Pre-eclampsia

Question 1

A 24-year old primigravida presents at thirty-two weeks in a previously uneventful pregnancy. She is symptom-free apart from marked facial oedema, but her blood pressure is sustained at 145/105 and there is proteinuria (+) on testing. You arrange her admission for further investigation and management.

a. List 4 investigations that would help you assess the maternal condition. (4)

Answer 1

1. FBC – platelets (may be ↓; may suggest HELLP - (H)aemolysis, (E)levated (L)iver enzymes, (P)latelets low)
2. LFTs – transaminases (part of HELLP)
3. U+Es – creatinine (↑ may indicate underlying renal disease / (rarely) development of failure)
4. Urate

Question 2

Abdominal examination shows a fundal height of 26cm with apparently reduced liquor volume.

b. List 3 ways ultrasound can be used to help assess the foetal condition? (3)

Answer 2

1. Estimated fetal weight
2. USS doppler of umbilical artery (for waveform)
3. Check movements of foetus

Question 3

c. What other investigation would help reassure you about foetal wellbeing? (1)

Answer 3

CTG (Cardiotocography) → measure variability of heart rate

Question 4

e. What is the most likely diagnosis in this mother’s instance? (1)

Answer 4

Pre-eclampsia

Question 5

A 36 year old primigravida is admitted with a raised blood pressure of 160/100 mmHg at 32 weeks gestation. Her pregnancy had been uncomplicated until two days ago. She attended her midwife
today and was referred to the hospital on account of her blood pressure.

a. What is the most important diagnosis to consider? (1)

Answer 5

Pre-eclampsia

Question 6

b. List 4 important symptoms you must enquire about. (2)

Answer 6

1. Headache
2. Visual disturbance
3. Discomfort in upper abdomen
4. Peripheral oedema

Question 7

c. Give 2 pieces of information which will be relevant from her booking attendance. (2)

Answer 7

1. Baseline BP
2. FH pre-eclampsia
3. Dipstick result
4. PMH of HTN

Question 8

d. What single important bedside (or ward) investigation would you arrange to be performed? (1)

Answer 8

Urine → proteinuria

Question 9

The blood pressure increases to 160/110 over the next 24 hours and biochemical abnormalities persist.

f. What is the best treatment for this condition? (1)

Answer 9

Delivery of placenta and baby