PIH (pregnancy induced hypertension)
Patient Presentation
JD is a 31 year old, primigravida at 30 weeks gestation. This is her sixth visit to the antenatal clinic. So far in this pregnancy, all of her findings and vital signs have been WNL, except for last week where she had a BP of 130/90, negative protein. Today she presents with a BP of 132/90 and proteinuria 1+.
Differential Diagnoses
PIH, HELLP syndrome, Pre-eclampsia
Diagnosis
JD denied any headaches, blurry vision, or upper abdominal pain today. She also denies any change in fetal activity. Postive fetal movement, fetal heart tones are in the 140’s (normal), and her uterine size is consistent with dates. Her signs and symptoms are consistent with mild pre-eclampsia (diastolic BP of 90 or greater on two separate occasions, pt is after 20 weeks gestation, and proteinuria up to 2+).
Treatment/Education
JD was given reassurance and counseled about the danger signs of severe pre-eclampsia (severe headache, blurred vision, upper abdominal pain, LOC) and the need to call the office if any occur. She was also advised on the possible consequences of PIH. She will now be returning to the office twice a week to have her BP, urine, and fetal condition (BPP profile) monitored. Pt was given signs and symptoms of preterm labor as well.
Evaluation
JD attends the clinic twice weekly. Her BP remains the same and she continues to have 1+ proteinuria. Four weeks later, however, her BP is 130/110 mm Hg, she has 2+ proteinuria, and she is extremely tired. She still denies headache, blurry vision, and upper abdominal pain. JD is admitted to the hospital for close evaluation of her pre-eclampsia and she should be explained the importance of biweekly follow-ups. If JD develops signs of fetal growth restriction, early childbirth should be considered.
Case created by Jacqueline Duffey, 2010.