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Kristina Karylle S.

Araojo December 21, 2011



Medical History
GENERAL OBJECTIVE:
To present a case of Pre-eclampsia.
SPECIFIC OBJECTIVES:
Present the clinical manifestations of pre-eclampsia.
Explain its pathophysiologic mechanisms.
Describe its Diagnostic approach.
Elaborate the management and prevention of this disease.

General Data:
Name: Norma Canoy Date of Consultation: December 1, 2011
Age: 35 years old Reliability: 90 %
Sex: Female
Address: Purok 4, Lakewood, Zamboanga del Sur
Marital Status: Married
Occupation: Housewife
Religion: Roman Catholic
Nationality: Filipino
Chief Complaint: Headache

History of Present Illness:
1 week prior to consult, patient experienced constricting headache which is bilateral in location
with a pain scale of 5 / 10 and lasted for approximately ten (10) minutes. It is non-radiating and not
aggravated by physical exertion. There are no associated signs and symptoms such as dizziness and
vomiting. The patient did not take any medications and no medical consult was done.
2 days prior to consult, patient again experienced headache with same characteristics. The
patient took Paracetamol 500 mg tablet for pain with no relief; still no consult done.
Hours prior to consult, headache worsened which prompted patient to seek consult at the Rural
Health Unit.
Past Medical History:
Patient has no history of previous hospitalization and surgery. No known allergies to food and
medications.
Family History:
No known heredo familial diseases such as asthma, hypertension, diabetes mellitus and cancer.
Personal and Social History:
Patient is a 35 year old G
7
P
5
housewife, married to Jesus Canoy, a farmer. Patient does not
smoke nor drinks alcoholic beverages. Patient has no regular exercise. Her usual meal is composed of
rice, vegetables and meat.
Menstrual History:
The patient had her menarche when she was 13 years old. Her menstrual period was regular
with an interval of 28 days and consumes 3- 4 pads a day. Her subsequent menses was still of the same
characteristics.
Pre- natal History:
Patient has regular prenatal check ups. Has 5 doses of Tetanus Toxoid and takes ferrous sulfate.
Obstetrical History:
G
7
P
5
TPAL (6- 0 1- 6 )
TT AOG TYPE OF
DELIVERY
PLACE OF
DELIVERY
GENDER OF
CHILD
COMPLICATIONS
G1 (1996) 3 months Abortion
G2 (1998) TT1, TT2 FULL TERM NSVD HOME MALE NONE
G3 (2000) TT3 FULL TERM NSVD HOME MALE NONE
G4 (2002) TT4 FULL TERM NSVD HOME FEMALE NONE
G5 (2007) TT5 FULL TERM NSVD HOME FEMALE NONE
G6 (2010) FULL TERM NSVD HOME MALE NONE
G7 ( PRESENT)


Review of Systems:
GENERAL SURVEY: (-) fever, (-) weakness, (-) loss of appetite, (-) weight loss, (+) facial edema
SKIN: (-) itchiness, (-) rashes
HEENT:
Head: (-) dizziness, (+) headache
Eyes: (-) itchiness, (+) blurring of vision, (-) pain
Ears: (-) hearing changes, (-) ear pain
Nose: (-) discharges, (-) epistaxis, (-) nasal congestion
Throat: (-) difficulty swallowing, (-) sore throat, (-) bleeding gums, (-) hoarseness
RESPIRATORY: (-) dyspnea, (-) cough, (-) hemoptysis
CARDIOVASCULAR: (-) chest pains, (-) palpitations
URINARY: (-) urinary frequency, (-) dysuria, (+) oliguria
EXTREMITIES: (-) joint pain, (-) bone pain, (-) cramps, (-) bipedal edema
NEUROLOGIC: (-) memory loss, (-) loss of consciousness,
HEMATOLOGIC: (-) easy bruising, (-) lymph node swelling
ENDOCRINE: (-) excessive hunger, (-) excessive thirst, (-) excessive urinating

Physical Examination:
GENERAL SURVEY: patient is awake ,afebrile, coherent and not in respiratory distress
VITAL SIGNS:
Temperature: 37.4 C
Blood pressure: 200 / 110 mmHg
Respiratory Rate: 13 cycles/ minute
Pulse rate: 101 beats/ minute
Weight: 69.2 kgs
LMP: March 27, 2011
EDC: January 4, 2012

SKIN: Dry with good skin turgor , no rashes, no lesions
HEENT:
Head: No lesions. Head is normocephalic and no mass palpated, facial edema
Eyes: Pink palpebral conjunctivae, anicteric sclerae with pupils equally reactive to light and
accommodation
Ears: no lesions, no aural discharges
Nose: midline, no nasal discharges
Throat: no mass, no lesion, tonsils not enlarged, no cervical lymphadenopathies
CHEST AND LUNGS: no gross deformities, no lesions, symmetrical chest expansion, no chest lagging, no
chest indrawing, no intercostals retractions, no use of accessory muscles, clear breath sounds on both
lung fields, equal vocal and tactile fremiti
HEART: Adynamic precordium. PMI at the 5
th
ICS Left Midclavicular line. No heaves. No thrills. Regular
rate and rhythm. S1 > S2 at the apex. S2 > S1 at the base. No murmurs.
ABDOMEN: gravid abdomen, with abdominal striae , evident linea nigra
FHT: 140 bpm @ LLQ
Fundic Height: 27 cms
L1: breech
L2: Fetal back (left)
L3: not engaged
L4: cephalic (flexion)
EXTREMITIES: Full pedal pulses, good capillary refill time, no bipedal edema,

Diagnosis: G
7
P
5
(6-0-1-6) Pregnancy Uterine, 35 4/7 weeks AOG, NIL ; severe pre- eclampsia

Bases for diagnosis:
(+) Headache
(+) Blurring of vision
(+) Facial edema
(+) Oliguria
(+) BP: 200 /110 mmHg
Differentials:
Rule in Rule out
Eclampsia Bp: 200 / 110 mmHg
(+) Headache
(+) blurring of vision
(+) facial edema
(+) oliguria

(-) seizures
Gestational Hypertension BP: 200 / 110 mmHg

Cannot be totally ruled out
Proteinuria should be present
Bp should return to normal < 12
weeks postpartum
Final diagnosis made only
postpartum
Chronic Hypertension BP: 200 / 110 mmHg
(+) Headache


(-) hx of previous hypertension

Tension Headache (+) Constricting quality of pain

Bilateral location

Not aggravated by physical
exertion / activity

(-) Nausea or vomiting
(+) increased BP
(+) Blurring of vision






Management:
Advised Hospital Delivery
Advised to reduce physical activity.
Ample protein and calories should be included in the diet.
Sodium and fluid intakes should not be limited or forced.
Hydralazine 25 mg tablet NOW
Methyldopa 25 mg tablet TID
*patient refused treatment
Ideal Management:
Basic management objectives for any pregnancy complicated by pre eclampsia are:
Termination of pregnancy with the least possible trauma to mother and fetus.
Birth of an infant who subsequently thrives.
Complete restoration of health to the mother.
EARLY PRENATAL DETECTION
Increase the frequency of pre natal visits during the third trimester to facilitate early
detection of pre eclampsia
For those with overt hypertension ( 140 / 90 mmHg or greater) should be admitted to
the hospital for 2- 3 days to evaluate the severity of new-onset hypertension
Women with persistent severe disease are observed closely, and many are delivered.
Women with mild diseases are often managed as outpatients.
Women without overt hypertension but in whom early pre eclampsia is suspected
during routine prenatal visits, consists primarily of increased surveillance.
TERMINATION OF PREGNANCY
Delivery is the cure for pre eclampsia.
Prime objectives are:
o forestall convulsions
o prevent intracranial hemorrhage
o prevent serious damage to other vital organ
o deliver a healthy infant

Anti hypertensive medications
1. Hydralazine ( direct arteriolar vasodilator)
2. Labetalol ( non-selective Beta blocker)