Review Question - QID 217060

A 25-year-old gravida 3 para 2 woman presents to her obstetrician for a routine prenatal check. She is at 36 weeks, 0 days gestation by exact last menstrual period. She denies headaches or visual symptoms. She has received all appropriate prenatal testing, which revealed iron deficiency anemia. She has no medical problems and takes a prenatal vitamin. Surgical history consists of 1 prior cesarean section for chorioamnionitis. Review of her medical record shows that her blood pressure at the last visit was 144/82 and she did not receive her 2nd trimester ultrasound. Physical exam reveals a soft, non-tender, and gravid uterus. Fundal height is 36 cm. Lungs are clear to auscultation bilaterally. Laboratory studies are as follows:

Serum:
Platelet count: 200,000/mm^3
Creatinine: 0.6 mg/dL
Aspartate aminotransferase (AST, GOT): 16 U/L
Alanine aminotransferase (ALT, GPT): 14 U/L

Urine:
Protein/creatinine ratio: 0.19 mg/mg (reference: <0.3 mg/mg)

An ultrasound is performed and shows a head circumference consistent with 32 weeks gestation and abdominal circumference consistent with 20 weeks gestation. Which of the following is the most likely cause of the fetal abnormalities?