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Based on the given history and pe of the patient please make a database followed by salient features of the case and give me initial impressions
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Here is the full structured write-up based on all three pages:
CASE II - Su Avilino | 13 July 2026
DATABASE
Demographics
| Parameter | Data |
|---|---|
| Name | Su Avilino |
| Age | 27 years old |
| Sex | Female |
| Civil Status | Married |
| Occupation | Employee |
| Address | Marikina, Manila |
| Religion | RM |
Chief Complaint
- Headache and blurring of vision
History of Present Illness
| OLDCARTS | Detail |
|---|---|
| Onset | Sudden, started at 8:30 AM (noted at 2:30 AM this morning) |
| Location | Forehead |
| Duration | Constant, continuous since onset |
| Character | Throbbing pain |
| Aggravating | None identified |
| Alleviating | Lying down; Paracetamol 500mg x1 (very slight relief); attempted sleep (could not sleep) |
| Associated Sx | Nausea, did not eat usual diet |
| Radiation | None |
| Timing | No improvement; no prior consultation |
| Severity | 7/10 |
Past Medical History
- Hypertension: Elevated BP documented during 1st pregnancy delivery
- Surgery: None
- Family History: Both parents with hypertension (HTN)
- Childhood illness: Chickenpox
- No chronic illnesses
Immunization History
| Vaccine | Status |
|---|---|
| COVID-19 | Complete |
| Influenza | Yearly |
| Tetanus Toxoid (TT) | Complete |
| Pneumococcal | Complete |
| HPV | 1 dose received |
| Hepatitis B | Not documented |
| MMR | Not documented |
Obstetric-Gynecologic History
Obstetric Score: G2P2
| Pregnancy | Details |
|---|---|
| G1 (2024) | NSVD, PMSF (full term), No elevated BP, Male infant |
| G2 (Current) | Ongoing (LMP: Nov 30, 2025) |
- LMP: November 30, 2025
- AOG (estimated): ~32-33 weeks as of July 13, 2026
- Prenatal check: Last week; all normal; no ultrasound done
- Recent BP at last prenatal: 110/70 mmHg
- Menarche: 12 years old
- Cycle: Regular, 4-5 days duration, 3-4 pads per day, moderate flow
- Dysmenorrhea: Tolerable
- Current prenatal meds: Multivitamins, Folic acid, Ferrous sulfate
Sexual History:
- Sexually active: Yes
- Partners: 1
- Contraception: Condoms
- Coitarche: 21 years old
- STI history: None
Personal and Social History
- Non-smoker, no alcohol use
- No pets
- Exercise: Walking 30 minutes/day
- Good sanitation, no pollution exposure
- Diet: Fruits, vegetables, protein; low intake of some items (salt/processed food implied)
Vitals (Current Visit)
| Parameter | Value | Reference |
|---|---|---|
| Heart Rate | 96 bpm | Normal |
| Blood Pressure | 168/115 mmHg | ELEVATED |
| Respiratory Rate | 18 breaths/min | Normal |
| SpO2 | 97% | Normal |
| Temperature | 36.0°C | Normal |
| Weight | 62 kg | |
| Height | 4'11" (150 cm) |
Recent BP at last prenatal (last week): 110/70 mmHg
Physical Examination
- HEENT/CV/Respiratory: Unremarkable
- General PE: All within normal / no deficits noted
- Leopold's Maneuver:
- Presentation: Cephalic, floating (not yet engaged)
- FHR: 150 bpm, heard at Right Lower Quadrant
Laboratory Data
| Test | Value | Reference | Interpretation |
|---|---|---|---|
| Hemoglobin | 12.2 g/dL | ≥11 g/dL (pregnancy) | Normal |
| Hematocrit | 36.6% | ≥33% (pregnancy) | Normal |
| WBC | 12,000 K/uL | 6,000-16,000 (pregnancy) | Normal (physiologic) |
| Platelets | 218,000 | >150,000 | Normal |
| Serum Creatinine | 0.68 mg/dL | <0.9 mg/dL (pregnancy) | Normal |
| AST | 23 IU/L | <40 IU/L | Normal |
| ALT | 18 IU/L | <40 IU/L | Normal |
| Urine Protein/Creatinine Ratio | 0.18 | <0.3 = negative for significant proteinuria | Borderline (just below threshold) |
SALIENT FEATURES
- 27-year-old G2P1 pregnant woman at approximately 32-33 weeks AOG (by LMP Nov 30, 2025)
- Sudden-onset severe frontal headache (7/10, throbbing, constant) with blurring of vision - both classical CNS symptoms of hypertensive emergency in pregnancy
- Markedly elevated BP: 168/115 mmHg at this visit - contrasting sharply with a normal BP of 110/70 mmHg only last week at prenatal check
- Acute rise in BP - over just 1 week, representing a de novo and severe hypertensive event in the 3rd trimester
- Family history of hypertension (both parents) - strong genetic predisposition
- History of elevated BP during 1st delivery - prior pregnancy-related hypertension, a significant risk factor for recurrence
- Urine Protein/Creatinine ratio: 0.18 - below the diagnostic threshold of 0.3 for significant proteinuria, but the clinical picture may not require it (see below)
- Liver enzymes (AST/ALT) normal - no hepatic involvement at this time
- Platelets 218,000 - normal, no thrombocytopenia
- Serum creatinine 0.68 - no renal impairment currently
- Fetal status: Cephalic presentation, floating (not engaged), FHR 150 bpm (within normal range), heard at RLQ
- No prior antihypertensive treatment; paracetamol gave only slight headache relief
- Leopold's: cephalic floating suggests preterm gestation consistent with ~32-33 weeks
INITIAL IMPRESSIONS
Primary Working Diagnosis:
Severe-Feature Preeclampsia (Gestational Hypertension with Severe Features)
Rationale:
- BP 168/115 mmHg meets the threshold for severe-range hypertension (≥160/110 mmHg) after 20 weeks gestation in a previously normotensive patient
- Severe headache + visual disturbance = severe features per ACOG criteria, regardless of proteinuria level
- Urine P/Cr ratio of 0.18 is below formal proteinuria threshold (0.3), but severe features are diagnosed on symptoms + BP alone - proteinuria is NOT required for the diagnosis of severe preeclampsia
- Acute onset within 1 week of a normal BP reading is highly consistent
- Prior elevated BP at delivery in G1 and family history of HTN increase susceptibility
Differential Diagnoses:
| Dx | Supporting | Against |
|---|---|---|
| Severe-feature Preeclampsia | BP 168/115, headache, visual changes, 3rd trimester, prior BP in pregnancy | P/Cr not yet in proteinuric range |
| Gestational Hypertension (without severe features) | New-onset hypertension post-20 weeks | Severe BP range + neuro symptoms rule this out |
| Eclampsia | Could evolve if untreated | No seizures reported yet |
| Chronic Hypertension with superimposed preeclampsia | Family Hx, prior delivery BP | No documented pre-pregnancy HTN |
| Hypertensive Emergency (non-obstetric) | BP severity | Pregnant patient, gestational context makes OB etiology primary |
| HELLP Syndrome | Must always be considered with preeclampsia | Normal LFTs, normal platelets currently |
| Tension/Migraine Headache | Headache location, throbbing | Concurrent BP 168/115 and visual symptoms refute a primary headache disorder |
Immediate Clinical Priority:
This patient requires urgent obstetric management:
- Antihypertensive therapy - Labetalol IV, Hydralazine IV, or Nifedipine oral for acute severe-range BP
- MgSO4 prophylaxis for seizure prevention (eclampsia prevention)
- Serial BP monitoring (every 15 minutes)
- Fetal surveillance - NST/CTG, biophysical profile
- Urgent ultrasound (no ultrasound done to date - patient at ~32-33 weeks with no imaging)
- Serial labs - repeat platelets, LFTs, creatinine, LDH, uric acid to monitor for HELLP evolution
- Urine protein - spot urine or 24-hour collection for formal quantification
- Ophthalmology consult if visual symptoms persist - papilledema / retinal vasospasm assessment
- Delivery planning - timing and mode depends on maternal/fetal response to treatment and gestational age
Bottom line: This is a time-sensitive obstetric emergency. The combination of BP ≥160/110, severe headache, and visual blurring at ~32-33 weeks gestation is severe-feature preeclampsia until proven otherwise and must be managed urgently.
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