(Oct-2008 Q8) A 25yo primigravida patient presents to the delivery suite at 38 weeks gestation complaining of a headache and difficulty with her vision. Her BP is 180/115 and she has clonus. CTG monitoring shows no indications of foetal distress. Outline your initial management of her pre-eclampsia
This term pregnant patient has severe pre-eclampsia (definition)and has signs of impending ecclampsia, which is a life-threatening condition. After a focused history and examination I would arrange for urgent lab investigations especially looking at the renal panel, PT/PTT , liver enzymes, Mg and FBC for platelet count.
My initial management wound be to stabilize the patient and discuss with her obstetrician …(multidisciplinary )and arrange for expedient delivery of the child.
In the mean time I will give her supplemental O2 and place her in a left lateral tilt to reduce aortocaval compression in this situation where there is already compromised blood supply to the fetus. Standard monitoring in addition: BP on both arms, urine output
I would start IV magnesium as a slow bolus (loading dose___) followed by an infusion of ____ to achieve serum Mg level of 2-4mmol/L
I would also lower the blood pressure by starting IV labetalol as an infusion 10-50mg/hour, avoiding precipitous falls in BP and targeting a BP of 140-150/100-110
Fluid resus; regional if no contraindications, post op HD +/- CVP
Severe hypertension: BP 160/110
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