A cause of pre-eclampsia?

Abstract

A 30-year-old woman was admitted to hospital in the 19th week of pregnancy in June, 1999, because of a slight rise in blood pressure. She had previously had a preterm delivery of a girl weighing 1600 g by caesarean section in the 31st week of pregnancy in September, 1995, because of abruption of normally implanted placenta due to preeclampsia. From the 25th to 30th weeks of the previous pregnancy she had had an abrupt weight gain from 60·8 kg to 68·5 kg, deterioration in proteinuria from negative to ++++, and a rise in blood pressure to 160/108 mm Hg. Her postpartum course had been uneventful and signs of pre-eclampsia disappeared completely within a month. In the early weeks of her second pregnancy, blood pressure, monitored at home, was normal, and systolic blood pressure measured in the clinic fluctuated between 110 mm Hg and 130 mm Hg. There was no proteinuria or oedema at the time of admission. During the first 3 weeks in hospital, her blood pressure was fairly stable between 100 mm Hg and 130 mm Hg systolic and 70–90 mm Hg diastolic, and there was no oedema or acute weight gain. Serum concentrations of epinephrine, norepinephrine, and dopamine at admission were within normal ranges, though renin activity was 6·1 ng mL h (normal range, 0·4–2·7). From the middle of the 22nd week her blood pressure gradually rose up to 220/120 mm Hg, even after treatment with hydralazine, methyldopa, prazosin, nifedipine, and magnesium sulphate. Her bodyweight remained at 68 kg, but proteinuria increased to 8·3 g/day by the 26th week of pregnancy. About 80% of urinary protein was albumin. Urinary concentrations of 2-microglobulin and N-acetyl-D-glucosaminidase increased to three to five times the normal upper value. There was slight elevation of serum creatinine and blood urea nitrogen to 80 mol/L and 6·8 mmol/L respectively. At 26 weeks and 4 days the fetus died in utero. The stillborn girl was severely underweight at 464 g. Within 2 weeks of delivery, the patient’s blood pressure, proteinuria, and renin activity had returned to normal. CASE REPORT