Lady present at 37 weeks with BP 150 mm/100hg proteinuria of 3+. On Pelvic examination cervix is found to be soft with 50% effacement, station is -3, pelvis adequate and cervical os is closed. Most appropriate step at the moment would be: (AIIMS NOV. 2010)
|A||Observation with monitoring of BP|
|B|| Anti-hypertensive & wait for spontaneous labour |
|C||Induction of labour|
Induction of labour
Note:We have received this memory base question in two variations.
In the present format, the answer is C
a. If the proteinuria is 1+, BP is 150/90 to 150/100 with an unfavourable cervix then we’ll use Anti hypertensives & wait for spontaneous labour till 38 weeks and then induce if no labour ensues.
b. If the question is 38 weeks with previous Ceasrean section, Its best to do induction of labour now.
c. Delivery is the cure for preeclampsiA. Headache, visual disturbances, or epigastric pain are indicative that convulsions may be imminent, and oliguria is another ominous sign. Severe preeclampsia demands anticonvulsant and usually antihypertensive therapy followed by delivery.
d. Whenever it appears that labor induction almost certainly will not succeed, or attempts at induction have failed, cesarean delivery is indicated for more severe cases.
e. For a woman near term, with a soft, partially effaced cervix, even milder degrees of preeclampsia probably carry more risk to the mother and her fetus-infant than does induction of labor by carefully monitored oxytocin infusion.
f. This is not likely to be the case, however, if the preeclampsia is mild but the cervix is firm and closeD.
g. The hazards of cesarean delivery may be greater than that of allowing the pregnancy to continue under close observation until the cervix is more suitable for induction.