Review Question - QID 103368

This patient is presenting with a headache (cerebral involvement) and a systolic blood pressure > 160 mm Hg in the setting of proteinuria suggesting a diagnosis of severe preeclampsia.

Severe preeclampsia can be thought of as preeclampsia but with more severe features defined as:
1. Systolic blood pressure > 160 mmHg or diastolic blood pressure > 110 mmHg
2. Platelet count < 100,000/mm^3
3. Creatinine > 1.1 mg/dL or doubling of baseline creatinine
4. Elevated liver enzymes double baseline/normal values
5. Pulmonary edema
6. Cerebral/visual symptoms

Other signs/symptoms of end-organ damage include epigastric pain, disseminated intravascular coagulation, or oliguria. If no end-organ damage is present, it is possible to monitor the patient in an ICU setting until 32 weeks gestation, when delivery is indicated regardless of end-organ damage. IV magnesium sulfate should be given for seizure prophylaxis and blood pressure control is dire (with agents such as labetalol or nifedipine). Definitive treatment is delivery.

Incorrect Answers:
Answer 1: Acute fatty liver disease of pregnancy presents with the same findings in HELLP syndrome in addition to renal failure and signs of liver dysfunction such as hypoglycemia, hyperbilirubinemia, hyperammonemia, and possibly coagulopathy.

Answer 2: Eclampsia is essentially preeclampsia/severe preeclampsia plus seizures and should be managed with magnesium and immediate delivery.

Answer 3: HELLP syndrome presents with hypertension, proteinuria, hemolysis, elevated liver enzymes, and low platelets.

Answer 4: Preeclampsia presents with hypertension and proteinuria; however, this patient's severely elevated blood pressure (SBP < 160 mmHg) and headache suggest a diagnosis of severe preeclampsia.

Bullet Summary:
Severe preeclampsia presents with severe features including: systolic blood pressure > 160 mmHg or diastolic blood pressure > 110 mmHg, platelet count < 100,000/mm^3, creatinine > 1.1 mg/dL or doubling of baseline creatinine, elevated liver enzymes or double baseline/normal values, pulmonary edema, and cerebral/visual symptoms.