Case Report: Hypertension in Pregnancy
DOI:
https://doi.org/10.59141/jiss.v6i10.1963Keywords:
Hypertension in pregnancy, Preeclampsia, Magnesium sulfate, Nifedipine, Case reportAbstract
Hypertensive disorders in pregnancy, such as preeclampsia, are a leading cause of maternal and perinatal morbidity and mortality. This case report details the management of a patient with severe preeclampsia, highlighting the challenge of a progressive hemoglobin drop without thrombocytopenia. The report aims to describe the clinical presentation, diagnostic approach, and management of a term pregnancy complicated by severe preeclampsia and a suspected concurrent urinary tract infection. A case study was conducted on a 23-year-old woman, G2P1A0, at 39 weeks’ gestation, who presented in the active phase of labor with hypertension and bleeding. Data were collected through clinical examination, laboratory tests, and monitoring of the implemented treatment regimen. The patient was diagnosed with severe preeclampsia based on hypertension (160/100 mmHg) and proteinuria (2+). Laboratory findings revealed a significant drop in hemoglobin (from 11.4 g/dL to 8.2 g/dL) with normal platelet counts, ruling out HELLP syndrome, alongside leukocytosis and nitrite positivity suggesting a urinary tract infection. Management with a combination of magnesium sulfate, nifedipine, oxytocin, and antibiotics successfully stabilized maternal hemodynamics. This case underscores the importance of vigilant monitoring for atypical presentations such as progressive anemia in preeclampsia and affirms the effectiveness of a combined MgSO₄–nifedipine regimen, alongside infection control and timely delivery, in managing severe preeclampsia at term.
References
Abalos, E., Cuesta, C., Grosso, A. L., Chou, D., & Say, L. (2018). Global and regional estimates of preeclampsia and eclampsia: A systematic review. European Journal of Obstetrics & Gynecology and Reproductive Biology, 222, 149–157. https://doi.org/10.1016/j.ejogrb.2018.01.014
Bartsch, E., Medcalf, K. E., Park, A. L., & Ray, J. G. (2016). Clinical risk factors for pre-eclampsia determined in early pregnancy: Systematic review and meta-analysis of large cohort studies. BMJ, 353, i1753. https://doi.org/10.1136/bmj.i1753
Brown, M. A., Magee, L. A., Kenny, L. C., Karumanchi, S. A., McCarthy, F. P., Saito, S., Hall, D. R., Warren, C. E., Adoyi, G., & Ishaku, S. (2018). Hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations for international practice. Hypertension, 72(1), 24–43. https://doi.org/10.1161/HYPERTENSIONAHA.117.10803
Chaiworapongsa, T., Romero, R., Korzeniewski, S. J., Chaemsaithong, P., Dong, Z., Yeo, L., … Hassan, S. S. (2023). Preeclampsia: Inflammation, angiogenic imbalance, and maternal endothelial dysfunction. Frontiers in Cardiovascular Medicine, 10, 1159372. https://doi.org/10.3389/fcvm.2023.1159372
Chang, K.-J., Seow, K.-M., & Chen, K.-H. (2023). Preeclampsia: Recent advances in predicting, preventing, and managing the maternal and fetal life-threatening condition. International Journal of Environmental Research and Public Health, 20(4), 2994.
Chappell, L. C., Cluver, C. A., Kingdom, J., & Tong, S. (2021). Pre-eclampsia. The Lancet, 398(10297), 341–354. https://doi.org/10.1016/S0140-6736(20)32335-7
Duckitt, K., & Harrington, D. (2021). Risk factors for pre-eclampsia at antenatal booking: Systematic review of controlled studies. BMJ Open, 11(4), e045336. https://doi.org/10.1136/bmjopen-2020-045336
Garovic, V. D., White, W. M., Vaughan, L., Saiki, M., Parashuram, S., Garcia-Valencia, O., … Jayachandran, M. (2020). Incidence and long-term outcomes of hypertensive disorders of pregnancy. JAMA, 323(10), 1000–1012. https://doi.org/10.1001/jama.2020.1875
Gillon, T. E., Pels, A., von Dadelszen, P., MacDonell, K., & Magee, L. A. (2019). Hypertensive disorders of pregnancy: A systematic review of international clinical practice guidelines. PLOS One, 14(1), e0211552. https://doi.org/10.1371/journal.pone.0211552
Lowe, S. A., Bowyer, L., Lust, K., McMahon, L. P., Morton, M., North, R. A., Paech, M., Said, J. M., & SOMANZ. (2020). Guidelines for the management of hypertensive disorders of pregnancy. Pregnancy Hypertension, 19, 19–55. https://doi.org/10.1016/j.preghy.2019.12.006
Magee, L. A., von Dadelszen, P., Stones, W., Mathai, M., & Say, L. (2022). The FIGO textbook of pregnancy hypertension: An evidence-based guide to monitoring, prevention, and management. International Journal of Gynecology & Obstetrics, 157(1), 1–12. https://doi.org/10.1002/ijgo.14044
McCarthy, F. P., Drewlo, S., Kingdom, J., & McCarthy, C. M. (2022). Endothelial dysfunction in preeclampsia: Translating discovery into clinical relevance. Nature Reviews Nephrology, 18(1), 69–84. https://doi.org/10.1038/s41581-021-00499-4
Milne, F., Redman, C., Walker, J., Baker, P., & Bradley, J. (2020). The paradox of smoking and pre-eclampsia: Epidemiological insights and biological mechanisms. Placenta, 103, 62–68. https://doi.org/10.1016/j.placenta.2020.09.010
Mol, B. W., Roberts, C. T., Thangaratinam, S., Magee, L. A., de Groot, C. J. M., & Hofmeyr, G. J. (2022). Preeclampsia. The Lancet, 399(10326), 1116–1130. https://doi.org/10.1016/S0140-6736(21)02783-2
Ngene, N. C., & Moodley, J. (2019). Role of the renin–angiotensin–aldosterone system in the pathophysiology of preeclampsia. Current Hypertension Reports, 21(6), 45. https://doi.org/10.1007/s11906-019-0948-5
Obeagu, E. I. (2024). Management Challenges in Aplastic Anemia with Concurrent HIV Infection. Elite Journal of Health Science, 2(9), 96–111.
Phipps, E., Prasanna, D., Brima, W., & Jim, B. (2019). Preeclampsia: Updates in pathogenesis, definitions, and guidelines. Clinical Journal of the American Society of Nephrology, 14(1), 110–120. https://doi.org/10.2215/CJN.12020118
Rana, S., Lemoine, E., Granger, J. P., & Karumanchi, S. A. (2019). Preeclampsia: Pathophysiology, challenges, and perspectives. Circulation Research, 124(7), 1094–1112. https://doi.org/10.1161/CIRCRESAHA.118.313276
Roberts, J. M., August, P. A., Bakris, G., Barton, J. R., Bernstein, I. M., Druzin, M., & Lindheimer, M. D. (2021). Preeclampsia: Pathophysiology, diagnosis, and management. Nature Reviews Disease Primers, 7(1), 1–22. https://doi.org/10.1038/s41572-021-00269-6
Sibai, B. M. (2019). Etiology and management of postpartum hypertension-preeclampsia. American Journal of Obstetrics and Gynecology, 221(3), 261–272. https://doi.org/10.1016/j.ajog.2019.03.009
Sibai, B. M. (2020). Chronic hypertension and superimposed preeclampsia: Diagnosis and management. American Journal of Obstetrics and Gynecology, 223(2), 177–188. https://doi.org/10.1016/j.ajog.2020.04.001
Staff, A. C., Redman, C. W. G., Williams, D., Leeson, P., Moe, K., Thilaganathan, B., … Poston, L. (2019). Preeclampsia, acute atherosis, and vascular remodeling of the uteroplacental arteries: Review of the literature and recommendations. Hypertension, 73(2), 431–440. https://doi.org/10.1161/HYPERTENSIONAHA.118.11652
Townsend, R., O'Brien, P., & Khalil, A. (2016). Current best practice in the management of hypertensive disorders in pregnancy. Integrated Blood Pressure Control, 9, 79–94. https://doi.org/10.2147/IBPC.S77344
Verdonk, K., Visser, W., Van Den Meiracker, A. H., & Danser, A. H. J. (2017). The renin–angiotensin–aldosterone system in preeclampsia: The delicate balance between good and bad. Clinical Science, 131(19), 2399–2409. https://doi.org/10.1042/CS20171199
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Dennison Himmelfarb, C., … Wright, J. T. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Hypertension, 71(6), e13–e115. https://doi.org/10.1161/HYP.0000000000000065
WHO. (2021). Trends in maternal mortality 2000–2020: Estimates from WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. World Health Organization. https://www.who.int/publications/i/item/9789240068759
Williams, D., & Kenny, L. C. (2019). Preeclampsia and other hypertensive disorders of pregnancy. BMJ, 366, l2381. https://doi.org/10.1136/bmj.l2381
Williams, D., Magee, L., & Steegers, E. A. P. (2022). Management of hypertension in pregnancy. BMJ, 378, e070694. https://doi.org/10.1136/bmj-2022-070694
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