Monday, March 30, 2015

37-year-old woman

A 37-year-old woman in her 32nd wk of gestation (G2P1) presents with a seizure. She has been healthy and does not smoke cigarettes, drink alcohol, or use illicit drugs. She has been poorly compliant in receiving her prenatal care.


Physical examination reveals a blood pressure of 150/95 mm Hg. The patient’s face and hands appear
edematous. Other than the patient being postictal (confused and disoriented after the seizure), the neurologic examination is normal. 

The urinalysis reveals proteinuria. The rest of the patient’s laboratory data is normal.
Which of the following is the most likely diagnosis?

a. HELLP syndrome
b. Preeclampsia
c. Eclampsia
d. Essential hypertension
e. Primary seizure disorder

The answer is c.  Preeclampsia is defined as hypertension, proteinuria (>300 mg/24 h), and/or nondependent edema of the face and hands. Risk factors for preeclampsia include African American race, nulliparity, multiple gestations, extremes of age (<15 or >35), chronic hypertension, and a family history positive for preeclampsia. Eclampsia is defined as seizures in a patient with preeclampsia. The cure for preeclampsia/eclampsia is delivery. Magnesium sulfate is often used for seizure prophylaxis and management. The HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is a variant of preeclampsia.


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