Case history
Case history #1
A 36-year-old white primigravida at 33 weeks' gestation complains of headache, epigastric pain, and nausea for the past 6 hours. She has also noted increasing swelling in her hands and feet over the past week. She is afebrile. Her heart rate is 86 bpm, respiratory rate is 16, and blood pressure is 160/95 mmHg. There is pitting oedema (+2) on her lower extremities and tenderness to gentle palpation in the right upper quadrant (RUQ). Reflexes are brisk (+3), with positive clonus. Fetal heart rate has a baseline of 150, accelerations are present, and there are no decelerations. No uterine contractions are noted. The fundal height is 33 cm. The haematocrit is 37%, the platelet count is 81 × 10⁹/L (81,000/microlitre), lactate dehydrogenase is 650 IU/L, aspartate aminotransferase (AST) is 93 IU/L, and alanine aminotransferase (ALT) is 98 IU/L. On dipstick analysis, the urine protein is +2 with a protein-to-creatinine ratio of 0.42.
Case history #2
A 37-year-old white primigravida at 36 weeks' gestation presents to her primary obstetrician complaining of nausea and RUQ pain for the past day. Her blood pressure is 138/89 mmHg, her heart rate is 105 bpm, and respiratory rate is 18. Urine dipstick analysis shows +2 protein and a protein-to-creatinine ratio of 0.3, which is a new finding. On physical examination, she has hyper-reflexia, pitting oedema (+2) on her lower extremities bilaterally, and mild tenderness to palpation in the right upper quadrant. The fundal height is 35 cm. The fetal heart rate is in the 130s, variability is moderate, and there are no accelerations. She is not contracting on the monitor. She is sent to triage for further evaluation, and laboratory studies reveal the significant findings of haemoglobin of 100 g/L (10 g/dL), platelet count of 76 × 10⁹/L (76,000/microlitre), AST of 95 IU/L, ALT of 106 IU/L, and uric acid level of 470 micromol/L (7.9 mg/dL).
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