Abstract
Preeclampsia is one of the most common causes of maternal mortality in the developed world. Until today, it is still one of the most researched entities in obstetrics mainly because it increases the risk of gestational complications, life-long sequalae and increased maternal and neonatal morbidity. Therefore, all causes of hypertension and /or proteinuria need to be ruled out of our differential diagnosis to get a clear definition of preeclampsia and manage it appropriately. Our case describes a patient with hypertension and proteinuria that presented after the 20th week of gestation. In hospital management and close follow up was done with patient’s symptoms, blood pressure, laboratory values and proteinuria resolving during her gestation leading to a good obstetrical and neonatal outcome. It has never been reported in literature to have a resolving case of hypertension and proteinuria in a singleton gestation resulting in a healthy living neonate. Our findings raise a lot of questions about the pathophysiology of the disease and whether preeclampsia can normalize before the delivery of the placenta. Therefore, is it time we start thinking about the maternal cardiovascular origin of preeclampsia instead of the placental vascular origin. We definitely need bigger studies to ascertain these clinical findings.
Highlights
Hypertension is notably one of the most common complications that can affect up to 10% of pregnancies worldwide
The most common hypertensive disorders associated with pregnancy include “Chronic Hypertension” that precedes the onset of gestation or before the 20th week of gestation and persists after delivery
According to the ASPRE trial, if a woman is considered to be at high risk for developing preeclampsia based on an algorithm that combines maternal factors, mean arterial pressure, uterine artery pulsatility index and maternal serum pregnancyassociated plasma protein-A and placental growth factor at 11 to 13th week, she should be started on aspirin (150mg qd) from the 11th to 14th weeks of gestations until the 36th week of gestation which results in a 62% reduction in the risk of developing preterm preeclampsia [11]
Summary
Hypertension is notably one of the most common complications that can affect up to 10% of pregnancies worldwide It is defined by either a systolic blood pressure of 140 mmHg or higher and or a diastolic blood pressure of 90 mmHg or higher or both [1]. It increases the risk of gestational complications as well as life-long sequelae affecting the mother and fetus as they increase morbidity and mortality for both parties [2]. The most common hypertensive disorders associated with pregnancy include “Chronic Hypertension” that precedes the onset of gestation or before the 20th week of gestation and persists after delivery. The current literature shows evidence of preeclampsia resolution following fetal death in multifetal gestations, an extensive research revealed no reported cases of antenatal resolution of hypertension and proteinuria in a singleton gestation [6]
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