Deviation in the Standard of Prenatal Care and Treatment of Eclampsia (Toxemia)

Evaluate breaches in the standard of care when determining whether or not there has been a Deviation in the Standard of Prenatal Care and Treatment of Eclampsia (Toxemia)

Answer the following questions to find out if the standard of care was followed for your case.

  • With which of the following symptoms did the patient present? (Choose all that apply)
    Seizures
    Abdominal pain
    Headache/Dizziness/Drowsiness/Visual disturbances
    Tinnitus
    Hyperreflexia
    Clonus
    Coma
    Hypertension
    None of the above
    Not elicited
    Answer unknown
    Why is this important?
    Pre-eclampsia (toxemia of pregnancy) is traditionally defined as the new onset of hypertension and proteinuria after the 20th week of gestation, but there can be atypical presentations including those with normal blood pressure.
    (2012) 33 ESUCTM 1 46-54

  • Was a medical history obtained? Why is this important?
    Answer this question
    
A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's examination, enables the clinician to make educated evaluations, and be better equipped to advise the patient. 

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  • Was a physical examination performed? Why is this important?
    Answer this question
    
A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's evaluation and enables the clinician to make the most judicious use of additional tests. It helps determine the value of incongruent and conflicting results that can emerge during the diagnostic process.

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  • Which of the following risk factors did the patient possess? (Choose all that apply) Why is this important?
    Answer this question
    
As part of the initial prenatal assessment, pregnant women need to be questioned about potential risk factors for preeclampsia. They need to be asked about their obstetric history, specifically the occurrence of hypertension or preeclampsia during previous pregnancies. A medical history needs to be obtained to identify medical conditions that increase the risk for preeclampsia, including diabetes mellitus, hypertension, vascular and connective tissue disease and nephropathy.

    (2011) 205 ESAJOG 6 553.e1 



  • Was the patient’s blood pressure measured during each prenatal visit and documented? Why is this important?
    Answer this question
    
The patient’s blood pressure needs to be measured and documented routinely at each prenatal visit by a clinician.

    (1998) 61 IJGYOB 2 127-133 



  • Was a urine sample obtained at each prenatal visit? Why is this important?
    Answer this question
    
Pre-eclampsia is a pregnancy-specific, multisystem disorder that is characterized by the development of hypertension and proteinuria after 20 weeks of gestation.

    (2000) 27 EPCCOP 1 185 



  • Did the clinician investigate and document the proteinuria in the patient? Why is this important?
    Answer this question
    
Proteinuria is defined as the presence of at least 300 mg of protein in a 24-hour urine collection.

    (2000) 27 EPCCOP 1 185 



  • Which of the following laboratory tests were performed? (Choose all that apply) Why is this important?
    Answer this question
    
Routine laboratory studies can provide important clues to diagnosis.

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  • Was the patient diagnosed with pre-eclampsia? Why is this important?
    Answer this question
    
Pre-eclampsia is defined as having a systolic blood pressure greater than or equal to 140 mmHg or diastolic blood pressure less than or equal to 90 mmHg after 20 weeks gestation in a previously normotensive woman and the presence of greater than or equal to 300 mg proteinuria in a 24-hour urine collection.

    (2013) 27 EBPCOG 6 877-884 



  • Which of the following diagnostic investigations were performed to assess utero-placental circulation? (Choose all that apply) Why is this important?
    Answer this question
    
Ultrasonography is used to assess the status of the fetus as well as to evaluate for growth restriction. 

    (2009) 200 ESAJOG 5 481.e1-481.e7 



  • Were serial fetal heart rate assessments made using electronic monitoring? Why is this important?
    Answer this question
    
Beginning at the time of diagnosis, weekly serial electronic fetal heart monitoring and a biophysical profile need to be performed. These tests need to be performed at least twice weekly if intrauterine growth retardation or oligohydramnios is suspected.

    (1999) 3 ECLIVD 1 15 



  • Which of the following potential causes of proteinuria were not investigated further? (Choose all that apply) Why is this important?
    Answer this question
    
Women with pre-eclampsia will need to be evaluated for potential preexisting renal disease.

    (2009) 200 ESAJOG 5 481.e1-481.e7 



  • Which of the following diagnosis was made? Why is this important?
    Answer this question
    
The most common clinical presentations of HELLP syndrome are abdominal pain and tenderness in the epigastrium or right upper quadrant, nausea, vomiting, and malaise, which may be mistaken for a nonspecific viral illness or viral hepatitis.

    (2009) 33 ESMPER 3 179-188 



  • Which of the following medications were administered? (Choose all that apply) Why is this important?
    Answer this question
    
Magnesium sulfate is the drug of choice for the control and prevention of eclamptic seizures and is used for the prevention of recurrent seizures.

    (2003) 21 EAMJEM 3 223 



  • Which of the following procedures did the clinician perform? Why is this important?
    Answer this question
    
In patients with severe pre-eclampsia, delivery after 34 weeks of gestation is advised for the health of the mother. The physician needs to weigh the severity of the disease against the stress of delivery, and determine if cesarean section would be a preferred option.

    (2004) 31 EOGCNA 2 223 



  • Which of the following criteria did the clinician fail to consider while diagnosing severe pre-eclampsia? (Choose all that apply) Why is this important?
    Answer this question
    
Criteria to establish a diagnosis of severe pre-eclampsia include: Severe blood pressure elevation, elevated liver function studies, low platelet count, persistent maternal headache, scotomata/blurred vision, proteinuria, non-reassuring tests of fetal well-being, oligohydramnios, fetal growth restriction and placenta abruption.

    (2004) 31 EOGCNA 2 223-241 



  • Was the patient assessed for pre-eclampsia and eclampsia in the post-partum period? Why is this important?
    Answer this question
    
Post-partum pre-eclampsia-eclampsia is defined as the development of signs and symptoms of preeclampsia-eclampsia for the first time at greater than 48 hours but less than 4 weeks after delivery. 

    (2009) 200 ESAJOG 5 481.e1-481.e7 



  • With which of the following symptoms did the patient present post-partum? (Choose all that apply) Why is this important?
    Answer this question
    
Women presenting with high blood pressure in association with shortness of breath, orthopnea, tachycardia, or palpitations need to be evaluated for possible pulmonary edema, post-partum cardiomyopathy, hyperthyroidism or pheochromocytoma.

    (2012) 206 ESAJOG 6 470-475 



  • Which of the following additional diagnoses were considered? Why is this important?
    Answer this question
    
Evaluation by a cardiologist may be necessary for women displaying symptoms of shortness of breath and tachycardia.

    (2012) 206 ESAJOG 6 470