[Atypical preeclampsia and perinatal success: a case report]

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Clinical Case Study

Background:

• Preeclampsia is a pregnancy-specific multisystem disorder characterized by abnormal vascular response to placentation.
• Typically presents with gestational hypertension and proteinuria after 20 weeks gestation.
• Atypical forms may lack hypertension or proteinuria but still manifest as severe preeclampsia.

Observation:

• A 32-year-old primigravida at 26.6 weeks gestation presented with projectile vomiting, headache, phosphenes, tinnitus, and epigastric pain.
• Initial blood pressure was 110/70 mmHg; laboratory tests and hepatic ultrasound were normal.
• Obstetric ultrasound revealed fetal growth restriction, increased placental resistance, and oligohydramnios.

Findings:

• Despite normal initial blood pressure, clinical manifestations were consistent with severe preeclampsia.
• Initiation of magnesium sulfate and antenatal corticosteroids, followed by abdominal delivery.
• Newborn weighed 595g (Apgar 4/7); mother experienced transient postpartum hypertension.
• Newborn discharged neurologically unimpaired after reaching 2000g.

Implications:

• This case underscores the importance of recognizing atypical presentations of preeclampsia.
• Early intervention and management are crucial for favorable maternal and fetal outcomes in severe preeclampsia.
• Highlights the need for vigilance in diagnosing preeclampsia beyond classic hypertension and proteinuria criteria.