Podcast
Questions and Answers
What is the most appropriate action to take given Harriet's current blood pressure of 140/90?
What is the most appropriate action to take given Harriet's current blood pressure of 140/90?
- Reassure Harriet that most women have a small rise in blood pressure at this time, especially with first pregnancies
- Take the blood pressure again, fully assess Harriet including urinalysis and send off bloods (correct)
- Request immediate full blood count and urates. Wait for the results
- Refer to a consultant Obstetrician immediately
How do Harriet's current platelet count of 150 x 10^5 mmol/l and urate level of 34 mmol/l relate to her pregnancy?
How do Harriet's current platelet count of 150 x 10^5 mmol/l and urate level of 34 mmol/l relate to her pregnancy?
- Harriet has some haematological changes but they are borderline. Ask her to come back and see you in a week
- Harriet's blood picture indicates serious haematological changes indicative of preeclampsia. She needs referral today (correct)
- Harriet's blood picture concurs with that of a normal 26 week pregnancy and normal haematological changes for the gestation
- Harriet is about to have an eclamptic fit and needs transfer to hospital by ambulance
Which statement about pre-eclampsia is correct?
Which statement about pre-eclampsia is correct?
- More serious when it starts in the third trimester
- More serious when it starts in the second trimester
- Very likely to lead to HELLP syndrome when its onset is at 26 weeks (correct)
- More serious when it starts after delivery
What should you communicate to Harriet about her health concerns?
What should you communicate to Harriet about her health concerns?
Given Harriet's booking blood pressure of 130/70, what does the increase to 140/90 likely indicate?
Given Harriet's booking blood pressure of 130/70, what does the increase to 140/90 likely indicate?
What does the change in Harriet's platelet count suggest in terms of her overall condition?
What does the change in Harriet's platelet count suggest in terms of her overall condition?
How should a midwife approach a pregnant patient presenting with elevated blood pressure?
How should a midwife approach a pregnant patient presenting with elevated blood pressure?
Which risk factor is associated with pre-eclampsia worsening?
Which risk factor is associated with pre-eclampsia worsening?
What is the primary underlying mechanism suspected in pre-eclampsia?
What is the primary underlying mechanism suspected in pre-eclampsia?
Which of the following conditions is associated with pre-eclampsia?
Which of the following conditions is associated with pre-eclampsia?
Which observation regarding Harriet would be most concerning in relation to pre-eclampsia?
Which observation regarding Harriet would be most concerning in relation to pre-eclampsia?
Which assessment is least appropriate for monitoring Harriet's condition?
Which assessment is least appropriate for monitoring Harriet's condition?
What is a common potential effect of pre-eclampsia on an infant's growth?
What is a common potential effect of pre-eclampsia on an infant's growth?
After a Caesarean birth, is Harriet still at risk for eclampsia?
After a Caesarean birth, is Harriet still at risk for eclampsia?
Which statement about severe pre-eclampsia is false?
Which statement about severe pre-eclampsia is false?
What is a common characteristic symptom of pre-eclampsia?
What is a common characteristic symptom of pre-eclampsia?
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Study Notes
Blood Pressure and Midwifery Actions
- Harriet's initial blood pressure was 130/70; current measurement is 140/90.
- Recommended action includes retaking blood pressure, conducting a full assessment, urinalysis, and sending off blood tests.
- Immediate referral to a consultant obstetrician is not deemed necessary at this stage.
Hematological Changes
- Harriet's initial platelet count was 350 x 10^5 µl; reduced to 150 x 10^5 µl.
- Urate levels are at 34 mmol/l.
- Results indicate serious hematological changes, suggesting possible preeclampsia, warranting a referral.
Pre-eclampsia Characteristics
- More severe risk when it begins in the second trimester and is likely to lead to HELLP syndrome starting at 26 weeks.
- Pre-eclampsia is a multi-system disorder linked to autoimmune responses in pregnancy and imbalances in placental blood flow.
Patient Communication
- Concerns about Harriet's blood pressure and blood changes should be communicated clearly, suggesting assessment by an Obstetrician.
- It's not just a routine check; reassurance without addressing concerns could be misleading.
Assessment of Pre-eclampsia and Associations
- Pre-eclampsia is associated with abnormal placental development affecting blood vessel formation.
- Relevant medical conditions linked to pre-eclampsia include abruptio placenta rather than placenta accrete or vasa praevia.
Symptoms and Risks
- Jitteriness and facial edema in Harriet indicate potential worsening of her condition, signifying a possible risk of an eclamptic fit.
- Regular assessments including biophysical profiles and full blood counts are crucial for monitoring her condition.
Effects on Fetal Development
- Harriet's condition could likely result in her baby being small for gestational age due to intrauterine growth restriction (IUGR) and risks associated with pre-term birth.
- Continuous monitoring of fetal growth and wellbeing is essential.
Postnatal Eclampsia Risks
- The risk of eclampsia remains high during the first week postpartum, notably within the first 48 hours, despite delivery.
- Medical team intervention is necessary in managing hypertension during and post-surgery.
False Statement Detection
- Among the listed outcomes of severe pre-eclampsia, all conditions mentioned (abnormal liver enzymes, cholestasis, epigastric pain) can occur. None of these can be considered false, ensuring emphasis on possible severe implications such as HELLP syndrome.
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