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Q1. A 21 yo g0p0 at 28 weeks gestation presents to your office for routine prenatal care. On questioning, she complains that her face has been swollen for the past few days, but denies visual changes or headache. On physical exam she is found to have a BP of 145/95. Her BP at her first visit during the pregnancy was 120/65. Urinalysis reveals 1+ protein on dipstick. Her previous urine samples had no protein. What is your diagnosis?
Q2. A 25yo g4p2012 at 32 weeks gestation presents to your office complaining of a severe headache which has not been relieved by paracetamol. She denies any history of migraines. On exam, her blood pressure is found to be 165/115. You note that her blood pressure was 115/70 at her last visit. She complains of tenderness to palpation in the right upper quadrant. Urinalysis reveals 4+ proteinuria on dipstick. Previous urinalysis revealed trace protein. What is your diagnosis?
Q3. A 31 yo g6p2122 at 32 weeks gestation with a history of a seizure disorder presents to your office stating that she has just had a seizure. She has not had any seizures during the pregnancy, but states that she recently discontinued her seizure medication due to concerns she had about the potential effects on her child. Her blood pressure is 145/95. Urinalysis reveals trace protein. Her previous urine samples had no protein. What is your diagnosis?
Q4. A 31 yp g3p2002 at 29 weeks gestation presents to your office with her husband. She reports that she recently lost consciousness. Her husband states that she was cleaning the kitchen when she suddenly began shaking and fell to the floor. On exam her blood pressure is 165/115. Urinalysis reveals 3+ proteinuria on dipstick. Previous urinalyis displayed only trace protein. What is your diagnosis?
Q5. What precautions do you take with any woman who presents with pre-eclampsia or eclampsia?
Q6. A 21 yo g0p0 at 28 weeks gestation presents to your office for routine prenatal care. On questioning, she complains that her face has been swollen for the past few days, but denies visual changes or headache. On physical exam she is found to have a BP of 145/95. Her BP at her first visit during the pregnancy was 120/65. Urinalysis reveals 1+ protein on dipstick. Her previous urine samples had no protein. Your diagnosis is mild pre-eclampsia. You monitor her overnight and find that her vital signs have not changed and that the fetus does not appear in distress.
a. What should be your management plan? b. She states that she has traveled several hours for this visit and that she cannot afford to make the trip twice a week. What should you do?
a. What should be your management plan?
b. She states that she has traveled several hours for this visit and that she cannot afford to make the trip twice a week. What should you do?
Q7. A 25yo g4p2012 at 32 weeks gestation presents to your office complaining of a severe headache which has not been relieved by paracetamol. She denies any history of migraines. On exam, her blood pressure is found to be 165/115. You note that her blood pressure was 115/70 at her last visit. She complains of tenderness to palpation in the right upper quadrant. Urinalysis reveals 4+ proteinuria on dipstick. Previous urinalysis revealed trace protein. You diagnose her as having severe pre-eclampsia.
a. What is your first step in management? b. What would you do if she presented at 22 weeks gestation? c. Once you have addressed the patient’s seizure risk with either magnesium sulfate or diazepam, what should your next step be?
a. What is your first step in management?
b. What would you do if she presented at 22 weeks gestation?
c. Once you have addressed the patient’s seizure risk with either magnesium sulfate or diazepam, what should your next step be?
Q8. A 31 yp g3p2002 at 29 weeks gestation presents to your office with her husband. She reports that she recently lost consciousness. Her husband states that she was cleaning the kitchen when she suddenly began shaking and fell to the floor. On exam her blood pressure is 165/115. Urinalysis reveals 3+ proteinuria on dipstick. Previous urinalyis displayed only trace protein. You diagnose her as having eclampsia. You decide to give magnesium sulfate.
a. What is the most important consideration in preparation of magnesium sulfate for intravenous administration? b. When giving magnesium sulfate intravenously why is it important to dilute from 50% to 20% solution and to give it slowly over 20 minutes? c. You notice that the respiratory rate drops to 13 breaths per minute, what should you do?
a. What is the most important consideration in preparation of magnesium sulfate for intravenous administration?
b. When giving magnesium sulfate intravenously why is it important to dilute from 50% to 20% solution and to give it slowly over 20 minutes?
c. You notice that the respiratory rate drops to 13 breaths per minute, what should you do?
Q9. What is the appropriate dosage of magnesium sulfate?
Q10. How does this change if you are unable to give IV?
Q11. What is the appropriate dosage if convulsions recur?
Q12. You are hours away from the closest hospital. On exam, you find that your patient is 8cm dilated, 80% effaced, and at 0 station. So far, she has responded well to magnesium sulfate. For how long should you continue giving magnesium sulfate and what should you do before administration of magnesium sulfate?
Q13. You decide that you will continue to administer magnesium sulfate every 4 hours until 24 hours after delivery when you discover that you have just used the last dose of magnesium sulfate. What should you do?
Q14. When else might you administer diazepam?
Q15. What is the appropriate dosage of diazepam?
Q16. You are ready to administer diazepam IV when the patient begins convulsing. You decide rectal dosing is appropriate. What is the appropriate rectal dosage?
Q17. You have administered diazepam and achieved adequate seizure control, but note that the patient’s blood pressure is still elevated. What is the next appropriate step in management?