Case presentation on

preeclampsia

02/08/2023 1
Patient Demographics
• Name: NA
• Age: 22 years
• Sex: F
• Address: Kombolcha
• Card No: 630010
• Admission date: 03/06/14
• Unit: Maternity ward

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Chief complaint
• Gushing fluid of 2 hours duration

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History of present illness (1)

• NA is a primigravida mother who doesn’t

remember her LNMP.
• She claimed to be amenorrhic for the past 9
months.
• She presented with the compliant of push of
fluid per vagina of 2 hours duration.
• She also has history of lower abdominal pain of
the same duration
• For this complain she was taken to Kombolcha
HC.
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History of present illness (2)

• Currently presented with referral paper from

Kombolcha HC with the diagnosis of
preeclampsia + anemia + NRFHB.
• Otherwise,
• She has no hx of vaginal bleeding, headache,
blurred vision, epigastric pain, ABM, decrease
fetal movement, foul smelling vaginal
discharge.

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Past medical history

• She has ANC follow up at nearby health center

• No history of hospitalization or any past
medication history available
• No history of HTN, DM or other chronic medical
conditions

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Drug allergy

• She has no known drug allergy

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Review of Systems (1)

• Physical Exam
• G/A: ASL
• V/S on admission: BP: 162/106, PR: 98,
RR: 20, T: ATT
• HEENT: Pink conjunctiva
• LGS: No Lymphadenopathy
• Chest: Clear chest with good air entry
• CVS: S1 & S2 well heard, no murmur, no gallop
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Review of Systems (2)

• Abd: 34 weeks size gravid uterus, longitudinal

lie, cephalic presentation, FHB: 120b/min, no
contraction.
• GUS: No active vaginal bleeding
• IGS: No pallor
• MSS: G II bilateral pitting edema
• CNS: COPPT

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 Vital signs
Vital Result on Result on Result on Result on
signs 04/06/20 05/06/2 06/06/20 07/06/20
14 014 14 14

BP 162/106 123/72 133/93 105/61

PR 92 96 103 92

RR 20 22 22 20

Temp ATT 37.1 36.4 ATT

FHB 142

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 Laboratory investigations (1)
Investi Result Result Result Normal
gation 03/06/14 04/06/14 06/06/14 range
WBC 5.8 5.8 8.2 4.0-11k/ul
RBC 1.4 1.9 1.8 4.0-5.6x10/ul
HCT 15 15 17 36-46%
Hgb 6 6 6.4 12-16g/dl
MCV 103 103 95 80-100 fl
MCH 29 39 35.5 27-33 pg
MCHC 38 38 37.3 32-36 g/dl
RDW 20 20 17.9 <14.5%
Platelet 263 265 158 150-450k/ul
count
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Laboratory investigations (1)
Urine analysis
03/06/14
Investigation Result Normal range
Sp.Gr 1.030 1.010-1.030
PH 5 Acid (5.5-6)
Acid -ve Negative
Glu -ve Negative
Ketone -ve Negative
bact -ve None
Urobilinogen -ve Negative or traces
Leucocyte -ve Negative

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Laboratory investigations (2)
Clinical chemistry
11/02/22
Investigation Result Normal range
ALT 23.5 0-40 U/L
AST 59.1 0-40 U/L
Urea 13.4 16.6-48.5mg/dl
Creat 0.42 0.7-1.20mg/dl
Ca2+ 2.01 2.15-2.50mmol/l
Na 134 136-145mmol/l
K 3.84 3.5-5.1mmol/l
Cl 104.6 98-107mmol/l
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Assessment

• Primigravida + 3rd TMT + preeclampsia

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 Current medication (1)
Indication Drug Dosage Start and
Product Regimen end date
Preeclampsia MgSO4 4 g IV 30 minutes 4/6/14
and then 2 g/hr
BP control Hydralazine 5mg IV if 4/6/14-
BP≥160/110
Fetal Dexamethaso 6mg IM BID 4/6/14-
maturation ne 5/6/14
Surgical Ceftriaxone 2g IV BID 4/6/14-
prophylaxis 5/6/14
Surgical Ampicillin 2g IV QID 4/6/14-
prophylaxis 5/6/14
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 Current medication (2)
Indication Drug Dosage Start and
Product Regimen end date
Anemia FeSO4 325mg PO TID 4/6/14-

Surgical Azithromycin 1g PO stat 5/6/14

prophylaxis
Discharge Amox + Clav 7/6/14
medications
Discharge Ibuprofen 7/6/14
medications

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Discussion (1)
• Preeclampsia is defined as hypertension and
either proteinuria or thrombocytopenia, renal
insufficiency, impaired liver function, pulmonary
edema, or cerebral or visual symptoms.
• Severe features of preeclampsia include
• SBP ≥160 mmHg or DBP ≥110 mmHg,

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Discussion (2)

• Platelet count <100×103 per μL,

• Liver enzymes levels 2x upper limit of normal
• Doubling of the serum creatinine or >1.1
mg/dL
• Severe persistent right upper-quadrant pain,
• Pulmonary edema
• New-onset cerebral or visual disturbances.

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Discussion (3)

• Preeclampsia without severe features can be

managed with
• Twice-weekly blood pressure monitoring
• Antenatal testing for fetal well-being and
disease progression
• Delivery by 37 weeks’ gestation.

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Discussion (4)

• Preeclampsia with any severe feature requires

immediate stabilization and inpatient treatment
with
• Magnesium sulfate
• Antihypertensive drugs
• Corticosteroids for fetal lung maturity if <34
weeks’ gestation, and
• Delivery plans

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Discussion (5)

• Severe headache, visual disturbances, and

hyperreflexia may signal impending eclamptic
seizure
• Proteinuria levels do not correlate with outcome
severity
• Increasing PVR or myocardial dysfunction may
lead to pulmonary edema.
• Decreased GFR may progress to oliguria and
renal failure.
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Discussion (6)

• Liver manifestations are elevated transaminase

levels, right upper-quadrant pain, and life-
threatening intra-abdominal bleeding.
• Preeclampsia-related coagulopathies include
HELLP (hemolysis, elevated liver enzymes, and
low platelet count) syndrome.
• Obstetric complications are intrauterine growth
restriction, placental abruption & fetal death.

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 Drug therapy problems (1)
DTP DTP Actions taken
Category
Cefazolin 2g Unnecess The physician was Not
single dose ary drug informed that accepted
and therapy either Ceftriaxone
Azithromycin or Ampicillin is
are the drug of enough for
choice in CS prophylaxis
The frequency Dose to The physician was Not
& duration of low informed that the accepted
Amox+Clav frequency of
625mg is not Amox+Clav 625mg
adequate should be TID

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Pharmacotherapy care plan

• Improving medication adherence by giving

discharge counseling
• Discontinuing Ampicillin IV injections
• Correcting the dose and frequency of
Amoxicillin+Clavulanic Acid
• Provide education on lifestyle modification to
prevent hypertension

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Patient education
• Take the medications based on the instructions
• Exercise/walk and take sufficient diet
• Education about the increased risk of
developing preeclampsia in subsequent
pregnancies
• Make a regular assessment of BP and other
underlying chronic diseases

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References

1. Joseph T. DiPiro, Gary C. Yee, L. Michael Posey,

Stuart T. Haines, Thomas D. Nolin, Vicki Ellingrod.
Pharmacotherapy: A Pathophysiologic Approach;
eleventh Edition; New York; 2020
2. American Family Physician. Hypertensive Disorders of
Pregnancy. Volume 93, Number 2
3. American College of Obstetricians and Gynecologists.
Hypertension in pregnancy.

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 Thank you

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