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7/29/21, 4:01 PM

Joanna Cho

A 24 y/o G4P2012 female at 22 weeks presents to the office for a prenatal checkup. Patient states that she has been having increased headaches for the past week. Additionally, she has noticed that her legs have become alarmingly swollen and that she has gained 5 pounds in the past 48 hours. She denies any abdominal pain, vision changes, chest pain, or shortness of breath. She reports good fetal movement and denies any contractions, vaginal bleeding, or loss of fluid. What is the next best step?

Obtain Doppler ultrasound

Reassure patient that these symptoms can be attributed to the physiologic changes of pregnancy

Obtain vitals, CBC, and CMP and treat with ACE inhibitors

Obtain vitals, CBC, CMP, USpot, and treat with hydralazine

Correct Answer:

D

This patient is presenting with signs of preeeclampsia with severe features. Preeclampsia is defined as elevated blood pressures with systolic BP >140 and/or diastolic BP >90. Severe features that signal the beginning of end-organ damage and result from elevated blood pressures include: headaches, vision changes, RUQ abdominal pain, edema in the extremities. The appropriate next step in to measure the patient's blood pressure, obtain a USpot to measure the Pr:Cr ratio in the urine, as well as obtain CBC and CMP to look for signs of HELLP Syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) that can accompany preeclampsia.

Resources:

-Beckmann and Ling's Obstetrics and Gynecology