Review Note
Last Update: 09/30/2024 05:34 PM
Current Deck: Geneeskunde::3e bachelor::long & hart::ZSO 4 hemodynamiek
PublishedCurrently Published Content
Front
A 28-year-old woman has an unremarkable first pregnancy with no serious complications through her first 28 weeks of gestation. She has been seen regularly by her obstetrician and has exhibited normal weight gain associated with pregnancy. She has no previous history of diabetes, hypertension, or other systemic disease before or during her current pregnancy. During her 30-week checkup, her blood pressure was 128/85, and she complains about feeling slightly more “bloated” than usual with swelling in her legs that seems to get more uncomfortable as the day goes on. Her obstetrician recommends she try to get more bed rest, stay off her feet as much as possible, and return for evaluation in 1 week.
At the patient’s follow-up visit 1 week later, her blood pressure is 145/95. Her face is noticeably “puffy,” and she has evidence of edema in her upper extremities. She has gained over 10 lb in 1 week. She complains of epigastric discomfort and being bothered by bright lights. A basic urinalysis is performed, and a simple dipstick measure reveals a 3+ reading for protein in the patient’s urine. Upon these findings, the patient is admitted by her obstetrician to a local tertiary care hospital.
In the hospital, the patient’s urine is rechecked for the presence of protein and again registers a 3+ value by simple urine dipstick determination. The patient is then catheterized for urine collection. Over the next 24 hours, the patient’s urine output is recorded at 500 mL, with protein present of 6.8 g. At this time, the patient complains of headaches and tenderness in her upper right quadrant, and she shows signs of definitive peripheral edema. Her blood pressure at this point is 190/100, and it is decided to try to deliver the fetus. Upon delivery, the newborn is placed in neonatal intensive care. The expelled placenta is small and shows signs of widespread ischemic damage. Within a week of delivery, the mother’s blood pressure returns to normal, and her edema subsides. One month later, the mother shows no ill effects of this later term syndrome.
Questions
1. At the 1-week follow-up visit, are any of the patient’s clinical findings or physical conditions considered abnormal and potentially significant in terms of the subsequent health of the mother or the fetus? If so, what condition or syndrome might be responsible for these findings?
Back
Three of the
patient’s clinical findings would be considered abnormal at this time: the
presence of hypertension, proteinuria, and evidence of generalized edema. The
patient’s blood pressure during her 31st week of pregnancy is definitively
elevated. Any pressure >140/90 during pregnancy is considered hypertensive
and can be cause for concern in a pregnant woman. There are three major
classifications of hypertension in pregnancy: (1) chronic hypertension, which
is present in the pregnant woman before pregnancy or before the 20th week of
pregnancy; (2) gestational hypertension, which is hypertension that develops
after the 20th week of pregnancy and resolves itself postpartum; and (3)
preeclampsia, which is hypertension with proteinuria that develops after the
20th week of pregnancy. The patient is presenting in her 31st gestational week
with hypertension and proteinuria, which is consistent with the development of
the syndrome known as preeclampsia. Edema in the lower extremities alone
would not be considered indicative of a generalized edematous state in a third
trimester of pregnancy, but edema in upper extremities and the face is not
normal. Such a generalized edematous state is yet another symptom of
preeclampsia
No published tags.
Pending Suggestions
No pending suggestions for this note.