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Federación Mexicana de Ginecología y Obstetricia, A.C.

2014, Number 05

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Ginecol Obstet Mex 2014; 82 (05)

Atypical preeclampsia: Case report

Romero-Arauz JF, Carranco-Salinas C, Leaños-Miranda A, Martínez-Rodríguez ÓA

Language: Spanish
References: 23
Page: 354-360
PDF size: 296.19 Kb.


ABSTRACT

Background: preeclampsia that occurs at ‹ 20 weeks of gestation is rare and has been usually reported with molar or hydropic degeneration of the placenta and antiphospholipid syndrome.
Case report: to describe the clinical presentation of atypical preeclampsia of a patient of 37 years old at her first gestation who developed this entity at 18.5 weeks of gestation. She had history of pre-existing hypertension and infertility. This pregnancy was obtained through in vitro fertility.
She reported a severe headache and was admitted to our hospital secondary to elevated blood pressure of 160/110 mm Hg. The laboratory evaluation revealed platelet count 51,000, alanine aminotransferase of 331 UI/L, aspartate aminotransferase of 285 UI/L, lactate dehydrogenase 421 UI/L and urinalysis with +2 proteinuria, soluble fms-like tyrosine kinase-1 / placental growth factor ratio 895.5. The diagnosis of chronic hypertension and superimposed preeclampsia and incomplete HELLP syndrome was supported. After termination of pregnancy, the patient improved rapidly. She was discharged home on postoperative day 7 with a blood pressure of 120/70 mm Hg with normal laboratory.
Conclusions: clinicians should consider the diagnosis of preeclampsia and HELLP syndrome before 20 weeks of gestation in women presenting with clinical or laboratory abnormalities consistent with this disease.


REFERENCES

  1. Steegers EA, von Dadelszen P, Duvekot J, Pijnenborg R. Preeclampsia. Lancet 2010;376:631-44.

  2. Sánchez EN, Nava S, Moran c, Romero JF, Cerbon MA. Estado actual de la preeclampsia en México: de lo epidemiológico a sus mecanismos moleculares. Rev Invest Clin 2010;62:252-60.

  3. Uzan J, Carbonnel M, Piccone O, Asmar R, Ayoub J. Preeclampia: pathophysology, diagnosis and management. Vascular health and Risk Management 2011;7:467-74.

  4. Nava SS, Sánchez RE, Mendoza RC, Romero JF, Cerbon M. Polymorphims in the hipoxia-inducible factor1 alpha gene in Mexican patients with preeclampsia: a case control study. BMC Research Notes 2011;4:68.

  5. Stella CL, Sibai BM. Preeclampsia: Diagnosis and management of atypical presentation. Journal Maternal-Fetal and Neonatal Medicine 2006;19:381-386.

  6. Sibai BM, Stella CL. Diagnosis and management of atypical preeclampsia-eclampsia. Am J Obstet Gynecol 2009;200:481.e1-481.e7.

  7. Romero JF, García EM, Morales BE. Guía de práctica clínica Preeclampsia-Eclampsia. Rev Med Inst Mex Seguro Soc 2012;50:565-79.

  8. Airoldi J, Weinstein L. Clinical significance of proteinuria in pregnancy. Obstet Gynecol Surv. 2007;62:117-24.

  9. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists. Obstet Gynecol 2013;122:1122-1131.

  10. Leaños-MA, Campos-GI, Isordia-SI, Rivera LR, Romero AJ, Ayala-MJ, Ulloa-AA. Changes in circulating concentrations of soluble fms-like tyrosine kinase-1 and placental growth factor measured by automated electrochemiluminescence immunoassays methods are predictors of preeclampsia. J Hypertens 2012;30:2173–2181.

  11. Verlohren S, Galindo A, Schlembach D. An automated method for the determination of the sFlt-1/PIGF ratio in the assessment of preeclampsia. 2010;201:161.e1-11.

  12. Stella CL, Khurram M, Malik, Sibai BM. HELLP syndrome: an atypical presentation. Am J Obstet Gynecol 2008;12: 34.

  13. Bornstein E, Barnhard Y, Atkin R, Divon Y. HELLP syndrome a rare early presentation at 17 weeks of gestation. Obstet Gynecol 2007;110:525-7.

  14. Pecks U, Maass N, Neulen J. Oocyte donation: a risk factor for pregnancy induced hypertension. Dtsch Arztebl Int 2011;108:23-31.

  15. Hazra S, Waugh J, Bosio P. “Pure”preeclampsia before 20 weeks of gestation: a unique entity. BJOG 2003; 110:1034-35.

  16. Sibai BM. Imitators of severe preeclampsia. Semin Perinatol 2009;33:196-205

  17. Romero JF, Lara AL, Izquierdo JC. Morbimortalidad materna asociada a síndrome de HELLP. Ginec Obstet Mex 2001; 69:189-93.

  18. Papageorghuiou AT. Predicting and preventing preeclampsia- where to next? Ultrasound Obstet Gynecol 2008;31:367-70.

  19. Sciscione AC, Hayes EJ. Utery artery Doppler Flow studies in obstetric practice. Am J Obstet Gynecol 2009;27:121- 26.

  20. Papageorghuiou AT, Roberts N. Uterine artery Doppler screening for adverse pregnancy outcome. Curr Opin Obstet Gynecol 2005;17:584-90.

  21. Schiettcatte J, Russcher H, Anckaert E. Multicenter evaluation of the first automated Elecsys sFlt-1 and PIGF assays in normal pregnancies and preeclampsia. Clinical Biochemistry. 2010; 43:768-70.

  22. Benton S, Yuxiang H, Xie F, Von Dadeltzen P. Angiogenic factors as diagnostic test for preeclampsia a performance comparison between two commercial immunoassays. Am J Obstet Gynecol. 2011; 205:49.e1-8.

  23. Sunderji S, Gaziano E, Wothe D, Sibai B. Automated assays for sVEGF and PIGF as an aid in the diagnosis of preterm preeclampsia: a prospective clinical study. Am J Obstet Gynecol 2010; 202:40.e1-7.




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