HISTORY AND PE
General Data: L.G.is a 19 y.o. G1P0, from ManilaCity, who consulted at the E.R. of the Hospital September 7, 2020
Chief Complaint: headache
Past Medical History: No HPN, D.M., (+) Bronchial Asthmalast attack six months ago (Salbutamol
•nebulization during acute attacks), No allergy to food or medications, No thyroid disorder.
•Family History:(+) Hypertension-parents and brother. No diabetes, thyroid disorder, asthma,
•cancer
•Personal and Social History: She is a student. She is a smoker(3 sticks per day for two years),
•alcoholic beverage drinker5 bottles of beer, 3 x a week.
Marital and Sexual History: She is living with her 20-year old boyfriend of 3 years. She denies having post-coital bleeding or dyspareunia. No form of family planning method is used.
• Before this partner, she had one sexual partner, her boyfriend, for six months.
•Menstrual history: Menarche was at 11y.o. Subsequent menses were regular every 28-30 days, with mild, tolerable dysmenorrhea, using 3-4 napkins per day.
•Obstetric history:
•G1P0
•LMP-December27to 31, 2020 PMP-November25 to 29, 2019
Marital and Sexual History:
She is living with her 20-year old boyfriend of 3 years. She denies having post-coital bleeding or dyspareunia. No form of family planning method is used.
Before this partner, she had one sexual partner, her boyfriend, for six months.
Menstrual history: Menarche was at 11y.o. Subsequent menses were regular every 28-30 days, with mild, tolerable dysmenorrhea, using 3-4 napkins per day. Obstetric history: G1P0 LMP-December27to 31, 2020 PMP-November25 to 29, 2020
History of present pregnancy:
At about 6weeks of missed menses, she did a home pregnancy test, and it was positive. She had a transvaginal ultrasound on February 25, 2021, which revealed 7weeksand 3 days AOGpregnancy by CRL. Since she was asymptomatic, she only had a total of 3prenatal check-ups during the 1sttrimester and 2ndtrimester at the health center. She is non-compliant with her prescribed prenatal supplementation. Three days k before admission, she started having dizziness and headaches. She would self-medicate with Paracetamol for the headaches. Five hours before access, she suddenlyexperiencedcontinuous abdominal cramps with the persistence of her headache and blurring of vision. She also noted a decrease in fetal movement. This prompted consultation at the emergency room.
SALIENT FEATURE
•G1P0, AOG 36 weeks two days
•19 Y.O.
•(+)headache
•(+) bronchial asthma
•Smoker ( 3 sticks per day)
•Alcohol drinker, five bottles of beer
•(+) dizziness and headache
•(+) continuous abdominal cramps with persistent headache and blurring of vision
•Decrease fetal movement
•Bp 180/110
•FH 30 , (+)intrauterine growth restriction
•Pale palpebra conjuctival
•Fht 90 beats /min at right lower quadrant
Initial impression
Severe Preeclampsia
Criteria for Dx:
•Systolic BP >/= to 160,
•Diastolic BP >/= to 110,
•(+)Visual disturbances
•(+) Upper abdominal pain
•(+) Headache
Upper is given a Medical clinical case,
MANAGEMENT AND TREATMENT
Admit the patient for severe preclampsia
Plan anticonvulsant+antihypertensive drugs followed by delivery
AOG of patient 36 weeks 2 days
Anticonvulsants :-
(MgSo4.7H2O 4-6 g IV fluid administered over 15-20 min, then 1-2 g/hr in every 4 hours)
Monitor for magnesium toxicity:-
Assess deep tendon reflexes periodically
Measure serum magnesium level at 4-6 hr and adjust infusion to maintain a level between 4 to 7 mEq/l.
Antihypertensive drugs:-
Hydralazine ( 5 mg iv initial doses then followed by 5-10 mg doses at 15-20 min interval until a satisfactory response is achieved )
Always careful monitoring to avoid
hypotension, bradycardia, and fetal bradycardia
If fetal bradycardia happens, Rapid crystalloid infusion raises mean pressure down to 115mm hg, fetal will recover.
Note IV fluid should be administered rate of 60ml to 125ml, not more than that, because of the risk of pulmonary edema or cerebral edema.
No diuretics until pulmonary edema occurs.
Delivery( induced labor: prostaglandin)
In case failed to dilated perform c section
Postpartum Treatment
Postpartum weight is compared with the last prenatal weight for excessive extracellular fluids. If weight increases, then diuresis with IV furosemide (20 mg )
Diet plan :
Low salt diet
Calcium-rich food
Fish oils
You must be logged in to post a comment.