Edema, proteinuria, and hypertension in a pregnant woman indicate pre-eclampsia. Untreated pre-eclampsia may progress to the HELLP syndrome, characterized by [H]emolysis, [E]levated [L]iver enzymes, and [L]ow [P]latelet count.
Pre-eclampsia and the HELLP syndrome are life threatening obstetric complications and should be treated with delivery of the fetus as soon as it is viable. The pathophysiology of the HELLP syndrome is unknown, but may be linked to general activation of the coagulation cascade that causes red blood cells to lyse as they pass through small blood vessels.
Leeman et al. review hypertensive disorders of pregnancy. Pre-eclampsia typically occurs from 20 weeks gestation to 6 weeks postpartum. Risk factors include maternal age greater than 35 years or less than 20 years, preexisting hypertension, chronic renal disease, diabetes, and autoimmune disorders. Eclampsia is pre-eclampsia with seizures.
Benedetto et al. review molecular mechanisms thought to be responsible for pre-eclampsia. The HELLP syndrome occurs in 0.2-0.6% of all pregnancies and in 10-20% of cases with severe preeclampsia. It frequently leads to adverse maternal and perinatal outcomes.
Illustration A diagrams the management of HELLP syndrome.
Answer 1: Urethral infection is more common in women than in men and can be a precursor to urinary tract infections. It is not associated with pre-eclampsia.
Answer 2: Hypovolemic shock may be a complication of severe volume depletion.
Answer 4: Obesity, maternal age, a family history of type II diabetes, and certain ethnic backgrounds are among the risk factors for gestational diabetes. Pre-eclampsia does not cause gestational diabetes.
Answer 5: The most common risk factor for placenta accreta is prior Cesarean section.
Leeman L, Fontaine P. Hypertensive disorders of pregnancy. Am Fam Physician. 2008 Jul 1;78(1):93-100. Review
PMID:18649616 (Link to Abstract)
Benedetto C, Marozio L, Tancredi A, Picardo E, Nardolillo P, Tavella AM, Salton L. Biochemistry of HELLP syndrome. Adv Clin Chem. 2011;53:85-104. Review
PMID:21404915 (Link to Abstract)
USMLE World Step 1 QBank Question #1914. Copyright © USMLEWorld, LLC 2012