CASE OF GESTATIONAL HYPERTENSION

Junior Intern Fairoz Macud Adap 200870003

General Data
J. B. 40 years old Married, Filipino, Catholic Housewife Cembo, Makati G4P3 (3003)

Chief Complaint
BP Elevation

History of Present Illness 1st Trimester

Amenorrhea Pregnancy Test not done No bloody show No nausea and vomiting With increase in appetite No medication taken No maternal illnesses noted No UTZ No consult done

History of Present Illness 2nd Trimester

Patient had nausea With quickening noted on the 6th month No mucoid/watery/bloody vaginal discharge Experienced irregular contractions First consult done at St. Andrew Lying-In Center

and was prescribed with multivitamins OD, ferrous sulfate OD and calcium tablet OD Isoxsuprine tablet given at 32 weeks for 1 week No laboratory work up done

History of Present Illness 3rd Trimester

Presence of good fetal movement With irregular contractions No mucoid/watery/bloody discharge With intake of multivitamins and ferrous sulfate UTZ, CBC with PC, UA, BT, VDRL/RPR, HbSAg

were done

Laboratory Results
Patient Nonreactive Nonreactive Nonreactive B positive

VDRL RPR HBsAg Blood Type

CBC with PC WBC Neutrophils Lymphocytes Monocytes Eosinophils Basophils RBC HGB HCT MCV MCH MCHC RDW Platelet 3.85 10.9 32 79 24.2 30.6 16.3 340 10 78.6 14.3 7.1

September 20, 2011

URINALYSIS Color Transparency Epithelial Cell Mucus Thread Amorphous Urates Pus Cells Erythrocytes Albumin Sugar Specific Gravity pH Bacteria

September 20, 2011 Yellow Hazy Few Rare Rare 4-8 0-2 Negative Negative 1.010 6.0

BPS with Biometry (November 11, 2011)

Single, alive, intrauterine pregnancy, cephalic presentation, 33 4/7 weeks AOG by BPD and 34 4/7 weeks AOG by FL. Placenta posterior, high-lying, grade 2-3. Adequate amniotic fluid. Sonographic estimated fetal weight is appropriate for gestational age. Biophysical profile score is 8/8.

History of Present Illness Few Hours PTA

4th PNCU at OMMC OB-OPD With good fetal movement No bloody show No watery discharge No headache No dizziness BP was 160/90 and patient was brought to ER for

further management

Past Medical History

(-) previous hospitalization (-) BA (-) HPN (-) DM

Family Medical History

Hypertension father (-) BA (-) DM (-) allergy to food and medications

Personal and Social History

Nonsmoker Non-alcoholic beverage drinker

Review of Systems
General: No fever, weight loss and loss of appetite Skin: No jaundice, no pallor, no cyanosis HEENT: No headache, no blurring of vision, no pain and

redness of the eyes, no tinnitus, no lymphadenopathies

Respiratory: No colds, cough and dyspnea Cardiovascular : Cardiovascular:

No palpitations, no nocturnal dyspnea and no chest pain

paroxysmal

Review of Systems

Gastrointestinal: Gastrointestinal : No abdominal pain, no change in bowel movement, no nausea, no vomiting, no melena. melena . Renal: No dysuria , no hematuria , no frequency, no Renal : dysuria, hematuria, incontinence Musculoskeletal : No paralysis, No numbness Musculoskeletal: Neurologic: Neurologic : convulsions No loss of consciousness, No

Menstrual History
M 12 y/o I regular D 6 days A 4-5 pads per day, fully soaked S (+) dysmenorrhea LMP: Last week of March 2011 AOG: 36 - 37 weeks EDC: First week of January 2012

Sexual History
Age of 1st coitus: 21 Sexual partner/s: 2 (+) OCP used for 6 years - Ergestrol (-) IUD (-) Dyspareunia (-) PCB (-) STI

Obstetric History
G1 G2 G3 G4 G4P3(3003) 1992 M FT NSD Chinese Gen 1994 M FT NSD Amisola LIC 2000 F FT NSD Chinese Gen Present pregnancy (-) (-) (-)

PNCU: St. Andrew Private Clinic x 6 OMMC x 4 (+) Multivitamins, (+) FeSO4

Physical Examination General Awake, conscious, not in respiratory distress Vital Signs 150/90 82 23 37.5 HEENT AS, PPC, (-) NAD, (-) TPC, (-) CLAD Chest and Lungs SCE, (-) retractions, clear breath sounds Heart AP NRRR (-) murmurs Abdomen Globular, nontender FH: 30 cm EFW (2.8-3.0kg) FHT: 140s Extremities Grossly normal, (-)edema, (-) cyanosis IE 1 cm, BE, cephalic, (+) BOW, floating

 URINE ALBUMIN: TRACE

Admitting Diagnosis
G4P3 (3003) Pregnancy Uterine 36 - 37

weeks AOG by LMP, Cephalic in Beginning Labor Gestational Hypertension

Course in the ER
NPO IVF: D5LR x 8 hours For Assisted Vaginal Delivery Diagnostics:
CBC with PC Urinalysis Blood Typing SGOT, SGPT, BUN, Crea, BUA, LDH

Course in the ER
Medication:
Hydralazine 5 mg TIV for BPu160/100

WOF: persistent BP elevation, signs of

eclampsia, difficulty of breathing Monitor progress of labor Monitor VS q1 and FHT q1

CBC with PC WBC Neutrophils Lymphocytes Monocytes Eosinophils Basophils RBC HGB HCT MCV MCH MCHC RDW Platelet 3.91 10.7 30.4 77.9 24.9 32 16.3 325 12.1 76.9 15.3 7.8

Urinalysis Color Transparency Epithelial Cell Mucus Thread Amorphous Urates Pus Cells Erythrocytes Albumin Sugar Specific Gravity pH Bacteria Yellow Slightly turbid Moderate Few Many 0-2 0-1 Trace

Laboratory Results
Patient BUN Creatinine Uric Acid AST ALT LDH 14.05 0.8 9.3 23.56 165.2 Normal Values 7-18 0.6-1.1 0-38 0-40 103-227

Course in the DR
BP = 140/70, HR = 86, RR = 20, FHT = 156 Maintained on NPO IVF: D5LR 1 L x 8 hours Meds: HNBB TIV q4

Hydralazine 5 mg TIV prn BP > 160/100 1 cerviprime gel given WOF: fetomaternal distress, BP elevation Monitor Progress of labor Monitor Vital signs q1 and FHT q 15mins

10th Hour of Labor

Patient delivered via normal spontaneous delivery with

perineal support to live baby boy, AS 9,9 Placenta out completed IVF: D5LR + 30 u oxytocin x 8 hours IVF to follow: D5LR 20 u oxytocin x 8 hours, then to consume To start on low salt and low fat diet

Final Diagnosis
G4P4(4004) Pregnancy Uterine Delivered

Spontaneously to a Term Cephalic Livebirth Baby Boy with AS 9,9, BW 2.9 kg, BL 50 cm, PA 37 weeks Gestational Hypertension

Course in the Wards 1st Postpartum Day

Vital Signs: BP 130/90 (BP range 120-130/80-90)

HR 89 RR 21 Temp 36.8
Low salt low fat diet Medications: Co-Amoxiclav 625 mg/cap TID x 7 days Multivitamins 1 tab OD Ferrous sulfate 1 tab OD Metoprolol 50 mg/tab 1 tab BID Clonidine 75 mcg/tab 1 tab SL prn BPu160/100 Mefenamic Acid 500 mg/tab 1 tab q6 prn pain on full stomach

SGPT, SGOT, BUN, Crea and LDH done normal results WOF: BP elevation, signs of eclampsia May go home once with control BP range

Course in the Wards

On 3rd postpartum day, patient was sent home with

controlled BP range of 120-130/80-90 No subjective complaints

Thank You