuria, 2+ edema, and 4+ DTRs. What constitutes appropriate management and counseling of this patient?
Scenario #2
Alberta Nashgatook is a 34 y/0 G3P1 at 34 weeks gestation who presents to the Emergency Department with abdominal pain and nausea of two days duration. She denies fever or urinary symptoms or diarrhea, but has not been able to eat and has a headache. The pain is epigastric, not colicy, and not referred. She denies uterine contractions, bleeding, loss of fluid, and has had good fetal movements. On examination she is afebrile with a BP of 136/86. She is not icteric but appears somewhat ill. There is mild tenderness to palpation in the RUQ but bowel sounds are normal. What constitutes appropriate management and counseling of this patient?
Scenario #3
Ida Joe is a 38 y/o G8P6 at 33 weeks 2 days by a "sure" LMP. She presents to your level I facility that offers obstetric services for her first prenatal visit and has no complaints. Your exam reveals a BP of 171/98, 4+ proteinuria, 1+ edema, and 1+DTRs. The fundus measures 28 cm and the cervix is floppy and fingertip dilated with a floating vertex. A normal FHR is recorded. Her creatinine is 1.3 mg/dL, hematocrit 29 vol %, platelets 305,000 mm3. What constitutes appropriate management and counseling of this patient?
