Today, I review, link to, and excerpt from Emergency Medicine Cases‘ CritCases 9 Pre-Eclampsia and Preterm Labor – Time Sensitive Management.*
*Written by Sean Moore, edited by Michael Misch & Anton Helman. Expert Peer Review by Glenn Posner, February 2018.
All that follows is from the above resource.
In this CritCases blog – a collaboration between STARS Air Ambulance Service, Mike Betzner, ORNGE Air Ambulance and EM Cases – we present a case of a 30 week gestational age pregnant woman with high blood pressure, headache, blurry vision and pelvic cramping. We discuss the management challenges of transporting a patient with severe pre-eclampsia and preterm labor, with special attention to dosing of magnesium, antihypertensive agents choice, and indications for steroids, tocolytics and antibiotics.
The Case
A 35-year old G1P0 woman presents to a small rural ED complaining of 10 hrs of 4/10 regular period-like pelvic cramping radiating into her lower back as well as gradual onset 8/10 diffuse “throbbing” headache accompanied by blurring vision.
She denies vaginal bleeding, urinary symptoms, GI symptoms, fever or chills. She denies neck pain or stiffness, limb weakness or numbness or speech difficulty. Her Group B Strep status is unknown. According to her LMP she is approximately 30 weeks gestation. She has had no prenatal care to date.
Her past medical history is unremarkable and she does not take any medication.
Her vital signs in the ED reveal a BP of 175/115, heart rate of 95, respiratory rate of 17 and temperature of 36.5.
Her GCS is 15, PERL, gait normal, no pronator drift, but her extremity deep tendon reflexes are hyper-reflexic. Her chest is clear. Her lower abdomen is tender with no periotneal signs and no organomegaly. Her cervix is 2 cm dilated and soft. There is some greenish discharge per os.
A urine dip shows 3+ protein and 2+ blood. Routine blood work is sent, but no results are available at this time.
The time to arrange for and complete a transfer to the closest tertiary obstetric center is approximately 4 hours.
