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OB: Preeclampsia?From: Garry E. Siegel, M.D. (garrys@mindspring.com)Mon Sep 26 21:26:37 2005
22 YO P0 at 30w4d calls Saturday PM Known twin pregnancy, later (16 weeks) and somewhat haphazard prenatal care. She called with RUQ/rib pain, and her smart obstetrician (initials GES) attributed it to musculoskeletal pain. She called an hour later and said her mother checked her BP--150/100. The same smart Ob said, come on in. Due to car trouble, she went to a closer to home hospital with no Ob services, and the ER doc called--BP 150/100, gave her morphine/phenergan for the pain, and got labs. WBC 18K, Hct 29, platelets 370K, SGOT normal, creatinine "normal" at 1.0. U/A negative protein, other stuff. I said, please start Mag, give her hydralazine (she was now 155/105) and send her over. My evaluation: BP 120 to 150/80's, no symptoms except RUQ/rib/upper flank pain. With questioning, she has had indigestion for a while. Exam unremarkable, cervix 1.5/25, breech. Brief U/S--breech/transverse. NST Non-reactive, spont. CST negative. BTW, was treated for a UTI this week found on routine urinalysis. So. . .Sunday AM, 30w5d 24 hour urine begun Steroids given MFM BPP 8/8 for both, but twin B is 24% with a 5th percentile abdomen Mag cut to 1 gram/hour, and levels still 5.9 Chart reviewed: spotty pre-natal care begun at 16 weeks; Urine C and S from mid 8-2005 10 to 25K E. coli--that is what she was treated for. WBC in June and August both around 18K, never addressed. Today, 30w6d: MFM suggests renal ultrasound--mild right hydronephosis, gallstones without inflammation/wall thickening AM Mag 6.0--cut to 3/4 gram/hour SGOT 30--on the upper edge of the normal range Platelets the same, Hct. 26 or so 24 hour Creat. clearance 96 ml/minute, 439 mg. protein/24 hours. Serum creatinine 1.2, repeat SGOT in PM 32. Mag 6.0, cut to 1/2 gram/hour. Does she have pre-eclamsia? Would you call it severe? Would you deliver? When? Do you think the ultrasound findings--gallstones, right hydro--have any relationship to her symptoms and findings? Garry
-- Garry E. Siegel, M.D. Private Practice Roswell, GA
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