The dilemma of managing Severe Preeclampsia - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 02-17-2012
USMLE Forums Scout
 
Steps History: 1 + CS
Posts: 59
Threads: 12
Thanked 10 Times in 10 Posts
Reputation: 20
ObGyn The dilemma of managing Severe Preeclampsia

A 36-year-old G1P0 woman pregnant with twins presents to her obstetrician for her routine 32-week appointment. She has gained 5.4 kg (12 lb) in the past 2 weeks. When questioned about her weight gain, she states she has had headaches and some blurred vision for the past 2 weeks, which she thinks is secondary to dehydration. To circumvent this she has been drinking a lot of water, which she claims “is making me swell, even my hands.” She also has had some epigastric pain for the past 2 weeks, which she attributes to “all the water I’ve been drinking.” Her blood pressure is 142/90 mm Hg, pulse is 105/min, and respiratory rate is 18/min. Urinalysis reveals 1+ glucosuria and 4+ proteinuria. Which of the following is the best next step in management?

A. Administer magnesium sulfate only
B. Administer oral antihypertensive therapy

C. Expectant management
D. Induce labor

E. Platelet transfusion


How do you differentiate between which severe preeclampsia to manage and which to deliver right away?
Reply With Quote Quick reply to this message



  #2  
Old 02-18-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 591 Times in 355 Posts
Reputation: 601
Default

D?
all cases in severe preeclampsia needs delivery.
...can manage conservatively only when baby is too immature [26-34 weeks] and you can control BP below 160/110.

in this q, though BP is controlled but there is evidence of end organ damage,so i go with delivery.

whats the ans?
Reply With Quote Quick reply to this message
The above post was thanked by:
Mondoshawan (02-18-2012)
  #3  
Old 02-18-2012
qurat21's Avatar
USMLE Forums Master
 
Steps History: 1 + CK
Posts: 623
Threads: 62
Thanked 289 Times in 186 Posts
Reputation: 299
Default

administer magnesium sulphate.....pt is showing the symptoms of preeclampsia tht can be controlled...only when pt has seizure we go for c section and even induction of labour may precipitate more fits which is not a good choice...
whats the ans??
Reply With Quote Quick reply to this message
The above post was thanked by:
Mondoshawan (02-18-2012)
 
  #4  
Old 02-18-2012
qurat21's Avatar
USMLE Forums Master
 
Steps History: 1 + CK
Posts: 623
Threads: 62
Thanked 289 Times in 186 Posts
Reputation: 299
Default

Quote:
Originally Posted by tyagee View Post
D?
all cases in severe preeclampsia needs delivery.
...can manage conservatively only when baby is too immature [26-34 weeks] and you can control BP below 160/110.

in this q, though BP is controlled but there is evidence of end organ damage,so i go with delivery.

whats the ans?
pt is 32 weeks pregnant...
Reply With Quote Quick reply to this message
  #5  
Old 02-18-2012
axax's Avatar
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 115
Threads: 3
Thanked 267 Times in 41 Posts
Reputation: 277
Default

A. Administer magnesium sulfate only
__________________
Learning is like to row your boat upstream, if you stop learning, you will be pushed back by the current.
Reply With Quote Quick reply to this message
  #6  
Old 02-18-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 590
Threads: 31
Thanked 1,233 Times in 411 Posts
Reputation: 1257
Default C according to guidelines, but I would do B

It's a hard question because there is not much information and the answer choices are not the ones we would jump at.
A. I would not choose magnesium sulfate because the question does not say that the patient is having contractions.
C. I almost chose this. The guidelines say antihypertensives in severe hypertension, which is systolic BP >160 mm Hg or diastolic BP >110 mm Hg. However, I would be wary of expectant management only because the patient has a headache and visual disturbance in the presence of hypertension, which are dangerous signs.
D. I would not induce labor - as qurat21 mentions, labor is contraindicated in the presence of such severe symptoms. The patient has not received steroids and fetal lung maturity has not been ascertained. No mention is made of non-reassuring fetal heart rate or low AFI also. I would keep the baby in there if possible.
E. There is no mention of a value for platelets or any sign of bleeding out; this is definitely the wrong answer.

I would admit the patient and place her on bed rest, monitor fetal heart rate and contractions, administer betamethasone to induce lung maturity, and labetalol to lower her heart rate and address her hypertension. The closest answer to this is B...
Reply With Quote Quick reply to this message
  #7  
Old 02-18-2012
drnrpatel's Avatar
Guest
 
Steps History: 1+CK+CS
Posts: 441
Threads: 153
Thanked 396 Times in 211 Posts
Reputation: 419
Default

http://emedicine.medscape.com/articl...w#aw2aab6c22aa

Patient of Severe Pre-eclampsia should be induced labor only after 34 weeks.
( 37 weeks in Mild Pre-eclampsia )

BP is not treated unless > 160/100

Now, MgSO4 Px is started once you diagnose Severe Preeclampsia and Eclampsia.
MgSO4 Px is also given to Mild preeclampsia only during labor-24 hours postpartum.

So answer is A.
Reply With Quote Quick reply to this message
The above post was thanked by:
drhnis (02-20-2012), Mondoshawan (02-18-2012), podebrad (02-18-2012), yugao (02-20-2014)
  #8  
Old 02-18-2012
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 116
Threads: 35
Thanked 16 Times in 14 Posts
Reputation: 26
Default ans

maternal jeopardy like headache, blurred vision, ,high chances of going to eclampsia if continued,, so prompt delivery ,,induce labor,,,whats the answer?
Reply With Quote Quick reply to this message
  #9  
Old 02-18-2012
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 116
Threads: 35
Thanked 16 Times in 14 Posts
Reputation: 26
Default

Quote:
Originally Posted by Mondoshawan View Post
It's a hard question because there is not much information and the answer choices are not the ones we would jump at.
A. I would not choose magnesium sulfate because the question does not say that the patient is having contractions.
C. I almost chose this. The guidelines say antihypertensives in severe hypertension, which is systolic BP >160 mm Hg or diastolic BP >110 mm Hg. However, I would be wary of expectant management only because the patient has a headache and visual disturbance in the presence of hypertension, which are dangerous signs.
D. I would not induce labor - as qurat21 mentions, labor is contraindicated in the presence of such severe symptoms. The patient has not received steroids and fetal lung maturity has not been ascertained. No mention is made of non-reassuring fetal heart rate or low AFI also. I would keep the baby in there if possible.
E. There is no mention of a value for platelets or any sign of bleeding out; this is definitely the wrong answer.

I would admit the patient and place her on bed rest, monitor fetal heart rate and contractions, administer betamethasone to induce lung maturity, and labetalol to lower her heart rate and address her hypertension. The closest answer to this is B...
...but htn is 140/90,,given further antihypertensive wud decrease bp to less thn 90 mmhg whch wud decrease uteroplacental insufficinecy
Reply With Quote Quick reply to this message
The above post was thanked by:
Mondoshawan (02-18-2012)
  #10  
Old 02-18-2012
USMLE Forums Scout
 
Steps History: 1 + CS
Posts: 59
Threads: 12
Thanked 10 Times in 10 Posts
Reputation: 20
Default

Induce labour is the answer according to the qbank
Reply With Quote Quick reply to this message
  #11  
Old 02-18-2012
qurat21's Avatar
USMLE Forums Master
 
Steps History: 1 + CK
Posts: 623
Threads: 62
Thanked 289 Times in 186 Posts
Reputation: 299
Default

Quote:
Originally Posted by gargabhi2 View Post
Induce labour is the answer according to the qbank
aaaa not convinced wts the explanation.????
Reply With Quote Quick reply to this message
  #12  
Old 02-18-2012
USMLE Forums Scout
 
Steps History: 1 + CS
Posts: 59
Threads: 12
Thanked 10 Times in 10 Posts
Reputation: 20
Default

there wasnt a convincing explanation.... they just wrote that a severe preeclampsia has to be delivered irrespective of gestation and mild preeclampsia can be managed conservatively...... u may check this....
http://emedicine.medscape.com/articl...iew#aw2aab6c21
Reply With Quote Quick reply to this message
The above post was thanked by:
qurat21 (02-18-2012)
  #13  
Old 02-18-2012
USMLE Forums Addict
 
Steps History: Not yet
Posts: 129
Threads: 18
Thanked 188 Times in 62 Posts
Reputation: 198
Default

Severe pre-eclampsia triads :
1-Pregnancy >20 wk.
2-Sustained HTN >160/100.
3-Protienuria >/= 5 grams/24 hrs.

OR
1-Pregnancy >20 wk.
2-Sustained HTN >140/90.
3-Headache or epigastric pain or visual changes.

OR
1-Pregnancy >20 wk.
2-Sustained HTN >140/90.
3-DIC or elevated liver enzymes or pulmonary edema.

Treatment includes :
IV MgSO4, lowering diastolic blood pressure to levels between 90 and 100, and aggressive prompt delivery.

Now if no jeopardy presents for the mother or the fetus then we can try conservative management if the gestational age is still between 26-34 weeks. Admit to the ICU monitor carefully and administer MgSO4 and betamethasone to enhance fetal lung maturity.

As far for this case, clearly the mother is having a severe symptomatic pre-eclampsia and prompt delivery is indicated at this time.
Reply With Quote Quick reply to this message
The above post was thanked by:
Ace3 (02-20-2012), gargabhi2 (02-18-2012), Mondoshawan (02-18-2012), pass7 (02-22-2012), qurat21 (02-18-2012), yugao (02-20-2014)
  #14  
Old 02-22-2012
mle2resident's Avatar
USMLE Forums Veteran
 
Steps History: 1 + CS
Posts: 252
Threads: 51
Thanked 187 Times in 94 Posts
Reputation: 197
Default

I wud go with C..
In cases of severe preeclampsia, if there is maternal/fetal jeopardy then delivery with control of BP wit MgSO4..
Conservative inpatient management if there is no maternal/fetal jeopardy btn 26-34 weeks.. give MgSO4 to bring down below 160/110, administer beclomethasone for lung maturity.

In this case, though she has symptoms of severe preeclampsia, but nothing mentioned about fetal/maternal jeopardy, her BP is 142/90 which is not too high, 32 weeks gestation.. Hence C.

Last edited by mle2resident; 02-22-2012 at 07:55 PM.
Reply With Quote Quick reply to this message
  #15  
Old 02-22-2012
drnrpatel's Avatar
Guest
 
Steps History: 1+CK+CS
Posts: 441
Threads: 153
Thanked 396 Times in 211 Posts
Reputation: 419
Info

Quote:
Originally Posted by mle2resident View Post
I wud go with C..
In cases of severe preeclampsia, if there is maternal/fetal jeopardy then delivery with control of BP wit MgSO4..
Conservative inpatient management if there is no maternal/fetal jeopardy btn 26-34 weeks.. give MgSO4 to bring down below 160/110, administer beclomethasone for lung maturity.

In this case, though she has symptoms of severe preeclampsia, but nothing mentioned about fetal/maternal jeopardy, her BP is 142/90 which is not too high, 32 weeks gestation.. Hence C.
hey, labetolol or hydralazine is used for BP control.
MgSO4 is for seizure prophylaxis.
Reply With Quote Quick reply to this message
The above post was thanked by:
mle2resident (02-23-2012)






Reply

Tags
ObGyn-, Step-2-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Chronic hypertension with superimposed preeclampsia drzamzam USMLE Step 2 CK Forum 1 10-11-2011 11:38 AM
superimposed preeclampsia or chronic renal disease drzamzam USMLE Step 3 Forum 0 10-11-2011 07:31 AM
Managing anxious child at sleep-time docoftheworld USMLE Step 2 CK Forum 14 06-01-2011 03:22 PM
Preeclampsia and MgSO4! obgynaim USMLE Step 2 CK Forum 3 04-11-2010 11:51 AM
TMT dilemma sunny86 USMLE Step 1 Forum 3 11-11-2009 08:36 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)