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Re: What would you do, new caseFrom: John Robertson (jgmr@unixg.ubc.ca)Sat Jan 4 15:12:32 1997
At 16:02 03/01/97 -0600, you wrote: > >On Fri, 3 Jan 1997, Garry E. Siegel wrote: > >> I'm interested in how different physicians would handle a case as described >> below: >> >> 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'm willing to guess that I'll be the exception here, but I would not >place any diagnosis on this. I would start seeing her more frequently >(twice weekly), and react if the bp went up more or the protein became >2+, or even if she developed a true generalized edema (not just wt gain). >But for now, heightened scrutiny, but no definitive intervention. > I tend to agree that watching her carefully should be enough. I agree with the others that platelets should be checked and LFTs (liver function tests) should be done. I would probably also "rim" her cervex (after talking to her about it and warning about cramping and bloody show). Although never published anywhere that I can think of, I have heard a number of experienced OBGYns state that the mild pre-eclamptic induces easily. Maybe stirring up her natural prostaglandins would solve everyone's problem.
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