Hy 2041
q-A 25-year-old nulliparous woman at 30 weeks' gestation comes to the labor and delivery ward complaining of contractions, a headache, and flashes of light in front of her eyes. Her pregnancy has been uncomplicated except for an episode of first trimester bleeding that completely resolved. Her temperature is 37 C (98.6 F), blood pressure is160/110 mm Hg, pulse is 88/minute, and respirations are 12/minute. Examination shows that her cervix is 2 centimeters dilated and 75% effaced, and that she is contracting every 2 minutes. The fetal heart tracing is in the 140s and reactive. Urinalysis shows 3+ proteinuria. Laboratory values are as follows: leukocytes 9,400/mm3, hematocrit 35%, platelets 101,000/mm3. Aspartate aminotransferase (AST) is 200 U/L, and ALT 300 U/L. What drug should you choose, TERBUTALINE, INDOMETHACIN, or MAGNESIUM SULFATE?

a-This patient has severe preeclampsia. Preeclampsia is diagnosed on the basis of hypertension, edema, and proteinuria. Severe preeclampsia may be diagnosed when the patient has one of the following: a headache that does not respond to analgesics, visual changes, seizure, very elevated blood pressures, pulmonary edema, elevated liver function tests, severe proteinuria, oliguria, an elevated creatinine, thrombocytopenia, hemolysis, intrauterine growth restriction, or oligohydramnios. The management of severe preeclampsia after 32 weeks is with delivery. Prior to 32 weeks, consideration may be given to expectant management of the patient depending on the clinical circumstances. Here, it is a hard question cause you have to ASSESS the severity. Here, the situation is serious enough to warrant Mag Sulfate, which is the strongest of the drugs mentioned. She is a little early for delivery considerations, but this is a tough decision to make--you must attempt delivery of the baby.