Diagnosis and Management of Atypical Preeclampsia-Eclampsia

Abstract

trophoblastic inclusions, and fetal or embryonic tissue; they usually have a triploid karyotype.Ultrasound technology allows the diagnosis of molar pregnancy to be made in the first trimester before classic signs and symptoms (excessive uterine size, anemia, toxemia, or hyperemesis) arise. Ultrasound findings of complete moles during the first trimester will show less cavitation and have smaller villi than complete moles found in the second trimester. An elevated human chorionic gonadotropin (hCG) level can distinguish an early complete mole from a missed abortion, especially when levels are greater than 100,000 mIU/mL. A partial mole is characterized by ultrasound findings that show focal cystic changes in the placenta and a gestational sac with a ratio of the transverse to anteroposterior dimension of greater than 1.5. Levels of hCG greater than 100,000 mIU/mL at presentation are seen less frequently in patients with partial moles. More accurate pathologic diagnosis using flow cytometry to determine ploidy can determine whether the mole is diploid or triploid and whether the biomarkers of paternally imprinted and maternally expressed gene products are present.Patients with molar pregnancies should be assessed for anemia, toxemia, and hyperthyroidism. Laboratory values for blood type, hematocrit, and thyroid, liver, and renal functions should be obtained. Suction curettage is the optimal method for evacuation of the mole if a patient wants to retain reproductive capabilities. Patients who do not want future children can undergo hysterectomy; hCG levels should be monitored after procedure because metastatic disease beyond the uterus and persistent neoplasia can develop. Rh-immune globulin should be administered in Rh-negative patients. Criteria for the diagnosis of persistent neoplasia include serum hCG levels that do not return to the normal range after evacuation of the mole, evidence of metastasis, and a pathologic diagnosis of choriocarcinoma within the molar tissue. Chemotherapy offers cure rates of 80% to 100% for nonmetastatic and metastatic diseases. In a study of 858 patients with a complete mole, persistent tumor after evacuation was more likely among patients with signs of marked trophoblastic proliferation, an hCG level greater than 100,000 mIU/mL, a uterine size that was larger than appropriate for the gestational age, and theca lutein ovarian cysts greater than 6 cm in diameter. The risk of gestational trophoblastic neoplasia after a partial molar pregnancy is 0% to 11%. As the development of a new fetus during follow-up testing could interfere with testing of hCG levels, patients with a molar pregnancy should use contraception during the monitoring process. The risk of a subsequent pregnancy being molar is approximately 1% after 1 mole and approximately 15% to 18% after 2 moles. A first trimester ultrasound examination is recommended in subsequent pregnancies.The required duration for follow-up hCG testing and whether prophylactic chemotherapy should be administered at the time of evacuation are un...

Preeclampsia before 20 weeks of gestation: a case report and review of the literature

“…However, recent data suggest that preeclampsia may develop before 20 weeks, after 48 h postpartum or in the absence of typical symptoms of hypertension or proteinuria. These cases are termed as atypical preeclampsia [6]. Development of preeclampsia before 20 weeks of gestation usually accompanies partial molar pregnancy with triploidy or antiphospholipid syndrome [6][7][8][9].…”

“…These cases are termed as atypical preeclampsia [6]. Development of preeclampsia before 20 weeks of gestation usually accompanies partial molar pregnancy with triploidy or antiphospholipid syndrome [6][7][8][9]. Preeclampsia not associated with these disorders before 20 weeks of gestation is considered to be rare.…”

Abnormal Liver Function Tests as Predictors of Adverse Maternal Outcomes in Women With Preeclampsia

“…This inclusive denition was chosen to reect the variable and multisystem nature of preeclampsia seen in clinical practice. [16][17][18] The PIERS database collected a wide range of data pertaining to liver function (INR, serum albumin, unconjugated bilirubin) and cellular integrity (serum AST, ALT, LDH, total bilirubin) from all women who met eligibility criteria for the study. This information was collected on admission to hospital and at various times over the period of hospital admission.…”

Towards biomarker-based tests that can facilitate decisions about prevention and management of preeclampsia in low-resource settings

“…Although the measurement of proteinuria is one of the formal diagnostic criteria for PE, 10% of women with clinical and/or histological manifestations of PE have been shown to have no proteinuria [12]. Furthermore, only 35% of women have been shown to have both proteinuria and hypertension before the development of E [13]. A need therefore exists for a diagnostic tool that can help to identify and monitor women at risk, but also to identify women with atypical PE (no proteinuria) in clinical practice.…”