Case 1

A 25-year-old, married, multigravida, black woman who has had six live births presented to a
health center with the chief compliant of abnormal body swelling of 2 days’ duration and loss of
consciousness. On arrival to the first contact health center her blood pressure was
170/105 mmHg and her temperature was 36.5 °C. She had generalized swelling, a history of
blurred vision, and headache. She had no history of abortion, stillbirth, and C- section and no
history of antenatal care follow-up. She gave birth to her previous children at home with no
history of obstetric complications. The gestational age at the time of arrival was 37 weeks. She
was referred to a general hospital for further management.

a) Define what is happening with this patient?

b) What other relevant clinical issues are relevant for this particular case?
c) If you are the doctor at the first contact health center – what would be your initial
management?
d) If you are at the general hospital what would you do upon the arrival of this patient?
e) Briefly, describe management given her current condition
Case 2
The patient is a 36yo G2P1001 at 34w2d presenting for headache and blurry vision. Her medical
history is uncomplicated. Her previous pregnancy was complicated by gestational hypertension
at
38 weeks, resulting in induction of labor and uncomplicated spontaneous vaginal delivery. She
has no known drug allergies. She has been taking Aspirin 81mg daily during pregnancy.
a) Is this patient having pre-eclampsia?
b) What should be the initial management of the patient?
c) If you are the doctor in the emergency room, what do you particularly look / ask for?
d) Is she a candidate for being managed at home or does she warrant admission?
Case 3
An otherwise healthy 29-year-old G2P0101 is admitted to labor and delivery at 28 weeks’ gestation
complaining of a severe headache and blurred vision. Her BP is 200/110 mmHg with 2+
proteinuria on urinalysis. Repeat BP a few hours later is 160/110 mmHg. Laboratory studies
showed a normal hematocrit, platelet count, and liver transaminase levels.
a) This patient has severe pre-eclampsia by symptoms and BP criteria. She is only 28
weeks’ gestation. Should she be delivered or can she be managed expectantly? Justify
your answer with adequate referencing
b) Her 24-hour urinalysis reveals 1.2 g protein. This patient meets criteria for the diagnosis
of pre-eclampsia. What type of pre-eclampsia does she have?
c) Are there risk factors for the development of pre-eclampsia? Can we accurately predict and
prevent pre-eclampsia?