What questions should I ask a 13-week pregnant patient with a history of preclampsia during the initial perinatal appointment?

Key Questions for Initial Perinatal Assessment of a Patient with History of Preeclampsia at 13 Weeks

For a 13-week pregnant patient with a history of preeclampsia, comprehensive risk assessment and early specialist referral should be initiated immediately, as previous preeclampsia is one of the strongest risk factors (RR 7.19) for recurrence in subsequent pregnancies. 1

Detailed History of Previous Preeclampsia

• When did preeclampsia develop in the previous pregnancy? (Early-onset before 34 weeks indicates higher recurrence risk)
• How severe was the previous preeclampsia? (Inquire about complications like HELLP syndrome, eclampsia, or need for preterm delivery)
• What was the gestational age at delivery in the previous pregnancy?
• Were there any fetal complications (growth restriction, stillbirth, neonatal complications)?
• What treatments were required (antihypertensives, magnesium sulfate, hospitalization)?

Current Pregnancy Assessment

• Is this a singleton or multiple pregnancy? (Multiple pregnancy increases risk, RR 2.93) 1
• What is the interval since the last pregnancy? (≥10 years increases risk) 1
• Current blood pressure readings (booking diastolic BP ≥80 mmHg increases risk) 1
• Current proteinuria status (protein ≥+ on more than one occasion increases risk) 1

Additional Risk Factors

• Age (≥40 years increases risk, RR 1.68-1.96) 1
• Current BMI (≥35 increases risk, RR 1.55) 1
• Family history of preeclampsia in mother or sister (RR 2.90) 1
• Pre-existing medical conditions:
  • Hypertension
  • Renal disease
  • Diabetes (RR 3.56) 1
  • Presence of antiphospholipid antibodies (RR 9.72) 1

Current Symptoms

• Any headaches or visual disturbances?
• Any epigastric pain or vomiting?
• Any concerns about fetal movement?

Prevention Planning

• Has low-dose aspirin (81-160mg) been initiated? (Should be started between 12-16 weeks and continued until delivery) 2, 3
• Is calcium supplementation needed? (1.0-1.5g daily for women with low calcium intake) 2

Monitoring and Management Plan

• Explain the need for early specialist referral due to history of preeclampsia 1
• Discuss increased frequency of monitoring after 20 weeks (minimum every 3 weeks between 20-32 weeks, then every 2 weeks until delivery) 1
• Review warning signs that require immediate medical attention (severe headache, visual changes, epigastric pain, sudden swelling)

Laboratory Investigations to Consider

• Baseline complete blood count with platelets
• Liver function tests
• Renal function tests
• Uric acid levels 2

Lifestyle Modifications

• Discuss dietary recommendations (fruits, vegetables, whole grains, limiting high-fat, high-sugar, and high-salt foods) 2
• Discuss appropriate physical activity (should be encouraged to reduce preeclampsia risk) 3
• Discuss appropriate weight gain goals during pregnancy 2

Long-term Health Implications

• Explain increased lifelong risk of cardiovascular disease and chronic hypertension after preeclampsia 3
• Discuss importance of postpartum follow-up and long-term cardiovascular health monitoring 2

Common Pitfalls to Avoid

• Don't wait until after 16 weeks to initiate aspirin therapy (ideally start before 16 weeks, not after 20 weeks) 3
• Don't assume mild preeclampsia cannot rapidly progress to severe disease 2
• Don't overlook the importance of patient education about warning signs requiring immediate medical attention
• Don't delay specialist referral for patients with previous preeclampsia 1

By systematically addressing these questions during the initial perinatal appointment, you can establish appropriate monitoring and interventions to reduce the risk of recurrent preeclampsia and improve maternal and fetal outcomes.