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Re: What would you do, new case From: douglas krell (douglas.krell@nsionline.com) Sat Jan 4 07:18:35 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: douglas krell: "Re: Evidence & Economics" Previous message: Rosamaria Favaro: "Re : C-section ? in women with hyperprolactinemic adenoma" Maybe in reply to: Garry E. Siegel: "What would you do, new case" Next in thread: Robert J. Woolley: "Re: What would you do, new case" Garry E. Siegel wrote: > 30 YO nulligravida with an uncomplicated pregnancy presents for routine > visit at 37 weeks. Her blood pressure (taken by the nurse, sitting) is > 120/80, no proteinuria, and a 5 pound weight gain in 2 weeks. Her baseline > BPs since 8 weeks, and in prior gyn visits, are 100 to 110/60 to 70 > Upon return at 38 weeks, she remains symptom free, gained 1 pound, has 1 + > voided protein (no other positives on dipstick), and has a BP of 138/94, > repeated 140/85. I think the first thing is to entertain a possible diagnosis. You might have done a quick mini-cath to rule out urine specimen contamination. I would probably get an NST in the office, send her to the lab for CBC, platelet count, give her warnings about pre-eclampsia symptoms, and send her home to bed rest L side if the tracing is reactive. Call her back if her platelet count is under 100Kand put her in the hospital. Otherwise follow up in 48-72 hours. > Diagnosis, if any? I don't think you can call it anything but some type of pregnancy induced hypertension until you have more reason to suspect toxemia (I like this term-it's shorter to write). > > Treatment options, if needed? bed rest. NB. I had a woman like this just recently...She was moderately obese to begin with. A little positional hypertension that always corrected. Never more than 1+ proteinuria. Trace edema. Platelets always >150K. She spontaneouly ruptured her membranes. She got an epidural in labor, her pressures normalized, everything else went smoothly. -- Douglas Krell MD Next message: douglas krell: "Re: Evidence & Economics" Previous message: Rosamaria Favaro: "Re : C-section ? in women with hyperprolactinemic adenoma" Maybe in reply to: Garry E. Siegel: "What would you do, new case" Next in thread: Robert J. Woolley: "Re: What would you do, new case"

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