OB/GYN
A 34-year-old woman G2 P0010 presents at 32 weeks gestation for a routine antenatal appointment.
She reports mild headache, but no right upper quadrant pain or visual disturbance. Physical examination is otherwise unremarkable (see lab result). Blood pressure 150/100 mmHg. Urine dipstick Test Result Normal Value: Protein +3 absent. Which of the following is the best next step of management?
Explanation
Core Concept: Preeclampsia without severe features is defined by new-onset hypertension (BP ≥ 140/90 mmHg) and proteinuria or end-organ dysfunction after 20 weeks of gestation, without severe criteria (BP ≥ 160/110, thrombocytopenia, impaired liver function, renal insufficiency, pulmonary edema, or new-onset cerebral/visual disturbances).
Clinical Presentation:
- Elevated blood pressure and proteinuria.
- Mild edema, mild headache.
- Complications: Progression to severe preeclampsia, eclampsia, placental abruption, and fetal growth restriction.
Diagnosis:
- First-line diagnostic tool: Blood pressure monitoring and urine dipstick for proteinuria.
- Most accurate (gold standard) test: 24-hour urine protein collection or urine protein-to-creatinine ratio, along with a comprehensive metabolic panel and CBC.
Management:
- Acute management: Admission for close maternal and fetal observation, serial blood pressure checks, and laboratory evaluation to rule out severe features.
- Definitive management: Expectant management until 37 weeks gestation, followed by delivery (induction of labor).