sunny2
Forum Elite
Topics: 51
Posts: 385
|
Celine Tin Dion a smoker ,25 year old primigravida at 31.3 weeks gestation with complaints of headache, BP 150/90 mmhg, physical exam - swelling in both hands and face, pitting edema 2+ in both lower extremeties, complaints of acid reflux, cough and mild dyspnoea and slight blurring of distant vision since last 21 weeks. Fetal heart rate tracing is reassuring, USG-complete breech,Lab.-increase in BUN and serum creatinine, urinalysis 2+ proteinuria, amniotic fluid analysis shows immature fetal lungs, what is your next best step in management of Celine Tin Dion .
A. Reassurence and diet control
B. Normal Vaginal delivery
C. Steroids and Delivery as soon as lung maturity is ascertained
D. Steroids and C.Section as soon as lung maturity is ascertained
E. Steroids and diet low in salt
F. Steroid and rapid vaginal delivery
G. Labetalol and steroids
H. Methyldopa and steroids
I. IM Magnesium Sulpate and steroids
J. Antihypertensive medication
K. Steroids
|
| Guptashutosh
Forum Elite
Topics: 35
Posts: 354
|
C
|
| sunny2
Forum Elite
Topics: 51
Posts: 385
|
Not correct, try reading the question once more carefully
|
| aml
Forum Senior
Topics: 5
Posts: 119
|
D
|
| Guptashutosh
Forum Elite
Topics: 35
Posts: 354
|
its I- MgSO4 for sure , this time i m correct and confident........ wat do u say
|
| yasmeen
Forum Guru
Topics: 67
Posts: 936
|
H FIRST TRY TO CONTROL PREECLAMPSIA AND TRY TO ATTAIN FETAL LUNG MATURITY DELIVERY IS THE DEFINITIVE TREATMENT BY C SEC AS ITS BREECH
|
| sunny2
Forum Elite
Topics: 51
Posts: 385
|
I - Not Correct
Guptashutosh -- IM Magnesium Sulphate is generally used for the prevention and treatment of seizures. In this patient however it should be used during labor and within 24 hours of delivery, and yes, in patient with severe form of eclampsia is is supposed to be used from the admission and carreied on until 24 hours after the delivery of a beautiful baby 
Yasmeen ----- why do you think Celine Tin Dion's delivery is definetively by Caesaerian Section ...please read the question again and try contradicting yourself
I bet this question will certainly clear few concepts, I am happy that I twisted the question to reveal some hidden distractors which are helping me to be vigilant and will help you too
|
| doc68
Forum Junior
Topics: 2
Posts: 56
|
Labetolo and steroids
|
| sunny2
Forum Elite
Topics: 51
Posts: 385
|
doc68,
why did you choose Labetolol and Steroids
why not , Methyldopa and steroids !!
|
| doc68
Forum Junior
Topics: 2
Posts: 56
|
i gues methyl dopa is central acting and has more side effects then labetalol ??
|
| sunny2
Forum Elite
Topics: 51
Posts: 385
|
Antihypertensive medications are used if the BP is more then 160/110, in this patient it won't be appropriate to use antihypertensives
Now what !!
Guess !
|
| sunny2
Forum Elite
Topics: 51
Posts: 385
|
and yes, doc68
about Labetolol...you are correct .....labetalol is infact the drug of choice to control hypertension in pregnancy, it is also effective in preventing Proteinuria and Diabetic Nephropathy
Methyldopa with Hydralazine is good too, but not the first choice in HTN
|
| sunny2
Forum Elite
Topics: 51
Posts: 385
|
Any Guess for the answer to this question !!!
Till now all the answers are Incorrect
|
| sheena2005
Forum Elite
Topics: 26
Posts: 257
|
I guess it is either B or F.
we need to rapidly remove the products of conception because signs of maternal jeopardy are developing.
i don't know about steroids and rapid deleivery because u need to give some time after steroids for the lung maturity to be attained.
|
| sunny2
Forum Elite
Topics: 51
Posts: 385
|
sheena2005
Please list the points / signs of maternal jeopardy which are developing in this patient so that we can justify the removal of the product of conception in Celine Tin Dion
|
| sheena2005
Forum Elite
Topics: 26
Posts: 257
|
well Miss celine Tin Dion has got headache,and visual changes which are signs of matenal jeopardy.
signs of maternal jeopardy...
headache
epigastic pain
visual changes
thrombocytopenia
elevated liver enzymes
pulmonary edema
oliguria <750 ml/day
cyanosis.
|
| sunny2
Forum Elite
Topics: 51
Posts: 385
|
Sheena , thanks for discussing the question
here of the 8 points you listed , Celine tin Dion has only headache that is significantly mentioned in this scenario on the very first sentence, now if you move ahead....acid reflux..hmmm...may be normal in pregnancy and vision disturbance ...that is going on for so long....it has no abrupt onset....may be because of correction or whatever
So, if you would think that way this patient is not that very serious as it appears to be on first fast reading of the question...and this is the trap here
|
| sunny2
Forum Elite
Topics: 51
Posts: 385
|
fetal heart rate is reassuring, and the Breech......oops....its only the 31 st week.....so no hurry worry....for now we just have to stabilize Celine.
Now guess
|
| yasmeen
Forum Guru
Topics: 67
Posts: 936
|
methyldopa with steroids isn,t right ?why methyldopa is infact drug of choice for preclampsia most commonly being used rather than labetalol
|
| yasmeen
Forum Guru
Topics: 67
Posts: 936
|
and yes no c sec at this stage its too early to decide it mostly rotates to cephalic position by term .
|
| sheena2005
Forum Elite
Topics: 26
Posts: 257
|
wow sunny 2 u really make my brain cells to wake up and think.
ok well yes now that i read the question clearly patient doesnot seemto be in distress . she is stable, the baby is stable it's just headache and some hypertension.
|
| sheena2005
Forum Elite
Topics: 26
Posts: 257
|
I guess it's K then. just give steroids to the mother.
|
| sheena2005
Forum Elite
Topics: 26
Posts: 257
|
thinking thinking thinking..........
|
| sheena2005
Forum Elite
Topics: 26
Posts: 257
|
can it possibly be I. Im Mgso4 and steroids.
|
| sheena2005
Forum Elite
Topics: 26
Posts: 257
|
hello
|
|
| |
| | | | | | | | | | | | | | | | | | | | | | | | | |
