This patient is currently suffering from pre-eclampsia, a triad of hypertension, proteinuria, and edema in a pregnant patient. Patients with pre-eclampsia are at risk for progression to eclampsia, which is the addition of seizures to the triad of pre-eclampsia.
Impaired perfusion of the placenta is hypothesized to underlie the disease process seen in pre-eclampsia/eclampsia. Pre-eclampsia may also progress to HELLP syndrome, which consists of Hemolytic anemia, Elevated Liver enzymes, and Low Platelets.
Wagner reviews the management of pre-eclampsia. Prior to delivery, management includes close monitoring of both maternal and fetal status. Seizure prophylaxis with magnesium sulfate and medical management of hypertension are the management goals during delivery, with delivery being the ultimate treatment..
Uzan et al. discuss the epidemiology and significance of pre-eclampsia. Nulliparous women have an incidence of pre-eclampsia of about 3-7%, while it is seen in about 1-3% of multiparas. Pre-eclampsia remains a significant cause of maternal morbidity and mortality and also an important risk factor for preterm birth, perinatal death and intrauterine growth restriction.
Illustration A reviews the hypothesized pathophysiology of pre-eclampsia; the top panel illustrates normal placentation while the bottom panel depicts the abnormal placentation that is thought to underlie pre-eclampsia.
Answer 1: Diabetes is a risk factor for the development of pre-eclampsia; however, it is not a direct manifestation of the condition.
Answer 3: While pre-eclampsia may be a predictor of long-term future cardiac problems, myocardial infarction is not a common acute manifestation of progression from pre-eclampsia to eclampsia.
Answer 4: Crohn's disease is not an outcome associated with pre-eclampsia.
Answer 5: Tubulointerstitial nephritis is typically due to either a drug or an infectious cause and is not a common manifestation of pre-eclampsia.
Wagner LK. Diagnosis and management of preeclampsia. Am Fam Physician. 2004 Dec 15;70(12):2317-24.
Uzan J, Carbonnel M, Piconne O, Asmar R, Ayoubi JM. Pre-eclampsia: pathophysiology, diagnosis, and management. Vasc Health Risk Manag. 2011;7:467-74.
PMID:15617295 (Link to Abstract)