Preeclampsia atípica: a propósito de un caso / Atypical preeclampsia: on the subject of a case

RESUMEN

Resumen ANTECEDENTES El trastorno hipertensivo del embarazo es una de las causas de mortalidad materna y perinatal. Se estima que hay complicaciones incluso hasta en 10% de los embarazos, con un aumento significativo en la incidencia mundial en las últimas dos décadas y alrededor de 50,000 a 60,000 muertes maternas anuales. CASO CLÍNICO Paciente de 26 años, con 17 semanas de embarazo; acudió a Urgencias debido a un episodio de 20 minutos de evolución de cefalea severa, con posterior episodio convulsivo tónico-clónico generalizado, con tensión arterial al ingreso de 170-102 mmHg, leve palidez mucocutánea, útero grávido con altura uterina de 18 cm y frecuencia cardiaca fetal de 136 lpm. Los estudios paraclínicos confirmaron síndrome de HELLP, sin duda una situación atípica para las semanas de embarazo en la que sucedió. CONCLUSIONES: Los casos atípicos de preeclampsia suelen ser raros, sobre todo cuando sobrevienen antes de las 20 semanas; cuando así sucede es importante que el proceso diagnóstico sea oportuno al igual que el tratamiento. Es indispensable estar alertas del posible surgimiento de nefritis lúpica, púrpura trombocitopénica trombótica y síndrome urémico hemolítico, embarazo molar y síndrome antifosfolipídico.

ABSTRACT

Abstract BACKGROUND: Preeclampsia before 20 weeks' gestation is exceptional; it is associated with antiphospholipid syndrome. Hypertensive disorder of pregnancy is the leading cause of maternal and perinatal mortality worldwide, represents a 10% complication of all the pregnancies worldwide, where there has been a significant increase in its incidence has been observed. In the last two decades, with an annual estimate of 50,000 to 60,000 maternal deaths in the world. CLINICAL CASE 26-year-old woman in the 17th week of pregnancy, who was admitted to the emergency department for a 20-minute evolution of severe headache with subsequent generalized tonic-clonic seizure episode, admission blood pressure was 170/102 mmHg, she was also found with mucocutaneas pallor, gynecological examination found a gravid uterus with a uterine height of 18 cm, and a fetal heart rate of 136 bpm. The paraclinical tests confirmed a HELLP syndrome, being considered an atypical situation due to the gestational age in which she presented. CONCLUSIONS: Atypical cases of preeclampsia are usually rare cases, especially when they appear before week 20; however, in this population it is important to make a diagnosis process in a timely manner, to initiate rapid treatment. Additionally, caution should be exercised with disorders including lupus nephritis, thrombotic thrombocytopenic purpura, and hemolytic uremic syndrome, as well as molar pregnancy and antiphospholipid syndrome.