ABSTRACT
Preeclampsia is a multi systemic syndrome of variable severity, pregnancy specific, consequence of an abnormal vascular response to placentation, with increase in peripheral vascular resistance, stimulation of platelet aggregation, activation of the coagulation cascade, and endothelial dysfunction. In the majority of cases, it will present with gestational hypertension and proteinuria, after 20 weeks, nevertheless, in other cases, it has presented as an atypical form (with absence of hypertension and/or proteinuria) behaving like severe preeclampsia. We report the case of a patient, 32 year old primigravida, with a 26.6 weeks gestation, that comes to the office with postprandial projectile vomiting. At the time of admission, she presents with sudden headache, phosphenes, and tinnitus, associated to epigastric pain, with a blood pressure of 110/70 mmHg; fetal heart rate of 146 bpm, normal lower limbs and reflexes. The Complete Blood Count and liver function tests are within normal values, urinalysis with proteinuria. Normal hepatic ultrasound. Obstetric ultrasound; with fetal measurements of 2.6 weeks below, with flattening of the growth curve, Doppler flowmetry with an increase in placental resistance and oligohydramnios. Given the clinical manifestations compatible with severe preeclampsia, magnesium sulfate, and antenatal corticosteroid therapy are initiated, and abdominal termination of pregnancy is decided. A female newborn is obtained, of 595 g, Apgar 4/7. On immediate puerperium, she presents with an increase in blood pressure of 150/90 mmHg, discharged with normal blood pressure 96 hours later. The newborn girl was discharged when she reached a weight of 2000 g. Today, she is neurologically unimpaired.
Subject(s)
Pre-Eclampsia/physiopathology , Pregnancy Outcome , Adult , Blood Pressure , Diagnosis, Differential , Female , Gestational Age , Glucocorticoids/therapeutic use , Humans , Infant, Newborn , Magnesium Sulfate/therapeutic use , Pre-Eclampsia/diagnosis , Pre-Eclampsia/therapy , Pregnancy , Severity of Illness IndexABSTRACT
The evolution of obstetrics has led us to beneficial discoveries, and to new pathologies. The increase of cesarean section is due to elective cesarean section and cesarean section on maternal request, which have increased in popularity over the last past few years. Without condemning them, we have to take into account the benefits, as well as the complications that may arise from them, leading us to pathologies that were not frequent before, such as placental acretism, which today, is the second cause of obstetric hemorrhage worldwide. For us to be able to counteract the potential complications, it is important to have a multidisciplinary team that allows us to decrease maternal and neonatal death, starting with primary prevention, capable of identifying risk factors, so as to be able to make an early diagnosis. Today, imaging studies have described suggestive markers of acretism at early gestational age, such as 8.4 to 14.2 weeks, allowing us a wide range of time for decision making. In the majority of cases, it is required to perform an obstetrical hysterectomy as a definitive treatment, which is a real challenge for medical skills. Nevertheless, conservative treatment with limited evidence, with uterotonics, and uterine artery embolization, has proved useful. When set on a scale, the risks and benefits of an elective, or maternal request cesarean section, we can understand why we have concluded that, in absence of maternal or fetal indications, natural delivery is the best way to resolve pregnancy.
