Preeclampsia with pulmonary oedema — emergency management station

Emergency management station: acute pulmonary oedema complicating severe preeclampsia, precipitated by iatrogenic fluid. Tests recognition, oxygen and positioning, diuresis, severe-range blood pressure control with named drugs and doses, magnesium, the fluid-restriction principle, escalation to critical care, and the decision to deliver. Includes assessor timeline, marking domains, assessor key and fail criteria.

Prompt

A 37-year-old G4P3 at 32+1 weeks with preeclampsia has been an inpatient for three days on labetalol 400 mg three times daily. At 02:40 the midwife calls you: the woman is sitting bolt upright, breathless and frightened, unable to complete a sentence. Respiratory rate 32, oxygen saturation 88% on room air, blood pressure 182/118 mmHg, heart rate 118. There are bilateral basal crackles. She received 1 litre of Hartmann's solution over the preceding four hours after a nurse recorded a urine output of 15 mL per hour. You are the registrar; the consultant is 20 minutes away and the anaesthetist is in theatre.

Station brief

Format. Emergency management station, approximately 12 minutes. You are the obstetric registrar on night duty in a tertiary unit. A midwife is with you; the consultant is 20 minutes away and the anaesthetist is in theatre with another case. The assessor runs the clock and feeds new observations. ^[1]

Candidate instruction. Recognise and manage this emergency. Verbalise your actions, your drug orders with dose and route, your escalation, and what you say to the woman. ^[1]^[3]

References8Show

[1]American College of Obstetricians and Gynecologists Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222 Obstet Gynecol, 2020.PMID 32443079
[2]Magee LA, Brown MA, Hall DR, et al. The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice Pregnancy Hypertens, 2022.PMID 35066406
[3]Shanmugalingam R, Barrett HL, Beech A, et al. A summary of the 2023 Society of Obstetric Medicine of Australia and New Zealand (SOMANZ) hypertension in pregnancy guideline Med J Aust, 2024.PMID 38763516
[4]Altman D, Carroli G, Duley L, et al. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial Lancet, 2002.PMID 12057549
[5]Rana S, Lemoine E, Granger JP, Karumanchi SA Preeclampsia: Pathophysiology, Challenges, and Perspectives Circ Res, 2019.PMID 30920918
[6]von Dadelszen P, Payne B, Li J, et al. Prediction of adverse maternal outcomes in pre-eclampsia: development and validation of the fullPIERS model Lancet, 2011.PMID 21185591
[7]Roberts D, Brown J, Medley N, Dalziel SR Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth Cochrane Database Syst Rev, 2017.PMID 28321847
[8]Magee LA, Nicolaides KH, von Dadelszen P Preeclampsia N Engl J Med, 2022.PMID 35544388

Preeclampsia with pulmonary oedema — emergency management station

Station brief

Candidate instruction. Recognise and manage this emergency. Verbalise your actions, your drug orders with dose and route, your escalation, and what you say to the woman. ^[1]^[3]

References8Show

[1]American College of Obstetricians and Gynecologists Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222 Obstet Gynecol, 2020.PMID 32443079
[2]Magee LA, Brown MA, Hall DR, et al. The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice Pregnancy Hypertens, 2022.PMID 35066406
[3]Shanmugalingam R, Barrett HL, Beech A, et al. A summary of the 2023 Society of Obstetric Medicine of Australia and New Zealand (SOMANZ) hypertension in pregnancy guideline Med J Aust, 2024.PMID 38763516
[4]Altman D, Carroli G, Duley L, et al. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial Lancet, 2002.PMID 12057549
[5]Rana S, Lemoine E, Granger JP, Karumanchi SA Preeclampsia: Pathophysiology, Challenges, and Perspectives Circ Res, 2019.PMID 30920918
[6]von Dadelszen P, Payne B, Li J, et al. Prediction of adverse maternal outcomes in pre-eclampsia: development and validation of the fullPIERS model Lancet, 2011.PMID 21185591
[7]Roberts D, Brown J, Medley N, Dalziel SR Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth Cochrane Database Syst Rev, 2017.PMID 28321847
[8]Magee LA, Nicolaides KH, von Dadelszen P Preeclampsia N Engl J Med, 2022.PMID 35544388