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Unusual clinical course of preeclampsia heralded by generalized edema
Takashi Kojima1, Takahiro Yamada, Takashi Yamada
1Department of Obstetrics, Hokkaido University Graduate School of Medicine.
Preeclampsia monitored by the amount of proteinuria usually does not show amelioration during pregnancy. A 37-year-old nulliparous woman was admitted to our hospital at gestational week (GW) 24(-1/7) due to rapid weight gain (6.2 kg/4 weeks) and oligohydramnios. Hypertension (151/91 mmHg) appeared at GW 25(-0/7) and proteinuria not detected at GW 24(-0/7) became significant (0.55 g/day) at GW 25(-2/7) . During the 2 successive weeks after administration of betamethasone at 12 mg twice and transabdominal amnioinfusion with 250 mL of Ringer's acetate solution at GW 25(-3/7) , generalized edema, proteinuria and thrombocytopenia markedly improved: bodyweight, 78.0 to 69.0 kg; proteinuria, from 7.1 to 1.3 g/day; and platelet count, from 111 to 230 × 10(9) /L. However, intrauterine infection accompanied by non-reassuring fetal status necessitated emergency cesarean section at GW 28(-3/7) . Extraordinary bodyweight gain can herald the occurrence of preeclampsia and this weight gain together with signs of preeclampsia can ameliorate even during pregnancy, although its mechanism is unclear.
Preeclampsia monitored by the amount of proteinuria usually does not show amelioration during pregnancy. A 37-year-old nulliparous woman was admitted to our hospital at gestational week (GW) 24(-1/7) due to rapid weight gain (6.2 kg/4 weeks) and oligohydramnios. Hypertension (151/91 mmHg) appeared at GW 25(-0/7) and proteinuria not detected at GW 24(-0/7) became significant (0.55 g/day) at GW 25(-2/7) . During the 2 successive weeks after administration of betamethasone at 12 mg twice and transabdominal amnioinfusion with 250 mL of Ringer's acetate solution at GW 25(-3/7) , generalized edema, proteinuria and thrombocytopenia markedly improved: bodyweight, 78.0 to 69.0 kg; proteinuria, from 7.1 to 1.3 g/day; and platelet count, from 111 to 230 × 10(9) /L. However, intrauterine infection accompanied by non-reassuring fetal status necessitated emergency cesarean section at GW 28(-3/7) . Extraordinary bodyweight gain can herald the occurrence of preeclampsia and this weight gain together with signs of preeclampsia can ameliorate even during pregnancy, although its mechanism is unclear.
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