PERSONAL DETAILS

Name : Z
Age : 34
Occupation : Company secretary
Relationship status : Married
Gestation : 39+6
Gravidity/Parity : G2 P1
Presenting Complaint
High blood pressure
Admitted 3 times before
Started from week 7
BP on admission 150/101
Headache
Frontal headache
Started 4 weeks ago
Relieved by paracetamol
Protein in urine
No PV bleeding, diabetes, anaemia, abdominal pain, visual
disturbance, fever, hand or feet swelling, show/SROM.
HOPP
First day of LMP 26/12/2013
EDD 2/10/2014 (IOL today)
Menstrual cycle regular, 28 days
Symptoms of pregnancy Amenorrhea, increased urinary
frequency, nausea
Problems during pregnancy High blood pressure and protein
trace (4 times), urinary tract infection (twice earlier in
pregnancy)
Tests All scans and blood tests were normal
Past Obs/Gynae Hystory
G2 P1
Current pregnancy - planned
Previous pregnancy has similar problems
Has a 3 years old boy
Born at 40+2 weeks, IOL, Ventouse delivery, birthweight was 3.67 kg

No past gynae history
Last smear was normal 2013
Never took contraceptive pills and no problem with conceiving
Past Med/Surg History
Medications
None
No allergy
Never been depressed (medically)
Taking Paracetamol for the headache
Took preconceptual folic acid starting 6 weeks before
pregnancy

Family/Social History
Aunt has a twin, sister and 2 nephews had DDH.
Father has Type 2 DM

Non-smoker, social drinker 3-6 units/week (not
during pregnancy)
Living with husband and son
BMI 27
BP at booking 114/74

Singleton fetus in longitudinal lie with cephalic
presentation.

What do you think she has?
A Pre-existing hypertension
B - Gestational/Pregnancy-induced hypertension (PIH)
C - Pre-eclampsia
What is Pre-eclampsia?
Hypertension of 140/90 mmHg recorded on 2 separate
occassions of at least 4 hours apart and proteinuria 300mg
protein in a 24 hours urine colleection, arising de novo, in a
previously normotensive women, after 20
th
week of pregnancy and
resolving completely by 6
th
postpartum week.
Severe pre-eclampsia : BP 160/110 and proteinuria 1g/24 hours
or if maternal complications occur.
What is eclampsia?
Occurence of tonic-clonic seizure in association with
a diagnosis of pre-eclampsia
It is an obstetric emergency!

What are the risk factors of pre-
eclampsia?
Primiparity
Multiparity with:
Pre-eclampsia in previous pregnancy
10 years since last baby
Age >40
BMI >30 (Obesity)
FH of pre-eclampsia
Multiple pregnancy

Pre-existing medical conditions:
Hypertension
Renal disease
DM
Antiphospholipid antibodies
Connective tissue diseases
Thrombophilia
Booking diastolic BP >90
Booking proteinuria >300mg/24hours
SOME MCQs

1 - Which is the most common sign/symptom experienced
by a woman with pre-eclampsia?
A Epigastric pain
B Frontal headache
C Visual disturbance
D Facial edema
E Asymptomatic

2 - The following drugs can be used to treat her
EXCEPT:
A ACE inhibitor
B Hydralazine
C Methyldopa
D Labetolol
E Calcium channel blocker
3 Regarding Eclampsia/ Pre-Eclampsia, which of the
following is TRUE?
A - General oedema is a useful diagnostic feature
B - Pre-eclampsia always precedes eclampsia
C - A blood pressure of 160/110 gives a diagnosis of severe pre-
eclampsia
D - Thrombocytopenia is a common finding in pre-eclampsia
E All patients with pre-eclampsia must be treated in-patient

4 - Regarding hypertension in pregnancy, which of the
following is true?
A The combination of hypertension and proteinuria always
indicate pre-eclampsia
B The presence of edema is a useful diagnostic sign
C Pre-eclampsia may occur after birth
D Pre-eclampsia is more common in multigravida
E Proteinuria in pre-eclampsia is defined as the presence
of 200mg of protein in 24 hours urine collection
5. Pre-eclampsia can be cured by:
A Antihypertensives
B Magnesium sulphate
C Diuretics
D Termination of pregnancy (TOP)
E Deliver the baby
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