Question

How will you manage a primigravida at 32 weeks pregnancy with severe preeclampsia?

Hint:

Control blood pressure, use magnesium sulfate for seizure prevention, and plan early delivery in cases of severe preeclampsia to reduce maternal and fetal risks.

Answer 1

Step 1: Management of Severe Preeclampsia in a Primigravida at 32 Weeks Pregnancy.
The management of a pregnant woman with severe preeclampsia aims to control blood pressure, prevent maternal and fetal complications, and decide the timing of delivery. In a 32-week pregnant primigravida with severe preeclampsia, the management involves the following steps:
(1) Hospitalization:
- The patient should be hospitalized for close monitoring of maternal and fetal status. Continuous monitoring of blood pressure, urine output, reflexes, and fetal heart rate is essential.
(2) Blood Pressure Control:
- Antihypertensive medications such as labetalol, nifedipine, or hydralazine are used to reduce systolic BP to 140-150 mmHg and diastolic BP to 90-100 mmHg. The goal is to avoid severe hypertension while preventing the adverse effects of lowering BP too rapidly.
(3) Magnesium Sulfate for Seizure Prophylaxis:
- Administer magnesium sulfate intravenously for seizure prophylaxis, as severe preeclampsia puts the patient at high risk of eclampsia. The typical dose is 4-6 grams IV bolus followed by a maintenance infusion.
(4) Steroid Administration:
- Corticosteroids (e.g., betamethasone 12 mg IM every 24 hours for two doses) should be given to accelerate fetal lung maturity if delivery is anticipated before 34 weeks.
(5) Delivery Planning:
- Timing of delivery is critical. In cases of severe preeclampsia after 34 weeks, delivery should be initiated as soon as maternal stabilization occurs. At 32 weeks, careful monitoring is required to decide if immediate delivery (e.g., cesarean section) is necessary or if further stabilization and steroid administration for fetal lung maturity are warranted.
(6) Fetal Monitoring:
- Continuous fetal heart rate monitoring is essential to detect fetal distress. In severe cases, biophysical profile or Doppler ultrasound may be used to assess fetal well-being.
(7) Supportive Care:
- Fluid management to avoid fluid overload, and monitoring for complications such as pulmonary edema, renal failure, and HELLP syndrome.
- Blood transfusions may be necessary if there is thrombocytopenia or HELLP syndrome.