[Rapid Deterioration of Preeclampsia and Suspected Monogenic Hypertension - A Case Report]

Despite all the knowledge reached regarding preeclampsia, including preventive strategies, predictive algorithms, diagnosis and treatment, we still encounter cases that rapidly deteriorate while jeopardizing the patient and her fetus. It is known that hypertension constitutes a considerable portion of pregnancy complications and is associated with significant maternal and perinatal morbidity and mortality. A continuous global increase in its prevalence is noted, mainly due to lifestyle changes, a tendency toward obesity, and delayed childbearing to a more advanced age. We present a case of rapid deterioration of a 35-year-old parturient who underwent an emergency cesarean section at 33 weeks of gestation due to superimposed preeclampsia with severe features. The patient developed chronic hypertension-related target organ damage such as hypertensive cardiomyopathy and retinopathy, and developed acute complications, including uncontrolled blood pressure, pulmonary edema, Type-2 myocardial infarction and renal insufficiency. Following surgery, she was admitted to the intensive care department, and as her condition stabilized, follow-up treatment took place at the maternity ward. Treatment was provided by a multidisciplinary team including: the obstetrics division, with the intensive care department, the cardiology division, and the nephrology institute. The patient was eventually discharged for continued outpatient follow-up. The nephrology follow-up raised relevant differential diagnosis in accordance with the patient's personal and family history, and in collaboration with the genetics unit, a monogenic hypertensive disorder was suspected and sought. This case underscores the importance of early diagnosis of high-risk cases in general, and chronic hypertension in particular, and thorough evaluation and recommendations for preventive medicine. It highlights the necessity of appropriate treatment adaptation, patient adherence and compliance, and maintaining blood pressure control, as well as early identification and management of acute and chronic disease-related complications. If a genetic basis for the condition is confirmed, we can identify and counsel other family members and encourage early monitoring and treatment before target organ damage occurs.