robin082006
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A 28-year-old G2 P1 woman is admitted to the hospital, at 34-weeks gestation. She has been closely followed for severe preeclampsia since 30-weeks gestation and is now stabilized under oral antihypertensive treatment, bed rest, and salt-reduced diet. She now complains of new onset of mild scleral icterus, blurry vision, and aggravated headache. Her blood pressure is 160/100 mm Hg, and physical exam is within normal limits. Initial evaluation reveal 3+ proteinuria, oliguria, and normal fundoscopic appearance. Her previous pregnancy was without incident. Fetal heart tracing shows: short term variability > 5 beats/min and a long term variability of 6/min (normal 3-10). The workup shows:
Hb 8.5 g/dL
Platelets 58,000/mm3
Peripheral blood smear Schistocytes and RBC fragments
Prothrombin time 12.4 sec.
Partial thromboplastin time 23.6 sec.
Total bilirubin 2.8
Aspartate aminotransferase 230 U/L
BUN 18mg/dL
Serum creatinine 1.2 mg/dL
Fibrinogen 400-mg/ dL
What is the most appropriate management for this patient?
A. IV steroids and conservative treatment in hospital setting
B. IV magnesium sulfate and induction of labor
C. Scheduled C. section
D. Platelet transfusion and conservative management in hospital
E. Plasmapharesis and conservative management in hospital
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| fox
Forum Guru
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This looks like HELLP syndrome......Schedled C section seems to be the answer, although you would wanna give steroids to acclerate fetal lung maturity. Tricky one.
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| sarika
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to prevent a seizure we should do B. IV magnesium sulfate and induction of labor as delivery is the only treatment of severe eclampsia
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| CocaCola
Forum Guru
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It's HEELP -
B - give magnesium and induce labor
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| robin082006
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this is HELLP,
answer is B
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