Organ System

Author: Harry Nonez, MD
Edited by: Nicole Anthony, MD

You are a senior resident working in the critical care area of a busy ED. You are juggling eight patients, and the triage nurse pulls you aside to evaluate another one. The patient is a 35-year-old woman at 37 weeks gestation who is presenting with a severe headache and acute abdominal pain. She had a routine prenatal visit four days ago at which she was asymptomatic, and her prenatal care has been uncomplicated thus far. On your initial evaluation, the blood pressure is 165/110 mm Hg; the patient is alert and oriented, her abdomen is gravid and tender in the right upper quadrant, there is no fundal tenderness, and there is 2+ pitting edema to the knees bilaterally.

Although we don’t see many pregnant patients over 20 weeks gestation in our ED, it is important to know how to manage this very common obstetrical emergency. Hypertensive disorders are among the most common medical complications of pregnancy, affecting about 7-10% of all pregnant women.  (more…)