KH is an 18 y/o G1P0 at 36w6d who presents to L&D triage for evaluation to rule out preeclampsia. Patient was seen in the clinic yesterday and was noted to have elevated blood pressure of 153/85 and sent to triage. At present, she denies any complaints, any HA, blurry vision, chest pain, shortness of breath, epigastric pain or RUQ pain. She denies vaginal bleeding, contractions or leakage/loss of fluid. Patient reports good fetal movement.
Notably blood pressures in triage yesterday were noted to be persistently elevated in the mild range of 140’s-50’s/90’s and was noted to have had one severe range blood pressure of 162/101. Today, patient is noted to have all elevated systolic blood pressures in the 160’s.
OBHx: G1P0. PMHx only significant for controlled asthma. Patient denied any hx of abdominal surgery or any known allergies. Patient is taking a prenatal vitamin and Tylenol prn. She admits to a family hx of Ovarian cancer in her paternal grandmother. Pt lives with her boyfriend, is sexually active with only him. Denies use of contraception or protection. Denies alcohol, tobacco or illicit drug use.
Prenatal course: LMP 01/29/2021. First prenatal visit 5/17/2021. Last prenatal visit 10/13/2021. Total of 7 visits. Total of 0 pre-natal hospitalizations.
Physical exam:
Vital signs: Temp 98.2 F. R 18 b/m, unlabored. P 73 bpm, regular rhythm. BP 167/98. O2 sat 98% room air. BMI 21.4.
Patient is well-appearing, in no pain or acute distress. Patient is asymptomatic.
Membrane status: intact. Baby’s FHR: 135 bpm, moderate variability, category I tracing.
Uterine activity: uterine contractions are present, onset 10/14/2021 @ 19:15. Irregular frequency, 40-50 seconds duration, mild.
OB ultrasound: vertex presentation, posterior placenta, AFI 14, + fetal movements.
EFW: 3,000 g
SVE: 1/30/-3
Labs:
POC urinalysis only significant for large leukocyte esterase, no proteinuria. Lactate dehydrogenase – 237. Prenatal labs: NIPS WNL, GBS negative, Rh positive.
KH is an 18 y/o F G1P0 at 36w6d with preeclampsia with severe features. Plan is to consent and admit, start NPO and IV fluids, stat dose nifedipine 10 mg IR, magnesium for seizure prophylaxis, Procardia 30 mg XL for BP control, betamethasone for fetal lung maturity. Process 24 hour protein, induction with foley Pitocin.
Professor Melendez offered constructive criticism and helped me in areas which needed strengthening. We discussed preeclampsia with and without severe features and the guidelines of next-step management depending on presence or lack of severe features and gestational age. He added to my learning and aided in my understanding of preeclampsia.
