A 28-year old woman presents to her obstetrician for her regularly scheduled pre

Question

A 28-year old woman presents to her obstetrician for her regularly scheduled prenatal examination. She is 30 weeks pregnant. She has noted some swelling of her hands and feet in the last 2 weeks that seems to be getting progressively worse, such that she is no longer able to wear her rings and can only wear open-heeled shoes. She is otherwise without complaints. She has no past medical problems. This is her first pregnancy. She has had regular prenatal multivitamins. Family history is notable for maternal hypertension and diabetes. She is married and works as a schoolteacher. She denies alcohol, tobacco, and drug use. On examination she appears to be well, with blood pressure of 152/95 mmHg. Fundal height is consistent with gestational age. Fetal heart rate is 140 beats/min. Extremities have 1+ lower extremity edema to the knees and trace edema of the hands. Urine dipstick reveals 3+ protein.

What is the likely diagnosis

What are some risk factors for developing this condition?

How does this condition develop? How does it result in maternal hypertension, edema, and proteinuria?

What are the risks to the fetus if this condition is left untreated?

What are the maternal sequel of leaving this condition untreated? Treatment?

Explanation / Answer

The most likely diagnosis is Preeclampsia.

Some of the risk factors for the development of preeclampsia include nulliparity, diabetes mellitus, a history of renal disease or chronic hypertension, a prior history of preeclampsia, extremes of maternal age (>35 years or <15 years), obesity, antiphospholipid antibody syndrome, and multiple gestation.

The precise pathophysiology of preeclampsia remains unknown. Excessive placental production of antagonists to both vascular epithelial growth factor (VEGF) and transforming growth factor (TGF-). These antagonists to VEGF and TGF- disrupt endothelial and renal glomerular function resulting in edema, hypertension, and proteinuria.

If left untreated, it exposes the fetus to the risk of premature birth.

Also, the mother may develop severe elevation of blood pressure (>160/110 mmHg), central nervous system (CNS) dysfunction (headaches, blurred vision, seizures, coma), renal dysfunction, pulmonary edema, hepatocellular injury, hematologic dysfunction (platelet count <100,000/L or disseminated intravascular coagulation [DIC]).

The management includes delivery of fetus and placenta.

Other tharapies include IV labetalol or hydralazine, magnesium sulfate.

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