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Basic obstetrics

14-year-old G1P0 girl who is 29 weeks’ pregnant with twins presents to the emergency department following a seizure. She was watching television and stood up to go to the bathroom when she “fell down and started shaking.” The patient has no history of seizures and is otherwise healthy. She missed her last obstetrician’s appointment, and her aunt states that her niece has had a lot of headaches and swelling over the past 2 days. On examination the patient is somnolent and difficult to arouse, and has edema of her hands and face. Her blood pressure is 205/120 mm Hg, pulse is 80/ min, and respiratory rate is 16/min. The fetal heart rate is 130/min. Which of the following is the most correct advice for the patient’s aunt?

“Your niece has a life-threatening condi- tion called eclampsia, and needs to be put on strict bed rest and monitored until the baby can be delivered at term”“Your niece has a life-threatening condi- tion called eclampsia, and the baby needs to be delivered as soon as possible”“Your niece has a life-threatening condi- tion called eclampsia, but this can be man- aged with antiseizure medications until the baby can be delivered at term”“Your niece has a life-threatening condi- tion called preeclampsia, and needs to be put on strict bed rest and monitored until the baby can be delivered at term”

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ExplanationB. This patient’s seizure,hypertension, headache, and facial edema are consistent with a diagnosis of eclampsia. Eclampsia is defi ned as seizure activity or coma in an obstetric patient with preeclampsia. De- livery is an immediate necessity once the patient is stabilized to prevent maternal and fetal mortality.

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