Name: Subramaniyan Ravichandiran Aarthy

Id.no: 16-0655-975
Batch & block: September batch, Block 11B
Topic: Hypertension in pregnancy

1) What Is the diagnosis of the case? What is the basis for the diagnosis?
G3P2 (1102), pregnancy uterine, 30 week AOG by ultrasound, cephalic, not
in labor, previous preecclampsia (2011), preeclampsia with severe features.
Basis for diagnosis is obstetrical history, ultrasound report, family history with
hypertensive parents and her sister who had preeclampsia during her
pregnancy, gynaecological history of previous preeclampsia and the patient
has an elevated BP of about 190/100, with severe headache and dizziness.

2) Give differential diagnosis.

Differential diagnosis Rule in Rule out

Chronic hypertension Elevated BP (-) previous HTN
with superimposed Headache
preeclampsia Dizziness
Bipedal edema

Preeclampsia with Elevated BP

severe features Headache
Dizziness
Anemia
Bipedal edema
Advanced maternal age
Family history of
hyptertension
Sister who had
preeclampsia
Previous preeclampsia
Multiparity
Obesity

Ecclampsia Elevated BP (-) convulsion

Headache (-) change in mental state
Dizziness
Anemia
Bipedal edema
Advanced maternal age
Family history of
hyptertension
Sister who had
preeclampsia
Previous preeclampsia
 Multiparity
Obesity

3) What are the factors present in the case that may have contributed to
patient's condition?

The risk factors of preeclampsia with severe features that coincides the
patient are,
 Advanced maternal age
 Family history of hypertension and preeclampsia
 Previous preeclampsia
 Multiparity
 Obesity
 The patient has the chief complaint of headache and dizziness, that
may be due to changes in brain which is because of increase in high
blood pressure and these are the signs of preeclampsia.
 The patient also has bipedal edema. Because the maternal
dysfunctional endothelial cells causes vasoconstriction, which increase
the vascular permeability. So, the intravascular fluid escape into the
extravascular space causing edema. And this is also associated with
preeclampsia.

4) What diagnostics would be appropriate for the case?

 CBC with platelet count

 Blood smear test if needed
 HBsAg blood type
 Homocysteine blood test
 Indirect bilirubin blood test
 Serum Uric acid test
 Serum creatinine test
 ALT and AST tests
 Lactate dehydrogenase test
 24 hr urine protein test
 Microalbumin urine test
 Protein creatinine ratio test
 Calcium creatinine ratio test
 Color Doppler studies to determine IUGR & cerebal umblical pulsatility
ratio
 Nonstress test or biophysical profile
 Magnectic resonance imaging
5) What will be the appropriate management for the case?

 Admit the patient & do conservative management to secure and to

continue the pregnancy.
 Give dexamethasone 6mg IM every 12hrs x 4doses for fetal lung
maturity
 Give hydralazine 5 mg IV bolus every 20 minutes for a maximum of 20
mg. (As an antihypertensive medication.)
 According to Pritchard regime, Give MgSO4. 7H2O IM 10gms (5gms in
each buttock) and IV 4gms. And maintainance dose of 1g IV every
hour for 24 hrs. And the therapeutic level should not exceed 4-7 meq.
As the patient has the severe headache which is a significant
symptoms of impending eclampsia. So we considered giving
ecclampsia prophylaxis. ( do close monitoring, observation of urine
output, respiratory rate, and deep tendon reflexes as these are the
signs of MgSO4 toxicity.)
 Daily assessment of Intrapartum fetal monitoring & Maternal vital sign
evaluation
 After 34 weeks, the decision to deliver should be based on the
maternal and fetal condition and any identifiable risk factors for
progression of disease.
 If the gestational age attained >37 weeks then plan for delivery is
made.

6) What advise will you be giving to the mother for the future.

Bed rest
As the patient is obese we will suggest diet control plans.
Increase potassium intake as it may helps your body balance the
amount of fluids it holds onto.
Recommend iron supplement.
Reduce caffeine intake because it may elevate BP and also makes the
swelling worse. As caffeine is a diuretics, it increase furthermore fluid
loss.
Advice patient to drink more water.
Avoid exercise as it may increase the BP.