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Sunday, August 29, 2010

A Patient With Possible Severe Preeclampsia

A 34 year old Gravida 3, Para 2 with a history of 2 cesarean deliveries and chronic hypertension was seen in the office at 25 weeks' for a routine examination. She was noted to have a blood pressure of 210/105 mm Hg with 4 + proteinuria on urine dipstick. She did not have proteinuria on urine dipstick in the past and a 24 hour urine collection at 14 weeks' showed 300 mg of protein. Her fetus measured 22 weeks' and had oligohydramnios. Doppler examination of the umbilical artery showed absent end diastolic flow. She denied headache, epigastric pain, visual complaints, cough, and shortness of breath. She had been taking methyldopa 500 mg orally twice daily for the control of her blood pressure.

She was admitted for treatment of her severe hypertension and evaluation for possible superimposed preeclampsia. She was given a 4 gram loading dose of magnesium sulfate followed by 2 grams per hour infusion. She was also given Celestone 12 mg IM. Over the course of one hour she received three doses of hydralazine 5 mg IV followed by labetalol 20 mg , 40 mg, and 80 mg. Her blood pressure was decreased to 156 / 90 mm Hg.

(20 mg IV is the maximum cumulative dose of hydralazine recommended for the treatment of acute severe hypertension in pregnancy. 220 mg IV is the maximum cumulative dose of labetalol recommended for the treatment of acute severe hypertension in pregnancy [1]).

Platelet count: 120 X 10 9/L
Alanine aminotransferase , ALT, SGPT  : 33 U/L (0.55 µkat/L)
Aspartate aminotransferase ,AST, SGOT  : 32 U/L (0.53 µkat/L)
Urinalysis significant for 3+ protein, trace blood.
Urine toxicology screen: Negative

Two hours after admission she began to complain of abdominal pain and cramping. Her blood pressure was 180 /100.

Her fetal heart tracing showed the following pattern:

What would you do next?

1. Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 2000;183:S


Anonymous Anonymous said...

I would deliver for possible concealed abruption and a "non reassuring" fetal heart rate tracing. B.R.

September 1, 2010 at 11:09 AM  
Anonymous Anonymous said...


September 2, 2010 at 6:11 PM  
Anonymous Anonymous said...

Max cumulative dose of labetalol is now 300 mg (from 220 mg).
Concern for abruption. Even with better looking FHT delivery is indicated

September 28, 2010 at 11:49 AM  
Blogger laborlovinrn said...

Delivery is immenent, probable abruptio placente!

September 3, 2011 at 2:10 AM  
Anonymous Anonymous said...

Faltan datos para precisar pero no podemos olvidar la posibilidad de una evolcuión hacia el HELLP

November 4, 2011 at 1:37 PM  
Anonymous Anonymous said...

What was the outcome?

December 3, 2011 at 8:49 AM  

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