Clinical Pearl of the Month – Preeclampsia, High Risk Pregnancy, High Blood Pressure

Gerard Kiernan, MD, FAAFP, FHMClinical Pearls, Emergency Medicine, Family Medicine, Guideline Knowledge Check, Internal Medicine, Nurse Practitioner, Nursing RN/PN, Pediatric Medicine, Physician Assistant, Urgent Care

preclampsia prevention

Preventing Preeclampsia in a 36-year-old Pregnant Woman with High Blood Pressure

High Risk Pregnancy Clinical Pearls of Wisdom Q&A Case

Preeclampsia is a pregnancy complication characterized by high blood pressure and signs of damage to another organ system, most often the liver and kidneys. Preeclampsia usually begins after 20 weeks of pregnancy in women whose blood pressure had been normal.

Left untreated, preeclampsia can lead to serious — even fatal — complications for both you and your baby. If you have preeclampsia, the most effective treatment is delivery of your baby. Even after delivering the baby, it can still take a while for you to get better.

Pregnant Patient Case:

A 36-year-old woman has recently found out that she is pregnant.

She is nulliparous and presents at 9 weeks gestation based on her last menstrual period.

She has planned on pregnancy and started prenatal vitamins before conception.

An ultrasound at first visit is concordant with her dates by LMP.

There is no family history of preeclampsia, but she reports that her mother had gestational diabetes during her pregnancy, and her mother went on to have Type 2 diabetes later in life.

The patient, at her initial visit at 9 weeks gestation, has a blood pressure of 144/92 mm Hg.

She does not have proteinuria, and her blood glucose, hepatic enzymes and complete blood count are all normal

Question:

Of the following, which, when prescribed, will reduce the risk of preeclampsia in this patient?

Answer Options:

Vitamin E, 400 IU PO daily.

Aspirin 81mg PO daily.

Folic acid 1mg PO daily.

Nifedipine extended release 60mg PO daily.

See the Answer:


About the Author:

Gerard Kiernan, MD, FAAFP, FHM is a Dartmouth-Hitchcock Clinic hospitalist in Keene, NH. He attended the University of Rochester School of Medicine and Dentistry, followed by a Family Medicine residency at the University of Wisconsin, Madison, where he was a chief resident. Dr. Kiernan is a Lean Six Sigma Greenbelt and has led hospital medicine quality improvement efforts. He is a fellow of both the American Academy of Family Physicians and the Society of Hospital Medicine. He has achieved the Recognition of Focused Practice in Hospital Medicine offered through the AAFP and ABIM via their joint examination pathway.

About Clinical Pearl of the Month:

Med-Challenger's Clinical Pearl Blog Series is a recurring segment of Med-Challenger's popular Medical Education BlogSubscribe for more free pearls of wisdom. Opt-out anytime.

About Med-Challenger:

Med-Challenger provides online medical education products and services to physicians, nurses, and other medical specialists as well as medical training programs and healthcare groups world-wide via its web-based medical education library and world-class assessment platform at challengercme.com.

preeclampsia prevention - high risk pregnancy, pregnant with hypertension

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