as i could get it NICE say severe preeclampsia even if BPcontrolled deliver after 34 wks, mild to moderate preeclampsia offer birth between 34-36+6 wks depending on maternal fetal condition,risk factor and availibilty on SCBU. mild to moderate preeclampsia must deliver within 24-28 hrs. am I getting it right paul? please discuss.
sorry for error
Posted by sofia S.
mild to moderate preecclampsia must deliver within 24-48 hrs after completion of 37 wks.
severe hypertension -nice
Posted by SRABANI M.
by definition in nice; severe pre-eclampsia is pre-eclampsia with severe hypertension and/or with symptoms, and/or biochemical and/or hematological impairment; so for severe pre-eclampsia there must be severe htn;
Paul am i right?
Posted by sofia S.
how to classify. suppose a BP of 170/96 . systolic in range of severe but diastolic in range of mild. in which group to classify this BP?
URODYNAM,ICS EMQ
Posted by vaneeza K.
In the last exam we had emq based on urodynamics studies paul please give us the link where we could read and solve these types of emq
Dr.Mohanad
Posted by vanosch M.
a)
This patient should be managed as PET until proved otherwise, first I will take detailed history, is she had an essential hypertension before pregnancy and is this required any treatment. Any high BP readings in this pregnancy and at what gestational age. Any medical problems including renal diseases or urinary tract infections. Any history of previous high BP in previous pregnancies and also I will ask her about her previous obstetric history including number of deliveries and mode of delivery in each one as this will affect the subsequent management. I will review her antenatal care notes, if any, and I will ask her about LMP and if it was sure or not any if she have ultrasound during this pregnancy for dating or as anomaly scan. After that I will examine her vital signs symphesio-fundal height and is going with her date. CTG is essential to assess the fetus and any uterine contractions. Dipstick is advised to assess proteinuria and urine should be collected for 24 hours to assess proteinuria as it is more accurate. Ultrasound scan is important to evaluate the average fetal size and also Doppler is required to assess the fetal well being.
b)
As this patient has high BP and proteinuria the diagnosis will be PET or essential HTN superimposed PET if she is known case of HTN. The management will be the same. If she has severe PET,ABP>170/110 with proteinuria, this is an emergency and the definitive treatment is delivery after stabilization, caesarian section or vaginal this will be depended on the effacement and dilatation of the cervix and if the patient responded to treatment, corticosteroids can be given to enhance the maturity of the fetal lungs but without endangering the mother's life. Mgso4 should be started immediately and continued for 24 h after delivery
If BP was stabilized and patient has a mild PET a conservative management can be applied till lung maturity is achieved. However, if patient has been deteriorated delivery should be considered without any delay.
If conservative management is chose then in-patient is preferred and ultrasound scan should be performed to assess amniotic fluid, UA Doppler and average fetal size and with follow up if normal in 2 weeks to assess fetal growth. Any abnormality then delivery should be expedited. Fetal medicine should be consulted if available and neonatologists should be informed, too. If they are not available intra-uterine transport to tertiary centre should be considered after stabilization.
c)
If this patient has severe PET that required treatment with Mgso4 this should be continued 24 h after delivery or after last seizure if she had eclampsia. Her ABP should be monitored and antihypertensive drugs continued as in-patient for at least four days after delivery. If she had mild PET and her ABP was stable after delivery, this patient can be discharged after 24 h after delivery with medical advice to measure her ABP regularly. Breast feeding should be encouraged, and appropriate contraceptive advice should be given.
Her medical problem should be explained including recurrence rate and the management in the subsequent pregnancies.
