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Under pressure

Step 1: View clinicals

A 30 year old lady in her first pregnancy is referred from the ante-natal clinic when her blood pressure is found to be 150/95 mmHg, although she is asymptomatic. Her period of amenorrhea is 32 weeks. She was normotensive prior to this, with an unremarkable medical history. Her full blood count is normal. A urinary dipstick tests 2+ for proteinuria.

Step 2: Order all relevant investigations

Urinary Protein-Creatinine Ratio

The Urinary Protein-Creatinine Ratio is 51 mg/mmol (elevated).

Renal Function Tests

Blood Urea : 22 mg/dl (normal) Serum Creatinine : 0.6 mg/dl (normal)

Liver Function Tests

AST : 25 IU/l (normal) ALT : 22 IU/l (normal) ALP : 110 IU/l (normal) S. Bilirubin: 0.3 mg/dl (normal)

Ultrasound abdomen + doppler

The ultrasound scan of the abdomen shows fetal growth compatible with the age of gestation. The volume of amniotic fluid is normal while umbilical artery doppler velocimetry shows normal systolic and diastolic flow.

Step 3: Select appropriate management

Salt restriction
Induction of labor

Score: ★★☆