Re : How to proceed with changing symptoms?
Posted: Mon Nov 14, 638929 9:55 pm
As usual the data here are sparse. This is a chronic hypertensive but how long she has been hypertensive(meaning does she have a degree of focal glomerular sclerosis or otehr renal changes of chronic hypertension when not pregnant etc etc?. That is she did not mention what her baseline values were at the beginning of pregnancy (which should be sought for all high risk women.)
At any rate the amount of proteinuria she had manifested is borderline and since proteinuria in every one normally increases in the second half of pregnancy variations should have little influence on management if the remainder of the clinical picture is stable,
The major things her doctor will focus on are control of blood pressure, no evidence of progressing renal dysfunction (such as creatinine rising), no evidence for superimposed preeclampsia showing ominous signs such as falling platelet counts, appearance and/or worsening of liver enzyme abnormalities, symptoms of concern such as headache abdominal pain etc.
Finally, having been both a chronic hypertensive and supposedly a previous preeclampsia gives her ~30% chance of superimposed preeclampsia, but no one can predict if it will less or more severe.
At any rate the amount of proteinuria she had manifested is borderline and since proteinuria in every one normally increases in the second half of pregnancy variations should have little influence on management if the remainder of the clinical picture is stable,
The major things her doctor will focus on are control of blood pressure, no evidence of progressing renal dysfunction (such as creatinine rising), no evidence for superimposed preeclampsia showing ominous signs such as falling platelet counts, appearance and/or worsening of liver enzyme abnormalities, symptoms of concern such as headache abdominal pain etc.
Finally, having been both a chronic hypertensive and supposedly a previous preeclampsia gives her ~30% chance of superimposed preeclampsia, but no one can predict if it will less or more severe.