A 32-year-old G3P2 woman at 35 weeks' gestation has a past medical history significant for hypertension. She was well-controlled on hydrochlorothiazide and lisinopril as an outpatient, but these drugs were discontinued when she found out that she was pregnant. Her blood pressure has been relatively well controlled in the 120-130 mm Hg systolic range without medication, and urinalysis has consistently been negative for proteinuria at each of her prenatal visits. She presents now to the obstetric clinic with a blood pressure of 142/84 mm Hg. A 24-hour urine specimen yields 0.35 g of proteinuria.Which of the following is the most appropriate next step?
In the question patient has past history of hypertension which was controlled on diuretics and ACE inhibitors prior to pregnancy.Till date her B/P was normal, she was not using any antihypertensive and now all of a sudden her BP is 142/84 mm of hg and proteinuria is 0.35 g all this suggests a possibility of superimposed preeclamplsia on chronic hypertension.
In this situation since BP is not much raised falling in the category of mild preeclampsia and gestational age is 35 weeks, no need to induce labor (labor should be induced at 37 weeks in mild preeclampsia) i.e option ‘b’ ruled out.
I/V Furosemide and hydralazine again are not justified in mild preeclampsia patients (Role of antihypertensives is controversial in the setting of mild preeclampsia) i.e. option ‘a’ and ‘c’ ruled out.
Her pre pregnancy regime which consisted of a diuretic along with ACE inhibitor cannot be started as ACE inhibitors are contraindicated during pregnancy ruling out option ‘e’.
So we are left with option d-initial inpatient evaluation followed by restricted activity and outpatient management, which is the most logical step .
Start iv furosemide
Induce labor after doing Bischop score
Put her on hydralazine
Initial inpatient evaluation followed by restricted activity and outpatient management.