Hey guys, welcome back to Diagnose This! This has been an intense week of MCRs, study, and crying at babies in the nursery so let’s get straight into it!
Last week we were introduced to the 37 year old female in her 28th week of pregnancy presenting with hypertension and a headache. Her urine dipstick showed proteinuria and a the patient detected reduced foetal movement. The diagnosis we are looking for here is pre-eclampsia, a condition characterised by hypertension, oedema, and proteinuria and most commonly occurring after 32 weeks. As this woman is below that, and is above the age of 35 in her first pregnancy, she has an increased risk of major complications including eclampsia (convulsions in a pregnant woman with preeclampsia.) Treatment would include hospital admission, as any woman with pre-eclampsia should be admitted for monitoring. Delivering the baby is not ideal right now, but with the administration of corticosteroids (1st option betamethasone) the lungs of the foetus can be matured to hopefully aid the growth of the foetus (with the reduced movement it is likely that there is some form of growth retardation.) As her BP is quite high the guidelines state that giving labetalol is the best option for this patient, as 80% of women respond to this as a monotherapy. Finally, without treatment, this can result in eclampsia which, as stated above, means seizures and incredible risk to the baby and mother. The administration of magnesium sulfate is the primary option if this is the case.
Well, that was an interesting case don’t you think? We certainly do. And you are wrong if you disagree with us.
So, the next case!
We have decided that, for this case, we are going to make it a long one. We will give you a brief vignette for this week and, for next week, will give you the relevant history and examination findings. Then comes investigations, and finally we will get the differentials and the actual diagnosis down. So here we go!
Mr Alex Jones is a 59 year old male presenting to the GP complaining of abdominal pain for the past 3 months. Please take a relevant history and perform the relevant exam for this patient.
Any questions send us a message!