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A case of preeclampsiaFrom: Sing-Hung Chang (changl@cariari.ucr.ac.cr)Thu Jan 30 16:45:32 1997
Dear list, I would like to submit a recent case. 20 yo G2P0100, previous pregnancy ended 2 years ago by c/s at 26 wk for eclampsia, now with 28 wks (good dates and adequate prenatal care) came to ER complaining of severe headache and restlessness. BP upon arrival: 190/120 (all the previous BPs registered on her prenatal card were around 100/70). Pt was completely conscious and lucid, but she looked apprehensive, tremulous. She had limb and facial edema, hyperreflexia (+++). FH was 26, normal uterine tone, FHR 140, no uterine activity nor cervical changes. The rest of the physical examination was unremarkable (including fundoscopy). After the first bolus of hydralazine, BP was 200/130, and patient still very apprehensive. After 2 more boluses of hydralazine and the loading dose of MgSO4, BP was lowered to 170/110, then 160/100, and even came down to 140/80. Less headache, but with dizziness and nausea. Still hyperreflexic. Blood drawn and urine collected for tests. At this point, what should be the next step in her management? How soon should the pregnancy be resolved? Is it wise to observe her, wait upon lab results, while inducing pulmonary maturity with steroids? And how about using oral antihypertensive drugs during that lapse? I would like to hear different opinions about the proper management on this case. Thanks a lot in advance for your attention and help.
-- Sing-Hung Chang, MD Resident
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