Obstetric Case Presentation

Nick Harper

Ms X

• 17 yo• G1 P0• 38 weeks gestation

• Admitted in early labor• Discharged

4X tonic-clonic seizures

Presenting Complaint

History of Presenting Complaint

• 8/10 pain headache

• 8/10 pain abdo pain

• 4X tonic-clonic seizures

• Witnessed by boyfriend and sister

• Admission via Ambulance

Obstetric History

• 38/40

• 1+ protein seen from 28/40

•BP 92/50 @ 25 weeks

•BP 130/80 @ 37 weeks

Differential Diagnosis

• Eclampsia

• Epilepsy– 1/3 have inc. seizures– Decreased drug levels

• Severe hypoglycaemia

Initial management

Diazepam 10mg IV (ambulance)

MgSO4 (St Michaels)

Investigations

• BP 200/120 (<140/90)

• Creatinine 123 (60-100)

• Uric Acid 0.66 (0.19-0.36)

• ALT 145 (5-40)

• Platelets 435 (150-400)

• Hb 11.0 (12-16)

•“Shining Forth”

•One or more convulsions superimposed on pre-eclampsiaEclampsia

Diagnosis

•Severe pre eclampsia5:1000•Eclampsia 5:10,000

•14 deaths (2000-2002)

Risk Factors

Signs & Symptoms

Management - BP

• BP >160/110

• Hydralazine 5mg IV unless pulse >120

• Labetolol 20mg IV (total 200mg)

• Restrict fluids 90mL/h

Management - Seizures

• Magnesium sulphate 4g IVI 5 min• Magnesium sulphate 1g/h IVI 24 hrs

•Magnesium sulphate 2g IVI 5 min•Diazepam 5mg IV

•Stop MgSO4 if RR <14 or lose tendon reflex•Calcium Gluconate

Ms X

• MgSO4 commenced• MgSO4 maintenance infusion• 190mg Labetolol given in 25mg boluses

• Into theatre• Spinal• Forceps delivery, 2nd degree tear• Healthy baby

Important points

• BP not a good measure

• Do not ignore 1+ of protein

• Delivery is only cure

• 44% of fits are post partum

• Inform intensive care facilities early