Dx: 30 years old patient, primigravida, nullipara pregnant for 32 weeks +2day coincide with fundal level, longitudinal

lie, left anterior-occipital position, living and single with albuminuria most probably pre-eclampsia for further investigation. Personal History Patient name Amira Mohamed Ahmed, 30 years old, married for 1 year (1st marriage), nullipara. She lives in Kafr Sheikh, Elyin and work as a clerk. She have no special habit of medical importance. She was admitted here since 1 week. Her husband name is Zainal Abidin Helmi Aqraq, 31 years old. He is an agricultural engineer. Complaint 1. Puffiness of eyelid 2. Edema of lower limb 3. Headache at the end of 7th month Present History She is pregnant +- 32 weeks as the first day of last menstrual period was on 10 July 2011 and her expected delivery date will be on 17 April 2012. She passed through normal 1st trimester of pregnancy with mild nausea and vomiting and perceived fetal movement for the first time at the end of 4th month The headache started 1 week ago on (site ?) with (character?) for (duration?) The condition was not associated with any other warning symptoms such as blurring of vision, epigastric pain, lower abdominal pain or vaginal bleeding, but there is lower limb edema The investigations done are urine analysis, complete blood count, ultrasound, renal function test and liver function test Urine analysis on 15/2 showed albuminuria but the latest data which was taken on 18/2 shows no abnormal data CBC shows mild normocytic normochromic anemia with leucocytosis (absolute neutrophilia) . Platelets count are normal Ultrasound shows visible fetal movement and visible cardiac pulsation Liver function test and renal function test are normal She is now on Aldomet and Epilat(nifedipine)

Menstrual history Age of menarche was at 13 years old, with regular cycle occurring every 28 days, average in amount, no intermenstrual pain, no bleeding, and no discharge. The first day of last menstrual period was on 10/7/2011

Obstetric history No history of contraceptive usage EDD will be on 17/4/2012 Past history No history of medical disorders such as DM, HTN, and heart diseases No history of drug intake She did operation to remove piles 2 years ago and tonsillectomy (? Years ago) Family history No history of similar condition among family, no medical disorder such as DM, HTN, or heart diseases. No consanguinity

Examination General The patient is conscious, average body build with no special attitude on bed Vital signs Pulse B/P : : 80 beat/minute with regular rhythm, average force & volume with no special character 130/90 (before: 200/100) 37 degree celcius

Temp : Regional

There is mild pallor on the inner side of lower lips with butterfly pigmentation of the nose & cheeks (chloasma gravidarum) There is no yellowish discoloration of the sclera, no congested neck vein and no enlarged thyroid

Abdomen Inspection Generalized distended abdomen, normal contour and shape of the abdomen Umbilicus is inverted slightly shifted downward with no pigmentation, discharge or dilated veins No scars or dilated veins There is linea nigra and stria gravidarum. Palpation No tenderness, no hotness, no mass Fetal parts are felt Fundal level Fundal grip : : at 32 weeks (2 fingers below xiphoid process) breech presentation ( soft, limb inside it; continuous with trunk) longitudinal lie cephalic presentation left occipito-anterior

Umbilical grip : Pelvic grip Position Auscultation : :

Fetal heart sound audible below the umbilicus

Management 1. Rest in bed 2. Diet; salt restriction, vitamins and minerals 3. Medical; aldomet(alpha methyl dopa), atenolol(beta blockers), labetolol( alpha + beta blockers)