Notes

### **Case Study:**
**Patient Name**: Maria Gutierrez
**Age**: 34 years old
**Gravida**: 3, Para 1 (G3P1)
**Gestation**: 28 weeks
**Background**: Maria is a 34-year-old woman in her third pregnancy. Her first pregnancy resulted in a healthy baby delivered at 40 weeks. However, her second pregnancy ended in a miscarriage at 12 weeks. Maria has been receiving regular prenatal care during this pregnancy and had no complications until recently. She has a history of mild hypertension but was otherwise healthy before her pregnancy. She works as a teacher and leads a moderately active lifestyle.

### **Symptoms Presented**:
At her 28-week check-up, Maria reports experiencing **severe headaches** that started a week ago. The headaches are accompanied by **visual disturbances** like blurry vision and seeing flashing lights. She also mentions noticing **decreased fetal movement** over the past two days, with fewer than 5 movements in the last 24 hours, which is significantly less than usual.

### **Assessments and Recommended Actions**:

1. **Vital Signs**:
- Blood pressure: 162/100 mmHg (elevated).
- Pulse: 85 beats per minute.
- Temperature: 36.7°C (normal).
- Respiratory rate: 18 breaths per minute (normal).

2. **Physical Examination**:
- Swelling in the lower extremities (edema).
- Mild pitting edema in the hands and feet.

3. **Fetal Monitoring**:
- **Non-Stress Test (NST)**: Reveals a non-reactive fetal heart rate, indicating reduced variability and a lack of accelerations.
- **Biophysical Profile (BPP)**: Ultrasound assessment shows reduced fetal movements and low amniotic fluid index, scoring 4/10, which is concerning for potential fetal distress.
- **Doppler Ultrasound**: Shows reduced blood flow through the umbilical artery, suggesting placental insufficiency.

4. **Laboratory Tests**:
- **Urine dipstick test**: Positive for protein (++), indicating proteinuria.
- **Blood tests**: Elevated liver enzymes and a mild reduction in platelet count, consistent with signs of preeclampsia.

### **Diagnosis**:
Maria is diagnosed with **severe preeclampsia** based on her elevated blood pressure, proteinuria, and symptoms of severe headaches and visual disturbances. The decreased fetal movement and abnormal NST results suggest **fetal distress**.

### **Recommended Actions**:

1. **Immediate Hospital Admission**:
- Maria is admitted to the hospital for continuous monitoring of her condition and the fetus. Her severe preeclampsia and fetal distress require close observation to prevent further complications.

2. **Fetal Monitoring**:
- Continuous electronic fetal monitoring is initiated to closely track fetal heart rate patterns and detect any further signs of distress.

3. **Medications**:
- **Antihypertensive drugs** (Labetalol or Hydralazine) are administered to control Maria's high blood pressure and reduce the risk of stroke or other maternal complications.
- **Magnesium sulfate** is started to prevent seizures (eclampsia) given her severe preeclampsia.
- **Corticosteroids** (Betamethasone) are given to promote fetal lung maturity in preparation for potential preterm delivery.

4. **Decision for Early Delivery**:
- Given the severity of Maria’s preeclampsia and the signs of fetal distress, the medical team recommends **immediate delivery** to protect the health of both mother and baby. A cesarean section is scheduled due to the likelihood that the fetus may not tolerate labor.

### **Outcome**:
Maria undergoes a cesarean section, and a baby girl weighing 1.5 kg is delivered at 28 weeks. The baby is transferred to the neonatal intensive care unit (NICU) for monitoring and respiratory support. Maria’s blood pressure stabilizes post-delivery, and her preeclampsia resolves gradually. Both mother and baby are monitored closely in the days following delivery.