A 34-year-old female, G2P1, with a history of pre-eclampsia in her previous pregnancy, comes for her first ANC visit at 12 weeks. What is the most appropriate intervention for prevention of pre- eclampsia in her current pregnancy?

Appeared in: AIIMS Delhi NO - 2017

Explanation

Low-dose aspirin is the recommended prophylactic therapy for women at high risk of developing pre-eclampsia.
A history of pre-eclampsia in a previous pregnancy is a primary indication for initiating this treatment.
Guidelines from ACOG and the U.S. Preventive Services Task Force support starting low-dose aspirin between 12 and 28 weeks of gestation, ideally before 16 weeks, to reduce the risk of recurrence.
Aspirin works by inhibiting platelet thromboxane A₂ biosynthesis, which helps to counteract the vasoconstriction and platelet aggregation characteristic of pre-eclampsia.

Option B: Adding Low Molecular Weight Heparin (LMWH) to aspirin is not the standard first-line prevention for a history of pre-eclampsia alone. It does not offer significant additional benefit over aspirin for this indication.
Option C: Recommending low calcium intake is incorrect and potentially harmful. There is no evidence that restricting calcium prevents pre-eclampsia.
Option D: A low-salt diet is an outdated recommendation that has been proven ineffective for preventing pre-eclampsia in randomized trials.

Clinical Relevance

Nursing practice connection: Use the key finding related to Pharmacological prevention of pre-eclampsia in high-risk pregnancy to guide bedside assessment, documentation, and the next nursing action.
Nurses play a crucial role in identifying high-risk patients for pre-eclampsia during antenatal checkups based on their medical history.
Patient education is key. The nurse must explain the importance of adhering to the low-dose aspirin regimen and educate the patient on the signs and symptoms of pre-eclampsia to report immediately (e.g., severe headache, visual disturbances, upper abdominal pain, sudden swelling).
Regular monitoring of blood pressure and urine for protein are essential components of antenatal care for high-risk women.

How to Approach the Question

First, analyze the patient's clinical data provided in the stem: age (34), gravidity/parity (G2P1), and most importantly, the 'history of pre-eclampsia'.
Recognize that a history of pre-eclampsia automatically categorizes the patient as 'high-risk' for recurrence in the current pregnancy.
Identify the gestational age (12 weeks), which is a critical factor for determining appropriate interventions.
Recall the current evidence-based guidelines for the prevention of pre-eclampsia in high-risk women.
Evaluate each option based on these guidelines. Low-dose aspirin is the well-established first-line prophylactic measure.
Eliminate the other options: LMWH is for more specific conditions, low calcium is contrary to evidence (supplementation is considered), and low salt is an outdated and ineffective practice.

Concept Tested & Keywords

Concept Tested: Pharmacological prevention of pre-eclampsia in high-risk pregnancy.
Stem keywords: 34-year-old female, G2P1, history of pre-eclampsia, 12 weeks, ANC visit, prevention of pre-eclampsia
Lead-in keywords: most appropriate intervention
Clinical cues: A history of pre-eclampsia is a significant risk factor for recurrence, making this patient high-risk.
Clinical cues: The gestational age of 12 weeks is the ideal time to start prophylactic therapy.

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E6 Obstetrics Williams p. 17-33

Practise the full AIIMS Delhi NO - 2017

Attempt every question from this paper in a timed mock, then review the full solution for each one.