Severe Pre-eclampsia Presenting With Breathlessness: A Diagnostic and Management Challenge

Pre-eclampsia is a multisystem disorder that can complicate pregnancy and contribute to significant maternal morbidity and mortality. When complicated by pulmonary edema and pneumonia, which are rare but life-threatening, it presents a diagnostic and management challenge due to overlapping respiratory symptoms and potential delays in identifying concurrent conditions. We report the case of a 28-year-old woman at 35 weeks of gestation who presented with severe breathlessness. She was diagnosed with severe pre-eclampsia complicated by pulmonary edema and concurrent pneumonia. Initial symptoms developed within 24 hours of presentation, and early interventions, including oxygen supplementation, antihypertensive therapy, and antibiotics-were initiated promptly upon admission. Due to rapid clinical deterioration and peri-arrest condition, a timely category 1 cesarean section was performed after efforts towards stabilization to facilitate maternal resuscitation. The patient required supplemental oxygen, intravenous antihypertensives, and close multidisciplinary monitoring. Both maternal and neonatal outcomes were favorable. This case highlights the importance of early recognition and comprehensive management of atypical presentations of pre-eclampsia. In pregnant women with hypertension presenting with breathlessness, a high index of suspicion for pulmonary complications, particularly edema and infection, is essential. Prompt diagnosis and multidisciplinary care are critical to optimizing maternal and fetal outcomes.