A 36-year-old G1P0 at 35 weeks gestations presents with several days H/O generalised malaise, anorexia, nausea emesis and abd. discomfort. She has loss of apetite and loss of several pounds wt in 1 week. Fetal movements are good. There is no headache, visual changes, no vaginal bleeding, no regular uterine contractions or rupture of membranes. She is on prenatal vitamins. No other medical problem. On exaeration she is mild jaundiced and little confused. Her temp is 100 degree F, PR- 70, BP- 100/62, no significant edema, appears dehydrated. FHR is 160 and is nonreactive but with good variability. Her WBC- 25000, Hct- 42.0, platelets- 51000, SGOT/SGPT-287/ 350, GLUCOSE-43, Creatinine- 2.0, fibrinogen-135, PT/PTT- 16/50, S. Ammonia level- 90 micromol/L. Urine is 3+ Proteins with large amount of ketones.What is the the recommened treatment for this patient
A 36-year-old G1P0 at 35 weeks gestations presents with several days H/O generalised malaise, anorexia, nausea emesis and abd. discomfort. She has loss of apetite and loss of several pounds wt in 1 week. Fetal movements are good. There is no headache, visual changes, no vaginal bleeding, no regular uterine contractions or rupture of membranes. She is on prenatal vitamins. No other medical problem. On exaeration she is mild jaundiced and little confused. Her temp is 100 degree F, PR- 70, BP- 100/62, no significant edema, appears dehydrated. FHR is 160 and is nonreactive but with good variability. Her WBC- 25000, Hct- 42.0, platelets- 51000, SGOT/SGPT-287/ 350, GLUCOSE-43, Creatinine- 2.0, fibrinogen-135, PT/PTT- 16/50, S. Ammonia level- 90 micromol/L. Urine is 3+ Proteins with large amount of ketones.What is the the recommened treatment for this patient
💡 Explanation
**Core Concept**
The patient is presenting with symptoms suggestive of severe pre-eclampsia with HELLP syndrome, characterized by hemolysis, elevated liver enzymes, and low platelet count. This condition requires prompt treatment to prevent maternal and fetal complications.
**Why the Correct Answer is Right**
The patient's laboratory results show elevated liver enzymes (SGOT and SGPT), low platelet count (51000), and elevated creatinine levels, indicating renal impairment. The presence of proteinuria (3+ proteins) and ketones in the urine further supports the diagnosis of severe pre-eclampsia with HELLP syndrome. The patient's mild jaundice and confusion suggest liver dysfunction. The recommended treatment for this patient is delivery, as it is the only definitive cure for pre-eclampsia. Magnesium sulfate is administered to prevent seizures and control blood pressure.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect as it does not address the underlying cause of the patient's symptoms, which is severe pre-eclampsia with HELLP syndrome.
**Option B:** This option is incorrect as it does not mention the administration of magnesium sulfate, which is essential in preventing seizures and controlling blood pressure.
**Option C:** This option is incorrect as it does not address the need for delivery, which is the definitive treatment for pre-eclampsia.
**Option D:** This option is incorrect as it does not mention the administration of corticosteroids to promote fetal lung maturation, which is essential in cases of preterm delivery.
**Clinical Pearl / High-Yield Fact**
In cases of severe pre-eclampsia with HELLP syndrome, delivery is the definitive treatment, and magnesium sulfate should be administered to prevent seizures and control blood pressure.
**Correct Answer: C. Immediate delivery and administration of magnesium sulfate.**
✓ Correct Answer: A. Immediate delivery
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