Romero-Arauz Juan Fernando, Carranco-Salinas Caridad, Leaños-Miranda Alfredo, Martínez-Rodríguez Oscar Arturo
Ginecol Obstet Mex. 2014 May;82(5):354-60.
Preeclampsia that occurs at < 20 weeks of gestation is rare and has been usually reported with molar or hydropic degeneration of the placenta and antiphospholipid syndrome.
To describe the clinical presentation of atypical preeclampsia of a patient of 37 years old at her first gestation who developed this entity at 18.5 weeks of gestation. She had history of pre-existing hypertension and infertility. This pregnancy was obtained through in vitro fertility. She reported a severe headache and was admitted to our hospital secondary to elevated blood pressure of 160/110 mm Hg. The laboratory evaluation revealed platelet count 51,000, alanine aminotransferase of 331 UI/L, aspartate aminotransferase of 285 UI/L, lactate dehydrogenase 421 UI/L and urinalysis with +2 proteinuria, soluble fms-like tyrosine kinase-1/placental growth factor ratio 895.5. The diagnosis of chronic hypertension and superimposed preeclampsia and incomplete HELLP syndrome was supported. After termination of pregnancy, the patient improved rapidly. She was discharged home on postoperative day 7 with a blood pressure of 120/70 mm Hg with normal laboratory.
Clinicians should consider the diagnosis of preeclampsia and HELLP syndrome before 20 weeks of gestation in women presenting with clinical or laboratory abnormalities consistent with this disease.
妊娠<20周时发生的子痫前期较为罕见，通常与胎盘的葡萄胎或水肿变性以及抗磷脂综合征有关。
描述一名37岁初产妇在妊娠18.5周时发生的非典型子痫前期的临床表现。她有高血压病史和不孕史。此次妊娠通过体外受精获得。她自述严重头痛，因血压升高至160/110 mmHg而入住我院。实验室检查显示血小板计数51,000、丙氨酸转氨酶331 UI/L、天冬氨酸转氨酶285 UI/L、乳酸脱氢酶421 UI/L，尿检显示蛋白尿++，可溶性fms样酪氨酸激酶-1/胎盘生长因子比值895.5。支持慢性高血压合并子痫前期及不完全性HELLP综合征的诊断。终止妊娠后，患者迅速好转。术后第7天出院，血压120/70 mmHg，实验室检查正常。
对于出现与该病相符的临床或实验室异常的孕妇，临床医生应在妊娠20周前考虑子痫前期和HELLP综合征的诊断。
