Question 249

Question:

A 24-year-old primigravid woman at 28 weeks’ gestation has had nagging headaches, a puffy-looking face, and swollen legs for the past week. Her blood pressure is 180/95 mm Hg; it was within normal limits earlier in the pregnancy. Urinalysis shows a protein concentration of 0.6 g/dL. Which of the following is the most likely diagnosis?

Correct Answer: E.  Preeclampsia

Proteinuria, edema, and hypertension after 20 weeks’ gestation in a previously normotensive woman are pathognomonic for (E) preeclampsia. Preeclampsia occurs in approximately 5 to 8 percent in the United States, although it is mild in 75 percent of cases. This disease is associated with the HELLP syndrome (Hemolysis, Elevated LFTs, Low Platelets.) When the above presentation includes seizures, a diagnosis of (C) eclampsia is made. In this case, this woman’s headaches are caused by hypertension, while her edema is secondary to the reduced plasma oncotic pressure following protein loss in the urine.
(A) Acute glomerulonephritis can cause hypertension, but is less likely to cause edema, while (D) Nephrotic syndrome causes edema without hypertension. (B) Congestive heart failure does not cause orbital edema.