MANAGEMENT OF A CLINICAL CASE OF PREECLAMPSIA IN THE TERTIARY PERINATAL CENTER.

Introduction: Hypertensive disorders in pregnancy are a relevant medical and social problem that can have consequences for both, the mother and the fetus. According to the World Health Organization (WHO), preeclampsia is one of the most serious complications, affecting approximately 2-8% of pregnancies worldwide. Case Report: Patient X., 26 years old, second ongoing pregnancy, 37-38 weeks of gestational (w.g.), presented herself at the Emergency Unit of Tertiary Perinatal Center, Chisinau, Republic of Moldova (RM) with the complains: fatigue, persisting occipital headache for 2-3 days, along with high blood pressure (BP) 165/100 mmHg. Information gathered via clinical case monitoring, through diligent examination of the medical record, and by a comprehensive review of the literature. Discussions : Patient X., 26 years old, admitted with complaints: fatigue, persisting occipital headache for 2-3 days, along with high BP 165/100 mmHg. Obstetric history revealed the history of cesarian section (C-section), due to preeclampsia, associated with premature rupture of the amniotic sac at 39 w.g. Ultrasound exam revealed a placentomegaly at 36 w.g. in the current pregnancy. The patient, hemodynamically stable, with a respiratory rate of 17 breaths per minute, a pulse rate of 88 beats per minute, and BP initially measured at 170/110 mmHg, which subsequently decreased to 150/100 mmHg over 2 hours, without changes in the pulse rate. Palpation of the uterus revealed an ovoid shape and normal tone. The fetus was in the cephalic presentation. Fetal heart rate was ~146 beats/min, clear, rhythmic. The pelvic exam revealed the biologically unprepared birth canal. Traces of protein in urine. The diagnosis was established: Pregnancy 37-38 w.g. Rh negative without isoimmunization. History of C-section. Pregnancy induced hypertension. Antihypertensive treatment was administered according to the guidelines (methyldopa, nifedipine, metoprolol). Despite the treatment, BP values remain elevated (165-150 /100-90 mmHg) for the next 2 days with periodic occipital headaches. Ultrasound of the fetus showed blood flow centralization, also cardiotocographic changes were determined. In support of the preeclampsia diagnosis update, the C-section was recommended along with magnesium therapy. A female fetus was delivered, 3000 grams, Apgar score 7/8. The post-operative period was uncomplicated. Conclusions: Comprehensive understanding and management of hypertensive disorders in pregnancy is crucial for preventive measures to minimize maternal and/or fetal risks. Therefore, handling the appropriate medication, deciding a delivery method, and timing, along with optimal postpartum management are essential. [ABSTRACT FROM AUTHOR]