Feeling unwell in pregnancy, what a headache!

Author: Kat Ritson / Editor: Gillian Park / Reviewed: Eugene Henry / Codes: / Published: 03/02/2021

A 29-year-old primiparous woman attends the Emergency Department (ED) at 35/40 weeks gestation. She has been regularly monitored in the last few weeks of her pregnancy due to on-going proteinuria and a borderline raised blood pressure. She presents with 48 hours of increasing generalised headaches, blurred vision and right upper quadrant pain.

She has also noticed that her hands and feet have become more swollen and she has gained over 1kg in weight. In the last 6 hours she has noted decreased foetal movements.

On examination she has a fundal height in keeping with her gestation with abdominal pain worse in the right upper quadrant. She has marked swelling of her hands and feet and is also noted to have 5 beats of ankle clonus.

Her initial observations show a pulse of 96, BP 151/103 mmHg, RR 18, sats 96% on air and temperature 36.7. Her urine dip shows 3+ of protein and 1+ of ketones. Her initial blood tests are as follows: Hb 103, WCC 7.1, Platelets 82, Na 140, K+ 4.1, Ur 6.2, Cr 103, Bil 16, ALT 116, ALP 70, albumin 25.

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