Preeclampsia Case Study

Joan is a 29 year old G4P0 who presented at 10 weeks amenorrhoea with a blood pressure of 120/76. She had 3 previous miscarriages in early pregnancy.

She has been well prior to pregnancy.

She has a family history of thrombosis, but has never had a DVT herself.

She has attended antenatal shared care with your practice and the antenatal clinic. She had a normal viability scan at 8 weeks, done due to her recurrent miscarriages. Her NT screen at 12 weeks was normal. The morphology scan at 20 weeks was normal.

At 28 weeks you feel the baby is a bit small so you organise a growth scan that reportsd as normal. Her BP is now 130/84.

At 32 weeks hyer BP is 130/90 with 1+ proteinuria. She is asymptomatic. She has normal platelets and her protein/creatinine ratio is 26. (in pregnancy <35 is normal).

2 days later she contacts your secretary between scheduled appointments to say that she wants to see the doctor as she has some swelling of the ankles, and is feeling unwell with a headache.

You have educated your staff so pregnant women who are unwell are triaged as urgent , so she is fitted in with your nurse for assessment later that day.

When seen by the nurse she complains of a headache and vague upper abdominal pains. She feels she may have the flu or have eaten something that is causing her to feel unwell

Her BP is 150/94 and she has urinalysis showing 2+ proteinuria.

When you assess her she looks unwell and has obvious pitting oedema up to knees and her hands are oedematous.

She has some upper right abdominal tenderness and her reflexes are brisk with some clonus in the ankles.