nadiabarati
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it says in severe preeclampsia more than 32 weeks gestations OR if the signs of renal failure, hepatic injury, HELLP syndrome, pulmonary edema or DIC, we must deliver the fetus immediately.
But I wonder why in UW it explains a severe preeclampsia with elevated BUN and creatinine in 28 weeks of gestation, it still pays attention just to fetal lung immaturity and wait! and NOT choose termination of pregnancy. I don't know what to do and follow??!
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| Justice
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Well, I think that at 28 weeks you have a greater chance to loose the baby (it would be literally ...termination of pregnancy...) whereas at 32 weeks this chance isn't that high... I may be wrong... These 4 weeks make a huge difference for a baby to mature his lungs...
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| nadiabarati
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Yes you are right. But when BUN and creatinine are elevated it means mother's situation is in danger and we need to go with delivery regardless of gestational age. Otherwise of course we wait till lung maturity. AsI wrote there are indications for delivery regardless of gestational age including: renal failure, increased liver enzymes, HELLP, pulmonary edema, DIC.
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| vradojc1
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I would do beclomethasone IM and deliver.
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| Justice
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vradojc1 wrote:
I would do beclomethasone IM and deliver.
Even if steroids are given, there is a great risk for neonatal ARDS, which we know is fatal... I am sure that each clinical situation is unique, and at this stage we have to know standard care, management, etc... I personally hate this type of Qs, as they compromise your ability to think and act "by book"...
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| vradojc1
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It's the same as qs with DKA on IM section. What first? You'd give saline + insulin drip at the same time, and not just one or another.
That drives me crazy. Generally, principle of USMLE is OK, but when you stumble on qs like that, it looks like they made it for morons that can't do mental multitasking.
Exam in 12 days.
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| vradojc1
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BUN/Creatinine do not fall in the "severity criteria" you stated. It is like that all over literature. So if BUN/Cr are up, but mother/fetus not endangered, admit to ICU, lower BP to <160/110, give MgSo4 and Bethamethasone and wait.
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