Rachel Hardy Shadow Health — Obstetric Assessment & Gestational Hypertension

Rachel Hardy is a 28-year-old G2P1 (second pregnancy, one prior delivery) at 32 weeks gestation presenting for her routine prenatal visit. She reports a mild headache for two days and ankle swelling. Her blood pressure on arrival is 148/96 mmHg — meeting the criteria for gestational hypertension (BP ≥140/90 on two occasions after 20 weeks, without prior hypertension).

The case tests your ability to take a complete obstetric history, perform the prenatal physical examination, recognise and document gestational hypertension, screen for preeclampsia features and provide appropriate patient education.

The obstetric history follows a structured format using gravida/para terminology. Rachel is G2P1 — document her previous delivery including type (vaginal or caesarean), gestational age, birth weight and any complications. Current pregnancy history covers prenatal care attendance, screening tests completed, any complications this pregnancy and fetal movement.

Medications, supplements (folic acid, prenatal vitamins, iron), allergies and family history of hypertension or preeclampsia are all specifically scored.

Fundal height: Measured from the symphysis pubis to the top of the uterine fundus in centimetres. At 32 weeks, fundal height of 32cm is expected (fundal height in cm roughly equals gestational age in weeks ±2cm). Rachel measures 32cm — appropriate.

Leopold maneuvers: Four systematic maneuvers to assess fetal position. First maneuver identifies what is in the fundus (buttocks — vertex presentation confirmed). Second identifies the fetal back. Third assesses the presenting part. Fourth assesses descent into the pelvis.

Fetal heart tones: Auscultated using Doppler. Normal FHR is 110-160 bpm. Rachel's baby is 152 bpm — normal.

Urine dipstick: Protein trace — significant in the context of new hypertension. Must be documented and followed up with 24-hour urine protein.

This distinction is clinically important and specifically tested. Gestational hypertension is BP ≥140/90 after 20 weeks without proteinuria or other signs of organ dysfunction.

Preeclampsia requires BP ≥140/90 PLUS proteinuria (≥300mg in 24-hour urine or protein:creatinine ratio ≥0.3) OR severe features (BP ≥160/110, thrombocytopenia, renal insufficiency, impaired liver function, pulmonary oedema, or new headache unresponsive to medication).

Rachel has a trace protein on dipstick and a headache — she needs a 24-hour urine protein to rule out preeclampsia. Document clearly why the 24-hour urine is being ordered.

The completed Rachel Hardy Shadow Health Obstetric Assessment is available on NursingProxy. Includes the full obstetric interview transcript, G2P1 history documentation, fundal height and Leopold maneuver findings, fetal heart tones documentation, BP interpretation and preeclampsia screening documentation.