A)
Elicit history of high blood pressure before this pregnancy.High blood pressure in past pregnancies,need for treatment and outcome.History of symptoms of severe pre-eclampsia including headache , visual disturbance,epigastric pain,reduced urination.I would review handheld notes for booking blood pressure , BMI, other risk factors,previous scans for placental location.history suggestive of UTI
Examination including repeat blood pressure,look for swelling of legs and abdomen.I would check the reflexes auscultate chest.Measure symphysio-fundal height ,check lie and presentation and auscultate fetal heart.
Investigations i would perform include blood tests for full blood count,clotting profile,LFT,U&E,urine PCR,group & save.fetal CTG trace
B)
The management principles include initially arresting the convulsions and safeguarding the airway.Followed by measures to prevent further convulsions.Stabilising her airways , breathing circulation and blood pressure.Arranging care in high dependency unit and involving anaesthetic team , consultant obstetrician,midwife,neonatologyteam and hematology/blood transfusion team.Appropriate restraint to prevent fall or injury.Monitoring blood pressure , urine outout,saturation.
The initial convulsion would be managed by preventing aspiration and IV Mgso4 loading dose 4gm diluted in saline over 10 minutes.Tongue guard to prevent tongue bite.Inform consultant obstetrician and anaesthetist.Arrange trabsfer to high dependency care.Review blood tests to detect onset of HELLP syndrome.
Once she is conscious to apprise her of the situation and offer induction of labour after explaining merits and demerits of delivery.inform her of risk of severe morbidity to herself and baby if pregnancy continues.
Involve neonatology team to counsel regarding consequences of preterm birth and arrange a cot for baby.assess cervix for suitability of induction.offer caesarean section if unfavourable.
Continue Mgso4 infusion untill 24 hours after delivery.regular blood tests every 6 hours.
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