pre-eclampsia
Doctor Information
Heidi Patton, age 41
Last entry from midwife 2 weeks ago:
Now 27+4, feels well in self, reflux seems to be settling with ranitidine
Missed appointment with obstetric consultant, says she forgot. BP today 131/87
Emphasised how important these meetings are, rearranged for next week.
PMH
Ex IVDU, completed rehabilitation 2008
Para 2 (1994 and 1996)
Ex smoker
Multiple DNAs for routine appointments
Medication:
Aspirin from week 12 of pregnancy
No allergies
Last entry from midwife 2 weeks ago:
Now 27+4, feels well in self, reflux seems to be settling with ranitidine
Missed appointment with obstetric consultant, says she forgot. BP today 131/87
Emphasised how important these meetings are, rearranged for next week.
PMH
Ex IVDU, completed rehabilitation 2008
Para 2 (1994 and 1996)
Ex smoker
Multiple DNAs for routine appointments
Medication:
Aspirin from week 12 of pregnancy
No allergies
Patient Information
|
Heidi Patton age 41
Opening line: Can you give me something to get rid of all this swelling, I cant get my flipping shoes on! History: (NB you are generally quite blunt and can come across as rude and standoffish) You know that hands and feet get swollen in pregnancy, but this is getting silly! Your feet look like chipolatas and the only shoes you can wear are flip flops. Isn't there a tablet to get rid of the swelling? You dont feel too bad in yourself otherwise. If asked - no headache or abdominal pain, no visual disturbance. You are getting regular movements from baby (currently 29 and a half weeks), and are eating and drinking normally. Past History: Cant you see it on my records? If pushed - you used to inject drugs but stopped years ago and don’t need methadone anymore Social History: You live on your own. The father of your baby was a friend of yours who is going to help out but you are not a couple. Your other children are adults and think it is disgusting that you are pregnant. You haven't smoked in a few years and drink alcohol once a week (just a glass of wine). Medication: You sometimes forget to take your aspirin No drug allergies. Ideas: the swelling is just a pregnancy thing Concerns: you don't want any fuss, just a tablet Expectations: wouldn't a water tablet work? If the doctor mentions pre-eclampsia and the need for admission, you get a bit upset - what is the big deal its just a bit of swelling! You will calm down and be agreeable if the doctor explains the diagnosis well and is sympathetic towards you. |
Examination Findings
Pulse 78
Blood pressure: 163/90, 161/93, 159/91
Fundi - no papilloedema
Hands and feet - marked oedema
Abdomen soft and non tender, no organomegaly, foetal size appropriate for dates
Reflexes brisk
Urine dip, urine protein +++
Blood pressure: 163/90, 161/93, 159/91
Fundi - no papilloedema
Hands and feet - marked oedema
Abdomen soft and non tender, no organomegaly, foetal size appropriate for dates
Reflexes brisk
Urine dip, urine protein +++
Mark scheme
Data Gathering
|
Positive indicators
Gathers history of current symptoms, making enquiries specifically regarding pre-eclampsia Establishes risk factors for pre-eclampsia Explores previous obstetric history Examines patient including urinalysis and blood pressure |
Negative indicators
Fails to establish history or risk factors for pre-eclampsia Does not explore previous obstetric history Does not examine patient or request urinalysis |
Clinical Management Skills
|
Positive indicators
Recognises pre-eclampsia and explains diagnosis to patient Identifies and interprets abnormal examination findings Offers appropriate management options including referral to maternity day unit |
Negative indicators
Fails to recognise symptoms and signs of pre-eclampsia Unable to interpret examination findings Fails to explain diagnosis to patient Does not share management options |
Inter Personal Skills
|
Positive indicators
Explores health beliefs, concerns and expectations Builds good rapport Provides explanation in lay terms Non judgemental |
Negative indicators
Fails to explore health understand or concerns Poor rapport with patient Uses jargon when explaining diagnosis Quick to judge |
Management
Pre-eclampsia Explanation: This is a condition that only happens during pregnancy, which results in high blood pressure, and protein leaking from the kidneys into the urine. The cause is not known, but it is thought to be due to a problem with the afterbirth. The most common symptoms are headache, tummy pain, and swelling. Having pre-eclampsia can cause problems for you and your baby, however with early treatment, most women do not have any complications.
Pre-eclampsia causes new hypertension (>140/90) and significant proteinuria (> 1+ on dipstix) after the 20th week of gestation.
Risk factors to consider in your history:
first pregnancy (or first with new partner)
>10y since last pregnancy
age >40 or BMI >35 at presentation
previous pre-eclampsia
family history in first degree relative
Pre-existing diabetes/renal disease/hypertension/antiphospholipid antibodies
Women with any of the above risk factors should be started on aspirin 75mg daily after week 12.
The most common symptoms are headache, sickness and visual changes. There can also be sudden onset swelling of the hands feet and face. On examination, check is the foetus is small for dates, examine the eyes for any papilloedema, the abdomen for tenderness over the liver or epigastrium, and check for brisk reflexes and clonus.
The management of pre-eclampsia is in secondary care, which does make things a bit easier for you - you should either admit the patient directly to the antenatal ward, or if the protocol in your area involves the antenatal day unit, you should have discussed with an obstetrician on the day regarding care.
Pre-eclampsia causes new hypertension (>140/90) and significant proteinuria (> 1+ on dipstix) after the 20th week of gestation.
Risk factors to consider in your history:
first pregnancy (or first with new partner)
>10y since last pregnancy
age >40 or BMI >35 at presentation
previous pre-eclampsia
family history in first degree relative
Pre-existing diabetes/renal disease/hypertension/antiphospholipid antibodies
Women with any of the above risk factors should be started on aspirin 75mg daily after week 12.
The most common symptoms are headache, sickness and visual changes. There can also be sudden onset swelling of the hands feet and face. On examination, check is the foetus is small for dates, examine the eyes for any papilloedema, the abdomen for tenderness over the liver or epigastrium, and check for brisk reflexes and clonus.
The management of pre-eclampsia is in secondary care, which does make things a bit easier for you - you should either admit the patient directly to the antenatal ward, or if the protocol in your area involves the antenatal day unit, you should have discussed with an obstetrician on the day regarding care.