Sarah is a 27yo, G1 P0, who was seen for an assessment due to a diagnosis of increased intracranial pressure. In talking with the patient, she overall sounds as if she was asymptomatic but she had an ophthalmology exam that revealed some swelling of the optic nerve. She then had an MRI which suggested increased intracranial pressure and she was treated with acetazolamide. Since she has had a positive pregnancy test she has stopped the medication and states that she feels perfectly fine. She does not believe that she has had ever a spinal tap or anything to actually assess the intracranial pressure. Otherwise, she denies any other major-medical disorders. Based on her height and weight at the start of the pregnancy, her BMI was 30. She is Rh-. This is her 1st pregnancy and denies any obstetrical problems to date.
By dates, she is 9 ½ weeks and the crown-rump length measurement is concordant with good cardiac motion noted. The cervix appears to be long and closed and the intraamniotic cavity appears normal. …show more content…
In addition, acetazolamide can be used in pregnancy if she has any symptoms. She states that she does have a follow-up appointment with neurology in the next couple of weeks. The primary issue would be anesthesia during delivery. We would need neurology to let us know if epidural and/or spinal anesthesia are any issues related to the increased intracranial pressure. In addition, whether or not there would be any concern with Valsalva maneuver in the second stage of labor. Again, these would need to be answered by neurology in conjunction with anesthesiology; however, obstetrical management can remain routine and acetazolamide can be used if the patient were to become symptomatic and/or if neurology felt that this drug should be used to decrease the intracranial
By dates, she is 9 ½ weeks and the crown-rump length measurement is concordant with good cardiac motion noted. The cervix appears to be long and closed and the intraamniotic cavity appears normal. …show more content…
In addition, acetazolamide can be used in pregnancy if she has any symptoms. She states that she does have a follow-up appointment with neurology in the next couple of weeks. The primary issue would be anesthesia during delivery. We would need neurology to let us know if epidural and/or spinal anesthesia are any issues related to the increased intracranial pressure. In addition, whether or not there would be any concern with Valsalva maneuver in the second stage of labor. Again, these would need to be answered by neurology in conjunction with anesthesiology; however, obstetrical management can remain routine and acetazolamide can be used if the patient were to become symptomatic and/or if neurology felt that this drug should be used to decrease the intracranial