The Clinical Problem Solvers Episode 397: Rafael Medina Subspecialty Episode – Hypertension in Pregnancy
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May 22, 2025 Dr. Greg Kirschen, a Maternal-Fetal Medicine fellow at the Hospital of the University of Pennsylvania, and Dr. Mary Peeler, a fellow at UNC, dive deep into hypertension in pregnancy. They discuss a compelling case involving a pregnant woman with headaches and blurry vision, underscoring the risks of preeclampsia. Insights include essential lab tests for diagnosis, the significance of blood pressure control, and the protective role of medications like magnesium. The duo emphasizes addressing health disparities and the collaborative approach necessary for optimal patient care.
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Evaluate Pregnancy-Specific Headache Causes
- Always consider pregnancy-related causes first when a pregnant patient presents with a headache.
- Assess for preeclampsia symptoms and neurological signs promptly, especially after 20 weeks gestation.
Preeclampsia Diagnostic Criteria
- Diagnose preeclampsia with repeated blood pressure ≥140/90 plus proteinuria or end-organ signs.
- Severe features include BP ≥160/110, headache unresponsive to meds, and laboratory abnormalities.
Early Labor & Delivery Insights in Preeclampsia
- Severe hypertension and cervical changes at 24 weeks suggest preterm labor linked to severe preeclampsia.
- Breech presentation before 25 weeks allows for possible vaginal delivery, an exception to usual practice.