TEALE FENNING

EMAK · Century Club Joined: 26 Nov 2006 Posts: 572

A Intravenous labetalol
B Immediate delivery by caesarean section
C Intravenous magnesium sulphate
D Measure serum aspartate transaminase immediately
E Measure FBC and clotting profile
F Blood transfusion
G Immediate induction of labour
H Provide a fluid challenge with colloids
I Antihypertensive treatment
J Administer iv phenytoin
K Measure 24h urine protein excretion
L Arrange in-utero transfer to tertiary centre

EMAK · Century Club Joined: 26 Nov 2006 Posts: 572

A 32 year old primigravida with a previously normal pregnancy is seen in the antenatal clinic at 39 weeks gestation with a BP of 160/95mmHg and 3+ proteinuria. The uterus is appropriate for gestation age with a cephalic presentation.

Select single most appropriate management from options above.

farha · Century Club Joined: 18 May 2007 Posts: 156

Well what i feel it is I but i really feel bad about word" immediate "induction . Why idecided this option she is 39 week and there is no reason why to prolong pregnency when things have started getting worse with the woman. I donot know i am correct or not :?:

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 921

Yeah, I too dont like this word "immediate!"
But would still go for the answer-Induction of Labor.

EMAK · Century Club Joined: 26 Nov 2006 Posts: 572

What if I say:

Single initial management [/b]

EMAK · Century Club Joined: 26 Nov 2006 Posts: 572

farha · Century Club Joined: 18 May 2007 Posts: 156

Emak if you say single initial management then iwill go for antihypertensive because it covers all type of antihypertensive (oral and iv) what do u say :?:

EMAK · Century Club Joined: 26 Nov 2006 Posts: 572

May be.
also you can say measuring liver enzyme for accurate assessment of patient condition.
You can say also measuring FBC and coagulation profile to detect any situation that need correction before induction or before C/S if needed...

and this is exactly what will happen in exam,, you may find many possible answers , each with its own justification...
But you should have faith in God, in your brain, your practice and knowladge. Rolling Eyes

masooma · Joined: 22 Jan 2007 Posts: 10

i think it's -k
to measure 24 hr urinary protein excretion.

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966

Select single most appropriate management.

induction --- not initial as you'll like to get some more info and Mx is h/o, Ex, Ix and Rx

antihypertensives -- no, bp is 160/95 hence map is only 116 and you have only 1 reading, i'll like to repeat BP

24 hr ur prot / pet bloods as a whole, not lft or fbc seperately --- may be this should be the 1st step, as if more than 3 prot or deranged pet bloods it's preecclampsia and you'll start thinking of iol

i wd have also kept msu as an option --- as bp may be a one off and the protein may be due to infection.

well emak, where is ur emq from and what answer does the book give???

raj
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region

farha · Century Club Joined: 18 May 2007 Posts: 156

Raj I AM REALLY THINKING ABOUT WORD APPROPRIATE WHICH AGAIN
HAS A MEANING .
I THINK AMEK WILL SOLVE THE ISSUE

EMAK · Century Club Joined: 26 Nov 2006 Posts: 572

farha wrote:

Well what i feel it is I but i really feel bad about word" immediate "induction . Why idecided this option she is 39 week and there is no reason why to prolong pregnency when things have started getting worse with the woman. I donot know i am correct or not Question

True>>>> Induction of Labour.
but initial management >>>>>

stil

farha · Century Club Joined: 18 May 2007 Posts: 156

I still feel itis antihy pertensive

Nick Raine-Fenning · Posted: Sat Jun 02, 2007 9:24 am Post subject:

There are two possible answers here:

G Immediate induction of labour

L Arrange in-utero transfer to tertiary centre

I would probably go with the first one as we do not know if she is stable. Induction would still be OK as you could add magnesium etc and still go for a vaginal delivery. Transfer of a symptomatic woman is less safe.

The rest can all be argued against.

masooma - 24 hour collections have no predicitve value and are only used for the diagnosis. Two ++ of proteinuria may also be used to diagnose significant proteinuria now anyway. Higher levels of proteinuria do not equate with worse PET.

She does not have a BP or symptoms / signs that warrant iv antihypertensives or anticonvulsants but as Raj says the key here would be to assess her for this. That would have been a much better answer.

The answer 'antihypertensives' is also appropriate as farha says because her BP is high (although ? a one off measurement) and the CEMD constantly stress the need for active treatment of hypertension.

Blood tests - absolutely but why FBC over AST?

I would much prefer to know if she is symptomatic or has clonus! That would have been my answer. Confused

vani s · Century Club Joined: 20 Jan 2007 Posts: 141

This feels just like the Exam... so many seem nearly right.

I would have gone for " antihypertensive treatment"

Single immediate Mx , if you say " induction of labour" does it not mean you are giving her time to convulse till she actually goes in labour and delivers?
As Nick says, If clonus was given, I would have given MgSO4.

The only other thing is ... " do we rely on 1 reading or not?" But there is no option of taking a second reading.

wolverine · Century Club Joined: 16 Jan 2007 Posts: 394

This is a case that you see almost everyday on a busy labour ward! What would be the first thing to look at before deciding when, where and how I'd deliver her is her bloods. And most important her liver function (answer D)

wolverine · Century Club Joined: 16 Jan 2007 Posts: 394

FBC is also needed but the "clotting" bit is making the answer wrong as you take clotting studies only if the plts are low or the LFT's are abnormal.

wolverine · Century Club Joined: 16 Jan 2007 Posts: 394

antihypertensives are not usually necessary if systolic is <160 or diastolic <100 unless she is symptomatic. 24hour protein urine is a bit of a waste of time as she's already 39 weeks and 3+ of protein on dipstix means more than 1g/lt of protein. She may need transfer to a tertiary centre but the question says that she is still in the ANC. Therefore my initial Mx would be a full detailed meticulus history and examination (now that I have finished I can use these words... Twisted Evil

) bloods and admission.

vani s · Century Club Joined: 20 Jan 2007 Posts: 141

so out of the options... you would go for D?

farha · Century Club Joined: 18 May 2007 Posts: 156

In above we have to stress on the word appropriate asgiven in the clue
so ifwe take the word appropriate then it is induction