Case

Presentation
GROUP B1
SALMAN ALI ALSHAMRANI

AHMED TARIQ ALGHABBAN

ABDULRAHMAN OMAR ALFAKHRI

TALAL HUSSAIN ALHARBI

ABDULLAH AHMAD ALHEJAILY

MISHAAL SALEH ALATWI

HISTORY
PRESENTED BY:

TALAL HUSSAIN ALHARBI

MISHAAL SALEH ALATWI

HISTORY

▪ Personal data:
- Mrs. NADA is 29-year-old G3T1P1A0L2 is admitted to labor and
delivery at 28 weeks’ gestation complaining of a severe headache and
blurred vision. Her LMP was 4/8/2022 and her EDD 11/5/2023.
▪ History of present illness:
- She was presented to the ER at 1 / 02 / 2023 complaining of sever
headache and blurred vision for 3h .There is slight blurred vision but No
Nausea or vomiting , No edema , No vaginal bleeding .
▪ Past Obstetric History:

- Married for 9 years

- First baby : GA 37 wks , VD , Boy , no complication during or after

pregnancy.

- Second baby : GA 35 wks , caesarean section but elevated BP , Boy ,

complicated by slight PPH.
HISTORY

▪ Gynecological History:
- Patient menarche started when she was 13 Y/O , her menstrual
duration is 5-6 days , regular cycle of 28 days .
- No history of PID or STD.
- No history of pap smear or contraceptive use.
 Past Medical History:
- She has a history of chronic HTN.
- No history of any another chronic diseases as DM , asthma ,
cardiac diseases , nor bleeding disorder.
- No history of blood transfusion or hospital admissions.
▪ Past surgical History:
- History of previous 2 caesarean section.
HISTORY

▪ Drug history:
- Antihypertensive medication.
- Patient No allergy to food or drug.
 Family History:
- No family history of HTN ,her mother have DM
- No congenial anomalies , blood disorders, breast , ovarian or colon
cancers.
- No history of twins pregnancy.
 Social History:
- She is a housewife, and she does not smoke.
- No history of recent travel.
- No history of pets contact.
HISTORY

▪ REVIEW OF SYSTEM:
- CVS : No chest pain , No palpitations , No Syncope.
- RES : No cough , No sputum , No Shortness of breath.
- GIT : slightly Nausea , No Vomiting , No diarrhoea.
- CNS : blurred vision , no numbness , headache, No dizziness.
- URINARY : No loin pain , No oliguria or dysuria.
- Musculoskeletal : No joint pain , No rash Or pigmentations.
- Haematology : No anemia , No bruising, No past transfusion.
HISTORY

▪ Summary:
- Mrs. NADA is a 29 Y/O women presented
to the ER complaining of sever headache
and blurred vision last for 3 h.
EXAMINATION
PRESENTED BY:

ABDULRAHMAN OMAR ALFAKHRI

ABDULLAH AHMAD ALHEJAILY

PHYSICAL EXAMINATION

General Examination Cardiovascular Examination

I. Patient appear well. o No surgical scars on the chest

wall. No chest wall deformities.
II. She is a little overweight . No Visible pulsation.
BMI=26
o First and second heart sounds
III. She have no jaundice no pale were heard. No additional heart
or cyanosis. sounds or murmurs.
IV. No dysmorphic or dehydration
or deformities. she is good
hygiene.
V. The vital sign BP: 155/ 117, HR:
90 , Temp: 37.2 , RR: 23.
VI. Connect to IV cannula in right
hand.
PHYSICAL EXAMINATION
Respiratory Examination
o Normal vesicular breath sounds
all over the lung zones bilaterally
with normal expiratory to
inspiratory ratio.
CNS Examination
o Conscious, Alert and oriented ,
normal reflex response.
o Face: no facial edema
o Eye: the sclera are non icteric
and conjunctivae are pink and
moist. Extraocular movements
are intact and pupils are equal,
round, and reactive to light and
normal accommodation.
o Neck: no thyroid enlargement,
tenderness, or masses.
PHYSICAL EXAMINATION

Skin and Lower Limbs Breast Examination:

o Skin: no petechia, ulceration, o Symmetrical, darkening of

and rashes. nipples. No scars, discharge, and
masses. No tenderness.
o Lower limb: No edema, cyanosis,
no varicose veins.
ABDOMINAL EXAMINATION

Inspection Palpation

o Symmetrica abdominal wall, o Tenderness in right epigastric

normal movement during area
inspiration.
o Fundal hight: 28weeks
o Scar of previous c/s
o Lie: longitudinal
o Visible fetal movements.
o Presentation: cephalic
o Everted umbilicus in normal
position. o Fetal head is not engaged

o No distended superficial veins. Auscultation

o +FHR
VAGINAL EXAMINATION
DEGITAL EXAMINATION

o Cervix: 3cm dilatation, 80% effacement

o Fetal presentation: cephalic
o position: lefto occipto anterior
o Engagment: not engaged
DIFFERENTIAL DIAGNOSIS

Essential hypertension
Pregnancy induced hypertension
HEELP
Eclampsia
INVESTIGATIONS
PRESENTED BY:

AHMED TARIQ ALGHABBAN

INVESTIGATIONS

URINE TEST PATEINT RESULT

24-hour urine collection. Urine protein is: positive. (+1)

Urine dipstick. Urine protein/creatinine ratio:
O.42.
Urine protein/creatinine ratio.
INVESTIGATIONS

Blood work: CBC (RBC, HB, HCr, Platelets ), blood group & cross
matching
Signs of hemolysis (LDH and Bilirubin)
LFT (ALT & AST, Serum albumin ) & RFT (serum creatinine & uric
acid)
Peripheral smear & coagulation studies (PT & PTT) are indicated if
HELLP syndrome is suspected.
INVESTIGATIONS
*patient results*

CBC OTHER TESTS

WBC: 8.2cells/mcL. (N) Blood type & cross match:

RBC: 5.4cells/mcL. (N) Blood group is B+, Rh+, Ab
screening is –ve.
HBG: 11.3g/dl. (low)
Coagulation studies: (N)
MCV: 82fL. (N)
PT: 13 sec. PTT: 25-35.
MCH: 31PG. (N)
LFT: (High)
MCHC: 34g/L (N)
ALT: 61U/L. AST: 43U/L.
PLT: 186/mcL. (N)
RFT: (N)
Creatinine: 0.62mg/dL. Uric acid:
3.8mg/dL.
MANAGEMENT
TREATMENT
PRESENTED BY:

SALMAN ALI ALSHAMRANI

 MANAGEMENT

The “cure” for preeclampsia is delivery → always

beneficial for mother but deleterious for fetus.

If the features is mild (BP<160/110):

Delivery should be at ≥37 weeks of gestation.

If the features is severe (BP>160/110):

Delivery should be immediate at 34 week of
gestation or before.
CONSERVATIVE MANAGEMENT

Corticosteroid for fetal lung maturation.

Magnesium sulfate used to prevent seizures.
Oral antihypertensives
TREATMENT

DRUGS PATEINT TOOK

Methyldopa (used in mild cases). Infusion of 1g of MgSO4 1g/h for

24h
Labetalol (should be avoided in
asthma, used in moderate to 20mg of IV Labetalol
severe cases).
Nifedipine (used during labor,
and with renal disease).
Hydralazine ( used in severe
cases, increase the risk of
maternal hypotension).
PREVENTION

1) Calcium lower risk of preeclampsia, and death or serious

morbidity especially in women with low calcium levels and intake.
2) Low-dose aspirin form 12w to 36w.
3) Antioxidants.

Drugs to avoid:
ACE inhibitors (may cause fetal renal abnormalities).
Diuretics (decrease milk production).
THANKS FOR YOUR
ATTENTION
ANY QUESTIONS?