Term
| A 29-year-old primigravida at 36 weeks has BP 160/110 and urine protein ++. What ACOG criteria confirm preeclampsia? |
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Definition
Hypertension (≥140/90) + proteinuria or
Hypertension + thrombocytopenia/renal impairment/liver dysfunction/pulmonary edema/cerebral symptoms.
Why this matters: Proteinuria is no longer mandatory; organ dysfunction suffices. |
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Term
| What is the criteria for severe preeclampsia? |
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Definition
Blood pressure ≥160 mm Hg systolic or ≥110 mm Hg diastolic on two separate occasions at least 4 hr apart
Serum creatinine >1.1 mg/dl or a doubling of the serum creatinine
New onset of cerebral or visual disturbances
Pulmonary edema
Hepatocellular injury (serum transaminases at least twice normal) or severe persistent right upper quadrant or
epigastric pain
Thrombocytopenia <100,000
Why this matters: Severe features necessitate urgent delivery and magnesium sulfate.
Why this matters: Severe features necessitate urgent delivery and magnesium sulfate.
Why this matters: Severe features necessitate urgent delivery and magnesium sulfate. |
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Term
| What first-line medications should be administered? |
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Definition
Labetalol/Nifedipine for BP control.
Magnesium sulfate to prevent seizures.
Why this matters: Reduces maternal mortality and eclampsia risk. |
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Term
| What 4 tests are critical for monitoring this patient? |
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Definition
Blood tests: Platelets, LFTs, creatinine.
Urine protein quantification.
Fetal monitoring: NST, ultrasound (growth, amniotic fluid).
BP checks every 15–30 minutes initially.
Why this matters: Detects progression to HELLP syndrome or fetal compromise. |
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Term
| At 36 weeks with severe preeclampsia, when should delivery occur? |
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Definition
Immediately (within 24–48 hours).
Why this matters: Delaying increases maternal/fetal risks (eclampsia, placental abruption). |
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Term
| Can this patient attempt vaginal delivery? |
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Definition
Yes, if BP stabilizes and fetal status is reassuring. Induction with prostaglandins/oxytocin is appropriate.
Why this matters: Vaginal delivery is preferred unless emergent C-section is needed for fetal distress. |
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Term
| Why is pool delivery contraindicated? |
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Definition
Requires continuous maternal-fetal monitoring (impossible underwater) and rapid intervention for seizures/hemorrhage.
Why this matters: Safety risks outweigh benefits in preeclampsia. |
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Term
| The patient asks, “Can I go home with medication?” How do you respond? |
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Definition
| “No. Severe preeclampsia requires hospitalization for BP control, seizure prevention, and fetal monitoring. Discharge risks eclampsia/stillbirth.” |
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Term
| The patient worries, “Will labetalol harm my baby?” How do you reassure her? |
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Definition
“Labetalol is safe in pregnancy. It lowers BP without affecting fetal growth. We’ll monitor you closely.”
Why this matters: Alleviates anxiety and promotes adherence. |
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Term
| How long should BP monitoring continue postpartum? |
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Definition
At least 72 hours (eclampsia can occur up to 6 weeks postpartum).
Why this matters: 30% of eclampsia cases happen postpartum. |
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Term
| How do you rule out chronic hypertension with superimposed preeclampsia? |
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Definition
Check prior BP records (booking BP was 110/70). No history of HTN confirms new-onset preeclampsia.
Why this matters: Guides long-term management and counseling. |
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Term
| What red flags should the patient report immediately? |
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Definition
Severe headache, visual changes, RUQ pain, decreased fetal movement.
Why this matters: Early recognition prevents complications. |
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Term
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Definition
SEVERE PREECLAMPSIA: CRISP
Cerebral symptoms, Renal/liver dysfunction, Intense hypertension (≥160/110), Severe thrombocytopenia, Pulmonary edema.
MgSO4 Protocol: 4-4-4 Rule
4 g IV load, then 4 g/hr infusion, monitor reflexes/respiration/urine output every 4 hours. |
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Term
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Definition
Prioritize delivery at ≥34 weeks for severe preeclampsia; <34 weeks, consider steroids for fetal lung maturity.
Avoid diuretics/ACE inhibitors (harmful in pregnancy).
Counsel recurrence risk: 15%–25% in future pregnancies. |
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Term
Risk Factors for
Preeclampsia |
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Definition
Nulliparity
• Age >40 yr
• Pregnancy with assisted reproduction
• Interpregnancy interval >7 yr
• Family history of preeclampsia
• Woman born small for gestational age
• Obesity/gestational diabetes
• Multifetal gestation
• Preeclampsia in a previous pregnancy
• Poor outcome in a previous pregnancy
• Fetal growth restriction, placental abruption, fetal
death
• Preexisting medical-genetic conditions
• Chronic hypertension
• Renal disease
• Type 1 (insulin-dependent) diabetes mellitus
• Antiphospholipid antibody syndrome
viral hepatitis
Medications or medication withdrawal |
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Term
| Monitoring during MgSo4 Rx |
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Definition
Seizure prophylaxis: Load 4–6 g MgSO4 IV in 100 mL NS over 30 min.
Maintenance: Add 20 g MgSO4 to 500 mL NS infuse at 50 mL/h (2
g/h). Side effects: flushing, headache, dizziness, ↓reflexes,
respiratory/cardiac arrest. Monitor patellar reflexes, respirations, and
keep urine output ≥ 25 mL/h. Reverse with calcium gluconate (10%)
10–20 mL slow IV push. Caution: MgSO4 use may cause
cardiorespiratory depression in myasthenia gravis, maternal
cardiovascular or renal disease, or use with nifedipine, β-agonists. |
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