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Preeclampsia with severe features, induction

Room 4GA 34+5G1P027 yIntact

Magnesium sulfate running, balloon catheter in, 2 cm. High risk, watching.

34+5wksG1P0 · 27 y
  1. Triage
  2. Latent
  3. Active
  4. Second stage
  5. Delivery
  6. Postpartum

07:30: 2 cm, 40% effaced, station -3

Maternal

BP
148/94
HR
88
Temp
37
Labs
Platelets 108, AST 96 U/L, Creatinine 78 micromol/L, Urine protein-to-creatinine 0.42 g/mmol
Running
Magnesium sulfate, Labetalol, Betamethasone

Fetal

Monitor
Reduced variability on magnesium
Presentation
Cephalic, station minus 3
Membranes
Intact
Next
Hourly BP, bloods

Summary

27-year-old G1P0 at 34+5, preeclampsia with severe features, induction. Magnesium sulfate running, balloon catheter in, 2 cm.

Membranes
Intact
Fetal presentation
Cephalic, station minus 3
Board status
High risk, watching

Notes

  • Presented overnight with headache and a blood pressure of 172/112; platelets and liver enzymes abnormal, so delivery was decided at 34+5.
  • Blood pressure now controlled; magnesium running for seizure prophylaxis.
  • The strip shows minimal variability without decelerations, consistent with magnesium and prematurity.

Plan

  1. Continue magnesium through delivery and 24 hours after
  2. Hourly blood pressure, 4-hourly bloods, strict fluid balance (80 mL/h total)
  3. Anaesthesia review (platelets over 70 to 80 for neuraxial); paediatrics aware

Medications

  • Magnesium sulfate: 4 g load at 06:10, infusion 1 g/h; reflexes present, RR 16, urine output 40 mL/h
  • Labetalol: 20 mg IV at 06:05, 40 mg IV at 06:25; now oral 200 mg 8-hourly
  • Betamethasone: First dose 06:30; second due 06:30 tomorrow

Maternal vitals

TimeHRBPTemp
06:0096168/11036.9
07:0092152/9836.9
09:0088148/9437

Labs

  • Platelets108(150 to 400)
  • AST96 U/L(under 35)
  • Creatinine78 micromol/L(35 to 70 in pregnancy)
  • Urine protein-to-creatinine0.42 g/mmol(under 0.03)
  • Fibrinogen4.1 g/L

What to watch

  • Blood pressure every hour; recurrence of severe hypertension
  • Magnesium toxicity: reflexes, respiratory rate, urine output
  • Platelets and liver enzymes on the 4-hourly bloods
  • Decelerations appearing on the strip

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