Obstetrics

B: the pts seizure, hypertension, headache and facial edema are consistent with a diagnosis of eclampsia. Eclampsia is defined as seizure activity or coma in an obstetric pt with preeclampsia. Delivery is an immediate necesity once the pt is stabilized to prevent maternal and fetal mortality

C abruptio placentae refers to premature separation of a normally implanted placenta after 20 wks gestation but prior to delivery of the infant. Since the detached portion of the placenta is unable to exchange gases and nutrients the fetus can become compromised if teh area of separation is large. This pt is at risk for placental abruption secondary to compression-decompression and acceleration-deceleration stresses of the motor vehicle crash. Vaginal bleeding is this setting is concernign as bleeding is the first signs of abruption It is unlikely that a complete abruption has ocurred as the pt is not frankly hypotensive and her bleeding was minimal. All women > 24 wks of gestation subjected to abdominal trauma should have continuous fetal and uterine monioring with an external fetal heart rate to asses for preterm labor and/or abruption. Signs of fetal compromise are associated with moderate to severe abruption and would necessitate immediate delivery

C: septic abortion. common presenting sx include fever, malaise, chills, abdominal or pelvic pain, and vaginal bleeding with or without retained products of conception. Septic abortions do not commonly complicate spontaneous abortions, but can occur as complications of illegally performed induced abortions, foreign bodies, invaseive gynecologic proceedures, or incomplete spontaneous abortions

B: Early decelerations are shallow, symmetric deceleration in which the nadir of the decelration is coincident with the peak of uterine contraction. They are mediated by vagal stimulation due to fetal head compression from the contracting uterus and thus indicate a normally functioning fetal autonomic nervous system. They are not associated with fetal hypoxia, acidosis or poor neonatal outcome no further managment is nessisary

E. She is showing signs of subacute thyroiditis, consistent with a low thryroid stimulating horomoen and high thyroxine. This commonly follows a viral upper respiratory infection, and pain from teh thyroid can be referred to the throat. Thyroid disorders are common during pregnancy and may be subtle and/or present in the context of normal or near normal thyroid horomone levels. Medical managment is the treatmetn of choice in pregnant pts or in those with mild hyperthyroidism

This woman has preeclampsia which is characterized by her hypertension >140/90 and her proteinuria. nondependant edema such as facial or hand edema is usually present as well but not necessary criterion. Proteinuria is defined as excretion of >300 mg of protein in 24 hrs. The pt is experiencing both subjective as well as objective signs of severe disease, as evidenced by her headaches, visual changes, epigastric pain and urine dipstick >3. A dipstick of 1+ to 2+ is more consistent with mild disease. The underlying pathophysiology of preeclampsia is vasospasm and leeky vessels but the origin is unclear. Vasospasm and endothelial leakage causes local hypoxemia of tissue which can lead to hemolysis, necrosis, and end-organ damage. It is cured only by termination of pregnancy and almost always resolves in delivery. Thus the managment of the disease will depend on the gestational age of the fetus, together with the severity of the disease. If the pregnancy is at term then delivery is indicated. If the pregnancy is preterm then the severity of disase is assessed. If severe preeclampsia is present then delivery is usually indicated reguardless of gestational age. Administration of magnesium sulfate serves as an anticonvulsatn therapy and should be given during labor to prevent eclampsia