Obs - Pre-eclampsia

Question 1

40-year-old lady with chronic hypertension, on atenolol/methyldopa. How would you counsel her on pregnancy risks?

Answer 1

1. Chronic hypertension
   Risks: PET, abruptio, IUGR.
   Mx: HBPM, return if 140/90 or symptomatic; FU for urine albumin, USG for IUG, aspirin prophylaxis 12-37 weeks
2. Atenolol: risk of IUGR, change to labetalol
3. Methyldopa: safe to continue
4. AMA: gdm, down, etc…. DSS1, morpho scan and OGTT (24-28wk)

Question 2

35 week, urine dipstick 3+, bp 155/95. Management?

Answer 2

Provisional dx: pre-eclampsia

Admit patient, check vitals, resuscitation (NPO with IV hartmann).
Abdominal exam, neuro exam.
continuous CTG.
Continue to monitor BP, confirm PET 4 hours later

Ix:
spot urine protein-creatinine ratio ≥ 30mg/mmol
CBC, platelet count/clotting, urate, renal and liver function tests,
X-match
U/O for oliguria

Give IV labetalol, aim delivery at 37 weeks

Question 3

HELLP syndrome with low platelet and elevated ALT

Answer 3

HELLP syndrome

Check vitals and fetal condition, resuscitation if needed

Call for help, senior and paedi, prepare OT for emergency CS

Question 4

Seizure / eclampsia. Management?

Answer 4

abc, Stabilise patient in left lateral position, check vitals.

Call for help.

Mx: IV MgSO4 for seizure prophylaxis + diazepam if ongoing.

Tx: delivery

Question 5

Postpartum management?

Answer 5

BP control by labetalol

Postnatal FU to review BP and proteinuria. Refer if not resolved