A gravida 2 patient with previous LSCS comes at 37 weeks, has BP= 150/100 mm of hg. And on pervaginal examination, cervix is 50% effaced station-3, os is closed and pelvis is adequate. Protein uria is +1, Most appropriate step at the moment would be:

Explanation

This patient has BP: 150/100 mm hg Proteinuria: +1 Therefore it is classified as mild preeclampsia In mild preeclampsia – if gestational age is > than labour induced should be 37 wks (here in the question = gestational age is >37 weeks). Here BP is 150/100, (Therefore, it is not necessary to start antihypertensive). The NICE clinical guidelines suggest treating moderate hypertension (BP-150/100-159/109 mm Hg) with antihypertensives to keep B I P <150/80-100 range. The benefits or disadvantages of this intervention have not been elucidated by adequate clinical trials. Fernando Arias 4/e, p 209. “There is a consensus that if BP is below 150/100 mm Hg, there is no need for antihypertensive therapy. An exception may be if mild hypertension is associated with markers of potential severe disease or sign of organ dysfunction, (heavy proteinuria, liver dysfunction, hematological dysfuntion)”. Fernando Arias 4/e, p 209. Thus, in this patient, the role of antihypertensive is not confirmatory as BP is 150/100 mm Hg. But role of induction of labor is confirmed, as patient is 37 weeks pregnant with mild hypertension. PIH is not a contraindication for VBAC (Vaginal birth after cesarean) and further more that the pelvis of this patient is adequate – so there is no harm in inducing labour, rather it is advantageous, because it will help in developing lower uterine segment. At any point of time; if there is scar tenderness or if patients BP rises immediately perform cesarean section’ therefore the best answer here is – Antihypertensive regime and then induce labour